This document sets out the context of the CODE iComply Standard Operating Procedures (SOP), otherwise known as the ‘C Documents’, including the background on the COVID-19 pandemic and explanation of risks. All information contained within SOP documentation is believed to be current at time of publication, however, the SOPs should be considered “live” documents—meaning that they should be read in conjunction with up-to-date NHS for your nation and recognised guidance (e.g. FGDP). Policies and procedures contained within the SOP should therefore be updated accordingly. CODE understand that this may be frustrating for practices, who are already having to adapt to a new way of working, however, due to the rapid changing nature of the pandemic this is an unavoidable necessity. However, to help practices keep abreast of possible changes, links to "live" guidance has been provided throughout the document where possible and pointers regarding key decisions to be made have been included.
Coronavirus disease (COVID-19) is an infectious disease caused by a newly discovered coronavirus. Most people infected with the COVID-19 virus will experience mild to moderate respiratory illness and recover without requiring special treatment. Older people, and those with underlying medical problems like cardiovascular disease, diabetes, chronic respiratory disease, and cancer are more likely to develop serious illness.
Most people with coronavirus have at least one of these symptoms.
The COVID-19 virus is primarily transmitted between people through respiratory droplets and contact routes. Droplet transmission occurs when a person is in in close contact with someone who has respiratory symptoms (e.g., coughing or sneezing) and is therefore at risk of having his/her mucosae (mouth and nose) or conjunctiva (eyes) exposed to potentially infective respiratory droplets. Transmission may also occur through fomites in the immediate environment around the infected person. Therefore, transmission of the COVID-19 virus can occur by direct contact with infected people and indirect contact with surfaces in the immediate environment or with objects used on the infected person (e.g. thermometer).
There are various risks of transmitting COVID-19 in the provision of dental services are through direct and in-direct contact, through droplets in the air and through the spray created through Aerosol Generated Procedures (AGPs).
The policies in this SOP aim to mitigate risks of transmission utilising the following precautions:
To respond to the unique challenges of the COVID-19 pandemic, CODE have created a new document set within iComply. These documents are labelled with the prefix "C" and will be referred to as "C Documents".
The policies and procedures contained within these new C Documents do not replace previous practice policies, but are to be read as running in parallel with the requirements already established CODE iComply Governance Documents (G Documents) and the CODE iComply Management Modules (M Documents). It is possible, however, that there will be some cases where the requirements between the new C Documents differ from those contained in the G and M Documents. Where this is the case, the practice will follow the most stringent requirement and control measure (this is most likely to be contained within the C Documents). Where there uncertainty as to which procedure or control measure is more stringent, team members should speak to their Practice Manager. Team members must also ensure that they put their own safety and the safety of those under their care at the forefront of their decision-making.
UK guidelines currently state that to reduce the likelihood of COVID-19 transmission, individuals from separate households should maintain a gap of two metres between each other at all times—this is referred to as “social distancing”. Social distancing will be observed within the practice as much as possible, however, it is recognised that the provision of dental treatment will mean that closer contact is often necessary. Where social distancing cannot be maintained team members will ensure that appropriate personal protective equipment (PPE) is worn in line with current guidance. As far as is possible we will implement physical measures to allow for social distancing by moving non-essential furniture, placing social distancing markers on the floor, and limiting the number of people in the practice at any one time. Measures to mitigate the risks of team members, patients and other visitors to the practice coming closer than two metres will be managed in the Practice Risk Assessment (C 204).
All team members have been made aware of the impact of COVID-19 on CPR and resuscitation. Whenever CPR is carried out, particularly on an unknown victim, there is some risk of cross infection, associated particularly with giving rescue breaths. Normally, this risk is very small and is set against the inevitability that a person in cardiac arrest will die if no assistance is given. The first things to do are shout for help and dial 999.
The practice follows guidance from the UK Resuscitation Council (RCUK) on conducting CPR/defibrillation.
The guidance as of 31 May 2020 is listed below and is based on the heightened awareness of the possibility that the victim may have COVID-19. This is subject to change and therefore all team members will ensure that they are up-to-date with the current guidance issued by (RCUK).
The importance of calling an ambulance and taking immediate action cannot be stressed highly enough. If a child is not breathing normally and no actions are taken, their heart will stop and full cardiac arrest will occur.
Doing rescue breaths will increase the risk of transmitting the COVID-19 virus, either to the rescuer or the child/infant. However, this risk is small compared to the risk of taking no action as this will result in certain cardiac arrest and the death of the child.
Patients will be encouraged to attend the practice alone if possible. Some patients may require a chaperone (for example a child attending with their parent or carer, or an adult with a physical or leaning disability). Chaperones will also undergo the same screen questions as a patient (see C 226 - Patient Screening and Triaging Procedure) and be categorised accordingly (see C 224 - Patient Group Categorisation and Acceptance Criteria). As far as possible, a chaperone should be from the same household as the patient. Chaperones will be asked to leave and wait outside the surgery whilst all procedures are carried out. However, this may not always be possible (for example where the patient is a young child or where the patient would be distressed to be left alone). In cases such as this team members will pay particular attention to the Faculty of General Practice’s guidance which advises that ‘there should be an individual case by case risk assessment of whether parents/carers or guardians should be present in the surgery during treatment and make sure that this is done as safely as possible where this is deemed essential’.