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Prevention and Infection Control for Seasonal Influenza and COVID-19

California CareForce serves a diverse population and is committed to providing care to those in-need, in a safe and healthy environment, for all volunteers and patients. California CareForce has developed COVID-19 safety guidelines to minimize the risk of transmission of COVID-19 and seasonal influenza. 

Even with COVID-19 screening of patients, we may serve patients who are infected with COVID-19. Volunteering to work near people who may be infected with COVID-19 puts you at a higher risk of getting the virus. If you volunteer to work at a California CareForce clinic, please know you are doing so at your own risk.  

Procedure - Before Arrival -- Patients and Volunteers

Patients and Volunteers should contact their primary healthcare provider or local health department if they are feeling unwell.  Patients who have symptoms of any respiratory infection (e.g., cough, runny nose, sore throat, fever) should not attend a California CareForce clinic, and to take appropriate preventive actions (e.g., wear a facemask while in the presence of others).

Upon Arrival -- Patients and Volunteers

  1. Signage will be posted at the outside Patient Waiting, COVID-19 screening area (patient and volunteer), and throughout the clinic building providing information on hand hygiene and proper use/fitting of an N95 facemask.
  2. Signage will be posted at the outside Patient Waiting and COVID-19 screening area (patient and volunteer) providing information on COVID-19 and seasonal influenza symptoms.
  3. Points of clinic entrance will be restricted and monitored.
  4. Prior to patients or volunteers being given entrance to a California CareForce clinic, each will be screened for COVID-19 through a questionnaire and temperature check (utilizing non-contact Infrared thermometer). Any patient or volunteer with positive COVID-19 symptoms (temp over 100.4 or answered “yes” to symptom question) will not be allowed entrance into the clinic and will be referred for follow-up care.
  5. All patients and volunteers will be required to have completed a full COVID-19 vaccination series, with booster, and provide proof of vaccination.
  6. If a patient or volunteer has not been vaccinated, the patient or volunteer must provide proof of a negative COVID-19 test taken within 24 hours of volunteering or seeking clinic service.
  7. Proof of vaccination or negative test result will be documented on the COVID-19 screening form.
  8. For patients or volunteers with no COVID-19 symptoms, who have not been vaccinated and who do not have a negative COVID-19 test within 24 hours of volunteering or seeking clinic services, COVID-19 testing will be provided onsite prior to clinic entrance. Any patient or volunteer with a positive COVID-19 test result will be denied clinic entrance and referred for follow-up care.
  9. All patients and volunteers will be required to wear an N95 mask while in the clinic area (except for patients during dental treatment and/or medical exam). No cloth or surgical masks will be allowed. If a patient or volunteer only has a cloth face covering or surgical mask, an N95 will be provided.
  10. All patients and volunteers will line up in a designated COVID-19 screening area maintaining appropriate social distancing (6 feet apart).  
  11. Only those receiving services will be allowed to enter the clinic. Other family members, or children, not receiving services will not be permitted within the clinic (except for caregivers, or parents and/or legal guardian accompanying a child under 18 years of age).

Within the Clinic

  1. Copies of the full Prevention and Infection Control for Seasonal Influenza and COVID-19 will be available at Volunteer Check-in.
  2. All volunteers will be asked to confirm that they have read, understand, and will follow California CareForce Prevention and Infection Control for Seasonal Influenza and COVID-19 guidelines.
  3. Rental of additional buildings for greater separation of services and social distancing for all attendees.
  4. Clinic flow changes to limit the number of patients within the clinic event at any one time.  Patients will gain entrance throughout the day versus large groups entering the event at one time.
  5. Dental section has individual operatories with partitions around each operatory (draped from one another).
  6. Expanded separation between dental operatories to ensure adequate distancing.
  7. Reduced number of dental operatories. 
  8. Most patient waiting is outside of the clinic services buildings.
  9. Implementation of respiratory hygiene and cough etiquette.
  10. Adherence to infection control precautions for all patient-care activities.

Hand Hygiene  --  Perform hand hygiene frequently, including before and after all patient contact, contact with potentially infectious material, and before putting on and upon removal of personal protective equipment, including gloves. Hand hygiene in healthcare settings can be performed by washing with soap and water or using alcohol-based hand rubs. If hands are visibly soiled, use soap and water, not alcohol-based hand rubs.

Gloves  --  All CCF professionals must always wear disposable exam gloves during patient services. Exam gloves must not be washed or decontaminated for reuse. New gloves must be used for each patient regardless of the type of treatment or circumstances. The gloves must be changed as soon as feasible if they are torn, punctured, or when their ability to function as a barrier is compromised. In addition, gloves must be worn during all preclinical and post clinical procedures (when handling sterile items during set-up or contaminated items during cleanup). Sterile gloves are required for all surgical procedures. Plastic over gloves (food handler gloves) may be used as a barrier to protect exam gloves while dispensing medicaments, retrieving items from the dispensary, or whenever touching objects or areas that will either become contaminated with the patient's body fluids or compromise the cleanliness of the exam gloves. These gloves are not primary gloves intended for personal protection.  Utility gloves (heavy-duty rubber) must be used during clean-up procedures when sharp contaminated objects may be encountered.  These gloves are more puncture-resistant than exam gloves and provide greater protection. Utility gloves may be disinfected, or heat sterilized for reuse. Utility gloves must be discarded if they become cracked, peeled torn, punctured, exhibit signs of deterioration, or when their ability to function as a barrier is compromised. Gloves are available at the Section PPE table.

Patients will be asked to wear gloves when they are selecting a frame for their glasses. Patient should use hand sanitizer then don gloves prior to touching any frame. The patient will be instructed to only touch the frame and not touch their face with the gloved hand(s). If the gloves become contaminated the patient will be asked to change gloves.

Gowns  --  Wear gowns for any patient-care activity when contact with blood, body fluids, secretions (including respiratory), excretions are anticipated or aerosol particles. Remove gown and perform hand hygiene before leaving the patient’s environment. Do not wear the same gown for care of more than one patient. Gowns will be worn by all volunteers working directly in the dental section of the clinic.

Protective Eyewear  --  Eye protection, such as goggles or glasses with solid side shields, or chin-length plastic face shields must be worn whenever splashes, spray, spatter, or droplets of blood or saliva may be generated. Side shields are available in all clinics that may be added to prescription eyewear to provide the necessary side protection. If prescription glasses are worn, they must be of adequate size to protect the wearer’s eyes from spray, spatter and droplets and side shields must be attached.

Patients must wear protective eyewear during dental procedures involving the use of splatter-producing devices (handpieces, Cavitron, etc.), when instruments will be passed during the treatment of the patient, or when reclined in the dental chair. Patient’s personal eyewear such as sunglasses or prescription glasses is acceptable for this purpose.

Volunteers and patients may wear face shields/goggles for any patient-care activity in the dental, medical or vision sections of the clinic.

Face Masks  --  Disposable masks must be worn whenever splashes, spray, spatter or droplets of blood or saliva are generated (e.g., scaling, polishing, and during use of handpieces).  Always change masks between patients and more often if they become moist or their ability to act as a barrier is compromised. Do not touch or handle masks during patient treatment. Masks must cover both the nose and mouth of the wearer and should be worn in a manner that prevents gaps between the mask and the wearer’s face. Volunteers working in the dental section of the clinic will be required to wear an N95. 

Patients may remove their N95 mask when receiving dental treatment but should put it back on when leaving at the end of treatment.

Facemasks should not be placed on young children under age 2, anyone who has trouble breathing, or anyone who is unconscious, incapacitated or otherwise unable to remove.

The volunteers should always wear an N95 mask while they are in the clinic setting, including in lunchrooms, restrooms, or other spaces where they might encounter other volunteers or patients.

Volunteers should remove their N95 mask, and dispose of mask, perform hand hygiene, and put on their cloth face covering when leaving the clinic at the end of their shift.

Physical Distancing  --  Patient waiting areas will be outside the dental, vision, and medical buildings.  Seating in waiting areas will have chairs 6 feet apart.  Markers on the ground in front of Patient Registration, COVID-19 screening and Patient Waiting prior to entrance into the clinic to demonstrate appropriate social distancing.

Administrative Controls and Work Practices 

Vision  --  Vision equipment will be wiped down with 70% alcohol solution between each patient.  Frames will be wiped off with 70% alcohol solution and/or UV sanitizer following a patient trying on the eye glass frame for selection.

Dental  --  Dental operatories will have only the clean or sterile supplies and instruments needed for the dental procedure readily accessible. All other supplies and instruments should be in covered storage, and away from potential contamination. Any supplies and equipment that are exposed but not used during the procedure should be considered contaminated and should be disposed of or reprocessed properly after completion of the procedure.

Aerosol generating procedures (see below for definition) will be avoided whenever possible, including the use of high-speed dental handpieces, air/water syringe, and ultrasonic scalers.

If aerosol generating procedures are necessary for dental care, use four-handed dentistry, high evacuation suction and dental dams to minimize droplet spatter and aerosols. The number of volunteers present during the procedure should be limited to only those essential for patient care and procedure support.

Preprocedural mouth rinses (PPMR) -- There is no published evidence regarding the clinical effectiveness of PPMRs to reduce COVID-19 viral loads or to prevent transmission. Although COVID-19 was not studied, PPMRs with an antimicrobial product (chlorhexidine gluconate, essential oils, povidone-iodine or cetylpyridinium chloride) may reduce the level of oral microorganisms in aerosols and spatter generated during dental procedures.

Respiratory Hygiene/Cough Etiquette  --  Respiratory hygiene/cough etiquette infection prevention measures are designed to limit the transmission of respiratory pathogens spread by droplet or airborne routes. 

  • Keep hands away from face
  • Limit surface touching
  • Remove Personal Protective Equipment when leaving work area
  • Perform hand hygiene

Universal Use of Personal Protective Equipment (PPE)  --  Volunteers should wear N95, eye protection (goggles or a face shield that covers the front and sides of the face), a gown, and gloves during procedures likely to generate splashing or spattering of blood or other body fluids. Follow Donning and Doffing guidelines.

Layered Prevention Approach Utilized

  • PPE provides the first layer of protection for dental professionals including N95, gloves, surgical masks, eyewear, and gowns.
  • Antimicrobial Mouth Rinse - The second layer of protection is having the patient use an antimicrobial mouth rinse before the procedure.
  • High Velocity Air Evacuation (HVE - ReLeaf) – The third layer of protection, the HVE, reduces airborne dental aerosol by up to 90%.
  • Air Filtration – The fourth layer of protection is air filtration systems using a HEPA filter, and/or maximizing five exchanges of the airspace per hour to minimize COVID risks indoors.
  • Air and Waterline Disinfection – The CDC also recommends following equipment guidelines for air and water discharge for a minimum of 20 to 30 seconds on each piece of equipment between each patient.