PPE and Infection Control Guidelines for Ontario

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We have summarized the RCDSO and CDHO PPE and Infection Control Guidelines for Ontario

Note: PPE and Protocol Requirements depend on:
1. If the patient has Screened Positive for COVID-19, and

2. Whether the procedure is an Aerosol Generating Procedure (AGP)

Below is a summary - and you'll note that an N95 Mask is only required when doing an AGP on a patient who has screened positive for COVID-19. Otherwise a Level III mask is fine.

And for a patient who has screened positive for COVID-19, they should not be coming to your office for anything except emergency treatment that cannot be delayed - and even then, really try to avoid doing an AGP.

But if you need to do an AGP on a patient who screens positive for COVID-19, you need to get suited up in full PPE - fitted and seal-checked N95, gown, gloves, eye protection AND face shield. Get comfy!

The CDHO's guidelines are a bit different than the RCDSO:

Essentially, for now - if you do an AGP as a hygienist - it's a bit of a pain:

Floor to ceiling of the operatory must be sealed off and the door closed during the procedure
Wait 3hrs after the procedure (fallow period) before seeing another patient in that operatory (or use the HVAC fallow times above if your office's HVAC has been assessed).
Fit-checked N95 mask required
Ensure that any charts are protected from aerosols

If you're not doing an AGP (ie. hand scaling, x-rays, etc. - see below), then follow IPAC (gloves, mask, gown, eye protection).

For general reference: among provincial regulatory bodies, it seems the generally accepted categories for procedures are as follows:

NAGP Dental Hygiene Procedures

- Intraoral/extraoral cancer screening assessment

- Radiographs necessary for determining periodontal diagnosis (recommend extraoral radiographs to minimize risk)

- Periodontal assessment, including communicating periodontal diagnosis and treatment plan - Communicate oral hygiene instruction only, no intraoral demonstrations

- Debridement (hand instrumentation only)

- Administration of local anesthetic, topical anesthetic, and non-injectable anesthetic

- Use saliva ejector

- Use High-Volume Evacuation (HVE)

- Preventive procedures such as the application of topical agents (fluoride, silver diamine fluoride, desensitizers, etc.)

- Dry teeth with cotton roll/pellet or gauze

- Flossing performed by operator

- Rinsing and expectorating into disposable cup OR rinsing with monoject syringe and saliva ejector/HVE

AGP Dental Hygiene Procedures

- Air-water syringe

- Ultrasonic/power instrumentation

- Air polishing

- Slow-speed handpiece

- Selective polishing/prophy

- Pit and fissure sealants

The CDHO has published the following requirements for their dental hygienist members

Note: This is an unofficial summary. For official documentation of requirements, or for clarification, refer to the links in each section.

For the official RCDSO published guidelines, go here.

For the official CDHO published guidelines, go here.

And if you do an AGP on a patient who has screened negative, you have to wait 15min between patients.

If you do an AGP on a patient who screens positive, you have to follow the fallow times according to your HVAC system: