What are the new guidelines from the Ministry of Health and Dental Council around treating those with Covid or suspected Covid?
Last year, the Ministry of Health and Dental Council of New Zealand released updated guidelines in August/September 2021 for dental surgeries who provide urgent or emergency care of patients who are Covid-positive (or suspected to be).
Research has now shown that Covid can be effectively spread by aerosol particles – especially the highly contagious SARS-CoV-2 or Delta variant. As such, the new guidelines specify that under Alert Levels 2, 3 or 4, if you are a dental surgery that needs to carry out aerosol-generating procedures on a Covid-infected patient or a patient-assessed as a ‘High Risk’ and potentially infected, you should do so in a negative-pressure environment.
The guidelines specifically say: “Room requirements: The patient should be treated in an Airborne Infection Isolation Room (AIIR). If an AIIR is not available, treat the patient in a single room with a door which should remain closed. This room should not be positively pressured to the outside corridor. A portable HEPA filtration unit, if available, may be used in this setting and it would provide an additional measure of infection prevention during the assessment and treatment of the patient.”
Why would I need a special room to operate on patients with Covid?
Airborne infectious diseases (like Covid) can spread via large water droplets and small water particles, released by an infected patient when coughing, sneezing, shouting or speaking. With aerosol-procedure dental work typically involving high-speed electric and air-driven equipment, significant volumes of potentially infected aerosols can be produced and released into the immediate vicinity.
Larger water droplets can travel up to 1 metre from a person, although they’re typically heavy, so don’t readily enter most ventilation systems.
Smaller particles (aerosolised water droplets that are typically produced when a person coughs or sneezes, or from some dental procedure equipment) can stay airborne for extended periods of time and can travel relatively long distances. These aerosols are buoyant and can be drawn into air conditioning units and ventilation systems, further increasing the risk of distributing contaminated particles.
If a room has inadequate ventilation using outdoor air or a lack of overall air movement, it allows dust particles and aerosols to remain present in the room for longer. This increases the concentration over time and the likelihood of contamination by direct contact or being inhaled by the room occupants.
Negative pressure rooms – also called Airborne Infection Isolation Rooms (AIIR) at some hospitals – are designed to stop contaminated air (and all those particles) from escaping from the room.
What constitutes a suitable negative pressure environment?
The concept is relatively simple:
A negative pressure is created within the treatment room by extracting a known quantity of air from the room at all times. The amount of air extracted will depend on how well the room is sealed.
Make-up or replacement air can either be from adjacent rooms or from a dedicated outside air supply, usually filtered and heated as a minimum requirement.
It is important to integrate these systems with any existing air conditioning systems and treatment of the discharge air may be required, depending on the discharge location.
The systems should be set to operate for a period before treatment begins and continue to operate for a specified period post treatment.
What does that mean for me?
If you are a dental surgery, clinic or hospital that wants to carry out emergency aerosol-generating procedures during levels 2, 3 or 4 and on people who have or are suspected of having Covid, the guidelines detail using a negative-pressure Airborne Infection Isolation Rooms in your clinic/surgery, as well as specifications around PPE, stand-down times and other guidelines specified by the MOH and Dental Council. The MOH and Dental Council’s suggested minimum requirement of a negative-pressure room isn’t to the same standard as one you’d find in a hospital but they use the same concept of negative pressure.
Won’t this negative-pressure room be redundant after Covid?
Firstly, who knows when Covid will be completely eliminated and how long we’ll be dealing with these last-minute lockdowns!
Secondly, there are on-going benefits gained from negative-pressure rooms. On a health and safety front, the management of airflow rates will help improve infection control which helps protect your staff and patients from catching colds, influenza and other illnesses.
Wellbeing and performance-wise, the increased air change and air flow means you’re not working in a clinic with stale, static air. Having additional outside air circulating makes for better working conditions, improving mental acuity and concentration levels and reduces brain fog. The brain loves fresh air!
The creation of negative-pressure rooms not only supports operation under Covid conditions but helps to future-proof the clinic by reassuring staff and patients that their health and wellbeing is of paramount importance.
What’s the cost?
The good news is that you generally don’t have to build a new dedicated room – in most cases, you can turn an existing room into an effective negative-pressure room.
Unfortunately it’s impossible to give an investment guide into fitting out a clinic to be negative pressure because it’s dependent on a number of factors, including size and location of the room within the facility.
From work completed to date, overall costs may vary from $10K for a simple room, to $50K or more for a two or three-chair clinic with more complicated requirements.
Jacksons can assess your specific site for suitability and provide a quote for the design work and a construction cost estimate, to give you an idea of what kind of investment you’re looking at.
An initial site visit, inspection and basic report from us would typically cost $2,000 – $5,000+GST, depending on location, size of the facility and the scope of work.
Our team of engineers have extensive experience in designing negative pressure rooms around NZ, for hospital theatres, procedure rooms, labs, pharmaceutical facilities and dental clinics (like this one we’ve written a short case study on).
To discuss requirements for your clinic, please contact us and we will arrange for our closest office to contact you.
Ph: 09 378 8736