by Dr Milind rajan mds pediatric dentistrty mumbai

1. World follows namaste for better future

2. BYDR MILIND RAJAN

3. Case definitions of COVID-19
DEFINITIONS – SUSPECT / PROBABLE INFECTED
PERSON
• A person with acute respiratory illness (fever and at least one
sign/symptom of respiratory disease (eg. Cough, shortness of
breath) AND history of travel to or residence in a country/area or
territory reporting local transmission of COVID-19 disease during
the 14 days prior to symptom onset
OR
• A person with any acute respiratory illness AND having being in
contact with a confirmed COVID-19 case in the last 14 days prior
to onset of symptoms
OR
• A person with severe acute respiratory infection {fever and at
least one sign/symptom of respiratory disease (eg., Cough,
shortness of breath)} AND requiring hospitalization AND with no
other etiology that fully explains the clinical presentation
OR
• A case for whom testing for COVID-19 is inconclusive.

4. Case definitions of COVID-19

5. Quarantine and Isolation
Quarantine:
Quarantine refers to separation of individuals
who are not yet ill but have been exposed to
COVID-19 area or travel history to affected
countries / states and therefore have a
potential to become ill.
Isolation
Isolation refers to separation of individuals
who are ill and suspected or confirmed of
COVID-19 will be hospitalized and kept in
isolation in a designated facility till such time
they are tested negative.

6. Latest Case Definitions as per WHO
Probable case
A suspect case for whom testing for the COVID-19 virus is
inconclusive.
a. Inconclusive being the result of the test reported by the
laboratory.
OR
b. A suspect case for whom testing could not be performed
for any reason.
Source: WHO interim guidance of Global Surveillance of COVID-19 dated 20/03/2020
Confirmed case
 A person with laboratory confirmation of COVID-19
infection, irrespective of clinical signs and symptoms.

7. Clinical Presentation
COVID-19 may present with
1. Mild(Those with lowgrade fever/cough/malaise/rhinorrhoea/sorethroat
WITHOUT any shortness of breath)
2. Moderate
3. Severe: Severe pneumonia, Acute respiratory distress syndrome( ARDS),
sepsis and septic shock.
• Timely recognition of suspected patients allows for timely initiation of
Intermittent Pneumatic Compression (IPC.)
• Severe acute respiratory illness:
• ARI with history of fever or measured temperature ≥38 C° and
cough;
• onset within the last ~10 days;
• and requiring hospitalization.
• the absence of fever does NOT exclude viral infection.

8. Severe Pneumonia
• Adolescent or adult: fever or suspected
respiratory infection, plus any one of
these
• respiratory rate >30 breaths/min,
• severe respiratory distress, or
• SpO2 <90% on room air
• Child with cough or difficulty in
breathing, plus at least one of the
following:
• central cyanosis or SpO2 <90%;
• severe respiratory distress (e.g.
grunting, very severe chest
indrawing);
• a general danger sign: inability to
breastfeed or drink, lethargy or
unconsciousness, or convulsions.
• The diagnosis is clinical; chest
imaging can exclude complications
• Patient with pneumonia
and no signs of severe
pneumonia
• Child with non-severe
pneumonia has cough
or difficulty breathing +
fast breathing:
• fast breathing (in
breaths/min):
• <2 months,≥60;
• 2–11 months, ≥50;
• 1–5 years, ≥40
• and no signs of severe
pneumonia
Mild
Pneumonia

9. Indications for hospital admission
Any ONE of the following five criteria:
1. Respiratory rate > 24/min
2. SpO2 < 94% on room air
3. Confusion/drowsiness
4. Systolic BP < 90 mmHg or diastolic BP < 60 mmHg
5. Those at high risk for severe disease:
a) Age > 60 years
b) Cardiovascular risk including hypertension.
c) Diabetes mellitus/other immunocompromised states.
d) Chronic lung/liver/kidney disease
• This is general guidance regarding which patients should be admitted.
However, the final decision to admit is at the discretion of the treating
physician

10. ASEPSIS PROTOCOL FOLLOWED
IN VIEW OF COVID-19
IN GENERAL DENTAL PRACTICE

11. • Before taking case history and
• before starting of any treatment plan
patient should be asked to rinse and gargle
his /her mouth with povidone iodine
(Betadine gargle) for 1 min

12. Kindly introduce a screening question regarding visit
to any country/state which has reported covid -19, into
the case history format
Any suspicious/symptomatic cases should be
immidiately referred to the nearest Hospital with
isolation facility

13. Eye facial protection
Clean long- sleeved fluid resistant
gowns
gloves
proper mouth masks

14. Disposal of biomedical waste by guidelines of
biomedical waste management

15. Ensure proper disinfection of all casts and
specimen before dispatch to the laboratory
All specimen should be transported by
packing in leak proof bags and finally
packed in bio hazard bags before dispatch

16. Ensure proper sterlization of used instruments
Use high vacuum suction along with saliva
ejectors,routinely

17. Ensure proper ventilation of all operative
rooms
Limit the number of patient assistants in the
clinics

18. HAND HYGIENE & USE OF MASK

19. Hand hygiene
i. Health care provider should perform hand hygiene
using alcohol-based hand rub (minimum 20 seconds)
or by washing with soap and water (minimum 40
seconds). If hands are visibly soiled, use soap and
water for hand wash.
ii. Performed before and after using bathroom, before,
during and after preparing food, before and after
eating /drinking, after coughing, blowing or
sneezing, after touching garbage, after touching
mask or soiled PPE.

22. MASK

23. Points to be remembered while using the
mask
• Place mask carefully to cover mouth and nose and tie securely to
minimize any gaps between the face and the mask
• While in use, avoid touching the mask
• Remove the mask by using appropriate technique (i.e. do not touch
the front but remove the lace from behind)
• After removal or whenever you inadvertently touch a used mask,
clean hands by using an alcohol-based hand rub for 20 seconds or
soap and water if visibly soiled for 40 seconds
• Replace masks with a new clean, dry mask as soon as they become
damp/humid
• Do not re-use single-use masks
• Discard single-use masks after each use and dispose-off them
immediately upon removal
• For N95 respirators adequate fit check must be performed after
wearing. CDC recommends the following hairstyles styles for male
HCP suitable for wearing N-95 respirators

24. Use of Masks
• Individuals with respiratory symptoms should
wear a medical mask while waiting in triage or
waiting areas or during transportation within the
facility
• Mask alone is insufficient to provide the adequate
level of protection and other equally relevant
measures should be adopted- hand hygiene
• Using a mask incorrectly may hamper it’s
effectiveness to reduce the risk of transmission
Correct technique to wear a medical mask-
https://www.youtube.com/watch?v=lrvFrH_npQI

25. PRACTICES FOR
ENVIRONMENTAL
CLEANING IN Dental
HEALTHCARE FACILITIES

26. • The interiors and external areas and premises of the
clinic should be kept clean and odour free.
• Solid waste and garbage should be removed and
disposed of hygienically.
• A clinic cleaning manual should be developed to
provide detailed guidelines for procedures and
practices.
• There should be a cleaning schedule for daily, weekly
and terminal cleaning. The cleaning process, be it for a
single room, or ward, must be coordinated with the
nurse in-charge.

27. 1. Wear heavy duty/disposable gloves, disposable long-sleeved
gowns, eye goggles or a face shield, and a medical mask
2. Avoid touching the nose and mouth (goggles may help as
they will prevent hands from touching eyes)
3. Disposable gloves should be removed and discarded if they
become soiled or damaged, and a new pair worn
Personal Protective wear (ppe) to wear while
carrying out cleaning and disinfection works

28. Cleaning agents and
disinfectants
1. 1% Sodium Hypochlorite can be used as a disinfectant for
cleaning and disinfection of non metal surfaces
2. The solution should be prepared fresh.
3. Leaving the solution for a contact time of at least 10 minutes is
recommended.
4. Alcohol (e.g. isopropyl 70% or ethyl alcohol 70%)spirit can be
used to wipe down surfaces where the use of bleach is not
suitable, e.g. metals.

29. •Telephone
•Mobile phone
•Door knobs / handles
•Lift/elevator buttons
•Keypad & Mouse
•Dental Chair arms (including
wheel chairs)
•Hand rails
•Side rails of stretchers
High frequency touch
surfaces :
 should be cleaned
twice daily by mopping
with a
linen/absorbable cloth
soaked in 1% sodium
hypochlorite.

30. Cleaning Protocol : Dental
operating areas ,waiting rooms
,• Sweeping and mopping thrice daily (morning and
evening) and Night .
• Cleaning of the hand rails of the stairs cases, grill, window sills -
Thrice daily.
• Lifts to be wiped on all sides including the floor- thrice daily
• Horizontal surfaces, ledges, window frames & curtain tracks,
taps, etc constitute the general equipment &should be. cleaned-
Thrice daily
• Main doors, door handles, light switches knobs to be cleaned
every hours.
dental chair handles , equipment table should be disinfected
properly
Hand sanitizing stations should be installed at entry and near high
contact areas
•
All areas such as entrance lobbies, corridors
and staircases, escalators, elevators, security
guard booths, office rooms, meeting rooms,
cafeteria should be mopped with a disinfectant
with freshly prepared 1% sodium hypochlorite
solution

31. Disposal PPE
• Remove PPE , discard disposable PPE in a Yellow Disposable
bag and wash hands with Soap Water.
• Thereafter, immediately to be incinerated or Deep buried.
• Hands should be washed with soap and water immediately
after each piece of PPE is removed, following completion of
cleaning.
• Masks are effective if worn according to instructions and
properly fitted. Masks should be discarded and changed if
they become physically damaged or soaked.