EP 64: PPE & Current Covid-19 Update

In today’s episode of the Double Your Production Podcast, Dr. John and Wendy are sharing an in-depth virus update and an update on personal protective equipment that can be used in dental practices.

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Get a discount on PPE at twiceasniceuniforms.com with our code:  TT2020

Henry Schein item code for HEPA filter: 129-4415

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Welcome to the Double Your Production podcast with The Team Training Institute. The one place designed for dentists and their staff who want to grow their practices by following in the footsteps of those that have done it, who are in the trenches, who know exactly what you're going through. And now your leaders, the stars of the podcast, Dr. John Meis and Wendy Briggs.

Hey listeners. We're bringing another COVID-19 update to our podcast feed today. Hoping to give everyone the tools that they need to continue moving forward through this unforeseen pandemic. We just want you all to be able to hit the ground running once we get up and moving. So real quick before we get going. I just wanted to let you know that there are a few resources on our page that are linked to this podcast episode which was a Facebook live video. So if you head over to our www.theteamtraininginstitute.com/podcast, that will have the original video, so if you'd rather watch it in the video form.

It also has a link to the Facebook page so you can continue to get these updates as Wendy and Dr. John do them, but it also has the discount code that Wendy talks about later in this episode for scrubs as well as the Henry Schein item number for those HEPA filters, and all of those kind of things. If you don't have time to jot them down, don't worry about it. Just head over to that website, that www.theteamtraininginstitute.com/podcast. So if you need any of that info, that'll be there, but otherwise, enjoy this episode. Let us know if you have any other questions [ready to link?] that on that Facebook page. They are answering questions and doing real time responses during this time of unknown. So I'm going to turn this over here to Wendy and Dr. John, and we hope to hear from you soon.

Today is the 10th. It's kind of an important day. The 11th is considered to be the-- or is projected to be the maximum [inaudible] versus the COVID-19 virus. So tomorrow is the peak, and the projection show it should be getting better each day after that. Of course, there'll be ups and downs, but it should be getting better. So I'm excited to have the peak behind us, and hopefully the trajectory downward is more rapid than the trajectory up.

That's right. And we always tell people don't over obsessively watch the news, but of course, we have to because we're looking for all the information for some of these things, and so everyday is a new day. And it's an interesting mix from what I'm seeing. I'm still seeing the news sources pushing hysteria, but we are starting to see as well some people question the previous models that all these really aggressive tactics were derived from. And so it's been kind of an interesting show to watch. And certainly not the typical show that we'd like to watch. We'd prefer something lighter and less stressful, but it's been really interesting to see.

Yeah. Well, I think we can go ahead and hop in here. So today Wendy is going to do a fantastic update on the personal protective equipment is what does it look like and recommendations are going to be. Remember the APA and the CC cannot come out with any specific recommendations, but we do have recommendations from the Clinical Research Associates after [inaudible] of the group and then [inaudible] do a quick disease update, so here we go. We know that this all can change at any time, but this is kind of what our best guess is.

Very good. So here are some of the things that we're going to be talking about in regards to infection control, and PPE post-COVID , right? So the questions really are that we've received is, what are we going to need to do differently after dentistry is back in business with elective services? Is it going to be safe for us to treat our patients on the hygiene side? What kind of PPE do we need? Can we access that and get it? So we're going to cover that. We're also going to talk about how we can more effectively reduce the bacteria load as well as sterilization of the treatment rooms. So we'll talk all through those three. Those are our big three today, all having to do with PPE.

So, Doctor John, we both have followed Doctor Gordon Christensen for years. We feel like they've got tremendous resources with the clinicians' report, and this month's report is probably one of the best I have ever read from CRA. All the news of COVID-19 are covered in this report. So the report you can access by going to Clinical Resources website. I believe it's CR report, you could just google that and find it. And it's the $29 report. And we would actually encourage everybody to go and buy their own copy because there are so many great resources in there. If you don't subscribe already, you can buy just this one issue for $29 and it's well worth every penny of that. It's such a good resource for practices on materials, techniques, equipment. It's just a great resource.

So I believe the website there is cliniciansreport.org. So take a look at that. In this report, Dr. Christensen goes backwards and forwards through all the PPE you need, and we're just going to share a few quick highlights. I think one of the most common questions is about masks. What kind of masks do we need? And he walks all the way through the best brands. What rates the highest, what tested the highest. Because obviously they're running everything through very comprehensive, scientific evaluations, and so the masks that Dr. Christensen recommended were positive lock mask with high filtration and all that.

So if you're dealing with a patient that you don't know if they're ill, he recommends a positive facial lock mask, critical cover PFL is the name. And then for an M95, he recommended the isolator plus mask for you. So it's more difficult to breathe through that high filtration mask. And in the report, he actually goes step-by-step through what to do if you're dealing with a COVID-19 positive patient, which is important as well. So again, for everyday operations in the treatment rooms, we need to make sure there's no gap as you can see in this image, right? So that's what the positive facial lock masks remove that side gap, which is more effective for the clinicians to protect us against the aerosols, and to protect them against the aerosols as well. Okay. Very good. So the other thing they talked about in-- everything that I've read is the importance of having a face shield.

So patients are going to want to know what we are doing to differentiate, right? What were our processes before COVID, and what is it now that COVID's here? And we're dealing with this very real respiratory threat. So a face shield, many-- I used a face shield even 10, 12 years ago with patients, especially if I was doing a procedure where I was worried about splatter, right. So if it was an intensive scaling root planting patient, I would wear a face shield anyway even back then. So I know many of us are used to wearing face shields. And if you haven't worn a face shield in the past, it may not be a bad thing to add, so that you can differentiate your patients that you're definitely doing something different.

So there's disposable options here through Henry Schein that are great. I know they are on backorder. So reach out to your rep, talk to them about what they can do to put you in line for those shields. And make sure that they alert you as soon as some of these valuable PPEs are back in stock and ready to ship. The other thing that they talked about is clothing, right? When you look at the CDC recommendations, we need to be wearing long sleeves with fitted cuffs and a high closed neck. Those recommendations have not changed, but our willingness to actually follow the recommendations may have changed now that we're dealing with our current situation. We were joking earlier about all of the different practices we've been in. And certainly, every practice has their own culture. And some of that is evident in what the team chooses to wear every day. Right.

So there are certainly practices where we've seen the entire team in just a short sleeve scrub top. I think those days are gone. We've seen doctors practicing in khakis and a polo. I think those days are gone. I think there's going to be a stronger focus on what we're wearing and what we're doing to follow the CDC requirements as far as our clothing. So this is one of our favorite partners twice as nice uniforms-- they're sponsors for our champions of dentistry summit that's going to be happening later this year. They're doing a fashion show there. And I think one of the reasons I love this company is it was founded by another entrepreneurial-minded hygienist who wanted to solve the frustrations that we often have, right. The thermometer war-- front desk is freezing, [back?] debt-- back office clinical team is sweating. And how can we fix that? Well, the scrubs that she makes actually are temperature adjusting so that she's got moisture-wicking fabric, and they do a better job of keeping you comfortable all day. Plus, of course, I think we've moved beyond the desire for scrubs that look like pajama pants. And we can have scrubs that fit better, that feel better. That looks better.

And this is an example of again revolutionary technology that this is this a lab jacket that you see in the grey that's specifically made to add another layer of radiation protection for practices that are using [no mat?]. So I love everything that she offers. And we do have a discount code for TTIs. So if you're watching this, and you go to twice as nice uniforms and you want to place an order, our discount code is TTteamtraining2020. So be sure to enter that so you can get a discount. Another thing that they've done if you can flip to the next slide, Dr. John, this is the thing that I think I'm most excited about that they put together, is they have masks that they are making in their factory now. And there are two layers. They're washable, they're reusable. So the outer layer is 95% organic heavyweight cotton. And the inner layer is antimicrobial. So the interlayer is moisture-wicking temperature regulating fabric just like their scrubs. The air loop design is powerful. They're more comfortable to wear and but the big feature is that they're [auto capable?] and [UB safe?]. So here we have if we have scarce PPE, if we can't get our disposable masks, here's at least something that is antimicrobial, that can be autoclaved and reused. So I think that's a tremendous feature, especially for those of us that are worried about getting PPE in stock so that we can begin seeing patients again. This is a nice feature to have. Any comments on that, Dr. John, on personal PPE?

Okay. So let's talk about how we can reduce the bacterial load. And certainly, we could go on for an entire hour about each one of these topics individually but our goal here is to prevent cross-contamination and to try and reduce the bacterial load as much as we can. So there's a few innovative strategies I've read about how we're going to do that. So the first thing that we're going to talk about with preventing cross-contamination is some things that you've probably read about. So if you can advance to that next slide for us here.

One of the things that we've talked about is ozone therapy. It has come up on a question on a previous Facebook live. And they actually used ozone therapy in Italy during this crisis. And so I think that this is something that's interesting. I've been watching this closely. And there's been a coalition formed in Texas of state national and international physicians and researchers that have approached Congress and federal agencies with a call to action to consider the use of medical ozone as a safe therapy for the treatment for COVID-19. So I thought that we are going to talk about how practices are using ozone and just do a brief update on the history of ozone therapy so that those that are interested in learning more have someplace they can go.

Okay. So let's click forward and look at the history of ozone. So I didn't know much about ozone therapy. I seem to remember in the dark recesses of my brain hearing Scott Luna do an update for MSNBC or some news channel on ozone therapy. And they asked him to do it and asked if he was a dental expert on it. And he said, "Of course, I'd be happy to do it." And then he spent the next 12 hours cramming and trying to get all the information about ozone therapy that he could, and he ended up doing a wonderful interview and it was amazing. So that's the first I really think I heard too much about ozone therapy. But since then, we've had several practices that we've worked with that have used it, and they've been big advocates for using this therapy. So it's really nothing new. It goes back to 1840. And the first one to use it was a German chemist at the University of Basel in Switzerland. And interestingly enough it was used in medicine in 1870 by another revolutionary thinker.

So it wasn't until 1932 that ozone was seriously embraced by the scientific community. And at this point, what happened was ozonated water was used as a disinfectant by a Swiss dentist in his practice. And some of the mechanisms of action were to reduce that bacterial load. So by a twist of fate, a surgeon was actually traded by Doctor Fish, the Swiss dentist, for a gangrenes issue in his mouth and remained absolutely astonished by the results that were achieved by using this ozonated water. So he enthusiastically extended his application to general surgery. So kind of a fascinating history of ozone therapy.

So when I was digging in, of course, I'm looking for the science. I want to know published recourses was reputable sources, and I want to be able to look at the science and clinical review here. So this was published in 2011 in the Journal of Natural Science, Biology, and Medicine. I'm going to share a few things that they published in this report. So as we look at how it works, they published that it was effective in disrupting the integrity of the bacteria itself. And the way it does this is it oxidizes the possible lipids in the liver proteins. In viruses, we're talking about bacteria there, what we're dealing with is a virus. So how does it work with viruses? Well, the ozone therapy actually damages the viral capsid and the reproductive cycle of viruses. So it disrupts the virus to cell replication when it comes into contact with pure peroxidation. So interesting mechanism of action. So basically, it diminishes the virus's capability of replicating itself

And the way it does this is cells have a weak enzyme coating on them which make them vulnerable to invasion by viruses, okay. So what happens is the oxygen is able to interfere with that process, okay. And the viruses are not able to replicate effectively and the body can then eliminate the viruses from the body and replace those contaminated cells, if you will, with healthy cells. So certainly, I am not a scientific expert. I haven't done years and years of research. I'm just trying to help you understand how ozone therapy can be disruptive in the virus process and point you towards some great resources that can give you some more information about these tools, okay.

So what does ozone have to do with the Coronavirus ? So it was studied extensively with SARS as another Coronavirus , and it was really interesting what they found. So when they used it in therapy of treating SARS they found that there was a unique reaction that happened. So there is excess energy that was contained within the ozone molecule, and it showed very promising effectiveness against the entire genotype of the Coronavirus and the sub-type spectrum of SARS. So people that studied that were really excited about the potential impact of ozone therapy in the entire genotype of Coronaviruses, okay. So if we flip to the next slide, here is some specific quotes from people using the ozone therapy with COVID-19. So this was Peter Jovan.


All right. We're here with the executive director of the Ozone Without Borders, and they've studied COVID-19 usage of ozone therapy. And here's a few things that he had to say about this. We now know of one Sierra Leone physician who is COVID-positive whose symptoms abated after four hours of ozone treatment and one American COVID-positive patient who was essentially normal one day after a single direct intravenous gas treatment. So this is obviously not using ozonated water in therapy. This is using a high-level, physician-monitored treatment of intravenous gas of ozone.

So another example that he shared was a Spanish physician with high exposure risk and all the symptoms of COVID. Cleared his symptoms within a day or two of treatments. So they were excited about the promising results from this therapy. And again, they petitioned government and state to be able to use it. So this was published in a PR Newswire article March 5th of this year. They said ozone has been proven to kill 99.999% of pathogens in the air including SARS, coronaviruses, and influenzas such as H5N1. Researchers anticipate that it may be an important tool in preventing the spread of the coronavirus disease in 2019. So they go on to say in this article that ozone really is the strongest disinfectant available to the public, and ozone has safely been used for decades in homes and businesses and even documented research-- they published documented research showing that ozonated water for handwashing kills bacteria and viruses on impact.

So there's a variety of ways we can use it in dentistry, right? Here's the goals. We want to eliminate pathogens, restore proper oxygen metabolism, have an induction of a more friendly ecologic environment, increase circulation, immune activation, and stimulation of our own body's antioxidant system. So there's a lot of ways we can use ozone. And really, there's three ways documented that people are using it in dentistry. And one of these, I thought would be helpful especially when we're talking about reduction of bacterial load in the mouth prior to any treatment. So we've all heard about using a mouth rinse of hydrogen peroxide. We're going to talk about that in just a minute. But what if we have-- if you have ozonated water in your practice, if you have an ozone machine that you're using with your treatment, absolutely use it as a mouth rinse prior to care. Especially we've seen success on the perio side with gingivitis and other illnesses in the mouth, other areas of inflammation.

They also say as you're treating affected areas-- so let's say, we get the green light, we open up, and we're doing restorative dentistry in the practice. We can use it as a spray to cleanse whatever area we're working on. Whether it's surgical or restorative, we can use ozonated water in that way. Also, they've proven an impact in using ozonated water after teeth have been prepped. So after we've prepped teeth, it adds another layer of protection in removing any remaining bacteria during our treatment. So there's a lot of ways that it can be used in dentistry. And I think that's exciting for those that are interested and following the science and adding additional services to your practice that may be helpful. But especially now, post-COVID, as patients and team alike are worried, this may be something that we can add to reduce their fear, minimize anxiety, and have them feel more comfortable getting back to work.


Okay. So here's other ways that we want to make sure we're focusing on reducing the risk of cross-contamination . We mentioned hydrogen peroxide. So Gordon Christensen in his article said, the ideal strategy here is to have patients rinse for one minute. And he recommended that the result were better if we did two thirty -second rinses with 1% hydrogen peroxide. So if you have trouble finding it, you can pick up at Walgreens or CVS or any store that you can find it. They usually sell at 3% hydrogen peroxide over the counter. And you'll just dilute that down. Chlorhexidine is ineffective. So chlorhexidine as a pre-rinse is not effective. It's not suggested at this point. Of course , you need a strong focus on office disinfection; door knobs, door handles, phones, computer, keyboards. Anything that are physically-- anything that is physically touched.

We want to have a more frequent disinfection of these surfaces. We want to arm our team with bottles of disinfectant, and have them spray liberally, spray often in the view of patients and other team members alike. Of course, we want to amplify our use of barriers, plastic wraps. We want to cover any surface that is touched in the office, with a barrier that can be disposed off after each patient. So I think all these steps are really important. And as we mentioned before, in this article, there's just incredible resources. So make sure go and purchase that. Because he'll give you so much more information on PPE, that I know you'll find very beneficial to you.

Fantastic. Winnie, that was great over view. So here we go. How about the room sterilization?

Yeah. Just a few other things. Most of everything, we've already covered. When it comes to room sterilization, again we want to differentiate. We want patients to know, here is what we've added to make sure we're safe. And so the medical grade HEPA filters-- we talked about this on previous live updates. I actually have an item number from Henry Schein that you can utilize. Now this is not a dental product on their medical side. But that's an advantage to having Henry Schein for us as a resource. Because they have medical and dental supplies. So they drop-ship it directly from the medical side. And this is the item number 129-4415. S o I would talk to your rep about that. I personally think having a medical grade HEPA filter is going to be necessary.

I think it's going to be, again, another way you can differentiate what you were doing prior, what you're doing now. I have a medical grade HEPA filter in my home, that filters out, sizes of viruses and particles smaller than the COVID-19. So that helps my family feel a little bit better as we are social distancing. If you bring in a package from Amazon, people are getting crazy. Because there's been known COVID-19 positive people at Amazon warehouses and supply centers. It's everywhere. And it would continue to be everywhere. But that helps to be a little better having a medical grade HEPA filters. So again I would get one. This one, I believe, can clean out an 800 square foot room every 30 minutes. So it will help alleviate some of the stress and worry from teams and patients about what were doing differently to make sure they are safe.


Another thing that's a gem for you in the report, he says, "All disinfectants are not created equal." You would think the that FDA or the CDC tests all of these things. And they all have to pass some efficacy test. And that's just not true. So doctor [inaudible] recommended BioSURF. He said it rates high above everything else. And for our setting in our practice, we want to use BioSURF service disinfectant. It's really the only one available to us that can accomplish everything that it needs to do in a three- minute time frame.

So as we're transitioning rooms and needing to kill viruses and bacteria and microbes, we're going to need a bio surface-- BioSURF surface disinfectant rates the highest out of all the ones that Doctor [inaudible] tested. So again another little gem from that report. And there's so much more. He goes into all the others. And how they rank. And how they're used. So that's our update on creating a safe environment so that we can get back to work, and get back to doing what we love and serving our patients and serving our community. So with that - I had a couple of questions come in to Dr. John, so after you talk about the government situation, we'll handle some of the questions about [PPD?].

All right. So Uncle Sam to save the day. Really, the relief loan process is now working relatively smoothly. I am unaware of anyone who's actually gotten any money yet. I am aware of people who've been, not in dentistry but in other industries, denied. And so, again, until the money's in hand we have to assume that it's not coming, and once we get it, we have to assume that it's not going to be forgivable. I know that's what they're saying, but that's what it is.

All right. So here is the new model. This is the model the federal government is using. It's from a health data institute in Washington, and you can see here there are some key features on here. Tomorrow is the peak day of resource use, and the other thing on here is that invasive ventilators needed 15,000. You may remember that some states were asking-- some states were asking for 30, 40,000 ventilators. The entire country's only projected now to need 15,000. It doesn't mean that there may be shortages in individual hospitals and individual situations, which is tragic, but it's not going to be a national problem.

This is COVID-19 cases based on date of illness onset. This is when people first started to feel icky. And these numbers have been inconsistent from day to day. This is from the CDC, and I began to think that they are changing the way in which they report this just like the way they have done with deaths. So here are the new daily deaths, and you can see now we're a couple of days going down, but this was the week that everyone anticipated would have the highest death rate. Tomorrow is the peak, and hopefully every day after that these would be going down.

So that's it for the update. We're just about over the hump as a nation, but as we all know there are places in the country that the number of infections has gone down dramatically. I heard just before we hopped on that San Francisco is considering within the next couple of weeks opening up their social distancing. You remember they were one of the first to lock down. And so the number of cases there has fallen so dramatically that they are thinking about opening things back up within the next few weeks. Many places in the country, of course, will be much longer than that. They were one of the first places to get it. They have a hyper response to it. But hopefully we're on the downward slide of this.

So we will continue to give you an update every Monday, Wednesday, and Friday at 4:00 PM Eastern at Team Training Institute Facebook page. We have a little technical glitch with that, so we moved over to Wendy's personal page, but we should have that worked out by next Monday. And our team is doing systems training. This is now not Monday through Friday. It's on Tuesdays and Thursdays at 2:00 PM Eastern time, Tuesdays and Thursdays at 2:00 PM Eastern. If you got good information from this and think it would be helpful for other people, please share. Please share it with people in your study clubs, things like that, and we hope that everybody has a great weekend, a very happy--

You're not done yet, Dr. John. You got a couple of questions.

Okay. All right. Let's hear the questions.

Yeah. So there are two questions I have come across. So the first one is seeking clarification on unemployment insurance, right? It's my understanding that unemployment rates will not go up as a result of claims that occur during the COVID crisis. Does that include self-employed owners making claims? Just trying to make some good decisions there. Have we heard anything regarding that?

I have not heard that unemployment rates will about to go up. That may be the case, but I have not heard that. The unemployment system is a pool of money that is gotten from employers. And so if the employers are not paying the [freight?] of unemployment, then perhaps the federal government is going to step in and do that. So I have not heard that. Maybe it's true. I don't know the answer to that.

Okay. And obviously, I know people having a horrible time trying to get through to the unemployment in their states. They're inundated. You're not going to get a phone call or an email back. But maybe that's something that HR can help resolve. I don't know if you have financial advisers that may know the answers, more specifically regarding unemployment. And they may not know the answers either, right? We've been saying from day one how rapidly the rules are changing.

That's true.

The insurance companies are doing things differently than they have in the past because of this scenario, so there's a lot of ebb and flow. And certainly, if we find out the answer, we'll share it next week. So we can dig a little bit too. Okay. So there's one more question that came in about employees. And hopefully, after our update on PPE and creating a safe environment, teams and doctors can feel better and more safe about opening up their doors and providing care. We got this question. What if a team member decides not to come back right away because there's still some concern about the virus and/or they're making as much or more on unemployment? How long should we get them? And this was a team member that have been furloughed and the doctor is still paying their health insurance.

Okay. So this is a great question for your HR consultant. And we really recommend, as was the previous question, we really recommend that every practice have an HR consultant. There's several that focus on dentistry, and many that are generalists. Here is my understanding. If the employee was laid off, they're no longer employed, right? So if you invite them back and they don't come, no big deal, because they're not employed. Now, if they're taking unemployment and they turn down employment, that may affect their unemployment benefits. So if they're laid off, that would be the situation I see.

If they're furloughed, they are still employed. But if they're called back from furlough and they refuse to come back, that's grounds for dismissal, unless they were furloughed after the April 1st deadline when the Emergency Family Medical Leave Act would have come into play. So it really depends on the date of the furlough. And also, those are kind of the federal recommendations, but states have their own different things. So this a great questions for your HR consultant. But my understanding is that furloughed employees, if they are called back to work and they don't come, it's grounds for dismissal.

Right. So all very important questions and new territory for many of us. I think if you communicate clearly with your team and your patients both and say, "Hey, here are some of the things. Have people listen to this today." It may be the topic for a meeting. Or here are some of the things that were shared on this live update, here's some things from PPE. And people that are listening that are our members, we are going to be giving those slides on everything that I just talked through to our coaches, and they can do a personalized one-on-one hygiene coaching session with you to help you come up with your plan for making everything safe once you come back.

So people support what they help create. Involve your team in creating this plan, so they could feel better and you could better about what you're going to put in place, so they can come back and be safe. And then I would also create a patient-basing resource, that you do a live update to share with your patients. Hey, here's how we've always treated you. We've always been very focused on infection control. But now, with some of the new science and new information we have about the latest, right, here are some of the changes that we are making to make sure you are very, very safe, and we're very focused on reduction of bacteria and viruses and all that, so that they can be confident as well. So I think there's opportunities right here. We always say crisis is danger and opportunity put together, and there's some big opportunities here, but communication is key.

Absolutely. All right.

There we go. Now, we can wish them all a happy weekend.

Okay, very good. Happy weekend. Happy weekend.

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