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CDPHE Releases the Fifth Revision to Public Health Order 20-29

By: Colorado Dental Association

Based on changes from the CDC earlier this month, the Colorado Department of Public Health and Environment (CDPHE) released a revised public health order (PHO) over the weekend for voluntary or elective surgeries and procedures in Colorado.

Read the August Revised Public Health Order 20-29 Here

There are a few notable changes in this fifth amended version of the PHO. Please review the PHO in its entirety and note the following highlights:

The most significant change concerns PPE. Note the following changes, however, please be sure to watch for additional information and interpretation from DORA, which is expected to be emailed in the future. The CDA has provided feedback to CDPHE and DORA on this order, specifically around the changes in face mask requirements during aerosol-generating procedures.

  • Specific language was added to address PPE for non-aerosol generating procedures: During non-aerosol generating dental care conducted on patients assumed to be noncontagious, in areas of moderate to substantial community transmission, the workforce should wear a surgical or higher grade mask, eye protection (e.g., goggles or face shield), gown or other protective clothing, and gloves.
  • Eye protection was more specifically defined: Eye protection should consist of either goggles or a face shield that covers the front and sides of the face. Protective eyewear (e.g., safety glasses, trauma glasses) are designed for safety protection from hard objects, not from droplets and therefore likely do not protect the wearer from splashes and sprays. Contact lenses and personal eyeglasses are also insufficient.
  • A website was noted for acceptable training for donning and doffing procedures.
  • The new order removed language stating that surgical masks may be used as an acceptable alternative if an N95 mask is not available. This is generating some confusion among dental offices and the CDA has requested further guidance from DORA.
  • To align with CDC recommendations, the order now states: During aerosol-generating procedures conducted on patients assumed to be non-contagious, the workforce should use eye protection (e.g., goggles or face shield), in addition to an N95 respirator or a respirator that offers a higher level of protection such as other disposable filtering facepiece respirators, PAPRs, or elastomeric respirators.
  • Also added: Respirators with exhalation valves are not recommended for source control and should not be used during surgical procedures as these allow unfiltered exhaled breath to escape. If only a respirator with an exhalation valve is available, the exhalation valve should be covered with a facemask that does not interfere with the respirator fit.
  • Gowns were also discussed in this section: Discard disposable gowns after each use. Launder cloth gowns or protective clothing after each use according to the CDC.

Other additions were added around infection control and patient screening:

  • A fever was defined as greater than 100.0 F.
  • Patient masks were addressed for certain populations: Facemasks and cloth face coverings 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 mask without assistance.
  • When making and confirming appointments offices should: Request that the patient limit the number of visitors accompanying him or her to the dental appointment to only those people who are necessary.
  • Telephone screen all patients and visitors for symptoms and exposure consistent with COVID-19. If the patient reports symptoms of COVID-19 or has been instructed to quarantine due to exposure to someone with COVID-19, avoid non-emergent dental care.

Lastly, under the “Definitions” section of the order, additional “Vulnerable Individuals” categories were included:

  1. Individuals who are 65 years and older;
  2. Individuals who have cancer;
  3. Individuals who have chronic kidney disease
  4. Individuals who have chronic obstructive pulmonary disease;
  5. Individuals who are immunocompromised;
  6. Individual who have a body mass index of 30 or higher;
  7. Individuals who have serious heart conditions, such as heart failure, coronary artery disease, or cardiomyopathies;
  8. Individuals who have Sickle cell disease;
  9. Individuals who have Type 2 diabetes mellitus; and
  10. Other individuals determined to be high risk by a licensed healthcare provider.

This PHO is in effect until 11:59 p.m. on Sept. 20, 2020.