COVID 19 Risk Assessment

Introduction

At the time of completing this Risk Assessment on behalf of House of Smiles, it is clear that absolute protection from the virus in all environments is extremely difficult if not impossible, without the correct levels of PPE which is incompatible with dental care. We will treat every patient and every staff member as if they are potentially infectious unless they have a registered and valid test result to say they have already undergone infection and recovered. This is the same as any other current viral infection.

Table of Risks

Hazard	Cause	Risk arising	How likely is this?	The impact on business function	Additional Precautions
Dentist being off	Symptomatic Positive diagnosis of COVID 19 Possible household self-isolation Childcare issues if schools and nurseries close	Cancellation of patients Closure of the practice Added pressure on other dentists Loss of income	The likelihood of this occurring is increasing as the pandemic rises	HIGH	Check Practice insurance Check government advice for reduction in business rates/loans etc. to keep the business afloat. https://www.gov.uk/government/publications/guidance-to-employers-and-businesses-about-covid-19/covid-19-support-for-businesses Speak with other local practices to help provide cover if needed Dental and Skin practice
Nurses being off	Symptomatic Positive diagnosis of COVID 19 Possible household self-isolation Childcare issues if schools and nurseries close	Dentists having to work un-assisted Cancellation of patients Closure of the practice Added pressure on other staff members	The likelihood of this occurring is increasing as the pandemic rises	HIGH	Increase hours of other personnel. Use of temp/ agency staff? Written Procedures and policies in place for routine tasks. Some staff members are trained in multiple roles within the organisation and will be able to cover.
Other staff members being off	Symptomatic Positive diagnosis of COVID 19 Possible household self-isolation Childcare issues if schools and nurseries close	Patients unable to contact the surgery Added pressure on other staff members	The likelihood of this occurring is increasing as the pandemic rises	MEDIUM	Some staff members are trained in multiple roles within the organisation. Increase hours of other personnel. Written Procedures and policies in place for routine tasks.
Running out of hand sanitisers	Suppliers reducing the amount practices can purchase Suppliers running out of stock	Unable to get patients to use Compromised infection control	The likelihood of this occurring is increasing as the pandemic rises	MEDIUM	Continuous ordering from all suppliers to maintain deliveries Ask patients to wash their hands when they enter the surgery if unable to use hand sanitisers
Running out of face masks	Suppliers reducing the amount practices can purchase Suppliers running out of stock	Compromised infection control Cancellation of patients Closure of the practice	The likelihood of this occurring is increasing as the pandemic rises	HIGH	Continuous ordering from suppliers to maintain stock Check BDA advice as they might change guidance to say visors are acceptable Consider lengthening appointments so if patients require simple treatment, they can be completed in 1 appointment to save masks
Running out of other stock	Suppliers running low on stock being imported	Cancellation of patients	The likelihood of this occurring is low but possible if other countries are placed on lockdown affecting production	MEDIUM	Plan ahead for treatments Check with suppliers if they are having any stock delays. Borrow from the buddy practice
Staff at work	Risk of spreading infection	The likelihood of this occurring is increasing as the pandemic rises	HIGH	If a worker’s symptoms start at the workplace, they must return home without delay to start self-isolation; if well enough, they can drive their own vehicle, alternatively they should request a member of their household pick them up immediately. If neither is possible, the worker can take public or private transport home directly to start self-isolation. If using public transport, they should try to keep away from other people and catch coughs and sneezes in a tissue. If they don’t have any tissues available, they should cough and sneeze into the crook of the elbow. Social distancing of 2m (6 ft.) should be adhered to whenever feasible at the workplace, including at breaks Antibody testing of all staff to be undertaken at the earliest possibility.
Patients undergoing treatments	Patients who may be carriers of Covid-19 Symptomatic Positive diagnosis of COVID 19 Possible household self-isolation Childcare issues if schools and nurseries close	Risk of spreading infection to both staff and other patients Late notice cancellations of appointments with extended timings	Likelihood is a major threat as different patients attending daily rather than the constant staff who have already been tested.	Possible legal ramifications from other patients should they catch Covid-19 after attending for treatment. Serious health risk to patients who may have underlying health issues.	Pre-appointments updating of medical history as a compulsory activity Further telephone triage if the patient appears to be medium or high risk to ascertain whether appointments should be booked Advice to reduce risk of exposure during travel to practice taking a patient temperature with remote device before entering the practice availability of suitable hand washes mouthwashes and nasal sprays demonstrated to be effective against coronavirus such as povidone iodine, hydrogen peroxide, hypochlorous acid and proprietary alcohol-based hand sanitisers. Hand sanitiser should be used by all members of staff at all times whenever they pass a sanitiser station. reducing or eliminating waiting time for patients in the waiting room wearing of FFP 2 or FFP 3 masks by all members of staff depending on exposure to aerosol generating procedures at all times wearing of disposable gowns and hats by all members of clinical staff and patients in the surgery wearing a full-face visor by all clinical staff use of hypochlorous acid or hydrogen peroxide based full room vapour disinfection between patients and at the end of the day testing of all staff prior to starting back at work and referral of patients for Covid 19 antibody production to see if they have already come into contact with the virus making all patients aware that testing is available at The London Global Practice (Harley Street) and refer as required if patients wish to be tested. Voluntary testing before they attend the practice will also be recommended on the website.
Virus transmission ( spreading)	Staff Patients Visitors Delivery personnel (drivers) Cleaners Contractors Vulnerable groups (Pregnant, underlying conditions) Anyone else who comes in contact with patients and staff	The likelihood of this occurring is increasing as the pandemic rises. Strict adherence to infection control measures	MEDIUM	Infection prevention and control Patient Screening and triage H2O2 9 (1.5% dilution) mouthwash rinse for 1 min Temperature Monitoring and logged in Handwashing Hand sanitiser Providing appropriate PPE PPE(donning & doffing) 2 m distance patients-reception desk Screen protectors 20 minutes + 10 between appointments for aerosols to set and disinfecting Remove of magazines, leaflets, toys in the waiting area Infection control designated person to monitor patients journey and implement procedures for staff Certified Antibody testing for staff Updating with new guidelines Pregnant staff > 28 weeks not nursing in AGP environment Pregnant staff letter from GP fit to work Placing barriers on the working hard surfaces/replace after each patient
Cleaning		Medium	Mops and buckets will be ready to use Mop head changed regularly and used per colour coding in the appropriate areas Cleaning solutions containing bleach/dilute as per instructions Frequently cleaning and disinfecting objects and surfaces that are touched regularly particularly in areas of high use such as door handles, light switches, reception area using appropriate cleaning products and methods Cleaning and disinfecting in surgeries after each patient Cleaning/disinfecting whole practice at the end of the day (cleaners/staff)
Social Distancing	Staff members Patients Visitors	Spreading the virus in case of asymptomatic staff/patients Viral transmission between clinical and admin staff members	Medium	Reducing the number of persons in any work area to comply with the 2-metre (waiting room) (6.5 foot) gap When 2 m can not be achieved, face masks is required to be used in the communal areas Provide face masks to all employees PM to monitor constantly the following of the rules Staff to be reminded on a daily basis of the importance of social distancing both in the workplace and outside of it. Management checks to ensure this is adhered to. Conference calls to be used instead of face to face meetings
Respirators	Staff members performing AGP treatments	Failing the fitting test will not allow provider to perform treatments Risk of transmission during the fit test session Shortage of stock Inability to purchase on time from suppliers Male staff needs daily shaving	Medium-high	To minimise the risk of transmission of COVID-19 during face-fit testing the following additional measures should be carried out – Both the fit tester and those being fit tested should wash their hands before and after the test. Those being fit tested with non-disposable masks should clean the mask themselves before and immediately after the test using a suitable disinfectant cleaning wipe (check with manufacturer to avoid damaging the mask). Test face pieces that cannot be adequately disinfected (e.g. disposable half masks) should not be used by more than one individual. Fit testers should wear disposable gloves when undertaking cleaning of the tubes, hoods etc. and ensure they remove gloves following the correct procedure