I have attached thee links that practitioners may find useful regarding air disinfection in the dental surgery and protection of health care workers from the Novaerus website. Hopefully this can add to your knowledge when researching options to get back to work.

Air Quality in the Dental Cloud Part 1
Air Quality in the Dental Cloud Part 2
Protecting Healthcare workers during Covid 19

There was a very interesting article published in ‘the bulletin’ in January 2018. This is a publication from the Royal College of Surgeons London. The article was titled ‘Excising Infection in the Surgical Environment (ExISE)’. It was a new initiative in exploring the architecture and design of operating theatres and what it could mean for AntiMicrobial Resistance (AMR) research. The interdisciplinary team was not composed of the usual specialities. There was as expected academics in infectious diseases, pathogen transmission then architecture, history and philosophy of science, fluid mechanics and history of art.

The initiative was to build on the ‘Bloody Rooms’ project that was NHS funded enabling a basic understanding of the behaviour of pathogens within airflows in a hospital room. The aim of the research was to eliminate Aerosol-Related Surgical Site Infections (SSIs) in operating rooms through re-examing the evidence.

The importance of airborne transmission in operating theatres appears to have dominated design throughout the past 60 years. SSIs are not eliminated in contemporary operating theatres. The primary mechanism of airborne -related transmission are thought to be due to pathogens already within the room- normally bacteria or fungi-being released into the air. This maybe from a surgical procedure that aerosolises droplets containing microorganisms from the patients own body or released on skin squame from the surgical team. Rather than being inhaled as in classic airborne infection, these pathogens deposit out-either directly into wound sites or indirectly by contaminating instruments. The mid 20th century design was driven by the concept that flows of cool air would reduce SSIs. 

Modular operating theatres and the observed reduction in SSIs under the Chanley-Howorth canopy system supported design decisions on high-volume air exchanges in theatre to reduce airborne infection risk and became firmly established. Yet none of this was evidence based. The group was to look at modelling behaviour of pathogens within common airflow patterns. All very relevant to todays coronavirus situation. We have had three novel Coronaviruses in twenty years and this is the first one to affect us dramatically in Ireland and it will certainly not be the last as its behaviour in a population long term has yet to be revealed.  

Oral Surgery in the U.K. and Ireland has moved on from the 1970’s and 80’s when it was mainly a hospital based procedure under GA. It has now transitioned in 2020 to a position were well over 80% of oral surgery can be undertaken in primary care under local anaesthesia with or without IV sedation by a competent Specialist Oral Surgeon. Patients don’t want to go to hospitals; governments and insurance companies are keen to avoid the costs of hospital admission. As a result the specification of premises to undertake surgical dentistry and oral surgery in primary care has had to increase accordingly as the speciality has transitioned from secondary care to primary care over the decades whilst in the middle of a digital dental revolution. The issues of airborne infection and the need for air exchange in operating theatres could equally apply to dental surgeries and oral surgery clinics going forward. This is an area that needs explored in the long term with research. As usual with anyone seeking to raise standards or having standards imposed upon the profession, this all costs money on a background were there is no history of grants to the dental profession in the Republic of Ireland. Any form of grant scheme towards air purification systems for dentists who undertake AGPs in the current and immediate post Covid phase would be welcomed to get general dental  practices up and running again safely when practice funds for so many are depleted.