Milwaukee VA Medical Center
Safeguards allow VA dental clinic to reopen
In the age of COVID-19, probably the last thing anyone wants is to be in close proximity, for a long period of time, with someone whose mouth is wide open.
But that’s the conundrum faced by dental practices, including the dental clinic at the Milwaukee VA Medical Center.
However, the clinic – which was shut down in March for everything but emergency procedures – has been able to slowly reopen, thanks to strict adherence to safety procedures and modifications to keep everyone as safe as possible.
“Dentistry is inherently an aerosol-rich environment – pretty much all of the work we do generates aerosols,” said Dr. Ankur Patel, head of the clinic. And it is aerosols -- specifically respiratory droplets expelled by people when they talk, sneeze or cough – that have been shown to spread COVID-19.
And because of that, the clinic shutdown was fast.
“It was like we hit a wall – that’s how quickly things just stopped here,” he said.
The clinic became a ghost town as dental assistants, medical support assistants and others soon found themselves disbursed throughout the hospital, answering the call to take on other jobs in order to keep the hospital safe.
Even Patel found himself in a new role as a co-incident commander with the newly formed COVID-19 incident command.
But as the hospital adapted and more was learned on how to prevent the spread of COVID-19, the dental clinic started to spring to life again.
With the help of the Facilities Management team, a section of the clinic was essentially walled off, creating an isolated area where riskier procedures could occur.
“If you were a Veteran sitting in the waiting room, an MSA or not with a patient, you weren’t anywhere near the aerosolized environment,” Patel said.
“We’ve gotten to the point where we can operate and provide dentistry in a safe manner. These efforts have helped with the safety of everyone – not just the dentists and staff, but also the Veterans.” Dr. Ankur Patel, dental clinic chief
New air filtration systems were installed in operatories, dental aerosol extraction devices were brought in, and the staff was equipped with the best PPE possible, from gowns, eye protection and face shields to N95 masks and CAPR – controlled air-purifying respirators – helmets.
Temperature-screening of patients was instituted. The number of chairs in the waiting room was reduced to keep everyone at least 6 feet apart. Patients were told to show up no earlier than 15 minutes before their appointments, and they were told to come alone, in order to maximize waiting room space and distancing.
“As time has gone on, we’ve learned better ways to manage our environment, not only from a process standpoint but also from an environmental control standpoint,” Patel said.
And Patel said Veterans and staff alike have taken all personal precautions seriously, including wearing masks and washing hands.
“We’ve gotten to the point where we can operate and provide dentistry in a safe manner,” Patel said. “These efforts have helped with the safety of everyone – not just the dentists and staff, but also the Veterans.
“When they came in, they knew it looked and felt different, but they also knew we were taking steps beyond most, if not all of other places, to provide care in a safe manner.”
Patel said he probably overreacted when it came to reopening the clinic, making sure all the necessary resources were in place.
But it appears to have been successful.
“I haven’t had anybody come up to me and say they don’t feel safe,” he said. “It’s been very good.”
Kristy Wojciechowski, a dental assistant, agreed.
“I feel that Doctor Patel has gone above and beyond the community to make us safe,” she said. “He’s put a lot of safety features in place, and I feel comfortable using these processes.”
Mari Liestman, a resident who started in the clinic in July, agreed.
“Everything’s been going well,” she said. “I feel safe coming to work. The patients are treated very well.”
Before COVID, Patel estimated the clinic saw 100 to 150 patients a day. By August, the clinic was up to 50 percent of its usual capacity, and Patel hopes to be at 75 percent by October.
While standard cleanings and other procedures have returned, Patel said truly elective care is still on the back burner.
In addition, the clinic is still playing catch-up with its patients.
“Being closed for three months with dentistry puts you behind,” Patel said. “It also changes treatment plans. Teeth that were sick are now more sick and may not be fixable and may need to come out.”
Patel lauded Dr. David Armin for filling in for him while he worked in incident command and commended the dentists and assistants who continued to perform emergency care when the clinic was shut down.
He also said he’s glad to have the PPE he needs to keep everyone safe.
“Our leadership and our safety department really understood how important it was for dental to have those types of PPE. They understood our environment,” he said. “(They) have really given dental a fair shot at moving forward.”
So will the clinic ever be back to 100 percent? Patel isn’t so sure.
“I’ve been telling my staff I wouldn’t be surprised if 75 percent is the new 100 percent,” he said, noting that while he feels confident the clinic could safely work at 100 percent, the bigger problem is overwhelming the hospital, the waiting room and the supply of PPE.
“I dream that someday we will get back to 100 percent, but I think the immediate future would lend us to continue working within the confines of our spatial limitations.
“And it’s to keep the Veterans safe. Our practice prides itself on our relationship with our Veterans, and I think our Veterans feel a sense of having a dental home. To be able to come back … has been really encouraging.
“I think there has been some frustration with the speed we’ve been able to ramp back up … but at the same time the reason we haven’t is for the safety of everyone. I think, by and large, they are very understanding of that.”