to provide financing in cases of prolonged office closures and staffing needs. In the case of COVID, these relationships were key in the acquisition of the Payroll Protection Program (PPP) funding. In addition, the practice should have an emergency financial reserve of approximately 6 months of anticipated operating expense funds. This will ensure financial solvency for the practice and the staff in cases of prolonged office closure/ limitations.
Supplies and Inventory
The availability of sufficient supplies and inventory are critical to the reopening process and performance of procedures. In general, offices should maintain adequate reserve of all necessary supplies and inventory items, especially those that tend to have limited availability.
The following sections describe practices that are helpful in both generalized supply and inventory management as well as for specific items that may be necessary in emergency situations. Adequate supplies of PPE and adjunctive practices that may reduce exposure (eg, ventilation and filters) assist in working conditions and occupational safety among the staff and may ease their ability to resume their in-clinic responsibilities.
General Supply/Inventory Practices
Implementation of routine (eg, weekly/monthly) supply and inventory monitoring (that may include photographing) that includes quantities and, if applicable, expiration dates, will assist in both office management as well as in cases of emergency closure and reopening. These listings can be extremely beneficial in cases of prolonged office closures during which the products reach/exceed their expiration dates and may allow an easier/expedited manufacturer product exchange process. As mentioned previously, it is imperative to keep an up-to-date listing of preferred suppliers for essential office- and patientrelated supplies and inventory.
Inventory practices should also include provisions in case of energy failures. Specifically, the availability/back-up plans to ensure continuous proper (eg, refrigerated) storage of products. Refrigerators and freezers with temperature excursion alarms are standard for offices doing clinical trials. However, these units should be considered as a precautionary measure in the storage and protection of supplies such as botulinum toxins, hyaluronidase enzymes, and other agents that require refrigeration/freezing. As a further precautionary measure, an in-office generator may warrant consideration to ensure that refrigeration/freezing units are kept operational in case of a power failure. Battery operated light sources should also be available in the office in case of power outages that occur during a procedure.
There should also be a digital/hardcopy listing of all officerelated items that are in staff possession. These include office/supply room keys, various electronic equipment(s), and other office items.
Personal Protective Equipment and Other Emergency-related Items
COVID-19 and other infectious disease outbreaks and emergency situations have highlighted the need to maintain a 3- to 6-month supply of PPE. The limited availability of PPE has been a ratelimiting step for many reopening scenarios following the easing of governmental-imposed COVID-19 restrictions. Unfortunately, some practices reported not having sufficient supplies at the outset of the crisis. Others, in gestures of good-will, reported giving away their PPE supplies not realizing the limitations and the difficulties and expense of obtaining sufficient amounts for reopening.
Emergency supplies of PPE include goggles, laser and surgical procedural face masks, face shields, head caps, body gowns/ scrubs, gloves, and hand and surface sanitizer(s). Ideally, offices would have a sufficient supply of N-95 (or at least KN-95) masks for all staff members as well as methods for disinfecting (eg, ultraviolet germicidal irradiation) certain types of disposable face masks.3-5 Unfortunately, few practices stocked enough N95 masks for all staff members, which resulted in staff members wearing other, less protectively masks.
Ancillary items that should be accessible include infrared “no-touch†thermometers, additional batteries for these, and patient-illness/symptom questionnaires. Some offices report the stocking of hypochlorous acid for the staff to use in the cleaning of eyes and sinuses. Personnel should be advised to wear shoes that can be cleaned/disinfected or shoe covers. Other items to be included in this, and as we learned from earlier epidemics, was the importance of trash bags for clearance of contaminated items. As mentioned in a later section, the office should consider having a high-level bactericidal/virucidal air filtration system (high-efficiency particulate air [HEPA] filters) with replacement filters available.
The use of antimicrobial mouthwashes and/or nasal sprays have been suggested as a method to avoid exposure from infected (COVID or other pathogen[s]) patients undergoing “aerosolgenerating†procedures. However, recent literature searches by a collaborative team from Cochrane’s Oral Health and Ear, Nose, Throat groups identified no completed studies supporting this theory.6-8 Several studies are currently underway at the time of press including randomized controlled trials that will hopefully provide robust guidance for the future.
Adjunctive Infection Control Measures
When offices reopen following an infectious disease crisis, the performance of procedures represents a cause for health and wellness concerns among patients and staff. To date, the CDC has not provided any recommendations for the use of portable
Supplies and Inventory
The availability of sufficient supplies and inventory are critical to the reopening process and performance of procedures. In general, offices should maintain adequate reserve of all necessary supplies and inventory items, especially those that tend to have limited availability.
The following sections describe practices that are helpful in both generalized supply and inventory management as well as for specific items that may be necessary in emergency situations. Adequate supplies of PPE and adjunctive practices that may reduce exposure (eg, ventilation and filters) assist in working conditions and occupational safety among the staff and may ease their ability to resume their in-clinic responsibilities.
General Supply/Inventory Practices
Implementation of routine (eg, weekly/monthly) supply and inventory monitoring (that may include photographing) that includes quantities and, if applicable, expiration dates, will assist in both office management as well as in cases of emergency closure and reopening. These listings can be extremely beneficial in cases of prolonged office closures during which the products reach/exceed their expiration dates and may allow an easier/expedited manufacturer product exchange process. As mentioned previously, it is imperative to keep an up-to-date listing of preferred suppliers for essential office- and patientrelated supplies and inventory.
Inventory practices should also include provisions in case of energy failures. Specifically, the availability/back-up plans to ensure continuous proper (eg, refrigerated) storage of products. Refrigerators and freezers with temperature excursion alarms are standard for offices doing clinical trials. However, these units should be considered as a precautionary measure in the storage and protection of supplies such as botulinum toxins, hyaluronidase enzymes, and other agents that require refrigeration/freezing. As a further precautionary measure, an in-office generator may warrant consideration to ensure that refrigeration/freezing units are kept operational in case of a power failure. Battery operated light sources should also be available in the office in case of power outages that occur during a procedure.
There should also be a digital/hardcopy listing of all officerelated items that are in staff possession. These include office/supply room keys, various electronic equipment(s), and other office items.
Personal Protective Equipment and Other Emergency-related Items
COVID-19 and other infectious disease outbreaks and emergency situations have highlighted the need to maintain a 3- to 6-month supply of PPE. The limited availability of PPE has been a ratelimiting step for many reopening scenarios following the easing of governmental-imposed COVID-19 restrictions. Unfortunately, some practices reported not having sufficient supplies at the outset of the crisis. Others, in gestures of good-will, reported giving away their PPE supplies not realizing the limitations and the difficulties and expense of obtaining sufficient amounts for reopening.
Emergency supplies of PPE include goggles, laser and surgical procedural face masks, face shields, head caps, body gowns/ scrubs, gloves, and hand and surface sanitizer(s). Ideally, offices would have a sufficient supply of N-95 (or at least KN-95) masks for all staff members as well as methods for disinfecting (eg, ultraviolet germicidal irradiation) certain types of disposable face masks.3-5 Unfortunately, few practices stocked enough N95 masks for all staff members, which resulted in staff members wearing other, less protectively masks.
Ancillary items that should be accessible include infrared “no-touch†thermometers, additional batteries for these, and patient-illness/symptom questionnaires. Some offices report the stocking of hypochlorous acid for the staff to use in the cleaning of eyes and sinuses. Personnel should be advised to wear shoes that can be cleaned/disinfected or shoe covers. Other items to be included in this, and as we learned from earlier epidemics, was the importance of trash bags for clearance of contaminated items. As mentioned in a later section, the office should consider having a high-level bactericidal/virucidal air filtration system (high-efficiency particulate air [HEPA] filters) with replacement filters available.
The use of antimicrobial mouthwashes and/or nasal sprays have been suggested as a method to avoid exposure from infected (COVID or other pathogen[s]) patients undergoing “aerosolgenerating†procedures. However, recent literature searches by a collaborative team from Cochrane’s Oral Health and Ear, Nose, Throat groups identified no completed studies supporting this theory.6-8 Several studies are currently underway at the time of press including randomized controlled trials that will hopefully provide robust guidance for the future.
Adjunctive Infection Control Measures
When offices reopen following an infectious disease crisis, the performance of procedures represents a cause for health and wellness concerns among patients and staff. To date, the CDC has not provided any recommendations for the use of portable
