Rapid review of AGPs guidance reassessed

The Scottish Dental Clinical Effectiveness Programme (SDCEP) published Mitigation of aerosol generating procedures in dentistry - a rapid review in September 2020.1

It was noted at that time that this was a living document and that the Working Group would continue to assess emerging evidence in the following months. The Working Group met again on 13

January 2021. New members present included the Chair of the SAGE Environment and Modelling Group, who is an expert in healthcare ventilation, and representatives from the National Physical

Laboratory.

The literature search used for the rapid review has been updated and the results screened for relevance to the review questions. Appraisal is ongoing but, to date, no new evidence has been

identified that changes the conclusions of the rapid review.

The Working Group considered the implications of the substantial increase in prevalence of COVID-19 infections in recent months,2the emergence of more transmissible variants of SARS-CoV-2,

no reports of transmission associated with dental care, the greater availability of testing and the vaccination programme that has recently commenced. The Working Group agreed that at

present, despite these developments, the agreed positions and other conclusions within the rapid review remain unchanged.

The Working Group was keen to re-emphasise the importance of staff and patients continuing to adhere to the precautions specified in current national guidance, including:

Reviewing all stages of the patient journey to assess adherence to procedures and any improvements required

Rigorous use of face coverings/masks and application of social distancing measures in clinical and nonclinical areas, including staff rooms

Individual patient risk assessment to determine the appropriate COVID-19 care pathway as described in the PHE Infection Prevention and Control (IPC) guidance3

The IPC guidance describes high, medium and low risk care pathways. For a patient to be in the low risk pathway, a negative PCR test is required, and the patient must have followed

self-isolation advice. A lateral flow test is not sufficient unless the patient is part of a regular formal NHS testing plan and remains negative and asymptomatic

While vaccination will provide protection for the vaccinated individual, this is not 100% and it is also unknown whether vaccination prevents onward transmission. Therefore, the same

precautions are required for both vaccinated and unvaccinated patients and staff

Screening questions should be consistent with current triage criteria, including quarantine requirements following international travel4

Adequate ventilation in both clinical and non-clinical areas.

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