Aerosol Generating Procedures

Aerosol generating procedures (AGPs) can potentially transmit respiratory infection or disease. These hazardous aerosols are a growing concern for dentists and other healthcare professionals.

Dental clinics might pose risks for both patients and dental healthcare workers. The aerosols and splatter produced during dental procedures have the potential to spread infection to both dental personnel and patients. Transmission of microorganisms may occur by direct contact with contaminated tissues or instruments. Also direct contact with saliva, blood or aerosol particles from saliva and respiratory fluids might transmit infection.

Aerosols generated by routine dental procedures may carry potentially hazardous microbes, viruses, allergens and other toxic substances that may harm the dental operator, patient, and the dental assistant by causing infections.

Reducing the risk of contamination

Several options can be considered in the control of aerosol in the dental clinics. Equipment producing less aerosols might be used but hard to obtain, and additional barriers such as respirator masks or face shields could be used. Another example of ways of to reduce the contamination risk is extraction of the aerosols at or close to the source since most of the aerosols have been found to radiate toward the patient's chest and the operator, as well the dental assistant's face.

• Face masks - A well-fitting surgical facemask is preferable to the paper type which rapidly can becomes permeable and inefficient.

• Eye protection - Protect eyes against splatter and aerosols which may arise during operative dentistry.

• Protective clothing - Wear protective clothing which covers areas that can be contaminated.

• Surface cleaning and decontamination - The area around the dental unit becomes contaminated for example by direct splatter and by touching surfaces with gloved hands. Cleaning the surface prevents transmission of infection by direct contact with hands and equipment.

• Extraction and ventilation - Good ventilation and  source extraction which exhaust the aerosol reduce the risk of cross-infection and cross-contamination.

It is difficult to completely eliminate the risk posed by dental aerosols, but it is possible to minimize the risk with relatively simple precautions. Routine use of standard barriers such as masks and gloves, the universal use of pre-procedural rinses, high-volume evacuation and source extraction are potential solutions for reducing the risks.

Controlling Aerosol Exposure

The CDC's National Institute of Occupational Safety and Health (NIOSH) recommends applying a hierarchy of controls to mitigate the risk of airborne contaminants resulting from aerosol generating procedures. While no single system can fully mitigate risk, the use of a well-design engineering controls, as part of a multi-tiered safety strategy and independent working interactions, can significantly reduce worker exposure to hazardous aerosols. Nederman offers a highly effective, source capture aerosol control solution that aligns with relevant health and safety organization recommendations. 

Source Capture - The Most Effective Aerosol Removal Method

Common approaches to indoor air quality are based on ambient air cleaning with air-change schedules by the HVAC system or by adding auxiliary air cleaning equipment. While these techniques may be effective over time, this approach does not remove the immediate worker exposure to aerosols.

Nederman's source capture method is the most effective and energy efficient aerosol control solution. An independent study found that the Nederman FX₂ extraction arm achieved 100% capture efficiency with adequate air volume and proper hood positioning. Read our white paper results here.

The Nederman Approach to Aerosol Control  

1. Capture the aerosol at the source using a high-volume extraction system with an articulating FX₂ extraction arm with well positioned hood. 
2. Where possible, exhaust the captured aerosol safely from the building using a certified, High Efficiency Particulate Air (HEPA) filter when necessary. 
3. Where exhaust is not possible, filter the aerosol with a medical grade HEPA filter and recirculate within the room. 

Nederman's aerosol control solution consists of the following elements that seamlessly integrate into your dental operatory:

• FX₂ extraction arm - proven effective, easy-to-use and position, reliable and aesthetic modern design
• Ceiling-mount installation - arm mounts to ceiling, freeing up valuable floor space, eliminates trip hazards and avoids obstructing dental procedures
• MFS HEPA filter kit - unique filter system with flexible installation arrangement. Internal filter media reduces contaminant exposure during service. Optional when air cleaning is required
• N-Series fan - fans engineered to provide proper airflow and suction pwoer throughotu the complete operational range
• Duct system - based on Nederman design parameters, local contractors source and install duct based on actual building, operatory arrangement and local requirements
• Capture hood options - transparent hoods are available based on dental healthcare preferences or requirements from the mini hood, dome hood, flange hood and combi hood. 

Nederman FX₂ arms are also available in self-assembly kits (Bench Top Extraction Kits), which include a fan, a filter, a fan speed controller, hoses, table bracket and connectors. No duct is needed. These kits provide a quick and convenient solution for improved extraction of aerosols.

Contact Nederman for assistance in selecting the correct aerosol control solution for your workplace.