Adriana Anastasio, senior dental nurse at Queen Elizabeth Hospital Birmingham, shares her experience of working on the frontline with Fiona Ellwood, patron of the Society of British Dental Nurses

The Queen Elizabeth Hospital Birmingham Maxillofacial OPD Dental Nursing Team is made up of 10 GDC-registered dental nurses, four being senior dental nurses. Each of us offers a range of post-qualification skills and education, which creates a strong working team.

On a usual day in our department we prepare and close the clinical areas, offer Cone Beam CT and X-ray services, additional post-qualification skill set services, run specialised consultant-led clinics, assist with minor oral surgeries and skin surgeries.

The department specialises in Head and Neck Oncology, Trauma, Orthognathic Surgery, Temporomandibular Joint Dysfunction Surgery, Cleft Lip and Palate, Routine Maxillofacial Services, Minor Oral Surgery with and without Sedation, Skin Cancer Surgery and Reconstruction, Restorative Dentistry for Haemophilia patients and Cleft Orthodontic services.

Response to COVID-19

When the Prime Minister held a National Emergency press conference on 23 March declaring COVID-19 a global pandemic, the devastating effects of this virus and the gravity of the situation became apparent.

Key workers were told to remain in work where they could, whilst the rest of the Nation went in to lockdown and watched as the virus rapidly spread through neighbourhoods, cities and the world.

In response to this news, the Maxillofacial OPD team promptly cancelled all routine services and set up telephone consultations, only offering on-site treatment and review to patients with trauma, oncology and urgent two-week wait referrals, with departmental CBCT and X-ray services running alongside them to ease the hospital’s footfall.

After week one of lockdown and working with reduced on-site services, staffing levels were assessed and it was concluded that three to four dental nurses, with a range of skills, would be required to run the department. A seven-day working week was initially set up to take some pressure off the A&E services.

In response to this, the dental nursing team agreed to work flexibly, adjusting their shifts to coincide with the clinicians and offering support and minor surgical assistance.

Departmental members of staff were promptly mask fit tested for FFP3 masks and taught donning and doffing techniques for full PPE. These are safety requirements for any aerosol-generating procedures we carry out in the department and for working within COVID-19 positive patients within hot zones in the hospital.

We were informed of new cross-infection control practices in line with COVID-19, which we immediately put in to place and were tasked with the designation of specific treatment areas and donning and doffing of PPE areas within the department.

By week two, the team of surplus dental nurses started attending inpatient wards, providing personal care and nursing support for a mixture of COVID-19 positive and negative patients, whilst working within the constraints of their additional skill sets.

We were soon asked by management to offer support in ITU, by providing specialised mouth care to COVID-19-positive patients who were extremely unwell. This move was initiated by a Senior Registered Nurse who understands the benefits of good mouth care and champions the Mouth Care Matters scheme lead within our hospital.

Mouth Care Matters

The Mouth Care Matters initiative is supported by scientific research highlighting the need for effective Mouth Care whilst in Hospital to minimise the risk of Hospital Acquired Pneumonias. These infections are linked to poor oral hygiene, where the oral bacteria have had a chance to colonise and then travel in to the lungs causing an infection.

The COVID-19 virus lives and replicates at the base of the lungs, causing poor lung function, so preventing the risk of a further lung infection is extremely important to patient outcomes.

By week three, the dental nurse team had started to visit ITU regularly in teams. We had all become confident in the process of changing into scrubs then donning full PPE before entering the hot zones of ITU and doffing upon exit.

We provide mouth care to the patients who were presenting with pressure sores on their lips and at commissure from ventilation tubes and tube ties, dry and sore soft tissues, intra-oral ulcers, intra-oral sloughing and sticky secretions. Some of these symptoms were a result of ‘proning’, a technique where the patient is turned on to their front for up to 18 hours per day. The intention is to increase their lung function, but creates facial swelling and saliva pooling.

The Dental Nurse Mouth Care Specialist team successfully introduced ITU and the step-down wards to suction tooth brushing, with a low foam sodium lauryl sulphate free fluoride tooth paste to prevent aspiration of secretions; twizzle sticks for thick secretion removal and mouth moisturiser for dry intra-oral tissues and lips. The mouth moisturiser is water based and safe to use regularly with oxygen therapy.

Our Oral Health Education-qualified Dental Nurses currently offer COVID-19 mouth care training to all nursing, DCTs and care team staff. This was written by a QEHB Senior Dental Nurse and Mouth Care Matters project lead within our department.

The dental nurses have gained additional training and skills in:

  • Correct techniques to apply PPE using donning and doffing methods for aerosol generating procedures in our department and on COVID-19 positive ITU areas and step -own wards.
  • Training in tracheostomy care, how to remove and clean inner tubes plus how to suction and redress tracheostomy sites.
  • Training for ‘non-critical care nurses working in critical care’. This aided a greater understanding of how COVID-19 affects the body and the machines we see attached to the patient.
  • Changes to infection control practices for aerosol and non-aerosol generating procedures within the department.
  • Changes to CPR practices.

I have been through a multitude of emotions since working through the COVID-19 pandemic, but, at the end of each day, I feel proud and very well supported by the team, management and by staff in areas that I have never worked in before like ITU.

I am confident to work in the departments assisting with aerosol procedures and within the ‘Hot Zones’ at the hospital as I have had access to full PPE every time, even though there is a National shortage. I am but a tiny cog in the giant NHS pandemic fighting wheel, trying to do my bit to help wherever I can.

I would advise any dental nurses to offer their skills and expertise to the health care sectors that have been under extreme pressure, as you will find that dental nurses have a number of skills and attributes that are transferable at this time.