This term, widely used in intensive care units (ICUs) has gained prominence in recent months because of coronavirus infection (COVID-19).
Patients are faced down on their hospital bed in practice, known as pruning.
This change in the position is often enough to improve lung functionality and reduce the impact of respiratory distress caused by covid-19.
Proning — or placing a patient face-down — minimizes the effects of gravity on the lungs.
Putting the patient with the belly down helps increase the ability to use the lungs to absorb more oxygen. In this position, the heart no longer weighs heavily on the lung tissue but instead rests against the sternum.
As a result, lung tissue at the back of the thoracic cavity is relieved of the burden of gravity and is more capable of expansion and gas exchange.
In COVID-19, severe patients with Respiratory Distress Syndrome (RDS) have important dysfunction of the gas exchange made by the lungs.
A primary position is an important tool for improving these exchanges, being a viable option in the treatment since gas exchange would be facilitated. As a result, the patient would improve the oxygenation levels of the body, a fact observed in about 70% to 80% of patients with RDS.
How can dentistry assist patients in prone position?
The patient can be in a prone position for 18 hours per day, even with disabilities, oral hygiene still can be done.
To perform this procedure, the multidisciplinary team must be very well trained as constant manoeuvres are necessary to avoid injuries that may occur, due to the long stay of the patient in the same position.
In the orofacial region, it is very frequent the appearance of lesions in the mentum, cheeks, nose, lips, vestibular mucosa and dental traumas.
Before we carried out any mouth care it was important to ensure that the endotracheal tube cuff was inflated to prevent aspiration, and it was important to note how far the endotracheal tube was in the mouth.
The following recommendations were made for mouth care for proned patients:
Carry out tooth brushing at least once a day ideally with a disposable toothbrush. Try and brush all surfaces of the teeth.
- Avoid using electric toothbrushes as they generate more aerosol spray.
- Use a small-headed toothbrush with a long handle for better access.
- Use a smear of toothpaste or a non-foaming toothpaste on a dry toothbrush to prevent the build-up of secretions.
- Carry out gentle oral suctioning or use a single-use suction toothbrush.
- Try to stand to the side of the patient or behind them so your face is not directly in front of their face.
- Carry out dry mouth care regularly by moistening the mouth with water or using a dry mouth gel on a toothbrush as needed
- Gently brush the tongue in a forward sweeping action.
- Make sure the lips are regularly lubricated with a lip balm or water-based gel.
The prone is a technique that can save lives. However, applying the necessary care is essential to mitigate the sequels of a disease that has left many marks. Especially the emotional one.
Dr Adriana Figueiredo Flato
Now more than ever we see the need for reliable systems to adapt to unforeseen events.
With every country experiencing very different stages of the pandemic, the return to normal is further for some than others. And then, what does normal now look like within a dental care setting?
Now more than ever we see the need for reliable systems to adapt to unforeseen events. Salud’s flexibility allows your organisation to quickly adapt to the changing landscape and provides the data required to manage operations into the future.
Here are just some of the areas where Salud is helping dental care providers worldwide to adapt.
Covid-19 Diagnosis Codes
As many of our customers are acting as testing sites, Salud is helping to capture emergency use diagnosis codes for Covid-19, and therefore the ability to easily track and report. Salud provides customers with the autonomy to easily alter their configuration as data capture requirements, processes and procedures evolve over time.
In the early days of this pandemic, we assisted many customers to cancel appointments in bulk.
Now we’re working with them to get back up and running by rescheduling appointments.
Automatic SMS or email reminders can be customised to send safety instructions to patients in advance of attending appointments.
Many customers have created screening questionnaires in Salud to help assess potential Covid-19 symptoms in patients with booked appointments. Customers are able to edit and create questionnaires and make changes to configuration themselves – for free.
Track and Report
Salud’s reporting capability can provide real-time tracking of diagnosis and accurate monitoring of key data. With 150+ inbuilt reports, a custom report builder, and real-time Dashboards, any data captured can be monitored in the preferred format for viewing.
Salud’s Sterilisation module is tracking the instruments used during each appointment. Simply scan the barcodes directly to the patient file.
The data captured can be used to analyse trends, and conduct comparisons for epidemiological studies. The strength of Salud’s reporting and data drill-down capability means that all data captured can be easily extracted in the preferred format for viewing.
We continue to be here to support our customers – and we’re happy to share our knowledge and expertise wherever it may be useful. If your dental organisation needs any help or advice on adapting to the new normal, please get in touch.
Thank you to everyone providing essential services throughout this difficult time. In particular, Salud users on the front line. Your commitment and discipline is critical at this time to maintain essential services.
How to protect yourself and your patients?
The impact of coronavirus on Dental Practitioners: how to protect yourself and your patients?
The new strain of coronavirus which originated in China last December continues to cause chaos worldwide. As dental practitioners, it is important that your organisation remains vigilant to protect patients and dental practitioners.
What measures can dental practitioners take to prevent cross infection?
How does the coronavirus spread?
Investigations are ongoing as to how 2019-nCoV spreads. However, it is presently thought to be passed on when an infected person coughs or sneezes via respiratory droplets, which end up in the lungs of people in the vicinity, like how the flu spreads. Investigations into whether infection can occur from contact with an object, such as touching something that is infected and then touching your mouth or nose, are continuing.
What can dental practitioners do to prevent cross infection?
First, revise risk assessment procedures with the entire practice team. The first step to limiting infection in the practice is to try to prevent it from entering in the first place. In the case that a patient presents with symptoms, on arrival the patient should be requested to reschedule their appointment.
As practitioners, there are measures that you can take and can advise your patients to follow to protect against the coronavirus, as well as flu. Here are some points to remember:
Wash your hands: Wash hands for at least 20 seconds, or use an alcohol-based rub, especially before eating or after coughing or sneezing.
Keep your distance: As stated, viruses spread via respiratory droplets, so maintain a distance of at least 3 feet from people who have a cough or fever.
Avoid contact with eyes, nose, and mouth: Your hands touch many objects, and you could end up transferring the virus to yourself.
Seek medical care: Get help early if you are symptomatic and tell your medical practitioner if you have been in contact with anyone who has traveled to China.
Stay home: If you experience symptoms, stay home and rest until you are fully recovered. Do not come to work and infect your colleagues.
Disinfect surfaces: Clean objects and surfaces thoroughly that are frequently touched by people in the workplace. First, the surface must be cleaned, and then a second wipe is used to disinfect.
Do not be afraid to question patients before they enter the practice. It is, after all, a public health issue.
Vigilance, not panic, is the key to keeping viruses at bay.
How 2019-nCoV spreads. Centres for Disease Control and Prevention. February 5, 2020. Accessed February 10, 2020.
How flu spreads. Centres for Disease Control and Prevention website. August 27, 2018. Accessed February 10, 2020.
The impact of coronavirus on dental practitioners: Protecting your patient, practice and public. 13/02/2020. Accessed February 14, 2020
Beat flu in dental practice. National Health Service Whales website. September 24, 2018. Accessed February 10, 2020.