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COVID-19 Mask, Screening and Physical Distancing FAQ

August 04, 2021 5151

CDA Practice Support answers members’ top questions about physical distancing, patient screening, the use of face coverings and other requirements that continue in health care settings after June 17.

Do vaccinated patients have to wear masks while in the practice?

Yes. CDC recommendations and CDPH guidance for fully vaccinated individuals clearly state that masks must be worn in health care facilities, schools, public transportation and other specific settings. As a best practice, refresh patient communications and signage.

Must we continue to screen patients and take temperatures?

Yes. Patient screening and temperature taking are recommended in the CDC guidance for dental practice. Employers are required by Cal/OSHA to implement controls to limit the COVID-19 transmission, and patient screening is considered a control. You may ask patients about vaccination status; it is not a violation of law to do so.

Do vaccinated staff have to wear masks while at work?

Yes. CDC guidance for vaccinated healthcare personnel state that PPE recommendations are unchanged. Although the Cal/OSHA emergency temporary standard permits fully vaccinated employees to go without face coverings, dental practices should continue to follow CDC guidance.

If all staff are vaccinated, do the staff have to wear masks when not with patients?

No. If patients are not present, and the employer has written documentation that shows all staff have been fully vaccinated (at least 14 days have passed since the employee had the 2nd vaccine dose), then employees do not need to wear masks.

What are an employer’s obligations if one or more workers (paid or unpaid) are not fully vaccinated?

Starting August 23, a healthcare employer is required to ensure unvaccinated workers are tested weekly for COVID-19 if the employer does not have documentation that the workers are fully vaccinated. In addition, all California employers must provide respirators to unvaccinated employees upon their request for their voluntary use. Voluntary use of a respirator does not require the employer to provide a medical evaluation or fit-testing but the employer must ensure employee is trained on how to put it on and how to perform a seal check each time the respirator is worn.

Are respirators still required to be used in the practice?

Yes, for aerosol generating procedures according to CDC guidance for dental practices and the Cal/OSHA emergency temporary standard.  Cal/OSHA requires respirators used in the practice be approved by NIOSH.

How often must an employer provide an employee with a new respirator?

Filtering facepiece respirators, such as the N95, are disposable respirators that cannot be cleaned or disinfected. They must be replaced if they get damaged, deformed, dirty, or difficult to breathe through. A best practice is to replace filtering facepiece respirators at the beginning of each shift. Employers should follow the manufacturer’s instructions. CDC recommends replacing a disposable filtering facepiece respirator after it has been taken on and off five times. Filtering facepiece respirators may not fit correctly after repeated use.  For voluntary use, the need to replace a respirator varies with use and environment.  

Is physical distancing still required?

Yes, as recommended by the CDC in healthcare facilities. However, if all employees in a room are fully vaccinated and patients are not present, social distancing is not required. Unvaccinated employees who cannot wear face coverings or reasonable alternative must be six feet or more away from others or else undergo weekly COVID-19 testing.

Are barriers still required?

Barriers are no longer required by Cal/OSHA.

What should my practice’s mask policy state?

The dental practice’s mask policy should clearly state that all patients and visitors must wear a face covering in the dental office regardless of their vaccination status, according to CDC and CDPH guidance. Practice owners can find sample messaging in the Back to Practice center.

If a patient refuses to wear a mask in my dental practice, can I deny them service?

In limited circumstances, there could be a situation in which a patient cannot wear a mask due to a legitimate health reason. In this case, the practice may consider a special accommodation, such as, scheduling the patient when other patients are not present.

The goal of the practice should be to clearly communicate the policy to patients prior to their appointment and answer any questions they may have. If the patient expresses concern prior to the appointment and refuses to wear a mask, develop messaging for your dental team to use to reschedule the patient for a later date prior to their arrival for their appointment. CDA has developed sample messaging for rescheduling patients.

What if a patient gets upset about the mask policy?

If a patient refuses to wear a mask while in the dental office and becomes confrontational, it may be necessary to call security or law enforcement to help de-escalate the situation. Practice owners are responsible for keeping employees safe while they are at work. Physical and verbal violence should never be tolerated in the dental office.

A chart is provided below to assist with requirements in a dental practice:

Person Type Face-Covering (surgical mask) Pre-Visit COVID-19 Screening NIOSH-certified Respirator for Aerosol Generating Procedure Social Distancing (6 ft.)
Unvaccinated Patient / Visitor Yes Yes N/A Yes
Fully Vaccinated Patient / Visitor Yes Yes** N/A Yes, unless all parties fully vaccinated in room
Unvaccinated Employee Yes Yes Yes Yes
Fully Vaccinated Employee* Yes Yes Yes Yes
All Employees Fully Vaccinated in a Room - No Patients Present No N/A N/A No
Employees in a Room, Not all vaccinated - No Patients Present Yes N/A N/A Yes

*Cal/OSHA defines a “fully vaccinated” employee as when the employer has documentation showing that the person received, at least 14 days prior, either the second dose in a two-dose COVID-19 vaccine series or a single-dose COVID-19 vaccine.

**If the patient attests to full vaccination, screen for symptoms only and not for close contact, COVID-19 testing or travel. Observational screening, instead of questioning patient about symptoms or having patient complete a form, should be noted in the patient chart.