COVID-19 update: Gowns at alert level 2 and price setting

Level 2 guidelines – gowns clarification

We have received several queries about the requirements in the alert level 2 guidelines for outer protective clothing, such as gowns.

Long sleeved gowns are mandatory only under the alert level 2 guidelines when performing aerosol generating procedures for high risk patients (confirmed or suspected COVID-19).

When treating low risk patients (non COVID-19 positive or suspected patients) the normal infection prevention and control (IPC) practice standard PPE rules apply, regardless of whether aerosol is being generated or not.  

The IPC practice standard requirement for outer protective clothing is:

Wear outer protective clothing (for example, gowns, tunics) over your street clothing or uniform. Outer protective clothing is to be made from material that does not permit blood or other potentially infectious materials to reach clothes or skin underneath.

To meet this requirement practitioners typically wear:

  • First layer - street clothes or uniform.
  • Second layer - either a gown, or a tunic, or scrubs as the outer protective clothing. This provides additional protection to prevent contaminants from reaching the skin and is usually short sleeved to allow for appropriate hand hygiene up to the elbow. 

The outer protective clothing does not need to be impervious but should be water resistant at minimum.

The requirements for changing outer protective clothing, specified in the IPC practice standard are:

  • Change outer protective clothing - as soon as possible when visibly soiled or wet, when exposed to contaminated aerosols for prolonged periods of time, and at least daily.
  • Remove outer protective clothing before leaving the treatment area for - a break involving eating and/or drinking, a toilet break, and before leaving the practice premises.

In the event that a practitioner chooses to wear a long sleeved gown or arm sleeves (personal preference), then the long sleeved gown/arm sleeves must be changed at least between patients. This is because, unlike the situation when a short-sleeved gown is worn, the forearm cannot be ‘cleaned’ between patients.

Practitioners have also asked whether a plastic apron is appropriate outer protective clothing.  A plastic apron does not provide the same coverage as a gown or tunic. Specifically, the shoulders, upper arm and back will not be covered – and the neck area may gape dependent on the practitioner’s positioning during the procedure. For this reason, a plastic apron as the only outer protective clothing is not considered appropriate. You might want to consider wearing a plastic apron as an additional layer of outer protective clothing over your gown/tunic when cleaning or decontaminating instruments, or during procedures generating a lot of splatter. 

Price setting

Increased costs due to COVID-19 requirements

Precautions and protocols required to practise safely during the COVID-19 pandemic have added to the cost of providing dental services. Many practices are facing increased cost and lower revenue due to PPE costs, hygiene requirements and limits on patient numbers and proximity.

In the last weeks we have received inquiries about dentists charging their patients up to $110 to cover PPE or toilet cleaning required to meet alert level 4 and 3 guidelines.

This situation raises the question of how practitioners can increase their pricing so that is consistent with their legal and professional obligations. 

Consumer protection – Price Watch

Since the first cases of COVID-19 appeared in New Zealand, there have been reports of inflated prices for some essential or high-demand goods such as hand sanitiser and face masks. 

In response to these reports, the Government has set up Price Watch – a team within the Ministry of Business, Innovation and Employment that monitors and, if necessary, takes action against businesses involved in price gouging.  As part of this initiative, consumers are being actively encouraged to ask businesses questions about any price increases and to notify Price Watch of any suspected price gouging.

Price Watch has recently advised the Dental Council that it has received multiple reports relating to fees charged by oral health practitioners.  

Relevant considerations for practitioners

It is not illegal for businesses to increase their prices. Oral health practitioners, like any other business, are free to set their own prices.

However, engaging in misleading or deceptive conduct or making false representations is not legally permitted. If a practitioner tells a patient the reason for a price increase, then that reason must be genuine.  If the reason is misleading or not genuine, then the practitioner risks breaching the law. 

Some ethical and professional obligations are also relevant to price setting.  The Standards Framework for Oral Health Practitioners requires practitioners to:

  • Put patients’ interests first, including by putting the interests of patients ahead of personal, financial, or other gain. 
  • Maintain public trust and confidence, including by:
    • acting with honesty and integrity at all times with patients and the public
    • ensuring their professional and personal conduct justifies trust in them and the profession.

These principles and standards mean that oral health practitioners must always be clear and transparent with patients about their pricing and only give honest and genuine reasons for price increases.  If a practitioner fails to do so, they risk breaking the law and breaching their professional obligations.

Patients should be fully informed, not only on treatment options but for all possible costs. To reduce the likelihood of patients making complaints, practitioners should proactively advise patients of price increases (for example, by advising patients of an applicable price increase at the beginning of an appointment rather than at the end). 

Andrew Gray & Marie Warner

Chair & Chief Executive