Attached is the Clinic Policy Document ‘Infection risk management and mitigation guide’ with regard to attending the clinic during the COVID-19 pandemic.
Adapting practice: Infection risk assessment and mitigation guide
|I have assessed practice (Osteopathy at the Mews) for risks outlined and put in additional processes as detailed below
|This provides an overview of measures taken to adapt the practice for preparation for operating in the current COVID-19 pandemic and may be considered clinic policy.|
|Undertaken a risk assessment||· Date undertaken: 18th June 2020.
· This will be reviewed in line with iO +/- Government recommendations.
|Heightened cleaning regimes||· Clinic room will be cleaned after each patient with disinfectant and aerating the room for at least 15 mins.
· Reception area, if used, will be cleaned with disinfectant at the end of every 4 hour session.
· The communal toilet will be cleaned before and after each 4 hour session.
|Increased protection measures||· Clinic linen will be replaced with wipeable products.
· No screened areas are required.
· Cashless payments will be requested via BACS or by new online booking system if possible.
· No staff involved to issue with PPE.
|Put in place distancing measures||· Appointments will be booked followed by cleaning and aerating time to ensure no patient cross-over.
· Only one patient in the practice at any one time.
|Providing remote/ telehealth consultations||· Patients will be offered a telephone/video consultation initially (this is separate to the pre-screening/triaging call prior to anyone entering the practice).
· Followed only by hands-on appointments if required and safe to do so.
· Follow-up/maintenance appointments available also via telephone/video call.
|Document last updated: 18th June 2020
|Table 2a. Protection of staff and patients before they visit, and when in, the clinic.
We have assessed the following areas of risk in our practice and put in place the following precautions to
|Description of risk||Mitigating action||When introduced|
|Pre-screening for risk before public/patients visit the clinic
|High||· Patients will be offered a telephone/video call for initial consultations to minimise the time in the clinic. This will determine the need for a follow-up face-to-face consultation.
· If a telephone/video consultation does not meet the needs of the patient, the patient will need to be pre-screened via the telephone before they (or their chaperone) may enter the clinic.
· Patients will be pre-screened for COVID-19 symptoms (temperature, persistent cough, change/loss of smell) in the last 7 days.
· Further questions regarding vulnerability will also be asked where indicated to decide of the patient is safe to visit the community setting.
· Respiratory health will also be questioned.
· Health and vulnerability of household members will be questioned.
· Has the patient been in contact with anyone who might have suspected COVID-19 in the last 14 days?
· The patient will be told about modified appointment times, asked not to bring unnecessary chaperones, told about PPE and that they should wear a face mask, hand sanitising on entering the clinic, asked not to touch anything, booking and payments will be done remotely, no cash or cheques will be accepted.
· Patients will be warned that, whilst every measure has been taken to reduce the transmission of COVID-19, there is still a risk whilst in the community and do they consider that risk significant to their wellbeing. Telephone/video calls will be offered.
· All triage/pre-screening information must be documented in the patient notes.
|Confirmed cases of COVID 19 amongst staff or patients?||High||· Should I suspect infection or have COVID-19 confirmed by testing I will self-isolate for 7 days and advise patients who I have seen in the previous 7 days to isolate for 14 days (see iO for further guidance).
· Should a patient advise me that they have COVID-19 type symptoms after visiting the clinic I will self-isolate for 14 days.
· Other patients on the same day as above will be informed but will not need to isolate as no cross-over will have occurred. They will be advised to monitor for symptoms.
|Travel to and from the clinic
|Medium||· I will travel to work in my own car and will not travel with others.
· Patients will be asked to enter the clinic alone and only at their appointment time.
· Family members and friends will be asked not to enter the clinic.
· Chaperones will be asked to wait outside if possible or, if not, will also need to be risk assessed and will need to wear a mask during face-to-face consultations, as well as sitting on the far side of the clinic room.
|Entering and exiting the building||Low||· Clothing will be change when entering or leaving the building and work clothes will be bagged-up separately for washing.
· Patients will be asked to arrive on time for their appointment, not arriving early whilst cleaning might be underway.
· Normal access to and from the clinic will be used as no cross-over with other patients.
· Patients will be expected to don their masks before entering the building and use hand sanitiser as they enter
|Reception and common areas||Medium||· Patients will be asked not to use the waiting room but to enter at allotted appointment time only
· Patients will be asked to make BACS/online payments and to use online booking where possible.
· Patients will be advised against using the toilets, unless urgent, as these are communal and, though cleaned, hold a higher risk of contamination than the clinic
|Social/physical distancing measures in place||Low||· Appointments will be spaced apart to avoid patient cross-over and allow for cleaning.|
|Face to face consultations (in-clinic room)||Medium||· Patients will be asked to sit on the opposite side of the room for case-history taking/symptom updates.
· Appointment times will be shorted if telephone/video call has been conducted – to reduce transmission risk.
· Treatments will be modified to avoid face-to-face techniques unless necessary.
· If chaperones are required only one per patient will be allowed (and should be declared and screened prior to appointment).
· Children of patients will only be allowed to accompany their parent if no childcare is possible and ideally only one child per patient.
· Pre-screening of children will also be required.
· Vulnerable patients will be asked to attend at the first appointments of the session.
|Table 2b Hygiene measures
We have assessed the following areas of risk in our practice and put in place the following heightened hygiene measures
|Description of risk||Mitigating action||When introduced|
|Increased sanitisation and cleaning||Medium||· Cleaning with disinfectant will follow each patient consultation and will include all touched areas (door handles, plinth, chair, floor, taps).
· Patients will be asked to avoid bringing unnecessary items into the clinic.
· Patient will be asked to place their clothes on their chair only.
· Patients may not need to undress (on a case by case basis).
· Disinfectant zoflora will be used.
· Hand towels will be provided for each patient (rather than a stack).
· Plastic ‘linen’ will be used and wiped between patients.
· Rooms be decluttered and patients asked not to touch anything unnecessarily.
· Flooring will be vinyl and if not will be steam cleaner at the end of each session.
|Aeration of rooms||Medium||· The rooms will be aerated by leaving the window open and the door closed for at least 15minutes after each patient;
· A fan will not be used.
|Staff hand hygiene measures||High||· Bare below the elbow/hand washing before and after patients with soap and water for at least 20 seconds, including forearms/use of hand sanitiser gel/ use of gloves.||18/06/2020|
|Respiratory and cough hygiene||High||· Provision of disposable, single-use tissues waste bins (lined and foot-operated).
· Patients to wear masks at all times in the building.
· Hand hygiene facilities available for patients, visitors, and staff.
|Cleaning rota/regimes||· Cleaning rota will not be documented as GC is solely responsible.||18/06/2020|
|Table 3. Personal Protective Equipment: Detail here your policy for use and disposal of PPE|
|Clinicians will wear the following PPE||The osteopath (GC) will wear:
· New single-use nitrile gloves and plastic apron with each patient.
· Fluid-resistant surgical masks (or higher grade) with each patient.
· Eye protection, e.g. if there is a risk of droplet transmission.
|When will PPE be replaced||Masks will be replaced when:
· When potentially contaminated, damaged, damp, or difficult to breathe through.
· At the end of a 4 hour session.
|Patients will be asked to wear the following PPE||Detail here in what circumstance you may ask patients to wear PPE, and what types e.g.
· Fluid-resistant surgical masks if respiratory symptoms e.g. from hay fever or asthma
· Face-covering in clinical and waiting areas
|PPE disposal||· Double-plastic bagged and left for 72 hours before removal.
· This will then be placed in your normal waste collection.
· Cloths and cleaning wipes also bagged and disposed of with PPE.
|Table 4. Communicating with patients: Detail here how you will advise patients of measures that we have taken to ensure their safety and the policies that have been put in place in our clinic|
|Publishing your updated clinic policy||· Clinic policy will be available on clinic website.
· Patients will be made aware of the policy document when booking.
· Social media and emailing will also flag the new web-based clinic-policy document.
· Patients will be told to consult this document for updates of changes.
|Pre-appointment screening calls||· Pre-screening will be mentioned at the time of booking
· Pre-screening will take place 24 hours before an appointment
· Patients will be asked to NOT attend the clinic if at all unwell after the pre-screening call
|Information for patients displayed in the clinic||Detail here any patient information posters that you have in your clinic e.g.
· Door notices advising anyone with symptoms not to enter the building.
· Notices on other public health measures e.g. hand washing/sanitising/Catch-it, bin it kill