Adapting practice:  Infection risk assessment and mitigation guide

 This document provides a written record of the heightened infection control measures that this clinic has put into place to ensure the safety of all staff and patients during COVID-19.

Table 1: This is an overview of the measures you have taken for operating during COVID-19 and available to all staff and patients.

Table 2: Areas assessed for risk and mitigating action taken. This records in detail the areas of potential risk identified and  the mitigating actions taken and when.

    • Table 2a – Protection for staff and patient before and when in clinic
    • Table 2b – Heightened hygiene measures

 

Table 3: Outline of PPE policy for staff

Table 4: Communicating policies to staff and patients

TABLE 1

We have assessed our practice for risks outlined and put in additional processes as detailed below

 

OVERVIEW OF THE MEASURES TAKEN TO ADAPT THE BROAD STREET PRACTICE FOR OPERATING IN THE CURRENT COVID-19 SITUATION.
Undertaken a risk assessment THIS RISK ASSESSMENT WAS CONDUCTED ON 18th MAY 2020

·         This Risk Assessment will be under constant review according to the changes in guidance from the Government, PHE, GOsC and iO.

Heightened cleaning regimes ·         Clinic rooms will be cleaned between each appointment where a patient is seen face to face – aired for 15 mins (minimum) for droplets to settle and then cleaning of all contact surfaces.

·         Common areas/washrooms will be cleaned at least every day and at intervals through each day.

·         Hard surfaces in common areas will be cleaned at least every day and at intervals through each day.

Increased protection measures ·         All waiting area and treatment room furniture has been replaced with furniture that can be wiped clean

·         All linens have been removed from the treatment rooms

·         All treatment rooms now have hand washing facilities

·         A tray is provided into which patients can place their personal belongings (phone, keys, jewellery etc) during the treatment session.

·         Signs request that patients avoid touching surfaces in the clinic if at all possible

·         Magazines have been removed from waiting areas

·         Lobby areas in both practice buildings have hand sanitiser dispensers – duly signposted

·         Protective screens are in place at reception

·         PPE is available for employed staff – masks (compulsory) and gloves (optional).

·         PPE is available for self-employed associates at cost – masks (compulsory), gloves, aprons (optional)

·         Payment can be made by contactless payments (multiple payments if required), by phone or by BACS transfer

·         Patients are requested not to pay by cash

·         Hand sanitiser is available at reception for use by patients or staff, with alcohol wipes for reception staff to sanitise keyboard, telephone, appointment card machine, card payment machine and desk surfaces at regular intervals.

·         Patients will be contacted by their practitioner for screening C-19 risk and vulnerability phone call before a firm booking is made, if a remote consultation is appropriate this will be organised in preference to a face to face treatment.

·         All patients will be required to complete a self-declaration of health at the time of arriving for their appointment, and prompted to discuss relevant health issues (if not previously discussed in the triage phone call) with their practitioner before 2m distancing is breached.

·         All patients will be required to wear a face mask. They can either provide their own, or masks can be provided at cost.

·         We reserve the right to take patient’s temperature, record it and, if concerned, to decline to treat patients.

·         All staff and practitioners will be required to take and record their temperature at the start of their clinic session and sign a declaration of their fitness to work.

·         All staff have been told to report in sick and self-isolate for a period of at least 7 days if they develop any symptoms of Covid-19, or for 14 days if any member of their household develops symptoms, whether diagnosed of not.

Put in place distancing measures ·         Appointment times have been staggered to reduce the number of patients waiting in waiting areas at any one time

·         Seating in reception and waiting areas is available only in emergencies (this may have to be reviewed in inclement weather conditions).

·         Patients are asked to wait outside the practice – seating will be provided.

·         Patients are asked not to arrive early for their appointment.

·         Clear pathways have been provided for patients and staff to access toilets without compromising social distancing

Staff training ·         Posters have been put up by every sink describing correct handwashing technique best practice

·         Video has been circulated to all staff demonstrating correct technique for donning and doffing PPE

·         All new and updated clinic policies and infection measures have been circulated to practitioners

Providing remote/ telehealth consultations ·         All new patients and old patients returning for their first appointment after lock-down will be telephoned for a discussion of C-19 infection risk and assessment of vulnerability and the appropriateness of a face to face appointment

·         Where suitable, patients will be offered a remote consultation or telephone support.

  (Document last updated: 31.5.20) / (edit and delete the below form as appropriate)

 

 

 TABLE 2a

 

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

  Description of risk Mitigating action When introduced
Pre-screening for risk before public/patients visit the clinic

 

Risk to practice, staff and practitioners Before their first attendance after lock-down all patients to be telephone by their practitioner to asses C-19 risk and vulnerability and to consider suitability for a F2F appointment. 

 

Case histories to be taken over the telephone for new patients reducing face to face contact time and to determine whether a face to face is relevant or if virtual support is adequate.

 

If a virtual consultation does not meet the needs of the patient, they (and their chaperone, if relevant) will be pre-screened before they arrive in the clinic.

 

Screening to include:

·         Screening for any symptoms of COVID 19 (e.g. high temperature or a new, persistent cough) in the last 7 days

·         Screening for vulnerable patients

·         Screening for additional respiratory symptoms or conditions e.g. hay fever, asthmas etc

·         Screening for other relevant co-mobidities

·         Screen to see if a member of their household is in a high-risk category i.e. shielded as considered extremely clinically vulnerable 

·         Have they knowingly been in contact with someone with suspected/confirmed COVID-19 in last 14 days – at home or elsewhere

 

In addition

·         Inform of the risk of face to face consultation – clinicians must document that they have informed the patient of risk associated with attending the clinic, and that they are not experiencing symptoms of COVID-19.

·         Explain that on arrival for appointment, patients (and chaperones, if relevant) will be required to complete a form declaring that they are not infected, to the best of their knowledge, and declaring whether they are vulnerable or in contact with vulnerable individuals.  They will also be required to consent that they understand the risks associated with attending for face to face treatment and that they accept this risk.

 

This form will be filed with the patient notes.  An update to this declaration will need to be completed at each and every visit the patient makes to the practice.

 

We reserve the right to take and record patient temperatures.

 

If clinicians have any concerns about proceeding with the face to face appointment, we reserve the right to turn patients away.

 

25th May 2020
Protecting members of staff   Full discussion with staff to ascertain household situations, contact with vulnerable individuals outside of work.  Staff from low risk settings are likely to be bought back to work before those who are vulnerable or have vulnerable contacts in their home setting.

 

Reception staff will be behind the protective screen and adequately distancing, masks will be compulsory (subject to review) and gloves optional.

 

PPE will be provided free of charge to employees.

 

Self-employed associates are required to provide their own PPE, as appropriate to their discipline, and are to wear masks of at least IIR rating when breaching social distancing as a compulsory requirement.

 

See PPE policy in Table 3 below.

1st June 1010
Confirmed cases of COVID 19 amongst staff or patients?   Detail here what your process is should a member of staff be tested for COVID-19 see the attached Flowchart describing return to work following a SARS-CoV-2 test.

 

·         Patients are obliged to notify the clinic if they experience symptoms within 2/3 days of visiting the clinic.  Provided staff have been wearing PPE in the form of a facemask of at least IIR rating during close contact for 15 minutes or more, there is no requirement to self-isolate but they should monitor for symptoms. If PPE was not worn during the period where social distancing was not observed, they should self-isolate until 14 days after the contact day.

·         Anyone with indirect contact with the patient, should be advised of the situation and be advised that they monitor for symptoms.

·         If a practitioner or member of practice staff becomes unwell or knowingly comes into contact with active C-19 patient outside of work, they should not come in to work but should stay at home and self-isolate until 14 days from the contact day and if they develop symptoms, for a further 7 days. Please contact the practice at the first opportunity so that any necessary steps can be taken.

 

1st June 2020
Travel to and from the clinic

 

  All staff come to clinic by either private car or on foot.  No public transport is used.

 

N/A
Entering and exiting the building   ·         Clinical staff to change into work clothing at the clinic and on completion of shift change back into home clothes and place work clothing in a separate bag to take home for washing.  

·         Patients not to arrive early for their appointment to avoid overcrowding therefore complying with social distancing.

·         Patients will be asked to wait outside the building (observing social distancing).

·         Practitioners will guide patients through the clinic, reinforcing a minimum or no touch policy.

·         Hand sanitiser is provided in the lobbies of both practice buildings for patients and practitioners to use on entering and leaving the building.

 

1st June 2020
Reception and common areas   ·         Unless weather is inclement, patients will wait outside to avoid congestion of common areas.  If patients have to wait, efforts will be made to maintain social distancing (3 separate waiting areas)

·         Contactless payments, or protected pin-pad use, or remote payments.  Cash to be avoided if possible.  Any cash will be handled with due attention to hand hygiene.

 

1st June 2020
Social/physical distancing measures in place   ·         Appointment times are to be staggered to reduce the risk of congestion in common areas.

·

1st June 2020
Face to face consultations (in-clinic room)   ·         Patient chair has been moved to an appropriate distance from the practitioner chair.

·         Practitioners encouraged to adapt or avoid techniques which involve close proximity if possible.

·         Practitioners will be required to wear masks and in addition gloves, aprons or protective eyewear according to their clinical judgement.

·         Patients to avoid bringing companions and children to the treatment.

·         If a chaperone is required – only one is permitted. Chaperones will be required to sign self-declaration of health and acceptance of risk form on arrival.  Chaperones will be required to wear a face mask and maintain 2m social distancing if at all possible.

 

 

 

1st June 2020

 

TABLE 2b

 

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   ·         Clinic rooms – plinths, desk, door handles, equipment chairs – cleaned by practitioner between each patient

·         Reception surfaces, doors and door handles in common areas, chairs, taps, card machines etc. to be cleaned with alcohol wipes at intervals through the day by reception staff

·         Use of detergent sanitising solution to clean hard surfaces or wipes containing at least 60% alcohol

Actions to minimise the number of surfaces requiring cleaning

·         All linen has been removed from treatment rooms

·         Supports, pillows, couches are wipeable.

·         Clinic rooms and waiting areas have been decluttered and all magazines and leaflets removed.

·         Consideration to be given to propping doors open if appropriate

 

1st June 2020
Aeration of rooms   ·         THIS MATTER IS SUBJECT TO SOME VARIATION IN ADVICE FROM THE AUTHORITIES GOVERNING DIFFERENT DISCIPLINES IN THE PRACTICE.  THE POLICY BELOW SHOULD BE  ADHERED TO BY OSTEOPATHS.  OTHER PRACTITIONERS TO ADHERE TO GUIDELINES GIVEN TO THEM BY THEIR OWN PROFESSIONAL ORGANISATIONS.

·         Leaving the window open (if possible), or extractor fan operating (to be installed in Room 2 ASAP), the door left closed for 15 minutes minimum after each patient before cleaning.

·         If there is no opening window or extractor fan, the door should be left open for 15 minutes.

·         All fans have been removed from treatment rooms.

1st June 2020
Staff hand hygiene measures   ·         Bare below the elbow/hand washing before and after patients with soap and water for at least 20 seconds, including forearms. Use of gloves according to practitioners clinical judgement.  Hand sanitiser provided in all treatment rooms. 1st June 2020
Respiratory and cough hygiene   Communication of cough hygiene measures for staff and patients e.g.

·         ‘Catch it, bin it, kill it’ policy

·         Provision of disposable, single-use tissues and waste bins (lined and foot-operated)

·         Hand hygiene facilities available for patients, visitors, and staff

1st June 2020
Cleaning rota/regimes   ·         A written record of decontamination clean to be recorded by practitioners.

·         Clinic cleaning record to be kept – cleaning to take place between every clinic session

·         Cleaning materials provided so that patients and practitioners can wipe down contact surfaces in the toilet before use if desired.

 

1st June 2020

 

TABLE 3

 

Table 3. Personal Protective Equipment: Use and disposal of PPE
Clinicians will wear the following PPE ·         All clinicians to wear IIR Fluid-resistant surgical masks (or higher grade) at all times when with patients and when breaching 2m social distancing rules.

·         Single use nitrile gloves and plastic aprons will be used according to clinical judgement and vulnerability of patient

·         Clean clinic scrubs or tops – changed between patients if plastic aprons not used

·         Eye protection, for self-protection according to clinical judgement and risk of the procedures employed (AGP’s?)

When will PPE be replaced ·         Masks to be replaced when potentially contaminated,  damaged, damp, or difficult to breathe through or at the end of a half-day (4 hr) session, as a minimum

·         Eye protection to be washed after every use

·         All other PPE to disposed of after single use

·         Please observe the video showing correct donning and doffing technique https://www.youtube.com/watch?v=-GncQ_ed-9w&feature=youtu.be

 

Reception staff will wear the following PPE ·         PPE for reception staff (masks and gloves) will be provided.  Masks should be worn (subject to review – this may be relaxed in time, provided the receptionist maintains 2m distancing or remains behind the protective screen) and gloves can be worn according to personal choice.
Patients will be asked to wear the following PPE ·         Patients will be required to wear a face-covering in clinical and common areas in the practice, and disposable or fabric masks will be provided (charged for – all payments made to be donated to UK Sepsis Trust) if patients arrive with no face-covering
PPE disposal ·         PPE waste and other non-clinical waste from contact with patient during treatment (eg couch roll, paper towels from decontamination cleaning) will be double-plastic bagged and left for 72 hours before removal, kept separate from other household/garden waste, and then placed with normal waste for collection by commercial waste contractor.

·         Aprons and gloves should be removed before leaving the treatment room and disposed of in the bin with used couch roll. Masks should be kept on.

·         Masks, when they are removed, should be disposed of in the marked bin provided in the staff toilet on the first floor in 20/21, or with other PPE in the treatment room bin.

 

 

TABLE 4

 

Table 4. Communicating with patients: Advising patients measures taken to ensure their safety and the policies that have been put in place in our clinic
Publishing your updated clinic policy ·         Provide as part of appointment confirmation emails

·         Available on the website at www.thebroadstreetpractice.co.uk (Attending the practice after lock-down link from our home page)

 

 
Pre-appointment screening calls The booked practitioner will call the patient in advance of a booked appointment (recommended 48-72 hours in advance) to assess for Covid-19 symptoms, risks and vulnerabilities, to discuss suitability of face to face appointment, risks involved and impress on the patient that they must not attend if they become unwell.

 

Information for patients displayed in the clinic ·         Door notices advising anyone with symptoms not to enter the building.

·         Notices asking patients to sanitise hands, and hand washing instructions at all sinks

·         Notices asking patients to avoid touching surfaces where possible while in clinic

·         Notices advising patients of cleaning materials for wiping down surfaces in the toilet before use if desired