Covid-19 Policy and Procedures

Updated 16th June 2020, Keith Burland

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Because coronavirus is a novel virus where the body has no natural immunity and for which there is currently no vaccine available, additional care is required to reduce the risk of exposing clinicians, clients and others in the clinical setting to infection. 

Additional procedures will be observed to minimise risk of infection. Initial consultations will be made using a virtual first approach using digital solutions to provide care and limit face to face contact. A balanced and reasoned decision will be made on how to proceed e.g. in the case of proceeding with face to face contact, the benefits of seeing a patient face to face must be demonstrably greater than the risk of infection transmission.

The following document has been created by following Public Health England- COVID-19: infection prevention and control guidance (Version 3.1 21 May 2020), HCPC and CSP guidelines.

 

1. Clients will be triaged via telephone or video call to establish if face to face is appropriate. This process will be documented showing clinical reasoning and justification of a face to face consultation if that is advised.

2. We operate a “remote first” policy when considering options of how to assess and treat people.

3. If the clinician determines it is necessary to see a client face to face the risks of contact must be discussed with the patient along with the measures that will be taken to mitigate that risk. Discussion will highlight that the interaction will include contact between patient and therapist of less than 2 metres. The clients’ consent will be recorded in the clinical notes. 

4. Clients will need to complete Covid-19 screening questionnaire and sign a consent form on the day of their face to face consultation. This will include informed consent acknowledging the exposure to increased risk of infection transmission and to agree their details would be provided to contact tracing if requested.

5. Prior to each shift each therapist will complete a Covid-19 screening questionnaire and signed consent form. This will include informed consent acknowledging the exposure to increased risk of infection transmission and to agree their details would be provided to contact tracing if requested.

6. Clients will be requested to not enter the building until their appointment time to avoid people gathering within the reception area and avoid using the toilet facilities to minimise risk.

7. Clients are encouraged to self check in via the QR code reader at the entrance of the building.

8. Clients are requested to wear a face covering for their consultation.

9. Clients are requested to use the hand sanitiser on arrival.

10. Clients are requested to bring their own clean towel with them for the purpose of covering untreated areas of the body.

11. If clients would like a chaperone to be present during their session, they need to bring someone with them. This would ideally be a household member who will need to complete a questionnaire to establish they are low risk and to agree to have their details passed on to contact tracers if requested.

12. Following Progress Works policy, each person entering the facility will be required to have their body temperature taken with an infrared thermometer. Anyone found to have a raised core temperature will not be able to enter.

13. The therapist will wear PPE in accordance with Public Health England recommendations. Currently this is disposable gloves, apron and mask. Eye protection is not deemed necessary as no aerosol generating procedures (AGPs) will be anticipated. Therapists will be instructed in the use of PPE: https://www.youtube.com/watch?reload=9&v=-GncQ_ed-9w&feature=youtu.be

14. Sessional use of PPE Aprons and gloves are subject to single use as per Standard Infection Control Precautions (SICPs), with disposal and hand hygiene after each patient contact. Fluid-resistant (Type IIR) surgical masks (FRSM) and eye protection can be subject to single sessional use. A single session refers to a period of time where a health care worker is undertaking duties in a specific clinical care setting or exposure environment. A session ends when the health and social care worker leaves the clinical care setting or exposure environment. PPE is treated as clinical waste and will be double bagged, stored for 72hours and disposed of in general waste.

15. Fluid resistant surgical masks. Fluid-resistant (Type IIR) surgical masks (FRSM) provide barrier protection against respiratory droplets reaching the mucosa of the mouth and nose. FRSMs should be well fitted and subject to the same level of care in use as respirators. FRSMs are for single use or single session use and then must be discarded. The protective effect of masks against severe acute respiratory syndrome (SARS) and other respiratory viral infections has been well established. There is no evidence that respirators add value over FRSMs for droplet protection when both are used with recommended wider PPE measures in clinical care, except in the context of AGPs. Surgical masks should: • cover both nose and mouth • not be allowed to dangle around the neck after or between each use • not be touched once put on • be changed when they become moist or damaged • be worn once and then discarded – hand hygiene must be performed after disposal

16. Disposable aprons and gowns. Disposable plastic aprons must be worn to protect therapists' uniform or clothes from contamination when providing direct patient care and during environmental and equipment decontamination. Disposable aprons are subject to single use and must be disposed of immediately after completion of a procedure or task and after each patient contact as per SICPs. Hand hygiene should be practised as per SICPs and extended to exposed forearms.

17. Disposable gloves Disposable gloves must be worn when providing direct patient care and when exposure to blood and or other body fluids is anticipated or likely, including during equipment and environmental decontamination. Disposable gloves are subject to single use and must be disposed of immediately after completion of a procedure or task and after each patient contact, as per SICPs, followed by hand hygiene. Double gloving is not necessary.

18. Eye protection provides protection against contamination to the eyes from respiratory droplets, aerosols arising from AGPs and from splashing of secretions (including respiratory secretions), blood, body fluids or excretions. Eye protection can be achieved by the use of polycarbonate safety spectacles or equivalent. These will be made available to all therapists  Regular corrective spectacles are not considered adequate eye protection. 

19. The therapy room will have windows open or an extractor fan in operation for all sessions to maximise ventilation.

20. The cleaned treatment couch will be covered with disposable paper towel. Used paper towel is considered clinical waste and will be disposed of accordingly.

21. The room will be laid out in a way to allow a 2 meter distance seating between the therapist and client.

22. The time spent closer than two meters will be kept to a minimum, only what is needed for an effective therapeutic intervention. Careful positioning will minimise risk for example using prone client positioning procedures where possible. It is acknowledged this may exceed the recommended 15 minutes. 

23. The treatment couch and all touch points within the room will be cleaned with antiviral disinfectant between clients,

24. There will be 15 minutes allowed between client appointments to allow adequate time for cleaning and change of PPE.

25. Payments will be made online, bank transfer or contactless. Due to infection control, cash and cheques are no longer accepted. 

26. On exit from the property the patient will be asked to use hand sanitiser.

27. We operate a one therapist per room per day policy.

28. Respiratory and cough hygiene – ‘Catch it, bin it, kill it’ Patients, staff and visitors are encouraged to minimise potential COVID-19 transmission through good respiratory hygiene measures which are: • disposable, single-use tissues should be used to cover the nose and mouth when sneezing, coughing or wiping and blowing the nose – used tissues should be disposed of promptly in the nearest waste bin • tissues, waste bins (lined and foot operated) and hand hygiene facilities, should be available for patients, visitors and staff • hands should be cleaned (using soap and water if possible, otherwise using ABHR) after coughing, sneezing, using tissues or after any contact with respiratory secretions and contaminated objects • encourage patients to keep hands away from the eyes, mouth and nose 

29. Hand hygiene must be performed immediately before every episode of direct patient care and after any activity/task or contact that potentially results in hands becoming contaminated, including the removal of personal protective equipment (PPE), equipment decontamination and waste handling. Refer to 5 moments for hand hygiene. Before performing hand hygiene: • expose forearms (bare below the elbows) • remove all hand and wrist jewellery (a single, plain metal finger ring is permitted but should be removed (or moved up) during hand hygiene) • ensure finger nails are clean, short and that artificial nails or nail products are not worn • cover all cuts or abrasions with a waterproof dressing. If wearing an apron rather than a gown (bare below the elbows), and it is known or possible that forearms have been exposed to respiratory secretions (for example cough droplets) or other body fluids, hand washing should be extended to include both forearms. Wash the forearms first and then wash the hands.

30. Staff uniform- The appropriate use of personal protective equipment (PPE) will protect staff uniform from contamination in most circumstances. there is a  changing rooms where therapists can change into uniforms on arrival at work. Therapists are to change out of their uniform prior to leaving the premises. Uniforms should be transported home in a disposable plastic bag or reusable cloth bag that can be laundered. Hand hygiene should be performed after removal of uniform and placing it into a bag for transport. Plastic bags should be disposed of into the household waste stream, cloth bags should be laundered with the uniform. Uniforms should be laundered: • separately from other household linen • in a load not more than half the machine capacity • at the maximum temperature the fabric can tolerate, then ironed or tumbled-dried

31. AGP- Chest compressions and defibrillation (as part of resuscitation) are not considered AGPs; first responders (any setting) can commence chest compressions and defibrillation without the need for AGP PPE while awaiting the arrival of other clinicians to undertake airway manoeuvres. Based on the NERVTAG evidence review and consensus statement, chest compressions will not be added to the list of AGPs. 

32. Patients informed consent for treatment will be obtained prior to each session, acknowledging the increased risk of infection transmission and agreeing for their information to be provided for contact tracing if requested.

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