Please see below for all of the things we are doing during the pandemic.
We are committed to ensuring the highest standards of safety at all timed and even more so during the COVID-19 pandemic. As health care providers, we are expected to prioritize the safety of their patients, staff, colleagues and others visiting our practice.
Below is an in-depth list of the various precautions being taken by all members and staff of the clinic. Individual practitioners must adhere to these guidelines at a minimum as well as the guidelines of their particular College or Governing body and may wish to increase protective standards according to their own regulating bodies. These guidelines are based on recommendations of the Ministry of Health, Public Health Ontario, the Chief Medical Officer of Health and other authoritative bodies regarding practices during COVID-19.
COVID-19 SCREENING
Public Health requires pre-screening of all patients, staff and visitors. All patients must be screened prior to their arrival at the clinic by either phone call or emailed survey and then once again upon arrival. It is strongly recommended that each practitioner keep a record of these screenings in the patient file.
The questions are yes or no and all patients, visitors and staff must answer NO to ALL the following regular screening questions prior to their visit and again upon arrival to be allowed into the clinic: The questions currently are as follows:
1. Have you had close contact with anyone with acute respiratory illness or travelled outside of Ontario in the past 14 days?
2. Do you have a confirmed case of COVID-19? Or have you had close contact with a confirmed case of COVID-19?
3. Do you have any of the following symptoms:
- Fever
- New onset of cough
- Worsening chronic cough
- Shortness of breath
- Difficulty breathing
- sore throat
- difficulty swallowing
- decrease or loss of sense of taste or smell
- chills
- headaches
- unexplained fatigue/malaise/muscle aches (myalgias)
- nausea/vomiting, diarrhea, abdominal pain
- pink eye (conjunctivitis)
- runny nose/nasal congestion without other known cause
Please see the following link for the Ministry of Health COVID-19 Reference Document for Symptoms of COVID-19:
4. If you are over 70 years of age, are you experiencing any of the following: delirium, unexplained or increased number of falls, acute functional decline, or worsening of chronic conditions?
5. Please answer this question if you answered Yes to question 2. If you have had close contact with a case COVID-19 did you wear the required and/or recommended PPE according to the type of duties you were performing (e.g., goggles, gloves, mask and gown or N95 with aerosol generating medical procedures) when you had close contact with a suspected or confirmed case of COVID-19?
If the patient/visitor/staff member answered “yes” to questions 1-4, they should be advised to:
• not attend in person at the member’s office for at least 14 days;
• complete the Ontario Government’s self-assessment: https://covid-19.ontario.ca/self-assessment/
- contact an appropriate authority such as their family physician, local medical officer of health or Telehealth Ontario.
Here: http://www.health.gov.on.ca/en/common/system/services/phu/locations.aspx
If the patient/visitor/staff member answered “yes” to questions 2 and “no” to question 5 they will also will not be able to enter the clinic for a minimum of 14 days.
If the patient/visitor/staff member answered “yes” to question 2 but “yes” to question 5, they may proceed to enter the clinic. Enhanced PPE and cleaning is required as per the practitioner’s appropriate regulating body. In addition these patients should be grouped or placed at the end of day or particular part of the day for safety and should be contacted on the phone prior to coming to the appointment to ensure appropriate steps are taken.
These questions may change based on recommendations of public health. If the practitioner forms the opinion that a person has or may have COVID-19, they are required to report this to the medical officer of health of the health unit in which the professional services are provided.
In conducting screening, a practitioner should consider whether in-person treatment is the most advisable one taking into consideration the patient’s other conditions and whether they fall into a high-risk group. When appropriate a member is encouraged to consider telehealth as an option.
Staff must document the screening of patients as part of the record of personal health information. Please note: a patients who has screened positive is not equivalent to a confirmed diagnosis of COVID- 19.
In addition, some practitioners may choose to measure and record the temperature of each patient prior to their entering the clinic. While this is not mandatory it add an extra level of perceived safety for our patients and is recommended. It is advised that this is recorded in the patient chart or at least recorded that the temperature was not above the recommended temperature as stated by Public Health on that visit 37.8 degrees Celsius – however we will use 37.5 degrees Celsius as a cut off.
**Practitioners must also do a COVID-19 screening or self-assess daily before arriving at the clinic and it is recommended that a log be kept that this was done. All staff, including reception, must also log that they were screened or self-assessed appropriately each day.
GUIDELINES IF YOU SUSPECT A PATIENT HAS COVID-19
If a member encounters a patient or staff who exhibits signs and symptoms consistent with the COVID19, the member must:
- Establish and maintain a safe distance of two metres;
- Have the patient complete hand hygiene;
- Provide a new mask for the patient to wear;
- Separate the patient from others in the clinic;
- Explain the concern to the patient that they are symptomatic, discontinue treatment and reschedule the appointment;
- Members must not attempt a differential diagnosis of patients who present signs and symptoms of COVID-19.
- Advise the patient to self-isolate for at least 14 days, complete the online self-assessment and contact their local medical officer of health;
- Clean and disinfect the practice area immediately; and
- Keep a record of all close contacts of the symptomatic patient and other visitors and staff in the clinic at the time of the visit. This information will be necessary for contact tracing if the patient later tests positive for COVID-19.
KEEPING A REGISTER FOR CONTACT TRACING
A register of all people entering the setting should be kept to aid in contact tracing, if required. This would include people in the clinic aside from patients/clients (e.g. couriers, guardians accompanying a patient/client, etc). The register should include name and telephone number. This is not an open sign-in book and should be kept and managed privately by the clinic receptionist or in the reception area. This registry should be kept until further notice. Explain to visitors that this information will be used for contact tracing only, should someone who visited the setting later be diagnosed with COVID-19, and that visitors can refuse to provide their name and telephone number.
CLINIC AND STAFF GUIDELINES & PROCEDURES
- Staff must be screened at the beginning of every shift and document this – if a staff member is sick they cannot come into work.
- Only ONE patient PER PRACTITIONER at a time can be seen at the clinic. Family members must be asked to wait outside – exceptions to this include parents of young children.
- No walk-in patients are to be accepted at this time. New patients need to call the clinic, book appointments and be screened appropriately.
- Appointments for EXISTING patients will be booked but must follow the following: an online or telephone COVID-19 screening questionnaire when the appointment is booked AND an in-person screening when the patient comes into the clinic. This will be performed at the front door prior to the patient entering the clinic. The clinic doors will remain locked as patients will be asked to remain in their cars or outside while maintaining appropriate physical distancing until their practitioner is ready for them and calls them in. Please see below.
- Each appointment will be incorporate a 15 min buffer time between patients scheduled to allow for proper sanitization procedures between patients (see below).
- Patents will be directed to wait outside the front door. The door is to be LOCKED between patients. The waiting room is NOT to be used.
- Patients have been instructed to come alone to appointments. If someone has accompanied them, that individual is NOT allowed in the clinic and must wait for them outside the clinic (unless the patients is a minor and requires parent/guardian consent for treatment – but we request that the adult maintain physical distance during the visit).
- Cash and Check Payments at the clinic will not be accepted at this time. If the POS (point of sale) machine is chip enabled, contactless payment will be requested. E-transfer may also be accepted dependant upon each practitioner’s preference.
- Receipts will be emailed where possible in order to reduce the amount of paper being exchanged.
- Front desk staff will remain at the front desk, with the door to reception area closed when helping patients. (They may be required to leave this area to assist with cleaning procedures as needed).
- Practitioners and staff should NOT shake hands with or hug patients.
- Practitioners will have available to them gloves and surgical masks to be used at their discretion. Gloves will be discarded after one patient use. One mask is sufficient for one practitioner shift, especially due to shortages. Practitioners are expected to use safe donning and removal of PPE and are NOT to touch the filter of the mask. For guidelines see here:
- Patients are required to wear masks while in the clinic for the safety of the staff and the patient. They can bring their own, or we can provide one for them for minimal fee/donation.
SANITIZATION PROCEDURES BETWEEN PATIENTS
Each practitioner is responsible for appropriate sanitization of their office and equipment before, between and after each patient. In addition, it is required by public health that each practitioner change into clothing that has not been worn prior to their shift with patients, and then change clothes before leaving the clinic. Clothing should be washed in hot water and put in the dryer on hot. Disposable gowns may be used to cover clothing but is not mandatory for all practitioners.
- Prior to patient’s arrival at the clinic all high touch areas should be wiped down. The practitioner should first thoroughly wash their hands for 20 seconds with soap and water and then wipe down high touch areas. The first arriving practitioner should do this at the beginning of each day and this would include door knobs, the front desk counter, point of sale machines, bathroom doorknobs, toilet flush handles and taps at the sinks. This may be done by each practitioner on arrival as well but at least by the first one.
- Each practitioner is responsible for their own equipment and private office rooms and then must wipe down equipment, tables and all high touch surfaces in their own offices upon their arrival. Disinfectant used must be on Health Canadas approved list and have a DIN number that is listed on their website.
- Upon entry into and upon leaving the clinic, each patient must use hand sanitizer.
- After each patient treatment, the practitioner will use hand sanitizer and the disinfect all equipment, tables, point of sale machine, doorknobs touched or implements used must also be disinfected. All touchpoints must be sanitized.
- If the practitioner is taking payment they must disinfect the Point of sale machine and all items touched including pens, clipboards or computer. If the payment is taken by the receptionist, the receptionist must disinfect all surfaces touched after applying hand sanitizer for themselves.
- The patient will use hand sanitizer prior to exiting the clinic – the practitioner may elect to walk the patient out and open the door for them and then lock it again behind them. All touched surfaces must be disinfected after being touched.
- After the patient departs the practitioner or anyone who may have had interaction with the patient must wash their hands with soap and water for 20 seconds.
SANITIZATION PROCEDURES DURING THE DAY AND END OF DAY
Members should follow the cleaning and disinfection protocols from Public Health Ontario.
- Throughout the shift (minimum, every 1-2 hours), cleaning of all high “traffic areas” must be performed. This includes reception desk (computer, telephone, keyboard, POS machine, printer), washrooms, hallways, doorknobs, reception chairs and other high traffic areas.
- Treatment rooms and equipment (treatment tables, chairs, treatment modalities, diagnostic and therapeutic tools and devices, exercise/rehabilitation equipment etc) should be wiped down after EVERY PATIENT using a proper anti-viral disinfectant.
- Members should use single-use equipment instead of shared high touch equipment whenever possible.
- At the end of day, a deep clean over and above COVID-19 protocol of treatment area used throughout the shift shall be performed. This will include but not be limited to: washing of the floors, hallways, deeper cleaning of the bathroom, all treatment rooms that were used and other touch surfaces as identified in the clinic, such as light switches, doorknobs, toilets, taps, handrails, countertops, touch screens, mobile devices, phones, keyboards, payment machines, clipboards, pens.
- Cleaning is to be done with disinfectant wipes and/or sprays. Use a disinfectant that has a Drug Identification Number (DIN) and a virucidal claim (efficacy against viruses). Alternatively, use a bleach-water solution with 100 ml of bleach to 900 ml water.
** Disinfecting is only effective after surfaces have been cleaned. Use a “wipe-twice” method to clean and disinfect. Wipe surfaces with a cleaning agent to clean off soil and wipe again with a disinfectant
- Books, magazines, toys, etc. should be removed from patient areas.
- A regular schedule for periodic environmental cleaning should be established and documented.
- Any cloth items, such as towels, sheets, and headrest coverings that are used in the clinic, must be laundered in hot water (above 60 degrees Celsius). Staff that are handling these items should be gloved for both dirty and clean laundry processing. Staff must always use new gloves when handling clean laundry.
PATIENT GUIDELINES & PROCEDURES
- Patients will be required to fill in the COVID-19 screening questionnaire when an appointment is made in JANE (for Dr. Karen Hudes) or will be called by their other practitioner prior to their arrival at the clinic to be screened and they will ALSO be screened when they arrive at the clinic for their appointment at the door prior to admittance into the clinic.
- Patients are to wait outside the clinic or in their vehicles and will be allowed access only for their scheduled appointment times. Patients can be called on their cell phones to alert them to enter the clinic or waved in by their practitioner or receptionist. The doors will otherwise remain locked.
- Patients only will be allowed access to the clinic. If someone has accompanied them they will need to wait outside of the clinic. No one will be allowed to wait in the reception area.
- Patients should limit the number of items brought into the clinic.
- Patients will be required to use hand sanitizer upon ENTERING and EXITING the clinic.
- Patients must bring and wear their own masks for the duration that they are in the clinic. If they do not have access to a mask, one will be provided.
- Patients and all other individuals should remain two metres away from each other within the office whenever possible, including in:
• waiting areas
• transition areas and hallways
• reception and payment areas
• treatment areas. - Patients should be reminded to avoid touching their faces during their appointments.
- If patients need to cough or sneeze at any point, they are to advise the practitioner as soon as possible and direct it into a tissue or their sleeve at the elbow. They will then be required to sanitize again.
- Patients may not pay in cash. All payments will be contact-less and receipts will be emailed where possible to reduce the exchange of paper.
- Unless it is an absolute emergency, we ask patients not to use our washroom facilities.
The clinic reserves the right to update and amend these procedures and protocols at any time for the safety of their staff and patients.