COVID-19 clinic policy and procedures.  Infection risk assessment and mitigation

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.

This risk assessment and mitigation record has been undertaken in conjunction with review of the iO’s guidance ‘Infection control and PPE’ and ‘Adapting practice guide’.  In this document you will find the following:

Table 1: This is an overview of the measures we have taken that will form your clinic policy 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 we have identified and record of the mitigating actions we have taken and when.
  • Table 2a – Protection for staff and patient before and when in clinic
  • Table 2b – Heightened hygiene measures

• Table 3: PPE policy for staff in your practice

• Table 4: Details of how I have communicated to patients our policies

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

Undertaken a risk assessment	As of 11th May 2020, I have undertaken a risk assessment of my practice. All patients will be triaged over the telephone to assess for symptoms of COVID 19 in the patient, in the patient’s family, or whether they have been in contact with someone with suspected/confirmed COVID 19 in the last 14 days. Screen for extremely clinically vulnerable patients, or a member of the patient’s family is considered clinically vulnerable.
Heightened cleaning regimes	All Hard surfaces will be cleaned before and after each patient, including chairs, door handles, plinth, pillows, card machine etc. Treatment times staggered to give time to clean the room between appointments. Aeriation of the room: leaving the window open during and after treatments.
Increased protection measures	All linen has been removed from the treatment room. Practitioner will have bare arms up to the elbow and will wash hands and arms with soap and water for at least 20 seconds or use hand sanitiser gel. Practitioner to wear mask, gloves, and either plastic apron or change clothes between each patient. New pedal bins for deposing of waste between patients All toys and books removed from treatment room and waiting areas. Each patient will be offered 70% alcohol hand gel before and after treatments. The practitioner will open and close all doors for the patient.
Put in place distancing measures	Patients will be able to wait in their cars until the practitioner calls to say the room is ready for them. No other people will be in the hallway before or after treatments. The patient will come alone, and only bring what they need for the appointment. Patients asked to arrive close to their appointment times as to minimise contact with other patients Treatment times staggered so patients don’t come into contact with each other.
Providing remote/ telehealth consultations	Telephone consultations and advice available
	(Document last updated: 3/11/2020)

	Description of risk	Mitigating action	When introduced
Pre-screening for risk before public/patients visit the clinic	Patients coming to the practice that have COVID 19 symptoms   Patients in vulnerable category that need a treatment and therefore putting themselves at risk.   Patients coming to the clinic and not being aware of the risk of coming.   Patients coming to the clinic and putting other members of their household at risk or other people they are shielding.	•  Triaging patients over the telephone in the first instance to see if advice can alleviate symptoms.  Case history can be taken over the telephone to consider whether a face to face consultation is needed. • If face to face consultation is needed the screening for symptoms of COVID 19 • Screening for clinical vulnerable patients. Clinically vulnerable people are those who are: I .aged 70 or older (regardless of medical conditions) II. under 70 with an underlying health condition listed below (that is, anyone instructed to get a flu jab each year on medical grounds): III. chronic (long-term) mild to moderate respiratory diseases, such as asthma, chronic obstructive pulmonary disease (COPD), emphysema or bronchitis IV.    chronic heart disease, such as heart failure V.           chronic kidney disease VI.          chronic liver disease, such as hepatitis VII.         chronic neurological conditions, such as Parkinson’s disease, motor neurone disease, multiple sclerosis (MS), or cerebral palsy VIII.        diabetes IX.          a weakened immune system as the result of certain conditions, treatments like chemotherapy, or medicines such as steroid tablets X.            being seriously overweight (a body mass index (BMI) of 40 or above) XI.          pregnant women •             Screening for additional respiratory symptoms or conditions e.g. asthma, hayfever etc •             Screen to see if other members of the family have symptoms of COVID 19 or are in a high-risk category i.e. shielding. •             Have they been in contact with someone with suspected/confirmed COVID 19 in last 14 days. •             Communicate the risk of face to face consultation – document that the patient has been informed and that they are not experiencing symptoms. •             Communicate process on arrival in clinic: patient needs to stay in their car until called, they will be given hand sanitising gel on arrival.  Practitioner will open and close doors. NB: All triage pre-screening information will be documented in the patient notes.	11th May 2020
Protecting members of staff		PPE to be worn by practitioner for treatments, detailed below in table 3	11th May
Confirmed cases of COVID 19 amongst staff or patients?	A patient who has visited the clinic experiences symptoms of COVID 19 after their appointment	Should a patient advise me that they have symptoms of COVID-19 after visiting the clinic in line with government guidance.	11th May
Travel to and from the clinic	Patients need to use public transport to the clinic Patient need a chaperone	This is a low risk for my clinic as most people can walk or come by car. If possible the chaperone will be asked to wait in their car, if they come by public transport then they can wait in the hallway or outside if the weather is nice.	11th May
Entering and exiting the building Reception and common areas	Patients will not be able to social distance if they meet in the hallway between appointments.               Patients will have to touch more surfaces if they must go into the bathroom to wash their hands before and after treatments	Patients will wait in their car until asked to come in.   Patients will be asked to arrive close to their appointment time so that they are not kept waiting long.                 Patients will be given alcohol gel before and after treatment at the entrance door 11th May	11th May
Social/physical distancing measures in place	Patients may still meet outside	Appointment times will be staggered to allow for one person to leave before another arrives	3rd April 2020
Face to face consultations (in-clinic room)	Minimise close contact during face to face consultations	Increase distance initially in treatment room. All treatment techniques are gentle and do not increase droplet production. Practitioner will look away from patient if its not necessary to look at them e.g. when not talking.	11th May

	Description of risk	Mitigating action	When introduced
Increased sanitisation and cleaning	Areas that are difficult to clean between patients. Touch points are potential areas of cross contamination	Clinic decluttered, all linen, toys and books removed.  Pillows and plinth covered in plastic. All hard surfaces wiped clean after each patient including door handles and chairs. Practitioner to open and close doors for patient	11th May
Aeration of rooms	Droplets in the air from the patient contaminating room	Leave windows open during and after treatment.	11th May
Staff hand hygiene measures	Cross contamination to patient and from patient.	Practitioner will wash hands and arms for at least 20 seconds before putting on gloves for treatment and again after.	3rd April 2020

Clinicians will wear the following PPE	Single-use nitrile gloves and plastic aprons with each patient Fluid-resistant surgical masks (or higher grade)
When will PPE be replaced	When potentially contaminated, damaged, damp, or difficult to breathe through. At the end of a session (4 hours), or sooner if needed to be removed
Patients will be asked to wear the following PPE	Patients will be asked to wear face coverings as per government advice to wear face coverings in places where social distancing is difficult.
PPE disposal	New foot pedal bin for treatment room to dispose of PPE and paper on plinth. Double-plastic bagged and left for 72 hours before removal, keeping away from other household/garden waste, and then this can be placed in your normal waste for collection by your local authority. Cloths and cleaning wipes also bagged and disposed of with PPE

Publishing your updated clinic policy	Available on website
Information on how you have adapted practice to mitigate risk	Available on Website
Pre-appointment screening calls	24 hours/morning before a scheduled appointment, practitioner will either call, text or email to confirm that they are well, their household is well and they have not been exposed to the virus
Information for patients displayed in the clinic	Notices displayed for hand washing, hand rubbing with gel. Notices informing patients that they cant be treated if they have symptoms of COVID 19
Other patient communications	Video on facebook page