Covid 19 Executive Physiotherapy Policy Aug 03 2020

Executive Physiotherapy Covid Policy for Face to Face Treatment 

Executive Physiotherapy Clinic Reopening and Workplace safety 

Managing COVID-19 


Author: Josephine O’Callaghan, Head of Physiotherapy

Date: 3/8/20


Therapist and patient health and safety is paramount, where possible we will adapt online work arrangements. Where this is not possible precautions have been put in place. This document covers the following:

  • Patient Journey
  • PPE Protocol
  • Cleaning Protocol
  • Test and Trace
  • Therapist Illness
  • Social Distancing


Patient Journey

Before Attending the Clinic:

The Following Patients should not attend the clinic for a face to face appointment:

  1. If you are shielding or in a vulnerable risk group you should not attend the clinic for a face to face appointment. Please notify us and request an online physiotherapy appointment.
  2. If you are displaying symptoms of Covid 19 as outlined by Public Health England 
  3. If you have been in contact with anyone in the last 14 days who has displayed symptoms of Covid 19 as outlined by Public Health England
  4. If you have a condition that can be effectively managed via online physiotherapy.

New Patients:

All new patients must be booked in for an online initial physiotherapy consultation to assess whether a face to face consultation is necessary. This is in accordance with the CSP (Chartered Society of Physiotherapy) guidelines which states that the need for a face to face physiotherapy appointment has been clinically reasoned and cannot be done online. The physiotherapist must document in the clinical notes the reason why a face to face consultation is deemed necessary.

Face to Face Patients:

Vicki Machin, administrator for Executive Physiotherapy, will email all patients who are booked into a face to face clinic our Covid 19 Consent for Face to Face Appointment form. This must be completed at least 24 hours before the appointment to enable to appointment to go ahead. All questions require the response ‘yes’ in order to go ahead with the appointment. If there are any responses marked ‘no’ or any questions arising from the form then this will need to be addressed prior to attending a face to face appointment. 

This form needs to be completed before each face to face appointment at the clinic.

If a patient’s condition changes following completion of the form then please notify the clinic immediately and do not attend the appointment.

To avoid use of pens these consent forms will be sent and returned electronically.

On The Day Of Your Appointment:

The patient must attend the appointment alone, if a chaperone is required then the clinic must be notified before the appointment so that the clinic and the therapist can plan for an extra person attending in the clinic.

The patient must arrive at the clinic at their appointment time, or a maximum for 5 minutes before the appointment time. There will be no waiting area at the clinic due to social distancing policies so there is no place to accommodate anyone who arrives early.

Face masks need to be worn at all times in the clinic and during the physiotherapy session.

The patient must bring suitable clothes for examination and treatment. Executive Physiotherapy will not provide shorts.

On Arrival To The Clinic:

On arrival at the clinic the patient should press the buzzer and wait to be let in. The clinic is running on reduced staffing levels so the wait time may be longer than usual. If a patient is concerned that the buzzer has not been heard then they can call Executive Physiotherapy on 020 3488 2244.

Steps have been taken to reduce the number of patients in the clinic, by  staggering appointments and allowing time between sessions. However if a patient arrives at the clinic and there is another visitor at the door or in the common spaces then the patient should either wait outside the clinic, or if they are already inside the clinic then they should adhere to social distancing rules. If there is any doubt on arrival then the patient should wait outside and call the clinic on 020 3488 2244 to alert us that you are waiting outside.

All members of staff, visitors and patients will be screened on entry to the main building. The purpose of this screening is to detect and prevent any person with COVID-19 symptoms entering the workplace and to reduce to spread of the disease. 

At the entrance of each site a screening table will be set up. The nominated ‘Screener’ will be provided with full PPE. (Mask, Visor, Gloves, Apron). 

Screening Process:

Instruct visitor to maintain social distancing, Markers clearly visible on flooring where possible.

Screening Questions:

A. Ask the person if he/she has experienced any of the COVID-19 symptoms: cough, shortness of breath, difficulty breathing, fever (temperature at or above 100.4 ºF), chills, repeated shaking with chills, muscle pain, headache, sore throat, or the new loss of taste or smell. Please reference the relevant public health body guidelines for the latest list of symptoms and other best practices. 
– If No, move to Step B.
– If Yes, and the symptoms are due to a known cause other than COVID-19 as advised by a health care professional, move to Step B.
– Otherwise, explain that they cannot enter the premises today and should return home and seek medical advice. Mark the log sheet with Fail.  
B. Ask the person if within the last 14 days he/she has been in close contact with anyone who has been diagnosed with or who has symptoms that suggest they might have COVID-19. 
• If No, move to Step C. 
• If Yes:
– Ask if he/she is deemed a critical infrastructure worker. If Yes, ask he/she to wear a facemask (and remind he/she to follow the relevant public health body guidelines for critical infrastructure workers who have been in close contact) and then move to Step C.
– If he/she is not a critical worker, explain that he/ she cannot enter the premises today and should return home. Mark the log sheet with Fail.
C. Ask the person if he/she has been diagnosed with COVID-19 by either a positive test or a health care professional. 
• If No, move to temperature testing. 
• If Yes, ask if he/she has recovered from COVID-19 per the guidance found in ‘Post Infection – Return to work. 
– If Yes, move to the temperature check testing. 
– If No, explain that he/she cannot enter the premises today and should return home. Mark the log sheet with Fail.

Temperature Check

A. Confirm with the person that he/she is authorising you to take his/her temperature (verbal consent). If you receive consent, go to the next step. If the person refuses, then send him/her home and mark Consent Not Granted in the log.

B. Instruct the person to remain still during the process for accuracy. 
C. Obtain temperature using the thermometer as per the manufacturer’s instructions. 
• If the temperature is below 100.4 F (38 C), write Pass on the log sheet, ask the person to sanitise hands with Hand Gel provided. Masks and Gloves are also available to don. This person is then able to enter the workplace. 

D. If the temperature is at or above 100.4 F (38 C), inform the person that he/ she has failed the temperature testing and that an additional test will be performed in five minutes. If the additional test indicates a temperature at or above 100.4 F, write Fail on the log sheet and explain that he/she cannot enter the workplace and suggest that the person seek medical advice.

Screening Site Sanitation 

A. Using 80 % Alcohol wipes, clean and sanitise all surfaces in surrounding area as appropriate, particularly those touched by a person who failed the screening. 

B. Sanitise the thermometer after each use with a sanitising wipe. 

C. Clean and sanitise all equipment when screening is complete. 

D. Wipe iPad used for Screening Log. 

During Your Physiotherapy Session

On entry to the physiotherapy treatment room the patient will be asked to wash their hands in the sink within the treatment room following the government guidelines on hand washing.

At the start of the session the therapist will ask the patient to confirm that they have read our Covid policy and whether they have any questions.

The patient must wear your face mask at all times: a face mask can be purchased at the cost of £2 per mask

The physiotherapist will be wearing PPE including:

  • Face Mask
  • Apron
  • Gloves

These are all single use (disposed after each patient)

  • Protective Eyewear, such as glasses or a visor which are cleaned between patients.

The window in the treatment room will remain open to allow the room to be ventilated.

During the physiotherapy session close contact may be required in order to assess and treat the presenting complaint.

The physiotherapist must document any questions which arise regarding face to face contact.

All payments will continue to be done via our invoicing system, invoices will be sent after the appointment. Patients can then click the link to make a payment or pay via BACS transfer.

End of The Treatment Session

The patient will be asked to sanitise your hands when exiting the clinic.

The physiotherapist will remove all PPE and dispose of it in clinical waste bags. Removal of all waste disposal will be the responsibility of the Alevere clinic.

The physiotherapist with wash their hands following the government guidelines on hand washing.

The physiotherapist will then commence cleaning procedures, followed by hand washing in accordance with government guidelines.

PPE PROTOCOL

The physiotherapist must remove all outside clothing on arrival to the clinic and change into their uniform. At the end of the clinic session the physiotherapist must put their uniform in a pillow case and take it home to be washed at a high temperature.

Every patient must wear a face mask for the duration of their time in the clinic.

Every physiotherapist will wear, gloves, apron, mask, eye protection (glasses or visor) and adhere to the Public Health England donning and doffing procedures: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/877658/Quick_guide_to_donning_doffing_standard_PPE_health_and_social_care_poster__.pdf

CLEANING PROTOCOL

Time has been allocated between each patient appointment to clean the treatment room.

All surfaces that have come into contact with the patient or physiotherapist during a treatment session will be cleaned with disinfectant wipes between patients.

Plastic pillows are being used and will be cleaned with disinfectant wipes between use.

No pillow cases or couch covers will be used so that everything can be cleaned with disinfectant wipes. Couch roll will be used to cover the couch and pillow for patient comfort and this will be disposed after each session.

Only one physiotherapist will be using the treatment room per day.

The room will be cleaned after each clinic session by the Alevere clinic cleaners. This is the Alevere clinic Cross Contamination protocol:

Perform routine environmental cleaning and disinfection:

  • Routinely clean and disinfect all frequently touched surfaces in the workplace, such as workstations, keyboards, handrails, doorknobs, tables, light switches, countertops, handles, phones, keyboards, toilets, faucets, sinks, and similar.
  • Provide anti-viral wipe stations near common work areas and encourage staff to clean their workstation and equipment.
  • Perform deep-cleaning when any person is identified as being COVID-19 positive by testing or where this is suspected.
  • Close off areas used by confirmed or suspected COVID-19 positive persons. – After the appropriate amount of time, deep clean the space. How to Clean and Disinfect.
  • Ventilate areas before you clean and leave windows and doors open during cleaning.

  • If surfaces are dirty, they should be cleaned using a detergent or soap and water prior to disinfection.
  • For disinfection, most common household disinfectants should be effective. Follow the manufacturer’s instructions for all cleaning and disinfection products (e.g., regarding concentration, application method, and contact time). Silverlink Clinics Preferred product is 80% Alcohol wipes. 
  • Disinfecting may be performed with any of the following: – A product that meets local government criteria for use against SARS-CoV-2, the virus that causes COVID-19.

  • Unexpired bleach, labelled for disinfection, as per label instructions. – Alcohol solutions with at least 60% alcohol.
  • Disinfection techniques may include surface cleaning, spraying, fogging, and laundering. 
  • Deep cleaning may be performed by a specifically trained internal response team or by contract personnel. If so:
  • Products are to be used per label requirements and updated in the COSHH file
  • Specialised equipment should be considered, such as foggers and electrostatic spraying devices. 
  • Ample stations offering anti-viral hand lotions and disinfectant wipes near common work areas are provided
  • Workers from using other workers’ phones, desks, offices, or other work tools and equipment, when possible. If necessary, clean and disinfect such items and areas before and after use. 
  • Disposable wipes are provided to employees so that commonly used surfaces (doorknobs, keyboards, remote controls, desks, and other work tools and equipment) may be wiped down by employees before each use. 
  • Frequent and thorough hand washing is encouraged.
  • Employees are always encouraged to maintain safe distances. Safety Guidelines for Cleaning Personnel During Cleaning and Disinfection. 
  • Wear disposable gloves (see Safety Data Sheet) when cleaning and disinfecting. Gloves should be discarded after each use. Wash hands immediately after gloves are removed. 
  • Wear eye protection when there is a potential for splash or splatter to the face. 
  • Wear work attire and footwear that is easy to clean. 
  • Gowns or aprons are recommended to protect personal clothing. 
  • Store chemicals in labelled, closed containers. Keep them in a secure area and in a manner that prevents tipping or spilling. (COSHH)
  • Place all waste generated during cleaning into a separate waste bag and collect the waste frequently. 
  • Employees need to know to recognise the signs and symptoms of COVID-19 and to report immediately. 
  • Employees will be notified upon the discovery of possible exposure and the organisation’s response.
  • All members of the team MUST always adhere to the 5 moments for hand hygiene and implement universal precautions.  

Treatment Rooms

All surfaces will be cleaned with 80% alcohol wipes before and after a patient has been treated.  Anything the patient touches and anything the therapist touches must be cleaned thoroughly with care.  This includes but is not exhaustive of door handles, bench surfaces, treatment couches and chairs.

TEST AND TRACE

“People will be deemed to have been in contact if they have had close contact, been coughed on, or spent more than 15 minutes within 2 metres of someone with COVID-19”. However, the government have stated that people working in health and social care professional roles who have correctly used PPE as part of their employment are not considered to be in close contact” 

NHS England, Physio First Ebooklet.

If a physiotherapist comes into close contact with someone who tests positive for Covid 19 and they were NOT wearing full PPE, then they will have to self isolate for 14 days.

If the therapist tests positive for Covid 19 then the test and trace trackers will contact all the people they have been in contact with over the previous 14 days. However patients should not be asked to self isolate if full PPE has been worn by the physiotherapist.

Important Patient information:

COVID 19 is a serious communicable disease, which must be reported to the Public Health authorities for disease management. Therefore, in the situation of exposure to this disease we may be required to report your information to the authorities as part of the track and trace scheme. Please discuss this further with your therapist before your session if this is a concern for you.

PHYSIOTHERAPIST ILLNESS 

It is the responsibility of the physiotherapist to perform a temperature check on themselves and self report if they have a temperature at or above 38 degrees C.

It is the responsibility of the physiotherapist to inform Executive Physiotherapy and the patient caseload if they are displaying symptoms of Covid 19 as outlined by Public Health England or have been in contact with anyone in the last 14 days with symptoms Covid 19 as outlined by Public Health England. The physiotherapist must adhere to the most up to date government guidance regarding self isolation and return to work. Any plan to return to work must be discussed with Josephine O’Callaghan, Head of Physiotherapy, and will be planned in accordance to Public Health England and Government guidance.

DISTANCING AND MINIMISING CONTACT

Where possible social distancing will be adhered to, where the role allows, physiotherapists will work from home.

Physiotherapy appointments will be booked with extra time for cleaning processes, PPE donning and doffing and Covid patient screening. 

Where appropriate physiotherapy appointments will be conducted online.

The Alevere clinic have used markers to give guidance of social distancing.

Patient weekly appointments are staggered. This is to allow for only one patient and therapist in a single area at any one time.

Physiotherapists will use their own working space for breaks.

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