The Institute of Osteopathy

Covid 19 Risk Assessment

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.

We have assessed our practice for risks outlined and put in additional processes as detailed below
 
Undertaken a risk assessment 20th May 2020
Heightened cleaning regimes
  • Clinic rooms will be cleaned in between each patient
  • Common areas/washrooms will be cleaned after every patient
  • Hard surface in common areas will be cleaned after every patient
Increased protection measures
  • All linens have been removed from the clinic
  • There is a screen in the reception area
  • Cashless payments only
  • Staff PPE is available
  • Hand sanitising station at reception entrance
Put in place distancing measures
  • Appointments to be staggered
  • Only one patient per time in reception unless cannot be avoided e.g. carers or bad weather and the patient has walked and cannot wait outside
Staff training
  • Correct hand washing technique best practice
  • Put on/remove PPE safely
  • Staff briefed and trained on updated clinic policies and infection measures
  • Cleaning of the beds, pillows and hard surfaces and loos etc
Providing remote/ telehealth consultations
  • All patients will have telephone pre-screening call 24 hours before an appointment
  • New patients and Previous patients that have not been in for 6 months to have a case history taken on the telephone
  • All patients to be screened by practitioner for susceptibility and suitability for on line or face to face consultation
  • Follow-up/maintenance appointments available via telephone/video call
Document last updated:6th October 2020
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 to
Description of risk Mitigating action When introduced
Pre-screening for risk before public/patients visit the clinic You need to triage and offer a virtual consultation in the first instance. Consider taking an initial case history by telephone to determine if a face to face is relevant or support can be provided by a telehealth consultation.

  • If a virtual consultation does not meet the needs of the patient,
  • Screen for any symptoms of COVID 19 (e.g. high temperature or a new, persistent cough) in the last 7 days?
  • Screening for extremely clinically vulnerable patients
  • Screening for additional respiratory symptoms or conditions e.g. hay fever, asthmas etc
  • Screen to see if a member of their household had/has symptoms of COVID-19 or are in a high-risk category i.e. shielded as considered extremely clinically vulnerable? 
  • Have they been in contact with someone with suspected/confirmed COVID-19 in last 14 days?

Information given at pre screening call:-

  • Inform of the risk of face to face consultation – staff 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.
  • Options for telehealth

When arriving at the clinic the patient

  • should wait in their car if at all possible
  • they will be invited in when the practitioner has done the appropriate cleaning
  • the patient will then be asked to wash or sanitise their hands
  • the patient will be escorted to the treatment room
  • where possible the doors will be opened for the patient with the light switches on

NB: All triage pre-screening information must be documented in the patient notes.

 
Protecting members of staff   All staff have been contacted to see if they are shielding anyone or have health conditions that make them particularly susceptible to Covid 19

All staff to wash their hands when entering the clinic and at regular intervals in the day

  • Where possible the staff should stay behind the screen
  • Staff should bring their own drinking vessels and take them home to wash
  • Staff should clean the toilet after use
  • See PPE policy below o be followed by staff as well as clinicians
 
Confirmed cases of COVID 19 amongst staff or patients?   If staff or clinician have symptoms of Covid 19 they should get a test and self isolate until they get the results of the test.

 Anybody who has been in direct contact with that person should self isolate until the test results are made clear.

 If as patient advises that they have  the symptoms of Covid 19 after visiting the clinic in line with government guidance :-

  • If the patient experiences symptoms within 2/3 days of visiting the clinic, any staff or clinician with direct contact to that individual should self-isolate
  • Anyone with indirect contact with the patient, should be advised of the situation and suggest they monitor for symptoms (those with indirect contact with suspected cases COVID 19 do not need to self-isolate)This should include the receptionist
Travel to and from the clinic  Patients that arrive on foot or by public transport will be asked to wait out side if at all possible

  • If it is not possible one patients will be allowed to wait in the waiting room. The chairs are 2 meters apart where possible
Entering and exiting the building   Detail here if you have a process for both staff and patient entering and exiting the clinic

  • Clinic staff should not be in contact with patients so need not change their clothes
  • Clinicians will be asked to bring separate clothes to work in and change at the beginning and the end of their working day and to take the clinical clothes home to wash in a cloth bag or pillow case..
  • We are asking patients to stay in their cars if at all possible until called so they do not use the waiting room at all.
  • Any patient on foot should not arrive early
  • Patients to be asked to wait in their cars until called
  • Patients should only enter when invited and will be directed.
  • Patients will be asked to wash their hands with soap and water where possible and to sanitise if not eg if they are carrying a babe in arms.
Reception and common areas   Detail here recommendations such as

  • The waiting room is not to be used unless the patient cannot wait outside.
  • We will ask for contactless or Bacs payments only. This information will be given at the pre screening
  • Hand sanitiser station at reception entrance
 
Social/physical distancing measures in place   Detail here what measures other distancing you are putting in place. This can include but not limited to

  • Staggered appointment times so that patients do not overlap in reception
  • Only one member of staff per day.  No half days to be worked.
 
Face to face consultations (in-clinic room)  
  • The chairs for the patient  in the consultation room to be as far away from the desk as possible.

The policy on chaperones is :-

  • One parent/guardian only with visits for children
  • No additional family members except if requested as a chaperone
  • Chaperones to be given the risks of Covid 19 and the implications of coming into the clinic
  • All chaperones to wear masks and to do the hand washing routine. screen chaper ones at same time as pre screen call
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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    Surfaces to be cleaned with  bleach wipes or Clinell wipes after every patient

  • Clinic rooms – plinths, desk, door handles, equipment chairs – between each patient
  • Reception surfaces, doors and door handles, chairs, taps, card machines to be cleaned. The credit card machine has a wipeable screen cover. The pin pad only needs to be used  for transactions over £45 or where asked.
  • Use of at least 60% alcohol sanitisers/wipes, using bleach-based detergents

 To minimise the number of surfaces that need to be cleaned:-

  • All linen has been removed from the clinic There are now plastic pillows and just the plinths with no covers so that it can be cleaned inbetween each patient
  • The clinic has been decluttered of unnecessary
  • Keeping doors between common areas open if safe and appropriate to do so, to reduce touch points
 
Aeration of rooms
  • Leaving the window open and the front door open to aerate whole clinic at lunch time and during cleaning
  • Removal of fans and other air-circulation mechanisms
 
Clinician  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 hand sanitiser gel/ use of gloves
  • Hand sanitiser available in all rooms and reception area
 
Respiratory and cough hygiene Communication of cough hygiene measures for staff and clinicians

  • ‘Catch it, bin it, kill it’ posters
  • Provision of disposable, single-use tissues waste bins (lined )
  • Hand hygiene facilities available for patients, visitors, and staff
Cleaning rota/regimes   The taps in the toilet will be cleaned in between each patient the toilet will be cleaned if used

 A written record will be kept when the toilet is cleaned.

Table 3. Personal Protective Equipment: Detail here your policy for use and disposal of PPE
Clinicians will wear the following PPE
  • Single-use nitrile gloves or similar and plastic aprons with each patient?
  • Fluid-resistant surgical masks (or higher grade)
  • Eye protection,  if the patient has hayfever or other runny nose that has proved not to be Covid19
When will PPE be replaced
  • When potentially contaminated,  damaged, damp, or difficult to breathe through
  • IIr masks can be worn for 4 hours and Fpp2 for eight hours
Reception staff will wear the following PPE
  • Fluid resistant surgical masks for those in direct contact with patients.
Patients will be asked to wear the following PPE Detail here in what circumstance you may ask patients to wear PPE, and what types e.g.

  • Fluid-resistant surgical masks if respiratory symptoms e.g. from hay fever or asthma
  • Face-covering in clinical and waiting areas
  • Carers accompanying patients eg mothers must wear a fluid resistant surgical mask
PPE disposal
  • 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

 

Table 4. Communicating with patients: Detail here how you will advise patients of measures that we have taken to ensure their safety and the policies that have been put in place in our clinic
Publishing your updated clinic policy
  • Publish on clinic notice board and or available on request
  • Available on our website
Information on how you have adapted practice to mitigate risk Detail here what general information on steps taken and where it has been published

  • Updating of website and via our social media accounts
Pre-appointment screening calls
  • 24 hours/morning before a scheduled appointment
  • A receptionist or clinician will call.
  • If non-clinicians to be trained to ask if patient has fever , cough or feels unwell. Check if patient has been in contact with anyone with C19 or suspected C19. To tell patient the practice procedure. To stay in car until called, then will wash hands , then go through to treatment room. Only that person to come to appointment except if carer needed.
  • Payment by card only
  • All new patients and those who have not been in recently to have new case history done over the phone or on Whats  app by an osteopath
Information for patients displayed in the clinic
  • Door notices advising people not to enter the building unless invited
  • Notices on other public health measures e.g. hand washing/sanitising/Catch-it, bin it kill
  • Posters about social distancing
Other patient communications Patients will be asked to contact us if they begin with symptoms of fever , cough or feeling unwell between  pre screening phone call and appointment or after they have had an appointment  for a period of 2 weeks.

Patients asked to categorise Osteopaths as healthcare workers when completing questionnaire for track and trace.

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