Training and Educating our TEAM

One of the most important things we are doing during this time is to train and educate our staff.

Our TEAM has had refresher training in proper hand washing techniques. This may seem basic, however it is the most important thing we can do to prevent spread of the virus. Research shows that this is often poorly complied with and not done well. Consequently, we have spent a lot of time ensuring our TEAM does it well and often, especially before and after every patient encounter.

Our TEAM has practiced and continues to practice appropriate use of personal protective equipment (PPE) prior to caring for a patient to prevent contamination.

We encourage staff that is not feeling well to proactively stay home for 2 weeks. We have a back up team if needed.

We have everyone in the office take their temperature at the beginning of each day and we will immediately send home anyone with an elevated temperature (100.2 F and above).

We limit the number of staff providing care to our patients to facilitate social distancing within the office and among TEAM members.

We have created a checklist of recommendations for our TEAM to follow so that they arrive to work healthy and go home to their families worry-free. See below.

Recommendations for our TEAM

Before coming to work

  • Take temperature before heading to work. Do not come in to work if you or any family member is experiencing symptoms, cough, sore throat, fever, etc.
  • Remove all jewelry and leave it at home.
  • Wear hair in a pony tail or tied up and keep fingernails short.
  • Bring work clothes in a washable bag (pillow case).

At work

  • Change into scrubs and work shoes (preferably plastic and wipe able) as soon as you arrive.
  • Continue the appropriate use of personal protective equipment (PPE) prior to caring for a patient, during care and following patient dismissal.
  • Leave all clutter (pens, phones, etc) outside of the patient treatment rooms.
  • We discourage all TEAM members from using other TEAM member’s phones, desk space, offices and equipment.
  • Clean the phone handset after use.
  • Do not use your cell phones during work hours to prevent cross contamination.

After work

  • Wash hands and arms with soap and water.
  • Remove scrubs, place in washable bag and take home to launder.
  • Wash hands and put on clean clothes.
  • Sanitize your phone and work area, face shields, etc.

At home

  • Wash hands and arms with soap and water.
  • Wash clothes/scrubs in bag in washing machine with detergent and hot water.
  • Shower immediately with soap and water before touching anything or anyone.

Scheduling patient protocol

  • Filter patients during the phone call when scheduling appointments for care using established and recommended screening checklists and scripts.
  • Prepare scripts and questions to recognize potential carriers.
  • Reschedule patients who show any signs of a cough or fever or who describe having any concerning warning signs.
  • Instruct patients to call ahead and reschedule their appointment if they develop symptoms of a respiratory infection on the day they are scheduled to be seen.

To promote social distancing

  • Prioritize high risk patients (immune compromised, over 60 y/o, etc) with early morning appointments so less contact with other people is likely to occur.
  • When scheduling patients, spread out the schedule to limit less people in the reception area (maximum of 3 people at at time).
  • If a patient is being accompanied, their escort should wait in the car to limit the number of people in the reception area.
  • Utilize a “virtual” reception area by having patients wait in their cars or outside. Contact patients via mobile phone when it is their turn to be seen.

Safety measures taken upon arrival

  • Only allow entry through the front door and exit through the side door.
  • Leave the office doors open to avoid unnecessary contact with the door handles.
  • Post signs at the entrance door advising patients of the COVID-19 risks and advising them not to enter if they are ill.
  • Masks and tissue should be made accessible immediately upon arrival and instructions should be provided on how to use tissues to cover the nose and mouth when coughing or sneezing. Waste baskets should be available to dispose of tissue or contaminated items.
  • Provide alcohol-based hand sanitizer with 60-95% alcohol at the entrance, in the reception area and at the front desk.

Measures upon arrival

  • Immediately escort patient to a hand washing station.
  • Ask patients to rinse with 1% hydrogen peroxide before each appointment.
  • Escort the patient into the operatory with the door closed as quickly as possible to avoid lingering in the front office.
  • Ask patient about any symptoms of a respiratory infection and history of travel or contact with a possible COVID-19 patient.
  • Assess for respiratory symptoms and fever (non-contact digital infrared forehead thermometer) and ask patient to sign a health declaration form.
  • If a temperature of 100.2 F or higher or respiratory symptoms are present, the patient will be advised to seek medical clearance and their visit will be rescheduled.
  • As testing for the virus becomes more available, we will be offering this added benefit to screen patients.

Measures taken upon patient entry into the clinic

  • If the operatory is not ready, ensure social distancing in the reception area by placing seating a minimum of 6 feet apart.
  • Remove all clutter and anything that is not easily disinfected from the reception area (magazines, etc)

Reception area and front desk safety measures

  • Install physical barriers or partitions if possible, at the reception areas to limit close contact between reception and patients.

Protocols of the clinical team

  • We adhere to usual standard and transmission-based precautions in the operatory, but with greater attention to detail to ensure that procedures are followed consistently and correctly.
  • Hand hygiene performed by the staff
  • Wash hands before and after each patient, during contact with potentially infectious material and before putting on and after removing personal protective equipment (PPE), including gloves.
  • Wash hands after removing PPE in order to remove any pathogens that might have been transferred to bare hands during the removal process.
  • Wash hands with soap and water for at least 20 seconds.

Personal Protective Equipment

  • Wear PPE (masks, gloves, hair cap, eye protection, face shields, gowns) during all patient contact.

Eye protection

  • Put on eye protection (goggles or shield that covers the front and sides of the face) upon entry to the operatory or care areas.
  • Remove eye protection before leaving the operatory or care area.
  • Reusable eye protection (goggles and shields) must be cleaned and disinfected according to manufacturer’s instructions prior to re-use.

Gloves

  • Put on clean, non-sterile gloves upon entry into the operatory room.
  • Change gloves if they become torn or heavily contaminated during patient care.
  • Remove and discard gloves when leaving the operatory and immediately perform hand hygiene.

Gowns

  • Put on a clean isolation gown upon entry in the operatory room.
  • Change the gown if it becomes soiled. Remove and discard the gown in a dedicated container for waste or linen before leaving the patient room. Disposable gowns should be discarded. Cloth gowns or lab coats should be laundered.
  • Gowns should be prioritized for all aerosol-generating procedures and during activities where splashes and sprays are anticipated.

Patients in the operatory

  • Health care personnel (HCP) should strictly follow basic infection control practices between patients (hand hygiene, cleaning and disinfected shared equipment) and wear PPE as described above.
  • Room doors should be kept closed except when entering or leaving the room, and entry and exit should be minimized.
  • Once the patient has left the operatory, the room should undergo appropriate cleaning and surface disinfection before it is returned to routine use.

Protocols after the clinical treatment

  • All non-disposable medical equipment used for patient care should be cleaned and disinfected according to manufacturer’s instructions.
  • Ensure that environmental cleaning and disinfection procedures are followed consistently and correctly.
  • Routine cleaning and disinfection procedures (using cleaners and water to pre-clean surfaces prior to applying an EPA-registered, hospital-grade disinfectant to frequently touched surfaces or objects for appropriate contact times as indicated on the product’s label) are appropriate for SARS-COV-2 in healthcare settings, including those patient care areas in which aerosol-generating procedures are performed.