COVID – 19 POLICY

WRITTEN June 2020

PURPOSE

In response to the COVID-19 Pandemic, Rory Holliday Physiotherapy (RHP) aims to reduce risk of transmission of the virus within the working environment as far as practicably possible. This policy sets out the considerations and actions.

BACKGROUND

Epidemiology (taken from GOV.UK)

On 31 December 2019, the World Health Organization (WHO) was informed of a cluster of cases of pneumonia of unknown cause detected in Wuhan City, Hubei Province, China.

On 11 March 2020 WHO declared a global pandemic

Transmission

A zoonotic source to the outbreak has not been identified yet, but investigations are ongoing.

According to current evidence, the COVID-19 virus is primarily transmitted between people through respiratory droplets and contact routes.

Human-to-human transmission is occurring extensively. Hence, precautions to prevent human-to-human transmission are appropriate for both suspected and confirmed cases (see infection prevention and control guidance).

In addition to respiratory secretions, SARS-CoV-2 has been detected in blood, faeces and urine.

In the context of COVID-19, airborne transmission may be possible in specific circumstances and settings in which procedures or support treatments that generate aerosols are performed.

Clinical features

Fever, cough or chest tightness, anosmia, myalgia, fatigue and dyspnoea are the main symptoms reported.

SCOPE

This policy applies to all clinicians working under the umbrella of Rory Holliday Physiotherapy.

This policy has been developed alongside guidance from Gov.uk: Working Safely During Coronavirus (COVID-19).

  1. Carry out a COVID-19 risk assessment 
    1. RHP has completed a risk assessment for practice of Physiotherapy and associated therapies. (SEE COVID-19 RISK ASSESSMENT). This incorporates guidance from: -
  • Health and Safety Executive
  • Chartered Society of Physiotherapy 
  • Public Heath England



    1. RHP will review the risk assessment monthly and update as required.
    2. RHP will update Risk Assessment in line with National guidance and legislation from Gov.uk.
    3. RHP will update the risk assessment immediately following a related incident occurring.
    4. risk assessment results will be shared with all clinicians and via the website


2. Develop cleaning, handwashing and hygiene procedures

2.1. Clinic equipment and surfaces will be cleaned between clients. See Appendix 1 for cleaning protocol

2.2. Clinician will follow hand hygiene procedures before and after seeing each client and after cleaning regimes.

2.3. Clients will be asked to perform hand hygiene on entering the clinic and before leaving. See appendix 2a & 2b for handwashing/gelling guidelines

2.4. PPE will be worn by clinician for all client contacts and cleaning regimes. See appendix 3 for PPE guidelines and Appendix 4 for Donning and Doffing procedure

2.5. Survival on environmental surfaces is also dependent on the surface type. An experimental study using a SARS-CoV-2 strain reported viability on plastic for up to 72 hours, for 48 hours on stainless steel and up to 8 hours on copper. With this in mind, rubbish bags will be tied up at the end of the day and disposed of in line with guidelines See appendix 1.

2.6. Cleaning products will be stored securely in clinic rooms not in public areas (with the exception of handwash and gel).


3. Help people to work from home

3.1. Clinicians will undertake a pre-appointment screening phone call.

3.2. Clinicians will offer virtual appointments by telephone or video call where possible.

3.3. RHP will offer mentoring and support to clinicians as required by the individual whether related to the workplace or personal issues. RHP will make contact with clinicians at least weekly.

3.4. RHP will ensure associate clinicians are informed of any updates to procedures or guidelines via email.

3.5. RHP will ensure clinicians have access to computer system with remote access.

3.6. In accordance with the Governments publication “Working Safely During COVID-19, Guidance for Employers, Employees and the Self- Employed” and the Health and Safety Executives “Working Safely Guide” RHP has produced a guidance and checklist for staff to consider when returning to the workplace. Each clinician must consider each point in the checklist before returing to practice at the clinic: -

  1. Do I (clinician) feel there are any personal or health barriers to practicing from the clinic?
  2. Can I deliver some/all appointments virtually via phone or video call?
  3. If the client wishes to have a face to face consultation, have I explained the risks about potential COVID 19 transmission in public places?
  4. Is my client in the Shielding category? If so, face to face should be avoided where possible.
  5. How can I implement Social distancing at work?
  6. Can visitors and contractors be minimised during working hours?
  7. Can I clean the workplace effectively between clients?
  8. Do I have the correct level of Personal Protective Equipment (PPE)?



4. Maintain 2m social distancing, where possible

4.1. Posters will be displayed within the clinic setting reminding clients to adhere to 2m social distancing rules wherever possible.

4.2. Clients will be asked to wait in their car or outside the building before being called in to their appointment.

4.3. Clients will be discouraged from using public restrooms wherever possible. If they have been used, clinician must clean the surfaces immediately.

4.4. Clinic rooms will be strictly one in-one out.

4.5. Shared reception desks will not currently be used. Where communal areas such as entrance/exit cannot be avoided, staggered appointment times will be offered and posters displayed to advise of social distancing.

4.6. Appointment times will be staggered with other practicing clinicians in the building to avoid foot traffic at the same time.


5. Where people cannot be 2m apart, manage transmission risk

5.1. Where treatment techniques require closer contact than 2m, PPE will be worn by the clinician following PHE guidelines.

5.2. Appointment times will be minimised where practicable.


6. PPE

6.1. PPE will be used for each client contact due to the nature of the intervention.

6.2. Surgical masks

6.2.1. Surgical masks should: 

  • • cover both nose and mouth 
  • • not be allowed to dangle around the neck after or between each use 
  • • not be touched once put on 
  • • be changed when they become moist or damaged 
  • • be removed and placed in a lidded container if to be reused. Hand hygiene must be performed after disposal 


6.2.2. Surgical masks may be used for Sessional use (PHE describe this as between 2-6 hours depending on the specific clinical environment and whether the mask has become moist or damaged.)


6.2.3. The use of masks for one HCW to use in one work area. This is currently recommended in the UK Infection Prevention and Control guidance. 




      1. If masks are touched or adjusted, hand hygiene should be performed immediately 




      1. If the mask is removed for any reason (for example, upon exiting the clinic area, taking a break or completing a shift), they are disposed of, unless they can be safely reused as outlined below 




      1. Reuse of surgical masks
  • the mask should be removed and discarded if soiled, damaged, or hard to breathe through 
  • masks with elastic ear hooks should be re-used (tie-on face masks are less suitable because they are more difficult to remove) 
  • hand hygiene should be performed before removing the face mask 
  • face masks should be carefully folded so the outer surface is held inward and against itself to reduce likely contact with the outer surface during storage 
  • the folded mask should be stored between uses in a clean sealable bag/ box which is marked with the person’s name and is then properly stored in a well-defined place 
  • hand hygiene should be performed after removing the face mask 



    1. Gloves

6.3.1. Gloves will be worn for every client contact.

6.3.2. Non-powdered, nitrile gloves are the most commonly recommended for healthcare.



    1. Eye protection


      1. Eye and face protection provides protection against contamination to the eyes from respiratory droplets, aerosols arising from AGPs and from splashing of secretions (including respiratory secretions), blood, body fluids or excretions. 
      2. Eye and face protection can be achieved by the use of any one of: 
  • • a surgical mask with integrated visor 
  • • a full face shield or visor 
  • • polycarbonate safety spectacles or equivalent 


      1. Regular corrective spectacles are not considered adequate eye protection.
      2. Eye protection can be sessional use and cleaned down with detergent wipes at the end of each session and stored in a lidded container
      3. If damaged or soiled, to be disposed of and replaced



    1. Disposable aprons
      1. Aprons will be used for every client and disposed of after each client.


  1. STAFF

7.1. Prompt recognition of cases of COVID-19 among healthcare staff is essential to limit the spread. Any staff with symptoms of COVID-19 should not come to work for at least 7 days or longer until symptoms have resolved in line with Government guidelines.


7.2. Individual risk assessment will be required for staff at high risk of complications from COVID-19, including pregnant staff.

7.3. Drinking water is available in clinics to ensure workers are appropriately hydrated during prolonged use of PPE which can lead to dehydration, fatigue and exhaustion.


7.4. Staff will be asked to familiarise themselves with this policy and all the accompanying documentation relating to COVID 19

7.5. Staff will be expected to watch the PHE Donning and Doffing Video and adhere to the guidelines at all times

7.6. staff will be expected to ask patients to perform handwashing/gelling pre and post treatment sessions

7.7. Staff will be expected to report any concerns to RHP immediately.


  1. Exposure to COVID-19

8.1. If a staff member or client tests positive for COVID-19, 

  • They will be expected to self isolate as per PHE guidelines.
  • They will not be allowed on the premises during the period of self isolation
  • They will be expected to inform NHS test and trace service so that all contacts can be informed

    1. Staff members must agree for RHP to provide their contact details to NHS test and trace should they be requested.
    2. Clients will be asked to agree for RHP to provide their contact details to NHS test and trace should they be requested.



REFERENCES
  • COVID-19 INFORMATION

https://www.gov.uk/government/publications/wuhan-novel-coronavirus-background-information/wuhan-novel-coronavirus-epidemiology-virology-and-clinical-features

https://www.nhs.uk/conditions/coronavirus-covid-19/symptoms/

https://www.gov.uk/guidance/nhs-test-and-trace-how-it-works

  • INFECTION CONTROL:

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/886668/COVID-19_Infection_prevention_and_control_guidance_complete.pdf

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/886370/COVID-19_Infection_prevention_and_control_guidance_Appendix_2.pdf

https://www.england.nhs.uk/south/wp-content/uploads/sites/6/2017/09/catch-bin-kill.pdf

  • PPE

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 

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/878677/PHE_11606_Putting_on_PPE_062_revised_8_April.pdf

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/878678/PHE_11606_Taking_off_PPE_064_revised_8_April.pdf

https://www.gov.uk/government/publications/ppe-waste-from-home-healthcare-workers-treating-patients-with-covid-19-rps-c5/ppe-waste-from-home-healthcare-workers-treating-patients-with-covid-19-rps-c5

  • MENTAL HEALTH RESOURCES

https://www.gov.uk/government/publications/covid-19-guidance-for-the-public-on-mental-health-and-wellbeing/guidance-for-the-public-on-the-mental-health-and-wellbeing-aspects-of-coronavirus-covid-19

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/876996/Easy_read_looking_after_your_feelings_and_body.pdf

https://www.mind.org.uk/information-support/coronavirus/

  • WORKING SAFELY

https://www.gov.uk/guidance/working-safely-during-coronavirus-covid-19/5-steps-to-working-safely

https://www.hse.gov.uk/simple-health-safety/risk/index.htm

https://www.csp.org.uk/system/files/documents/2020-06/001750_COVID-19_Face-to-Face%20Consultations_Flow%20Chart_V6_0.pdf


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