TRIUMPH PHYSIO AND WELLNESS COVID-19 SAFETY PLAN

PHASE 2 RE-OPENING POLICIES AND PROCEDURES

This document describes the policies and procedures in place at Triumph Physio and Wellness to support appropriate infection prevention and control (IPAC) practices to mitigate the impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of COVID19. As of May 19, 2020 all staff and contractors working at Triumph Physio and Wellness will adhere to these policies and procedures.

Public Health Measures

Self-Isolation and Quarantine

Health care providers and staff with common-cold, influenza, or COVID-19 like symptoms are instructed to stay home, be assessed by their health care provider and tested for COVID-19. If a staff member or an independent contractor is symptomatic, they are advised to self-isolate and follow directions provided by their health care provider. Self-isolation is also advised for those who are considered a close contact of a confirmed case and are waiting to see if they develop COVID-19 illness.

Environmental Measures

Cleaning and Disinfection

Regular cleaning and disinfection are essential to preventing the transmission of COVID-19 from contaminated objects and surfaces. Clinic spaces will be cleaned and disinfected in accordance with the BCCDC’s Environmental Cleaning and Disinfectants for Clinic Settings document.

The following cleaning protocols are being applied:

• Shared equipment will be cleaned in between clients. Equipment used by the client will be left in the treatment room, so that the front desk staff know it has been used and needs to be cleaned before returning it to the appropriate storage location.

• Treatment equipment, practice tools, tables and examination beds will be cleaned in between clients.

• Frequently-touched surfaces (e.g. medical equipment, treatment table knobs, treatment stools, bolsters, call bells, door knobs, light switches, telephones, keyboards, computer mouse, ipads, pens, cell phones, and countertops) will be cleaned and disinfected at least twice a day.

• General cleaning and disinfecting of treatment rooms will occur at least twice a day (e.g. Any surface that is visibly dirty will be cleaned and disinfected).

• Cleaning products utilized in the disinfection of clinic equipment and surfaces include: Cavicide, Lysol Wipes, Isopropyl Alcohol

• Bed linens and pillow cases will be washed after single use.

• Garbage containers will be emptied daily.

• Disposable gloves will be worn when cleaning blood or body fluids, for example, runny nose, vomit, stool, urine.

Physical Changes to the Clinic

• Clients are instructed to enter the facility through the side entrance of Planet Ice. This is a private entrance point reserved only for Triumph Clients and Staff.

• Clients are instructed to call from the parking lot when they arrive for their appointment so that front desk staff can instruct them on the best time to enter the facility in order to maintain social distancing

• The clinic has been separated into zones, and one person will be permitted per zone (not including the treating therapist). There are two waiting zones, two treatment zones, one acupuncture zone, and two exercise zones.

• All but 2 chairs positioned 2 meters apart remain in the waiting room. These are designated into zones (e.g. Waiting Zone 1 and Waiting Zone 2). Clients are to be placed in Waiting Zone 1 first if it is not possible to be brought directly back to their treatment room. This will allow for the next client to be placed in Waiting Zone 2 without crossing Waiting Zone 1.

• Alcohol-based hand rub (ABHR) with a minimum of 70% alcohol is available immediately upon entry to the clinic as well as on the counter at the reception desk.

• Procedure/exam rooms have only a treatment table, 2 pillows with wipeable covers, a towel over the pillow, a sheet over the treatment bed, a chair, a wipeable bolster, a call bell, a box of tissues, and a treatment stool.

• Frequently used doors will be kept open to avoid recurrent contamination of doorknobs and high touch contact points.

• Signage has been placed at the entrance/exit doors, in the reception area, and throughout the clinic.

• Signage includes information on proper hand hygiene, social distancing, use of masks, and signs of COVID-19 which if present require that the client does not enter the clinic and seeks the appropriate medical attention.

• Treatment room curtains have been replaced with plastic curtains to allow for a wipeable surface for enhanced infection control protocols.

• The clinic will be utilizing the HVAC systems to circulate air throughout the space as it is not possible to open windows.

• An acrylic partition has been installed at the reception counter, and this area is marked off by tape to remind clinicians not to enter the reception work area.

Administrative Measures

Physical Distancing and Minimizing Physical Contact

Physical distancing means maintaining a distance of 2 metres between two or more people. The following physical distancing strategies have been implemented:

• Clients will enter the facility through the side door. This entrance is reserved for Triumph clients and staff only, and will not be used by the general public.

• We have reduced the number of people in waiting rooms. Clients are asked to wait in their cars and call upon arrival so that the front desk staff can inform them when the appropriate time to enter the clinic is in order to maintain physical distancing.

• If client’s require the elevator to access the clinic, they are to call upon arrival and staff will come down to the main entrance to open the sliding doors and direct clients to the elevator.

• Staff are advised to avoid close greetings (e.g., handshakes, hugs).

• Appointment times have been staggered, with practitioners reducing the number of clients they treat in a day (maximum number of clients per practitioner is 10/day).

• Only one staff member at a time is allowed in the break room, and kitchen utensils, microwave or kettle/keurig handles, and countertops are to be wiped down by staff/contractors after use.

• One way traffic flow of people has been implemented in the clinic, including waiting rooms and hallways.

• Two “Exercise Zones” are demarcated with tape on the floor, and clients who need to use equipment outside their treatment room will only be permitted one at a time in each of the Exercise Zones.

• The therapist is responsible for cleaning any equipment used in the “Exercise Zones”, as the front desk staff will not know which surfaces have been contacted.

• Clients are asked to attend their sessions independently, with exception for minors who are allowed to have one parent attend their session and siblings must stay at home.

Contact tracing

Front desk staff will record by name any individual who enters the clinic facility. This information will be noted within the JaneApp EMR for each treatment day in order to provide accurate records if required should someone who attended the clinic test positive for COVID-19 and contract tracing documentation be requested.

Scheduling

Scheduling approaches include reducing the number of clients each clinician can treat in a single hour to a maximum of 2. Appointment times are lengthened by 10-20min or breaks in schedule will be added to the clinicians schedule in order to allow for the increased cleaning requirements of treatment rooms and equipment between clients. The automated pre-visit messages sent via Janeapp, clinic telephone message/voice mail, and website have all been adjusted to instruct clients on clinic procedures during sessions as well as where to seek up-todate instructions on assessment for COVID-19.

Pre-Appointment Triage

Triumph clinicians are responsible for determining if client appointments can be virtual or if they need to be in person. Staff and contractors have been referred to the Provincial Health Services Authority COVID-19 Virtual Health Toolkit to support health care practitioners to deliver virtual care. Staff and contractors have also been instructed to seek guidance from their respective regulatory college or association about appointment prioritization, in order to determine which clients qualify for in person care and which clients can be treated virtually. All clients are to be pre-screened prior to the start of their appointment. Front desk staff will verbally ask every client all of the questions within the Triumph COVID-19 Screening/Liability form. The form will be signed in JaneApp by the front desk staff upon verbal confirmation from the client that they meet the requirements to allow for safe attendance of their in person session and acknowledge the increased risk in doing so. Clients who do not meet the requirements for safe attendance of in person sessions will be given a mask and advised to self-isolate and follow directions provided by their health care provider. They will be asked to leave out the front door of the clinic and not permitted to enter the treatment areas of the clinic in order to protect staff and other clients from risk of exposure. Services for the clients who answer yes to the pre-screening questions are to be delayed until 10 days from the onset of symptoms AND until symptoms resolve, whichever is longer. If an appointment is deferred, the client will be informed about what to do if their symptoms get worse. Clients with symptoms of common cold, influenza, COVID-19, or other infectious respiratory disease should only be seen if by not doing so, they would experience undue harm or injury. These clients will be treated as testing positive for COVID-19 symptoms and treated at the end of the therapists day, with the therapist donning full PPE for droplet and contact precautions (mask, gloves, gown, eye protection).

Older clients or those with Chronic Illnesses

• If an in-person appointment is required for an older client or client with a chronic illness, staff and independent contractors are advised to consider scheduling these as the first appointments of the day.

• Staff and independent contractors are to suggest to clients who live alone that they arrange to have a friend to check in on them in the event that they fall ill.

Personal Measures

Stay Home When Sick

• All staff who have symptoms of COVID-19 OR travelled outside Canada in the last 14 days OR were identified as a close contact of a confirmed case must stay home and self-isolate.

• Staff must assess themselves daily for symptoms of common cold, influenza, or COVID-19 prior to entering the clinic. This will be documented either via an email from the clinician to the clinic at info@triumphphysio.com stating they are cleared to work that day, or will be added within the JaneApp sign in requirements for staff to acknowledge they do not present with increased risk of COVID-19 exposure or symptoms prior to logging in for each.

• Those unsure of if they should self-isolate are directed to use the BC COVID-19 SelfAssessment Tool. If concerned, they can also contact 8-1-1 or the local public health unit to seek further input.

Hand Hygiene

All Triumph staff and contractors will practice diligent hand hygiene by adhering to the following:

• Wash hands with plain soap and water for at least 20 seconds. Antibacterial soap is not needed for COVID-19.

• If sinks are not available, use alcohol-based hand rub containing at least 70% alcohol.

• If hands are visibly soiled, alcohol-based hand rub may not be effective at eliminating respiratory viruses. Soap and water are preferred when hands are visibly dirty.

• Staff have been briefed on best practice for hand washing using the BCCDC’s hand hygiene poster.

Clinic strategies to ensure diligent hand hygiene include:

• Hand hygiene stations are set up at the clinic entrance and exit, as well as in the main treatment area of the clinic so that everyone can perform hand hygiene when they enter the clinic, as needed during their treatment sessions, and prior to exiting the clinic.

• Hand washing supplies including plain soap, paper towels and where appropriate, alcohol-based hand rub with a minimum of 70% alcohol are stocked to ensure a minimum of 2 weeks supply at all times.

• Posters to promote the importance of regular hand hygiene are placed within the clinic.

• Paper towels will be disposed of in non-touch waste-baskets lined with a garbage bag.

For clients and staff, hand hygiene is to be performed:

• On entering the clinic;

• On entering the examination/procedure room;

• On leaving the examination/procedure room;

• After using the washroom;

• After using a tissue for their face;

• After coughing or sneezing.

For staff, including health care providers, hand hygiene must also be performed:

• Before and after contact with client or the client care environment;

• Before and after breaks;

• Before clean or sterile procedures;

• After risk of body fluid exposure;

• Before donning PPE; and

• In between each step when doffing PPE.

Respiratory Etiquette

Clients and staff are advised to:

• Cough or sneeze into their elbow sleeve or a tissue;

• Throw away used tissues and immediately perform hand hygiene;

• Refrain from touching their eyes, nose or mouth with unwashed hands; and

• Refrain from sharing any food, drinks, eating utensils.

Personal Protective Equipment

Where there is low incidence and prevalence of COVID-19, additional PPE over and above that required for normal precautions is not required.

Point-of-care risk assessment (PCRA) for COVID-19

Prior to any client interaction, all health care providers have a responsibility to assess the infectious risks posed to themselves, other health care workers, other clients and visitors from a client, situation or procedure. The PCRA is based on the health care provider’s professional judgment about the clinical situation, as well as up-to-date information on how the specific health care facility has designed and implemented physical (engineering) and administrative controls, and the use and availability of PPE. Performing a PCRA to determine whether PPE is necessary is also important to avoid over-reliance on PPE, misuse or waste. Over-reliance on PPE may result in a false sense of security. Incorrect use and doffing of PPE can expose clinicians and staff to infectious agents and contaminate the environment.

Front desk staff and clinicians will:

Always follow routine practices and conduct a PCRA prior to any client interaction.

• Health care providers and staff who have direct contact with symptoms suggestive of COVID-19 must follow droplet and contact precautions.

• Services for the client/clients who answer yes to the pre-screening questions are to be delayed until 10 days from the onset of symptoms AND until symptoms resolve, whichever is longer.

PPE is not required for HCWs who work more than 2 meters from clients at all times.

When wearing PPE staff are instructed to:

• Avoid touching your mask or eye protection unnecessarily. If you must touch or adjust your mask or eye protection, perform hand hygiene immediately.

• If you see a colleague touch or adjust their mask/eye protection, remind them to perform hand hygiene.

• Use extreme care when doffing/removing PPE and always perform hand hygiene when finished.

• Proper donning and doffing of PPE is to be practised prior to the treatment of any clients.

• Hand hygiene is required before donning and after doffing PPE.

• When doffing, resist the urge to touch your clothes, skin, hair or face with your hands until after the final hand washing.

PPE Guidance for clients

• Clients presenting in-person to Triumph are asked to wear their own masks to their treatment sessions and if they do not have a mask a disposable one will be given to them upon entry to the clinic provided mask wearing is medically tolerated.

Office Management Clinic Response Planning, Organization and Ethical Decision Making

COVID-19 Practice Lead

• The owner, Karen Bhartu, has been designated as the lead for the purposes of mounting a coordinated response to COVID-19 at the practice level.

• The lead will coordinate staff responsibilities, information gathering and dissemination, and develop a preparedness plan for the clinic.

Staff Education and Communication

• During times of crisis to ensure that health care providers and staff have the most up-to-date information, updates will be provided by email to company email addresses.

• If email communications channels are not working, the clinic owner will communicate with staff and contractors via cell phone (call or text).

• Regularly updates will be communicated to contractors and staff to ensure that staff have clear, up to date information for communicating with clients.

• Health and safety concerns are to be reported to the clinic owner in written format, via email to karen@triumphphysio.com.

• Phase 2 re-opening plans have been prepared and reviewed with staff via a Zoom meeting held Sunday May 17, 2020 at 3:00pm to ensure comprehension, and smooth implementation.

Psychosocial Support

It is important to support the psychosocial well-being of health care providers and staff during the COVID-19 pandemic. Open communication is key to this objective.

• Staff should be provided with access to up-to-date information on COVID-19, including how to protect against infection and transmission.

• Staff should be provided with flexible options for remote/teleworking options, where possible and appropriate.

• Staff should be provided with sick-leave to support self-isolation. BCCDC offers guidance for psychosocial planning for health care providers during the COVID-19 pandemic.

www.bccdc.ca/health-professionals/clinical-resources/covid-19-care/health-care-provider-support

Staff Scheduling and Reassignments

Staff scheduling should be considered when developing a coordinated pandemic response for the clinic.

• Consider adjusting clinic hours to accommodate client and staffing needs, while supporting physical distancing and infection prevention measures.

• Assess staffing availability relating to greater staffing needs and expected staff absences for family or self care.

Sick Leave Policy

• Health care providers and staff who have suspected or confirmed COVID-19 are to self-isolate at home.

• Staff and clinicians with symptoms of COVID-19 will be permitted to return to work upon receiving negative results from a COVID-19 testing facility nasal swab.

• Clinicians and staff testing positive for COVID-19 will be permitted to return to work 10 days after the onset of symptoms AND until symptoms resolve, whichever is longer.

In extreme circumstances where a shortage of healthcare providers compromises client safety, a “fit for-work with restrictions” approach may be taken, provided ALL the following requirements are met.

The healthcare provider must:

• Only have mild respiratory symptoms;

• Feel well enough to work;

• Practice strict respiratory and hand hygiene protocols; and

• Wear a mask.

Some staff might be only mildly ill or already recovering and/or caring for others and are able to perform some of their duties remotely by internet or telephone, depending on how a clinic is set up.