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REOPENING PROPOSAL AND RESULTS OF RISK ASSESSMENTS FOR OSTEOFUSION ACROSS HIGH WYCOMBE AND HARWELL CLINICS

 

These guidelines are subject to constant reassessment and, therefore, change and will be reviewed on a weekly and case-by-case basis.

 

Proposed reopen date – Wednesday 20th May 2020. 

(This allows enough time for PPE to arrive).

There may be slightly reduced hours of operation for now, but will be at least 6 hours a day for session timings.

 

Sources: 

UK Government Guidelines for Covid-19 Public

Health England (PHE)

General Osteopathic Council (GOsC) as regulatory body by law under the Osteopaths Act 1993.

 

Patients will not be waiting for appointments as they will be seen at least 60 mins apart and will be asked to come in on time and not early, unless requested. If toilets used, then I will wipe areas of fomite transmission and disinfect as necessary.

Room will be devoid of all linens and there is a hard floor in situ.

Room has wipe clean patent/intact couch cover and waterproof pillows.  Use of couch roll disposed of between each patient. If towel used then single use, bagged and removed after treatment for laundering. Separate mop and bucket for clinic use only – flash floor or other suitable disinfectant used at session end and allowed to air dry.  Further mopping to be done throughout session as usual if body fluids or other soiling.  Alcohol wipes for cleaning fomite surfaces – door handles, couch, desk and plastic chair.  Milton solution in spray bottle as a safe alternative for wiping couch (PVC cover can be degraded by bleach)Frequent hand washing with soap and water via sink, dried on paper towels or air-dried.   Followed up with alcohol gel.  

Max 5 patients a day to allow for increased turnaround time. Patients must be urgent cases or those who would otherwise access GP or Physio care.

Shielding patients not to be treated at the current time.  Other pre-screened, vulnerable patients will be assessed on case-by-case basis.  Patients subject to pre arrival brief questionnaire verbally. Patients will have temperature and oxygen saturations taken upon arrival and asked to clean hands with alcohol gel provided at door. The evidence for taking temp and saturations as adequate screening is poor, but I believe patients will be reassured by this measure. Patients will be asked to wear a mask but cannot be enforced at this time and must agree to risk if not worn – note will be made on record.   Patients will be asked to supply their own mask but some will be available if required. 

No extra consent process to examine and treat is required at this time, as this is covered in consent and communication already practiced. Practitioner will wear a mask whilst in room with patient. Clothing will be changed between patients otherwise plastic disposable apron will be worn. Surgical gloves will be worn if skin on hands compromised.

Wave and pay only via card terminal and no cash taken.

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Waste produced (couch cover and paper towels) not deemed to be needing disposal via my clinical waste contract, will be double bagged at session end and left for 72 hours before being placed into general waste bins for disposal – as per PHE guidelines.  This can be stored in the outer areas of both clinic sites as appropriate and will not be more than half a bin bag produced per session.

 

I have a certificate of registration under the waste regulations 2011, to act as a lower tier waste carrier for waste produced commercially.   I can therefore transport bags to my home for disposal if necessary.

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Procedure in the event of being notified of subsequent covid-19 positive test result, or strong indicating symptoms from patient I have treated.

 

Current symptoms of Covid-19 infection are incredibly hard to screen for without a lab swab test, and so it is nearly impossible to assess if someone may be suffering.   All we can do is try to mitigate as much risk as possible with suitable pre screening and scrupulous hygiene and PPE measures.

A patient may be carrying the virus but be asymptomatic.  The contagious period has been described as 72 hours before symptoms even appear and then these can be very mild and barely noticeable.

Younger people tend to have cardiac or clot related illness whilst older people tend to have respiratory illness requiring ventilation in ICU.  Children have had symptoms of abdominal pain and digestive upset.

 

General known symptoms include –

Persistent cough, fever, aches and pains, diarrhoea, abdominal pains, headache, lethargy and shortness of breath.

I will therefore be asking such questions on booking patient in, as well as enquiring as to their movements and exposure to others in the preceding 5-7 days (incubation period).

Patients are known to still be viral shedding 32 days after infection and immunity to re-infection post Covid-19 is not confirmed, and should not be assumed.

 

Should I be notified that a patient has developed symptoms – I will advise them to seek medical advice, and then contact all other patients I have seen after them to let them know to be vigilant, perhaps isolate to protect their family members and to let me know if they develop symptoms so I can record appropriately. 

If I myself suspect I am infected, then of course I will cease to practice and self isolate for 7 days.

The room will be deep cleaned at end of every day anyway.

Patients will sign a declaration before treatment covering all treatment sessions, that they have answered my screening questions and do not knowingly have symptoms of Covid virus infection.  This is not a malpractice disclaimer. 

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With all these procedures in place, I believe I can practice safely and provide much needed care to my patients, after an extended break, relieving overstretched NHS GP and Physio services.

With my access to LAS NHS procedures and knowledge, I have and increased depth of information to assist me in my endeavours. 

 

Document correct and dated as of Monday 11th May 2020.

 

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