Coronavirus operational protocol

perfect image consultants - updated - 03/07/2020

1. Covid-19 INFECTION PREVENTION & CONTROL PROTOCOL

Understanding transmission and principles of infection control

The transmission of COVID-19 is thought to occur mainly through respiratory droplets generated by coughing and sneezing, and through contact with contaminated surfaces. The predominant modes of transmission are assumed to be droplet and contact.

The incubation period is from 1 to 14 days (median 5 days). Assessment of the clinical and epidemiological characteristics of COVID-19 cases suggests that, similar to SARS, most patients will not be infectious until the onset of symptoms. In most cases, individuals are usually considered infectious while they have symptoms; how infectious individuals are, depends on the severity of their symptoms and stage of their illness.

The median time from symptom onset to clinical recovery for mild cases is approximately 2 weeks and is 3 to 6 weeks for severe or critical cases. There have been case reports that suggest possible infectivity prior to the onset of symptoms, with detection of SARS-CoV-2 RNA in some individuals before the onset of symptoms.

Further study is required to determine the frequency, importance and impact of asymptomatic and pre- symptomatic infection, in terms of transmission risks.

From international data, the balance of evidence is that most people will have sufficiently reduced infectivity 7 days after the onset of symptoms.

Guidance – Transmission characteristics and principles of infection prevention and control – https://www.gov.uk/government/publications/wuhan-novel-coronavirus-infection-prevention-and-control/transmission-characteristics-and-principles-of-infection-prevention-and-control

(accessed May 2020)

2. Risk assessment for patients and staff

2.1 Staff

  • Consider personal circumstances, family circumstances and their social behaviours and how those might impact risk to patients.
  • Reduce their own exposure and risks to patients as far as is possible.
  • Individual circumstances will need to be assessed and taken into account when considering how and when to deploy.
  • Should feel that the measures taken and roles allocated are appropriate and safe for them to undertake.
  • Please alert Dr. Silva as soon as possible if you have an concerns or information that may risk the clinic staff and its patients.

2.2 Patients

  • Will be screened patients over the telephone before the appointment, in addition to the usual medical, social and psychological history, specific risks for Covid-19 need to be identified.

In Addition

Some exclusion criteria are common sense, some Dr. Silva may decide upon himself. Some risks will be appropriately addressed with additional precautions.

Risk factors to be included in the screening questionnaire include;

2.3 Medical History

Patients who have been asked to shield or a deemed as high-risk may refused an appointment.

 Medical conditions include-

  • System diseases such as cardiac disease, respiratory disease, liver disease or kidney disease
  • Diabetes
  • Immunodeficiency
  • Currently being treated for cancer
  • Obesity

Other factors include

  • Age 65 or over
  • Any patient that has been advised to shield at home
  • Any seasonal allergies which cause spontaneous coughing or sneezing

Please note

2.4 Recent symptoms

  • Fever
  • Persistent cough

Additionally any symptoms that are not ‘normal’ such as (but not limited to);

  • Fatigue
  • Body aches
  • Headache
  • Sore throat
  • Loss of smell or taste
  • Nausea

2.5 Social factors

  • Living with vulnerable family members (elderly or shielding).
  • Recent contact (within 14 days) with someone diagnosed with Covid-19.
  • Current employment and social distancing measures at work.
  • Living with family who continue to work without adequate social distancing.
  • Uses public transport to work.

Any staff  with symptoms must self -isolate and close contacts advised and act as per government guidelines.

Any patients with the symptoms above may not be given an appointment and therefore refused treatment

3. Infection control measures

3.1 The environment

  • Ensure that non-essential clutter, decoration, magazines or brochures are removed from the clinic
  • Any soft furnishings are removed
  • Decommission door knockers or buzzers and substitute with call or text message system for entry
  • Signage or screens/cordons may be installed where necessary to support the new systems
  • Established patient ‘journey’ through the clinic.

3.2 Cleaning

3.2.1 Common Areas

All common areas will be cleaned daily. All hard surfaces, including door handles, light switches etc. will be wiped using household bleach diluted as per brand instructions, or detergents which confirm they are effective against Covid-19. Once wiped with detergent, surfaces should be left for 10-15 minutes

70% alcohol wipes, sprays or gels are known to be effective within 30 seconds. For additional guidance please read: Persistence of coronaviruses on inanimate surfaces and their inactivation with biocidal agents. Steam or fogging can be used on soft furnishings that cannot be removed such as carpets in common thoroughfares.

3.2.2 In treatment rooms

Clinical work surfaces, treatment couches and anything used or touched during the treatment episode will be wiped with a detergent effective against covid-19 with clinnell wipe.

Staff will be allocated cleaning tasks associated with their designated role, ensuring all areas and risks are covered.

3.3 Ventilation

Rooms will be well ventilated, the quality of ventilation should be risk assessed according to the size of the room and what measures are possible to ventilate it between procedures.

To avoid patients and staff being irritated by cleaning fluids, time following cleaning will be allowed for any fumes to disperse and surfaces to dry.

If windows can be opened, they will be.

If air conditioning is necessary to maintain the room at a comfortable temperature, the fan will be kept on low and the unit used to cool the room between treatments, rather than during.

3.4 Personal Hygiene

Staff should ensure they use clean clothes or scrubs you only wear at work. These should not be worn to or from work and will be taken away in a specific bag and washed at 600 between clinics.

Keep hair clean and tied up if long as per infection control policy.

Do not wear sleeves, jewellery (except a wedding band)and keep nails naked and short, as per infection control policy.

Wash hands as per infection control policy. For additional information please read: My 5 Moments for Hand Hygiene

Avoid touching eyes or face.

Alcohol hand gels are not more effective than proper hand washing procedure and should not be substituted in a clinical environment.

Patients will be invited to wash their hands on arrival.

Alcohol hand gel is offered on departure, this will be dispensed by clinical staff wearing masks or from a hands free dispenser.

3.5 Additional infection control

Staff must bring in their own food (not go out to the supermarket for breaks), bring in their own utensils and mugs and take them home at the end of the day.

Patients will not be served refreshments.

4. Use of PPE

4.1 The appropriate PPE will be provided for staff

  • Disposable gloves
  • Disposable aprons and
  • Fluid resistant surgical face masks
  • Facial visors
  • (accessed May 2020)

Fluid-resistant (Type IIR) surgical masks (FRSM) provide barrier protection against respiratory droplets reaching the mucosa of the mouth and nose. FRSMs are for single use or single session use and then must be discarded. The FRSM should be discarded and replaced and NOT be subject to continued use if they become soiled or damaged.

The protective effect of masks against severe acute respiratory syndrome (SARS) and other respiratory viral infections has been well established. There is no evidence that respirators add value over FRSMs for droplet protection when both are used with recommended wider PPE measures in clinical care, except in the context of AGPs.

4.2 Surgical masks should:

Cover both nose and mouth
Be worn once and then discarded – hand hygiene must be performed after disposal

Be changed when they become moist or damaged
Not be allowed to dangle around the neck after or between each use
Not be touched once put on

A single face mask can be worn for a single task or session where you are going to be within a metre of the patients face. A single session refers to ‘a period of time where a practitioner is undertaking duties in a specific care setting/exposure environment A session ends when the practitioner leaves the care setting/exposure environment’.

Sessional use should always be risk assessed. PPE should be disposed of after each session or earlier if damaged, soiled, or uncomfortable. It may not be necessary to change the mask between patients, providing you do not need to adjust it or remove it. If you need to take it off, remove it completely and dispose of it. Avoid touching it, or your face.

4.3 Eye protection or full-face visors

Eye and face protection provides protection against contamination to the eyes from respiratory droplets, aerosols arising from AGPs, from plume generating procedures and from splashing of secretions (including respiratory secretions), blood, body fluids or excretions.

Eye and face protection can be achieved by the use of any one of the following:

  • Surgical mask with integrated visor
  • Full-face shield or visor
  • Polycarbonate safety spectacles or equivalent
  • Regular corrective spectacles are not considered adequate eye protection.

4.4 Other points to note

  • Since we are not treating confirmed, suspected cases or symptomatic patients (though we cannot know), such protection should be worn if there is a risk of splashing with blood, respiratory or bodily fluids or you are performing plume generating procedures which include laser and ablative plasma.
  • Staff should be dispose of the PPE correctly and in the appropriate manner
  • Wash hands after removing and disposing of PPE hand washing guidelines.
  • Staff wearing PPE should take regular breaks and maintain hydration
  • When requiring signatures, risk assess and use alternative methods.

For example;

  • Paper records, the patient may sign with their own pen and place the record face down in a tray. These records can stored securely, for filing 72 hours later and not touched in the meantime.
  • Pens/ stylus can be disinfected between use with alcohol wipes and used immediately following hand washing.
  • No hugging, hand shaking, keep talking to a minimum and no laughing.
  • Patients (and staff) with seasonal allergies who are prone to sneezing or coughing should take antihistamines and if symptoms are not managed, wear masks which may limit the treatment options. (This risk should be identified at pre appointment screening). It is important to minimise the dispersal of respiratory secretions, reduce both direct transmission risk and environmental contamination.
  • If either a member of staff or a patient does need to cough or sneeze, then the ,’Catch it, bin it, kill it’ process must be applied.
  • Disposable tissues must be available, used covering nose and mouth, then disposed of promptly in a lined, pedal operated bin and hands washed immediately.
  • Patient’s skin should be disinfected with either hypochlorous products such as Clinisept+ or Natrasan or 70% alcohol.

4.5 Patient guidance

Consider how patients will access the clinic. Can you see them at the door? Is there a buzzer, if yes it should be decommissioned and a call or text message system put in place.

If for the patient, cash payment is necessary, then additional precautions should be taken; gloves worn, the cash bagged, and hands washed following the exchange.

Patients will be asked not to bring unnecessary belongings with them, essentials must be placed on a surface or in a container which can be disinfected or disposed of between patients.

Patients asked to attend their appointments wearing a face covering. The face covering to be worn at all times if possible.  

 

5. Social distancing

5.1 Changes to practice/ Premises

Minimum contact time should be maintained

Post treatment patients will be contacted by phone, this may be a voice call or a video call in if need, instead of an appointment at the clinic if possible.

Appointment schedule has changed to ensure only one patient is in and out the clinic at any one time.

There will be a half an hour gap between in each patient to minimise the chance of patient crossing paths. This also allows to enough time to ensure that the infection control and preventions steps are being adhered to..

The reception area and consultation room has been decommissioned, patients will be taken straight to the treatment room, maintaining a 2 metre distance from any staff until the procedure commences.

Payments – Cash payments are not accepted. Where possible patients should pay by Bank transfer, if this is not possible the card machine will be available to use, but will be wiped down before and after each use.

5.2 Staff deployment

Only one admin staff will be working on any given day.

Other than Dr. Silva there may be only one other practitioner on any give day.

Non-clinical staff may be redeployed in pre-appointment screening and ensuring patients receive all necessary information and advice in advance and appropriate remote follow-up.

Non-clinical staff may also be helpful in escorting and supervising patients from entry to treatment room, allowing the clinician to remain in and prepare the treatment area between patients.

Staff members will be restricted to their own area of work, with their specific duties. There  should be no overlap in staff for example sharing computers, pens etc.

6. Risk assessing procedures

Some treatments present a higher degree of risk than others, either because of the site (close to the nose or mouth) or because they may generate aerosol, splash or plume.

Risk assess and determine which treatments require specific and additional measures and which treatments cannot be offered.

6.1 Injectables

Whilst injectables do not impact risk of contracting or recovery from any viral infection, there is some evidence to suggest viral or bacterial infections can trigger immunogenic reactions in the implants, which may be delayed. This risk is specifically addressed in your consent and documented. Should this complication arise, management may be challenging as steroids cannot be used, and should lock down recur, face to face treatment such as HyalaseTM (hyaluronidase) cannot be administered. The symptoms may be inconvenient, but will not be life threatening and may settle spontaneously.

6.2 Treatments requiring prolonged contact time

Subject to patient specific risk assessment, procedures are now planned to minimise contact time.

Multiple procedures should be avoided in.

Mouth washed may be provided if the treatment are is near the mouth.

6.4 Treatments requiring a staged course or more than one treatment at intervals

Circumstances may change rapidly.

Treatment may be deffered depending on the length and the number of treatments required.

6.5 Plume generating procedures (laser, ablative plasma or diathermy)

More information can be found at : https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/474136/Laser_guidance_Oct_2015.pdf

7. Adverse events and outcome dissatisfaction

If Perfect Image Consultants cannot employ a strategy to support the patient, do not proceed. Defer treatment.

8. Complaints and concerns management strategy and terms

Generally, patients will be advised in advance and in writing that should a complication (any complication described in consent) arise and a lock down is enforced, face to face consultations will not be possible and any assessment, management and support can only be provided by telephone or video call, remotely. Corrective procedures will not be possible until lockdown is released. If this risk is unacceptable to the patient, they should not proceed. No refunds or financial compensation can be offered for circumstances beyond our control. By booking a treatment they are accepting these risks and terms.

 

9. Reassuring and educating patients

Patients will be anxious.

As part of pre-appointment screening and consultation, each point will be explained all the steps you are taking to manage risk.

Staff will identify and address any specific concerns a patient might have. If a patient seems especially anxious, avoid persuading them, but rather reassure them they can defer treatment until they feel safer.

Patients can ask for an email to help understand the patient journey.

10. The Patient Journey

 

Step 1 : Patient to make an appointment by telephone. No walk in appointments

Step 2: Patients to be asked the patient COVID 19 screening questionnaire.

Step 3: If the patient pass the screening questionnaire- appointment to be made for 1.5 hours and the patient explained the patient journey. If the patient does not pass the screening, appointment will be refused until the circumstances change.

Step 4: Patient to arrive for appointment on time – not early or late. If the patient arrives late, they maybe be asked to rebook their appointment. Patients to arrive wearing a facial covering . Avoid bringing personal belongings to your appointment. You should also attend your appointment unaccompanied, if possible.

Step 5: Patient to call the clinic, to alert staff,-  staff will allow entry.

Step 6: Patients will be escorted directly to the treatment room, patients not to wait or sit in the reception area.

Step 7: Patients will be invited to wash their hands- Dr Silva will over see this and ensure patients are washing hands according to the guidance and provide the necessary to avoid patients touching all surfaces.

Step 8: Patients temperature will be taken and recorded

Step 9: Patient consultation – patient should wear a mask at all times if possible. Staff will maintain a safe distance.

Step 10: Patient Treatment

Step 11: Patient escorted to reception to make payment if they cannot pay by bank transfer.

Step 12: Patient leaves the clinic.

Step 13: Appropriate staff to ensure all surfaces are wiped down, change PPE.

 

 

11. Patient screening Questionnaire

Coronavirus Patient Questionnaire For Perfect Image Consultants

Please note as a safety measure we require the following information.

 

SURNAME

 

FIRST NAME

DOB

AGE

 

Have you travelled abroad in the last 30 days?

YES

NO

Have you experienced any of following symptoms in the last two weeks?  if yes please circle

 

PERSISTENT COUGH

 SORE THROAT

FATIGUE

NAUSEA

DIARRHOEA

LOSS OF SMELL / TASTE

BODY ACHES

HEADACHES

HIGH TEMPERATURE

SHORTNESS OF BREATH

 

Do you suffer from any of the following medical condition ?  if yes please circle

CARDIAC DISEASE

 RESPIRATORY DISEASE

LIVER DISEASE

KIDNEY DISEASE

DIABETES

IMMNUODEFICIENCY

CURRENT CANCER TREATMENT

OBESITY

SEVERVE ALLERGIES

 

 

 

Are you living with anyone over the age of 70?

YES

NO

Are you or anyone in your household shielding?

YES

NO

 

Have you been in contact with anyone who has a confirmed case of coronavirus?

YES

NO

 

PLEASE NOTE:-

·      Patients must attend their appointment wearing a face covering

·      Patient temperature will be taken on arrival

·      Patient must maintain a safe distance from others at the clinic

·      Patients must wash their hands on arrival

YES

NO

 

Date of questionnaire

 

Completed by

 

 

Please confirm that the above is correct as at today’s date.

YES

NO

PATIENT SIGNATURE:

DATE:

       

 

Temperature on arrival

Time Taken

Taken By (Name and Sign)

Please ask patient to wash hands as per guidelines