COVID 19 Clinic Safety
booking & Pre-screen
We are currently able to offer face to face appointments for Podiatry | Osteopathy | Physiotherapy | Acupuncture for urgent and essential cases. This includes:
- Progressive pain that has not responded to conservative treatment or medication.
- Having essential care needs, which if not met, will require care from General Practice, secondary care or social care agencies.
- Symptoms which are causing a significant impact to your daily living activities
Regrettably at this time we are unable to accept any face to face bookings from patients:
- who are required to shield, due to underlying health conditions
- who have experienced Coronavirus symptoms (raised temperature, persistent cough, loss of smell/taste) in the past 14 days
- live with someone who has exhibited these symptoms in the past 14 days
To make a booking please call 01392 875770 or book online here. Following a booking you will receive and email with a pre-screen form to complete. Once this form is completed you will receive a call from your practitioner who will discuss with you and identify whether a Telehealth or face to face appointment is most appropriate in advance. Please do not attend until your appointment until you receive a confirmation call from your practitioner.
Entering the premises
On coming to the premises please:
- bring your own face mask and ensure you arrive on time not early as to avoid waiting. If you do not have one we have a limited supply that can be purchased from the clinic.
- be mindful of social distancing if necessary as indicated by signage. Appointments are staggered to reinforce this.
- Ring bell at the reception entrance (controlled barrier) where your practitioner will great you in necessary PPE and complete the pre-screen by taking your temperature with a contactless infrared thermometer.
- Use the hand sanitiser provided
You will then enter the treatment room which will have an open a window to allow for air circulation. Other changes to the clinic to maximise safety include:
- ‘De-cluttered’ clinic and waiting rooms, to minimise surface areas for cleaning. This includes magazines, tea making facilities.
- Clinic linens such as plinth covers and pillowcases have been replaced with sanitisable plastic pillowcases.
Our Clinicians' PPE Level
Understanding Personal Protective Equipment (PPE)
All clinician have undergone training to inform themselves of current best practice in the wearing of personal protective equipment.
Before undertaking any procedure, clinicians will ensure relevant PPE is worn. They will provide adequate protection against the risks associated with the procedure or task being undertaken and be trained in the proper use of all PPE that they may be required to wear.
All PPE is:
- Located close to the point of use;
- Stored to prevent contamination in a clean/dry area until required for use (expiry dates must be adhered to);
- Single-use only;
- Changed immediately after each patient and/or following completion of a procedure or task;
- Disposed of after use into the correct waste stream i.e. healthcare/clinical waste (this may require disposal via orange or yellow bag waste; local guidance will be provided depending on the impact of the disease).
HCW less than 2 metres away but not involved with AGPs should wear the following:
- Fluid resistant surgical mask
- Disposable plastic aprons
- Risk assessment for eye protection
Any technique which induces a cough and/or increases respiratory rate is considered aerosol generating procedures (AGPs). Therefore, any HCW involved with patient rehabilitation should assume full AGP-required-PPE (within <2m) even if patient status is not confirmed as a COVID-19 case (Thomas et al., 2020):
- FFP3/N95 mask
- Fluid resistant gown
- Eye protection
Infection Prevention and Control (IPC) Measures
All our practitioners have undergone training in current best practice infection prevention control (IPC).
Introduction to IPC measures
These IPC measures are primarily based on the latest update of the ECDC Technical Report (ECDC, 2020), and WHO Interim Guidance (WHO, 2020). Both documents provide an evidence-based set of technical measures and resources aimed at limiting the spread of COVID-19 in healthcare settings.
Ensuring triage, early recognition, and source control
- Health Care Workers (HCW) should have a high level of clinical suspicion during phone and face-to-face triaging;
- Using screening questionnaires according to the updated case definition.
- Posting signs in public areas reminding symptomatic patients to alert HCWs.
Hand hygiene and respiratory hygiene are essential preventive measures.
Applying standard precautions for all patients
Standard precautions include hand and respiratory hygiene, the use of appropriate PPE according to a risk assessment, safe waste management, proper linens, environmental cleaning, and sterilisation of patient-care equipment.
- Ensure that all patients cover their nose and mouth with a tissue or elbow when coughing or sneezing;
- Offer a medical mask to patients with suspected COVID-19 while they are in waiting/public areas or in cohorting rooms;
- Perform hand hygiene after contact with respiratory secretions.
HCWs should apply WHO’s My 5 Moments for Hand Hygiene approach before (1) touching a patient, (2) before any clean or aseptic procedure is performed, (3) after exposure to body fluid, (4) after touching a patient, and (5) after touching a patient’s surroundings.
- Hand hygiene includes either cleansing hands with an alcohol-based hand rub or with soap and water;
- Alcohol-based hand rubs are preferred if hands are not visibly soiled;
- Wash hands with soap and water when they are visibly soiled.
Implementing empiric additional precautions
Contact and droplet precautions
- Health care workers (HCWs) should follow guidelines in the following section on PPE;
- Equipment should be either single-use and disposable or dedicated equipment (e.g. stethoscopes, blood pressure cuffs and thermometers). If equipment needs to be shared among patients, clean and disinfect it between use for each individual patient (e.g. by using ethyl alcohol 70%);
- HCWs should refrain from touching eyes, nose, or mouth with potentially contaminated gloves or bare hands;
- Where possible, a specific HCW should be designated to care exclusively for suspected or confirmed cases to reduce the risk of transmission;
Airborne precautions for aerosol-generating procedures (AGPs)
Aerosol generating procedures (AGPs) create an airborne risk of transmission of COVID-19. The following AGPs are taken as example from physiotherapy guidelines and include:
- Cough generating procedures e.g. a cough during treatment, a huff;
- Positioning / gravity assisted drainage techniques and manual techniques (e.g. expiratory vibrations, percussion, manual assisted cough) that may trigger a cough and the expectoration of sputum;
- Manual hyperinflation (MHI);
- Inspiratory muscle training;
- Sputum inductions;
- Any mobilisation or therapy that may result in coughing and expectoration of mucus.
(N.B. It is not clear which osteopathic techniques are AGPs at this moment in time but likely examples would be; supine thoracic HVT, upper rib sternal thrusts, any exercise that gets the patient out of breath, deep breathing techniques.)
If it is deemed essential, and cannot be performed in another manner (ie. prone, from behind etc), ensure the following precautions are taken:
- Perform procedures in an adequately ventilated room – that is, natural ventilation with good air-flow;
- Use a particulate respirator at least as protective as a FFP2, or equivalent. When HCWs put on a disposable particulate respirator, they must always perform the seal check. Note that facial hair (e.g. a beard) may prevent a proper respirator fit;
- Use eye protection (i.e. goggles or a face shield);
- Wear a clean, non-sterile, long-sleeved gown and gloves. If gowns are not fluid-resistant, HCWs should use a waterproof apron for procedures expected to create high volumes of fluid that might penetrate the gown;
- Limit the number of persons present in the room to the absolute minimum required for the patient’s care and support.