Risk Assessment of The Faringdon Clinic
Clinic Measures and New Procedures for Re-opening
Following Covid-19 Lockdown May 2020

Risk:

The potential risk of transmission of coronavirus (COVID-19) from an infected person. The WHO states:

“​Data from published epidemiology and virologic studies provide evidence that COVID-19 is primarily transmitted from symptomatic people to others who are in close contact through respiratory droplets, by direct contact with infected persons, or by contact with contaminated objects and surfaces.”

There are no reports of airborne transmission.

The symptoms of Coronavirus as stated by ​www.nhs.uk​ are:

  • a high temperature – this means you feel hot to touch on your chest or back (you do not need to measure your temperature)
  • a new, continuous cough – this means coughing a lot for more than an hour, or 3 or more coughing episodes in 24 hours (if you usually have a cough, it may be worse than usual)
  • loss of taste and smell

The Faringdon Clinic has a duty of care to have procedures in place to minimise the risk of transmission for:

Staff and practitioners – to provide a safe working environment and to have procedures in place which will minimise the risks for those working in the clinic.
Clients – to provide a safe environment which clients feel confident to come in to.

The following information outlines the measures which have been put in place to mitigate the risks, the adaptations to practice and the new procedures which the clinic will now operate by. As this is a new pandemic and an evolving situation, these measures will need to be reviewed and reassessed on a weekly basis, especially in the early stages of re-opening, to ensure that the measures continue to minimise the risks. The information in this document will also be reviewed in line with government advice and advice from governing bodies. This document has been prepared with advice and recommendations provided by the Chartered Society of Physiotherapy, Physio First (Private Physio Group), the Institute of Osteopathy and GCMT (The Council for Soft Tissue Therapists). A clinic walk through has also been completed with a specialist nurse in respiratory and infectious diseases.

The clinic will re-open on June 1st 2020 for limited osteopathy, physiotherapy and podiatry services. Not all practitioners will be able to return to the clinic at this stage for various reasons including shielding, protecting other family members or members of their household or childcare. Also, other professions including massage and soft tissue therapists are not able to resume until July 4th at the earliest in line with government guidance.

Testing

If a member of staff or any of the practitioners develop symptoms then testing is available either by home testing or attending a regional test site. The test should be done within 3 days of developing symptoms.
www.nhs.uk/conditions/coronavirus-covid-19/testing-for-coronavirus/ask-for-a- test-to-check-if-you-have-coronavirus/

Anyone with symptoms will need to self-isolate for 7 days. If a household member develops symptoms, then self-isolation will need to be for 14 days from when the first person in the house started to have symptoms.

If a client develops Covid-19 symptoms after visiting the clinic:

  • If the client experiences symptoms within 2-3 days of visiting the clinic, any
    person with direct contact to that individual should self-isolate.
  • Anyone with indirect contact with the client should be advised of the situation and suggest they monitor for symptoms (those with indirect contact with suspected cases do not need to self-isolate).

Contact tracing

The diary management system enables the clinic to record which practitioners are in on which days as well as the reception staff and clients. All appointments will need to be pre-booked so that the clinic can manage and keep track of who is coming into the building.

Cleaning procedure

Regular daily and weekly cleaning procedures are already in place. However, additional and more stringent cleaning procedures will need to be in place for both the therapy rooms and reception / waiting area.

Door handles, railings, bannister, chairs, telephone, computer mouse, keyboard, card machine, desk and reception area will need to be wiped down with disinfectant every hour, at least. However, certain pieces of equipment may need to be cleaned more frequently such as the card machine and reception desk which will need to be cleaned after each contact.

The reception area will need to be cleaned at the end of the day and between staff changeover. The member of staff finishing their shift will be responsible for cleaning the area.

The clinic building will need to be well ventilated during opening times.

Therapy rooms:

Door handles, the treatment couch, chair, desk and any equipment used or surfaces touched during a treatment session will be cleaned after each client. Floors cleaned regularly after each clinic session.

A cleaning procedure checklist will be provided in each room.

Cleaning solution and alcohol wipes are available in each room and reception. Wipes should be disposed of in the pedal bins.

Clients

All clients will be asked to arrive at their appointment time and ​not ​before. They must not bring anyone with them unless they are required as a chaperone during the treatment (see next section). Clients may bring a sheet/towel to place on the couch to lie on for comfort and another one to act as a covering to keep warm if desired. The couch will have wipeable pillows and tissue covering.

There will be a 15 minute window between bookings to allow for cleaning of the treatment room and client turnaround to avoid too many people in the reception at the same time as social distancing will not be able to be maintained otherwise. This means that there will be less people in the clinic, treatment times will be more spaced out and treatment times will be staggered to avoid clients for different practitioners arriving or leaving at the same time. Clinic sessions for practitioners will be staggered to prevent the movement of too many people through the clinic at any one time as the layout of the building does not lend itself to a one-way system. During the month of June there will be just 2 out of the 3 treatment rooms in use – room 2 (the bigger of the two upstairs rooms) and the exercise room downstairs. Social distancing is easier to maintain in these rooms whilst talking to clients and discussing treatment plans.

All clients will be required to wash their hands on arrival.

Clients being seen in the Exercise Room can wait in reception and clients being seen upstairs will be asked to go upstairs to wait.

The folding chairs will be made available in reception, on the upstairs landing and treatment rooms as these can be wiped down regularly.

Plastic tubs will be made available in each treatment room for clients to put clothes in. These can be wiped out after each session.

Payment – card payment only will be accepted. Contactless payments have now been raised to £45. Any payments of £45 or under can be made in one transaction. Payments above £45 can be split into 2 payments to enable contactless payment to be used.

Any client who has any symptoms which could, potentially, be related to COVID-19 must not come to the clinic.

All new clients will be asked when booking an appointment if they have had COVID-19 or have been in contact in the previous 14 days with a person who has confirmed COVID-19 symptoms.

All clients will be screened prior to treatment. This will be done by filling out a declaration which will be sent to them with their appointment reminder. This can be filled out electronically and will be sent through to the clinic email address.

No exercise classes will be held until further notice as social distancing cannot be maintained in the Exercise Room or reception.

Chaperones

Ideally, the client should come into the clinic unaccompanied. However, there will be occasions when they may need to be accompanied by a chaperone. This may be for mobility reasons, communication, or if the client is a minor.

All chaperones must adhere to the same guidelines as clients, i.e. handwashing on arrival and before leaving, wearing a facemask.

The chaperone (name and relationship to client) must be recorded in the Notes section of the client’s appointment for tracing purposes.

If the chaperone needs to accompany the client during the appointment then the appointment should take place in the larger Rooms 2 or 3.

Practitioners

The following information relates to generic procedures adopted by the clinic. However, there are several different disciplines working at the clinic who are regulated by different governing bodies. These governing bodies may have specific procedures in place which need to be followed by the relevant practitioner. It is the responsibility of each practitioner to make themselves aware of their profession’s specific recommendations and advice. It is their responsibility as a self-employed practitioner to adhere to their profession specific guidelines. If there are recommendations which are not detailed in the generic information, then practitioners must advise the clinic accordingly with written information.

All practitioners must wear different clothes to and from the clinic (and transport their work clothes in a pillowcase or cloth bag). They should also have a spare set of uniform in clinic as well. No watches or jewellery can be worn on the arms or hands, and arms should be bare from the elbows down to allow good handwashing procedures.

Hands must be washed on arrival to the clinic and before and after each client session.

The practitioner must open and close the door so that the client does not use the door handle.

Consent for treatment and awareness of the risks needs to be documented in the notes. The documentation required will be specific to the profession and, again, practitioners must familiarise themselves with the requirements of their governing body and advise the clinic accordingly.

Patient notes, once completed, to be put in the second drawer of the right hand filing cabinet in reception ready for filing rather than being put in the tray on the reception desk.

PPE:

Facemasks will be provided for clients and washed at 60 degrees alternatively clients may purchase a single use mask for £1 or they can bring their own.

All practitioners are responsible for providing their own PPE dependent on the requirements set out by their governing body.

For most practitioners which may include: facemask (sessional use), apron and gloves (single use), eye protection / face shield will require a separate risk assessment depending on the treatment being carried out.
Level of PPE required and worn during the session should be documented in the notes.

Information on the donning and doffing of PPE is attached in Resources below.

Reception

Reception staff should wash hands on arrival at the clinic and, at least, every hour. However, handwashing may need to be done more frequently dependent on the tasks, e.g. handling of deliveries (see below).

Facemasks, gloves and face shield will be available for reception staff to wear.

A screen will be erected around the reception desk. Floor markings will guide clients where to stand when paying and booking appointments so that they do not lean on the reception desk.

The reception area has been decluttered to enable easier cleaning. The reception area and waiting area will need to be cleaned regularly as per the cleaning procedure.

The last member of reception staff leaving the building at the end of the day will need to ensure that all windows are closed.

The first person in will need to open treatment room windows.

All staff

All staff must provide their own pens.

All staff must provide their own mug / travel mug.

Glasses, water and magazines will not be provided in reception.

Handling of deliveries

Deliveries are to be left outside on the bench. If weather does not allow, surfaces in contact with parcel must be cleaned, outer packaging must be disposed of immediately in the waste bin outside the clinic. Gloves can be worn but hands must be washed afterwards.

Post box to be put on the outside wall by the front door.

Disposing of waste

All non-recyclable waste, including, aprons, masks and gloves, to be put in the lidded bins in each treatment room. The bins will have a bin bag in. Once full the bag should be removed, the top of the bag should be brought together, twisted and then folded back on itself into a swan neck twist before tying into a knot. This is then placed in the large bin outside the clinic.

Exceptions: Podiatry skin and nail – double bagged and taken away from premises by practitioner.

Acupuncture: Specialist sharps boxes in the appropriate treatment room for used acupuncture needles.

Electrotherapy machine
Must be cleaned between each use with the alcohol wipes.

Telephone screening and client declaration
Documents relating to the screening of clients and the declaration which clients will be asked to complete are attached with this document.

Resources

www.gov.uk/government/publications/wuhan-novel-coronavirus-infection-prev ention-and-control

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attach ment_data/file/877529/Best_Practice_hand_rub.pdf  (PDF download)

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attach ment_data/file/877530/Best_Practice_hand_wash.pdf (PDF download)

https://www.gov.uk/government/collections/coronavirus-covid-19-personal-protective -equipment-ppe

https://www.csp.org.uk/system/files/publication_files/Face%20to%20face%20or%20 not%3F%20Guidance%20for%20England.pdf (PDF download)

https://www.iosteopathy.org/wp-content/uploads/2020/05/iO-adapting-your-practice-q uick-guide-and-checklist-052020-V1.pdf (PDF download)

Donning & doffing of PPE attachment:
www.iosteopathy.org/wp-content/uploads/2020/05/iO-poster-use-of-PPE-in-os teopathic-practice.pdf (PDF download)

www.iosteopathy.org/wp-content/uploads/2020/05/iO-patient-assurance-in-cli nic.pdf (PDF download)

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attach ment_data/file/877533/Routine_decontamination_of_reusable_noninvasive_equipme nt.pdf (PDF download)

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attach ment_data/file/878056/PHE_COVID-19_visual_guide_poster_PPE.pdf (PDF download)

https://www.gov.uk/government/publications/guidance-to-employers-and-businesses -about-covid-19/guidance-for-employers-and-businesses-on-coronavirus-covid-19#h andling-post-or-packages

The Faringdon Clinic
May 27th 2020
To be reviewed June 5th 2020