The NLCHP has given us a document explaining potential return to work in Alert level 3. The following are highlights from their document explaining guidelines for return to work in a clinical setting. For further details, please visit the NLCHP website www.nlchp.com

 

This document provides direction and resources for health professionals registered under the Health Professions Act in relation to re-opening services during the COVID-19 pandemic. The Government of Newfoundland and Labrador has outlined a 5-Level Alert System in terms of the public health restrictions in place due to COVID-19. It is anticipated that health care providers previously prevented from working will be allowed to resume practice in Alert-Level 3. We recognize that resuming practice does not mean a return to normal services, as they had operated in the past. In some cases, health professionals may decide to continue to provide emergency and/or urgent care only or to remain closed. In all cases, it is recommended that health professionals, if not self-employed, contact their employers to discuss a return-to-work plan.

 

The intent of this document is to outline requirements that health professionals will need to consider in resuming services and resources available to health professionals.  Health professionals who work within Regional Health Authorities and/or the Provincial Government should refer to guidelines provided by their employers.

 

Appointment Scheduling

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Prior to booking patients, Acupuncturists must ensure all directions and the following guidelines are being followed.




• Acupuncturists and clinic staff must complete the screening questionnaire for COVID-19 symptoms prior to each clinical shift to ensure they are safe and fit to work. 


•  Acupuncturists and clinic staff must follow procedures on patient screening prior to in- person services. 


• When scheduling patients, space appointment times to minimize patient waiting and the number of people in the clinic at any given time, and allow time for cleaning and disinfection procedures between patients. 


•  Acupuncturists must wear a surgical/procedure mask continuously, at all times and in all areas of their workplace to safely provide in-person services. 


•  Any instruments or pieces of equipment used in patient care must be cleaned and disinfected after each use. 


• In the event that an Acupuncturist or a patient reports experiencing symptoms of COVID-19 within 14 days of visiting the clinic, the clinic must be closed immediately and thoroughly cleaned. The Acupuncturist shall immediately inform the CTCMPANL, NLCHP, or Department of Health- NL.

 

The CTCMPANL recommends the following consideration on how to prioritize patient visits: 


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• Acuteness of the patient’s condition 


• Necessity of services which can only be provided in person 


• Duration of patient wait times for care 


• Benefit of in-person services relative to the risk to the patient and Acupuncturist     

•  It is recommended to space appointment times to minimize patient waiting and the number of people in the clinic at any given time. 


•  Allow adequate time for proper cleaning and disinfection of the treatment area between patients. 


• Whenever possible, patients should be asked to wait in their vehicles until it is appropriate to enter the clinic. 


• Ensure that the number of patients in the clinic at any given time complies with ongoing directives on group gatherings, and enable physical distance between patients in the clinic. 


• Consider treating only one patient at a given time. Treating more than one patient at the same time increases the risk of cross-contamination. 


• Acupuncturists must consider the increased risk of cross-contamination when treating more than one patient, appropriate measures must be in place to mitigate the risk of cross- contamination.

    

 

All patients must complete the screening questionnaire at the time of booking and again in- person before entering the clinic with the following questions:

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○  Do you have current symptoms of COVID-19, such as cough, fever, shortness of breath, 
runny nose or sore throat, and less common signs and symptoms? (For a full list of signs and symptoms of COVID-19 see the Department of Health self assessment tool) https://www.811healthline.ca/covid-19-self-assessment/are-you-experiencing-any-of-the-following/

 

Patients (and Companions) Entering the Clinic

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• Patients and companions must complete the screening before entering the clinic. 


  • Both the patient and the companion should not enter the clinic. 


  • Establish and maintain a safe physical distance of two metres. 


  • Provide new masks for the patient and the companion to don. 


  • Explain the concern that they are symptomatic and reschedule the appointment. 


  • Advise the patient they should self-isolate and call Health Link 811. 


  • Clean and disinfect the area immediately. 


• A no-touch, clinical-grade quality infra-red thermometer is recommended for measuring temperatures. 


• Records of patient and companion temperatures must be included in the patient files. 


• Instruct patients and companions to wash their hands with soap and water or hand sanitizer 
approved by Health Canada (https://www.canada.ca/en/health-canada/services/drugs-health- 
products/disinfectants/covid-19/hand-sanitizer.html) immediately upon entering the clinic. 


• Do not bring extra people to the appointment unless absolutely necessary. 


• Patients should be directed to the treatment room immediately upon entering the clinic 
whenever possible. 
During Appointment Guidelines for an Acupuncturist in Contact with the       Patient

 

• Acupuncturists must wear a surgical/procedure mask continuously, at all times and in all areas of their workplace to safely provide in-person services. 


• The surgical/procedure mask should be immediately changed and safely disposed of whenever it is soiled or wet, whenever the Acupuncturist feels it may have become contaminated, and at the end of the day. 


• A new mask must be used for each clinical shift. 


     

Acupuncturists are recommended to provide and obtain a revised patient consent form while the Guidelines remain in effect. The revised patient consent form should, at a minimum, include the following:

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• Clearly defined COVID-19 prevention protocols and policies. 


• Patient should be informed of the risks associated with contraction of COVID-19 despite the implementation of the COVID-19 prevention protocols and policies. 


• Allow the disclosure of contact information in the event that a patient who has visited the clinic in the last 14 days and is now testing (or has tested) positive for COVID-19. 


 

If a patient enters the clinic after they have been screened, but subsequently identified by the Acupuncturist that the patient exhibits signs and symptoms consistent with a respiratory illness, whether COVID-19 is suspected or not, the Acupuncturist must:

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• Have the patient complete hand hygiene. 


• Isolate the patient from others in the clinic. 


• Explain the concern that they are symptomatic, discontinue treatment and reschedule the 
appointment. 


• Advise the patient they should self-isolate and call Health Link 811. 


• Clean and disinfect the practice area immediately. 


• Keep a record of all close contacts of the symptomatic patient and other visitors and 
staff in the clinic at the time of the visit. This information will be necessary if the 
symptomatic patient later tests positive for COVID-19. 


                   

Acupuncturists must not attempt a differential diagnosis of patients who present with signs 
and symptoms of COVID-19 and discontinue treatment immediately. 


                   

Acupuncturists are required to call NLCHP to receive guidance if they are aware of 
a patient who has visited their clinic in the last 14 days and is now testing (or has tested) positive for COVID-19. 
After Appointment 
 


        

Have the patient pay for the treatment online, if possible. Recommend using the tap-function of a credit or debit card to minimize touching the merchant terminal. Cash transactions should be avoided, if possible, to prevent the spread of infection. 


                 

If possible, use electronic receipts to limit the exchange of papers. If papers are required, avoid sharing pens and office equipment and disinfect each after use. 


                 

Patients must wash their hands with soap and water or hand sanitizer approved by Health Canada prior to processing payments. 


                   

Thoroughly clean and disinfect any surface area the patient may have come in contact with using a Health Canada approved disinfectant at the link below, https://www.canada.ca/en/health-canada/services/drugs-health-products/disinfectants/covid- 19/list.html 


                   

Wash hands for a minimum of 30 seconds with soap and water or hand sanitizer approved by Health Canada between each patient. 
Staff Health Screening 
Acupuncturists and staff must keep up-to-date with current COVID-19 guidelines and policies from the CTCMPANL, NLCHP, and the Government of Newfoundland. 


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Under no circumstances should an Acupuncturist or staff attend work if any of the following applies:

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•  Feeling unwell or exhibit any symptoms of fever, cough, runny nose, sore throat, or shortness of breath; 


• Travelled within the last 14 days; or 


• Have been in close contact with confirmed or suspected cases of COVID-19. 


                        

 

 

Facility Requirements

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Protective measures to put in place for receptionists and reception/waiting area:

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• Consider the installation of physical barriers (e.g., plexiglass) at reception desks. 


• Any staff who do not work in patient care areas or have direct patient contact are required to 
mask at all times in the workplace if a physical barrier e.g. plexiglass is not in place or if 
physical distancing (2 metres) cannot be maintained. 


• Seats in waiting areas must be appropriately spaced to maintain a minimum of 2 meters 
physical distance. 


• Clean and disinfect any item that cannot be disposed of between patients, i.e. pens, 
clipboards, terminals. 


• Items that cannot be effectively cleaned and disinfected between use must be removed from 
the clinic environment (e.g., magazines or toys in waiting areas). This includes but is not limited to chairs and other items with porous fabric upholstery, and treatment beds with torn surfaces or patched with tape. All non-essential items must also be removed. 


                 

 Transition as many staff to home offices as possible.




•  Physical distancing. 


                  ○ Hand hygiene (hand washing and hand sanitizer use.) 


                  ○ Help limiting the spread of infection. 


                  ○  At a minimum this includes placing them at entrances, in all public/shared washrooms, 
and treatment areas. 


•  Increase access to hand sanitizer approved by Health Canada or hand-washing stations. 


•   Have a clearly defined COVID-19 prevention protocols and policies available to provide to 
any person with questions. 
Hand Hygiene and Personal Protective Equipment (PPE) 


•  Acupuncturists must wear a surgical/procedure mask continuously, at all times and in all areas of their workplace to safely provide in-person services. 


•  The surgical/procedure mask should be immediately changed and safely disposed of whenever it is soiled or wet, whenever the acupuncturist feels it may have become contaminated, and at the end of the day. 


•  A new mask must be used for each clinical shift. 


•  Masks should never be reused. 


     

Acupuncturists must practice routine hand hygiene:

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• Before contact with patient/patient’s environment. 


• Before clean/aseptic procedure. 


• After body fluid exposure risk. 


• After contact with patient/patient’s environment

• Acupuncturists must also avoid touching their face and practice respiratory etiquette by coughing or sneezing into their elbow or covering coughs and sneezes with a facial tissue and then disposing of the tissue immediately. 


• Patients should be asked to complete hand hygiene using soap and water or hand sanitizer. At the following times:

• Upon arrival at the practice setting. 


• Prior to processing payment. 


• Prior to departure from the practice. Environmental Cleaning and Disinfect

 

Effective cleaning and disinfection are essential to prevent the spread of COVID-19, which is transmitted primarily through contact with respiratory droplets, or from contact with contaminated surfaces.

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Cleaning refers to the removal of visible soil. Cleaning does not kill germs but is highly effective at removing them from a surface. Disinfecting refers to using a chemical to kill germs on a surface. Disinfecting is only effective after surfaces have been cleaned.

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Use a “wipe-twice” method to clean and disinfect. Wipe surfaces with a cleaning agent to clean off soil and wipe again with a disinfectant.

Use a disinfectant that has a Drug Identification Number (DIN) and a veridical claim (efficacy against viruses).

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Health Canada has approved several hard-surface disinfectants and hand sanitizers for use against COVID-19. Use these lists to look up the DIN number of the product you are using or to find an approved product. Make sure to follow instructions on the product label to disinfect effectively.

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Disinfectants: https://www.canada.ca/en/health-canada/services/drugs-health- products/disinfectants/covid-19/list.html
Hand sanitizers:

 

https://www.canada.ca/en/health-canada/services/drugs-health- products/disinfectants/covid-19/hand-sanitizer.html

The frequency of cleaning and disinfection is dependent on the nature of use/contact of the surface/item in question:

 

Patient care/patient contact items must be cleaned and disinfected between each patient/use. 
Examples of patient contact items include but are not limited to:

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• treatment tables, all contact surfaces, and the entire headpiece and hand rests 


• therapeutic tools and devices (e.g. cupping tools and acupressure tools) 


• pin pads used to process payment, and reception area 


• High touched areas must be cleaned and disinfected a minimum of twice daily or whenever visibly soiled. Examples include but are not limited to:

• light switches, doorknobs, toilets, taps, handrails, counter tops, touch screens/mobile 
devices, phones and keyboards 


• Clipboards used by patients must be disinfected after each patient encounter. 


• Pens/pencils used by patients must be disinfected after each patient use or be single-use 
only. 


• Any cloth items, such as towels, sheets, headrest coverings, etc., that are used in the clinic 
must be laundered in hot water (above 60°C) with regular laundry soap before being dried
and used again. Staff that is handling these items should be gloved for both dirty and clean laundry processing. Staff must always use new gloves when handling clean laundry.

 

Record Keeping

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Clear documentation records are essential to ensure the successful implementation of COVID-19 prevention protocols and policies. It is recommended that Acupuncturists include the following information in the patient files:

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• Screening questions and records for symptoms of COVID-19 


•  Revised patient consent form – please consider to ask regular patients to resign consent to receive treatment.

•  Actual appointment date and time (arrival and departure) 


•   Up to date address and phone number of the patient and companions 


•  Specific treatment room if multiple rooms are used 
In addition, separate files must be kept for the following information: 


•  Daily cleaning and disinfection records 


•  A registry of all people entering the clinic, include the Acupuncturists, staff, people in the clinic aside from patients (e.g. couriers, guardians accompanying a patient, etc.).