INTRODUCTION

With recent announcements from Premier John Horgan and Dr. Bonnie Henry, practitioners can begin to resume in-person practice in a way that promotes safe care to patients and continues to prevent the spread of the virus. As this new normal is being defined, your practitioners will be adjusting how they deliver care, conduct business, and attend to physical environments to ensure best infection and prevention control practices.

This Return to Practice Plan reflects the most current guidance available at this time, and will change as required to reflect updates in our understanding of the virus and it’s transmission.

For a safe return to practice, our practitioners are committed to providing you with a safe clinical environment and therefore have established new safety protocols in five different practice areas:

1. Professional Duties – Following guidance required by the Provincial Health Officer, the BC Centre for Disease Control, WorkSafeBC and our professional regulatory bodies.

2. Clinic Environment Measures – Cleaning, disinfection, and creating a safe environment for health care practitioners and patients.

3. Administrative Measures – Implementing new policies and procedures at the clinic.

4. Personal Practices – Committing to behaviours inside and outside of the clinic that prevent the spread of COVID-19.

5. Personal Protective Equipment – Following PPE guidance for practitioners and patients.

 

PROFESSIONAL DUTIES

A return to work is not a return to normal. It is important that our practitioners move about in their work and personal environments consciously to help slow the spread of COVID-19.

We are following guidance received from the Provincial Health Officer, our professional regulatory colleges, the BC Centre for Disease Control (BCCDC), and WorksafeBC. It is our duty to abide by the orders received from the Provincial Health Officer, and it is our duty to implement the safety protocols provided and required by the BCCDC, WorksafeBC and our professional regulatory colleges for the duration of COVID-19.

As professionals, we are expected to collaborate with our colleagues when making decisions in regards to operating business, and we are expected to make such decisions while monitoring the risks and benefits of maintaining in-person care.

It is our duty to determine which services are reasonable to resume in the coming weeks, remembering that the goal is to gradually resume services for in-person care that supports physical distancing as best as we can. We are not expected to provide treatment, unless, in our professional opinion, it is safe to do so for both patient and practitioner.

From a risk management perspective, therapeutic treatment takes place in an enclosed space, where the practitioner and patient are unable to socially distance. Further cross-transmission is a risk, given that practitioners will interact with a number of patients in a day. It is our duty to inform you that no in-person appointment is risk free, even if the patient and practitioner appear well. Be aware that those not showing symptoms can also spread COVID-19.

It is also our responsibility to understand how COVID-19 is spread and how to implement procedures and protocols to slow transmission. It is our responsibility to educate you in this as well.

 

HOW COVID-19 SPREADS

• Health experts believe that COVID-19 is transmitted via liquid droplets when a person coughs, sneezes or talks within a close proximity.

• It is believed that COVID-19 spreads when infected droplets reach the eyes, nose or mouth or another person, either directly or indirectly.

• The virus is not known to be transmitted through airborne transmission (by much smaller evaporated particles containing the microorganism floating in the air for long periods of time).

 

CLINIC ENVIRONMENT MEASURES

Our practitioners are committed to making changes within the clinic environment to reduce the risk of exposure to COVID-19. The clinic environment measures we are taking include:

1. physical changes in the clinic that reduce the risk of exposure by isolation and/or ventilation; and

2. cleaning and disinfection practices that are being adopted for your safety and ours.

 

PHYSICAL CHANGES

The following physical changes that have been implemented are as following:

• We have removed all unnecessary items in the treatment rooms and waiting area, such as extra decor or books

• All clutter, decorations, and items that cannot be washed/wiped and sanitized are removed from the treatment space.

• No touch garbage bins are in all common areas and treatment rooms;

• Wicker and cloth laundry hampers have been replaced by hampers that are easy to disinfect and have washable liners;

• Fabric seating chairs in the treatment rooms have been replaced with cleanable chairs

• There is a dedicated cleanable area for your possessions

• All pillows, linens and items that are not being used for the treatment in question are not in the treatment room or are enclosed in a cabinet or bin.

• Non-porous surface covers will be on all bolsters, pillows, and heating pads, for easy cleaning.

 

CLEANING AND DISINFECTION PRACTICES

Practitioners are committed to cleaning and disinfecting all touched surfaces and maintaining the cleaning guidelines laid out by the BC Center for Disease Control.

The following cleaning and disinfection schedule has been implemented:

1.Between every appointment, using an approved disinfectant spray cleaner or a pre-moistened disinfectant wipe, practitioners will disinfect the treatment room and all touch surfaces, including:

• Oil bottles and treatment tools

• Door handle inside and out

• Light switches

• Cabinet handles/touch areas

• Desk, devices/pens used

• Stool

• Treatment table with special attention to the head rest cradle, headrest cushion, table legs and floor near the headrest

• Chair

• Side table

• Any other surfaces touched by the patient or their belongings

• Exercise equipment, or walls touched in self-care demonstrations

• Floor

2.Regularly throughout the day, on a schedule followed by all staff, practitioners will disinfect all high touch areas in the common area and bathroom using an approved disinfectant spray cleaner or a pre-moistened disinfectant wipe, including:

• Door handles

• Faucet/sink

• Toilet handle and seat

• Washing machine

• Laundry baskets

• Cabinet open areas

• Front desk

• Counters

• Sitting bench

• Light switches

• Debit machine

• Pens

3. Laundry of all linens, blankets, and hand towels will be executed after every use. Contaminated linens can transmit disease via direct contact or by aerosols of contaminated lint generated during sorting, and handling of contaminated items. Practitioners will:

• Avoid shaking out laundry before placing into the washing machine

• Wear a mask and use gloves or use proper hand washing after touching and processing dirty laundry, as well as cleaning and disinfecting of the buttons, knobs, and doors of the laundry area.

• Linens, work attire, and cleaning items will be washed using regular laundry soap and hot water (60-90 degrees Celsius) and put through a high temperature dryer cycle until completely dried.

 

CLEANING SUPPLIES AND EQUIPMENT

We have procured the following cleaning supplies for your safety and ours:

• Cavi-Wipes AND Spray Nine: Hard surface cleaner and vinyl cleaner/disinfectant approved and listed on the government of Canada’s website. Found at: Hard-surface disinfectants and hand sanitizers (COVID-19): List of disinfectants with evidence for use against COVID-19

• Cleaning cloths & Paper towel: for disinfecting, hand washing and available for door opening – cloths will be washed after every single use.

• Hand soap at all sinks.

• Hand sanitizer (at least 70% alcohol) in cleanable dispensers at front desk and in each treatment room.

 

ADMINISTRATIVE MEASURES

Administrative measures represent the implementation of new policies and procedures at the clinic. This includes:

1. Mandatory patient screenings and policy;

2. Hand-washing procedures;

3. Patient arrival-at-the-clinic instructions;

4. Treatment and scheduling modifications;

5. Late-cancelation policies;

6. Patient illness policy; and

7. Practitioner sick-leave policy.

 

MANDATORY PATIENT SCREENING 

Careful screening of all visitors that enter the clinic provides an extra level of safety to the clinic, its practitioners, and patients. Clear and honest communication regarding symptoms of COVID-19 before entering the clinic will help us manage risk

It is required that we have a 3-step screening protocol in place. Practitioners will ensure three screening procedures with each patient for every appointment:

1. At appointment booking, or at the 24hr appointment reminder email via a screening form or the BC Symptom Self-Assessment Tool

2. During a phone call up to 24 hours prior to the appointment

3. When they first enter the treatment room

Practitioners will document that the screening was done.

 

Practitioners will refuse to provide treatment if their patient refuses to participate in any of the three screening processes.

Should a screening reveal the patient is at risk of having COVID-19 but is not exhibiting any signs and symptoms of COVID-19, the patient will be referred to a COVID-19 testing centre, and appointments at Jade will be deferred until testing proves negative.

 

HAND WASHING & WASHROOM PROTOCOLS

A hand washing sign is placed in the washroom to educate patients on proper hand washing. There are paper towels provided to dry hands with and waste receptacle near the door for disposal. Touchless trash receptacles and an easily cleaned soap dispenser is available for use. Washrooms will be thoroughly cleaned at least twice per day with common contact points wiped down between each patient.

 

PATIENT ARRIVAL-AT-THE-CLINIC INSTRUCTIONS

Practitioners will:

• Ask patients to remain in their vehicle or at the outside the clinic doors until their practitioner collects them at their appointment time.

• Ask patients to come into the facility alone and not bring spouses or children, unless required for mobility or personal assistance. This is important to promote social distancing in treatment rooms and the larger clinic space.

• Ask patients to have their clean mask on (if they choose to wear one) prior to entry and upon entry into the clinic.

• Ask patients to wash their hands or use the provided hand sanitizer upon entering the clinic.

• Explain to their patients that bringing their own mask is recommended, but disposable are available upon request.

 

TREATMENT AND SCHEDULING MODIFICATIONS

Our common area is quite small and it is not possible to have a single direction of traffic through the hallway, nor is it possible to maintain two meters of distance with more than two people in the common area at one time. For this reason, we have implemented the following procedures for your safety:

• Appointments are to be staggered between practitioners to ensure that at any one time, there is only one practitioner and one patient in the common area at a time.

• Appointments will start and end on time as much as possible to ensure proper staggering of people in the common areas.

• Appointments have adequate cleaning time scheduled in between them.

To reduce the need for prolonged use of our common area and to reduce touch surfaces needing disinfection, we have also implemented the following practices:

• Patients will be asked to fill out all intake forms online at least 24 hours prior to their appointment to limit the time spent in the common area, as well as limit the use of shared objects touched such as pens and paper.

• Patients will be asked to wait in their car or outside the clinic until their practitioner is ready for them.

• Practitioners will issue an electronic receipt to limit shared objects touched, such as paper and pens.

• Doors to treatment rooms and bathroom will be left open when the rooms are not in use to reduce door handle touching. Practitioners will open doors for patients when possible.

• Patients will be asked to be efficient in their preparation to leave the clinic to limit time spent in the common areas and to give the practitioner time to prepare a safe space for the next patient.

• Water and tea will not be made available at this time, we ask that you bring your own water bottle if needed.

 

LATE CANCELATION FEE

Due to the extraordinary circumstances we find ourselves in, no charge of penalties will be levied for appointments canceled due to patient illness, or due to the patient being denied treatment in the screening process. There will still be a charge of fees for an appointment missed with no notice or explanation of the reason, and for reasons other than illness.

 

PATIENT ILLNESS POLICY

Should a patient present with symptoms of common cold, influenza, COVID-19, or other infectious respiratory disease, treatment and services will be delayed until 14 days from the onset of symptoms OR until symptoms resolve (whichever is longer)

If a patient is deferred, the patient will be informed about what to do if their symptoms get worse:

1. 8-1-1

2. Www.healthlink.ca

3. Self-assessment support

4. Lab testing

5. Local public health unit

 

PRACTITIONER SICK-LEAVE POLICY

Practitioners will not go to work if they are not feeling well – even if their symptoms are mild and they are uncertain of whether it is COVID-19 or not. Practitioners are committed to protecting their colleagues and their patients and will stay home if there is any doubt in their mind. Practitioners expect to miss more work than usual to make sure that they are taking care of themselves, their colleagues, and their community.

Practitioners commit to:

• Staying home, not going to work, not going to public places, not having visitors to their home if they feel mildly ill.

• Calling 8-1-1, their family physician, a walk-in clinic or a local public health unit, and/or completing the COVID-19 self-assessment .

• Getting proper testing to determine the nature of their illness.

Should a practitioner test negative for COVID-19, but still aren’t feeling well, they will stay home until they are healthy and cleared by their Doctor.

Should a practitioner test positive for COVID-19 they will:

• follow the instructions from the BC Centre for Disease Control.

• Immediately contact patients to inform them to monitor for symptoms.

• Determine if they are part of a cluster of cases or part of a local outbreak by reporting to a public health official.

• Receive proper care and follow-ups from their Doctor.

• Stay home and self-isolate until well.

• Stay away from the clinic and staff for at least 14 days beyond the onset of symptoms, AND until the fever is gone without medication, AND until they are feeling better AND until they have been cleared by a public health official.

Should a practitioner be in close contact with a person who has tested positive for COVID-19 or is suspected of having COVID-19, they will:

• follow the instructions from the BC Centre for Disease Control.

• Self-isolate and monitor for symptoms.

• Only return to work once their close contact has been tested and the results for COVID-19 come back negative and they are well.

• OR after self-isolating for 14 days and having no symptoms or fever develop.

• OR being cleared by a public health official.

 

PERSONAL PRACTICES

What we do in our day-to-day life matters. We recognize that in order to work safely, it is important to think ahead about what we can do to stay healthy and prevent the spread of COVID-19 within our practice and our community. This involves:

1. Social distancing; and

2. Proper hygiene and hand washing.

 

AVOIDING CLOSE CONTACT

• We will avoid close contact with people who are sick within our family and close social circles.

• We will practice social distancing guidelines in our everyday life.

• We will be particularly mindful of those who are at the highest risk of getting very sick: those over 65, individuals in a care home or long term care facility, those with underlying medical conditions – particularly if not well controlled, those with chronic lung disease or moderate to severe asthma, those with heart conditions, those who are immunocompromised, those who are severely obese, those with diabetes, those with chronic kidney disease undergoing dialysis and those with liver disease.

 

PROPER HYGIENE AND HAND WASHING

To minimize personal risk of exposure, practitioner and patient should:

• Wash their hands often with soap and water for at least 20 seconds (or use a hand sanitizer that contains at least 70% alcohol), especially after being been in a public place, after blowing their nose, coughing or sneezing.

• Always cover their mouth and nose with a tissue when they cough or sneeze, even while wearing a mask.

• Throw used tissues in the trash.

• Avoid touching their eyes, nose and mouth with unwashed hands.

• Keep 2 meters or 6 feet apart from other patients or practitioners where possible (social distancing).

In addition, practitioners at Jade commit to:

• Being conscious of the number of places we are going to before and after work and on their days off.

• Avoid non-essential trips within their community.

• Limit contact with those at high risk.

• Enjoy the outdoors but stay close to home and avoid distant travel.

• Practice social distancing (stay at least 2 meters apart) outside of our home to the best of our ability.

For measures on prevention see: BCCDC COVID19 Prevention & Risks

or for a brief summary see: COVID-19 COVID-19

 

PERSONAL PROTECTIVE EQUIPMENT (PPE)

Personal Protective Equipment is the last and least effective of the infection prevention and exposure control measures, and is not effective as a stand-alone preventive measure. However, your practitioner will wear required PPE according to risks associated with their practice, and will wear PPE as per your request.

Additionally, practitioners will place their street clothes in an enclosed bin, and change into work clothes at the clinic, and implement the following PPE protocol:

• Recommended: Your practitioner might be wearing a procedural/surgical or cloth mask in the common areas and in the treatment room. Proper Donning and Doffing procedures are to be adhered to.

• Depending on comfort: A disposable paper mask for the patient (you can either come to the clinic wearing your own mask, or the clinic will provide you with one should you wish to wear one).

• Depending on comfort: Your practitioner will have these available for use should you request them:

  • Safety glasses or goggles

  • Scrubs, or change of clothes

  • Gloves

*Note Gloves do not offer any protection over regular and rigorous hand washing that is typical hygienic practice. Gloves are recommended during cleaning, intra-oral work (as per normal practice), and in the case of cuts or open injuries on the patient or the practitioner (as per normal practice). Gloves are always discarded after every use. If the patient is comforted by the use of gloves, they can be used.

The current global risk of COVID-19 has made procurement of many items difficult and/or impossible. The above-listed considerations have been taken to ensure an environment that is as safe as possible for practitioners, patients, and the public. If the items listed, or suitable replacements cannot be found, Jade Wellness will cancel appointments until those items can be procured. This includes both PPE and cleaning supplies.

Thank you to all of our valued patients and community members for your patience and understanding during this time as we all adapt to the new normal.

 

“Be Kind, Be Calm, Be Safe.” – Dr. Bonnie Henry PHO