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Personal Protective Equipment (PPE) and Clinic Reopening Resources

Change is Coming! 

Just as we all began to settle into the comforts of working from our homes, seeing our patients virtually, and wearing questionable levels of pants, a change has once again been put forward:    

Last week, on May 26, 2020, the Chief Medical Officer of Health of Ontario amended Directive #2. In case you are not sure what that means, Directive #2 for healthcare providers (HCPs) required all non-essential and elective services be ceased or reduced to minimal levels. Directive #2 was amended to support the gradual restart of all deferred and non-essential elective services provided by HCPs. 

This blog will summarize some of the most pertinent information available to date surrounding clinic reopening/screening, general reopening resources, screening questionnaires and PPE resources. At the end of this blog you will find a resource table with some valuable links. This blog does not replace checking your health governing body and provincial/national websites. Please make sure to check appropriate websites regularly as new information becomes available.   

Virtual vs. Face to Face, How to Choose?

Although clinics are reopening, health care providers (HCPs) are still encouraged to limit the number of in person visits for the safety of the HCPs and their patients. HCPs must determine which of their services can continue to be offered remotely, and which services can safely be offered in person. The gradual restart of services must also be done in accordance with each HCP’s applicable health regulatory college.

HCPs are encouraged to: 

  • Implement a system for virtual/telephone consultations.
  • Where possible, conduct initial consultations remotely (phone or secure messaging) to determine whether a virtual consultation is appropriate or whether an in-person appointment is necessary.

HPCs must ensure to:

  • Modify the delivery of services to reduce patient time spent in health care settings, and to maintain physical distancing of 2 meters.  
  • Provide face coverings when physical distancing is not possible. 
  • Provide tissues and lined garbage bins (no touch preferred).
  • Ensure that there are supplies for proper hand hygiene. 
  • Post appropriate signage (e.g. hand hygiene, physical distancing, respiratory etiquette).

Before Reopening Your Clinic: 

An organizational risk assessment (ORA) should be performed before the reopening of your clinic. An ORA is a systematic approach to assessing the efficacy of control measures in place to mitigate transmission of infections in a healthcare setting. 

Educational information and training must be provided by the clinic to all employees regarding the clinic’s ORA.

How to Keep Your Clients Safe - Hierarchy of Hazard Controls: 

  1. Elimination and Substitution: This is the most effective hazard control. If/when possible, avoid having patients come into the clinic, instead opting to continue with virtual screening or consultations.  
  2. Engineering and Systems Control Measures: These measures help to reduce pathogen exposure by implementing methods of isolation or ventilation (e.g. plexiglass barriers for administrative staff). 
  3. Administrative Control Measures: These measures aim to reduce risk of transmission of infections to staff and patients through implementation of policies, procedures, training and education. These measures include active and passive screening, signage, and restricted visitor policies. We have included examples of screening and signage below.  
  4. Personal Protective Equipment (PPE): PPE is the last tier of hazard controls and should not be relied on as a stand-alone primary prevention program. Clinic owners must make sure that their staff have access to appropriate PPE for their task and that they receive the necessary training to ensure proper use, removal and disposal of PPE. 

Active screening:

Screen all patients and essential visitors over the phone for symptoms of COVID-19. We’ve included a sample COVID-19 screening questionnaire below which you may use with your patients: 

Click here if you would like to download the COVID-19 screening questionnaire.

Passive Screening - Signage: 

Signage should be posted at clinic entrance and at reception areas requiring all patients and essential visitors to wear a face covering (if acceptable), perform hand hygiene, and only then report to reception to self identify. We have included sample signage from the MOH website. Additional signage (in English and French) can be found on their website.

Infection Prevention and Control:

Clinics must make sure to have written measures and procedures for staff safety, including for infection prevention and control; these should be easily accessible to staff. 

Patient contact and treatment surfaces considered "high-touch" (e.g., examination tables, chair arms, charting desks, etc.) should be disinfected after each patient, and before another patient is seen whether the patient is symptomatic or not. 

All central surfaces considered "high-touch" such as light switches, bathroom sinks, toilets, toilet handles, etc., should be cleaned and disinfected a minimum of twice daily (or when soiled). "Low-touch" surfaces (e.g. shelves, overbed light fixtures, outside of sharps containers, etc.) should be disinfected at least once per day. 

Hospital-grade, ready-to-use disinfectant wipes with the recommended contact time should be used to disinfect smaller patient care equipment after each use. Household cleaning and disinfecting products are also effective against COVID-19 when used as directed.

Remember to use disinfectants that have a drug identification number (DIN) and that are virucidal. Alternatively, you can also use a bleach solution in a well-ventilated area using the following dilution for bleach that is 5% sodium hypochlorite yielding a 0.1% sodium hypochrlorite solution: 
250 mL water to 5 mL (teaspoon) bleach /or/ 1 L water to 20 mL (4 teaspoons) bleach.

It is not necessary to disinfect the floor between each patient visit, however, if there is blood or other bodily fluids on the floor, then it should be cleaned and disinfected immediately. Booties are not necessary, but some physiotherapists have chosen to use them when reopening their clinics. 

Please review our resource table below for some useful links on infection prevention and control! 

PPE Resources:

Some sectors (e.g. long-term care facilities and retirement homes) have been issued specific guidance regarding the use of PPE. However, for all other sectors, Ontario Health has issued thorough recommendations which can be found here.

It is also crucial to know how to correctly don and doff PPE for HPCs as well as our clients. Alberta Health Services has provided a useful resource on how to do so; it can be found here: Personal Protective Equipment.

Please review our resource table below for some useful links on PPE! 

Additional Resources:  

Kids Physio, a group of pediatric physiotherapy clinics in British Columbia and Ontario, have gone through grueling research in preparation for clinic reopening. They have created their own set of policies and procedures. This information was later created into a course for Embodia. 

Learn More with Kids Physio

Another great resource is the Canadian Physiotherapy Association’s video on PPE and reopening your clinic: 

Physio Karim also has a great one hour video conversation in which he speaks to a few prominent clinics across Canada on the subject of re-opening. Some of the clinics have already reopened, others have all their plans in place and are preparing to open, while others are uncertain when their province will give them the green light:

In addition, we’ve included a useful resource table for clinic reopening. Please make sure to check the pertinent resources regularly as new information becomes available:

Resource

Information Provided

Link

Canadian Physiotherapy Association

COVID-19 Reopening guidelines, where available for each province. 

Provincial Clinic Reopening Guidelines, Including PPE and Infection Control

Canadian Physiotherapy Association

COVID-19 Clinic reopening updates 

Clinic Reopening

Ontario Ministry of Health

COVID-19 Operational Requirements: Health Sector Restart

COVID-19 Operational Requirements: Health Sector Restart

Ontario Ministry of Health

Downloadable signage for passive screening

OMH passive screening signage

Public Health Ontario 

Hand washing signage and best practice 

COVID-19 handwashing factsheet

College of Physiotherapists of Ontario

COVID-19 Return to Work - General Guidance

COVID-19 Return to Work - General Guidance

Government of Canada

Infection prevention and control for COVID-19: Interim guidance for outpatient and ambulatory care settings

Infection prevention and control for COVID-19: Interim guidance for outpatient and ambulatory care settings

Ontario Health

Personal Protective Equipment (PPE) use during the COVID-19 Pandemic

Ontario Health PPE use during the COVID-19

Government of Ontario 

Workplace PPE Supplier Directory

https://covid-19.ontario.ca/workplace-ppe-supplier-directory#no-back

Canadian Physiotherapy Association 

PPE and Infection Control Supply List from the CPA

PPE and Infection Control Suppliers List

COVID-19 PPE Exchange Marketplace

How to Beat the PPE Supply Chain Crisis

https://covidppehelp.ca/Marketplace/PPE-Offers

CBC

Masks: Everything you need to know but might be too afraid to ask, a patients’ and therapists’ guide

Face mask questions answered

National Geographic

How to clean your face mask

How to clean your face mask

Kids Physio (pediatric physiotherapy clinics in Ontario and British Columbia)

Returning to the clinic practices provided by Kids’ Physio, an Embodia course

Kids Physio's Best Practices for Returning to the Clinic


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Blog writer, editor: Nataliya Zlotnikov

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