Preparing Your Practice

Have a leadership meeting in your office or surgical facility staff and discuss the process of reopening based on national/state/local regulations. Make sure you have a good understanding of your environment, starting at the local/regional level.

  1. Practice Protocols: Establish updated protocols (with your colleagues and local organizations) based upon your region.
  2. COVID Consent: Update your COVID-19 consent forms both for patient visits and procedures and develop a protocol on how to verbally review this with patients. (https://www.surgery.org/sites/default/files/ASAPS-COVID-19-Consent-2020-04-28.doc).
  3. Staff Training: Hold and document staff meetings (virtual and/or on-site) to review and practice the protocols. It will take a TEAM to implement the necessary safety changes.
  4. Patient Education: Develop COVID-19 protocols to be sent to the patient prior to their visit.
  5. Office Disinfection: Clean and disinfect your office according to World Health Organization standards:
  6. Office Reorganization: Modify your physical office and routines.
    • a. Office Signage: Place signs in visible locations notifying patients of COVID-19-related precautions and add necessary markings to maintain appropriate social distance (e.g. tape marking in front of reception for patients to maintain social distance from staff and each other).
    • b. Patient Spacing: Reduce or remove chairs in the reception area and appropriately space them apart.
    • c. Reception Room: Convert your waiting room into a “non-waiting room” or reception room where the patients walk straight through to their designated appointment room/treatment area.
    • d. Office Paraphernalia: Remove all magazines, brochures, and other non-essential materials from the reception area and patient care areas.
    • e. Shared Equipment: Disinfect all shared writing utensils, tablets, and signature pads.
    • f. Sanitizing Supplies: Place additional hand sanitizers and wipes in the reception room for patients as well as in high traffic areas.
    • g. Sanitizing Rituals: Wash hands upon entering the exam room and instruct patients to do the same. Hand sanitizers include ethyl alcohol (Purell), fragrance free alcohol (Sterillium), and chlorhexidine gluconate (Avagard).
    • h. Patient Traffic: Keep all doors open on the patient path from the entrance to the exam room.
    • i. OSHA Standards: Maintain OSHA’s PPE standards (29 CFR 1910 Subpart I) and ensure there is enough appropriate PPE for all your staff. Review CDC Review guidance on how to optimize the supply of face masks: https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/face-masks.html
    • OSHA RISK EXPOSURE LEVEL

      Low Exposure Risk

      Tasks or job functions that do not require contact with people known or suspected of being infected with COVID-19; do not require frequent close contact with general public (i.e. within 6 feet).

      Medium Exposure Risk

      Tasks or job functions that require frequent and/or close contact with (i.e. within 6 feet) people who may be infected with COVID-19, but who are not known or suspected COVID-19 patients; may have contact with the general public and high-population-density work environments (i.e. schools, high volume retail settings).

      High Exposure Risk

      High potential for exposure to known or suspected sources of COVID-19; includes healthcare delivery and support staff (i.e. hospital-based physicians, nurses and other hospital staff and medical transport workers).

      Very High Exposure Risk

      High potential for exposure to known or suspected sources of COVID-19 during specific medical or laboratory procedures; includes healthcare workers (i.e. physicians, nurses, dentists, paramedics) performing aerosol-generating procedures (i.e. intubation, cough induction, bronchoscopies, some dental procedures and exams, or invasive specimen collection) on known or suspected COVID-19 patients.

      https://www.osha.gov/Publications/OSHA3990.pdf

    • j. Physical Barriers: Protect staff from potentially exposed patients (e.g. plexiglass sneeze guard between front desk and patient).
    • k. Patient Flow: Establish a “no patient exposed to another patient” policy.
      • i. Arrange for patients to wait in the car or outside the office until called or texted. Consider enrolling in a texting service to minimize staff cell phone use.
      • ii. Deliberately direct the traffic flow inside your office.
      • iii. Employ strategic scheduling in group practices (e.g. schedule only one doctor perclinic day)
      • iv. Plan on longer clinic hours with fewer patients.
    • l. Patient Status: See patients alone unless they need a caregiver (or parent for children) to physically assist them at the visit. Other companions should wait in the car or outside the office.
    • m. Personnel Protection:
      • i. Masks: Office staff should wear 3-ply surgical masks or earloop masks. Clinical staff should wear 3-ply surgical masks in most settings but use N95 masks for all aerosolizing procedures. For any procedure above the clavicle, use of N95 mask should be considered IF AVAILABLE. As per CDC guidelines above, 3-ply surgical masks should be worn by all staff with protective eyewear or face shields, especially for facial procedures.
      • ii. Glasses: All staff who would otherwise use contact lenses, should be encouraged to use eye glasses instead.
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