Covid-19 – New clinic procedures to help keep you safe

Carrying out the risk assessment meant walking through my clinic, imagining a patient’s route, noting all the surfaces and objects which may be touched, and identifying the occasions when the 2m distance cannot be maintained. I have made significant changes.

All the flooring has been changed, there is now vinyl flooring in the toilet and handwashing areas. The hall and treatment room have been re-carpeted with short pile commercial standard carpet which can easily cleaned (bleached, steamed).

My original furniture, which included some soft furnishings, has been replaced with contemporary furniture with non-porous surfaces which can be thoroughly and efficiently disinfected with anti-viral cleaners.

My desk has been replaced with a new longer table. When seated at either end we will be 2m apart. For the immediate future, we will both need to wear surgical face masks throughout the appointment. I suspect many people will want to maintain social distancing after we come out of this pandemic, so it made sense to take this approach.

Fabric couch covers, bolsters and pillows have been replaced with PU alternatives. Once cleaned, they will be stored in a clean polybag in a closed chest.

All open shelving, bookcases and storage units are being replaced with closed cupboards.

Hand Washing

Practitioners and patients are required to have separate hand washing facilities. The cloakroom hand wash and toilet facilities are now ‘Patient only’. I have converted my adjacent utility room into a cleaning station for my use. Taps at both sinks are now wrist rather than hand operated. Open bins have been replaced with suitable soft-close pedal and clinical waste bins.

Immediately on your arrival at the clinic, you will be directed to the cloakroom to wash your hands. The Government recommends hand washing with soap as the best method of hand cleansing. But hand sanitising is also an option. Hand sanitiser is available in the cloakroom and treatment room for your use.

Hands should be washed in accordance with Public Health England recommendations. Posters have been put up in the cloakroom to illustrate good hand washing and hand rub techniques.

• See Public Health England’s Best Practice: How to hand wash poster
• See Public Health England’s Best Practice: How to hand rub poster

If you use the toilet, please wash your hands before using the toilet as well as afterwards.

If you need to sneeze or cough while at the clinic, please do so into a disposable tissue and immediately put it in the yellow-lidded clinical waste bin in the treatment room.

View the NHS Respiratory & Cough Hygiene leaflet here.

Cleaning

Shared contact areas, such as door handles, chairs, tables, treatment couch, other surfaces, toilet facilities, will be thoroughly cleaned daily and disinfected before each patient. So you can be assured that the clinic is as clean as possible.

PU bolsters and pillows will be disinfected after each use.

A daily Cleaning Checklist has been prepared (like those you see in public loos!) and will be posted in the cloakroom, so you can see what has been cleaned and when.

The good news is that Covid-19 is readily inactivated by regular detergents and soaps. However, on the basis of Government guidance, the British Acupuncture Council also recommends the use of anti-viral detergents eg Dettol, and cleaning products containing 70% Isopropyl Alcohol (IPA). I will be using IPA wipes to disinfect surfaces between patients.

I have allowed extra time between appointments to ensure that there is sufficient time for thorough cleaning.

I will wear a mask, disposable gloves and apron to do the cleaning between patients and at the start and end of the day.

Please leave any accessory items of clothing or bags in your car and try to avoid putting your belongings on the floor in the treatment room. A table with a shelf has been put in the cloakroom: you may leave items there.

Ventilation

Research indicates that the risk of transmission is significantly reduced where there is good ventilation. An extractor fan in the treatment room will be switched on throughout your treatment. Weather permitting, windows will also be open. If the windows are closed, 2 air purifiers will be switched on.

The windows will be opened to bring fresh air into the room between patients. The treatment room will be heated, but may not be as warm as usual because of the ventilation.

You may wish to wear warmer (loose) clothing if you tend to feel the cold.

Laundry

Use of towels, gowns and other fabrics in clinic is discouraged for the time being. If it is necessary to use a towel/gown during your treatment it will be washed after each use at 60 degrees C.

Until further notice I will be wearing a clinic uniform which will be washed daily at 60 degrees. In the event that you accidentally sneeze or cough on me, I am required to change my uniform as soon as possible.

All clinic items to be washed are individually bagged in a drawstring cotton bag and placed in a yellow bin for washing.

Patients are encouraged to come to the clinic alone, unless a carer or parent is required.

I have scheduled gaps (15 minutes) between appointments, so you should not meet anyone else as you enter and exit the clinic. I would be grateful if you could arrive at the clinic no earlier than 5 minutes before your appointment time, and wait in your car until I text you to come in. Once I have texted you, please wait at a 2m distance from the front door. I will open the door and then stand back, so you can go to the cloakroom to wash your hands.

There will be no waiting room facilities until further notice.

At several times during your consultation and treatment I will need to come within 2m and have physical contact with you; for example, to palpate for an area of pain, take your pulses, find the acupuncture points and insert/remove the needles. Some patients may also need help getting on/getting comfortable on the couch.

The main ways of reducing the risk of transmission while in close proximity are:

• Frequent and through hand washing (see above)
• Regular surface cleaning (see above)
• Limiting the amount of time spent in close-proximity
• Wearing personal protective equipment

Limiting time spent at less than 2 metres

The risk of transmission increases with prolonged contact within 2m. Consequently, as far as possible, I will limit the amount of time I spend within 2m of you. As Covid-19 is spread via droplet contagion, close exposure to the face and mouth increases the risk.

Tongue diagnosis: The British Acupuncture Council has recommended that we do not carry out tongue diagnosis at the present time. If I need to see your tongue, I will ask you to text me a photo (yes, really!)

Massage: In the past I have offered/given a short tui na spine release massage to most of my patients. While the Covid-19 risk remains high, massage will only be carried out if considered absolutely necessary. Getting undressed also increases the risk of surface contamination. Consequently, the majority of patients will not need to undress to their underwear. Please wear loose comfortable clothes, such as a track suit, and slip on shoes.

Facial Rejuvenation Acupuncture will not be available until further notice.

Masks

Whilst the easing of national restrictions means that some safety measures will no longer be a legal requirement, the government expects and recommends that people continue to wear a face covering in enclosed spaces. The British Acupuncture Council has advised that acupuncture practitioners should continue to wear Type IIR fluid resistant surgical masks in clinic and a visor or goggles when in unsocially distanced encounters in clinic. A significant number of my patients are high risk, in terms of their vulnerability to Covid and other infections. The majority have expressed great concern over the easing of restrictions. Given that the risk of Covid remains high, and the close-contact nature of acupuncture treatment, patients attending my clinic are still required to wear a clinical mask. If you don’t have one, I will be pleased to provide one at no charge. Obviously if you are exempt from mask wearing due to a medical condition or disability, you will not be required to wear one.

When you enter you will be directed to the cloakroom to wash your hands. On the small table you will see a clean metal tray, containing a new mask for your use.

Public Health England posters on ‘Putting on personal PPE’ and ‘Taking off personal PPE’  have been put up in the cloakroom to help you use the mask correctly.

If you need to remove your mask eg to lie face down on the couch. You will be given a new mask once your position allows. You should wash your hands before and after removing your mask.

It is important to avoid touching your face and mask during the treatment as this can increase spread of the disease. You should keep your mask on until after you leave clinic and discard it safely at home. These are single use masks, so you cannot wear it again once you have removed it from covering your mouth.

Disposable gloves

Whilst it is generally recommended that clinical practitioners wear disposable gloves, it is not mandatory for clinicians to wear gloves if this impairs their ability to give treatment. Acupuncture treatment requires very sensitive touch in pulse taking and needling which would be impaired by wearing gloves. Regular and thorough hand washing is the most effective form of hand hygiene. I will wash my hands regularly during and in between treatments. In the event that there is a risk of touching bodily fluids eg a used tissue, I will put on gloves.

Acupuncturists have always had to observe strict hand hygiene under the British Acupuncture Council Guide to Safe Practice.
Disposable gloves are available if you would like to wear them. Just ask. Please do not wear your own gloves into clinic.

Visor

When I am in unsocially distanced close proximity I will wear a visor as well as a mask.

To reduce face to face time, the British Acupuncture Council recommends that we conduct part of the consultation by phone, online form or email before the appointment and reserve the face-to-face component for physical examination and treatment.

Clear communication of new procedures with patients is an essential part of making my practice ‘Covid-19 Secure’. Official guidance demands that I communicate with patients before, during and after appointments. It may seem a bit overwhelming, but it is absolutely imperative patients understand the following:

• at times during the treatment, it will not be possible to maintain a 2m distance – this increases the chance of Covid-19 transmission
• by coming to the appointment, patients consent to following the hygiene procedures at the clinic, including hand washing and wearing PPE
• patients must inform me in advance and may not attend clinic if they have any signs or symptoms of Covid-19, have been exposed to it, or should be isolating for any reason
• patients need to weigh up the risks and benefits of coming for treatment, especially if they or anyone in their household is considered ‘clinically vulnerable’ or ‘clinically extremely vulnerable’
• patients required to sign a Patient Consent Form at the start of their appointment giving their formal Consent to treatment, in light of all the above
• patients must contact me if they develop Covid-19 symptoms within 48 hours of attending my clinic, get tested as soon as possible and comply with NHS Test and Trace procedures (see Important: What should you do if you develop Covid-19 symptoms? Test and Trace procedures)

So, there’s quite a lot to remember … and one of the best ways to be sure everything has been covered is to write it down.

New Forms

Patient Pre-Appointment Screening & Consent Form (PSF)

Under the government ‘Covid-19 Secure’ guidelines, I am required to carry out a risk assessment for every patient I offer to treat. At present, we are not permitted to treat everyone. On the basis of your risk assessment, I will make a professional judgement as to whether I can treat you at this phase in lockdown.

So, until further notice, everyone seeking an acupuncture appointment will be required to complete a Patient Screening & Consent Form.

• Submit your Patient Pre-Appointment Screening & Consent Form here
• Download Patient Pre-Appointment Screening & Consent Form PDF (PSF)

This health information form asks you:

• to provide details of your presenting complaint (why you would like to have acupuncture), giving brief details of how severe it is, how it is affecting you etc
• to answer several questions about your health and Covid-19
• to inform me if you, or anyone you live with/ or have close contact with, is considered ‘clinically vulnerable’ or ‘clinically extremely vulnerable’ to Covid-19

On receipt of your completed form, I will call you to clarify any details and advise you whether I am able to offer you an appointment now – or whether we need to wait until further relaxation of lockdown.

New Patient Online Health Questionnaire (NPOQ)

All new patients or those I have not seen for several years, will also be required to fill out this online questionnaire, giving details of their general health and past medical history.

Submit your New Patient Questionnaire here.

Patient Advance Information Sheet (PAIS)

Once I have received your completed Patient Screening Form, we have had a chat on the phone and your appointment has been booked in, I will send you a Patient Advance Information Sheet. This is a brief summary of the key information from this web page ie what you need to know before you come for your appointment.

I will also send you an advance copy of the Patient Consent Form (below).

Patient Consent Form (PCF)

At the start of your appointment you will be asked to sign a Patient Consent Form, confirming your Covid-19 health status, and that you understand that acupuncture treatment will necessitate me being within 2m/ in physical contact with you and that you understand that this increases the risk of contracting Covid-19.

• Download a copy of the Patient Consent Form PDF here

It is vitally important for you to let me know if you develop one of the three main Covid-19 symptoms* within 48 hours of your appointment. You must get tested immediately.

Under the new NHS Test and Trace programme, anyone you have had ‘close contact’ with, ie contact less than 2m, (including me) in the last 48 hours will have to self-isolate for 14 days.

I would be grateful if you could contact the government to get tested as soon as possible and let me know your test results straightaway. My ability to return to work is directly dependent on you getting tested quickly.

If your test is negative, I can get back to work immediately.

If your test is positive, I will need to self-isolate and close my practice for 14 days from the date of your appointment. You will need to provide my contact details to the NHS Test and Trace Service.

The three main symptoms of Covid-19 are:

• A fever (feeling hot to touch on your back or chest)
• A persistent dry cough
• Loss of sensations of smell or taste

What happens if my practitioner develops Covid-19 symptoms?

If I, Judy Bowen-Jones, develop one on the main symptoms of Covid-19, I must immediately stop work and self-isolate for 10 days. I will contact the NHS Test and Trace service straightaway to request a test.

I am required to contact everyone that I have had ‘close contact’ (within 2 m) in the last 48 hours (including patients I have seen) and tell them that I may have coronavirus and am awaiting a test result. These contacts do not need to self-isolate, but they should take extra care in practising social distancing and good hygiene, such as regular hand washing. They should also watch out for their own symptoms.

If I test negative, I will inform all those I have contacted that the test was negative and will resume work.

If I test positive, I will be contacted by the NHS Test and Trace service and asked to provide contact details of all those (including patients) I have had ‘close contact’ with in the last 48 hours before my symptoms started. They will be contacted by the Test and Trace service and told to self-isolate.

I am required to self-isolate for 10 days from the first signs of Covid-19. According to the NHS, I can stop isolating after 10 days if either:

• My Covid-19 symptoms have gone, or
• I just have a cough or changes to my sense of smell or taste – these symptoms can last for weeks after the infection has gone

I will continue to self-isolate after 10 days if I still have any of the following symptoms:

• A high temperature, fever or feeling shivery
• A runny nose or sneezing
• Feeling or being sick
• Diarrhoea
• Loss of appetite

I will stop self-isolating after all these symptoms have gone and not before 48 hours after having any diarrhoea.

NHS Test and Trace: Your data and Clinic Procedures (Updated 30th Sept 2020)

Under the latest Government Covid guidelines, venues designated ‘close contact services’ (such as acupuncture) are required to maintain records of staff and visitors to support the NHS Test and Trace programme.

In practice, this means that I am legally required to keep a record of all patients and visitors attending my clinic, and to supply this information to NHS Test and Trace at their request. The information to be recorded includes:

• name of the patient
• patient contact telephone number
• date of visit, including time of arrival and departure (or estimated departure)

As an acupuncturist, I already have this information in your patient notes and my appointment diary. By attending your appointment you give your consent to this.

These data will only be supplied to NHS Test and Trace in the event that I (the practitioner) get symptoms of COVID-19 within 48 hours of having close contact with you during the appointment and then later test positive.

An NHS Test and Trace QR clinic code is now displayed as you arrive. If you have the NHS COVID-19 App on your phone, it would be very helpful if you could scan it (ie ‘check-in’). This information stays on your phone, and, in the event of a Covid outbreak including the clinic, a message is sent directly to app users giving the necessary public health advice. If you don’t have a mobile phone or don’t have the app…don’t worry, I will have all the necessary information on record. Patients are under no obligation to scan the QR code.