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COVID-19 Clinic Policy

Updated October 2020

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Introduction

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The health and safety of both patients and the therapist is paramount. Infection control standards at Podiatry Plus are always high, however stringent additional measures are currently being taken due to Covid-19.

 

This document is to be used in combination with documents from other organisations such as the College of Podiatry and Public Health England to outline best practice regarding clinic procedures in the current pandemic.

 

Additional Infection Control

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Some evidence suggests that Chlorhexidine is not an effective disinfector of the Corona virus so will use bleach or chlorine-based solutions which appear to be superior.

 

We will act to minimise:

 

  1. Contact with possible contaminated surfaces by minimising surfaces patients make contact with. We will keep the doors open, create zones where patients will keep belongings which are able to be wiped down between uses. We have created cleaning protocols for; before the clinic session, between patients and completion of the clinic session, details of which are below. We will ensure patients use alcohol hand gel on entering and exiting the clinic, if unable to use hand gel we will encourage patients to wash hands at a dedicated hand-washing sink. PPE will be worn in line with most recent Public Health England/College of Podiatry advice.
     

  2. Droplet particles from coughing and sneezing as a source of transmission will be reduced by appropriate use of PPE and a Perspex screen between patient and Podiatrist during the consultation. Distancing of 2m will also be enforced. Patients will be asked to wear a mask, unless medically exempt.
     

  3. Airborne particles from general respiration through appropriate use of PPE, cleaning protocols and patient use of face coverings. We will also remove any unnecessary items to allow for easy cleaning.

 

During the beginning of the clinic session and between treatments we will clean the below areas thoroughly:

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  • All instruments to be sterilised (before session begins and as needed)

  • Door knobs/handles

  • Entire treatment couch

  • Patients’ chair in clinic and waiting room chairs they may have sat on

  • Podiatrist’s chair

  • Foot Tray

  • Laptop/Tablet/Keyboard

  • Card machine

  • Clipboard and Pen

  • Treatment trolly

  • Drawer handles, drill, doppler and any other items touched in the course of treatment

  • Around hand washing sink and possible splashing zone around sink

 

At the end of the clinical session the below areas are to be cleaned:

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Instruments will be all cleaned following the clinic session to ensure maximum use of breaks to perform cleaning tasks between patients where possible.

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  • Front Door

  • All Door knobs/handles

  • Storage Units and Hard Surfaces in Waiting Room

  • All Clinic Work Tops, Sinks and Any Other Hard Surfaces

  • Entire Treatment Trolley and accessories e.g drill, emollient bottle and sprays

  • Desk and Desk Accessories

  • Laptop/Tablet/Keyboard

  • Card Machine

  • Ultrasonic Cleaner and Autoclave (following end of day use)

  • Window Sills

  • Skirting Boards

  • Entire treatment couch

  • All chairs in clinic

  • Podiatrist’s chair

  • Foot Tray

  • All Cleaning items e.g Mop Handle, Dustpan Handle and Cleaning Bottles

  • Floor to be moped

*Disposable cleaning items will be used where appropriate.

 

Personal Protective Equipment (PPE)

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The College of Podiatry currently directs podiatrists to the patient ‘pathway’ which has been developed from Public Health England recommendations.

 

It determines what PPE must be worn based on the ‘High risk pathway’, ‘Medium risk Pathway’ and the ‘low risk pathway’. The criterion is based on the outcome of patient screening. See table below.

 

Risk factors to be considered include the procedure being carried out and the outcome of patient screening. We will follow proper procedures of donning and doffing PPE and remain up to date with all procedures relating to Cov-19, including the use of PPE.

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High Risk Pathway

Covid-19 positive patients. 

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Symptomatic patients.

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Suspected Covid-19 patients who have been in close contact with a positive person.

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Untriaged patients (as in you have not checked before hand if they have symptoms etc.)

Must not treat in private practice

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Gloves

Full gown

FFP2/3 (if within 2 meters)

Visor

Plus FFP3 Mask or Hood if AGP.

Medium Risk Pathway

Low Risk Pathway

Triagged patients who have no symptoms and are either await a Covid-19 test result or have  one within the last 72 hours. 

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Asymptomatic patients who have declined to be tested. 

Gloves

Apron

Fluid resistent IIR Face Mask

Plus

Eye protection, FFP2/3 mask and full gown if extensive blood or bodily fluids expected or risk of splashing

or

Visor, FFP3 mask and full gown if AGP performed.

Triaged patients who have no symptoms and have had a negative Covid-19 test within the last 72 hours. 

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Patients who have recovered from Covid-19 and have had 3 clear days without symptoms and have had a negative test. 

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Patients who are regularly tested and remain negative i.e. NHS or care home workers. 

Gloves

Apron

Fluid resistent IIR Face Mask

Plus

Eye protection and full gown if extensive blood or bodily fluids expected and thus risk of splashing.

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Clinical Waste

 

Waste including disposable tissues/paper and consumables that have been in contact with the patient and those that have been used to clean the clinic will be disposed as clinical waste.

 

Podiatrist’s Attire

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  • Clean scrubs, scrub cap and socks to be put on in clinic.

  • Shoes to be kept in clinic

  • After session, scrubs and socks to be placed into a pillowcase and put directly into washing machine upon bringing them into the house and washed at 60 degrees.

  • After session, podiatrist to go directly home and shower, laundering clothes that have been worn between clinic and house as soon as possible.

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On booking the appointment

 

Patients are to be screened using updated recommendations from Public Health England which has been broken down by the College of Podiatry for accessibility. Screening will allow early recognition of Covid-19 cases and to be applied to accompanying persons.

 

screening patients will be broken in to three pathways which will ensure they can be seen and will dictate what PPE should be worn by the Podiatrist.

 

Screening questions all equate to evaluating the risk that a patient poses of having or coming into contact with Covid-19. 

All patients will be considered for remote consultations.

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For patients that book via telephone they will be screened during the call.

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For those that book via email they will be emailed a copy of the screening questionnaire to complete before attending. They will be asked to call us if they have any problems completing this.

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For those that book via our online booking system. They will be screened using the booking software.

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Each booking will be directed to information of the clinic’s current safety measures. Every patient will be informed on what to do if they suspect they have come in to contact with Covid-19 before their appointment. This information is also always accessible on the website.

 

 

On Arrival to the appointment

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  • Signage on door to ensure no one enters the clinic who is not safe to do so.

  • Signage on door to discourage visitors and drop-ins.

  • Signage to state clear advice on face coverings.

  • The patient is directed to hand gel before entering the treatment room.

  • We will verbally check patient is safe to gain entry by ensuring they or any of their family members/bubble have no symptoms, not been in contact or diagnosed with COVID, not travelled from abroad in the last 14 days and not awaiting test results. We will also ask whether they have had a test in the last 72 hours so we can ensure we have designated the right pathway and therefore done the correct PPE.

 

Other Safety Measures/changes to general running of the clinic

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  • Hand gel and tissues made available to encourage use of standard hygiene protocols.

  • As much as possible, surfaces are clear to allow for easy cleaning. 

  • Doors to be left open unless ambient temperature is intolerably low

  • Signs made visible to maintain outlined safety measures. Lavatory to be closed to the public until further notice. 

  • Gaps between patients’ appointments to avoid cross over and to allow additional time to clean.

  • Patients who are particularly vulnerable are to be seen at the start of the session 

 

References:

 

  • College of Podiatry (2020) ‘Clarification on use of Facemasks and following Government Guidance’.

  • College of Podiatry (2020) ‘Decision Tree for Independent Practitioners’.

  • Public Health England (2020) Covid-19: infection prevention and control guidance’

  • G. Kampf et al (2020) ‘Persistence of coronaviruses on inanimate surfaces and their inactivation with biocidal agents’. Journal of Hospital Infection 104 pp.246-251.

  • Public Heath England (2020) ‘Guide to donning and doffing standard Personal Protective Equipment (PPE)’.

  • Public Health England (2020) ‘Recommended PPE for primary, outpatient, community and social care setting, NHS and independent sector’.

  • Public Health England (2020) ‘Additional considerations, in addition to standard infection prevention and control precautions…’.

  • Public Health England (2020) ‘Covid-19 Guidance on the demobilisation of services within health and care settings’.

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