24 February 2022 - Update to Covid protocols
With the easing of Covid restrictions in England from the 24th February, we take the opportunity to review our covid protocols and we have updated our procedures as follows (Our initial Risk Assessment is available below this update):
No Change:
1. Mask wearing & Hand sanitising
Medical premises are still being advised to keep mask-wearing and hand sanitising for staff and visitors alike.
2. COVID screening
We are being advised by our advisory body to keep screening visitors attending the clinic for symptoms of Covid-19 so please continue to fill in your Covid questionnaire ahead of your appointment (but it has been simplified).
No change but in Need of Clarifications:
3. DO NOT Attend your appointment while you have Covid Whilst mandatory self-isolation for Covid positive cases is being lifted, the government advice is still to cancel routine medical appointments and we ask that you do not attend your appointment whilst testing positive and that you reschedule for at least 7 days from when you first started having symptoms. Please give us as much notice as possible.
Updated Guidance
4. DO NOT Attend your appointment while you have ANY respiratory infection or symptoms of Norovirus
We ask that you reschedule your appointment if you have any symptoms of respiratory infection until 7 days from when you first started having symptoms. Please give us as much notice as possible. If you need an emergency appointment whilst you have a respiratory infection please contact us and we will assess the situation on a case-by-case basis.
5. Attending your appointment if you are a close contact of someone who tested positive
If you have been in contact with someone who has tested positive, you can still attend your appointment IF you have no symptoms yourself AND have a negative lateral flow test (LFT) on the day of your appointment. We will review this guidance once free LFT are being withdrawn.
6. Attending your appointment when a household member is testing positive for Covid-19
We ask that you reschedule your appointment for 3 days after someone in your household has tested positive for Covid-19 AND have a negative lateral flow test (LFT) on the day of your appointment. We will review this guidance once free LFT are being withdrawn.
7. Our Cleaning Protocol
We are relaxing our cleaning protocols a little but we are confident that we are doing so without compromising anyone’s safety. We will continue to wipe our plinth and pillow between each appointment, but other surfaces such as chairs, tables, etc. will be treated with Viresist at least weekly.
VIRESIST is tested to ASTM E 2180 and remains active for up to 10 days after application and is resistant to the most common and harmful germs and viruses including SARS-CoV-2 (Coronavirus) , MRSA, Hepatitis B&C, Norovirus & Ebola.
8. Our PPE
Glove wearing Research has clearly shown that glove wearing doesn’t offer any additional protection over good hand hygiene in clinical settings such as ours where there is no contact with bodily fluids. From the beginning of the pandemic we were advised to wear gloves for the sole purpose of increasing public confidence and to comply with what HSE considered “full PPE” for track and trace purposes.
We will still use gloves (like we always have) for internal techniques and when there is a clinical need for it such as open cuts, wounds or otherwise broken skin on practitioner’s hands or in an exposed area of patient’s skin.
However, wearing gloves is now left to the individual choice of practitioners but will still be available.
If you feel more comfortable with us wearing gloves, please ask and we will happily don them!
9. QR check in Code
We are no longer displaying a QR check-in code, which was used for the purpose of track & trace services.
Our PPE & Environmental impact - No change
10. PPE Recycling Since the start of the pandemic, not a single item of our PPE from our Norwich clinic has gone to landfills. We are currently using a company called ReWorked to recycles our used PPE and difficult to recycle plastic and turn them into planters and other such items of garden furniture.
11. Environmental impact
We buy our alcohol-free and skin-friendly hand sanitizer - including our very popular Rhubarb and Custard one (fully certified against SARS-Co-2 and other germs) and Viresist from Serenity Hygiene, who have a strong commitment to using cruelty free, vegan and environmentally friendly ingredients.
We also use Edge Protect’s TriGuard for surface sanitising which is a UK manufactured water based pH neutral sanitiser that doesn’t use any aggressive chemicals, alcohol or bleach. It is non-toxic, biodegradable, and skin-friendly as well as being certified to BS EN:1276 & 13697 and proven to kill MRSA, E-coli, Influenza, and Coronavirus.
We are using repurposed cotton cloths to clean within our treatment room, which are washed after each use in order to reduce our waste and environmental impact, however, disposable paper towels are still being used in the washroom for complete peace of mind.
References:
https://www.gov.uk/government/publications/covid-19-people-with-covid-19-and-their-contacts/covid-19-people-with-covid-19-and-their-contacts
https://edge-protect.co.uk
https://shop.serenityhygiene.com
COVID-19 Risk Assessments
For: Body Flow Osteopathy - Norwich Waterloo Road Practice
Risks Identified and Mitigated for:
KEY POINTS FOR PATIENTS:
What you need to know and what you need to do
Below are our detailed protocols and procedures to mitigate the risks outlined above, presented in a step-by-step format reflecting the chronology of the patient’s journey.
COVID-19 Anxiety
We understand that the COVID-19 pandemic has created a huge amount of disturbance and anxiety throughout the population. This is a very anxious time for most and we share this feeling.
However, since the discovery of the severe acute respiratory syndrome coronavirus 2 virus (SARS-CoV- 2) which causes the Covid-19 infection, a great deal of scientific resources worldwide have been dedicated to learning everything we can about the virus and the plentiful evidence emerging from the research is informing our decision on an ongoing basis, making it easier to make effective and targeted decisions to reduce the risk of transmission to all of us. Of course, the scientific community has much left to learn and no doubt, guidance will change as we learn more about the minuscule and invisible virus that has so profoundly changed our lives.
However, the current research strongly indicates that respiratory droplets (the moisture released from our mouth and nose) coming into contact with someone else’s mucosa (the skin inside your mouth & nose and around your eyes) is the primary means of infection transmission. Surface transmission (from touching objects) is being shown through research to be a lesser modality of transmission than originally feared, whilst there is currently no evidence that COVID-19 can be transmitted through feces although research is ongoing.
Whilst COVID-19 is a new and unprecedented illness, its mode of transmission has been shown to be flu-like and this is a mode of transmission that is extremely well understood in the medical and scientific community. Rest assured that his knowledge underlines all of our decisions when it comes to safety and this is also why droplet management has been given such a large emphasis in our protocols.
Identifying the Risks
There is NO evidence that the virus can be transmitted through intact skin contact or through sweat so we are confident that our protocols which are aimed at controlling respiratory droplets and hand sanitising are in line with the best evidence available at this time, and will help to keep us and you safe during your visit.
It is also useful to understand that a virus can not cause harm until it gets inside the body in sufficient amounts. Therefore, having some viral particles on your hands (assuming intact skin) will not cause an infection unless you touch your mouth, eyes or nose from where the virus can get in. The same applies for droplets with viruses attached which may be present on surfaces like walls, floors, books, handles, etc.: these will only cause potential harm if they are inhaled or somehow get into the body (ie: touching the surface followed by picking your nose).
The most common route of infection is through breathing in infected droplets, in this scenario the virus is inhaled from the surrounding air or from the breath of a nearby person and gets into the body via the lining of the lungs. Research also indicates that the “viral load” (i.e.: how much viral particles you have been exposed to) is important. A small viral load (i.e.: if you only have been exposed to a small amount of viruses) is far less likely to cause an infection, whereas a large viral load - as experienced by nurses, doctors, cleaners and other health professionals working on COVID-19 wards is much more likely to result in an infection.
Therefore, viruses on the floor for instance, which may have landed there from the droplets of an infected but pre-symptomatic person (someone who has the virus and is contagious, but has not yet developed symptoms) who was breathing or speaking in the room, may transfer to the shoes or socks of the following person but as long as they are not then put into direct contact with a mucosa (mouth, nose, eyes or other moist tissues of the body), the virus will not cause an infection. However, if a toddler was left to crawl on the floor or if someone was to do push ups on the floor (transferring the virus particles to their hands) and soon after scratched their eyes, or put their fists in their mouth like toddlers often do (and therefore, putting the virus particles on their hands directly into contact with their mouth), there would be a certain risk of transmission. However, simply walking on a floor where infected droplets may be found is not a significant risk (so long as you don’t put your shoes in your mouth! But Covid aside, don’t do that!..)
Our protocols are very comprehensive and we hope you will find this reassuring.
HOWEVER, you must understand that despite our best efforts, the risk of transmission can not be nullified since we are dealing with an invisible enemy, meaning that no matter how careful we are with our PPE (Protective Personal Equipment), cleaning and how careful you are with your face covering and hand washing, there is an inherent and unquantifiable risk that you may catch or spread COVID-19 by leaving your house to attend an appointment with us, however minimal. Of course, this risk exists whenever you leave your house for any reasons, such as picking up medication or going food shopping. We continue to maintain our original stance that we are still much safer to visit than supermarkets and most other places due to the small size of our building, our very small footfall and the absolute control we have over our environment.
As part of our protocol, we will ask you to confirm that you are aware of this risk and that you accept it. This is what we call informed consent.
Your risk calculation when you decide to book an appointment with us must also take into account your journey to us, especially if this happens on public transport. You should also consider other people in your household as part of your personal risk assessment, especially if someone is at high risk of COVID-19 complications.
Due to the hands-on nature of our work, face to face treatments can not be carried out whilst maintaining the rules of social distancing, and proximity increases the risks of virus transmission. This is the reason why we wear PPE and the best quality mask we could buy, and the reason why we have made significant monetary investments in air sanitising equipment.
Research has shown that many people will have a very mild illness with COVID-19 (which they may not recognise) and transmission from asymptomatic or pre-symptomatic carriers (someone who has the virus but does not have any symptoms of the illness) is possible, this is the reason why we ask you to wear a face covering and the reason why we wear PPE.
Who We Can’t Treat:
We are unable to offer face to face appointments to:
Remote Consultation
Most Common Symptoms of COVID-19
The main key diagnostic symptoms are:
Most people with coronavirus have at least one of these symptoms. Note that you do not need to have all the symptoms, some people only have ONE of these symptoms.
Visit the NHS website for the latest guidance on Coronavirus symptoms or call 111 if you are experiencing symptoms: https://www.nhs.uk/conditions/coronavirus-covid-19/check-if-you-have-coronavirus-symptoms/
Appointments for those at high risks
With recent changes announced mid-June, we are now able to offer an appointment to anyone in need, even those who were asked to shield. However, we recognise this is a higher risk and we recommend that those at high risk should only book appointments as necessary (i.e: avoid maintenance or check up appointments) and we recommend they book the first appointment of the day or an appointment following a longer cleaning break (if possible).
A face visor is available, should you or your practitioner feel you need this extra layer of protection.
If you were not told to shield but a member of your household was, we strongly recommend that you take this into consideration when booking an appointment.
Who is at high risk (clinically extremely vulnerable)
People at high risk from coronavirus complications include people who:
Appointment for those at moderate risk (clinically vulnerable)
Some conditions listed in the moderate risk category (such as mild, controlled asthma) are listed in the NHS moderate risk category but other organisations have stated that the increased risk is minimal. However, we suggest increased precautions and a case-by-case assessment and we recommend only booking an appointment as necessary, if you feel comfortable with the risk.
People at moderate risk from coronavirus include people who:
Risks Identified and Mitigated for:
- Patient to Practitioner SARS-CoV-2 transmission
- Practitioner to Patient SARS-CoV-2 transmission
- Asymptomatic or Pre-symptomatic transmission
- Third Party Transmission to either patient or practitioner
- Surface transmission
- Droplets/ Aerosols transmission
KEY POINTS FOR PATIENTS:
What you need to know and what you need to do
- Before EVERY appointment, you will undergo a screening process to confirm you and your household are free from COVID symptoms. A screening questionnaire will be sent to you by email the days before your appointment for you to complete. Please look out for this email, or let us know if you prefer to receive this via text messages.
- Despite our best efforts, there is an inherent risk of catching or spreading COVID-19 that you take whenever you leave your house or attend an appointment. We’re taking every precaution we can to reduce the risk however, the risk can never be nullified. As part of the screening process, you will be asked to confirm that you are aware of this risk and that you accept it.
- You will be asked to wear a face mask during your appointment. We can supply you with one for £1 (cost price).
- You will need to use hand sanitizer upon entering the building or wash your hands.
- Avoid bringing in other people unless the appointment is for a child or you need someone as a chaperone. Chaperones must be from your household, have no COVID-19 symptoms, and they should not have any underlying health issues which puts them at Moderate or High risk of COVID-19 complications (to reduce the risk to them). Please speak to us if this affects you.
- We ask that you remain in your car until your appointment time. If the weather is bad and your are not driving, you will still be allowed to use the waiting room.
- Payment: We prefer payment by Apple pay or Google pay as they are contactless for any amount but card payments are also perfectly acceptable. If you pay cash please bring the exact amount. We will no longer accept cheques.
- We have heightened cleaning procedures in place, in line with guidance, and we will be wearing PPE during your appointment. Further details are outlined in this document.
- We have conducted a COVID-19 risk assessment and taken every possible precaution to reduce the risk of transmission. Protecting you and others working at the practice is our priority.
- Please DO NOT attend your appointment if you are unwell. If you become unwell between your screening and your appointment time, please contact us at once.
Below are our detailed protocols and procedures to mitigate the risks outlined above, presented in a step-by-step format reflecting the chronology of the patient’s journey.
COVID-19 Anxiety
We understand that the COVID-19 pandemic has created a huge amount of disturbance and anxiety throughout the population. This is a very anxious time for most and we share this feeling.
However, since the discovery of the severe acute respiratory syndrome coronavirus 2 virus (SARS-CoV- 2) which causes the Covid-19 infection, a great deal of scientific resources worldwide have been dedicated to learning everything we can about the virus and the plentiful evidence emerging from the research is informing our decision on an ongoing basis, making it easier to make effective and targeted decisions to reduce the risk of transmission to all of us. Of course, the scientific community has much left to learn and no doubt, guidance will change as we learn more about the minuscule and invisible virus that has so profoundly changed our lives.
However, the current research strongly indicates that respiratory droplets (the moisture released from our mouth and nose) coming into contact with someone else’s mucosa (the skin inside your mouth & nose and around your eyes) is the primary means of infection transmission. Surface transmission (from touching objects) is being shown through research to be a lesser modality of transmission than originally feared, whilst there is currently no evidence that COVID-19 can be transmitted through feces although research is ongoing.
Whilst COVID-19 is a new and unprecedented illness, its mode of transmission has been shown to be flu-like and this is a mode of transmission that is extremely well understood in the medical and scientific community. Rest assured that his knowledge underlines all of our decisions when it comes to safety and this is also why droplet management has been given such a large emphasis in our protocols.
Identifying the Risks
There is NO evidence that the virus can be transmitted through intact skin contact or through sweat so we are confident that our protocols which are aimed at controlling respiratory droplets and hand sanitising are in line with the best evidence available at this time, and will help to keep us and you safe during your visit.
It is also useful to understand that a virus can not cause harm until it gets inside the body in sufficient amounts. Therefore, having some viral particles on your hands (assuming intact skin) will not cause an infection unless you touch your mouth, eyes or nose from where the virus can get in. The same applies for droplets with viruses attached which may be present on surfaces like walls, floors, books, handles, etc.: these will only cause potential harm if they are inhaled or somehow get into the body (ie: touching the surface followed by picking your nose).
The most common route of infection is through breathing in infected droplets, in this scenario the virus is inhaled from the surrounding air or from the breath of a nearby person and gets into the body via the lining of the lungs. Research also indicates that the “viral load” (i.e.: how much viral particles you have been exposed to) is important. A small viral load (i.e.: if you only have been exposed to a small amount of viruses) is far less likely to cause an infection, whereas a large viral load - as experienced by nurses, doctors, cleaners and other health professionals working on COVID-19 wards is much more likely to result in an infection.
Therefore, viruses on the floor for instance, which may have landed there from the droplets of an infected but pre-symptomatic person (someone who has the virus and is contagious, but has not yet developed symptoms) who was breathing or speaking in the room, may transfer to the shoes or socks of the following person but as long as they are not then put into direct contact with a mucosa (mouth, nose, eyes or other moist tissues of the body), the virus will not cause an infection. However, if a toddler was left to crawl on the floor or if someone was to do push ups on the floor (transferring the virus particles to their hands) and soon after scratched their eyes, or put their fists in their mouth like toddlers often do (and therefore, putting the virus particles on their hands directly into contact with their mouth), there would be a certain risk of transmission. However, simply walking on a floor where infected droplets may be found is not a significant risk (so long as you don’t put your shoes in your mouth! But Covid aside, don’t do that!..)
Our protocols are very comprehensive and we hope you will find this reassuring.
HOWEVER, you must understand that despite our best efforts, the risk of transmission can not be nullified since we are dealing with an invisible enemy, meaning that no matter how careful we are with our PPE (Protective Personal Equipment), cleaning and how careful you are with your face covering and hand washing, there is an inherent and unquantifiable risk that you may catch or spread COVID-19 by leaving your house to attend an appointment with us, however minimal. Of course, this risk exists whenever you leave your house for any reasons, such as picking up medication or going food shopping. We continue to maintain our original stance that we are still much safer to visit than supermarkets and most other places due to the small size of our building, our very small footfall and the absolute control we have over our environment.
As part of our protocol, we will ask you to confirm that you are aware of this risk and that you accept it. This is what we call informed consent.
Your risk calculation when you decide to book an appointment with us must also take into account your journey to us, especially if this happens on public transport. You should also consider other people in your household as part of your personal risk assessment, especially if someone is at high risk of COVID-19 complications.
Due to the hands-on nature of our work, face to face treatments can not be carried out whilst maintaining the rules of social distancing, and proximity increases the risks of virus transmission. This is the reason why we wear PPE and the best quality mask we could buy, and the reason why we have made significant monetary investments in air sanitising equipment.
Research has shown that many people will have a very mild illness with COVID-19 (which they may not recognise) and transmission from asymptomatic or pre-symptomatic carriers (someone who has the virus but does not have any symptoms of the illness) is possible, this is the reason why we ask you to wear a face covering and the reason why we wear PPE.
Who We Can’t Treat:
We are unable to offer face to face appointments to:
- Anyone with symptoms of COVID-19
- Anyone who has someone in their household showing symptoms of COVID-19
- Anyone self-isolating after being in close contact with someone confirmed to have COVID-19 or told to self-isolate for other reasons.
- Anyone who tests positive for COVID-19 should allow 14 days between the onset of symptoms and appointment time AS LONG AS they no longer have a cough. If a cough persists beyond 14 days, advice should be sought from the NHS. This will be reviewed as more evidence emerges.
Remote Consultation
- Remote consultations (Tele-Heatlh) will continue to be available to everyone. If this is your preference, please specify your choice to the receptionist if booking over the phone or select “Tele-Health” in online bookings.
Most Common Symptoms of COVID-19
The main key diagnostic symptoms are:
- high temperature – this means you feel hot to touch on your chest or back (you do not need to measure your temperature)
- new, continuous cough – this means coughing a lot for more than an hour, or 3 or more coughing episodes in 24 hours (if you usually have a cough, it may be worse than usual)
- Feeling short of breath
- loss or change to your sense of smell or taste – this means you've noticed you cannot smell or taste anything, or things smell or taste different to normal.
- Fatigue
- Myalgia (pain in your joints and muscles)
- Sore throat
- A productive cough (when you bring up mucus).
Most people with coronavirus have at least one of these symptoms. Note that you do not need to have all the symptoms, some people only have ONE of these symptoms.
Visit the NHS website for the latest guidance on Coronavirus symptoms or call 111 if you are experiencing symptoms: https://www.nhs.uk/conditions/coronavirus-covid-19/check-if-you-have-coronavirus-symptoms/
Appointments for those at high risks
With recent changes announced mid-June, we are now able to offer an appointment to anyone in need, even those who were asked to shield. However, we recognise this is a higher risk and we recommend that those at high risk should only book appointments as necessary (i.e: avoid maintenance or check up appointments) and we recommend they book the first appointment of the day or an appointment following a longer cleaning break (if possible).
A face visor is available, should you or your practitioner feel you need this extra layer of protection.
If you were not told to shield but a member of your household was, we strongly recommend that you take this into consideration when booking an appointment.
Who is at high risk (clinically extremely vulnerable)
People at high risk from coronavirus complications include people who:
- have had an organ transplant
- are having chemotherapy or antibody treatment for cancer, including immunotherapy
- are having an intense course of radiotherapy (radical radiotherapy) for lung cancer
- are having targeted cancer treatments that can affect the immune system (such as protein kinase inhibitors or PARP inhibitors)
- have blood or bone marrow cancer (such as leukaemia, lymphoma or myeloma)
- have had a bone marrow or stem cell transplant in the past 6 months, or are still taking immunosuppressant medicine
- have been told by a doctor they you have a severe lung condition (such as cystic fibrosis, severe asthma or severe COPD)
- have a condition that means they have a very high risk of getting infections (such as SCID or sickle cell)
- are taking medicine that makes them much more likely to get infections (such as high doses of steroids)
- have a serious heart condition and are pregnant
Appointment for those at moderate risk (clinically vulnerable)
Some conditions listed in the moderate risk category (such as mild, controlled asthma) are listed in the NHS moderate risk category but other organisations have stated that the increased risk is minimal. However, we suggest increased precautions and a case-by-case assessment and we recommend only booking an appointment as necessary, if you feel comfortable with the risk.
People at moderate risk from coronavirus include people who:
- are 70 or older
- are pregnant
- have a lung condition that's not severe (such as asthma, COPD, emphysema or bronchitis)
- have heart disease (such as heart failure)
- have diabetes
- have chronic kidney disease
- have liver disease (such as hepatitis)
- have a condition affecting the brain or nerves (such as Parkinson's disease, motor neurone disease, multiple sclerosis or cerebral palsy)
- have a condition that means they have a high risk of getting infections
- are taking medicine that can affect the immune system (such as low doses of steroids)
- are very obese (a BMI of 40 or above) - a BMI calculator can be found here: https://www.nhs.uk/live-well/healthy-weight/bmi-calculator/
COVID-19 Protocols
Pre-Screening Process for Face to Face Appointments:
- A link to a questionnaire will be sent to you the day before your appointment and we ask that you return this within 24 hrs of your appointment. We may need to speak to you about your answers before your appointment so please make sure your phone number is up to date.
- For emergency appointments, please contact us on the phone as we may be able to provide a sooner appointment and carry out the pre-screening questionnaire at the same time.
- Should you develop any COVID-19 symptoms between booking an appointment and your appointment day/time, please contact us immediately to cancel your appointment via phone, email or text messages. No cancellation fee will apply but please do give us as much notice as possible.
Arriving & Entering the Practice:
- We ask people to remain in their car until their appointment time. Free parking is provided right outside the clinic. If you need to park elsewhere or plan to arrive on foot or via public transport, you may be asked to wait outside until your appointment time. If you do not have a car and the weather is bad, you will be allowed to wait in the waiting area but we respectfully ask to avoid this where possible. Please use the wipeable chairs in the waiting area rather than the fabric sofa.
- The front door will be locked (as usual) to allow us to control physical access to the building. Please ring the doorbell at your appointment time if we have not acknowledged your presence before then.
- You will be asked to put on a face covering and use hand sanitizer as you enter.
- We kindly request that you do not bring children to your appointment to reduce the risk to everyone, unless the appointment is for the child. If this is not possible, please discuss this with us first.
Chaperone for Adult Appointments
- You are still welcome to bring a chaperone to your appointment if it makes you feel more comfortable. This person should preferably be from your own household, should meet the conditions set above in the “pre-appointment screening” section to enter the building and must accept the inherent risks relating to COVID-19 transmission. This person’s name will be recorded on your records.
Children’s Appointments
- If you are bringing a child under 16 years of age to an appointment, we will require a parent or guardian to be present for the duration of the appointment. Both the child and the accompanying adult must meet the conditions set above in the “pre-appointment screening” section.
- For children’s appointments, we prefer if only one parent attends with the child, however we will not refuse for both parents to be present especially for the initial consulation.
- Please bring your own toys
- Babies will be treated on a clean hand towel (washed after a single use and stored outside the treatment room in a closed cabinet) to prevent any cleaning product residue causing skin irritation.
- Latex gloves are not used in our clinic to avoid reactions from a potentially unknown latex allergy and only Nitrate gloves are used.
Note: We decided against doing temperature checks at the door as we feel there are too many factors affecting reliability and interpretation of the reading. Including the device reliability, individual variation in basal body temperature, hormonal changes, hot summer weather, etc. However, if you feel you have a fever, please check your temperature at home before attending your appointment and cancel if you have a fever.
During Your Attendance at the Practice:
Controlling respiratory droplets is the key to reducing the spread of SARS-CoV-2, therefore significant emphasis is placed on this in our protocols. We appreciate your cooperation in keeping you, our practitioners and our families safe.
- We ask that you wear a face mask when attending the practice. Please put it on before entering the building and only remove it after you leave. This will help reduce the amount of droplets and aerosols in the building.
- If you do not have a face mask, we will provide a disposable one for you for a £1 surcharge to cover the cost. No profit is made on selling masks.
- If you are unable to wear a mask for any reason, please let us know and we will arrange for you to have the last appointment before a cleaning break or at the end of the day to reduce the risk to others. We will discuss this with you but refuse the right to refuse to treat if you will not, or can not wear a mask.
- If more than one practitioners are present in the building at the same time, we will do our best to maintain a minimum of 1-2 meters distance between us and would ask patrons to do the same outside the treatment room. The layout and size of our building makes this very difficult so we only ask that you do your best.
- We have modified our opening hours to avoid two practitioners using the building at the same time, as much as possible. Avoiding this completely was not possible but it has been reduced to a minimum.
- For new patients, the practitioner will increase the distance in between to nearly 2 m by using the end of the treatment couch as a desk for the interview part. If you prefer to arrange the interview part of your initial consultation via remote consultation (tele-health), please let us know and we will be happy to arrange this for you to reduce the amount of contact time.
Toilet Access
- Access to the toilet will continue to be available, however we ask that you avoid using it where possible. Disinfectant wipes will be left in the washroom should you wish to clean the surfaces before using the facilities (for your complete peace of mind), in addition to our frequent cleaning. Please do not flush the wipes, dispose of them in the bin provided.
- We also request that you close the toilet lid before flushing. Flushing can send feces particles into the air up to a few feet away from the toilet and promote the spread of certain viruses such as the many common winter bugs causing vomiting and diarrhea. There is currently no evidence that SARS-CoV-2 (COVID-19) can be spread in this way but it is a good rule of hygiene.
- We will aim to clean the washroom after each use, where possible.
Payment
- We encourage you to pay via Apple Pay or Google Pay which can be done via contactless payment for any amount simply by holding your phone against the reader.
- We will continue to accept other card payments requiring you to enter a PIN number on a touch screen (as usual). The screen will be disinfected between usage and you will be given hand sanitizer after touching the touchscreen. A bottle is kept next to the card machine, so if we forget to offer it to you, please help yourself.
- If paying by card, our card reader will be removed from its docking station so that you can insert and remove your card without us touching it.
- We will continue to accept cash but we ask that you bring in the exact amount, as much as possible. The notes and coins you give us will be left for a minimum of 3 days before they are handled.
- We ask that you do not give us a cheque to avoid an unnecessary trip to the bank for us.
Price Adjustments
Like most small businesses who survived the lockdown, we have had to adjust our pricing due to the significant increase in our cost and equipment for operating during the pandemic, over and above the general increase in operational cost over the last 8 years.
- Adults follow up appointments will increase to £50 from the 1st June.
- Initial Adult Appointments will be £60 (60- 75 mins) from the 1st June.
- Initial Children Appointments will be £45 (60 mins)
- Follow up children Appointments will be £40 (45 mins)
This is our first price increase for follow up appointments since 2012. We trust you will understand and be supportive of our decision.
Leaving the Practice
- A bottle of hand sanitizer will be left by the door and you are encouraged to use it before leaving the practice, at your discretion.
- If you need to wait inside for a taxi or pick up, you will still be welcome to do so but we encourage you to wait outside where and when possible.
- If you wait inside, please use the wipeable chairs in reception rather than the fabric sofa
- We will do our best to open the doors for you so that you do not have to touch any surfaces unnecessarily, however if we are unable to assist please use the release button (as usual) and we will sanitize all the handles, doorbell and release button between each appointment.
Infection Control Measures Taken:
From mid-March 2020, we introduced measures for infection control which will continue until further notice:
- We removed all reading material and toys from reception to minimise surface transmission
- We are only using single use towels in the washroom and in our clinic room
- Where a non disposable towel is used during an appointment, it will be single use before washing.
- We have made additional bottles of hand sanitizer available in reception.
- Hand soap and hand cream were always available and this will continue to be.
- We have removed fabric couch covers and replaced our pillow cases with wipeable ones to make it easier to sanitize surfaces between each client.
- Our chairs and stool in the clinic room are all wipeable and sanitized between every appointments
- We have a stringent cleaning protocol in place (detailed below)
- We will wear a mask and clinically indicated PPE during your appointment (see PPE section).
- We will follow guidelines ourselves and self-isolate if we show any signs or symptoms of COVID-19, as per current government guideline.
Hand Hygiene
- Upon entering the building, everyone except infants, will be asked to use hand sanitizer and/or to wash their hands.
- It was always recommended that you wash your hands with soap and water after using the toilet and this timeless advice remains unchanged! Hand sanitizer was always available in the washroom alongside soap and hand cream and this will remain so.
- Practitioners will also use hand sanitizer upon entering the building and wash hands thoroughly between appointments, following the WHO hand washing technique including the washing of forearms. Hand sanitizer is to be used by practitioners after hand washing and during the treatment session as required. If touching surfaces such as the computer or a pen to make notes, or following accidental contact with bodily fluid or other contaminants, additional hand sanitizing will be undertaken as per the practitioner’s professional judgement.
- As practitioners are expected to hand wash many times daily, we recommended that hand cream (provided) should be used after each hand wash to prevent dermatitis and dry cracked skin which would increase the risk of infection. Hand cream is also available for patient’s use.
- Inside the treatment room, we use a hand sanitizing mouse by Serenity Hygiene which contains a broad spectrum germicide and carries the following certifications:
- Elsewhere in the building a hand sanitizing mouse by Gompels SOSURE is used. This product is compliant with BS EN 1499 and certified effective against MRSA, C.Diff, E.Coli, Norovirus, Salmonella and Listeria. Whilst this product is not specifically tested against Coronaviruses, it is generally accepted that any product certified to be effective against Norovirus (which is notoriously hard to kill) will be effective against SARS-CoV-2 which is highly contagious but not especially difficult to kill. Due to the shortage of supplies, we may refill a Gompels’ container with Serenity Hygiene’s product refill or vice versa, but rest assured that we are extremely vigilant about the quality and certifications of the products we use.
Clinic Hygiene Protocols
In March, we implemented a stringent cleaning protocol which has been reviewed and updated and we will continue to do so (if needed) as new evidence related to virus transmission comes to light.
- High traffic surfaces will be disinfected between each appointment. These are: treatment plinth, wipeable pillow cover, bolster (if used), face pillow (if used), massage machine (if used), chairs and stool inside our treatment room, desk, door handles (outdoor and indoor), door release switch, door bell and any item used during treatment such as massage balm container, tapes, etc.
- The face pillow will be stored face down with a face cloth over it to prevent the deposition of droplets.
- Wipeable chairs in reception will be sanitized after each use and our computer’s keypad will be cleaned after each session as a minimum. Extra hand sanitizer will be used after using the computer during a session or touching other surfaces during the session (as appropriate).
- Practitioners will hand wash or use hand sanitizer after touching the filtering part of their masks each time.
- If the card machine, payment card, pin pad is used or handled, this will be disinfected after each use and hand sanitizer will be offered to the person who handled it.
- The high traffic areas of the washroom, namely taps, door handle, toilet flush, toilet seat lid, soap, hand cream and hand sanitizer container will be disinfected on a regular basis. The frequency will be dependent on the volume of people frequenting the building and using the washroom but we aim to do this between each patient’s visit as much as possible. A thorough cleaning of all surfaces will be done daily. Cleaning wipes or disinfectant spray will be available for you to use in the washroom for added peace of mind, should you wish to clean surfaces yourself before using them. Please do not flush the wipes, dispose of them in the bin provided.
- Hoovering will be done at the end of the day before mopping or steam cleaning the floor. Face mask and eye protection are to be worn during hoovering to avoid re-circulating virus particles so hoovering will be avoided during opening hours.
- If further cleaning is needed during opening hours, sweeping will be favoured and hoovering will only be done if no one is expected in the area concerned for 20 mins after to allow settlement time.
- Floor cleaning will be done daily at the end of the day to avoid anyone slipping on wet floors. Cleaning will be done using hot steam to kill pathogens or a traditional mop may be used with a mixture of detergent and bleach. If bringing a young child into the practice is unavoidable, please do not let them crawl on the floor or ask for the first appointment of the day or after a longer break to allow time for floor cleaning.
- Spillage and other such hazards will be dealt with immediately and followed with spot disinfection, if required.
- We recommend that you do not put your bags and personal items down on the floor, please use the hangers provided behind the door, hang them on the chair or put small items on the desk.
- All hard surfaces will be cleaned using Serenity Hygiene surface cleaner which complies to testing standards BS EN 1446 which is the European standard for the bactericidal activity of chemical disinfectants as proof of effective infection control against harmful micro-organisms such as MRSA, Salmonella, E.Coli, Flu Virus (H1N1) and Pseudomonas Aeruginosa. In order to pass this standard, products have been tested by an independent laboratory and must prove a bacteria kill rate of 99.999% within 5 minutes. In the absence of “Coronavirus Certified” products, it is widely accepted that this standard of certification is adequate.
- Product contact time will be 5 minutes as per certification testing.
- Protective cleaning gloves should be worn by the practitioner during cleaning to avoid exposure of cleaning products on skin.
- Clinell cleaning products may also be used as an alternative.
- Other areas which do not experience high traffic will be cleaned daily or as required.
1st September Update:
Surface Cleaner XtraProtect by Edge Protect was introduced as it has a much milder smell and is less irritant to the airways, and therefore doesn't trigger coughing fits. XtraProtect has been certified and Lab tested to the highest British Standards to ensure both its effectiveness and public safety.
- Kills and protects against 99.99% of bacteria and enveloped viruses - Lab proven to be effective against Coronavirus, MRSA, E-Coli and Norovirus
- British Lab tested to BS EN 1276 and BS EN 14476
- Lab proven as safe & non irritating on skin and to the eyes (Yordas Group Lab Testing – Q200330-RV-1)
- Contains no hazardous chemicals, elements or warnings (European Regulation (EC) No 1272/2008)
- Water based pH neutral sanitiser. It does not use aggressive chemicals, alcohol or bleach and is non toxic.
- Active ingredients Benzalkonium Chloride, Didecyl Dimethyl Ammonium Chloride
A fogging device was also introduced and available for practitioner to use at their discretion at the end of the day or before seeing a more vulnerable patient. 15 mins of room aeration should be allocated after fogging and plants should be removed. We recommend opening doors and window after fogging and using the Dyson fan at the highest setting durring the fallow time.
Added measures:
- Windows in the reception area will be kept open weather, pollen count and overall conditions permitting. This will be reviewed on an ongoing basis.
- The direction of air flow within the building with the clinic room’s door & window open, in addition to the reception’s windows being open, will result in lateral air flow from the treatment room into the reception area. If the reception area is being used (i..e: a nair bar is located there), the lateral displacement of air may potentially expose more people to the virus. In such cases, the door will be kept close and the air purifier will be used and/or the window open.
- In addition, where a practitioner or patient suffer from air borne allergies which may cause rhinorrhea (runny nose), sneezing and coughing, the additional handling of the face mask and the high air pressure associated with coughing and sneezing would reduce the filtering efficiency of the mask for containing droplets and overall increase the risk of aerosol generation, thus increasing the risk of transmission practitioner to patient (or vice versa). In such a situation, is it deemed more appropriate by the practice not to open the windows and use alternative forms of air sanitization (i.e.: UV-C / HEPA air purifier and UV-C light sanitizing between appointments).
- A Dyson cooling and humidifying fan equipped with an Hepa & carbon filter air purifier and UV-C light filter is available to use in the treatment room- at the practitioner’s judgement. If this is used, the fan should run aimed in a “head to door” direction and will help to quickly disperse potential pools of droplets and reduce the concentration of (potential) virus exposure for everyone present. This may be indicated if the patient is not wearing a mask for a valid reason or if the practitioner is doing head or neck treatment which would result in possible pooling of droplets near both patients and practitioners’ faces. During winter, the filtration mode will continue to be used wihtout the fan.
- If performing HVTs or any neck / shoulder / head treatment where the practitioner is sitting at the patients’ head, the practitioner should wear eye protection as the mask worn by the patient will direct their exhalation directly in the direction of the practitioner’s face thus increasing the patient to practitioner risk of transmission. Glasses, goggles and a face visor are available to the practitioner and should be sanitized between each use.
- Air sanitization will be provided by two available air purifiers fitted with a HEPA filter, carbon filter and UVC-light filter which will run continuously throughout the working day. Based on the room size (estimated 45’000 cubic meters and the Dyson’s published performance of 320 Liters of air per second processed by the air purifier), it is estimated that air from the room should fully run through the Dyson air purifier every 2.5 to 3 minutes when on full power, whereas the Homedic filter should process the room’s air every 20 mins or so on the highest setting.
- The air purifier system should only ever be used with the UV-C light function switched on and should be used continuously, whereas the fan function can be used at the practitioner’s discretion. Filters will be replaced in line with manufacturer guidelines.
- If all devices are used, the Dyson purifier / fan should be used at the head end of the treatment couch to help disperse droplets and avoid pooling.
- The Homedic air purifier is placed between the patient and practitioner's chairs to increase the chances of stray droplets being caught by the air purifier. An ioniser and UV-C light function is available on the unit and should be switched on.
PPE Protocol for Practitioners
- Practitioners will be asked to wear a mask and use hand sanitizer on entry.
- Practitioners will be issued with PP2F masks and will be asked to use it in line with WHO guidelines to reduce the risk of cross contamination from the incorrect handling of PPE. The mask should be tight and form a good seal around the face to maintain effectiveness.
- A surgical mask 3 ply, IIR rated will also be made available to patients and practitioners. Practitioners can use either a surgical mask or PP2F mask, at their discretion.
- Masks should be used per session and changed earlier if they become damp or physically damaged.
- Masks should be used in the treatment room at all times. The practice recommends for practitioners to keep their mask on to reduce the risk of inhaling suspended droplets and potential aerosols during cleaning and note writing at the end of the day.
- The practitioner may remove her mask in the staff room and the door/ window should be kept open if other practitioners are present in the building.
- Eye protection (goggle) is issued to the practitioner and should be sanitized after each sessional use with spray disinfectant or hot soapy water and stored in a plastic bag or glasses case when not in use. Eye protection is risk assessed and will be used at the practitioner’s discretion in the fashion of a dynamic risk assessment but it is recommended by the clinic during HVT techniques (potentially aerosol generating), when working sat at the patients head and when the patient is exempt from wearing a mask.
- A reusable apron will be used and sanitized between patients. A reusable apron is deemed adequate for our purpose as we do not come into contact with body fluid and skin to clothing contact is minimal. This helps to reduce waste generated from single use plastic which is a cause close to our hearts.
- The apron will be disinfected with the Serenity surface disinfectant listed above between each appointment. Ties and neck straps should also be disinfected in the same way. The straps will be pre-treated with waterproofing spray and will be re-treated as needed. Practitioners should hand wash & sanitize before and after handling PPE.
- Disposable nitrile gloves should be worn and disposed of correctly at all times for internal techniques and if the practitioner has broken skin on her hands, or if the patient has broken skin on area to be contacted (ie: dry cracked skin from overwashing) and when there is a high risk of coming into contact with bodily fluids.
- From June, clinic policies were update in line with PHE guiding documents to include the wearing of nitrile glove for treatment to eliminate skin to skin contact as much as possible. Patients are generally treated fully clothed, further minimising skin to skin contact.
- All necessary PPE will be made available to associates to purchase from the practice but as self-employed practitioners, they are free to procure their own PPE should they wish to.
- If a practitioner uses a different protocol to what is outlined by the practice [ie.: in this document], they should have their own risk assessment documents and this should be duly documented in patient's notes.
Update October 2020: in the original guiding document, Public Health England (PHE) stated in subtitles that re-usable PPE was acceptable, hence our decision to use a PVC apron. This sub-title has now been removed from the guiding document, and PHE was also disolved as an organisation so to mimise our risk and to comply with updated guidance, single use apron will now be used.
Disposal of PPE
- Unsoiled single use PPE and disposable paper towels used for cleaning should be double bagged and left in a secured place before being disposed of in the normal way as it does not constitute clinical waste.
- A PPE recycling bin is made available to all practitioners to dispose of used PPE.
Clinic Washing and Clothing
- The practitioner should change clothing once on the premises in the kitchen / staff room preferably with the door and window open. “Home clothes” should be worn for arriving at the practice and returning home, whilst “clinic clothing” should be worn during working hours.
- Clinic washing such as washable hand towels and clinic clothing should be placed in a pillow case in the kitchen area or placed directly in the clinic’s washing machine. If clothing and soft fabrics are being taken home to wash (which is acceptable) they should remain in the closed pillow case and be put into the home washing machine upon arrival without emptying it. Washing anywhere should be done with regular detergent, washed in 60 degrees water and tumbled dried, where possible.
Practitioners’ Commute and Self Isolation
- Should any of our practitioners develop symptoms of COVID-19, we will self-isolate immediately as per government guidance and seek testing as soon as possible. As such, we may have to cancel appointments at short notice. We appreciate your understanding.
- All our practitioners can get to the clinic by their own means (car, walking) and therefore, this reduces the risk of the virus being caught by our practitioners on public transports.
- Consultations with each practitioner have confidently taken place regarding the health status of their households and risk was discussed with them. All our practitioners are self-employed and therefore, the decision to return to work was their own.
Communication
- This document will be made available on our website under the “COVID-19” tab
- Communication of the key points of this document will be communicated on our Facebook page in addition to being available on our website.
- A link to our website’s COVID-19 page be included in all appointment confirmation emails.
- No hard copy will be available in reception as we have removed all non-essential items to reduce contamination risk, however we will be happy to provide an electronic copy on request.
- Our receptionists have always worked remotely and therefore, will continue to be available as normal to answer any questions. Alternatively, email your queries to: [email protected]
Data Sharing through the Track & Trace program
The UK has now entered into the “Track and Trace” phase of the pandemic, which means that we may be contacted by a governmental representative under this scheme where they ask us to release some data about who we have been in close contact with. This data will only ever be your name, phone number and email address.
The information commissioner and the government have both confirmed that in this specific situation, public health interest takes priority over your right to data protection under GDPR guidance. This means that we are legally obligated to release the data in an appropriate and lawful manner.
Should we be contacted for such requests, we will always verify the identity of the caller to ensure they are legitimate and verify the current advice provided by the Information Commissioner before releasing any information.
Safety
As outlined in this document, we have conducted a thorough risk assessment and considered every aspect of the patient and practitioner’s journey to allow us to understand what the risks to everyone are and how best to mitigate them. Although all these measures may seem scary at first, we still maintain our original stance that we are still much safer to visit than supermarkets and most other places due to the small size of our building and the absolute control we have over our environment. Should you have any concerns or questions, please do not hesitate to contact us and we will get back to you ASAP!
We look forward to seeing you,
Joelle Forham (principal) and the Team at Body Flow Osteopathy
Dated: 31st May 2020
Updated: 16th June. Section updated: Screening protocols, Children’s appointment, Air sanitizing sections, use of gloves, removal of UV-C light sanitizing unit from use.
Updated 1st September: Addition of fogging device and Edge protect cleaning products. Fallow period between appointments is now at the discretion of the practitioner and no longer an official guidance.
Updated October 2020: PHE removed a small print from the guiding document on the use of PPE in health care settings, by which it stated that re-usabe PPE was acceptable. Our decision to use PVC aprons was based on this (plus the fact that it is not required for infection control in our setting) but clinic protocols were updated nonetheless to reflect this and single use aprons were made available to practitioners.
