DW Osteopathy - Coronavirus Risk Assessment | Chepstow and Cardiff Osteopath

Chepstow Clinic

This document provides a written record of the heightened infection control measures that the staff of DW Osteopathy has put into place to ensure the safety of all staff and patients during COVID-19. This Document does not refer to prevention of infection protocols utilised by other businesses/employers, also working at the same premises who are not under the business of DW Osteopathy.

The purpose of this package is to provide subscribers to this service with general guidance only. The package does not aim to cover every topic related to Health & Safety and should be used as a tool to ensure your practice is meeting the requirements necessary in accordance with The Health and Safety at Work etc Act 1974, it is not designed to provide Specific authoritative Advice and should not be relied on as such.

Clinic Manager: Poppy Morgan

In this document you will find the following:

Table 1: This is an overview of the measures you have taken that will form your clinic policy for operating during COVID-19 and available to all staff and patients.
Table 2: Areas assessed for risk and mitigating action taken.
Table 2a - Protection for staff and patient before and when in clinic
Table 2b – Heightened hygiene measures
Table 3: Outline of the use of PPE for staff and patients in the practice
Table 4: Communication to staff and patients about our policies

Completion of risk assessment demonstrates compliance with the following Osteopathic Practice Standards including but not limited to:

A2: “…. adapting your communication to take account of [your patient’s] particular needs”
C5: “You must ensure your practice is safe, clean and hygienic”
D11: “You must ensure that any problems with your own health do not affect your patients”

We have assessed our practice for risks outlined and put in additional processes as detailed below.
Undertaken a risk assessment	Risk assessment performed: 2/6/2020. Assessment to be repeated every 3 weeks or when new government guidance is released, whichever is first.
Heightened cleaning regimes	Before any patients arrive, all hard surfaces that the patient may come into contact with will be disinfected, e.g cabinets, hand rails, chairs, shelving, desks, toilet, sinks, couch, handles, window ledges, radiators. Between each patient, all surfaces the patient came in contact with, the clinic room and all equipment used will be disinfected. Common areas/washrooms will be cleaned every 3 hours, or after every 4th patient, whichever comes first. Any hard surfaces used by every patient will be disinfected after every patient (15min gap between appointment times). All members of staff will ensure proper hand washing measures are taken between patients, irrespective of PPE usage.
Increased protection measures	Patient PPE: All patients attending the clinic will need to wear fluid-resistant surgical masks (either bring from home or provided by the clinic at a cost) All patients arriving already wearing gloves will be asked to remove gloves and sanitise hands. If the patient has open wounds on the hands then gloves can remain on but patient must sanitise the outside of the gloves. All patients will be asked to use 70% alcohol hand sanitiser (provided by clinic) upon arrival. No linen couch cover will be used. A waterproof, wipeable pillow protector will be used. Cashless payments using contactless means of payment will take place. Staff PPE: During talking moments with a patient (welcoming patient, taking case history and showing patient out): all practitioners will be required to wear a face mask. During assessment and treatment: all practitioners are required to wear surgical face mask, gloves and a plastic apron.
Put in place distancing measures	All Appointments will be separated by a 15minute gap to allow for social distancing and cleaning of appropriate areas. Patients will be asked, when booking their appointments, to arrive a maximum of 3 minutes before their appointment to ensure social distancing and cleaning. As there is only one treatment room and a 15minute gap between appointments there should be very limited numbers in communal areas/waiting rooms.
Staff training	All staff are trained in: Correct hand washing technique Correctly donning and doffing PPE safely New clinic policies and infection prevention measures Accurately identifying the key symptoms of Covid-19
Providing remote/ telehealth consultations	Patients booking an appointment via telephone/mobile: All patients will have a pre-screening call. This will include outlining increased risks to vulnerable people of certain age groups and chronic conditions, a brief questionnaire about current health to check for Covid-19 symptoms and details about current clinic policies and infection prevention measures (contactless payment, patient PPE, social distancing). Patients booking an appointment online will need to provide a telephone/mobile number to arrange a pre-screening call (see above). New and Follow-up appointments are available via telephone/video-call should a patient know they are Covid-19 positive, be unable to attend the clinic for shielding reasons or would prefer to do so.
When will these changes be introduced:	10/6/2020
Last Updated:	4/6/2020

Table 2a. Protection of staff and patients before they visit, and when in, the clinic. We have assessed the following areas of risk in our practice and put in place the following precautions.
	Description of risk:	Mitigating action:
Pre-screening for risk before public/patients visit the clinic.	Unnecessary infection of patients wishing to attend the clinic who are in the high risk category outlined by the government.	Where possible, patients who do not need urgent manual therapy will be able to book in for a telephone or online video consultation. Utilising a thorough pre-screening protocol will determine whether a face to face consultation is relevant and/or appropriate, or if support can be provided by a telephone/video consultation. If a telephone/video consultation does not meet the needs of the patient, before booking an appointment and arriving at the clinic, the patient (and chaperone) will need to undergo the follow pre-screening protocol: Do you, or anyone in your household, have symptoms of Covid-19 now or in the past 7 days (high temperature, new persistent cough, difficulty breathing and/or a change or loss of the sense of smell/taste)? Have you, or anyone in your household been in contact with someone with confirmed/suspected Covid-19 in the last 14 days? Are you, or anyone with whom you are in regular physical contact with considered to be in the high-risk group of serious illness if you contract the Corona virus? For more information on specific high-risk groups provide NHS website link. Are you, or anyone in your household, at high-risk of transmitting the virus due to the nature of your/their occupation, e.g nurse, doctor, care worker? Do you have respiratory symptoms or conditions such as asthma, COPD, emphysema or hay fever? If a face to face appointment is deemed worth the risk, patients/staff need to be aware of the following: Patient will need to wear a surgical face mask throughout the appointment and is only to be removed once off the clinic premises, or significant need demands it. Once the patient has an appointment, but prior to arriving, if symptoms of Covid-19 begin to occur patient must inform osteopathic clinic immediately. Appointment will be cancelled and best course of action will be provided based on government advice. Patients will be warned of increased risk to patients, and/or individuals within household, who are in the category of high-risk of serious illness should corona virus be contracted. Risk of face to face consultation: Due to close proximity, risk of exposure and transmission to both patient and practitioner. In light of risk, both patient and practitioner will be required to wear sufficient PPE. For practitioners: surgical facial mask, gloves and apron; for patients: surgical facial masks. Patient masks must be fluid repellent surgical face masks. They can be brought from home or purchased onsite from the clinic. Patient will need to wear a surgical face mask throughout the appointment and is only to be removed once off the clinic premises, or significant need demands it. All patients will be required to arrive a maximum of 3 minutes before their appointment, upon arrival must use the sanitising products provided, must either bring their own surgical facial mask from home or purchase one at the osteopathic clinic and wear the mask at all times when on the premises. The clinic has implemented new hygiene rules in line with infection prevention measures, such as: more regular cleaning of communal/commonly used areas (waiting room, toilets) more thorough cleaning on clinic room between patients a minimum of 15 mins between patients to allow time to clean and to avoid patients crossing paths in communal areas (maintain social distancing). The clinic has no parking. Parking for the clinic uses a nearby Pay&Display car park. Patients should be warned of potential cross-contamination from touching these machines. Reminded whilst using machine and thereafter not to touch face. Upon entering the clinic patient will be required to use sanitising gel, disinfecting hands. Door handles will be cleaned by practitioner between each patient. All patients will be required to use use 70% sanitising gel upon arriving at the clinic All patients arriving already wearing gloves will be asked to remove gloves and sanitise hands. If the patient has open wounds on the hands then gloves can remain on but patient must sanitise the outside of the gloves.
Protecting members of staff	Exposure to virus from patients/clients arriving at the clinic who are infected.	The clinic does not have a receptionist. The only person in the clinic during business hours is the sole osteopathic practitioner. The osteopath, and his household members, are not in the high risk category for getting seriously ill. The osteopath will be following the advice of the government and governing body with regards to PPE. Where possible and practical the osteopath will remain 2 metres away from the patient wearing a surgical face mask. Where not possible, during assessment and treatment, the practitioner will wear a disposable apron and gloves.
Confirmed cases of COVID 19 amongst staff or patients?	Risk of spreading infection onwards if staff/patients have been exposed.	Should a member of staff be tested for COVID-19 we will follow the policies as indicated in the Flowchart provided by Public Health England describing return to work following a SARS-CoV-2 test. Should a patient advise us that they have symptoms of COVID-19 after visiting the clinic we will adhere to the following policies in line with government guidance e.g. · If the patient experiences symptoms within 2/3 days of visiting the clinic, any staff with direct contact to that individual who were not wearing full PPE should self-isolate. If wearing PPE, staff can continue to work but if they develop symptoms they should self-isolate and obtain a test. · Anyone with indirect contact with the patient, should be advised of the situation and suggest they monitor for symptoms (those with indirect contact with suspected cases COVID 19 do not need to self-isolate)
Suspected case (staff or patient) whilst working on site	Risk of spreading infection onwards if staff/patients have been exposed.	If a member of staff/patient develops a high temperature or a persistent cough while at work, they should: Return home immediately Avoid touching anything Cough or sneeze into a tissue and put it in a bin, or if they do not have tissues, cough and sneeze into the crook of their elbow. They must then follow the guidance on self-isolation and not return to work until their period of self-isolation has been completed. Inform management of suspected COVID-19
Staff returning to work and using the clinic	Risk of spreading infection onwards if staff/patients have been exposed to the virus.	The following practices may be considered: Stop all non-essential visitors Monitor practice access points to enable social distancing. Door to be locked if working independently to prevent walk ins / patients crossing in waiting room. Alarm system to be wiped clean with antiviral/anti bacterial wipe after use on entry to practice and when using alarm on leaving. Require all workers to wash or clean their hands before entering or leaving the practice Regularly clean common contact surfaces in reception, payment machines, door handles etc. After every appointment and at end of clinic session. Clinic floors must be bleach mopped at end of every clinical day. Only the patient may attend appointment no family members to reduce numbers in practice, unless chaperone requested. Child patients to be accompanied with maximum of one parent. Remove reception chairs to maintain social distancing.
Travel to and from the clinic	Risk of coming into contact with cases of Covid-19 whilst taking public transport.	Where possible, all staff and patients/chaperones will be discouraged to use public transport and encouraged to walk, cycle or drive; enabling the 2 metre social distancing advice. Whilst travelling by public transport it is very difficult to maintain this level of social distancing. In the event of staff, patients or chaperones having no other choice but to use public transport we encourage they attempt to maintain 2 metres distant from other individuals, they stay on the transport for the shortest amount of time possible and that they wear a surgical face mask and gloves whilst doing so. The clinic does not have parking. Parking nearest the clinic is Pay&Display. These machines allow for contactless payments. Patients will be warned of the potential risk of cross-contamination from touching these machines. Reminded whilst using machine and thereafter not to touch face. Upon entering the clinic patient will be required to use sanitising gel, disinfecting hands. Door handles will be cleaned by practitioner between each patient. Patient will be allowed to arrive for their appointment a maximum of 3minutes before their scheduled time. This will help to minimise patients crossing paths and breaking social distancing. In the event more than one patient are attempting to use main door, practitioner will ask arriving patient to come back in a few minutes to allow other patient to leave and cleaning procedures to take place.
Entering and exiting the building. Reception and common areas	Risk of infection to both staff and patients through lack of social distancing and direct contact with surfaces in the common parts.	Clinic only has one treatment room so there is minimal foot traffic through waiting area and reception. This, in conjunction with the compulsory 15minute gap between patients, significantly reduces the chance of 2 patients being in the waiting area at the same time. Staff will change into work clothing at the clinic and place work clothing in a separate bag to take home for washing on a high temperature (60degrees) wash. Patients will be asked not to arrive more than 3 minutes early for their appointment to avoid overcrowding in reception and time spent in waiting area and to comply with social distancing policies. Patients arriving early by car will be asked to wait in their car or outside the building (observing social distancing) until their appointment time. On entering the building patients will be asked to sanitise their hands, with hand gel provided. Patients can also request a mobile telephone call from the osteopath to confirm they will be coming down to greet them in reception. Surfaces touched by patients in common parts such as door handles and handrails will be cleaned between patients. Patients will be warned during pre-screening that contactless payment is preferred instead of cash. Social distancing will be reminded and encouraged by the use of space markers on the floor of waiting room. The clinic does not have a receptionist so there will be no need for virtual reception service or a working from home option.
Social/physical distancing measures in place	Risk of patients and staff not upholding social distancing of 2m with other patients and staff where appropriate.	Appointments will be staggered by a 15 minute gap so that patients do not overlap in reception / waiting area or entrance/exit. This will also achieve a minimum number of patients/staff present on the premises at any one time. Chairs in the medical practice waiting room are placed with markers on the floor to indicate social distancing. All chairs will be removed from the waiting room, save 2.
Face to face consultations (in-clinic room)	Risk of infection transmission between staff and patient during consultation via proximity and direct contact.	Any verbal part of the consultation with the patient in the clinic room will take place at a minimum of 2 metres apart. Pre-treatment interview will take place by phone before the patient arrives at the clinic; either earlier that day or 24hours prior to the appointment. This will be used to establish most of details and reduce time spent in consultation with patient. Staff will wear the appropriate level of PPE during entire consultation and the patient will be required to wear a water repellent surgical face mask at all times that is either brought from home or purchased from the clinic. Treatment techniques will be adapted to reduce procedures which may lead to the increased risk of generated water particles and unnecessary proximity. Patients will be encouraged to pay on line with BACS before/ after their treatment or use the contactless option on the card machine which will be cleaned between patients. With reference to chaperones/family members in clinic rooms/waiting area our policy will be: One parent/guardian only with visits for children No additional family members except if requested as a chaperone. Chaperones will need to be contacted for screening for any risks of potential infection. Risk of infection from attending the clinic will also be communicated to them during the screening.
When will these changes be introduced:		10/6/2020
Last updated		4/6/2020

Table 2b Hygiene measures We have assessed the following areas of risk in our practice and put in place the following heightened hygiene measures
	Description of risk:	Mitigating action:
Increased sanitisation and cleaning	Risk of infection transmission from patient with direct contact with hard surfaces in the clinic to staff or other patients.	In clinic rooms: Plinths, desk, door handles, equipment, chairs, sinks, card machines and pens will be cleaned with sanitising wipes between each patient. The Use of at least 70% alcohol sanitisers/wipes will be available for both staff and patient use in waiting area and clinic room. Unnecessary linen will be removed from use, e.g couch cover and pillow cover. Plastic, water-proof pillowcases will be used and cleaned between patients. The clinic room will be decluttered to reduce the number of exposed surfaces to infection. As there is only one treatment room and staggered appointments, door to treatment can be left open to allow better movement of air circulation and less points of touch for the patient. In common areas: Parts that may be touched by patients i.e. door handles, handrails, taps, toilet and chairs will be cleaned between each patient. Patients / chaperones will be asked to clean their hands (with either soap and water or a hand sanitiser) upon entering and exiting the building and the clinic room.
Aeration of rooms	Risk of infection from respiratory droplets in the clinic room between patients.	As there is only one treatment room, the door to the treatment room will be left open to allow movement of air. There is no openable window in the treatment room. The door to the treatment room will be closed for 15mins after the patient has left. After the 15mins all surfaces and equipment mentioned above will be sanitised. Also during the 15mins between patients the entrance door to the premises will be left open. Fans and other air-conditioning mechanisms will be used.
Staff hand hygiene measures Respiratory and cough hygiene	Risk of infection transmission by staff through direct contact or contact with surfaces.	Staff will remain bare below the elbow throughout their time on the premises. On bare skin below the elbow/hand washing before and after patients with soap and water for 20 seconds, including forearms. Similar protocol with use of hand sanitiser gel. Provision of disposable, single-use tissues. Waste bins for different types of waste - colour coordinated (lined and foot-operated) Hand hygiene facilities available for staff on entrance/exit of the clinic room and building.
Cleaning rota/regimes	Risk of infection transmission through direct contact of respiratory droplets from patients/staff with hard surfaces.	All surfaces in the clinic room/waiting area will be fully cleaned down at the beginning and end of each day Thorough cleaning of clinic room floors and disposal of clinical rubbish in appropriately labelled bags to be removed by Practice Manager. Toilet room inspection will be increased from twice a day to every 3 hours.
When will these changes be introduced:		10/6/2020
Last updated		4/6/2020

Table 3. The use of PPE by staff and patients in the practice
Clinicians will wear the following PPE and will replace each item as instructed.	Single-use nitrile gloves and plastic aprons. To be replaced after with each patient. Fluid-resistant surgical face masks (IIR or higher grade FFP2). To be replaced every 4 hours, once item is soiled, if item gets wet, if item is contaminated or damaged and/or once the item becomes uncomfortable - whichever comes first. Eye protection not needed.
Patients will be asked to wear the following PPE	Fluid-resistant surgical face masks, either brought from home or purchased from the clinic. This mask will be worn at all times whilst on the premises, including in the treatment room and in writing area. Mask should only be removed if the need demands it, or once the patient has left the premises.
PPE/ cleaning wipes/tissue disposal	All PPE and any disposable couch roll will either be disposed of in the appropriately labelled clinical waste plastic bags, or will be double bagged and left to stand for 72 hours after which it can be collected by the local authorities (this advice given by Institute of Osteopathy). Handing of clinic waste will be handled by clinic manager. Cloths and wipes used for cleaning between patients will also be disposed of with PPE.
When will these changes be introduced:	10/6/2020
Last updated	4/6/2020

Table 4. Communication to staff and patients about our policies
Publishing your updated clinic policy	A clinic policy and Covid-19 risk assessment guide will be placed in the clinic room and is available on request. A summary will be provided as part of the pre-appointment telephone and confirmation email. Clinic policy will be publicly available on our website
Information on how you have adapted practice to mitigate risk	General information on steps taken will be published in various formats and different locations. Continual updating of website and posts on social media platforms Emailed updates to patients in for of newsletter All these will be updated in line with any new Government guidance
Pre-appointment screening calls	Pre-screening calls will take place the day before a scheduled appointment. Same day bookings will only be permitted if ample time is available to clinician to perform a scheduled pre-screening call, before the patient arrives at the clinic. ‘Walk ins’ currently not permitted. An osteopath will undertake the pre-screening call. No other persons allowed.
Information for patients displayed in the clinic	Door notices on entrance advising anyone with Covid-19 symptoms not to enter the building and what to do as an alternative. In washrooms, posters on adequate hand washing protocols. In clinic room, posters on how to correctly don and doff PPE.
Other patient communications	Information in our patient e-newsletter on the patient journey through the clinic and heightened hygiene measures. Posters throughout the clinic highlighting and explaining changes and what the patient can do to help. Clearly ask patients to contact us if they subsequently develop symptoms after treatment so contact tracing measures can take place.
Changes introduced:	10/6/2020
Last updated:	4/6/2020

Coronavirus Risk Assessment Breakdown

Chepstow Clinic