Infection risk assessment and mitigation guide

This document provides a written record of the heightened infection control measures that this clinic has put into place to ensure the safety of all staff and patients during COVID-19.

The risk assessment and mitigation record has been undertaken in conjunction with the iO’s guidance ‘Infection control and PPE’ and ‘Adapting practice guide’ available from here.  In this document you will find the following:

·       Table 1: This is an overview of the measures we have taken that form our clinic policy for operating during COVID-19 and are available to all staff and patients. This has been completed having undertaken an assessment of risk and detailed the mitigating action to be taken

·       Table 2: Areas assessed for risk and mitigating action taken. This records in detail the areas of potential risk we have identified and records the mitigating actions we have taken and when.

o   Table 2a - Protection for staff and patient before and when in clinic

o   Table 2b – Heightened hygiene measures

·       Table 3: Outlines our PPE policy for staff in our practice

·       Table 4: Details how we will communicate our policies to staff and patient    

We have assessed our practice for risks outlined and put in additional processes as detailed below

Undertaken a risk assessment

Risk assessment undertaken on 30th August 2021.  Further review of these processes will be undertaken should Government guidance change.

Heightened cleaning regimes

 ·       All key surfaces in the clinic room will be cleaned in between each patient

·       The rooms will be fully aerated (windows opened) between each patient

·       Key surfaces in the common areas of the medical practice i.e. door handles and handrails that the patient may have come into contact with on their journey into the clinic room will be cleaned between each patient.

Increased protection measures

 Additional processes and protection measures in place include:

·       All linens from the clinic room have been removed.

·       Cashless payments have been arranged. Patients may bring cash but exact money only to avoid supplying change.

·       Staff PPE

Put in place distancing measures

·       Appointments are staggered to avoid waiting times and to allow time for cleaning

·       The medical practice waiting room has put in place social distancing measures

·       Patients can arrange to wait in their car and enter the practice when they are called on their mobile phones.

Staff training

Additional training of staff has been undertaken:

·       Correct hand washing technique best practice

·       How to put on/remove PPE safely

·       Staff briefed and trained on updated clinic policies and infection control measures

Providing remote/ tele-health consultations

·       All patients will have a  telephone/ video pre-screening call to check on their health status, advise them of new procedures and to establish the case history in order to reduce time spent face to face.

·       Follow-up/maintenance appointments available via telephone/video call if appropriate again to reduce face to face time.

Document last updated: 30/08/2021

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 mitigating precaution

Protecting members of staff

Risk of staff becoming infected especially if vulnerable and risk of transmitting the infection to a vulnerable family member.

All staff will be asked if they or a member of their household is in a vulnerable category and they will be offered the alternative to work remotely if there is a high risk associated with exposure to infection.

All staff will be supplied with PPE in accordance with government guidelines as set out in table 3 below.

Last updated :31/08/2021

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 attached Flowchart 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)

Last updated: 31/08/2020

Entering and exiting the building and reception and common areas

Risk of infection through lack of social distancing, time spent in reception area and waiting room and direct contact with surfaces in the common parts.

·       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 wash. 

·       Patients will be asked not to arrive early or late 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 they can report to reception and sit in the medical practice waiting room.

·       Patients can also request a mobile telephone call from the osteopath to confirm they will be coming down to greet them in reception.

·       Patients 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.

·       Surfaces touched by patients in common parts such as door handles and handrails will be cleaned between patients. 

Last updated :30/08/2021

Social/physical distancing measures in place

Risk of patients and staff not observing social distancing of 2m with other patients and staff in the medical practice

·       Staggered appointment times (15 minute gaps) so that patients do not overlap in reception / waiting area or entrance and exit area.

·       Chairs in the medical practice waiting room are placed with markers on the floor to indicate social distancing.

·       There are floor spacing markers to indicate distancing from reception.

Last updated: 30/08/2021

Face to face consultations (in-clinic room)

Risk of infection transmission staff to patient during consultation via proximity and direct contact.

·       Verbal consultation with patient in the room will take place at more than 2 m and pre- treatment interview by phone beforehand to establish most of details and reduce time spent in consultation with patient.

·       Staff will wear PPE during entire consultation and patient will be offered an IIR face mask or can wear their own face mask if preferred.

·       Treatment techniques will be adapted to reduce procedures which may lead to the increased risk of aerosol generated particles and unnecessary proximity.

·       Patients will be encouraged to pay on line with BACS before/ after their treatment or use the card machine which will be cleaned between patients.

In relation to chaperones/family members in clinic rooms/reception/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 and any risks of infection communicated to them the day before the appointment.

Last updated : 30/08/2021 

Table 2b Hygiene measures

We have assessed the following areas of risk in our practice and put in place the following heightened hygiene measures

Increased sanitisation and cleaning  

Risk of infection transmission from patient direct contact with surfaces in the clinic to staff or other patients

·       Clinic rooms - plinths, desk, door handles, examination equipment, chairs, sinks and card machines and pens will be cleaned with sanitising wipes between each patient

·       Use of at least 60% alcohol sanitisers/wipes

·       To minimise the number of surfaces requiring cleaning, unnecessary linen will be removed and plastic pillowcases used which will be cleaned between patients

·       The clinic room will be decluttered to reduce the number of exposed surfaces to infection.

·       Areas in the common parts that may be touched by patients i.e. door handles and handrails 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.

 Last updated: 30/08/2021

Aeration of rooms

Risk of infection from respiratory droplets or aerosol generated particles in the clinic room between patients.

·        The window will be left open and the door closed for 20 minutes after each patient.

·       Fans and other air-conditioning mechanisms will not be utilised at present unless external air extraction is possible. Where the room is too warm, windows will be opened.

Last updated: 30/08/2021

Staff hand hygiene measures

Risk of infection transmission by staff through direct contact or contact with surfaces.

 ·       Bare below the elbow/hand washing before and after patients with soap and water for 30 seconds, including forearms or similar use of hand sanitiser gel and the use of single use gloves.

·       Provision of disposable, single-use tissues waste bins (lined and foot-operated)

·       Hand hygiene facilities available for staff on entrance /exit of the clinic room and building.

Last updated : 30/08/2021

Cleaning rota/regimes

Risk of infection transmission through direct contact and respiratory droplets from patients/ staff with clinical surfaces.

 ·       All surfaces in the clinic room will be fully cleaned down at the end of the day

·       Cleaning of clinic room floors and disposal of clinical rubbish in orange bags to be removed by the medical practice cleaners.

Last updated: 30/08/2021

 Table 3. Personal Protective Equipment: Policy for use and disposal of PPE

Clinicians will wear the following PPE

·       Single-use nitrile gloves and plastic aprons with each patient

·       Fluid-resistant surgical masks (IIR or higher grade FFP2)

·       Eye protection. If there is a risk of droplet transmission or fluids entering eyes

When will PPE be replaced

·       Nitrile gloves and plastic aprons changed between each patient

·       When potentially contaminated, damaged, damp, or difficult to breathe through

·       At the end of a session (morning or afternoon session:  4 hours)

Patients will be asked to wear the following PPE

·       Fluid-resistant surgical masks will be provided if patient has respiratory symptoms e.g. from hay fever or asthma that may make them cough/sneeze

·       Face-covering in clinical and waiting areas

PPE disposal including cleaning wipes and tissues after use.

·       All PPE and any disposable couch tissue will be disposed of in medical practice orange plastic bags which are then disposed of by the cleaners at the end of the day.

·       Cloths and wipes used for cleaning between patients will also be disposed of with PPE

Table 4. Communicating with patients:  How we will advise patients of measures that we have taken to ensure their safety and the policies that have been put in place in our clinic

Publishing our updated clinic policy 

·       Clinic policy will be placed in clinic room and available on request

·       A summary will be provide as part of appointment confirmation emails

·       Clinic policy will be publicly available on our website

Information on how we have adapted practice to mitigate risk

General information on steps taken and where it has been published

·       Updating of website and via our social media accounts

·       Emailed to patients

This will be updated in line with any new Government guidance

Information for patients displayed in the clinic

·       The medical practice provides door notices advising anyone with Covid 19 symptoms not to enter the building and what to do as an alternative. 

Other patient communications

·       Information in our patient e-newsletter on the patient journey and heightened hygiene measures.

·       A video on our website detailing heightened hygiene measures

·       Clearly ask patients to contact us if they subsequently develop symptoms after treatment so contact tracing measures can take place.