We are all looking forward to lighter lock down measures and a time when we can resume services for our clients.
However, I cannot return to business as usual, I must take extra care to protect both clients and myself from contracting the virus and promote safe treatments in a safe environment.
Over the past couple of weeks I have been preparing and planning for the re-opening of my clinic once the government gives us permission.
As the course of the pandemic evolves, new evidence is likely to emerge and government advice may change. This policy will not supersede government advice and thus must and will be reviewed and adapted accordingly.
This policy is in addition to routine infection control, health and safety measures, risk assessment and professional standards.
It should be made clear to my clients that these measures are intended to manage risk and cannot be assumed to completely eliminate any risk of contracting the virus.
The national goal remains clear; we must as a society, slow the spread of the virus and stay alert.
Covid-19 infection prevention and control policy
1 – Understanding transmission and principles of infection control
The transmission of COVID-19 is thought to occur mainly through respiratory droplets generated by coughing and sneezing, and through contact with contaminated surfaces.
The predominant modes of transmission are assumed to be droplet and contact.
The incubation period is from 1-14 days.
Assessment of the clinical and epidemiological characteristics of COVID-19 cases suggests that, similar to SARS, most patients will not be infectious until the onset of symptoms. In most cases, individuals are usually considered infectious while they have symptoms; how infectious individuals are, depends on the severity of their symptoms and stage of their illness.
Further study is required to determine the frequency, importance and impact of asymptomatic and pre- symptomatic infection, in terms of transmission risks.
From international data, the balance of evidence is that most people will have sufficiently reduced infectivity 7 days after the onset of symptoms.
Guidance – Transmission characteristics and principles of infection prevention and control (accessed May 2020)
2. Risk assessment for patients and staff
This includes me, Lucy and my clients; I have to consider mine and Lucy’s personal circumstances, family circumstances and own social behaviours and how those might impact risk to clients.
I will begin to screen clients over the telephone and via email, in addition to the usual medical history, specific risks for Covid-19 need to be identified.
A document will be emailed to you ahead of booking, in order for your booking to go ahead, this will need to be filled out, signed and sent back, once we have received this document back your booking will be confirmed.
Risk factors to be included in the screening questionnaire are;
2.1 Medical History
• System diseases such as cardiac disease, respiratory disease, liver disease or kidney disease
• currently being treated for cancer
• Age 65 or over
• any client that has been advised to shield at home
• any seasonal allergies which cause spontaneous coughing or sneezing
Recent symptoms / Covid-19
– Fever or cough in the last 14 days
– Tested positive for COVid-19, if so please specify
– Have you been in contact with someone with symptoms or who has tested positive to covid-19?
Additionally, any symptoms that are not ‘normal’ such as (but not limited to);
fatigue, body aches, headache, sore throat, loss of smell or taste, nausea or diarrhoea
3. Infection control measures
3.1 The environment I practice in;
- Removal of all non-essential clutter, decoration, magazines or brochures
- Removal of soft furnishings out of reception and treatment room
- Appropriate signage may be necessary to support the new systems
- Client ‘journey’ through the clinic will differ, I will be asking you to avoid touching any surfaces, I will open doors for you and invite you to wash your hands on arrival either using the sink or using the hand gel stations which will be situated at the bottom of the stairs and at the top of the stairs.
3.2.1 Common Areas
All common areas will be cleaned daily. All hard surfaces, including door handles, light switches will be wiped using household bleach diluted as per brand instructions, or detergents, which confirm they are effective against Covid-19. 70% alcohol wipes, sprays or gels that are known to be effective within 30 seconds.
3.2.2 In treatment rooms
Clinical work surfaces, treatment couches and anything used or touched during the treatment will be wiped with a detergent effective against covid-19 e.g. bleach solution, diluted as per brand instructions, or 70% alcohol, after each client treatment.
Rooms will be well ventilated, the quality of ventilation will be risk assessed according to the size of the room and what measures are possible to ventilate it between procedures.
To avoid myself and clients being irritated by cleaning fluids, time following cleaning will be allowed for any fumes to disperse and surfaces to dry. If windows can be opened, they will be. Appointments will now have a 15 min break between each client to allow for this to be implemented.
3.4 Personal Hygiene
Our tunics will only be worn at work. These will not be worn to or from work and will be taken away in a seperate bag and washed at 60 degrees between clinics. Both myself and Lucy have our own separate masks and will be responsible for washing them again at 60 degrees.
Our hair will be kept clean and tied up as per infection control policy.
Our tunics will not feature long sleeves; jewellery will be minimal and will keep nails tidy and short, as per infection control policy.
We will wash hands as per infection control policy. For additional information please read: My 5 Moments for Hand Hygiene
3.5 Additional infection control
Myself and Lucy will bring in our own food (not go out to the supermarket for breaks), bring in own utensils and mugs and take them home at the end of the day.
Clients will not be served refreshments.
4. Use of PPE
• Disposable gloves
• Disposable aprons
• Fluid resistant surgical face masks
• Fluid resistant surgical face shields
Surgical masks should:
– Cover both nose and mouth
– Be worn once and then discarded – hand hygiene must be performed after disposal
– Be changed when they become moist or damaged
– Not be allowed to dangle around the neck after or between each use
– Not be touched once put on
A single face mask can be worn for a single task or session where you are going to be within a metre of the patients face. A single session refers to ‘a period of time’ where a client is being treated in an exposure environment.
A session ends when the client leaves the exposure environment.
Sessional use should always be risk assessed. PPE should be disposed of after each session or earlier if damaged, soiled, or uncomfortable.
It may not be necessary for me to change the mask between clients, providing I do not need to adjust it or remove it. If I need to take it off, I will remove it completely and dispose of it.
Avoid touching the mask and face.
Clients will be asked to wear their own masks however masks will be available if needed.
Eye protection or full-face visors;
Eye and face protection provides protection against contamination to the eyes from respiratory droplets, aerosols arising from AGPs, from plume generating procedures and from splashing of secretions (including respiratory secretions), blood, body fluids or excretions.
Eye and face protection can be achieved by the use of any one of the following:
• Surgical mask with integrated visor
• Full-face shield or visor
• Polycarbonate safety spectacles or equivalent
• Regular corrective spectacles are not considered adequate eye protection.
Since we are not treating confirmed, suspected cases or symptomatic clients (though we cannot know), we may or may not choose to wear these based on risk assessment.
Such protection should be worn if there is a risk of splashing with blood, respiratory or bodily fluids or you are performing plume generating procedures which include laser and ablative plasma.
Wash hands after removing and disposing of PPE as per policy
We will be taking regular breaks and maintain hydration whilst wearing the correct PPE.
For additional information please refer to the Government Guidelines on COVID-19 personal protective equipment (PPE)
When requiring signatures; for example;
• Consent forms are all electronic and completed via a tablet device which is cleaned in accordance with the Covid-19 policy between each client treatment.
No hugging, hand shaking, keep talking to a minimum and no laughing L
Clients (and staff) with seasonal allergies who are prone to sneezing or coughing should take antihistamines and if symptoms are not managed, wear masks which may limit the treatment options. (This risk should be identified at pre appointment screening). It is important to minimise the dispersal of respiratory secretions, reduce both direct transmission risk and environmental contamination.
If either myself, Lucy or a client does need to cough or sneeze, then the, ‘Catch it, bin it, kill it’ process must be applied.
Disposable tissues will be available, used covering nose and mouth, then disposed of promptly in a lined, pedal operated bin and hands washed immediately.
No cash payments will be accepted in the clinic – alternative contactless methods of payment will be implemented. Bank transfer before your treatment will be preferred.
Clients will be asked not to bring unnecessary belongings with them, essentials must be placed on a surface or in a container which can be disinfected or disposed of between clients.
5. Social distancing
Minimise contact time.
We will conduct consultations, assessments, consent and routine follow up by video call, or booking app (Ovatu) to avoid unnecessary visits and keep ‘exposure’ time in the clinic to an absolute minimum.
Appointments will be scheduled to ensure only one patient in and out at a time.
The reception waiting area will be decommissioned, clients will be taken straight to the treatment room, maintaining a 2 metre distance from any staff until the treatment commences.
When seating is necessary, furniture will be moved to ensure a distance of 2 metres or more between myself and clients except during treatments.
6. Risk assessing procedures
Some treatments present a higher degree of risk than others, either because of the site (close to the nose or mouth) or because they may generate aerosol, splash or plume.
I will assess the risk and determine which treatments require specific and additional measures and which treatments cannot be offered.
Clients who have tested positive to Covid-19 will need to have another patch test again as it’s possible Covid-19 can make your skin more sensitive.
7. Adverse events and outcome dissatisfaction
All treatments carry some risk of adverse reaction or complications.
Risk assess each client and treatment ourselves and decides upon our own judgement for managing, worst case scenario. If we cannot employ a strategy to support our client’s safety, we will not proceed but defer the treatment.
8. Complaints and concerns
Generally, clients must be advised in advance and in writing that should a complication (any complication described in consent) arise and a lock down is enforced, face to face consultations will not be possible and any assessment, management and support can only be provided by telephone or video call, remotely.
Corrective procedures will not be possible until lockdown is released.
If this risk is unacceptable to the client, you should not proceed.
No refunds or financial compensation can be offered for circumstances beyond my control.
By booking a treatment you are accepting these risks and terms.
9. Reassuring and educating patients
Clients will naturally be anxious.
As part of pre-appointment screening and consultation, we will explain all the steps we are taking to manage risk.
- Identify and address any specific concerns a patient might have. If a client seems especially anxious, we will avoid persuading you, but rather reassure you that you can defer treatment until you feel safer.
- Provide written advice and instructions electronically, to support the verbal explanation.
- Include an explanation of how payment will be taken.
- Identify and risk asses any individual issues or concerns that may compromise safety.
All of these procedures have been implemented for your safety and ours. We will continue to take advice from the Government and the NHS regarding safe practice and will amend them as necessary.