TRIMETRICS PHYSIOTHERAPY
GROUP HEALTH AND SAFETY PROTOCOL:
COVID-19 HAZARD IDENTIFICATION AND RISK MANAGEMENT

OVERVIEW

The health and safety of all our workers is a top concern amid the global COVID-19 pandemic. During this time, we ask that everyone place an increased focus on health and safety in order to keep our sites safe and open. All measures implemented at our sites have been done in compliance with requirements under the provincial Occupational Health and Safety Act(s), associated regulations and public health directives issued by the provincial Chief Medical Officers of Health. Please remember this is a very fluid situation and as governmental and expert recommendations change so will our practices and guidelines. If you have any concerns about your health and safety, we ask that you discuss them with the clinic owner or manager.

WHAT IS COVID-19?

Coronaviruses are a large family of viruses found mostly in animals. In humans, they can cause diseases ranging from the common cold to more severe diseases such as Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS). The disease caused by the new coronavirus has been named COVID-19. While many of the characteristics of COVID-19 are still unknown, mild to severe illness has been reported for confirmed cases.

Provincial Public Health authorities have developed online COVID-19 self-assessment tools that can be used to help determine if further assessment or testing for COVID-19 is required for anyone that develops symptoms.

The symptoms of COVID-19 are similar to other respiratory illnesses including the flu and common cold. Symptoms can range from mild to severe. Sometimes people with COVID-19 have mild illness, but their symptoms may suddenly worsen in a few days. Symptoms of COVID-19 may include:

  • Fever
  • Chills
  • Cough
  • Shortness of breath
  • Sore throat and painful swallowing
  • Stuffy or runny nose
  • Loss of sense of smell
  • Headache
  • Muscle aches
  • Fatigue
  • Loss of appetite
Safe Work Practice COVID-19 Safety Measures
Objective To ensure safety of staff and patients during the global COVID-19 pandemic
Potential Exposure Hazard Controls
    · Exposure to COVID-19 Virus · Engineered Controls – Sneeze Guards

· Administrative Controls

– Patient Screening Protocols

– Physical Distancing Protocols/Practices

– Scheduling of staff and patients

– Infection Prevention and Controls  Protocols/Practices such as Hand Hygiene, Respiratory/Coughing etiquette, PPE practice, Exposure protocols, and Environmental Cleaning & Disinfecting Protocols

· PPE Controls

Protective Equipment Requirements ·       Face masks

·       Other PPE: Additional usage of PPE based on PCRA and Provincial Public Health and Regulatory Board requirement

Policy/Document Review Safe Working Practice COVID-19 Hazard Document Sick Leave Policy

• IPC Hand Hygiene Policy

• IPC Routine Practices Policy

o Respiratory /Coughing Etiquette

o Point of Care Risk Assessment

• IPC Reference Guide

SAFE WORK PRACTICE DETAILS

We can all play an active role in staying healthy and preventing the spread of COVID-19 by taking care of ourselves and monitoring our health:

Hygienic Practices

  • Wash your hands oft›››‹›4›en with soap and water, or use hand sanitizer regularly
  • Sneeze and cough into your sleeve
  • Avoid touching your eyes, nose or mouth
  • If you use a tissue, discard immediately and wash your hands afterward
  • Protect your hands from touching dirty surfaces as you leave the bathroom, e.g. using a paper towel to open the door
  • Frequently cleaning and disinfecting your workstation (telephone, computer keyboards, etc.) and treatment areas
  • Wash your clothes as soon as you get home

Monitor Health and Symptoms

  • Ensure healthy day to day practices to maintain good physical and psychological health
  • Monitor for symptoms such as fever, cough, and difficulty breathing
  • If you start having symptoms of respiratory illness, isolate yourself from others as quickly as possible
  • Stay home if you are sick. If you are ill or are experiencing symptoms, please notify the clinic owner and/or manager immediately, complete the online self-assessment tools for your province, and follow the instructions you get. You can always contact the Covid-19 Helpline (8-1-1) for additional guidance.

General Guidance

  • Practice physical distancing when out in public
  • Follow the latest travel advice from federal and provincial public health leaders

Engineered Source Controls

The usage of partitions (e.g. sneeze guards) to establish 2-meter distance and support physical distancing practices, where possible, and depending on patient treatment needs.

Administrative Controls

  1. Screening Protocols
  • Passive screening – signage posted at entrances
  • Active screening patient/examinee questionnaire – prior to appointment
  • Active screening staff questionnaire – prior to start of workday
  • Sick Leave Policy – Stay home if you are sick
  1. Physical distancing (2 metres) Protocols and Guidelines

As advised by public health officials, physical distancing is required to help control the spread of COVID-19. In order to ensure physical distancing on site wherever possible, it is necessary to consider different strategies to support adequate physical distancing within the workplace. Strategies include:

  • Staggering start times
  • Staggering breaks
  • Staggering lunches
  • Restricting the number of people on-site and where they are assigned to work within the site
  • Controlling site movement in order to limit the potential for workers and/or patients to gather · Limiting unnecessary on-site contact between workers, patients and any outside service providers
  • Encourage physical distancing in all areas of the workplace
  • Have staff work from home whenever possible (i.e. administrative staff)
  • Alter the workplace layout of the floor by moving furniture or using visual cues such as tape on the floor to enhance physical distancing
  1. Infection Prevention and Control Protocols
  • Sick Leave Policy
  • IPC Hand Hygiene Policy
  • IPC Routine Practices Policy

o Respiratory /Coughing Etiquette

o Point of Care Risk Assessment

  • IPC Reference Guide
  1. Cleaning and Disinfecting

The COVID-19 virus is spread person to person through close contact, including at work. While it has always been our obligation to maintain clean worksites, that obligation is absolutely critical during an outbreak like the current COVID-19 pandemic. In addition to general cleaning and disinfecting processes, it is critical to:

  • Ensure access to soap and water (ways to properly clean hands) or hand sanitizer
  • Clean and disinfect our washroom facilities
  • Clean and disinfect commonly touched surfaces or areas (door handles, light switches, POS machines, computers, phones, etc.)
  • Cleaning and disinfecting of all treatment and office equipment/areas after usage
  • Post signage on hygiene in the workplace so everyone can understand how to do their part
  1. Reporting Illness – Exposure

The symptoms of COVID-19 are like many other illnesses, including the cold and flu. Based on the recommendation of experts, it is Trimetrics Physiotherapy’s policy that any worker who has any symptoms related to cold, flu or COVID-19 must notify the clinic owner and/or manager and must not be present in the workplace. In the event a worker has such symptoms, they are advised to complete the online provincial public health assessments or to call their primary care provider (for example, family physician) for guidance based on their symptoms.

PPE Controls

  1. Current National Practice
  • All PATIENT/EXAMINEE entering our facilities will be asked to wear a face mask during the treatment/assessment
  • All Staff will be required to wear a mask. When not utilizing mask, please keep it in a bag or container to minimize risk of contamination.
  • Please ensure you have reviewed how to don and doff the PPE utilized.
  • Point of Care Risk Assessment – PCRA will determine the need for additional PPE requirements (gloves, gowns, goggles/face shields). Reusable Goggles/Face shields will be provided by each individual physiotherapist and are to be used appropriately based on the risk assessment and disinfected appropriately after use as per manufacture guidelines.
  1. PPE Usage & Maintenance
Best Practice Gloves (non-sterile) single use
Gloves are the most commonly used Personal Protective Equipment (PPE) in health care settings. They reduce soiling of health care worker hands and prevent transmission of microorganisms between health care workers and patients. Gloves should be worn when there is a risk of coming in contact with blood, body fluids, contaminated items or other sources of infectious agents.

ü  Gloves are single-use. Use only once, dispose immediately after use.

ü  Perform hand hygiene before accessing & putting on gloves AND after taking gloves off

ü  Change gloves between patients

ü  Do not wear gloves outside patient spaces unless carrying contaminated items or when cleaning spills of blood or body fluids

ü  Never wash disposable/single use gloves or use ABHR on gloves

Important Considerations when Using Gloves

ü  Inspect gloves for integrity and don just before a patient – care task

ü  Discard if integrity of glove becomes compromised

ü  Change between each patient

ü  Select gloves that fit snuggly

ü  Hand hygiene must be performed after removing gloves;

ü  Gloves are not required for routine care when in contact with intact skin

ü   Disposable gloves are worn for tasks other than direct patient care (e.g. laundry, working with chemicals, cleaners and disinfectants).

 

Best Practice Masks and Eye Protection
Masks, eye protection and face shields protect the mucous membranes (i.e. eyes, nose and mouth) of health care workers from splashes of blood or body fluids (e.g. patient’s cough or sneeze). Masks and eye protection work in tandem. If the Point of Care Risk Assessment determines the need for a mask, eye protection is also required. Proper eye protection shields eyes in all directions and should be worn when splashes, sprays or droplets of fluid are expected (e.g. contact with a client actively coughing, etc.). As per Safety guidelines, prescription eyewear is not considered adequate eye protection; an additional eye protection barrier is required.

ü  Wear to protect the mucous membranes of the nose, mouth and eyes during procedures/activities likely to generate splashes of blood, body fluids, secretions or excretions or within two meters of a coughing patient.

ü  Perform hand hygiene before accessing and putting on, and immediately after taking off

ü  Proper wearing of a mask includes: ensuring a snug fit over the nose and under the chin – molding the metal bar over the nose

– wearing the mask with the moisture-absorbing side closest to the face

– changing the mask when it is moist

– correct removal after use, touching only the elastic or ties

– not wearing masks around the neck

ü  Remove and discard the eye protection after use if disposable; if re-usable, clean with a disinfectant after each use.

ü  The outside of the mask and eye protection are considered contaminated.

ü  Clean hands after removing the mask and eye protection.

ü  Do not re-use disposable masks.

ü  Prescription eye glasses are not acceptable as eye protection.

ü  Discard single-use masks and eye protection in waste container

 

Best Practice Gowns/Aprons – single use
ü  Gowns/aprons are SINGLE USE – remove promptly after use and discard in appropriate receptacle. The outside of the gown/apron is considered contaminated so hand hygiene must be done following removal

ü  Wear a gown to protect exposed skin and clothing during activities likely to cause contact with blood or body fluids as based on the PCRA.

ü  Fasten tie strings at the neck and waist

ü  Make sure sleeves cover wrists

ü  Never use gowns as housecoats or warm-up jackets

ü  Do not wear gowns outside treatment space unless carrying contaminated items or cleaning contaminated items

ü  Remove damaged or heavily soiled gowns as soon as possible

ü  Do not reuse gowns

ü  After removing gown:

– place in waste container if disposable

– place in linen bag if reusable

– perform hand hygiene

 

  1. Donning and Doffing PPE

 To Don Mask:

  1. Perform hand hygiene
  2. Don gloves
  3. Grasp mask
  4. Place over face
  5. For medical mask: Secure ear loops behind the ears. Secure mask.
  6. Remove
  7. Doff gloves if applicable
  8. Perform hand hygiene
  9. A disposable facemask can be worn throughout your shift if not visibly soiled, torn or saturated.

To Doff Facemask with Intent to Reuse

  1. Perform hand hygiene
  2. Remove mask:

– Remove medical mask by holding the ear loops. The front is contaminated, so remove slowly and carefully. Do not let loops touch your face.

  1. After removing facemask, visually inspect for contamination, distortion in shape/form. If soiled, torn, or saturated the mask should be discarded.
  2. If the facemask is NOT visibly soiled, torn, or saturated, carefully fold so that the outer surface is held inward and against itself. The folded mask can be stored between uses in a container or bag.
  3. Perform hand hygiene

To Re-Don Mask

  1. Perform hand hygiene
  2. Don gloves if applicable
  3. Grasp used mask by ear loops
  4. Place over face
  5. For medical mask: Secure ear loops behind the ears. Secure mask.

Resources

  1. COVID-19 Information Site
  2. Stay updated with daily government updates: http://www.canada.ca/coronavirus
  3. Other COVID-19 resources
  • Health Canada outlines the actions being taken by the Government of Canada to limit spread of the virus, as well as what is happening in provinces and communities across the country. It also maintains a live update of the number of cases by province.
  • The World Health Organization is updating the latest guidance and information related to the global outbreak and spread beyond Canadian borders. It also provides the most up-to-date information on current research and development around the virus and a COVID-19 situation “dashboard.”
  • The CDC organization is provides guidance documents and the most up-to-date information on current research and development around the virus in collaboration with the WHO.