The wearing of personal protective equipment (“PPE”) by both practitioner and client is subject to any requisite safety directive and protocol which may be issued by the Minister of Health, the National and Provincial departments of Health or any other appropriate South African healthcare authority or by the National Institute of Communicable Diseases.
These guidelines have been developed to assist practitioners with regard to practice hygiene, specifically as a response to the pandemic, and the need to set out how practices should institute mechanisms to prevent the spread of the disease. Please ensure you familiarize yourself with new laws and ordinances at the local, state and national levels and with new regulations and guidelines from relevant professional governing bodies. Identify practices and policies that will need to be adjusted as a result of any new laws or regulations.
ABOUT THE SARS- CoV-2 (COVID-19) VIRUS
The virus itself is referred to as SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) and is an influenza type virus. Clients who contract COVID-19 present predominantly with fever, dry cough, malaise and shortness of breath, very much like the flu.
The virus is spread by droplets during sneezing, coughing or talking, and contact with droplets on surfaces (skin or inanimate objects [fomites]). It enters the body via the mucosal lining of the eyes, nose and mouth. Personal and surface hygiene is important to stop the spread of the virus
PERSONAL HYGIENE & SAFETY:
Washing hands (with soap and water) and/or disinfecting hands with sanitiser to remove inactive (if present) the viruses on your hands and to stop the transfer to your eyes, mouth and nose as well as other surfaces.
A minimum of 70% ethyl or isopropyl alcohol solution is required for adequate disinfection.
One should be covering their mouth and nose when sneezing or coughing, either with your elbow, a tissue or paper towel that must be discarded immediately into a waste bin that can close. Make sure to wash and disinfect your hands after you discard the tissue or paper towel.
Personal PPE is essential to safeguard from the contracting or spreading the virus. Wearing a mask correctly at all times to ensure safety from anyone coughing, sneezing, etc.
Avoid hand shaking; rather greet clients with elbow or just verbal.
Given the close contact nature of this industry, distancing is not possible. Therefore a level of personal protection and personal protection equipment (PPE) should be considered.
Cleaning and disinfecting general surfaces (with the appropriate solutions) that may have been exposed to, or that potentially have virus containing droplets.
Cleaning and disinfecting all equipment in your practice is essential in preventing the spread of the virus, this is achieved by following a sanitization procedure.
ESSENTIAL PROTOCOLS & PROCEDURES:
The correct method of hand washing is an important aspect of controlling the spread of the disease.
The following figures demonstrate the correct method of washing your hands and using hand sanitisers.
It is important to note that hand sanitisers will not work if the hands are visibly dirty.
Ensure you have a print out of how to wash your hands in your restroom as part of best practice policies; this must be visible to clients.
PERSONAL PROTECTION EQUIPMENT (PPE)
It is important to use these correctly; incorrect use may do more harm than good and equally important to appreciate that the mask may make you more likely to touch your face, as it may become an irritant, or that breathing and communication will be affected.
GUIDE FOR USING A FACE MASK: HOW TO PUT ON A FACE MASK:
Clean your hands with soap and water or hand sanitiser before touching the mask.
Remove a mask from the box and make sure there are no obvious tears or holes in either side of the mask.
Determine which side of the mask is the top. The side of the mask that has a stiff bendable edge is the top and is meant to mould to the shape of your nose.
Determine which side of the mask is the front. The coloured side of the mask is usually the front and should face away from you, while the white side touches your face.
Face Mask with Ear loops: Hold the mask by the ear loops. Place a loop around each ear.
Face Mask with Ties: Bring the mask to your nose level and place the ties over the crown of your head and secure with a bow.
Face Mask with Bands: Hold the mask in your hand with the nosepiece or top of the mask at fingertips, allowing the headbands to hang freely below hands. Bring the mask to your nose level and pull the top strap over your head so that it rests over the crown of your head. Pull the bottom strap over your head so that it rests at the nape of your neck.
Mould the stiff edge to the shape of your nose.
If using a face mask with ties: Then take the bottom ties, one in each hand, and secure with a bow at the nape of your neck.
Pull the bottom of the mask over your mouth and chin.
HOW TO TAKE THE FACE MASK OFF:
Clean your hands with soap and water or hand sanitiser before touching the mask. Avoid touching the front of the mask. The front of the mask is contaminated. Only touch the ear loops/ties/band. Follow the instructions below for the type of mask you are using.
Face Mask with Ear loops: Hold both of the ear loops and gently lift and remove the mask.
Face Mask with Ties: Untie the bottom bow first then untie the top bow and pull the mask away from you as the ties are loosened.
Face Mask with Bands: Lift the bottom strap over your head first then pull the top strap over your head.
Throw the mask in a bin with a cover. Clean your hands with soap and water or hand sanitiser.
OTHER PROTECTIVE WEAR
SCRUBS/ DISPOSABLE APRONS:
You may consider wearing a scrub or apron to protect your underlying clothes to avoid contamination.
NOT advised for treatments, but essential for cleaning and disinfecting. Hand hygiene is more important for treatment procedures.
No jewellery (watches, rings etc.), these make it difficult to clean effectively and can become carriers for droplets
No sleeves, hand washing should be up to and including the elbows
Face mask protocols must be adhered to
Clothes worn should be decontaminated between clients using a disinfectant spray and be washed immediately after seeing clients for the day. (on a wash cycle that has a high temperature with washing powder with proper oxidizing agent, and should be tumble dried or hung in the sun for UV disinfection).
CLIENT SAFETY & ASSESSMENT:
IMPORTANT RISK SYMPTOMS
It is imperative to ensure your safety and your client’s safety and ensure that clients with the viral disease do not access your practice or spread it. A list of symptoms that should be screened prior to our client arriving for their treatment. They include:
Fever (above 38 degrees)
Malaise (general body weakness)
Exposure to anyone with suspected or diagnosed with COVID-19 in the last 14 days
Worked or attended a clinic facility treating COVID-19 patients
Travelled internationally or domestically in the last 14 days
OTHER FACTORS RELATING TO CLIENT’S HEALTH:
Certain groupings have been identified as higher risk relating to the severity of disease and it should be considered whether the increased risk associated with these groups necessitates face-to-face consultation or even treatment. These include:
Over 60 years of age, with any pre-existing health concerns
Pre-existing respiratory conditions such as: Asthma, Chronic lung conditions
Hypertension (High Blood Pressure)
Autoimmune diseases (systemic lupus, rheumatoid arthritis, MS)
Organ transplants (due to immune suppressants)
Immunocompromised (HIV/ AIDS)
Obesity (BMI over 40, underlying health conditions)
Liver or kidney conditions
CLIENT SCREENING AND ARRIVAL AT PRACTICE
THE DAY BEFORE
Clients should be phoned and screened the day before consultations, and requested to take appropriate action if they are presenting with any risk symptoms or conditions mentioned above.
Appropriate signage must be visible outside and /or at the entrance to your practice, this is warn clients of hygiene and screening procedures.
NO UNAUTHORISED ENTRY
Clients should be stopped from entering your practice without control.
All clients should be asked to wait outside if they arrive early for their treatment.
All clients should be sprayed with hand sanitiser should wear or be given a face mask to wear, to reduce droplet spread.
On arrival, clients must be screened for risk factors, and preferably sign they do not have risk symptoms.
Temperature testing/screening of clients before or as they enter the practice, this must be documented.
A register should be kept of all persons entering the practice for each and on any given day.
Consultation forms should acknowledge the risks associated with potential exposure to SARS-CoV-2.
A thorough consultation should be performed with all the appropriate medical and administrative information; these records must be kept to assist in facilitating tracing a client should they develop symptoms.
Social distancing that will be part of everyday living for the foreseeable future as a mechanism to limit the spread of the disease This is relevant to practices that have the space to accommodate more than one client, where 2 or more practitioners are working or if you work in an environment where you share a reception area with other professionals.
No clients in your waiting room, clients are requested to wait in their car and should be called when you are ready for their treatment.
Clients should have no contact with other clients. If not possible, client should be staggered in a way that allows for 3 meters between their seating arrangements.
Rooms must remain open with adequate air flow to assist in removal of potential airborne droplets.
Family members or friends should be requested to stay in the car.
Sufficient spacing between consultations (15-20 minutes is recommended) is critical to allow for ventilation and surface hygiene protocols
The clients should not be allowed to touch anything inside the practice.
The use of the toilets should be carefully monitored with a thorough cleaning of surfaces after every use, including doorknobs and door surfaces.
CLEANING, DISINFECTION AND SURFACE HYGIENE PROCEDURES
TREATMENT ROOM & SURFACES
Remove any items in your consultation/ treatment room that is not required or that client’s may come into contact with unnecessarily, such as books, magazines, etc.
TOWELS & LINEN
If towels are to be used, these must be changed after every client and laundered immediately to ensure adequate cleaning; this is preferable to having a client bring in their own linen or towels. Towels must not pile up foe washing later. Do not shake the towels out as this could spread any contamination.
If gowns are provided for clients they must be laundering between clients.
Use of disposable linen savers, single use paper towels and other consumables should be used wherever possible. Practices should have the necessary waste management.
The cleaning product used should contain at least 70% ethyl or isopropyl alcohol, or 0.5% sodium hypochlorite is recommended (or approved cleaning detergent): check cleaners on small areas before use, as they can damage surfaces. Bleach or alcohol spray also work.
Surfaces to be cleaned include the entire bed (not only head piece), desk, chairs, door handles, pens, clipboards, and card machines, anything used in the room.
Surfaces must be washed at the start and end of the day, and disinfected between each client
Floor surfaces and general areas should be cleaned appropriately as often as required using an appropriate cleaning agent.
Any equipment used during the consultation or for treatment should be thoroughly cleaned and/or disinfected appropriately between each client. E.g. Bamboo Choo’s, hot stones, oil bottles, pens etc.
Ensure all items used including, door handles, light switches, etc. are cleaned between clients.
STAFF IN YOUR PRACTICE
Should you have staff, including cleaners or domestics in your practice, they must be familiar with screening and hygiene protocols and these should be clearly written up and displayed or readily available and explained to them.
All staff should have PPE as prescribed, a minimum being a face mask at all times.
Staff temperature screening daily, and recorded.
All staff members must engage in rigorous hand hygiene.
Cleaning staff: Must have correct training and PPE, as they are a critical link in the process: They should use gloves, plastic apron, and disposable paper towels. All mops and cleaning equipment should remain in the detergent and be sterilized after cleaning down.
PRACTITIONERS PRACTICE & TREATMENT PROTOCOL CHECKLIST
Evaluate treatment menu for items that may need to be removed or altered
Consider eliminating reusable copies of treatment menu and transitioning to single-use disposable copies or a digital or no-touch promotional display of available services
Verbal or visual indications, through poster signage of washing hands prior to and following treatments encouraging clients do so.
BOOKINGS & PAYMENT
Evaluate and adjust appointment scheduling to allow implementation of updated cleaning and sanitation practices, social distancing, etc
Evaluate cancellation policy and determine if changes need to be made (i.e. not penalizing those who cancel due to being sick, etc.)
Evaluate payment options and processes, implement touchless payment option, get clients to rather EFT, try stick to cashless model and communicate this with your client in advance.
Clean and disinfect high-touch areas which include:
Clean and disinfect hard surfaces
Treatment tables, massage beds
Clean and disinfect soft surfaces: Face cradles/ Face Holes/ Head pieces
Clean and disinfect hard surfaces and high-touch areas which include:
Faucet and handles
Toilet paper/paper towel dispensers
Launder clothing, towels, linens and other machine-washable items according to the manufacturer’s instructions, using the warmest appropriate water setting.
Dry items completely
Clean and disinfect clothes hampers.
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