Moving towards a New Normal

Screening

Screen staff, patients, suppliers/service providers and visitors - Updated June 25, 2020 (changed out of province travel to current public health travel restrictions)

Screening Update effective Sept 14 - Rotational workers

Effective Monday, Sept. 14, rotational workers travelling within Canada will be allowed to attend necessary (urgent and routine) medical appointments. This includes physicians and nurse practitioners, dentists, optometrists, and other regulated health professionals where in-person treatment is required. The COVID-19 safety practices you already have in place for all patients do not need to change. However, in pre-screening these individuals, the requirement related to travel outside of Atlantic Canada will no longer apply. for details https://novascotia.ca/news/release/?id=20200911006

Supplemental Update - Plexiglass/glass barriers do not replace requirement for Mask

Non-clinical staff must be masked when a physical distance of two metres cannot be maintained. This includes if they are behind a plexiglass barrier. While the plexiglass provides an immediate barrier if someone coughs toward it, the virus can still move in the air around it. This is the case in buildings and vehicles where plexiglass is installed (unless it is 100% sealed, which is not typical). So masks are still necessary to protect everyone, but the plexiglass is still a good investment because it provides an extra layer of protection, especially in places like a checkout or front desk reception area where physical distancing is difficult.

Supplemental Directive #1 - Gloves

In the approved reopening plan gloves are described as a requirement when dealing with used linens. This makes sense for visibly or potentially soiled linens, however, it is atypical for a private community clinic setting to have visibly soiled linens.

For non-soiled but used linen (more typical for the community setting), gloves do not mitigate the risk any more than just requiring hand hygiene after handling used linens. Gloves are now only required when used linens are visibly soiled. Hand hygiene is required after handling used linens.

Supplemental Directive #2 - Travel Screening

Screening questions related to travel history are intended to identify individuals (patients/family or staff) that are required by public health to quarantine or self-isolate. As travel restrictions are changed by Public Health the screening requirements for staff and patients must also change.

For example, the recent announcement related to reducing travel restrictions to within the Maritime/Atlantic provinces means clinics/clinicians should change their screening policy to reflect this (travel within the Maritimes does not require exclusion from work for staff or in-person care for patients). As the restrictions change, whether relaxing or tightening, clinics must adjust their screening practice accordingly.

Changes to screening practice should take effect on the date that the travel restriction changes take effect.

With the expanded testing criteria, and inclusion of very common symptoms like runny nose, headache, and muscle ache; do all patients with symptoms in the screen have to be sent for testing and be excluded from treatment?

If a client presents with a symptom consistent with COVID-19 that is not new, and for which a cause has been identified, and for which they are currently receiving treatment, then there would be no need for that individual to be referred for COVID testing. Screening for additional symptoms should continue as per the required frequency.

Are patients that present with localized muscle ache eligible for In-person treatment?

The muscle ache symptom in the screen relates to generalized muscle ache associated with flu-like symptoms, not injury related muscle pain. Patients with muscle ache related to injury would be eligible for in-person treatment.

How many symptoms from the list are required to be present for the screen test to be considered positive?

As of June 3, 2020 the symptom screen is positive with the presence of one or more symptoms consistent with COVID-19. Symptoms and the threshold for referral to 811 change over time. Refer to https://when-to-call-about-covid19.novascotia.ca/en for current symptom list. Unless the symptom is not new, and for which a cause has been identified, and for which they are currently receiving treatment.

If staff are wearing masks can they be closer than 2m(6ft) apart?

Yes, however, masks do not replace the risk reduction of social distancing. Social distancing must be maintained whenever possible. If social distancing cannot be maintained, then a mask is required. Clinical staff must wear surgical/procedure masks when providing in-person care.

If a staff member/patient becomes symptomatic at the clinic, does that mean we have to close the clinic, and all staff /patients have to leave work and go home to isolate?

The clinic does not need to close unless contacted by Public Health to do so. If a Physiotherapist / staff / patient develop symptoms of COVID-19 in the clinic they must immediately apply a surgical procedure mask and be excluded from work or treatment. The individual must be directed to call 811 to arrange for COVID-19 testing. Self-isolation must occur if an individual is awaiting test results or tests positive. If test results are negative, the worker may return to work, when symptoms are resolved and as long as the individual is not deemed a close contact of a positive case.

When can patients return if they present with a COVID-19 related symptom?

Patients may return after a negative COVID-19 test result.

Do we have to change and wash shirt and pants after each shift?

Yes. You may change at home or in the clinic at the end of your shift. You may not go into public (i.e. public transit or a grocery run on the way home), but you may drive directly home to change.

Do patients have to wear a mask?

Patients are strongly recommended to use a mask (Non-medical grade is acceptable), but it is not a requirement. Clinics may develop policies that meet or exceed this requirement.

If we have upholstered office chairs that the front desk and physios use at their desks but nowhere near patient care, do we have to remove them or can they still be used?

It depends on the ability to disinfect it, and the usage. It is not just about contact with patients but as a potential vector between staff as well. Coverings that can be disinfected or laundered regularly are suitable solutions.

Are staff not involved in direct patient care (i.e. receptionists) required to wear a medical grade surgical/procedure mask, or are non-medical grade masks (such as fabric ones) acceptable?

For staff not involved in in-person patient care non-medical grade masks are acceptable.

Do clinics have to follow the gathering/occupancy limitations?

Gathering limits apply to social settings not occupancy. Any workplace or business not required to be closed can remain open as long as a 2 m (6 ft) distance can be maintained. See social distancing guidelines. If you can’t maintain social distancing because of the physical size of your business, you must limit the number of patients to your appropriate limit.

If a document is being exchanged between two therapists with clean hands and face masks can they hand off a document?

The preferred option is to always social distance where possible. If documents must be exchanged, leave them on a clean surface while maintaining a 2 metre distance.

Can you define non-essential travel?

Reducing non-essential travel is a general public health principle that guides the design and implementation of the risk reduction strategy, not a hard and fast rule as what is essential may be different for different people and may change over time. For clinical purposes providing virtual care when appropriate would limit non-essential travel.

Can I use a face shield in place of a procedure/surgical mask

Face shields cannot be used in place of a procedure mask. They can be used in addition to procedure masks to reduce the risk of direct transmission by protecting the eyes. Face shields do not help reduce the spread in the event the wearer is contagious, which is the primary purpose of wearing the mask.