Covid 19

As of May 4th Alberta Health Services has permitted colleges to allow their members to return to practice as long as the new guidelines are followed.

With the new guidelines some of the changes you might notice in your hearing aid provider’s clinic are as follows;

You will be screened several times regarding covid-19 symptoms and travel.
- You may be asked to postpone your appointment if you are ill.
- Walk in services may not be permitted.
- You may be asked to remain in your vehicle until your appointment times.
- You may be asked to bring your own face mask or one may be provided to you.
- You may notice the staff at the clinic wearing masks/face shields and gloves.
- You may see barriers in place at reception and in offices
- You may have your temperature taken by staff.
- You may be asked to wash your hands upon entering the clinic.
- You may be asked to come alone or with one caregiver only.
- Please cancel any appointment if you have developed any symptoms.
- Please advise the clinic if you have been in contact with anyone with someone diagnosed with Covid-19 since a recent appointment..
- You may expect the clinic to have modified hours
- You may expect the clinic to be seeing fewer patients in a day to avoid double booking and overlapping appointments.
- You may expect your appointment time to be longer then normal.

CHAPA has provided these guidelines to their members to protect both the public and staff.

CHAPA would like to thank you for your patience as our members navigate and adapt their practices to the rapidly changing circumstances.

Covid 19 - New Guidelines for Practice. (Members)

Below are the guidelines from CHAPA based on the latest direction of AHS. Please remember, with the right to re-open and practice comes the responsibility to protect our safety and those we serve. Please continue to use common sense and do you try to circumvent the below recommendations. Again, there is a ZERO tolerance for Non-Compliancy. The AHS has explicitly said that if we do not have these safety measure in place or if you run out of compliance because you ran out of the recommended PPEs to defer appointments temporary instead of risking the safety of the most vulnerable portion of the population in which we primarily serve. It is your responsibility to read and understand the RECOMMENDATIONS and LINKS to AHS Covid-19 orders and guidelines CAREFULLY. Any non-compliance in your workplace or your area you may be aware is encouraged to report to AHS for review and subject to their penalties.

I would like to thank the entire CHAPA council for their sacrifices of time and effort and quick response to the ever changing guidelines. I would also like to extend a thank you to Michael Neth and the boards at ACSLPA, for their continue support to utilize their materials. We thank you for their hard work and collaboration during these unprecedented times.

David Lee
President of CHAPA

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Advisory Statement:

Providing Services During a Pandemic

May 3, 2020

Providing Services During a Pandemic
Advisory Statement: Addresses the legislated obligations that apply to Hearing Aid Practitioners. Advisory Statements inform regulated members about legislation, provide suggestions for compliance, and direct members to relevant resources.

Preamble

This guide is intended to provide CHAPA members with a decision-making framework for providing health/professional services as allied health services/businesses are now allowed to reopen. CHAPA members need to understand the risks related to COVID-19 in order to make informed decisions about the services they provide and to implement strategies to effectively manage and mitigate those risks.
CHAPA members are expected to keep themselves informed about the pandemic and any advice provided by public health officials, including specific public health orders. COVID-19 Information for Albertans provides information about COVID-19 and its etiology, strategies for minimizing risk, guidance for the public and business owners and public health orders. This site should be visited frequently as information is changing rapidly. Guidance for workplaces and for business owners should be reviewed frequently.
This Advisory makes reference to AHS resources which are intended for use by both AHS staff and health care workers outside of AHS.
This guide provides the minimum requirements from the College to practice safely. Members may choose to go above these recommendations.

Structure

This guide provides CHAPA members with:

Information to guide general decision-making regarding reopening a practice during the pandemic,
Strategies for minimizing the risk of spread of COVID-19regarding re-opening, and
Worksheets to apply guidance in practice.

Preparing to Reopen a Practice

All specific requirements laid out by the Government of Alberta and the Chief Medical Officer of Health must be followed.
While CHAPA members are able to reopen their practice/business, CHAPA does not require them to do so. CHAPA members should refrain from reopening their clinic/practice if they do not have access to appropriate cleaning/disinfecting supplies and personal protective equipment (PPE).
Practitioners will need to consider the available information/guidance and determine if they are able to sufficiently minimize their risks and are prepared to reopen their clinic/practice. Guidance from Alberta Health will need to be followed, including any public health orders.

CHAPA members who are employed by an agency/organization, will have a responsibility to also follow their employer’s requirements in addition to CHAPA guidance. Members who are self-employed, employers , or business owners have a responsibility to create procedures to ensure the safety of their staff and clients.
A key consideration in reopening a clinic/private practice will be to eliminate the risk of transmission of COVID-19.

Risk to Clients – when reopening a business, practitioners must take care to identify risks to clients related to COVID-19 and take steps to minimize these risks.
Risk to Workers/Staff – hazard assessments are required under Alberta Occupational Health and Safety legislation to identify risks (including COVID-19) for workers.

Where possible, hazards and risks to clients and staff should be eliminated. Where it is not possible to eliminate these risks/hazards, they must be controlled. There are several types of controls that can be implemented. They are hierarchically determined with engineering controls being considered the first level, administrative controls as the second level, and personal protective equipment (PPE) as the third. In most cases, CHAPA members will need to use all types of controls to appropriately minimize the risk of COVID-19 spread and to ensure compliance with ongoing public health orders.

General Considerations for Business Owners

1. While some decisions can be made for an entire business/practice, in many cases decisions
will also need to be made on a client-by-client basis.

2. Ensure staff have information about the COVID-19 outbreak and preventative measures.

3. Develop and provide information to staff and clients about any specific requirements related to services available and screening requirements.

4. Have a clear sick/illness policy which includes a plan for staff who are sick.
Insist that staff stay home if they are exhibiting any symptoms, even if they are mild, or if they meet the criteria for self isolation due to travel or close contact. This includes you.
Monitor staff throughout the day for symptoms, even if they are mild, and send them home immediately if symptoms arise. Direct them to the Alberta COVID-19 screening website https://myhealth.alberta.ca/Journey/COVID-19/Pages/COVID-Self- Assessment.aspx
Consider implementing a screening of staff when they arrive at work. Ensure you are aware of any legislation related to this practice (e.g., temperature checks, screening checklists).
Consider posting signage about staying home when sick and remind staff and clients how to cover coughs and sneezes to prevent the spread of infection.

5. Determine if you will implement specific screening of clients (e.g., temperature checks) in addition to a point of care risk assessment. If implemented, ensure screening is consistently completed.

6. Ensure handwashing is available to both staff and clients.
Have hand sanitizer available at the door and facilitate its use by clients. Consider whether you will have a staff member at the door to ensure clients and visitors are performing handwashing.

7. Ensure information is available about what services are currently available to clients and those that may have to be postponed.
Provide information for how clients can seek service alternatives if possible (provide referrals to other resources).

8. Develop a strategy for handling enquiries and concerns from clients and staff. This includes questions from those who are sick or self-isolating.

Consider posting signage that:
1. asks clients to reschedule if they are experiencing symptoms of COVID-19, have just returned to Canada from travelling within the last 14 days, or have flu-like symptoms such as cough, fever, fatigue, sore throat, runny nose, difficulty breathing and/or shortness of breath.
2. encourages self-isolation when feeling sick, and
3. encourages hand hygiene.

10. Avoid greetings such as handshaking or hugging/touching.

Specific Strategies to Reduce the Risk of Transmission of COVID-19
In accordance with of public health advice, COVID-19 spread can be minimized through a combination of overlapping strategies working in concert to minimize and control hazards/risks. All strategies must be employed vigorously to be successful. The strategies are:

Minimizing the risk of contact,
Social distancing,
Handwashing, personal cleanliness/sanitization, personal hygiene and respiratory etiquette,
Cleaning and disinfecting surfaces and contact areas,
Cleaning and disinfecting equipment, and
Personal protective equipment.

1.0 Minimizing the risk of contact

Minimizing the risk of contact will help to reduce the risk of COVID-19 transmission. Contact refers to that made with clients, caregivers, practitioners, support staff and others.

A)Services provided by alternative means:

1.1	CHAPA members should continue to use their judgement to determine if a particular service for a particular client presents risks that outweigh the benefits. Services should be postponed if risks cannot be appropriately managed/controlled.
1.2	CHAPA members must defer services for clients who have symptoms or who have been confirmed as having COVID-19. Services can resume once the minimum requirements for self-isolation have been met.

1.3	CHAPA members should continue to provide services by virtual or other means* where it is appropriate to do so. CHAPA members should ensure that the standards of service delivered via telepractice are equivalent to the standards expected in traditional delivery methods. Existing guidelines should be used to guide the provision of member services in telepractice, recognizing that some modifications may need to be made (for example, the lack of ability to complete tasks that may require physical cueing/ contact). In some cases, services may include both telepractice and face-to-face components. There will be situations where services must be provided in a face-to-face manner and practitioners will need to take appropriate precautions to do this safely. * includes but is not limited to telepractice, curbside pick up/drop off, etc.
1.4	If an entire service cannot be delivered remotely, consider starting with a virtual consultation and make the decision to move to a more direct service after the consultation. This will enable practitioners to minimize in-person contact time with the client and will enable any additional planning required for a particular appointment.
1.5	If providing a ‘drop-off’ or ‘pick-up’ program to service equipment, receive supplies, or to distribute resources, reduce the need for clients to attend in person. Implement more mailing and courier service deliveries. Consider creating a secure drop-off box secured outside your clinic/office or other service sites (e.g., support living environment) where clients can drop off or receive equipment or resources.
1.6	If there are services and/or procedures that require in-person interactions, implement a rigorous pre-screening and Point of Care Risk Assessment (PCRA) protocol to minimize COVID-19 exposure and transmission. Refer to Appendix A.
1.7	Consider implementing a screening tool, such as a temperature check using a forehead or ear thermometer, at all patient visits. Before implementing this strategy, members must be sure to understand the normal temperature ranges and any limitations of the screening tool being used.
1.8	Consider forgoing any cancellation fees to remove pressure for clients to attend who might be feeling unwell.

2.0 Social/Physical Distancing

Requirements for physical distancing remain in place under the public health orders. Therefore, practitioners must ensure that physical distancing can be maintained between clients and/or staff. There are frequently times where physical distance cannot be maintained during the health service being provided. When this happens, additional precautions must be taken.

A) Considerations for an office environment

2.1	Practitioners must make every effort to maintain a 2-metre physical distance between individuals. Physical distancing must be maintained between practitioners and clients, clients and other clients, and between staff. Where this is not possible, additional precautions must be taken.

2.2	Clinic appointments should be scheduled to minimize the number of people in the clinic at any one time to allow a safe distance between people. Keep in mind that people will move around the office or clinic when they are present. Considerations should include restrictions within the space such as hallways and doorways. Time appointments and movement of people so that clients and staff won’t likely have to pass near each other or sit close to each other in a waiting room. Ensure waiting room chairs are properly placed to ensure the 2-metre physical distance.
2.3	The number of clients seen in the office should be limited, especially those in high-risk groups (age 60+ and patients with pre-existing health conditions). The number of caregivers attending with the client should be limited.
2.4	If the clinic is likely to attract walk-in traffic, consider methods of restricting access to the clinic space to maximize social distancing within the space. If needed, provide a place for people to line up in a queue outside the clinic and encourage safe social distancing practices for individuals in the queue.
2.5	Ensure a safe working distance for clinic staff of at least 2 metres from clients and from each other. Increase the spatial separation between desks and workstations as well as individuals (i.e., employees, clients). A 2-metre distance should be maintained, unless there is a physical barrier between staff/clients (e.g., cubicle wall, Plexiglass window). Consider the use of physical obstructions such as tables, counters, or other objects to encourage space between individuals. If physical objects cannot be used to provide a safe working distance, consider other visual cues including tape lines on the floor.
2.6	Ensure a plan is developed for when services must be delivered at close proximity to the client (within 2 metres). Can you approach from the side? Should the client wear a mask? See additional information in Section 6.0 PPE.
2.7	Explain all physical distancing strategies to clients and staff using plain language. Consider placing posters in client and staff areas to visually display physical distancing. Reinforce the safe physical distancing strategies whenever small violations are observed.
2.8	Consider installing physical barriers where a 2-metre distance cannot be maintained (e.g., Plexiglas at counters).

Considerations for home visits

2.9	CHAPA members should consult with their liability insurance provider to see if any special coverage or riders are required for home visits.
2.10	CHAPA members must implement a screening protocol to determine if services can and should be provided in the client’s home. A pre-screening can be conducted over the phone before the visit. A point of care risk assessment (PCRA) must be conducted once at the client’s home as symptoms may have changed between the initial screening and the time of arrival.

	The pre-screening and PCRA should include the same questions.
2.11	CHAPA members should have a conversation with the client prior to the visit. The conversation should include sharing of information about cleaning/disinfecting, any PPE requirements, and anything else that might affect the visit.
2.12	Practitioners should have a pair of shoes that are dedicated to wearing when inside client homes. If attending multiple homes, soles of shoes must be cleaned between homes.
2.13	CHAPA members must maintain strict adherence to infection prevention and control (see sections 4.0 and 5.0).
2.14	CHAPA members must wash their hands upon entering the client’s home and again upon leaving. Members should carry hand sanitizer with them. Members should ensure they clean their hands again once outside the client’s home.

3.0 Handwashing, personal cleanliness/sanitization, personal hygiene and respiratory etiquette

3.1	Handwashing must be available to staff and clients. Practitioners and staff must be washing their hands regularly and often throughout the day. Hands should be washed before starting work, before and after providing any services to a client, after handling equipment or waste, after performing cleaning, after using the toilet, after blowing your nose, sneezing or coughing, after eating, drinking, or smoking and after handling money.
3.2	Clients should be instructed to wash their hands when entering the clinic and again just before leaving.
3.3	Handwashing must be completed upon entering a client’s home and again after leaving. Be sure not to touch any surfaces after leaving the client’s home until you have washed your hands. Hand sanitizer is likely required for handwashing after exiting the client’s home.
3.4	Respiratory etiquette must be followed. It is imperative to shield coughs and sneezes to prevent the spread of droplets. Cough or sneeze into a tissue, immediately dispose of the tissue, and then wash your hands immediately. If this isn’t possible, be sure to cough or sneeze into your elbow. Clients should be encouraged to follow respiratory etiquette.
3.5	It is important to avoid touching your eyes, nose and mouth, particularly when conducting client care or when with clients.
3.6	Personal cleanliness and hygiene are always important. These include matters such as clean and tidy clothing, trimmed and clean fingernails, and rigorous handwashing. Consider laundering clothing more frequently and clothes worn when in contact with clients should be laundered before wearing again.
3.7	CHAPA members may choose to wear gloves for direct patient contact. Wearing of gloves is not a substitution for appropriate hand hygiene.

4.0 Cleaning and disinfecting surfaces and contact areas

Cleaning and disinfecting will be different in a clinic setting versus when serving clients in their own home. There is greater control over cleaning/disinfecting at the clinic setting.
Cleaning and disinfecting are two steps; surfaces and contact areas should be cleaned first, then disinfected. The process of cleaning removes any debris while disinfecting is the process of “sanitizing”.
Cleaning and disinfecting must happen with greater frequency and rigor with COVID-19. Surfaces and contact areas should be cleaned and disinfected on a regularly scheduled basis and at the very least must be completed after each client visit.
All surfaces, especially those that are horizontal and frequently touched, must be cleaned at least twice daily and also when soiled or after being touched.

A)In the clinic setting

4.1	Surfaces that cannot be cleaned should be removed from client areas (e.g., books, magazines, cloth chairs).
4.2	Surfaces and contact areas that must be cleaned and disinfected include (but are not be limited to): Desks Keyboards/mice/monitors Worktables/workstations Countertops Shelves Printers/photocopiers Doorknobs/handles Pens (and other shared objects) Light switches Chairs – including armrests, backs and seats Sinks (including faucets), toilets (including flush handle), towel bars Railings Cash machines/pin pads.
4.3	Ensure handwashing facilities are available to clients and staff. If sinks are not available, ensure alcohol-based hand sanitizer is. Ensure tissues and no-touch garbage receptacles are readily available. Keep bathrooms stocked with soap and paper towels.
4.4	Where possible, consider going cashless and ensure hand hygiene after exchange of money or items. Avoid sharing communal office equipment/supplies (e.g., pens, phones, tablets).
4.5	Consider developing a checklist for required cleaning/disinfecting. Consider including a spot for staff to document the time of cleaning and their initials.
4.6	Consider displaying posters promoting hand-washing and respiratory hygiene.

In a client’s home or similar environment

Where a client indicates they have symptoms of COVID-19 or have been in close contact with a person who has COVID-19, home-based services should be deferred to a later date.
When in a client’s home, you may not be able to guarantee surfaces are cleaned and disinfected. This presents greater risk of transmission between the client and the provider.

4.7	CHAPA members must conduct a pre-screening and a PCRA for home visits (see 2.9). If possible, clean and disinfect any areas you need to be in with appropriate cleaners/disinfectant both before and after, including door handles and chairs (arms, backs).
4.8	Practitioners must use a barrier between the client’s table/work surface and any equipment/materials being used.
	A covering (e.g., sterile pad, tablecloth) will help to create a sterile surface.
	It is recommended that the covering be disposable and then thrown away after the visit. If it is not disposable, it must be bagged after use and then laundered before being used again or coming into contact with other equipment/materials.
4.9	CHAPA members must use approved cleaners/disinfectants.
	Products must have a DIN number and be on the Health Canada list for approved products.
	CHAPA members must read and follow manufacturer’s instructions for safe use of cleaning and disinfection products (e.g. wear gloves, use in well-ventilated areas, allow enough contact time for disinfectant to kill germs based on the product being used).

5.0 Cleaning and disinfecting equipment

Infection Prevention and Control (IPC) practices must be stringent and without exception.

5.1	Cleaning and disinfecting are two steps. Equipment should be cleaned first, then disinfected. The process of cleaning removes any debris while disinfecting is the process of “sanitizing”.
5.2	Any equipment used in either the clinic or a home environment must be cleaned and disinfected prior to its next use. This includes bags/suitcases/carts in which equipment is stored or transported. Where possible, single-use items should be considered. Discontinuation of the use of certain toys, activities or equipment may be appropriate during pandemic. Reusable non-critical equipment that has been in direct contact with a client or in that client’s environment should be cleaned and disinfected before use with another client. Items that cannot be cleaned and disinfected between clients should not be used during the COVID-19 pandemic.
5.3	In all cases, equipment should be cleaned according to the Manufacturer’s Instructions for Use (MIFU). The MIFU may include information about detergents to use, water type/temperature and any cleaning methods required. Some equipment (including toys) may not have a MIFU. In these cases, practitioners will need to determine the appropriate cleaning and disinfecting protocol.

5.4

Mixing of “clean” and “dirty” objects must not occur.
Practitioners should take additional precautions in the transport/storage of equipment
between sites and clients. Any equipment used for one visit should be placed into a “dirty” bin that is closed. The “dirty” objects cannot be used again nor come into contact with objects that have been cleaned and disinfected.

6.0 Personal protective equipment (PPE)

Up-to-date PPE information for all health care providers is available through Alberta Health Services at https://www.albertahealthservices.ca/topics/Page17048.aspx. Please check this site frequently as it is updated as new information becomes available.

6.1	Personal protective equipment (PPE) should be chosen based on level of risk and is only one of several preventive measures/ controls to reduce the risk of transmission of COVID-19.
	It is reasonable to ask clients with symptoms to refrain from attending appointments until they have met the public health directions for self-isolation/isolation. Conducting a Point of Care Risk Assessment ahead of the appointment and again upon arrival will help to determine if a service/activity needs to be deferred or if it can be completed in a different way.
6.3	If PPE is required in a clinic or home setting, and it cannot be procured, services must be deferred.
6.4	To protect clients, CHAPA requires all CHAPA members follow the AHS requirement for continuous masking when providing direct client care when a 2-metre distance cannot be maintained. Surgical/procedural masks should be worn if the provider is involved in direct patient contact or cannot maintain adequate physical distancing from patients and co-workers (2m). This would also apply to support personnel/staff within the clinic. Clients can be asked to wear a mask during their visit. A clean, homemade mask would be sufficient for the client.
6.5	CHAPA members must defer services for clients who have symptoms or who have been confirmed as having COVID-19. Services can resume once the minimum requirements for self- isolation have been met.
6.6	Practitioners may determine gloves should be worn for interactions with particular clients or in particular settings (e.g., home or clinic). If practitioners are touching clients, gloves are a reasonable PPE measure. Gloves must not be used as a substitute for other elements of hand hygiene.
6.7	Correct donning and doffing is imperative if using PPE as a preventive measure. Incorrect usage can place a practitioner at additional risk.
6.8	CHAPA members working outside of Alberta Health Services should attempt to procure their PPE from their regular suppliers. If the regular supply chain is exhausted, members may order PPE through the Government of Alberta’s process.
6.9	Practitioners may choose to ask clients to wear a mask.

Appendix A

Client Pre-Screening/Point of Care Risk Assessment (PCRA) Questions

These questions should be asked of clients in preparation for their appointment and again at the time they arrive for their appointment.

Clients should be encouraged to answer the questions truthfully for themselves and for any other person who may be accompanying them to their appointment.
If a client answers YES to any of the questions, the face-to-face service must be deferred until the minimum requirement for self-isolation has been met. Clients and visitors should be observed for symptoms during their visit.

		YES	NO
1.	Do you have any of the symptoms below: Fever (greater than 38.0 C) Cough Shortness of Breath / Difficulty Breathing Sore throat Runny nose
2.	Have you, or anyone in your household travelled outside of Canada in the last 14 days?
3.	Have you, or anyone in your household been in contact in the last 14 days with someone who is being investigated or confirmed to be a case of COVID-19?
4.	Are you currently being investigated as a suspect case of COVID-19?
5.	Have you tested positive for COVID-19 within the last 10 days?