|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.|
|10. Avoid greetings such as handshaking or hugging/touching.|
|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.|
|2.1||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).|
|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|
Members should carry hand sanitizer with them.
Members should ensure they clean their hands again once outside the client’s home.
|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.|
|4.1||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):|
|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.|
|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).|
|5.1||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.
|6.1||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 forcontinuous 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.|
|1.||Do you have any of the symptoms below:|| || |
|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?|
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