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to maintain physical distance, to wear a face mask, and to follow local orders to lessen community spread. If the office is closed, update voicemail messages to address telephone assessment, telemedicine, and how to reach the physician in the event of an emergency.
Physical Distancing: The CDC still recommends physi- cal distancing within your facility; require that patients and staff sit at least six feet or more apart. Patients should be asked to wait in their car if that option is available. Reconfigure seating as needed. Remove magazines and toys from the waiting room. Routinely disinfect the waiting room throughout the day. Develop a cleaning schedule and checklist for your facility, and document in administrative files that it is followed.
Suspected Infection: Evaluate patients on a case-by- case basis. If presenting symptoms and/or contacts
are suspicious for COVID-19, and it is determined that the patient must be seen, have the patient call prior to their arrival to make preparation for accommodation. When possible, conduct the patient evaluation outside your facility at a designated triage location. If that is not possible, immediately isolate the patient coming into the office (segregating them from other patients in the facility) in a designated regular exam room with dedicat- ed patient care equipment. A back entrance should be utilized.
Patient Precautions: For individuals entering your fa- cility, query all patients about symptoms of coronavirus and document findings on an administrative log. Instruct patients to put on a cloth mask, face mask, or respirator covering the nose and mouth (source control), utilize tissues, practice good hand hygiene, and physically dis- tance from others in the designated waiting area. Educa- tional resources, including posters and print resources for use in the medical office, are available from the CDC (Core Infection Prevention and Control Practices for Safe Healthcare Delivery in All Settings) and the WHO. Refer- ence the CDC’s Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic and In- terim Clinical Guidance for Management of Patients with Confirmed Coronavirus Disease (COVID-19) for patient management guidance.
Visitor Precautions: Allow only those visitors who
are essential for the patient’s well-being and care to enter your healthcare facility, and require screening and source control cloth masks as indicated.
Provider/Staff Precautions: Follow Standard Precau- tionsand Transmission-Based Precautions, including gloves, gowns, protective eyewear, and NIOSH-certified N95 respirators that follow OSHA’s If there is a shortage of N95 respirators in your facility, access current CDC respirator recommendations and review Optimizing Per- sonal Protective Equipment (PPE) Supplies. Remember that patients will scrutinize your adherence to infection control protocol; ensure that staff follow it precisely. Failure to do so may result in licensing board com-
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plaints, negative social media coverage, and the patient leaving the practice permanently. Provide updated staff training on infection control protocol as needed. See Updated Healthcare Infection Prevention and Control Recommendations in Response to COVID-19 Vaccination for more information.
Limit Exposure: Limit staff exposure to suspected COVID-19 patients, with the exam room door kept closed. Ideally, the designated exam room should be at the back of the office, far away from other staff and patients.
Surface Disinfection: Once the patient exits the room, conduct surface disinfection while staff members con- tinue to wear PPE. For general guidance, see Cleaning and Disinfection of Environmental Surfaces and . The CDC recommends that healthcare facilities utilize clean- ing agents from List N: Disinfectants for Coronavirus (COVID-19) from the Environmental Protection Agency (EPA) website for use against SARS-CoV-2.
Patient Education: Provide up-to-date, factual in- formation on the virus to suspected COVID-19 patients and their close contacts, including how to follow infec- tion-control practices at home, such as in-home iso- lation, hand hygiene, cough etiquette, waste disposal, and the use of face masks. Remind patients and their families to access information about the virus through reputable sources such as the CDC, not social media.
Provider/Staff Exposure: Encourage vaccination among your staff. Screen healthcare personnel daily for symptoms/contacts relevant to COVID-19. Any unpro- tected occupational exposure by staff members should be assessed, monitored, and documented in administra- tive files. See Interim U.S. Guidance for Risk Assessment and Work Restrictions for Healthcare Personnel with Potential Exposure to COVID-19. Should providers and/ or staff test positive within your facility, conduct and document a risk assessment identifying contacts, type of interaction, and PPE in use, then contact local health authorities for additional instruction. The CDC provides guidance under the section “Infection Control” for management. Disclosure to patients may be necessary depending on the type of exposure that occurred, if any, but always take necessary steps to protect the privacy of the infected employee. Telephone calls directly to
the patient are the most efficient method of notifica- tion, followed with a letter. Suggested notification may include “We are calling to inform you that someone in our office tested positive for COVID-19 on the day of your visit . . .” followed by recommendations for assessment and any needed follow-up. The health department may assist with patient notification if determined to be nec- essary. Contact your patient safety risk manager at The Doctors Company, as needed, for additional guidance. For return-to-work guidance, review the Return to Work Criteria.
Staff Training: Assess the need for additional staff training to review screening and triage protocols, pa- tient management, use of PPE, patient communications,
SEPTEMBER/OCTOBER 2021 | WWW.OCMS-MI.ORG