Corona Virus Information Page

A Balanced Body Health Services

11 Belmont Ave West

519 749 9600

Policies and Procedures to stop the spread of Covid 19

We ask that all patients and visitors to the clinic wear mask at any time!

What do we do to help:

At A Balanced Body Health Services we continuously strive to promote health through those difficult times, and we do our best to stop and prevent the spread of the Covid 19.

As we are now open for nonessential and non urgent care, we do our best to:

  1. Screen people over the phone
  2. Screen people at the front door
  3. Make sure everyone uses disinfectant and encourage patients to wear PPE
  4. Therapists working at the clinic shall wear PPE (based on a case to case need), wash or disinfect hands before and after each patient.
  5. Physical distancing of at least 2 meters is enforced
  6. Thorough cleaning and disinfecting of furniture, equipment and door handles after each patient is mandatory
  7. Use of personal electrodes, gowns, pillow covers etc is in force
  8. Keep a log of visitors, couriers and others who entered the clinic to facilitate tracing if required.

We have reduced the number of chairs in the waiting area to one only and the numbers of bed on the main floor so that there is plenty of distance between them. Curtains are used to separate therapy areas from one another. We escort patients in and out of the clinic making sure that there is no close encounters in case more than one patient is in the clinic at the same time.

A Balanced Body Health Services

11 Belmont Ave West

519 749 9600

Policies and Procedures to stop the spread of Covid 19

Active and Passive Screening:

 We undertake active screening and passive screening:

• Active screening over the phone before scheduling appointments, when possible and upon entry to the clinic.

 • Passive screening including signage at points of entry of the facility and at reception, using the latest case definition for COVID-19. Similar messages are being communicated on voicemails and websites.

Positive Screening: What to do?

*Positive screening over the phone

 A patient who screens positive over the phone should be asked to rebook their appointment for when they are no longer symptomatic and/or outside the 14- day period, if possible.  A patient who screens positive over the phone should be advised to call their local public health unit and/or telehealth (1-866-797-0000). Patients should not show up to the hospital unannounced.     

*Positive screening at the clinic:

 A patient who screens positive at the clinic needs to be separated from other visitors and staff so that they are at least 2 metres apart (use a separate room where available) and given a surgical/procedure mask while health workers call their local public health unit and a plan for travel and further COVID-19 assessment is made.

Patient-contact surfaces (i.e., areas within 2 metres of the patient who has screened positive) should be disinfected as soon as possible.

We have a log for all visitors to the clinic (patients, relatives, curriers, maintenance workers etc) with the exact time and duration of their visit. In case of identifying that someone has contracted the virus we will do the following:

  1. They will be separated from other visitors and staff so that they are at least 2 metres apart (use a separate room where available) and given a surgical/procedure mask.
  2. Contact surfaces (i.e., areas within 2 metres of the patient who has screened positive) will be disinfected as soon as possible.
  3. We will identify and contact all the visitors who may have been in contact with surfaces and/or in proximity to the infected person.

We have a log for all the cleaning and disinfecting efforts we make around the clinic identifying who did it and when it was done.

Hand Hygiene

  • At our clinic we promote and have sufficient means for frequent and proper hand hygiene for staff and patients. This can be done by washing hands with soap and water or using an alcohol-based hand sanitizer (greater than 70% alcohol content). Hand washing with soap and water must be performed if your hands are visibly dirty.
  • At a minimum, our therapists and staff should wash their hands before and after each patient contact, before putting on PPE, after taking off PPE, and after contact with potentially contaminated surfaces.
  • We provide:
    • Handwashing and sanitization stations. 
    • Signage instructing on proper hand washing techniques.
    • Requiring everyone, including staff, patients and visitors, to wash their hands upon arrival.
  • Gloves alone are not a substitute to hand hygiene. Hands must be cleaned after removing gloves.

Cleaning and Disinfecting

  • Cleaning refers to the removal of visible dirt. Cleaning does not kill germs but is highly effective at removing them from a surface. Disinfecting refers to using a chemical to kill germs on a surface. Disinfecting is only effective after surfaces have been cleaned.
  • We use a “wipe-twice” method to clean and disinfect. We wipe surfaces with a cleaning agent to clean off dirt and wipe again with a disinfectant. Or use a one-step process using a combined cleaner-disinfectant product.
  • Regular household cleaning and disinfecting products are effective against COVID-19 when used according to the directions on the label.
  • We use a disinfectant that has a Drug Identification Number (DIN) and a virucidal claim (efficacy against viruses).
  • Alternately, use can a bleach solution in a well-ventilated area and never mix with other chemical products. To prepare diluted bleach for a solution to disinfect high-touch hard surfaces, do so according to instructions on the label or in a ratio* of:

    250 mL (1 cup) of water per 5 mL (1 teaspoon) bleach, or
    1 litre of water (4 cups) per 20 mL (4 teaspoons) bleach

    * assuming bleach is 5 % sodium hypochlorite, to give a 0.1 % sodium hypochlorite solution

  • In addition to routine cleaning, surfaces that come into contact frequently with hands will be cleaned and disinfected a least twice per day and when visibly dirty. Special attention should be paid to commonly touched surfaces such as doorknobs, light switches, toilet handles, counters, handrails, touch screen surfaces, and shared materials, equipment, workstations, keypads, etc. All equipment used in patient contact will be cleaned and disinfected after each use.
  • Clothing and fabric items will be laundered and dried on the highest temperature setting possible. Ensure items are thoroughly dried.
  • We have developed and implemented procedures for increasing the frequency of cleaning and disinfecting of high traffic areas, common areas, public washrooms and showering facilities.
  • We document procedures around cleaning (e.g. frequency and by whom).

Booking Appointments:

  • We have posted information on our clinic website advising patients to call prior to coming to the clinic.
  • When booking appointments, all patients are being screened over the phone for any symptoms of COVID-19 based on the most current patient screening questionnaire from the Ministry of Health. You have developed a checklist for this purpose that we then include as part of the patient record.

    If a patient screens positive for COVID-19, we will:

    • Advise the patient not to come to the clinic; offer to provide virtual care where appropriate
    • Advise the patient to self-isolate AND to complete the online self-assessment tool before calling their doctor or Telehealth Ontario.
  • A patient who presents in the clinic without an appointment must be screened upon entry into the clinic. Staff will use appropriate PPE e.g., masks, eye protection, gloves and gowns if couldn’t keep at least 2 meters distance from the visitor.

    A patient who screens positive upon entry to the clinic will be:

  • Given a surgical/procedure mask,
  • Advised to perform hand and cough hygiene,
  • Provided with hand sanitizer, access to tissue and a hands-free waste receptacle for their used tissues and used masks; ensure patients do not leave their masks in waiting areas,
  • Placed in a room with the door closed where possible
  • If it is not possible to move a patient from the waiting room to an available exam room, the patient can be instructed to return to their vehicle (if available) and informed that they will be texted or called when a room becomes available
  • Pending the outcome of active screening, the decision to provide service should be based on risk, both to the patient and to you as the practitioner.  If we must provide service to a patient with symptoms or who has COVID-19, personal protective equipment (PPE) will be used. See “The Appointment” section below for more information.
  • We inform patients over the phone or via email of any public health measures you have implemented. 
  • We book appointments to allow time between patients to help maintain physical distancing and allow for surface and equipment cleaning after each appointment. 
  • Unless the patient requires assistance from another person, we encourage them to come alone to their appointment.

The Appointment:

  • Before each appointment, we:
  • Conduct a point-of-care risk assessment to determine the level of precautions required,
  • Wash our hands or use an alcohol-based sanitizer. 

  • If we encounter a patient who has gone through the screening process and enters the setting yet exhibits signs and symptoms consistent with COVID-19, we will:

    • Separate the patient from others so that they are at least 2 metres apart.
    • Have the patient complete hand hygiene.
    • Provide a surgical/procedural mask for the patient to wear.
    • Provide access to tissue and a hands-free waste receptacle for their used tissues and used masks. Ensure patients do not leave used masks in the waiting area.
    • Care can continue if the physiotherapist is able to wear the appropriate PPE, which includes gloves, a gown, a surgical/procedure mask, and eye protection (goggles or face shield).
    • Alternately, we explain the concern to the patient that they are symptomatic, discontinue treatment and reschedule the appointment.
    • Advise the patient that they should self-isolate, complete the online self-assessment tool before calling their doctor or Telehealth Ontario.
    • Clean and disinfect the practice area immediately.
    • Wash our hands or use alcohol-based hand sanitizer after contact with the patient and patient environment, and after the removal of PPE.
    • We will contact the local public health unit to report any probable and confirmed cases of COVID-19 based on the latest case definition posted on the Ministry of Health COVID-19 website.
  • Encourage patients to wash their hands or to use an alcohol-based sanitizer before and after the appointment.
  • Even when we are not interacting with a suspected or confirmed COVID-19 patient or someone with symptoms, if we are not able to maintain physical distancing with others, then:
    • We will wear a surgical/procedure mask.
    • We also consider using eye protection (goggles or a face shield). 
    • We also advise patients to wear their own mask (cloth or other) to the office/clinic if they have one. We ensure that patients do not leave their masks in waiting areas. Wash your hands or use alcohol-based hand sanitizer after contact with the patient and patient environment, and after the removal of PPE.
  • If the appointment involves direct contact with patients who have respiratory symptoms (e.g., coughing and sneezing), a confirmed COVID-19 infection or direct contact with contaminated objects or environments, appropriate PPE must be used.
    • This may include gloves, a gown, a surgical/procedure mask, and/or a face shield. Note that for protection against COVID-19, N95 respirators are only required for aerosol generating medical procedures (AGMPs) and when otherwise determined by a regulated health professional.
  • We ensure that you understand the safe use, care and limitations of PPE, including putting on and taking off PPE as well as proper disposal.
    • Ensure that gloves have no pinholes or tears and fit securely around their hands.
    • Gloves should be removed first, and hand hygiene should be performed immediately after removing gloves. The mask should then be removed, and hand hygiene performed again.

After the Appointment:

  • After each appointment, we wash hands or use an alcohol-based sanitizer.
  • We ensure that we clean the treatment area and surfaces, and anything used during the appointment by you and the patient.

Self-monitoring:

  • All healthcare providers should monitor themselves for signs of illness.
  • If we are sick, we stay home.
  • If we start experiencing symptoms while you are at work, we immediately put on a medical/procedure mask and leave work.
  • If we have symptoms, think we were exposed to COVID-19, or travelled outside of Canada within the last 14 days, we notify the clinic immediately, complete the self-assessment and follow the instructions provided.

Ministry of Health COVID-19 Patient Screening Guidance Document V. 3.0, May 17, 2020

 This screening tool is based on the latest COVID-19 case definitions and the Coronavirus disease (COVID-2019) situation reports published by the World Health Organization. This document should be used to screen people who are suspected or confirmed of having COVID-19 throughout the health and emergency response system. Ensuring all health and safety providers are following the same screening protocol will help ensure consistency when dealing with suspected or confirmed cases of COVID-19. COVID-19 Patient Screening Guidance

 • This checklist provides basic information only and contains recommendations for COVID-19 screening and should be used with applicable health sector or service specific guidance and training documents. It is not intended to take the place of medical advice, diagnosis, or treatment.

• The screening result is not equivalent to a confirmed diagnosis of COVID-19.

 • At a minimum, the following questions should be used to screen individuals for COVID-19 and can be adapted based on need/setting.

 • This information is current as of the date effective and may be updated as the situation on COVID-19 continues to evolve according to the evidence, including data received from surveillance testing initiatives

• Once the person has been screened as positive (answered YES to a question), additional COVID-19 screening instrument questions may discontinue.

 • In the event a hospital emergency department modifies or adds COVID-19 screening questions, they should alert the local paramedics services of any changes.

Regular Screening Questions

 Q1: Did the person have close contact with anyone with acute respiratory Illness or travelled outside of Ontario in the past 14 days?

 Q2: Does the person have a confirmed case of COVID-19 or had close contact with a confirmed case of COVID-19?

Q3: Does the person have any of the following symptoms:

•Fever •New onset of cough •Worsening chronic cough •Shortness of breath •Difficulty breathing •Sore throat •Difficulty swallowing •Decrease or loss of sense of taste or smell •Chills •Headaches •Unexplained fatigue/malaise/muscle aches (myalgias) •Nausea/vomiting, diarrhea, abdominal pain •Pink eye (conjunctivitis) •Runny nose/nasal congestion without other known cause

Q4: If the person is 70 years of age or older, are they experiencing any of the following symptoms: delirium, unexplained or increased number of falls, acute functional decline, or worsening of chronic conditions?

COVID-19 Screening Results If response to ALL of the screening questions is NO: COVID Screen Negative

 If response to ANY of the screening questions is YES: COVID Screen Positive Additional COVID-19 Screening Results

If response to ALL of the screening questions is UNKNOWN: COVID Screen Unknown

 If response to ANY of the screening questions is NO and UNKNOWN: COVID Screen Unknown

General Cleaning Practices for All Health Care Settings

Before cleaning:

 Gather materials required for cleaning before entering the room.  Follow the manufacturer’s instructions for proper dilution and contact time for cleaning and disinfecting solutions.  Check for Additional Precautions signs. Follow precautions as indicated.  Clean hands and put on appropriate personal protective equipment on entering the room.  Remove clutter before cleaning.

During cleaning:

 Progress from the least soiled areas to the most soiled areas.  Progress from high surfaces to low surfaces.  Remove gross soil prior to cleaning and disinfection.  Dry mop prior to wet/ damp mop.  Minimize turbulence to prevent the dispersion of dust that may contain microorganisms (e.g., never shake mops).  Do not double-dip cloths.  Change cloths/ mop heads frequently.  Change cleaning solutions as per manufacturer’s instructions. Change more frequently in heavily contaminated areas, when visibly soiled and immediately after cleaning blood and body fluid spills.  Containers for liquid soap, cleaners/disinfectants are disposable. The practice of topping up is not acceptable since it can result in contamination of the container and solution.  Be alert for needles and other sharp objects. Pick up sharps using a mechanical device and place into sharps container. Report incident to supervisor.  Collect waste, handling plastic bags from the top (do not compress bags with hands).  Clean hands on leaving the room.

After cleaning:

 Do not overstock rooms.  Tools used for cleaning and disinfecting must be cleaned and dried between uses.  Launder mop heads daily. All washed mop heads must be dried thoroughly before re-use.  Clean housekeeping cart and carts used to transport waste daily.

Procedure for Mopping Floors Using Dry Dust Mop

Working from clean areas to dirty areas:

 Remove debris from floor and dry any wet spots with paper towel.  Remove gum or other sticky residue from floor.  Starting in the furthest corner of the room, drag the mop toward you, then push it away, working in straight, slightly overlapping lines and keeping the mop head in full contact with the floor.  Do not lift dust mop off the floor once you have started, use swivel motion of frame and wrist to change direction.  Move furniture and replace after dust mopping, including under and behind bed.  Carefully dispose of debris, being careful not to stir up dust.  Replace mop head/pad when soiled and after mopping a room.

• Physical distancing plan – patients are being escorted by
staff in and out of the clinic ensuring distance of at least 2 meters between
them. One chair only in the waiting room. Separate rooms available if more than
one patient waiting.

• Patient appointments are scheduled to limit and, where
possible, eliminate having people gather in waiting areas.

 • Scheduling provides
for a time interval between the end of one appointment and the start of the
next (same room/treatment area), and clients are being asked to arrive as close to their appointment start
time as possible. This will minimize the overlap of clients in waiting areas.

• Individuals who are accompanying patients, but are not
participating in the service, such as those providing transportation to
patients or other family members are being asked to wait elsewhere and return
to meet the patient after the appointment is scheduled to end.

 • Masks are being
worn by all parties while in the clinic (in compliance with any public health
directives that have been issued).

 • Infection control
procedures: posters and educational materials for hands washing are posted in
many key locations at the clinic including sinks/wash rooms ; We clean and disinfect before and after each patient; we use individual electrodes, single use cloth for heat
packs and on traction tables. No fabric chairs or curtains in the clinic.

 • Health screening
protocols for employees, clients and suppliers : active and passive screening on
the phone and upon entrance is in force. Employees do self assessment tool
before coming into work and are instructed to not come if any symptoms positive.
Visitor log at main entrance available.

• Communications protocols for employees, clients : verbal
and electronic (email) communication for both patients and employees is an
on-gong action.

Employees are notified of return to work Communicate policy
that employees with symptoms stay home.

We communicate physical distancing protocols

We communicate infection control procedures

We develop and communicate PPE policy for employees

We develop and communicate PPE policy for patients/clients

We hold training session for staff on COVID-19 protocols

 

We implement health screening protocol for employees (self
assessment tool/form)

We developed and communicated protocol for employees who
develop symptoms while at work – immediately leave the clinic, call Telehealth
and self isolate for 14 days.

We have developed and communicated return to work guidelines
for employees who are sick or who have contact with someone with a known case
of COVID-19  – 14 days self-quarantine is
a enforced.

We ensure employees with multiple jobs/workplaces disclose
information to assist with contact tracing/case management in case of a known
COVID-19 exposure or positive diagnosis COVID-19

We removed all non-essential items from waiting room (ie.
magazines )

We limit contact of retail items

We eliminated the use of our second entry point/door

We limit capacity of high-traffic spaces/areas of congregation
(ie. break room, common spaces)

We installed hand hygiene stations for
clients/suppliers/staff at transaction areas (ie. point of sale, reception)

 We implemented
cleaning and disinfecting protocols of treatment areas between patients

 We implement cleaning
and disinfecting protocols of common/high touch areas several times per day
(ie. waiting room, point of sale interactions, washrooms)

We open non-essential doors to minimize contact

We provided contactless and remote pay options

 

• Notices are placed on the outer office door directing
patients and those accompanying them If a patient/visitor has any of the
symptoms noted, [i.e., fever, cough or difficulty breathing], or if they are
feeling unwell generally, they should not enter but should telephone the
office.

• At the time when appointments are being booked, patients are
being asked if they have been experiencing symptoms of illness consistent with
COVID 19; anyone who has symptoms will be scheduled for a later time (or
offered a virtual visit if applicable).

• Patients are being asked to self-screen or be screened by
staff for visible symptoms consistent with COVID. Appointments for anyone who
is symptomatic will be cancelled.

• A daily log of everyone coming to the clinic, staff and
visitors alike, are being kept in order to provide contact tracing should a
case of COVID 19 be associated with our clinic.

 Arrival and departure
times of each individual, including members themselves, are be recorded
accurately and the log maintained.

• Non-essential items are removed from patient waiting areas
(magazines, books, toys etc).

 • Common areas and
other high-touch surfaces and objects handled by patients (e.g., reception
counters, chairs and seating areas, door handles, handrails, credit card
machines, washroom fixtures, etc.) are being cleaned and disinfected after each
use.

• Equipment or items handled by patients are being cleaned
and disinfected after each use.

 • Barriers to
transmission (e.g., a physical barrier at reception, use of masks) should be
considered and implemented where possible.

• Use of masks by staff and patients should be considered
generally and, in particular, in situations where adequate physical distancing
is difficult.

 • Staff, agents and all others who work in the clinic will practice effective hand hygiene before and after having contact with a patient, washing their hands with soap and water or an alcohol-based hand sanitizer.

We have ensured that there are sufficient supplies on hand
for proper hand hygiene, including pump soap, warm running water and paper
towels. These supplies are available to both staff and to patients. Non-touch,
lined waste disposal receptacles for use by both staff and patients are
provided throughout the clinic.

• Additional visitors to the office, such as delivery
persons, are being discouraged or scheduled after hours where possible.
Delivery packages will be left at the entrance. Staff are being encouraged to
bring meals from home, rather than going out and returning to the office at
lunch or introducing additional individuals to the workplace [i.e., meal
delivery services].

The use of common areas is being discouraged and minimized
[i.e., kitchens] as well as sharing of common utensils, plates and drinking
cups.

• Wherever possible, those in the workplace should refrain
from sharing phones, desks, offices and other tools and equipment. This may
involve temporary reallocation of staff resources and job functions such that,
rather than several people doing the same thing, one individual is responsible
exclusively for each unique task.

• We minimized support staff physically in the office.

We ensure that employees and other health care professionals
we work with, understand and are aware of the protocols in place.

We ensure that the protocols that are implemented are
being followed. We will have each employee, agent or health care professional
working in the clinic sign an acknowledgement that they have reviewed the
guidelines and protocols and that they will abide by them.

Disclosure of Information: The details of the protocols we
have implemented are readily available for all visitors to the clinic. All the
protocols are posted on the Covid 19 section of our website and readily accessible.

We keep a copy of the protocols in a binder at reception.

Consent:

We need to obtain
additional consents from patients, employees and other visitors to our place of
business. With respect to patients, the consent would be in addition to the
normal informed consent discussion we have with a patient.

 

A Balanced Body Health Services Team,

Remain in Good Health

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