COVID-19 procedures and protocols
COVID-19 Risk Assessments for: Body Flow Osteopathy - Kilburn Clinic
Risks Identified and Mitigated for:
Patient to Practitioner SARS-CoV-2 transmission
Practitioner to Patient SARS-CoV-2 transmission
Asymptomatic or Pre-symptomatic transmission
Third Party Transmission to either patient or practitioner
Surface transmission
Droplets/ Aerosols transmission
KEY POINTS FOR PATIENTS
What you need to know and what you need to do
Before EVERY appointment, you will undergo a screening process to confirm you and your household are free from COVID symptoms. A screening questionnaire will be sent to you by email the days before your appointment for you to complete. Please look out for this email, or let us know if you prefer to receive this via text messages.
Despite our best efforts, there is an inherent risk of catching or spreading COVID-19 that you take whenever you leave your house or attend an appointment. We’re taking every precaution we can to reduce the risk however, the risk can never be nullified. As part of the screening process, you will be asked to confirm that you are aware of this risk and that you accept it.
You will be asked to wear a face mask during your appointment. We can supply you with one.
You will need to use hand sanitizer upon entering the building or wash your hands.
Avoid bringing in other people unless the appointment is for a child or you need someone as a chaperone. Chaperones must be from your household, have no COVID-19 symptoms, and they should not have any underlying health issues which puts them at Moderate or High risk of COVID-19 complications (to reduce the risk to them). Please speak to us if this affects you.
Payment: We prefer payment by Apple pay or Google pay as they are contactless for any amount but card payments are also perfectly acceptable. If you pay cash please bring the exact amount. We will no longer accept cheques.
We have heightened cleaning procedures in place, in line with guidance, and we will be wearing PPE during your appointment. Further details are outlined in this document.
We have conducted a COVID-19 risk assessment and taken every possible precaution to reduce the risk of transmission. Protecting you and others working at the practice is our priority.
Please DO NOT attend your appointment if you are unwell. If you become unwell between your screening and your appointment time, please contact us at once. Below are our detailed protocols and procedures to mitigate the risks outlined above, presented in a step-by-step format reflecting the chronology of the patient’s journey.
COVID-19 Anxiety
We understand that the COVID-19 pandemic has created a huge amount of disturbance and anxiety throughout the population. This is a very anxious time for most and we share this feeling.
However, since the discovery of the severe acute respiratory syndrome coronavirus 2 virus (SARS-CoV- 2) which causes the Covid-19 infection, a great deal of scientific resources worldwide have been dedicated to learning everything we can about the virus and the plentiful evidence emerging from the research is informing our decision on an ongoing basis, making it easier to make effective and targeted decisions to reduce the risk of transmission to all of us. Of course, the scientific community has much left to learn and no doubt, guidance will change as we learn more about the minuscule and invisible virus that has so profoundly changed our lives.
However, the current research strongly indicates that respiratory droplets (the moisture released from our mouth and nose) coming into contact with someone else’s mucosa (the skin inside your mouth & nose and around your eyes) is the primary means of infection transmission. Surface transmission (from touching objects) is being shown through research to be a lesser modality of transmission than originally feared, whilst there is currently no evidence that COVID-19 can be transmitted through feces although research is ongoing.
Whilst COVID-19 is a new and unprecedented illness, its mode of transmission has been shown to be flu-like and this is a mode of transmission that is extremely well understood in the medical and scientific community. Rest assured that his knowledge underlines all of our decisions when it comes to safety and this is also why droplet management has been given such a large emphasis in our protocols.
Identifying the Risks
There is NO evidence that the virus can be transmitted through intact skin contact or through sweat so we are confident that our protocols which are aimed at controlling respiratory droplets and hand sanitising are in line with the best evidence available at this time, and will help to keep us and you safe during your visit.
It is also useful to understand that a virus can not cause harm until it gets inside the body in sufficient amounts. Therefore, having some viral particles on your hands (assuming intact skin) will not cause an infection unless you touch your mouth, eyes or nose from where the virus can get in. The same applies for droplets with viruses attached which may be present on surfaces like walls, floors, books, handles, etc.: these will only cause potential harm if they are inhaled or somehow get into the body (ie: touching the surface followed by picking your nose).
The most common route of infection is through breathing in infected droplets, in this scenario the virus is inhaled from the surrounding air or from the breath of a nearby person and gets into the body via the lining of the lungs. Research also indicates that the “viral load” (i.e.: how much viral particles you have been exposed to) is important. A small viral load (i.e.: if you only have been exposed to a small amount of viruses) is far less likely to cause an infection, whereas a large viral load - as experienced by nurses, doctors, cleaners and other health professionals working on COVID-19 wards is much more likely to result in an infection.
Therefore, viruses on the floor for instance, which may have landed there from the droplets of an infected but pre-symptomatic person (someone who has the virus and is contagious, but has not yet developed symptoms) who was breathing or speaking in the room, may transfer to the shoes or socks of the following person but as long as they are not then put into direct contact with a mucosa (mouth, nose, eyes or other moist tissues of the body), the virus will not cause an infection. However, if a toddler was left to crawl on the floor or if someone was to do push ups on the floor (transferring the virus particles to their hands) and soon after scratched their eyes, or put their fists in their mouth like toddlers often do (and therefore, putting the virus particles on their hands directly into contact with their mouth), there would be a certain risk of transmission. However, simply walking on a floor where infected droplets may be found is not a significant risk (so long as you don’t put your shoes in your mouth)
Our protocols are very comprehensive and we hope you will find this reassuring.
HOWEVER, you must understand that despite our best efforts, the risk of transmission can not be nullified since we are dealing with an invisible enemy, meaning that no matter how careful we are with our PPE (Protective Personal Equipment), cleaning and how careful you are with your face covering and hand washing, there is an inherent and unquantifiable risk that you may catch or spread COVID-19 by leaving your house to attend an appointment with us, however minimal. Of course, this risk exists whenever you leave your house for any reasons, such as picking up medication or going food shopping. We continue to maintain our original stance that we are still much safer to visit than supermarkets and most other places due to the small size of our building, our very small footfall and the absolute control we have over our environment.
As part of our protocol, we will ask you to confirm that you are aware of this risk and that you accept it. This is what we call informed consent.
Your risk calculation when you decide to book an appointment with us must also take into account your journey to us, especially if this happens on public transport. You should also consider other people in your household as part of your personal risk assessment, especially if someone is at high risk of COVID-19 complications.
Due to the hands-on nature of our work, face to face treatments can not be carried out whilst maintaining the rules of social distancing, and proximity increases the risks of virus transmission. This is the reason why we wear PPE and the best quality mask we could buy, and the reason why we have made significant monetary investments in air sanitising equipment.
Research has shown that many people will have a very mild illness with COVID-19 (which they may not recognise) and transmission from asymptomatic or pre-symptomatic carriers (someone who has the virus but does not have any symptoms of the illness) is possible, this is the reason why we ask you to wear a face covering and the reason why we wear PPE.
Who We Can’t Treat
We are unable to offer face to face appointments to:
Anyone with symptoms of COVID-19
Anyone who has someone in their household showing symptoms of COVID-19
Anyone self-isolating after being in close contact with someone confirmed to have COVID-19 or told to self-isolate for other reasons.
Anyone who tests positive for COVID-19 should allow 14 days between the onset of symptoms and appointment time AS LONG AS they no longer have a cough. If a cough persists beyond 14 days, advice should be sought from the NHS. This will be reviewed as more evidence emerges. Remote appointments remain available for everyone and if you are in the categories above, you will ONLY be offered one of those appointments.
Remote Consultation
Remote consultations (Tele-Heatlh) will continue to be available to everyone. If this is your preference, please specify your choice to the receptionist if booking over the phone or select “Tele-Health” in online bookings.
Most Common Symptoms of COVID-19
The main key diagnostic symptoms are:high temperature – this means you feel hot to touch on your chest or back (you do not need to measure your temperature)
new, continuous cough – this means coughing a lot for more than an hour, or 3 or more coughing episodes in 24 hours (if you usually have a cough, it may be worse than usual)
Feeling short of breath
loss or change to your sense of smell or taste – this means you've noticed you cannot smell or taste anything, or things smell or taste different to normal.
Other common symptoms:FatigueMyalgia (pain in your joints and muscles)
Sore throat
A productive cough (when you bring up mucus).
Most people with coronavirus have at least one of these symptoms. Note that you do not need to have all the symptoms, some people only have ONE of these symptoms.
Visit the NHS website for the latest guidance on Coronavirus symptoms or call 111 if you are experiencing symptoms: https://www.nhs.uk/conditions/coronavirus-covid-19/check-if-you-have-coronavirus-symptoms/
Appointments for those at high risks
With recent changes announced mid-June, we are now able to offer an appointment to anyone in need, even those who were asked to shield. However, we recognise this is a higher risk and we recommend that those at high risk should only book appointments as necessary (i.e: avoid maintenance or check up appointments) and we recommend they book the first appointment of the day or an appointment following a longer cleaning break (if possible).
If you were not told to shield but a member of your household was, we strongly recommend that you take this into consideration when booking an appointment.
Who is at high risk (clinically extremely vulnerable)
People at high risk from coronavirus complications include people who:
have had an organ transplant
are having chemotherapy or antibody treatment for cancer, including immunotherapy
are having an intense course of radiotherapy (radical radiotherapy) for lung cancer
are having targeted cancer treatments that can affect the immune system (such as protein kinase inhibitors or PARP inhibitors)
have blood or bone marrow cancer (such as leukaemia, lymphoma or myeloma)
have had a bone marrow or stem cell transplant in the past 6 months, or are still taking immunosuppressant medicine
have been told by a doctor they you have a severe lung condition (such as cystic fibrosis, severe asthma or severe COPD)
have a condition that means they have a very high risk of getting infections (such as SCID or sickle cell)
are taking medicine that makes them much more likely to get infections (such as high doses of steroids)
have a serious heart condition and are pregnant Check the NHS website for any update to this list. https://www.nhs.uk/conditions/coronavirus-covid-19/people-at-higher-risk-from-coronavirus/whos-at-higher-risk-from-coronavirus/
Appointment for those at moderate risk (clinically vulnerable)
Some conditions listed in the moderate risk category (such as mild, controlled asthma) are listed in the NHS moderate risk category but other organisations have stated that the increased risk is minimal. However, we suggest increased precautions and a case-by-case assessment and we recommend only booking an appointment as necessary, if you feel comfortable with the risk.
People at moderate risk from coronavirus include people who:are 70 or older
are pregnant
have a lung condition that's not severe (such as asthma, COPD, emphysema or bronchitis)
have heart disease (such as heart failure)
have diabetes
have chronic kidney disease
have liver disease (such as hepatitis)
have a condition affecting the brain or nerves (such as Parkinson's disease, motor neurone disease, multiple sclerosis or cerebral palsy)
have a condition that means they have a high risk of getting infections
are taking medicine that can affect the immune system (such as low doses of steroids)
are very obese (a BMI of 40 or above) - a BMI calculator can be found here: https://www.nhs.uk/live-well/healthy-weight/bmi-calculator/
Check the NHS website for any update to this list. https://www.nhs.uk/conditions/coronavirus-covid-19/people-at-higher-risk-from-coronavirus/whos-at-higher-risk-from-coronavirus/
COVID-19 protocols
Pre-Screening Process for Face to Face Appointments
A link to a questionnaire will be sent to you the day before your appointment and we ask that you return this within 24 hrs of your appointment. We may need to speak to you about your answers before your appointment so please make sure your phone number is up to date.
For emergency appointments, please contact us on the phone as we may be able to provide a sooner appointment and carry out the pre-screening questionnaire at the same time.
Should you develop any COVID-19 symptoms between booking an appointment and your appointment day/time, please contact us immediately to cancel your appointment via phone, email or text messages. No cancellation fee will apply but please do give us as much notice as possible.
Arriving & Entering the Clinic
The front door will be locked (as usual) to allow us to control physical access to the clinic. Please knock on the door at your appointment time.
You will be asked to put on a face covering and use hand sanitizer as you enter.
We kindly request that you do not bring children to your appointment to reduce the risk to everyone, unless the appointment is for the child. If this is not possible, please discuss this with us first.
Chaperone for Adult Appointments
You are still welcome to bring a chaperone to your appointment if it makes you feel more comfortable. This person should preferably be from your own household, should meet the conditions set above in the “pre-appointment screening” section to enter the building and must accept the inherent risks relating to COVID-19 transmission. This person’s name will be recorded on your records.
Children’s Appointments
If you are bringing a child under 16 years of age to an appointment, we will require a parent or guardian to be present for the duration of the appointment. Both the child and the accompanying adult must meet the conditions set above in the “pre-appointment screening” section.
For children’s appointments, we prefer if only one parent attends with the child, however we will not refuse for both parents to be present especially for the initial consultation.
Please bring your own toys.
Latex gloves are not used in our clinic to avoid reactions from a potentially unknown latex allergy and only Nitrate gloves are used.
Note: We decided against doing temperature checks at the door as we feel there are too many factors affecting reliability and interpretation of the reading. Including the device reliability, individual variation in basal body temperature, hormonal changes, hot summer weather, etc. However, if you feel you have a fever, please check your temperature at home before attending your appointment and cancel if you have a fever.
During Your Attendance at the Clinic
Controlling respiratory droplets is the key to reducing the spread of SARS-CoV-2, therefore significant emphasis is placed on this in our protocols. We appreciate your cooperation in keeping you, our practitioners and our families safe.
We ask that you wear a face mask when attending the practice
Please put it on before entering the clinic and only remove it after you leave. This will help reduce the amount of droplets and aerosols in the building.
If you do not have a face mask, we will provide a disposable one for you.
If you are unable to wear a mask for any reason, please let us know and we will arrange for you to have the last appointment before a cleaning break or at the end of the day to reduce the risk to others. We will discuss this with you but we retain the right to refuse to treat, if you will not, or can not wear a mask.
Toilet Access
Access to the toilet will continue to be available, however we ask that you avoid using it where possible.
We also request that you close the toilet lid before flushing. Flushing can send feces particles into the air up to a few feet away from the toilet and promote the spread of certain viruses such as the many common winter bugs causing vomiting and diarrhoea. There is currently no evidence that SARS-CoV-2 (COVID-19) can be spread in this way but it is a good rule of hygiene.
We will aim to clean the washroom after each use, where possible.
Payment
We encourage you to pay via Apple Pay or Google Pay which can be done via contactless payment for any amount simply by holding your phone against the reader.
We will continue to accept other card payments requiring you to enter a PIN number on a touch screen (as usual). The screen will be disinfected between usage and you will be given hand sanitizer after touching the touchscreen. A bottle is kept next to the card machine, so if we forget to offer it to you, please help yourself.
If paying by card, our card reader will be removed from its docking station so that you can insert and remove your card without us touching it.
We will continue to accept cash but we ask that you bring in the exact amount, as much as possible. The notes and coins you give us will be left for a minimum of 3 days before they are handled.
We ask that you do not give us a cheque to avoid an unnecessary trip to the bank for us.
Leaving the Clinic
A bottle of hand sanitizer will be left on the reception desk and you are encouraged to use it before leaving the practice, at your discretion.
If you need to wait inside for a taxi or pick up, you will still be welcome to do so but we encourage you to wait outside where and when possible.
We will do our best to open the doors for you so that you do not have to touch any surfaces unnecessarily.
Infection Control Measures Taken
From mid-March 2020, we introduced measures for infection control which will continue until further notice:
Hand soap is available.
We have removed fabric couch covers and replaced our pillow cases with wipeable ones to make it easier to sanitize surfaces between each client.
Our chairs and stool in the clinic room are all wipeable and sanitized between every appointments
We have a stringent cleaning protocol in place (detailed below)
We will wear a mask and clinically indicated PPE during your appointment (see PPE section).
We will follow guidelines ourselves and self-isolate if we show any signs or symptoms of COVID-19, as per current government guideline.
Hand Hygiene
Upon entering the clinic, will be asked to use hand sanitizer and/or to wash your hands.
It was always recommended that you wash your hands with soap and water after using the toilet and this timeless advice remains unchanged. Hand soap is available in the washroom.
Practitioners will also use hand sanitizer upon entering the building and wash hands thoroughly between appointments, following the WHO hand washing technique including the washing of forearms. Hand sanitizer is to be used by practitioners after hand washing and during the treatment session as required. If touching surfaces such as the computer or a pen to make notes, or following accidental contact with bodily fluid or other contaminants, additional hand sanitizing will be undertaken as per the practitioner’s professional judgement.
As practitioners are expected to hand wash many times daily, we recommended that hand cream (provided) should be used after each hand wash to prevent dermatitis and dry cracked skin which would increase the risk of infection. Hand cream is also available for patient’s use.
Clinic Hygiene Protocols
In March, we implemented a stringent cleaning protocol which has been reviewed and updated and we will continue to do so (if needed) as new evidence related to virus transmission comes to light. High traffic surfaces will be disinfected between each appointment. These are: treatment plinth, wipeable pillow cover, face pillow (if used), massage machine (if used), chairs and stool inside our treatment room, desk, door handles (outdoor and indoor), door bell and any item used during treatment such as massage balm container, tapes, etc.
Practitioners will hand wash or use hand sanitizer after touching the filtering part of their masks each time.
If the card machine, payment card, pin pad is used or handled, this will be disinfected after each use and hand sanitizer will be offered to the person who handled it.
The high traffic areas of the washroom, namely taps, door handle, toilet flush, toilet seat lid, soap, hand cream and hand sanitizer container will be disinfected on a regular basis. The frequency will be dependent on the volume of people frequenting the clinic and using the washroom but we aim to do this between each patient’s visit as much as possible. A thorough cleaning of all surfaces will be done daily. Cleaning wipes or disinfectant spray will be available for you to use in the washroom for added peace of mind, should you wish to clean surfaces yourself before using them. Please do not flush the wipes, dispose of them in the bin provided.
Hoovering will be done at the end of the day before mopping the floor. Face mask are to be worn during hoovering to avoid re-circulating virus particles so hoovering will be avoided during opening hours.
If further cleaning is needed during opening hours, sweeping will be favoured and hoovering will only be done if no one is expected in the area concerned for 20 mins after to allow settlement time.
Floor cleaning will be done daily at the end of the day to avoid anyone slipping on wet floors. Cleaning will be done using a traditional mop with a mixture of detergent and bleach. If bringing a young child into the practice is unavoidable, please do not let them crawl on the floor or ask for the first appointment of the day or after a longer break to allow time for floor cleaning.
Spillage and other such hazards will be dealt with immediately and followed with spot disinfection, if required.
We recommend that you do not put your bags and personal items down on the floor, please use the hangers provided behind the door, hang them on the chair or put small items on the desk.
Protective cleaning gloves should be worn by the practitioner during cleaning to avoid exposure of cleaning products on skin.
Other areas which do not experience high traffic will be cleaned daily or as required.
The window in the treatment room will be kept open in between patient appointments to ventilate the indoor space.
The booking system has been set to have one hour time break between patient appointments to allow the cleaning tasks to be completed.
PPE Protocol for Practitioners
Practitioners will be asked to wear a mask and use hand sanitizer on entry.
Practitioners will use a surgical mask.
A surgical mask is used for a single patient then will be disposed.
Masks should be used in the clinic at all times when more than one person is present.
A reusable scrub is used for a single patient. Practitioner will change scrub for every patient.
Disposable nitrile gloves are used for assessing and treating patients.
Disposal of PPE
Unsoiled single use PPE and disposable paper towels used for cleaning should be double bagged and left in a secured place before being disposed of in the normal way as it does not constitute clinical waste.
Clinic Washing and Clothing
The practitioner should change clothing once on the premises in the closet room. “Home clothes” should be worn for arriving at the practice and returning home, whilst “clinic clothing” should be worn during working hours.
Clinic washing such as clinic clothing should be placed in a plastic bag in the closet room. If clothing and soft fabrics are being taken home to wash (which is acceptable) they should remain in the closed pillow case and be put into the home washing machine upon arrival without emptying it. Washing anywhere should be done with regular detergent, washed in 60 degrees water.
Practitioners’ Commute and Self Isolation
Should any of our practitioners develop symptoms of COVID-19, we will self-isolate immediately as per government guidance and seek testing as soon as possible. As such, we may have to cancel appointments at short notice. We appreciate your understanding.
Our practitioners can get to the clinic by walking and therefore, this reduces the risk of the virus being caught by our practitioners on public transports.
Consultations with each practitioner have confidently taken place regarding the health status of their households and risk was discussed with them. All our practitioners are self-employed and therefore, the decision to return to work was their own.
Communication
This document will be made available on our website under the “COVID-19” tab
A link to our website’s COVID-19 page be included in all appointment confirmation emails.
No hard copy will be available in reception as we have removed all non-essential items to reduce contamination risk, however we will be happy to provide an electronic copy on request.
Our receptionists have always worked remotely and therefore, will continue to be available as normal to answer any questions. Alternatively, email your queries to: [email protected]
Data Sharing through the Track & Trace program
The UK has now entered into the “Track and Trace” phase of the pandemic, which means that we may be contacted by a governmental representative under this scheme where they ask us to release some data about who we have been in close contact with. This data will only ever be your name, phone number and email address.
The information commissioner and the government have both confirmed that in this specific situation, public health interest takes priority over your right to data protection under GDPR guidance. This means that we are legally obligated to release the data in an appropriate and lawful manner.
Should we be contacted for such requests, we will always verify the identity of the caller to ensure they are legitimate and verify the current advice provided by the Information Commissioner before releasing any information.
Safety
As outlined in this document, we have conducted a thorough risk assessment and considered every aspect of the patient and practitioner’s journey to allow us to understand what the risks to everyone are and how best to mitigate them. Although all these measures may seem scary at first, we still maintain our original stance that we are still much safer to visit than supermarkets and most other places due to the small size of our building and the absolute control we have over our environment. Should you have any concerns or questions, please do not hesitate to contact us and we will get back to you ASAP!
We look forward to seeing you,
Massimo Monticelli (London's clinics principal) and the Team at Body Flow Osteopathy
Risks Identified and Mitigated for:
Patient to Practitioner SARS-CoV-2 transmission
Practitioner to Patient SARS-CoV-2 transmission
Asymptomatic or Pre-symptomatic transmission
Third Party Transmission to either patient or practitioner
Surface transmission
Droplets/ Aerosols transmission
KEY POINTS FOR PATIENTS
What you need to know and what you need to do
Before EVERY appointment, you will undergo a screening process to confirm you and your household are free from COVID symptoms. A screening questionnaire will be sent to you by email the days before your appointment for you to complete. Please look out for this email, or let us know if you prefer to receive this via text messages.
Despite our best efforts, there is an inherent risk of catching or spreading COVID-19 that you take whenever you leave your house or attend an appointment. We’re taking every precaution we can to reduce the risk however, the risk can never be nullified. As part of the screening process, you will be asked to confirm that you are aware of this risk and that you accept it.
You will be asked to wear a face mask during your appointment. We can supply you with one.
You will need to use hand sanitizer upon entering the building or wash your hands.
Avoid bringing in other people unless the appointment is for a child or you need someone as a chaperone. Chaperones must be from your household, have no COVID-19 symptoms, and they should not have any underlying health issues which puts them at Moderate or High risk of COVID-19 complications (to reduce the risk to them). Please speak to us if this affects you.
Payment: We prefer payment by Apple pay or Google pay as they are contactless for any amount but card payments are also perfectly acceptable. If you pay cash please bring the exact amount. We will no longer accept cheques.
We have heightened cleaning procedures in place, in line with guidance, and we will be wearing PPE during your appointment. Further details are outlined in this document.
We have conducted a COVID-19 risk assessment and taken every possible precaution to reduce the risk of transmission. Protecting you and others working at the practice is our priority.
Please DO NOT attend your appointment if you are unwell. If you become unwell between your screening and your appointment time, please contact us at once. Below are our detailed protocols and procedures to mitigate the risks outlined above, presented in a step-by-step format reflecting the chronology of the patient’s journey.
COVID-19 Anxiety
We understand that the COVID-19 pandemic has created a huge amount of disturbance and anxiety throughout the population. This is a very anxious time for most and we share this feeling.
However, since the discovery of the severe acute respiratory syndrome coronavirus 2 virus (SARS-CoV- 2) which causes the Covid-19 infection, a great deal of scientific resources worldwide have been dedicated to learning everything we can about the virus and the plentiful evidence emerging from the research is informing our decision on an ongoing basis, making it easier to make effective and targeted decisions to reduce the risk of transmission to all of us. Of course, the scientific community has much left to learn and no doubt, guidance will change as we learn more about the minuscule and invisible virus that has so profoundly changed our lives.
However, the current research strongly indicates that respiratory droplets (the moisture released from our mouth and nose) coming into contact with someone else’s mucosa (the skin inside your mouth & nose and around your eyes) is the primary means of infection transmission. Surface transmission (from touching objects) is being shown through research to be a lesser modality of transmission than originally feared, whilst there is currently no evidence that COVID-19 can be transmitted through feces although research is ongoing.
Whilst COVID-19 is a new and unprecedented illness, its mode of transmission has been shown to be flu-like and this is a mode of transmission that is extremely well understood in the medical and scientific community. Rest assured that his knowledge underlines all of our decisions when it comes to safety and this is also why droplet management has been given such a large emphasis in our protocols.
Identifying the Risks
There is NO evidence that the virus can be transmitted through intact skin contact or through sweat so we are confident that our protocols which are aimed at controlling respiratory droplets and hand sanitising are in line with the best evidence available at this time, and will help to keep us and you safe during your visit.
It is also useful to understand that a virus can not cause harm until it gets inside the body in sufficient amounts. Therefore, having some viral particles on your hands (assuming intact skin) will not cause an infection unless you touch your mouth, eyes or nose from where the virus can get in. The same applies for droplets with viruses attached which may be present on surfaces like walls, floors, books, handles, etc.: these will only cause potential harm if they are inhaled or somehow get into the body (ie: touching the surface followed by picking your nose).
The most common route of infection is through breathing in infected droplets, in this scenario the virus is inhaled from the surrounding air or from the breath of a nearby person and gets into the body via the lining of the lungs. Research also indicates that the “viral load” (i.e.: how much viral particles you have been exposed to) is important. A small viral load (i.e.: if you only have been exposed to a small amount of viruses) is far less likely to cause an infection, whereas a large viral load - as experienced by nurses, doctors, cleaners and other health professionals working on COVID-19 wards is much more likely to result in an infection.
Therefore, viruses on the floor for instance, which may have landed there from the droplets of an infected but pre-symptomatic person (someone who has the virus and is contagious, but has not yet developed symptoms) who was breathing or speaking in the room, may transfer to the shoes or socks of the following person but as long as they are not then put into direct contact with a mucosa (mouth, nose, eyes or other moist tissues of the body), the virus will not cause an infection. However, if a toddler was left to crawl on the floor or if someone was to do push ups on the floor (transferring the virus particles to their hands) and soon after scratched their eyes, or put their fists in their mouth like toddlers often do (and therefore, putting the virus particles on their hands directly into contact with their mouth), there would be a certain risk of transmission. However, simply walking on a floor where infected droplets may be found is not a significant risk (so long as you don’t put your shoes in your mouth)
Our protocols are very comprehensive and we hope you will find this reassuring.
HOWEVER, you must understand that despite our best efforts, the risk of transmission can not be nullified since we are dealing with an invisible enemy, meaning that no matter how careful we are with our PPE (Protective Personal Equipment), cleaning and how careful you are with your face covering and hand washing, there is an inherent and unquantifiable risk that you may catch or spread COVID-19 by leaving your house to attend an appointment with us, however minimal. Of course, this risk exists whenever you leave your house for any reasons, such as picking up medication or going food shopping. We continue to maintain our original stance that we are still much safer to visit than supermarkets and most other places due to the small size of our building, our very small footfall and the absolute control we have over our environment.
As part of our protocol, we will ask you to confirm that you are aware of this risk and that you accept it. This is what we call informed consent.
Your risk calculation when you decide to book an appointment with us must also take into account your journey to us, especially if this happens on public transport. You should also consider other people in your household as part of your personal risk assessment, especially if someone is at high risk of COVID-19 complications.
Due to the hands-on nature of our work, face to face treatments can not be carried out whilst maintaining the rules of social distancing, and proximity increases the risks of virus transmission. This is the reason why we wear PPE and the best quality mask we could buy, and the reason why we have made significant monetary investments in air sanitising equipment.
Research has shown that many people will have a very mild illness with COVID-19 (which they may not recognise) and transmission from asymptomatic or pre-symptomatic carriers (someone who has the virus but does not have any symptoms of the illness) is possible, this is the reason why we ask you to wear a face covering and the reason why we wear PPE.
Who We Can’t Treat
We are unable to offer face to face appointments to:
Anyone with symptoms of COVID-19
Anyone who has someone in their household showing symptoms of COVID-19
Anyone self-isolating after being in close contact with someone confirmed to have COVID-19 or told to self-isolate for other reasons.
Anyone who tests positive for COVID-19 should allow 14 days between the onset of symptoms and appointment time AS LONG AS they no longer have a cough. If a cough persists beyond 14 days, advice should be sought from the NHS. This will be reviewed as more evidence emerges. Remote appointments remain available for everyone and if you are in the categories above, you will ONLY be offered one of those appointments.
Remote Consultation
Remote consultations (Tele-Heatlh) will continue to be available to everyone. If this is your preference, please specify your choice to the receptionist if booking over the phone or select “Tele-Health” in online bookings.
Most Common Symptoms of COVID-19
The main key diagnostic symptoms are:high temperature – this means you feel hot to touch on your chest or back (you do not need to measure your temperature)
new, continuous cough – this means coughing a lot for more than an hour, or 3 or more coughing episodes in 24 hours (if you usually have a cough, it may be worse than usual)
Feeling short of breath
loss or change to your sense of smell or taste – this means you've noticed you cannot smell or taste anything, or things smell or taste different to normal.
Other common symptoms:FatigueMyalgia (pain in your joints and muscles)
Sore throat
A productive cough (when you bring up mucus).
Most people with coronavirus have at least one of these symptoms. Note that you do not need to have all the symptoms, some people only have ONE of these symptoms.
Visit the NHS website for the latest guidance on Coronavirus symptoms or call 111 if you are experiencing symptoms: https://www.nhs.uk/conditions/coronavirus-covid-19/check-if-you-have-coronavirus-symptoms/
Appointments for those at high risks
With recent changes announced mid-June, we are now able to offer an appointment to anyone in need, even those who were asked to shield. However, we recognise this is a higher risk and we recommend that those at high risk should only book appointments as necessary (i.e: avoid maintenance or check up appointments) and we recommend they book the first appointment of the day or an appointment following a longer cleaning break (if possible).
If you were not told to shield but a member of your household was, we strongly recommend that you take this into consideration when booking an appointment.
Who is at high risk (clinically extremely vulnerable)
People at high risk from coronavirus complications include people who:
have had an organ transplant
are having chemotherapy or antibody treatment for cancer, including immunotherapy
are having an intense course of radiotherapy (radical radiotherapy) for lung cancer
are having targeted cancer treatments that can affect the immune system (such as protein kinase inhibitors or PARP inhibitors)
have blood or bone marrow cancer (such as leukaemia, lymphoma or myeloma)
have had a bone marrow or stem cell transplant in the past 6 months, or are still taking immunosuppressant medicine
have been told by a doctor they you have a severe lung condition (such as cystic fibrosis, severe asthma or severe COPD)
have a condition that means they have a very high risk of getting infections (such as SCID or sickle cell)
are taking medicine that makes them much more likely to get infections (such as high doses of steroids)
have a serious heart condition and are pregnant Check the NHS website for any update to this list. https://www.nhs.uk/conditions/coronavirus-covid-19/people-at-higher-risk-from-coronavirus/whos-at-higher-risk-from-coronavirus/
Appointment for those at moderate risk (clinically vulnerable)
Some conditions listed in the moderate risk category (such as mild, controlled asthma) are listed in the NHS moderate risk category but other organisations have stated that the increased risk is minimal. However, we suggest increased precautions and a case-by-case assessment and we recommend only booking an appointment as necessary, if you feel comfortable with the risk.
People at moderate risk from coronavirus include people who:are 70 or older
are pregnant
have a lung condition that's not severe (such as asthma, COPD, emphysema or bronchitis)
have heart disease (such as heart failure)
have diabetes
have chronic kidney disease
have liver disease (such as hepatitis)
have a condition affecting the brain or nerves (such as Parkinson's disease, motor neurone disease, multiple sclerosis or cerebral palsy)
have a condition that means they have a high risk of getting infections
are taking medicine that can affect the immune system (such as low doses of steroids)
are very obese (a BMI of 40 or above) - a BMI calculator can be found here: https://www.nhs.uk/live-well/healthy-weight/bmi-calculator/
Check the NHS website for any update to this list. https://www.nhs.uk/conditions/coronavirus-covid-19/people-at-higher-risk-from-coronavirus/whos-at-higher-risk-from-coronavirus/
COVID-19 protocols
Pre-Screening Process for Face to Face Appointments
A link to a questionnaire will be sent to you the day before your appointment and we ask that you return this within 24 hrs of your appointment. We may need to speak to you about your answers before your appointment so please make sure your phone number is up to date.
For emergency appointments, please contact us on the phone as we may be able to provide a sooner appointment and carry out the pre-screening questionnaire at the same time.
Should you develop any COVID-19 symptoms between booking an appointment and your appointment day/time, please contact us immediately to cancel your appointment via phone, email or text messages. No cancellation fee will apply but please do give us as much notice as possible.
Arriving & Entering the Clinic
The front door will be locked (as usual) to allow us to control physical access to the clinic. Please knock on the door at your appointment time.
You will be asked to put on a face covering and use hand sanitizer as you enter.
We kindly request that you do not bring children to your appointment to reduce the risk to everyone, unless the appointment is for the child. If this is not possible, please discuss this with us first.
Chaperone for Adult Appointments
You are still welcome to bring a chaperone to your appointment if it makes you feel more comfortable. This person should preferably be from your own household, should meet the conditions set above in the “pre-appointment screening” section to enter the building and must accept the inherent risks relating to COVID-19 transmission. This person’s name will be recorded on your records.
Children’s Appointments
If you are bringing a child under 16 years of age to an appointment, we will require a parent or guardian to be present for the duration of the appointment. Both the child and the accompanying adult must meet the conditions set above in the “pre-appointment screening” section.
For children’s appointments, we prefer if only one parent attends with the child, however we will not refuse for both parents to be present especially for the initial consultation.
Please bring your own toys.
Latex gloves are not used in our clinic to avoid reactions from a potentially unknown latex allergy and only Nitrate gloves are used.
Note: We decided against doing temperature checks at the door as we feel there are too many factors affecting reliability and interpretation of the reading. Including the device reliability, individual variation in basal body temperature, hormonal changes, hot summer weather, etc. However, if you feel you have a fever, please check your temperature at home before attending your appointment and cancel if you have a fever.
During Your Attendance at the Clinic
Controlling respiratory droplets is the key to reducing the spread of SARS-CoV-2, therefore significant emphasis is placed on this in our protocols. We appreciate your cooperation in keeping you, our practitioners and our families safe.
We ask that you wear a face mask when attending the practice
Please put it on before entering the clinic and only remove it after you leave. This will help reduce the amount of droplets and aerosols in the building.
If you do not have a face mask, we will provide a disposable one for you.
If you are unable to wear a mask for any reason, please let us know and we will arrange for you to have the last appointment before a cleaning break or at the end of the day to reduce the risk to others. We will discuss this with you but we retain the right to refuse to treat, if you will not, or can not wear a mask.
Toilet Access
Access to the toilet will continue to be available, however we ask that you avoid using it where possible.
We also request that you close the toilet lid before flushing. Flushing can send feces particles into the air up to a few feet away from the toilet and promote the spread of certain viruses such as the many common winter bugs causing vomiting and diarrhoea. There is currently no evidence that SARS-CoV-2 (COVID-19) can be spread in this way but it is a good rule of hygiene.
We will aim to clean the washroom after each use, where possible.
Payment
We encourage you to pay via Apple Pay or Google Pay which can be done via contactless payment for any amount simply by holding your phone against the reader.
We will continue to accept other card payments requiring you to enter a PIN number on a touch screen (as usual). The screen will be disinfected between usage and you will be given hand sanitizer after touching the touchscreen. A bottle is kept next to the card machine, so if we forget to offer it to you, please help yourself.
If paying by card, our card reader will be removed from its docking station so that you can insert and remove your card without us touching it.
We will continue to accept cash but we ask that you bring in the exact amount, as much as possible. The notes and coins you give us will be left for a minimum of 3 days before they are handled.
We ask that you do not give us a cheque to avoid an unnecessary trip to the bank for us.
Leaving the Clinic
A bottle of hand sanitizer will be left on the reception desk and you are encouraged to use it before leaving the practice, at your discretion.
If you need to wait inside for a taxi or pick up, you will still be welcome to do so but we encourage you to wait outside where and when possible.
We will do our best to open the doors for you so that you do not have to touch any surfaces unnecessarily.
Infection Control Measures Taken
From mid-March 2020, we introduced measures for infection control which will continue until further notice:
Hand soap is available.
We have removed fabric couch covers and replaced our pillow cases with wipeable ones to make it easier to sanitize surfaces between each client.
Our chairs and stool in the clinic room are all wipeable and sanitized between every appointments
We have a stringent cleaning protocol in place (detailed below)
We will wear a mask and clinically indicated PPE during your appointment (see PPE section).
We will follow guidelines ourselves and self-isolate if we show any signs or symptoms of COVID-19, as per current government guideline.
Hand Hygiene
Upon entering the clinic, will be asked to use hand sanitizer and/or to wash your hands.
It was always recommended that you wash your hands with soap and water after using the toilet and this timeless advice remains unchanged. Hand soap is available in the washroom.
Practitioners will also use hand sanitizer upon entering the building and wash hands thoroughly between appointments, following the WHO hand washing technique including the washing of forearms. Hand sanitizer is to be used by practitioners after hand washing and during the treatment session as required. If touching surfaces such as the computer or a pen to make notes, or following accidental contact with bodily fluid or other contaminants, additional hand sanitizing will be undertaken as per the practitioner’s professional judgement.
As practitioners are expected to hand wash many times daily, we recommended that hand cream (provided) should be used after each hand wash to prevent dermatitis and dry cracked skin which would increase the risk of infection. Hand cream is also available for patient’s use.
Clinic Hygiene Protocols
In March, we implemented a stringent cleaning protocol which has been reviewed and updated and we will continue to do so (if needed) as new evidence related to virus transmission comes to light. High traffic surfaces will be disinfected between each appointment. These are: treatment plinth, wipeable pillow cover, face pillow (if used), massage machine (if used), chairs and stool inside our treatment room, desk, door handles (outdoor and indoor), door bell and any item used during treatment such as massage balm container, tapes, etc.
Practitioners will hand wash or use hand sanitizer after touching the filtering part of their masks each time.
If the card machine, payment card, pin pad is used or handled, this will be disinfected after each use and hand sanitizer will be offered to the person who handled it.
The high traffic areas of the washroom, namely taps, door handle, toilet flush, toilet seat lid, soap, hand cream and hand sanitizer container will be disinfected on a regular basis. The frequency will be dependent on the volume of people frequenting the clinic and using the washroom but we aim to do this between each patient’s visit as much as possible. A thorough cleaning of all surfaces will be done daily. Cleaning wipes or disinfectant spray will be available for you to use in the washroom for added peace of mind, should you wish to clean surfaces yourself before using them. Please do not flush the wipes, dispose of them in the bin provided.
Hoovering will be done at the end of the day before mopping the floor. Face mask are to be worn during hoovering to avoid re-circulating virus particles so hoovering will be avoided during opening hours.
If further cleaning is needed during opening hours, sweeping will be favoured and hoovering will only be done if no one is expected in the area concerned for 20 mins after to allow settlement time.
Floor cleaning will be done daily at the end of the day to avoid anyone slipping on wet floors. Cleaning will be done using a traditional mop with a mixture of detergent and bleach. If bringing a young child into the practice is unavoidable, please do not let them crawl on the floor or ask for the first appointment of the day or after a longer break to allow time for floor cleaning.
Spillage and other such hazards will be dealt with immediately and followed with spot disinfection, if required.
We recommend that you do not put your bags and personal items down on the floor, please use the hangers provided behind the door, hang them on the chair or put small items on the desk.
Protective cleaning gloves should be worn by the practitioner during cleaning to avoid exposure of cleaning products on skin.
Other areas which do not experience high traffic will be cleaned daily or as required.
The window in the treatment room will be kept open in between patient appointments to ventilate the indoor space.
The booking system has been set to have one hour time break between patient appointments to allow the cleaning tasks to be completed.
PPE Protocol for Practitioners
Practitioners will be asked to wear a mask and use hand sanitizer on entry.
Practitioners will use a surgical mask.
A surgical mask is used for a single patient then will be disposed.
Masks should be used in the clinic at all times when more than one person is present.
A reusable scrub is used for a single patient. Practitioner will change scrub for every patient.
Disposable nitrile gloves are used for assessing and treating patients.
Disposal of PPE
Unsoiled single use PPE and disposable paper towels used for cleaning should be double bagged and left in a secured place before being disposed of in the normal way as it does not constitute clinical waste.
Clinic Washing and Clothing
The practitioner should change clothing once on the premises in the closet room. “Home clothes” should be worn for arriving at the practice and returning home, whilst “clinic clothing” should be worn during working hours.
Clinic washing such as clinic clothing should be placed in a plastic bag in the closet room. If clothing and soft fabrics are being taken home to wash (which is acceptable) they should remain in the closed pillow case and be put into the home washing machine upon arrival without emptying it. Washing anywhere should be done with regular detergent, washed in 60 degrees water.
Practitioners’ Commute and Self Isolation
Should any of our practitioners develop symptoms of COVID-19, we will self-isolate immediately as per government guidance and seek testing as soon as possible. As such, we may have to cancel appointments at short notice. We appreciate your understanding.
Our practitioners can get to the clinic by walking and therefore, this reduces the risk of the virus being caught by our practitioners on public transports.
Consultations with each practitioner have confidently taken place regarding the health status of their households and risk was discussed with them. All our practitioners are self-employed and therefore, the decision to return to work was their own.
Communication
This document will be made available on our website under the “COVID-19” tab
A link to our website’s COVID-19 page be included in all appointment confirmation emails.
No hard copy will be available in reception as we have removed all non-essential items to reduce contamination risk, however we will be happy to provide an electronic copy on request.
Our receptionists have always worked remotely and therefore, will continue to be available as normal to answer any questions. Alternatively, email your queries to: [email protected]
Data Sharing through the Track & Trace program
The UK has now entered into the “Track and Trace” phase of the pandemic, which means that we may be contacted by a governmental representative under this scheme where they ask us to release some data about who we have been in close contact with. This data will only ever be your name, phone number and email address.
The information commissioner and the government have both confirmed that in this specific situation, public health interest takes priority over your right to data protection under GDPR guidance. This means that we are legally obligated to release the data in an appropriate and lawful manner.
Should we be contacted for such requests, we will always verify the identity of the caller to ensure they are legitimate and verify the current advice provided by the Information Commissioner before releasing any information.
Safety
As outlined in this document, we have conducted a thorough risk assessment and considered every aspect of the patient and practitioner’s journey to allow us to understand what the risks to everyone are and how best to mitigate them. Although all these measures may seem scary at first, we still maintain our original stance that we are still much safer to visit than supermarkets and most other places due to the small size of our building and the absolute control we have over our environment. Should you have any concerns or questions, please do not hesitate to contact us and we will get back to you ASAP!
We look forward to seeing you,
Massimo Monticelli (London's clinics principal) and the Team at Body Flow Osteopathy
