COVID-19: Risk management for workplaces V2

23 March, 2020

*NB Many useful resources for veterinary practitioners and clinic staff can be found on the Department of Health (DOH) website.

 

1: Minimising infection risk - general

To prevent the spread of COVID-19, practise good hygiene and social distancing.

This includes:

• covering your coughs and sneezes with a tissue or into your elbow
• disposing of tissues properly
• washing your hands often with soap and water, including before and after eating and after going to the toilet
• using alcohol-based hand sanitisers
• cleaning and disinfecting surfaces
• if you are sick, avoiding contact with others and staying more than 1.5 metres away from people
• cleaning and sanitising frequently used objects such as mobiles, keys and wallets

SARS-CoV-2 is most likely to spread from person-to-person through:

• direct close contact with a person while they are infectious,
• close contact with a person with a confirmed infection who coughs or sneezes, or
• indirect contact through touching objects or surfaces (such as door handles or tables) contaminated from a cough or sneeze from a person with a confirmed infection, and then touching your eyes, mouth or face.

Most infections are transmitted by people when they have symptoms. These can include fever, a cough, sore throat, tiredness and shortness of breath. However, people can shed virus for 24 hours before symptoms appear.

Hand hygiene

Recommendations as per the previous Infection Prevention and Control advice located on our Website https://www.ava.com.au/coronavirus/

Key points:

• Always wash hands if organic material is present, and dry hands with a disposable paper towel.
• Use alcohol based hand rub (ABHR) (if available) in the absence of organic matter
• For the SARS-COV-2 virus, soap and water hand washing over a 20 second period is sufficient.

Given the nature of the SARS-COV-2 virus, washing your hands with soap and water is sufficient to minimise transmission.

 

2: Minimising infection risk within veterinary clinics

 

Avoid close contact with other people

We are mindful of the practicalities of doing this within a veterinary practice, especially with fellow staff members when handling animals. However, it is recommended this be adopted whenever possible with members of the public whose health status may be unclear.

Clinics may be able to implement dividing staff members into separate teams so if one staff member becomes infected there is still another team able to provide services at the clinic. Staff should be encouraged to be responsible about social distancing outside work to minimise risk of infection to themselves and also the rest of the staff

Clinics should have clear protocols for staff who become unwell. DOH guidelines advise self isolation if:

• you have COVID-19
• you have been in close contact with a confirmed case of COVID-19
• you arrived in Australia after midnight on 15 March 2020

There are a range of measures that can be adopted by veterinary clinics to decrease risk to staff and clients. Implementation of these suggestions are at the discretion of individual clinics, however, restriction of clients entering clinics may be desirable as infections within the community increase.

Options to consider for your practice

We strongly suggest you restrict your practice to appointments only so that workflow is controlled. You may need to space appointment times out to accommodate changed procedures required to keep you and your staff safe. Clients should be screened by reception staff when making an appointment and have a contact history taken. An algorithm for use is included below (with thanks to Prof Scott Weese from the Ontario Veterinary College School of Public Health and Zoonoses - link in references).

We would suggest all clients and cases are triaged before attending a veterinary clinic.

In summary

 

Clients

• Need to be asked about recent travel history and current self-isolation requirements
• Need to be asked about whether they are in quarantine due to COVID-19 infection or contact with at COVID-19 patient
• Need to be asked about any current history of respiratory disease.
  
  

Pets

• Need to determine reason for attending the clinic
  
  • to minimise non-essential contact with the public
  • To minimise use of consumables in short supply please consider delaying non-essential elective procedures.
    
    
• In order to triage pets, clinics may wish to use telemedicine. Areas with high numbers of COVID-19 cases or known widespread transmission should utilise telemedicine to decrease infection risk to their staff. You will need to clearly advise clients of the reason for the change to this service platform and the cost involved. Clinics may wish to bill clients at the beginning of the tele-consult.
  
  
  • Many follow ups and consults can be done remotely. However, make sure you are aware of the laws regarding this in your state - you will need to check with your local boards. Record keeping in this circumstance may involve keeping photos and videos provided by clients on file.
  • Consider using established telemedicine providers to triage patients for you - they already have systems and protocols in place and are aware of the legal requirements and limitations of telemedicine practice.

Options for clinics include:

a: Kerbside service

• Cages are outside the clinic for owners to put their pet into. Owners ring the clinic to notify of their arrival and the animal is then collected by a clinic staff member so there is no contact between owner and clinic staff. Staff members preferably wear gloves (if available) and practice hand hygiene before and after collecting animals from cages. Clients are not allowed to enter the hospital.
• Carry cages containing animals will need to be wiped down with disinfectant by staff, as will the door and lock on outdoor cages.
• Veterinarians take a history over the phone and discuss treatment plans with the owner after they have examined the animal.
• Animal is returned to the owner using the procedure in reverse.
• Electronic payments only - clinics will need to make individual decisions about how this is facilitated.

b: Modified kerbside service

Animals are collected from owners by a designated staff member while maintaining appropriate social distancing. Only one owner is to be present when the animal is handed over to staff.

c: Modified clinic service

• Screen clients on the phone using triage flow chart in this document
• Close waiting rooms. Booked consultations only. Admit and discharge patients via quick drop off at the front desk or directly from vehicles, or put clients directly into consultation rooms.
• No walk-ins if possible - use discretion about emergencies - you may need to take animals from clients and then ask them to leave and you triage them over the phone using the flow chart provided while other staff provide emergency care to the animal.
• Only ONE client to come in with animals. This must be made clear on the phone. If there is an emergency and someone needs to bring their children with them, use discretion given the individual circumstance.
• Use support staff to restrain animals to minimise close contact with clients.
• Clients need to call in advance for medications and food pick ups so they can be organised by staff to minimise waiting time.
• Institute distancing from reception areas using signage and lines marked on the floor as visual cues.
• Electronic payments only.
• Email receipts and certificates to clients to reduce the risk of potential fomite transmission.
• Consider emailing documents to clients in advance for e-signatures. If signatures are required ideally the owner should use their own pen (When making appointments ask owners to bring their own pens in cae signatures are required)
• Provide hand sanitiser at all admission points. If not available make clients wash their hands on entering the clinic in the closest consult room. Disinfect taps after used by clients.
• Use telemedicine as much as possible.
  • Many follow ups and consults can be done remotely. However, make sure you are aware of the laws regarding this in your state - you will need to check with your local boards. Record keeping in this circumstance may involve keeping photos and videos provided by clients on file.
  • Consider using established telemedicine providers to triage patients for you - they already have systems and protocols in place and are aware of the legal requirements and limitations of telemedicine practice.  
• You may need to provide drop off services for food and medications for vulnerable clients or those who are self isolating. You will be able to safely leave a parcel at their door, even if they are COVID-19 positive.
• Regular cleaning of contact points - e.g. reception desk, door handles, taps, phones, others

 

Consideration of cases booked at the clinic

Due to difficulties in supplies of masks, disposable gowns and gloves clinics may need to make decisions about delaying some elective surgical procedures. This is currently at the discretion of each clinic, however delaying elective procedures will also minimise contact with members of the public and therefore decrease risk to you and your staff.

Practices should consider the development of clinic-specific guidelines around elective surgical caseload and ongoing medical management of patients in the event staff are quarantined - this disease will put a strain on small businesses like veterinary clinics and the usual mechanisms for compensating for staff availability, such as locums, may not work as quarantine protocols get tighter.

Developing a policy will ensure that all staff are aware of the clinic’s agreed actions Specific HR advice for veterinary practices has been posted on the AVA website https://www.ava.com.au/coronavirus/

For more information on veterinary-specific WHS and workplace relations considerations during this time, contact the AVA HR Advisory Service on 1300 788 977.

No face to face group meetings in the practice.

Use of teleconferencing such as zoom or skype is recommended.

Develop a practice policy for unwell staff if there is not already one in place and distribute to all staff.

As the pandemic continues to develop in Australia there will be greater numbers of community-acquired cases of COVID-19. All practices should develop clear guidelines for staff regarding taking leave and seeking medical advice if they become unwell.

Some medical facilities are instituting staff screening as they enter the workplace including contact questionnaires and getting staff to record their temperature as they arrive at work. You may need to implement these procedures if you are in an area with a cluster of cases such as the Ryde area in Sydney.

General recommendations for employers are contained in this link from the DOH.

General cleaning

When cleaning, staff should minimise the risk of being infected by wearing gloves and using alcohol-based hand sanitiser, or washing and drying hands before and after wearing gloves Advice regarding cleaning including appropriate disinfectants is located in this document from the DOH.

Whilst some of the information is directed at health care settings, the first three pages contain helpful advice for use in veterinary clinics.

Signage

Have clear signage in place on your door and at your reception area regarding your clinic requirements.

Veterinary clinics should use modalities such as social media and email to communicate their protocols to their clients

Please see the client information sheet available at https://www.ava.com.au/coronavirus/

PPE shortages

Please see AVA handout for advice regarding Reuse of surgical and P2/N95 masks

We are currently aware of difficulties practices are facing in accessing infection control products such as ABHR, paper towel and P2/N95 masks. We continue to speak to wholesalers about stock, as well as investigating other potential sources of supply for practitioners. Given the shortages currently experienced by human health providers, many PPE consumables will continue to be in short supply.

Consider use of reusable gowns that can be autoclaved. There is clear advice about use of cloth masks and other alternatives in the handout referenced above
Save disposable items such as disposable gowns wherever possible for instances where there is a risk of infection from COVID-19 or other zoonotic diseases.

Consider the use of chux for hand towels. These can be purchased in rolls, used once and washed, dried and autoclaved as recommended for reusable gowns.

What to do in the event of an unwell client or client who has broken quarantine in your clinic.

There are many reports of a member of the public attending their clinic with their pet after breaking quarantine/self isolation. Unfortunately, this is likely to become a regular occurrence with reports of similar incidents across many sectors. Instituting phone screening of clients and working on appointments will minimise this risk, but we are unfortunately dependent on people’s honesty, which may lead you to decide to institute restrictions on clients entering your clinic as detailed above.

Clients should be asked to leave the premises if they reveal they have broken quarantine or self-isolation.

If a person has attended your clinic after breaking quarantine, with a known COVID-19 infection or is displaying typical clinical signs you will need to contact the DOH, or your local public health unit, for further advice about the need for self-isolation. Call the COVID-19 Public Health Hotline 24/7 on 1800 020 080.

We suggest you keep a log of all individuals in the clinic present at this time, in case contact tracing is required. This includes staff and clients.

Cleaning procedures of all in contact areas should be instituted as soon as possible.

If cleaning rooms or areas of the workplace where a person with a confirmed case of COVID-19 or a person in isolation has frequented, staff should wear a mask as an added precaution.

Recommendations for cleaning are on the DOH website.

Recommended for clinic staff 

COVID-19 infection control training module from DOH - 30 minutes https://www.health.gov.au/resources/apps-and-tools/covid-19-infection-control-training

Additional Resources (designed for human health care workers but provide guidance for any health care workers)
http://cec.health.nsw.gov.au/keep-patients-safe/infection-prevention-and-control/Coronavirus-COVID-19/standard-and-transmission-based-precautions-including-ppe

Some other helpful links:

• COVID-19: what we don't know doesn't mean we can't do something
• Social distancing and veterinary medicine 
• Clinician's brief: COVID-19 updates
• WSAVA: Coronavirus and companion animals 

Please note that this is an evolving situation. Advice provided here is reflective of the evidence at hand. This document will be updated as required. For the most up-to-date advice on the COVID-19 situation in Australia, visit health.gov.au