On Tuesday, May 26, 2020, we hosted Dr. Jennifer Brett, the Director of the University of Bridgeport Acupuncture Institute and Editor of the CCAOM’s 7th Edition CNT Manual for a FREE webinar, Standards and Practices for Reopening TCM Clinics during COVID-19 Outbreak.
In this webinar recording, Dr. Brett provides useful information for practitioners reopening TCM clinics during this time of COVID-19. Utilizing the CDC and OSHA infection control requirements for COVID-19 as well as the CCAOM Clinic Infection Control Advisory, She offers step-by-step guidance on applying the standards to acupuncture clinics. Additionally, she discussed the differences between standard practices and best practices for common clinical activities.
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Q. I assume cosmetic facial acupuncture is completely off the table for services, as patient cannot wear a mask. That hurts, as facial acu is 1/3 of my business. Or if it’s possible to needle in 10 minutes and leave room is it ok?
You may need to use an N95 or KN95 mask and eye protection if you are going to be in prolonged close contact with patients who cannot wear a mask.
Q. Children especially under 2yo and those with medical problems that prevent mask use. I see children a fair amount, any suggestions?
A. Follow CDC guidelines for infection control and Standard Procedures.
As with any patient, make sure to limit contact with other people in your office and complete disinfection after every visit.
Q. If following best practice, how low is our risk when treating people?
A. If you are not treating acutely ill patients, following CNT, using regular hand hygiene and proper PPE, current studies of nurses in NYC demonstrate a lower rate of infection than the general population. There is no way to make the risk zero.
Review the following article for more information: https://pubmed.ncbi.nlm.nih.gov/32286766/
Q. Are scrubs best practice? Is table paper needed with sheets?
A. Keeping clothing clean is important.
If you are using fresh sheets for each patient, disinfecting the treatment tables, and laundering the sheets appropriately, then table paper is not necessary.
Q. About REQUIREMENT FOR NOTIFYING PEOPLE: if someone found out they are positive, how recent a visit with you would warrant contacting everyone else who was in that day? If they were in a week and a half ago and now have covid symptoms but have not been tested? And if positive.
A. In general, people are capable of infecting others about 2 days before they show symptoms and for the duration of their illness. You should work with your local Department of Public Health to help them track and trace possible contacts.
Q. Would you recommend getting a covid test myself every so often – some of these tests are available for order that are specific enough now?
A. CDC information for healthcare personnel: https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-risk-assesment-hcp.html
If you work with patients that might be at higher risk of being in contact with Covid19, then follow your local health department’s guidelines.
Q. If the bathroom is in the common area under my landlord’s control – do I need to worry about that bathroom?
A. I would recommend that you be in communication with your landlord about planned changes to cleaning schedules to meet local requirements.
Q. How would a practitioner positive antigen test affect these standard and best practices?
A. Positive antigen test results would not affect standard or best practices. This test does not indicate current infection. So all policies promoting infection control would remain in place.
Q. What if the practitioner can’t wear a mask due to health issues?
A. There should be some form of mask or face shield that would work for you.
Look over the information at: https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/face-masks.html
And work with your primary care provider to find a solution that works for you.
Q. How about using an ozone generator to clear the air?
A. Ozone has been used for waste water (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7194566/)
However, I am unaware of any studies demonstrating effectiveness with airborne droplets.
Q. What about vacuuming? Should we and how often or will it spread the droplets again?
Generally speaking, carpets are not high-touch areas so normal daily cleaning is probably appropriate.
Q. How often should we be disinfecting the floors in our offices?
A. All surfaces should be cleaned daily: https://www.cdc.gov/coronavirus/2019-ncov/community/reopen-guidance.html
Q. Do we need to change/launder clothes upon returning home at the end of day? could we hang for 3 days without using?
A. Laundering clothing used in a clinic should be sufficient.
Q. Do we need to shower and wash hair when we return home each day if we live alone?
A. General good hygiene practices should be followed.
Q. Do we need to cover the boxes of needles that we use in treatment room? I typically keep open boxes of a few sizes to choose from as needed. Do they need to be covered? If that would be best practice, any idea what we would cover them with??
A. If the needles are sterile inside packets, they are “clean” when in the box with the top closed.
Q. Are written procedures required?
A. The CDC recommendations indicate: “It is critical that your plan includes how to maintain a cleaning and disinfecting strategy after reopening. Develop a flexible plan with your staff or family, adjusting the plan as federal, state, tribal, territorial, or local guidance is updated and if your specific circumstances change.”
You will need to update your Hazardous Communication plan with any new disinfectants and procedures.
Q. Can you clean equipment like blood O2 meter and forehead thermometer with alcohol swabs? Rubbing alcohol?
A. Use appropriate disinfectants for medical equipment as found in FDA list: https://www.fda.gov/medical-devices/reprocessing-reusable-medical-devices-information-manufacturers/fda-cleared-sterilants-and-high-level-disinfectants-general-claims-processing-reusable-medical-and
Q. What are your thoughts about using sheets on tables and over patients?
A. If you are using fresh sheets for each patient, disinfecting the treatment tables, and laundering the sheets appropriately, then using sheets is OK.
Q. Do you have any recommendations for home visit safety?
A. Follow all CNT requirements, including proper handwashing, and use a procedure mask when in the home.
Q. Are there disinfecting products that will disinfect but Not destroy our vinyl tables, head rests, etc? We need to disinfect but not destroy our equipment, and this seems very difficult.
A. Contact your medical equipment supplier. There are a number of disinfectants that are designed for this use.
Q. Should we not have pillows, heaters and and mattresses on the treatment tables anymore? I would think not, but I want your opinion. Better yet, do you have a product that you recommend to disinfect massage tables.
A. Pillows would need to be cleaned and disinfected, as would any other reusable device.
Contact your medical equipment supplier. There are a number of disinfectants that are designed for this use.
Q. How much do rubber gloves deteriorate with use of hand sanitizer on the gloves?
A. I am not aware of any data on this.
Q. I have been open again here in Colorado since May 8th. I find myself as I get comfortable getting lazy about screening with repeat patients. Ideas for best practices around repeated screening in patients we see twice a week every week.
A. Have a regular checklist that the patient “answers” during appointment reminder calls.