Laurie's Blogs.

 

19
Sep 2020

Treating Pets with Clients Present IN CLINIC or IN HOME during Covid-19

Firstly, a disclaimer:  This article contains IDEAS, THOUGHTS, EXAMPLES, EXPERIENCES, and RESOURCES and compiles them into strategies for how to mitigate risk during this pandemic while trying to work in canine rehab.  As professionals, it is important to heed to the regulations and advice given in your own country or geographical region by local authorities or regulatory boards and to use your own professional judgement.

 

Some interesting conversations have come about since I posted the last blog.  

 

Firstly, REHAB maybe be entirely different than veterinary general practice.  In rehab, we get to know our clients quite well.  They begin to know, like, and trust us, and subsequently care about our health and well-being as well.  As such, they may be less inclined to lie about recent travel or symptoms… but not always.  Additionally, a large veterinary centre simply has too many moving parts, making it hard to control or contain ‘people’.  However, policies and mandates could help.

 

Secondly, in my communications, there has been a noticeable difference in the mindset between the human practitioners (that treat animals OR even just humans that treat humans) and the veterinary mindset.  It’s not a critique. It’s just something that was different that took some one on one conversations to truly understand.  So, I appreciate those that reached out to converse with me on the subject.  I also am aware that on the human side, we have been provided guidelines and information for HOW to work with humans within this pandemic (see the resources at the bottom – in particular the one from the Physiotherapy Alberta website).  That alone has likely had a significant impact on mindset, I think.

 

Thirdly, it remains that as we continue on with this pandemic that shows no signs of changing, some practitioners are looking at how to safely continue with house call practices where ‘out door’ appointments just won’t work (in -30C or +30C weather) OR are looking for safe ways to let clients in to their clinic.  So, to help those that are looking, here are some suggestions that I have compiled for your perusal and contemplation.

 

ASSUMPTIONS

1.  It is prudent to assume that both you and your client are carriers of the virus.

2.  It is not always practical to be 6 feet / 2 meters away from the owner at all times.

 

HOME VISITS

1.  Your appointment reminders should have your Covid protocols clearly stated and your website or Facebook page should as well.  Write your Covid protocols.  (This document might help.)

2.  Before leaving for or arriving at the appointment, call or text the client to let them know your health status and to inquire about theirs (and anyone else in the home).  Basic questions:

   a.  Have you or any household member travelled within the last 14 days?

   b.  Have you been in contact with a person with a confirmed case of Covid-19?

   c.  Do you or does anyone in your household have any of the following symptoms?

       i.  Fever, Cough, Shortness of Breath, Difficulty Breathing, Sore Throat, Chills, Painful Swallowing, Runny  Nose, Nasal Congestion, Feeling Unwell, Fatigue, Nausea, Vomiting, Diarrhea, Unexplained loss of appetite, Loss of taste or sense of smell, Muscle or joint aches, Headache, Conjunctivitis (pink eye)?  (These are from the Alberta.ca guidance documents for Covid-19).

   d.  I have read where one practitioner takes her temperature, reports it to the client, and asks the client to report back with their temperature.

3.  IN the home.

   a.  Before entering, wear your mask. Ensure the client is also wearing a mask.  Provide them a clean, new, disposable mask if they do not have a mask.

   b.  Use hand sanitizer before entering the home / leaving your vehicle.

   c.  You may want to treat in a less frequented area – spare bedroom or garage.  However, if you are in an asymptomatic home, your contact risk is small. (See the article from elemental.medium.com and the CDC media release on transmission.) 

   d.  Touch very little, but if you do, just know to sanitize your hands before removing your mask at your car.

   e.  Your equipment.  You may want to acquire equipment carriers that are plastic and able to be wiped off.  Think of storing your things in Ziploc bags.  Keep your equipment IN their bags, so that only cords or probes protrude.  If you bring in exercise equipment, just be prepared to wipe it down afterwards OR use what the owner has at hand on home (like the old days before all of this inflatable stuff existed!!).

   f.  Document – Perhaps your first line in the pet’s chart should read, owner health screened, appointment proceeded.

   g.  Wear a new gown between each appointment.  You can buy some online.  If your Canadian look into Vetlinens.ca for well-priced items.  I made the mistake of buying inexpensive ‘wraps’ on Amazon when human physio clinics were first able to open.  Let’s just say they were a little too sexy to be worn in a professional context.  I have heard of some practitioners changing their scrubs between each appointment – going into a grocery store or gas station bathroom to do so.  I’m not sure that makes as much sense, as you are just potentially spreading or accepting more viral contaminants by doing so.  So, I’d suggest just getting some cover-ups for each household you visit.

   h.  For human practice, we are being advised that we can wear the same medical mask throughout the day if we are treating asymptomatic people, but we must change the mask if we touch it, adjust it, if it becomes wet, soiled or contaminated.

4.  When you leave.

   a.  Wipe down your equipment.  A Lysol wipe might work, if you can find them to purchase!  What has been working well in clinic is a bleach water solution at 1000ppm. (See the albertahealthservices.ca resource on cleaning).   You could mix a batch to keep in a sealable container.  Have a cloth in a Ziploc bag where you add some of the bleach-water solution and use this as your portable cleaning rag.  This will also sanitize your hands.

   b.  Have in your car a hand washing station and/or hand sanitizer, or both.

   c.  At the end of the day, wash your scrubs and your cover-ups / gowns.

 

IN CLINIC

1.  Appointment reminders that comment on Covid policies.  Ours also asks people to reply to confirm their health status.  This way we have it documented.  We then add an appointment note onto the computer that states ‘health declaration received’… so it’s documented.  

2.  If they failed to reply, then they have to sign the Health declaration form upon entering the clinic.

3.  Signage – as per your city, state, country.  

4.  Hand sanitizer available when the clients enter.

5.  No waiting room, call from the car, and make sure that you have posted signs about your procedures (with your clinic phone number on them).  You can lock the front door if you like as well.  We found this cumbersome and have left it open.  Very few people ever just walk in now.

6.  Create a Covid protocol for staff.  Have them sign off that they have read it and have watched videos on proper hand washing and mask use. (We found good ones early on and posted them onto our Staff FB page for everyone to watch and declare that they watched them.)

7.  Mandate masks.

8.  Monitor staff temperatures.  You may also consider monitoring client temperatures as well and declining service to those with abnormally high temperatures.  Normal human body temperatures are 36.5–37.5 °C (97.7–99.5 °F).

9.  Implement distancing measures for your front desk and/or Plexiglas shields.

10.  Mix up a big batch of bleach-water solution (1000ppm – see info above and link to Alberta Health Services below).  Have a smaller bucket with a cloth for each treatment room, the reception area, the lunch room, the exercise area, etc.  Between each patient, bleach surfaces (door handles, equipment, chairs, other surfaces that were touched).   I lead clients out of the treatment room with a bleach-water rag in hand, bleaching the door knob, point of sale machine, distancing table, and exterior door handle, before returning to my treatment room to bleach the chairs, equipment, etc.  Making it routine is half the battle.

11.  Bleach the bathroom or other public areas several times a day.  Empower and encourage all staff to be involved.

12.  Remove any non-bleachable items from the treatment rooms (i.e. decorative pillows, cloth chairs).

13.  Limit the amount of people allowed to be in the appointment.  I personally feel safe with two pet parents in the room with me.  One of my therapists only feels comfortable with one.  So, her appointments, only one is allowed.  

14.  Offer drop off appointments if people would like them as well.

15.  If you have a pool, it’s not practical to wear a mask IN the pool.  If you have owners present, however, mandate that THEY wear a mask and you may also want to mark the floor with where they are allowed to stand / be during the appointment as well.

16.  Set policies for your staff in regards to quarantine and/or the need for a negative Covid test if they have travelled or been in a gathering of larger than a certain amount of people (as determined by you, with guidance from your local health authorities or government).

17.  You might also want to mandate the staff change OUT of their scrubs and back into ‘civilian clothing’ before leaving the clinic.

18.  For additional guidelines, I suggest looking at the human physiotherapy regulatory board websites

 

So, I hope this helps some of you who are looking to transition into interacting with clients IN your clinic or IN their homes.  It’s simply meant to provide some direction, things to think about, and links to resources.

 

Be safe everyone…  And I can assure you that next week’s blog will be on something far less controversial! 

 

Cheers, 

Laurie

 

Resources:

 

1. https://elemental.medium.com/the-most-likely-way-youll-get-infected-with-covid-19-30430384e5a5

2. https://www.cdc.gov/media/releases/2020/s0522-cdc-updates-covid-transmission.html 

3. https://www.alberta.ca/guidance-documents.aspx#toc-1

4. https://www.physiotherapyalberta.ca/covid_19_pandemic/?fbclid=IwAR0luIngd8IACkMpyHG_F-e4NU1AW-bEm9-0G2Ul4JIZx1BnS4mDsRvbrpo#faq_masks_and_physiotherapy 

5. http://vetlinens.ca/

6. https://www.albertahealthservices.ca/assets/info/ppih/if-ppih-covid-19-environmental-cleaning-public-facilities.pdf 

 



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