Reopening Precautions for Your Clinic

The country is gradually starting to reopen, and so are many clinics. With the difficult transition to pandemic conscious practice in mind, we would like to provide some resources, tips, and precautions for practitioners.

Resources:

ASA's Town Hall Meeting featuring Valerie Hobbs, DAOM, L.Ac. and Steve Shomo, DAOM, L.Ac.
CCAOM's Clinic Infection Control Advisory
CMS Guidelines for Reopening
Center for Disease Control Coronavirus Website
World Health Organization
The National Association of County and City Health Officials (NACCHO)
Please also monitor your state organization's guidance on ordinances and advisories for compliance. The USA State Guide will have updates.

Practice:

During consultations, it’s essential to maintain social distancing. If possible, try using either telemedicine or a glass door/window as a divider. If nothing else, maintain the CDC recommended distance of six feet.
During acupuncture treatments, try to minimize the time spent in the room, or in physical contact with the patient. Ensure that you’re following proper clean needle techniques, and are wearing gloves and a protective mask.
If treating a symptomatic patient, take extra precautions to use PPE (personal protective equipment) including goggles, face shields, N95 masks, and protective suits over your clothing. Remove and quarantine any protective equipment that has been soiled, and launder your clinic apparel daily. Keep an extra set of clinic apparel and protective equipment in case your clothes are unexpectedly dirtied.
Make sure you’re considering the best PPE for the situation that you find yourself in. Make sure all of your equipment is the right size, and follow proper hand sanitation techniques when putting on gloves, masks, and other equipment. When removing PPE, avoid contaminating your clothes or skin. If your equipment is contaminated or damaged, make sure you replace it immediately. Patients can have varied kinds of face masks, but practitioners always need at least a surgical face mask.
Consider offering curbside delivery of herbs for patients who need prescriptions refilled.
Pre-screening patients 24 hours in advance of appointments can prevent contagious patients from entering your clinic. Hobbes and Shomo recommend checking for shortness of breath, cough, chills, muscle pain, or sore throat.
Hobbes and Shomo mention that patients should come alone. If they require a companion, that person should go wherever the patient goes to reduce the area that will need to be cleaned. If you can avoid it, do not have companions stay in the lobby or waiting room. Have them wait in their vehicle until the appointment is over.

Office:

It’s best to wear protective masks at all times in the office. While it is not necessary to wear a mask when alone in the office, it is still recommended so that you do not contaminate surfaces by coughing or sneezing.
If you can, provide masks for patients; however, you should encourage patients to bring masks themselves.
Social distance from your coworkers, and make sure that your lab coat or scrubs are disinfected on a regular basis.
Wash your hands frequently and scrub for at least 20 seconds. Hobbes and Shomo suggest putting hand washing posters up, and requiring patients to wash their hands before and after appointments.
Avoid touching your mouth, nose, or eyes, particularly when you’re unsure if your hands are clean.
Sterilize doorknobs, surfaces of desks and treatment tables, cell phones, keyboards, and other frequently touched items. Set up a central dustbin for disposal of PPE and other supplies that have been soiled. Ensure the disinfecting sprays are anti-bacterial and anti-viral. Leave extra time between patients for disinfecting the room.
If there is laundry such as gowns, pillowcases, cloth room-dividers or blankets, change the linens between each patient and keep the clean laundry at a distance from patients. Hobbes and Shomo recommend storing them in a close-lid container or cabinet. Fold and replace them when you can do so at a safe distance from other people, in order to avoid re-contamination.
If you have the option for contactless payment, use it. Take credit card pre-payments over the phone or have patients pay online. If this is not an option, clean your payment exchange technology frequently.

Planning:

Hobbs and Shomo highly recommend creating a plan for opening with protocols that abide by CMS guidelines. Once state guidelines can be met, a thorough and detailed disinfecting routine and social distancing route for patients and physicians should be planned before opening. Open only when you have enough masks and safety equipment. Using daily checklists for cleaning the office and post patient appointments helps to ensure everything is properly disinfected.

Meals:

If possible, bring your own meals to work and eat on your own. If you go for take-out or order food, pick it up with clean gloves and make sure that it is well cooked. Wash your hands before and after meals, and after receiving take-out food.

Commute:

Try to take individual transport to work if possible (drive, walk, ride a bike). Wear a mask if you walk or travel by public transit. Wash hands after touching any public surface, and after arriving at either work or home. For patients commuting by car, ask if they are okay with waiting in their vehicle until their appointment rather than the lobby. This will minimize patient interaction with your clinic.

Mentality:

We all know how hard it can be to keep a good attitude during times like these, but it’s so important for both yourself and your patients. If helpful, practice breathing exercises or affirmations. Provide mental health resources for patients who are struggling during this time. Hobbes and Shomo emphasize the importance of self-care to get through these difficult times. Take care of yourself!

Herbs:

Everyone in our office has been taking Jade Screen Double Strength during this time. Tianjiang donated this formula to hospitals and clinics to support healthcare professionals' on the front line. As practitioners, you and your patients have access to this formula as well.

Stay safe, stay healthy, and thank you for everything that you do! You're providing an incredibly important service to your community, and we want to support you in any way we can.