16/05/2020 (BCA) 

• Travel to and from work – Chiropractor by bike, not coming within 2meters of anyone on commute. 
• PPE – Visor to be wiped and allowed to dry after every patient, sessional use of surgical (grade IIR) mask (8-13.00 or 13.00-19.00), single use disposable gloves and aprons.  
• Hygiene procedures – Sanitise all surfaces, door handles and rails patient contact (patient to be escorted into and out of clinic to ensure contacted areas immediately sanitised should rails, handles etc. be touched). Chiropractor to carry out correct donning and doffing procedure, sanitising room after every patient and leaving the room on completion. Due to lack of windows doors will remain open after every patient to allow ventilation.

16/05/2020 (BCA)

• Surfaces – antiviral disinfectant sanitiser spray (e.g. Super V1) 
• Hand Sanitiser (70% alcohol hand disinfectant) 
• Anti-bacterial hand soap (e.g. Carex)

Cleaning – the following protocol will be adopted: 

• All surfaces (including door handles, rails, taps and treatment bench and desk space) to be wiped-down using antiviral disinfectant at the start and end of business every day and after every patient entry/exist to treatment room. 
• Chiropractor and patient hands to be washed or hand sanitised on entry to room and after every patient (or more frequently as required). 
• PPE to be used – see below.

Review Materials used in clinic

• Towels, gowns and all unnecessary garments to be excluded from clinic. 
• All materials to be stored in containers or cupboards which will only be accessed by personnel after sanitising hands. 
• Floor and desk space to be kept clear so that comprehensive cleaning is possible. 
• Patients will be asked to avoid jewellery watches of unnecessary accessories to be work. 
• Patient waiting area will be outside treatment room. No more than one patient in waiting area at one time. Waiting room chair to be wiped between patients.

Use of Cleaning Products  

Super Professional antiviral disinfectant – V1 Healthcare 

Eye / skin irritation wash immediately. Toxic risk of poisoning if ingested, risk to small children. 

• Keep out of reach of children – Locked in a secure cabinet 
• Keep in a sealed, secure container 
• Wear mask and visor when spraying to reduce risk of it going in eyes and inhalation – should contact occur was immediately and seek medical help if discomfort persists. 

Evans Handsan – A051E 70% Alcohol hand gel disinfectant 

• Avoid contact with eyes – wash immediately if contact occurs and seek medical help if discomfort persists. 
• Avoid contact with clothes and fabric

Screening and Classification – All patients will have to sign a declaration prior to attending clinic to confirm that they have no signs/symptoms of Covid 19 and to confirm they have not been in contact with anyone displaying sign/symptoms of Covid 19 in the last 14 days. Should they answer ‘yes’ to any of the above they must self–isolate and only attend clinic after following Government guidance on self-isolation. 

High risk patients (see below list as released by the government/NHS) will be advised not to attend clinic unless benefits significantly outweigh risk. Should a high–risk patient need urgent care they will be treated on Monday morning before any other patient enters clinic to minimise the chance of airborne pathogens and cross contamination. 

High-risk patients as indicated by the Government include –  

• 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 leukemia, 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 

Reduced Footfall – Patients must wait outside the building, where possible prior to their appointment. Their Chiropractor will collect them on time for their appointment. Should the need to wait/ sit inside occur an easy wipeable chair (without fabric) will be provided and wiped down after each use. 

Patients will attend clinic alone unless they are minors or vulnerable. 

Only one member of staff will be present at one time covering all duties.

Patient Education – Posters on hygiene, correct hand washing, use of hand sanitiser, face covering/masks, bathroom, treatment room, arrival time etc, will all be on display. (see Appendix A – General overview hygiene requirements for patients)

Where possible patients should avoid using washroom facilities.

User Education – Patients to avoid using washroom where possible. To advice Chiropractor if they need to use facilities, so a full clean can be carried out after.

The Running Works, shared facilities (Staff kitchen and bathroom): 

Bathroom 

• Shower and change into clean clothes on arrival at clinic. 
• Any other bathroom breaks wipe door handles and touched surfaces after use 
• Before leaving remove clothing and bag it to wash. Put on different clothing to go home. 

Kitchen 

• Following use wipe down any contacted surfaces (e.g. microwave, kettle, fridge, surfaces, taps etc.).

Cleaning Policy – Hand wash when enter staff room. Where possible use staff room without other staff, avoid unnecessary contact with surface and wipe down after with disinfectant. Wash hands before exiting staff room. (see Appendix B for products and COSHH).

Physical changes – Pt not to sit or touch anything but the bench. Maintaining 2-meter social distancing (where possible). No fabric towels or other items shall be used unless essential. If used they will be bagged and laundered ASAP. Where possible use of equipment will be avoided, if used it will be thoroughly disinfected and left to dry in the vacated room.  

No changing. Patients must not wear any accessories such as watches or jewellery. Patient to leave coats, bags etc. at home. 

Should any surfaces be touched they will be sanitised. (see Appendix B for products and COSHH).

Personal Protective Equipment for staff and patients – Staff to wear disposable/single use apron and gloves for every patient with correct donning and doffing. Chiropractor will also wear a visor and surgical (grade II R) mask for each session. 

Session means – 5 hour maximum, or replaced after removal for breaks or any other reason. 

Use and training – Correct donning and doffing procedure. BCA Covid seminar.

Manual Technique Selection – Avoid use of equipment where possible. Hands on therapy with the use of gloves and regular hand washing.

Bookings – Online booking and telephone booking to avoid face to face contact.

Patient Education – Posters will be clearly displayed throughout clinic. Patients will also receive an email including consent form and risk assessment to ensure they are provided with all the information possible on how we are reducing the risk of spreading coronavirus and to allow they to make their own decision before attending. 

Patients will be required to wash their hands again before leaving clinic. Door will remain open to allow them to leave without touching door handles etc. on exiting.