Organizational Risk Assessment (ORA) 

Our Hazard Controls outlined below are in place to help lower the risk of contracting COVID-19 or other infections/diseases when providing in-person physiotherapy, massage therapy, acupuncture and osteopathic treatments.

AH will not be assessing/treating any patients that screen positive for COVID-19 and have a procedure in place to deal with those that screen positive upon arrival to the clinic. There are exceptions to this guideline if the patient is deemed an essential worker.  However, no patient that screens positive with symptoms or if they are currently COVID-19 positive will be seen regardless of whether they are an essential worker or not. (See section “Positive Screening”) This will help limit the likelihood that our staff and Health Care Provider will be seeing symptomatic patients in clinic. AH also has procedures in place if a staff or Health Care Provider becomes sick or if a patient who visited the clinic later tests positive for COVID-19.

An ORA will be performed more frequently (daily, weekly) in the early days of re-opening to ensure we are meeting all guidelines set out by the respective Colleges and Ontario’s Chief Medical Officer of Health. We will monitor closely the health and comfort of our patients and ourselves and make adjustments to any of our policies and procedures as needed to ensure the safest environment for all.

“These measures help reduce the risk of exposure to a pathogen or infected source hazard by implementing methods of isolation or ventilation. These measures work to reduce exposure by isolating the hazard from the worker and by physically distancing actions to reduce the opportunity for transmission.”

Awakening Health is located in a well-ventilated space with a central HVAC system. Standard maintenance on the ventilation and duct systems with continue to be performed by the owner of the space. A plexiglass barrier was installed at the front desk to help protect staff from sneezing/coughing patients when they are screening patients, booking appointments, or collecting payment.  The limit for our point of service terminal for taking payments was upgrade so most treatments will be able to be paid without contact to the machine.

Physical distancing is proven to be one of the most effective ways to reduce the spread of illness during an outbreak. - Public Health Canada
This means making changes in your everyday routines in order to minimize close contact with others, including:

• avoiding crowded places and gatherings
• avoiding common greetings, such as handshakes
• limiting contact with people at higher risk (e.g. older adults and those in poor health)
• keeping a distance of at least 2 arms lengths (approximately 2 metres) from others, as much as possible

Awakening Health will be practicing physical distancing between patients and staff. The exception is the interaction of a patient and their health care provider for which personal protective equipment will be used.

The waiting room will not be used at this time despite the fact that it is sufficient in size to have 2 separate areas with physical distancing being maintained and still allow for the flow of traffic from any of the treatment rooms to the front desk and then to the exit. We will enable clients may check in electronically through a portal in the Jane app. This will notify the clinician that they have arrived. Then the patient will be called into the clinic by staff to minimize the number of people in the clinic at one time.
In addition, the doors to the clinic will be locked save when someone is leaving or entering the premises for an appointment or is escorted by staff.
Should a patient require use of the washroom, the handles on the door, sink, and toilet as well as the toilet seat will be sanitized as soon as possible.

Patients are advised to arrive alone unless they require an essential visitor. An essential visitor is:

• a parent/guardian of a child or youth who is a patient
• someone who is helping a patient who needs physical assistance coming into the clinic
• someone who provides essential support to a patient (ie. translator, etc).

ACTIVE SCREENING

Awakening Health will be using a screening protocol that has at least two points. The staff will use the latest COVID-19 Patient Screening Guidance Documents that are found on the MOH COVID-19 website.

1. Upon booking, patients will be screened over the phone or electronically for symptoms of COVID-19. The results will be documented in their electronic records.
2. The patient (and an essential visitor) will also be expected to fill out the Screening Questionnaire a day or two prior to their appointment. This will be sent via email as a survey 2 days prior to their appointment and will need to be returned and/or completed electronically before arriving at the clinic. These results will be documented.
3. Upon arrival at the clinic, the patient and an essential visitor will also be asked by our staff (either behind a plexiglass barrier or over the phone when calling them into the clinic from their vehicle) to confirm their screening questionnaire answers.

The results for all of these will be documented.

If they still screen negative, they can attend their appointment in-person with the HCP.
If they screen positive at any of these checkpoints, procedures will be in place to handle this situation. See the “Positive Screening” section.
Patients and essentials visitors will also be asked to keep all unnecessary personal belongings in their car or at home and ideally come dressed for their appointment, if possible.

All staff and health care practitioners will complete the same Screening Questionnaire before they arrive at the clinic for their shift. If the screen negative, they can come to the clinic to work, but if they screen positive, see the “Positive Screening” section below.

PASSIVE SCREENING

Signage will be posted at the main entrance of our clinic space requiring all patients and essential visitors to wear a face covering, perform proper hand hygiene, and self identify to reception staff before coming into the clinic space.

• Anyone entering the clinic with either wash their hands or use an alcohol based sanitizer upon arrival.
• This procedure will be repeated at then end of the appointment.
• Therapists will wash or sanitize their hands before and after each patient, before putting on or taking off their mask and face shield, after contact with potentially contaminated surfaces and if their hands are visibly dirty.

All surfaces that come into contact frequently with hands will be cleaned and disinfected at least twice per day and when visibly dirty. These surfaces include but are not limited to: doorknobs, cupboard/cabinet handles, waiting room chair(s), light switches, counters, faucets, fridge handle, laundry machine knobs, computer screens, keyboards/mouse, phones, etc. The Plexiglass barrier at the front desk will be cleaned once a day. The Point of Sale terminal if touched during payment processing will be disinfected after each use.

All treatment rooms/areas will be cleaned and disinfected after each patient use before the next patient is brought into the treatment space. This includes cleaning the treatment table, chair, pillow and door handles, as well as changing the pillow case. All equipment used with patient contact (ie wedges, reflex hammers, goniometers, wall, etc) will be cleaned and disinfected after each use. Resistance bands used with a patient should be given to the patient to take home with them or are otherwise discarded. They should not be reused. If a computer is used after interaction with a patient, then the keyboard and mouse would also need to be disinfected. Use of plastic wrap over the keyboard may be used to help preserve the electronics – it would still need to be disinfected if used after contact with a patient.

The cleaner and disinfectant used in the clinic will be a diluted bleach solution (1 oz bleach to 32 oz water). The solution will be made fresh each workday and any unused solution will be discarded prior to the next workday. All surfaces will remain wet for 5 minutes for disinfectant to work before being rinsed with water and allowed to dry.

• All patients will wear a mask. If you do not have a mask, one will provided to you.
• Therapists wear a medical/surgical mask
• Hand hygiene before and after contact with a patient and removal of PPE with either soap & water or alcohol-based hand sanitizer

Additional steps will be included in the following case:

If due to their occupation a patient has

• Come in contact with a person with acute respiratory illness OR
• Come in contact with a person who is confirmed to be COVID-19 positive OR
• Travelled outside of the province of Ontario in the last 14 days

And

• Have not tested positive for COVID-19 AND
• Not more than one symptom

• A face shield will be worn
• The therapist has the option of any of the following:
  • wear a gown
  • use a barrier between them and the patient
  • change their clothes prior to seeing the next patient