HEPA purifiers for decontamination of COVID-19 in clinical areas or procedure rooms.
Interestingly, the CDC did suggest the use of portable HEPA purifiers as an adjunctive infection control strategy for SARSCoV- 1, the causative agent of the 2003 SARS outbreak. Given this, air purifiers with HEPA filters have been proposed as an adjunctive method of COVID-19 decontamination. Ideally, the clinic building would be outfitted with an effective HVAC bactericidal/virucidal filtration system that reduces the circulation of potential pathogens. In addition, the installation of an in-clinic portable HEPA purifier should be considered an adjunctive infection control measure and undertaken with a knowledge of HEPA filter functionality and limitations.9 It has been suggested that medical grade plume/smoke evacuators are utilized in order to reduce aerosolization of particles during procedures, especially those in close proximity to the nose and mouth that require removal of the patient’s mask. Nonmedical grade fume evacuators and vacuum cleaners for fume evacuation should be avoided.2
The office administrator should have a back-up supply of air filtration filters, if applicable. It is critical to advise staff personnel that proper PPE should be worn when exchanging these air filters as the filters may contain trapped pathogens. The proper disposal of these contaminated filters should also be followed. In addition, it would be extremely helpful for the office building or suite to be equipped with an emergency generator in cases of electrical outages/malfunction.
Office Staffing and Patient Considerations and Protocols
Proper staffing and effective communications and transparency among staff and with patients are the hallmarks of a wellfunctioning office. A robust and vibrant staff is particularly critical during emergency situations. These individuals are often charged with communicating emergency policies and protocols to patients and their families as well as enforcing these among office peers. The following sections discuss items for consideration in managing office staff and patients.
Office Staffing Considerations
In emergency situations that require office closure, a guidance policy detailing staffing options such as furlough versus termination/unemployment and the implications of each of these should be in place. In some cases, the practice may implement a “tiered†strategy to furloughing employees or reducing work hours across all staff members. All staff should understand and appreciate the potential for mental health stress, strain, and burnout among coworkers dealing with their own difficult financial and other situations or family circumstances related to the emergency.
In the case of infectious disease exposures, it is critical that office staff understand and comply with the need to stay “safe†both inside and outside of the office. They should be advised to limit all unnecessary exposure and travel and to practice good hygiene. This avoids the potential for these individuals to infect other staff members and patients. This may require the development of a specific employee protocol that stipulates the wearing of masks, sanitizing hands, using all appropriate cleaning precautions, and the need to avoid coming to the office when they are feeling ill.
It is important for office managers to identify and document staff that appear to be ill and ensure that they are provided with adequate sick leave. Staff should be aware of a stringent policy regarding “return-to-work†and a zero-tolerance policy for those who come to work feeling ill. In order to provide staff coverage in these situations, there is a critical need for back-up staff who are trained in providing the services that are essential to the practice (ie, consider back-up laser operator and injector in cases where key personnel are not available).
Consistent wearing of PPE by the staff and mandating that patients wear masks will alleviate some of concerns of illness/ infection transmission. Patients should be advised to attend their visit wearing a mask. The office should be ready to offer PPE to patients who present without these items (eg, masks, gloves, or whatever is necessary) and to impose a “no PPE, no visit†policy if necessary. Office managers should consider modifications to office hours (earlier mornings, later evenings) to reduce the number of patients in the office at any one time. A pre-planned staffing and office-hours protocol for emergency scenarios should be prepared and readily available to implement.
Patient Management Strategies
In the case of COVID-19, practice reopening is further complicated by the idea of contact tracing following possible in-clinic exposure. Patient’s should receive prompt information regarding the status of the office practice following any type of emergency. Specifically, it is prudent to develop pre-planned patient communication messages for emergency scenarios related to practitioner unavailability, office closures, or other events.
Communications and Contact Tracing
In situations of office closure or limited patient accessibility, the staff should be prepared to quickly switch to virtual access patient management tools such as telemedicine appointments. The office technology should include remote access to patient contact details (eg, phone numbers, email, etc), patient medical records including photographs and consent forms, and other pertinent items to perform efficient virtual appointments.
Once the office reopens, safety practices should be implemented. Specifically, with respect to patient management the staff needs
Interestingly, the CDC did suggest the use of portable HEPA purifiers as an adjunctive infection control strategy for SARSCoV- 1, the causative agent of the 2003 SARS outbreak. Given this, air purifiers with HEPA filters have been proposed as an adjunctive method of COVID-19 decontamination. Ideally, the clinic building would be outfitted with an effective HVAC bactericidal/virucidal filtration system that reduces the circulation of potential pathogens. In addition, the installation of an in-clinic portable HEPA purifier should be considered an adjunctive infection control measure and undertaken with a knowledge of HEPA filter functionality and limitations.9 It has been suggested that medical grade plume/smoke evacuators are utilized in order to reduce aerosolization of particles during procedures, especially those in close proximity to the nose and mouth that require removal of the patient’s mask. Nonmedical grade fume evacuators and vacuum cleaners for fume evacuation should be avoided.2
The office administrator should have a back-up supply of air filtration filters, if applicable. It is critical to advise staff personnel that proper PPE should be worn when exchanging these air filters as the filters may contain trapped pathogens. The proper disposal of these contaminated filters should also be followed. In addition, it would be extremely helpful for the office building or suite to be equipped with an emergency generator in cases of electrical outages/malfunction.
Office Staffing and Patient Considerations and Protocols
Proper staffing and effective communications and transparency among staff and with patients are the hallmarks of a wellfunctioning office. A robust and vibrant staff is particularly critical during emergency situations. These individuals are often charged with communicating emergency policies and protocols to patients and their families as well as enforcing these among office peers. The following sections discuss items for consideration in managing office staff and patients.
Office Staffing Considerations
In emergency situations that require office closure, a guidance policy detailing staffing options such as furlough versus termination/unemployment and the implications of each of these should be in place. In some cases, the practice may implement a “tiered†strategy to furloughing employees or reducing work hours across all staff members. All staff should understand and appreciate the potential for mental health stress, strain, and burnout among coworkers dealing with their own difficult financial and other situations or family circumstances related to the emergency.
In the case of infectious disease exposures, it is critical that office staff understand and comply with the need to stay “safe†both inside and outside of the office. They should be advised to limit all unnecessary exposure and travel and to practice good hygiene. This avoids the potential for these individuals to infect other staff members and patients. This may require the development of a specific employee protocol that stipulates the wearing of masks, sanitizing hands, using all appropriate cleaning precautions, and the need to avoid coming to the office when they are feeling ill.
It is important for office managers to identify and document staff that appear to be ill and ensure that they are provided with adequate sick leave. Staff should be aware of a stringent policy regarding “return-to-work†and a zero-tolerance policy for those who come to work feeling ill. In order to provide staff coverage in these situations, there is a critical need for back-up staff who are trained in providing the services that are essential to the practice (ie, consider back-up laser operator and injector in cases where key personnel are not available).
Consistent wearing of PPE by the staff and mandating that patients wear masks will alleviate some of concerns of illness/ infection transmission. Patients should be advised to attend their visit wearing a mask. The office should be ready to offer PPE to patients who present without these items (eg, masks, gloves, or whatever is necessary) and to impose a “no PPE, no visit†policy if necessary. Office managers should consider modifications to office hours (earlier mornings, later evenings) to reduce the number of patients in the office at any one time. A pre-planned staffing and office-hours protocol for emergency scenarios should be prepared and readily available to implement.
Patient Management Strategies
In the case of COVID-19, practice reopening is further complicated by the idea of contact tracing following possible in-clinic exposure. Patient’s should receive prompt information regarding the status of the office practice following any type of emergency. Specifically, it is prudent to develop pre-planned patient communication messages for emergency scenarios related to practitioner unavailability, office closures, or other events.
Communications and Contact Tracing
In situations of office closure or limited patient accessibility, the staff should be prepared to quickly switch to virtual access patient management tools such as telemedicine appointments. The office technology should include remote access to patient contact details (eg, phone numbers, email, etc), patient medical records including photographs and consent forms, and other pertinent items to perform efficient virtual appointments.
Once the office reopens, safety practices should be implemented. Specifically, with respect to patient management the staff needs
