Recommendations for Dermatology Office Reopening in the Era of COVID-19

July 2020 | Volume 19 | Issue 7 | Original Article | 22 | Copyright © July 2020

Published online June 26, 2020

Suleima Arruda MDa, Doris Hexsel MDb, Tingsong Lim MDc, Heidi A. Waldorf MDd, Ofir Artzi MDe, Whosung Choi MDf, Sahar Ghana MD PhDg, Huang Gaomin MDh, Wilson Ho MDI, Maria Cristina Puyat MDj, Elena Rossi MDk, Ava Shamban MDl, Sonja Sattler MDm, Neil Sadick MDn

aArruda Dermatology, Sao Paulo, Brazil bBrazilian Center for Studies in Dermatology, Porto Alegre, RS, Brazil cClique Clinic, Kuala Lumpur, Malaysia dWaldorf Dermatology Aesthetics, Nanuet, NY; Icahn School of Medicine of Mount Sinai, New York, NY eTel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel fPiena Aesthetic Clinic, Seoul, Korea gAlexandria University, Alexandria, Egypt; Sahar Polyclinic, Salmiya, Kuwait hShanghai WanTian Cosmetic Medical Management Consultancy, Shanghai, China iThe Specialists: Lasers, Aesthetic and Plastic Surgery, Central, Hong Kong jRizal Medical Center, Pasig, Philippines kHead and Neck Skin Cancer Service, Modena, Italy; Reggio Emilia University, Modena, Italy lAva MD, Santa Monica, CA; SKIN FIVE, Los Angeles, CA mRosenpark Klinik GmbH, Clinic for Aesthetic Dermatologic Surgery and Plastic Surgery, Darmstadt, Germany, nWeill Cornell College of Medicine, New York, NY

We are providing our enrolled subjects the option of conducting virtual or phone visits if subjects are unable to come on-site visits. This is a challenging time, but I am confident we will emerge with bulletproof protocols against any future adversity and equipped to as never before.

United States, Nanuet, NY – Heidi A. Waldorf
New York State, and in particular the southern part of the state, which includes my office, is the epicenter of COVID-19 cases in the USA. The state closed non-essential workplaces including medical offices in mid-March. Opening of strictly aesthetic practices like mine is expected in June. My office does not use electronic medical records or telemedicine. Currently, staff are working from home except when absolutely necessary to enter the office. Anyone entering office throughout the closure wears a mask. Staff will be brought back into the office, most likely on staggered schedules, the two weeks prior to the start of patient hours. The week prior to reopening, all staff will be present for OSHA training including training in the use of PPE for their contact-risk level and review of new Standard Operating Procedure guidelines and job definitions and new workstation assignments to provide physical distancing. The office will be ‘decluttered’ of all nonessential items that could risk contamination. Patients will be sent instructions, updated forms, and a link to a video explaining what to expect during their visit. Prescreening for COVID-19 risks will be done prior to arrival and repeated prior to entry. Front staff and patient will communicate by text or call to coordinate their entry into the office, hand sanitizing, and receiving a mask if they do not have one, and then have temperature taken, and be brought directly into the exam room by a nurse. In the room, the patient mask will be removed for face photos and then replaced so that the initial discussion may be done utilizing photos. Face masks will be removed for facial treatment and a new mask placed. In addition to PPE and room/equipment sanitizing, all procedures that may produce a smoke plume will be performed using a filtered smoke evacuator and in the presence of an air circulation, filtration, and UVC device. Check out will be done at reception, with only one patient present at any given time to ensure that recommended follow-up appointments are made prior to leaving.

Kuwait, Salmiya – Sahar Ghannam
All clinics have been under mandatory closure since the middle of March and are hoping to reopen by the beginning of June. When opening, we plan to instruct patients to come on time, prepare paperwork before entering the office, and use the stairs instead of the elevator. Temperature checks will be done upon arrival. We will consolidate treatments and checkout to be complete in one room. We will require patients and staff to wear masks. Teledermatology is not common in our area and we don’t utilize such platforms.

Brazil, Porto Alegre – Doris Hexsel In Porto Alegre, the social distancing recommendations started by the end of March, but by then, 50% of the physicians reopened their clinics adopting many measures in order to prevent COVID infections and avoid potential contaminated patients. By the end of April, some industries and other businesses were allowed to return to work. Some of the measures in our clinic, which has been open since April 15, include:

Staff measures: frequent handwashing, no jewelry, protective clothing, surgical masks and shield masks, scheduling of patients to avoid more than 2 patients in the waiting room and to keep distance between them; one exclusive room for risk patients (older people, under cancer treatment, etc). Avoidance of patients coming from other countries and states of Brazil, or those presenting with symptoms or living with patients who had COVID in the last 15 days.

Patient measures: we only admit patients using masks. We give them special disposable clothing, cover shoes and caps, as well as a clean plastic bag to bring handbags and clothing from outside. Alcohol-gel and hand moisturizing is available all rooms.

Brazil, São Paulo – Suleima Arruda
São Paulo is the most affected area in Brazil with the highest number of COVID-19 cases in the country. Partial lockdown started on March 16 and we are still respecting it till the present moment. If a medical consultation can´t be rescheduled for a later date, it must happen following the local safety guidelines. It’s important to note that telemedicine till now was not allowed in Brazil. It just started now with all the Covid19 adaptations, and it seems it will be here for good. Dermatologists in Brazil should continue to abide with the Brazilian local regulations.

Germany, Darmstadt – Sonja Sattler
Germany had a little different approach how to deal with COVID- 19: Depending on the state we were living in, and the hot spot centers of the COVID19 infections, we had a full or partial lockdown of the cities and area. In our state, Hessen, which always showed moderate numbers, we were asked to stay home, but were allowed to move more or less free outside. We never closed fully our clinic or our little satellite offices and have been available for emergencies (which were few) all the time. We saw between 4–8 patients per day. We separated all staff into 2 groups, which are now working 1 week and stay home 1 week, so if any infection of COVID-19 appears, only half of the staff must go into quarantine and be tested. Doctors and all staff in my clinic take all precautions: with PPE and disinfection, single use gowns (we now added multi-use cotton gowns, which will be washed every day, and can be sterilized if needed), etc, and consider that no matter what the patient tells us, each patient can be COVID-19 positive. So, we do not score our patients. We do not do temperature checks, since it does not give us more information. We do trust our patients, but even when they declare they feel well, we consult them as if they are COVID-19 positive. Patients and staff are always wearing masks. Staff working