Covid-19 Risk Assessment regarding face-to-face Chiropractic treatment – Aldgate Chiropractic Clinic Open

KH CHIROPRACTIC CLINIC RISK ASSESSMENT (Treatment Room) COVID-19 INFECTION RISK 

Rationale for Risk Factors 

COVID-19-19 transmission risk mainly arises from:       Contact, contaminated surfaces, droplet spread (e.g. coughs and sneezes)

Who might be harmed? 

Risk assessment for COVID-19 infection risk is to avoid harm to Staff (Employed and Self Employed), Patients, Cleaners, Contractors and any other visitor 

How might they be harmed? 

Risk assessment for COVID-19 infection risk is to reduce the potential for contact with COVID-19 virus 

A. STAFF EDUCATION  
MITIGATING ACTIONS TO TAKE RISK FACTOR MITIGATED RESPONSIBLE PERSON ACTIONED BY WHEN? DATE COMPLETED 
Communication – attended two courses: 1) British Chiropractic Association (BCA) ‘COVID 19 Risk Assessment and Implementation for Chiropractors Q&A’s’ seminar (2 hours); and 2) ‘Coronavirus (Covid 19) Awareness Course’ provided by Skills for Health (SFH; 2 hours).  All Karen Habershon As per completed. 05/05/2020 (SFH) 

16/05/2020 (BCA) 

Training – attended two courses: 1) British Chiropractic Association (BCA) ‘COVID 19 Risk Assessment and Implementation for Chiropractors Q&A’s’ seminar (2 hours); and 2) ‘Coronavirus (Covid 19) Awareness Course’ provided by Skills for Health (SFH; 2 hours). Topics covered:

  • 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.
All Karen Habershon As per completed. 05/05/2020 (SFH) 

16/05/2020 (BCA)

Information displayed – patient and staff information posters/guidance prepared using World Health Organization and NHS publicly available information sources (see Appendix A – General overview hygiene requirements for patients).  All Karen Habershon Update as Gov. guidance changes.  26/05/2020 
B. HR CONSIDERATIONS Column 2 Column 3 Column 4 Column 5
MITIGATING ACTIONS TO TAKE RISK FACTOR MITIGATED  RESPONSIBLE PERSON  ACTIONED BY WHEN? DATE COMPLETED
Staff return to work criteria – Staff will monitor for symptoms of COVID 19 daily. Should symptoms emerge, staff will enter a minimum period of seven days self-isolation. They will not return to work until all symptoms have abated or following advice from relevant health official (as necessary). To be updated in keeping with Government advice. All Karen Habershon Update as Gov. guidance changes. 26/05/2020 
C. GENERAL CLEANING PRINCIPALS 
MITIGATING ACTIONS TO TAKE  RISK FACTOR MITIGATED RESPONSIBLE PERSON ACTIONED BY WHEN? DATE COMPLETED
Product – Supplies of the following products will be maintained in the clinic and will be available for use as per methods prescribed in this risk assessment (see Appendix B – Cleaning product details and COSHH assessment): 

  • Surfaces – antiviral disinfectant sanitiser spray (e.g. Super V1) 
  • Hand Sanitiser (70% alcohol hand disinfectant) 
  • Anti-bacterial hand soap (e.g. Carex)
7 Karen Habershon 26/05/2020 26/05/2020 

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 on entry to room and after every patient (or more frequently as required). 
  • PPE to be used – see below.

5, 7, 8 Karen Habershon 26/05/2020 26/05/2020 

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. 
  • Flood 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.
5, 7, 8 Karen Habershon 26/05/2020 26/05/2020
Hand hygiene – Patient to wash hands when entering the room. Hand sanitiser, 70% Alcohol minimum available (Appendix B – Cleaning product details and COSHH assessment). Chiropractor will be in full PPE, however hand washing before and after donning, doffing. 5, 7, 8 Karen Habershon 26/05/2020 26/05/2020
Respiratory and cough hygiene – ‘Catch it, bin it, kill it’ poster displayed. Patients will be asked to confirm if they are suffering from any COVID 19 symptoms on entry. Patients will be asked to wear facemask or covering (following Government guidance). Hands to be washed on donning/doffing or facemask. 7, 8 Karen Habershon 26/05/2020 26/05/2020
Waste – Bin will be disposed of daily in compliance with legislation. 7, 8 Karen Habershon 26/05/2020 26/05/2020

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
1, 7, 8 Karen Habershon 26/05/2020 26/05/2020
D. PATIENT, STAFF AND VISITORS ENTRANCE TO THE CLINIC 
MITIGATING ACTIONS TO TAKE  RISK FACTOR MITIGATED RESPONSIBLE PERSON ACTIONED BY WHEN? DATE COMPLETED
Patient Triage – Appointment only attendance. Seek to hold digital appointment wherever possible. Urgent patients only/follow Government guidance. Patients not to be escorted by anyone unless the patient is a minor or in need of career/ vulnerable. 1, 2, 3, 9 Karen Habershon 26/05/2020 26/05/2020 

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 selfisolate 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 highrisk 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 
1, 3, 8, 9 Karen Habershon 26/05/2020 26/05/2020 
Online booking – Patients will be booked online or via telephone to minimise time in clinic. Payment machine touch-screen will be wiped after every patient. Not to be lifted from the desk. Patient to wash hands after use.  1, 7, 8 Karen Habershon 26/05/2020 26/05/2020
Reduce Footfall – Urgent care patients only. Only one Chiropractor in clinic at one time. Allow 20minute gaps between patients to allow time for disinfecting, drying and airing. 1, 2, 3, 5, 9 Karen Habershon 26/05/2020 26/05/2020
Patient Education – Patients will receive an email on booking their appointment explaining not to attend if they have signs or symptoms (a high temperature >37.8°C, a new continuous cough, loss of smell) 1, 8, 9 Karen Habershon 26/05/2020 26/05/2020
Hand hygiene – Anyone attending must wash hands on arrival and before leaving clinic. Chiropractor will wash hands prior and post donning, doffing PPE. (see Appendix B for hand sanitiser info). 7 Karen Habershon 26/05/2020 26/05/2020
E. RECEPTION AREA
MITIGATING ACTIONS TO TAKE  RISK FACTOR MITIGATED RESPONSIBLE PERSON ACTIONED BY WHEN? DATE COMPLETED

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.

1, 2, 5 Karen Habershon 26/05/2020 26/05/2020 

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)

1, 2, 7, 8, 9  Karen Habershon 26/05/2020 26/05/2020 
Physical changes – Patients to wait outside building unless weather or discomfort does not permit. One disinfected chair will be provided should the need arise. 2, 3, 5, 8 Karen Habershon 26/05/2020 26/05/2020
Hand hygiene – Sanitisers available by designated chair. Patient to wash hands on arrival and avoid touching anything but the bench and chair if they use it. (see Appendix B for products and COSHH)  7, 8 Karen Habershon 26/05/2020 26/05/2020
F. WASHROOMS 
MITIGATING ACTIONS TO TAKE  RISK FACTOR MITIGATED RESPONSIBLE PERSON ACTIONED BY WHEN? DATE COMPLETED
Enhanced Cleaning policies – Clean toilet, sink, taps, soap dispenser, door handles and locks after every patient who uses facilities. (see Appendix B for products and COSHH) 

Where possible patients should avoid using washroom facilities.

7, 8 Karen Habershon 26/05/2020 26/05/2020 

User Education – Staff will use separate washroom to patients. 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.

1, 7, 8  Karen Habershon 26/05/2020 26/05/2020 
G. STAFF ROOMS 
MITIGATING ACTIONS TO TAKE  RISK FACTOR MITIGATED RESPONSIBLE PERSON ACTIONED BY WHEN? DATE COMPLETED
Reduced Footfall – Only Chiropractor working in clinic.

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.).

1, 3, 6, 7, 8 Karen Habershon 26/05/2020 26/05/2020 

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).

7, 8 Karen Habershon 26/05/2020 26/05/2020 
H. THE TREATMENT ROOM
MITIGATING ACTIONS TO TAKE  RISK FACTOR MITIGATED RESPONSIBLE PERSON ACTIONED BY WHEN? DATE COMPLETED

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. 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 jewelry. Pt to leave coats, bags etc. at home. 

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

1, 2, 8 Karen Habershon 26/05/2020 26/05/2020 

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 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.

6, 7, 8 Karen Habershon 26/05/2020 26/05/2020 
Work Uniform – Freshly laundered uniform to be put on at work. To be removed at the end of the day and immediately bagged for washing before leaving the building. 4, 8 Karen Habershon 26/05/2020 26/05/2020
Staff Education – Attended two courses: 1) British Chiropractic Association (BCA) ‘COVID 19 Risk Assessment and Implementation for Chiropractors Q&A’s’ seminar (2 hours); and 2) ‘Coronavirus (Covid 19) Awareness Course’ provided by Skills for Health (SFH; 2 hours). All Karen Habershon 26/05/2020 26/05/2020
Cleaning Protocols – Hospital standard sanitiser to be applied to all surfaces, door handles, rails and surfaces patient comes into contact with. Correct donning and doffing of PPE and put all waste immediately into bins. Leave the room immediately to allow to dry. (see Appendix B for products and COSHH). 6, 7, 8  Karen Habershon 26/05/2020 26/05/2020
I. CLINICAL CONSIDERATIONS 
MITIGATING ACTIONS TO TAKE  RISK FACTOR MITIGATED RESPONSIBLE PERSON ACTIONED BY WHEN? DATE COMPLETED

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

1, 8 Karen Habershon 26/05/2020 26/05/2020 
Pediatrics – As with all patients consider pros and cons. Baby and attending parent/guardian must also be triaged for Covid symptoms and exposure following government guidelines. 1, 3, 9 Karen Habershon 26/05/2020 26/05/2020 
Geriatrics – Will consider risk and benefit to any patient. Any vulnerable patients will be seen first thing on Monday mornings when the clinic has been empty over the weekend where possible. Alternatively, first thing in the morning on any day to minimise the chance of airborne particles further. 1  Karen Habershon 26/05/2020 26/05/2020
Intra-oral Techniques – Only where essential will these be carried out and a new pair of gloves used for this which are immediately binned following completion of technique and replaced with a new pair. Hand and arm washing between glove changes. 7, 8 Karen Habershon 26/05/2020 26/05/2020
Consent  Gained at every treatment via email. All new patients must give written consent at their first appointment. Pens will be sanitised after each use. (see Appendix D – Patient consent form). 1, 3, 7, 8, 9 Karen Habershon 26/05/2020 26/05/2020
J. POST TREATMENT  
MITIGATING ACTIONS TO TAKE  RISK FACTOR MITIGATED RESPONSIBLE PERSON ACTIONED BY WHEN? DATE COMPLETED

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

1, 2, 3, 7, 8 Karen Habershon 26/05/2020 26/05/2020 
Hand hygiene  Patient and staff must wash hands before leaving clinic. (see Appendix C – Hand washing and hand sanitiser hand cleaning posters). 7, 8 Karen Habershon 26/05/2020 26/05/2020 

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.

1, 2, 3, 5, 7, 8, 9 Karen Habershon 26/05/2020 26/05/2020

Appendices

For documents please email info@khchiropractic.com

Watch for COVID-19 symptoms

Please reschedule your appointment if you:

1. Are experiencing any signs & symptoms of COVID-19

  • Cough
  • Sore throat
  • Loss of smell
  • Fever

2. Have been exposed to anyone with suspected or diagnosed COVID-19 in the last 14 days.

If you are in the ‘at risk group‘, you are strongly advised NOT to receive care at this time. Please contact your Chiropractor to discuss.Ultimately, at KH Chiropractic, we are doing all that we reasonably can to minimise risk. However, we cannot eliminate risk, especially as COVID-19 can be spread by those showing no symptoms.

Aldgate Chiropractic clinic open for those in urgent need of physical treatment. For those who are not in urgent need or clinic is too far to safely travel we will still be offering our online Chiropractic service via video link.We also have some great free tips on our blog which may help you through lockdown. If you would like more specific help do contact us via email or phone and we’d be happy to discuss your individual questions free of charge.

We have limited urgent appointments. Contact us:

Email info@khchiropractic.com

Phone 0203 633 0565