At the beginning of the coronavirus disease 2019 (COVID-19) pandemic, the Centers for Disease Control and Prevention (CDC) “recommended that healthcare systems prioritize urgent visits and delay elective care to mitigate the spread of COVID-19 in healthcare settings.”1
However, an unfortunate consequence of this guidance “has been the under-utilization of important medical services for patients with non-COVID-19-related urgent and emergent health needs.”1 For this reason, the CDC recommends that healthcare systems “balance the need to provide necessary services while minimizing risk to patients and healthcare personnel.”1 This focus on “reopening” is part of a broader drive to reopen the country, with specific guidelines being developed both federally and on a state-by-state basis.2 And as more states ease restrictions, medical practices hitherto closed or operating on a telemedicine basis only for non-urgent visits face increasing pressure to reopen.3 However, “conflicting information is causing confusion as practices carefully weigh resuming in-person visits.”3
To shed light on the complex and often delicate process of reopening, we spoke to Ada D. Stewart, MD, a family physician with Cooperative Health in Columbia, South Carolina, and president-elect of the American Academy of Family Physicians (AAFP).
“The overarching guiding principle, before you even start implementing the reopening process, is to make sure you have a safe environment, not only for your patients but also for your staff,” according to Dr Stewart. “All of the steps you take need to be undertaken and put into place with this in mind before you can reopen your doors to patients.”
1. Educate Your Staff
The AAFP recommends educating all staff about COVID-19. Even though most will be aware of the major aspects of the illness and its impact on patient care, a “refresher” training is useful.
Included in the review are explaining your policies and practices for minimizing exposure to the virus that causes COVID-19, including changes in how appointments are scheduled, patient flow, cleaning procedures, COVID-19 testing, and addressing patients’ concerns.
It is helpful to regularly go over the procedures and review any changes that may arise during this new process.
2. Implement Thorough Cleaning and Sanitizing Procedures
“We make sure that our office is constantly, constantly, cleaned,” Dr Stewart reported. Prior to COVID-19, nightly cleaning was sufficient, but now Dr Stewart and her staff have 2 or 3 midday cleanings, in which they disinfect the waiting room, wiping chairs and doorknobs, and also disinfect all surfaces of the examination room between patients.
“Hand sanitizing is an important part of our protocol. Not only do we constantly practice handwashing for at least 20 seconds, but we also encourage our patients to do the same. And we give out small hand sanitizer sample bottles to patients, especially if they don’t have sanitizer at home or in their cars,” she added.
The AAFP advises discontinuing the use of toys, magazines and similar items in waiting areas, as well as office items that patients usually share, such as pens, clipboards, and phones and providing no-touch waste containers with disposable liners in all areas of the office. As much as possible, limit surfaces that might be touched—for example, keep doors propped open or use sensors. Equipment such as stethoscopes and thermometers should be cleaned with appropriate cleansing solutions before each patient, and—if possible—disposable equipment should be used when possible.
“As much as possible, we are using disposable items, so laundry is not necessary,” Dr Stewart said. She advised following CDC guidelines for linen and laundry management, if relevant.
Ensure adherence to standard precautions, including airborne precautions and use of eye protection. Assume that every patient is potentially infected and could transmit the virus, Dr Stewart emphasized.