One of the most important things we are doing during this time is to train and educate our staff.

1. Our team has had refresher training in proper hand washing techniques. This may seem basic; however, it is the most important thing we can do to prevent spread of the virus yet research shows that is it is often poorly complied with and usually not done well.  Consequently, we have spent a lot of time ensuring that our team does it well and often, especially before and after every patient encounter.
2. They have practiced the appropriate use of personal protective equipment (PPE) prior to caring for a patient to prevent contamination.
3. We encourage staff that is not feeling well to proactively stay home for two weeks.
4. We have everyone in the office take their temperature at the beginning of every day and we will immediately send home anyone with an elevated temperature (100.2F and above).
5. Limit the numbers of staff providing their care to facilitate social distancing within the office and among team members.
6. We have created a specific checklist of recommendations for our team to follow so that they arrive to work healthy and go home to their families without worry. (see Checklist of Recommendations for Our Team).

Before coming to work

1. Take temperature (do not go in to work if you or any other family member are experiencing symptoms; cough, sore throat, fever…etc.)
2. Remove watch and rings and leave at home
3. Tie hair up, keep nails short
4. Avoid extra accessories
5. Place phone in a ziplock bag that you will discard at the end of the day.
6. They have practiced the appropriate use of PPE prior to caring for a patient to prevent contamination.

At Work

1. Change into scrubs
2. Use PPE as appropriate
3. Leave all clutter (pens, phones, etc.) outside of patient ops.
4. We discourage workers from using other workers phones, desks, offices, and other work tools and equipment when possible.
5. Clean phone handset after use.
6. Discourage cell phone use at work.

After Work

1. Wash hands and arms with soap
2. Remove scrubs and place in washable bag
3. Wash hands and put clean clothes on
4. Sanitize phone, glasses, etc
5. Wash hands again

At home

1. Do not touch anything
2. Remove shoes and clothes
3. Wash clothes/scrubs in washing machine with detergent and hot water
4. Shower immediately with soap and water before touching anyone/anything

Before patient arrival every effort is made to

1. Filter patients during the phone call when scheduling appointments for care using established and recommended screening checklists and scripts.
2. Prepare scripts and questions to recognize potential carriers
3. Reschedule patients who show any signs of a cough or fever or who describe having any concerning warning signs
4. Instruct patients to call ahead and reschedule their appointment if they develop symptoms of a respiratory infection (e.g., cough, sore throat or fever) on the day they are scheduled to be seen.

To promote social distancing

1. Prioritize high risk patients (immune compromised) with early appointments so less contact with other people
2. Patients will text us when they have arrived (561-210-7788) and we will text them back when to come in. No patients will sit in the waiting room at any time.
3. Parents are encouraged to wait in their car while their child is seen in the office. If parents request to come in, only one parent can accompany each child.  Siblings can only come into the office if they are being seen that day.

Safety measure taken upon arrival

1. Limit points of entry to the clinic.
2. Leave office door open to avoid contact with door handles.
3. Post visual alerts the entrance door for patients to not enter the facility when ill.

Patients are

1. Immediately escorted to a hand washing station
2. Asked to rinse with 1% hydrogen peroxide before each appointment.
3. Asked about the presence of symptoms of respiratory infection and history of travel or contact with possible COVID-19 patients.
4. Assessed for respiratory symptoms and fever (with a non-contact digital infrared forehead thermometer) and they will be asked to sign a health declaration form.
5. If fever temperature of 100.2 degrees F or higher or respiratory symptoms are present, they will be advised to seek medical treatment and their visit will be rescheduled.
6. As testing for the virus becomes more available, we will be incorporating this added benefit to screen patients.

1. Patients will be texted when to come into the clinic and will not sit down in the waiting room, instead going to their assigned clinical chair.
2. Remove all clutter and anything that is not easily disinfected from the office (ex: Casey the Crocodile)
3. Frequent wipe down of waiting rooms, bathrooms, door handles, tables, light switches, computers…etc.

1. Install physical barriers at reception areas to limit close contact between reception and potentially infectious patients.
2. Headphone use is encouraged, so hands are free and only one person uses it.
3.  

We adhere to usual standard and transmission-based precautions in operatory but with greater attention to detail and ensure that procedures are followed consistently and correctly. 

Furthermore, we will employ an additional team member whose main focus is only on sterilization.  This team member will be responsible for cleaning, sterilizing, disinfecting and wiping down everything in the operatories; chairs, handles, light switches, tables…etc on a regular basis.

Hand Hygiene is performed by our staff

1. Before and after all patient contact, contact with potentially infectious material, and before putting on and after removing PPE, including gloves.
2. After removing PPE in order to remove any pathogens that might have been transerred to bare hands during the removal process.
3. Washing hands with soap and water for at least 20 seconds.

Personal Protective Equipment

1. Wear PPE (Masks, gloves, eye protection, face shields, gowns)
2. Masks are one time use and replace if soiled
3. N95 respirators should be used when performing or present for an aerosol-generating procedure.

Eye Protection

1. Put on eye protection (goggles, face shield) upon entry to the patient room or care area.
2. Remove eye protection before leaving the patient room or care area
3. Reusable eye protection (face shields, goggles) must be cleaned and disinfected according to manufacturer’s reprocessing instructions prior to re-use.
4. Disposable eye protection should be discarded after use.

Gloves

1. Put on clean, non-sterile goves upon entry into the patient room or care area.
2. Change gloves if they become torn or heavily contaminated.
3. Remove and discard gloves when leaving the patient room or care area, and immediately perform hand hygiene.

Gowns

1. Put on a clean isolation gown upon entry into the patient room or area.
2. Change the gown if it becomes soiled. Remove and discard the gown in a dedicated container for waste or linenbefore leaving the patient room or care area.  Disposable gowns should be discarded at the end of the day.
3. Gowns should be prioritized for all aerosol-generating procedures and during activities where splashes and sprays are anticipated.

1. Health care personnel (HCP) should strictly follow basic infection control practices between patients (e.g., hand hygiene, cleaning and disinfecting shared equipment).
2. Limit transport and movement of the patient outside of the room.
3. Consider placing x-ray equipment in patient operatory to reduce need for patient transfer.
4. No other team member should enter the room during a procedure. Please knock on the door to let doctor know you are ready. 
5. Room doors should be kept closed except when entering or leaving the room, and entry and exit should be minimized.
6. The room should undergo appropriate cleaning and surface disinfection before it is returned to routine use.
7. Patients undergoing aerosol-generating procedures are in a separate op.

1. Encourage payment by credit card.
2. At the end of the day, the office will be disinfected in preparation for following day.