The clinic has implemented preventative measures intended to reduce the spread of COVID-19. The information below are the guidelines from the Nova Scotia Public Health office and our acupuncture association ATCMANS. I am asking my clients who are interested to receive acupuncture/TCM treatment during this Covid-19 Pandemic to read the documents for your own information. The two documents 1)  COVID-19 Informed Consent for Treatment and 2)  COVID-19 PATIENT PRE- SCREENING are a mandatory read, you will need to sign these documents before each treatment.

Covid-19 Safety Plan for Acupuncturists

ATCMANS Recommendations for Practitioners Returning to Work During The COVID-19 Pandemic

The Nova Scotia Government has announced that non-regulated health professions, such as Acupuncture, can re-open their clinics and resume practice as of June 5, 2020 as long as they have a Safety Plan in place and follow the approved Back to Work sector Plan. You do not have to resume your practice if you choose not to. Use your own judgment.

Practitioners are required to comply with the Back-to-Work Sector Document approved by the Nova Scotia Public Health office should they return to work. Members are required to read the document in detail, ​sign the attached form and send back to ATCMANS​ via e-mail before returning to work. This document will now be included in the Occupational Health and Safety Binder we will now be responsible for developing and keeping in our clinics. Public Health reserves the right to do spot checks of your clinic during this pandemic and issue fines for any violations.

Binders shall include: ● Back to Work sector Document ● Covid -19 infection prevention and Control Requirement- Clinical checklist ● Covid-19 Workplace Safety Plan ● Guest log ● Cleaning log ● Covid -19 Staff Self-Screening form ● Patient Pre-screening questions ● Covid-19 Informed consent ● Samples of signages that you have displayed in clinic

*Sample of these forms are being sent to you and will be posted in the Website Members areas

We would like to ensure that our members are aware of the government’s contact tracing protocols for COVID-19. Please read all the information carefully. There is updated information since our last Q&A session.

If a person is diagnosed with COVID-19 the Public Health office will ask them for a list of people they have been in CLOSE contact with and places they have visited in the last 14 days. The Public Health Office will then perform a “risk assessment” with all these people and places, contacting those they deem to be a high risk of being infected. If a client tests positive within 14 days of having an acupuncture treatment, the practitioner would likely be considered at risk by the Public Health Office because of the close contact between client and practitioner. The office will contact you and advise on how to move forward. I​t is the opinion of ATCMANS that should you come in CLOSE contact with a known active case of COVID-19 that you stop seeing clients immediately ​until you have received direction from Public health.

Public Health will want a copy of your Guest log to determine risk and to make the necessary contacts. ATCMANS advises to always stay on the safe side and to not practice if you are feeling unwell. You are reminded that insurance companies are not covering any COVID-19 related claims so you are choosing to practise at your own risk.

Some additional advice, above and beyond the requirements, is as follows:

o Use the provided COVID-19 waiver, in addition to your usual treatment waivers. This should be signed by each client moving forward, either in paper copy or digital copy, depending on your situation. Like other waivers, it should be resigned every 12 months.

o Consider sharing your “safety plan” not just in your office but also posting on your website, social media sites and communicating it to clients via e-mail and other appropriate methods so they can know what you are doing (sample provided)

o Post / share approved messages from the NS or Canada government for client reference in your office, such as those included in this e-mail. More are available online on Government of Canada and Nova Scotia websites.

o Consider moving from “plush” surfaces on chairs and other furniture to solid surfaces such as plastic or wood that are easier to clean. Although this may be cost prohibitive at this time, keep in mind for the future. Note that some stores, such as Ikea have solid-surface chairs for as little as $25.00. The same goes for eliminating carpet and moving to solid flooring in the future you currently have carpet.

o Please be careful of what information you are sharing online via social media, whether on your own personal page or a professional page. Avoid sharing non-factual information.

o Reach out to us at ​info@atcmans.com​ or via Facebook if you need help, we are all in this together.


ABOUT CORONAVIRUS DISEASE (COVID-19) COVID-19 is an illness caused by a coronavirus. Human coronaviruses are common and are typically associated with mild illnesses, similar to the common cold. Symptoms of human coronaviruses may be very mild or more serious, such as: KNOW THE FACTS

For more information on coronavirus: 1-833-784-4397 canada.ca/coronavirus

COVID 04-03-02 / 2020.04.16

Symptoms may take up to 14 days to appear after exposure to the virus. Coronaviruses are most commonly spread from an infected person through: f respiratory droplets when you cough or sneeze f close personal contact, such as touching or shaking hands f touching something with the virus on it, then touching your eyes, nose or mouth before washing your hands

These viruses are not known to spread through ventilation systems or through water.

The best way to prevent the spread of infections is to: f wash your hands often with soap and water for at least 20 seconds; f avoid touching your eyes, nose or mouth, especially with unwashed hands; f avoid close contact with people who are sick; f cough and sneeze into your sleeve and not your hands; f practice physical distancing at all times; f stay home if you are sick to avoid spreading llness to others; f wear a non-medical mask or face covering (i.e. constructed to completely cover the nose and mouth without gaping, and secured to the head by ties or ear loops) to protect the people and surfaces around you.

Note: The Government of Canada has implemented an Emergency Order under the Quarantine Act. This order means that everyone who is entering Canada by air, sea or land has to stay home for 14 days in order to limit the spread of COVID-19. The 14-day period begins on the day you enter Canada. • If you have travelled and have no symptoms, you must quarantine (self-isolate). • If you have travelled and have symptoms, you must isolate.


 

COVID-19 Informed Consent for Treatment

The novel human coronavirus SARS-CoV2 is a viral pathogen primarily affecting the respiratory tract. The disease this virus causes has been named COVID-19; it has been named a global pandemic. Coronavirus is spread by respiratory droplets generated when coughing or sneezing enter the body though the eyes, nose or mouth. It can also be transmitted by touching something or someone that the virus is on, then touching your mouth, nose or eyes before washing your hands. Coronavirus appears to have a long incubation period during which carriers of the virus may not show symptoms and still be contagious. 

To proceed with receiving care, I confirm that I understand the following (please initial each box) 

 I understand symptoms of COVID-19 can vary between people, but I can confirm that I do not currently have, nor have experienced the symptoms listed below within the last 14 days. If I do have any of these symptoms from an underlying or chronic condition, I confirm that they are not worsening for any unknown reason. 

o fever (chills, sweats) 

o cough o worsening of a previous cough 

o sore throat o headache o shortness of breath 

o muscle aches o sneezing 

o nasal congestion or runny nose 

o hoarse voice o diarrhea, nausea, vomitting 

o unusual fatigue 

o loss of sense of smell or taste 

o red, purple or blueish lesions on the feet, toes or fingers without clear cause 

I confirm that I, as well as all household members, have not been diagnosed with COVID-19 within the last 30 days, nor am I currently awaiting test results for COVID-19 

I confirm that I, as well as all household members, have not knowingly been exposed to anyone diagnosed with COVID-19 within the past 30 days. 

I verify that I have not returned to Nova Scotia from any other province or country whether by car, air, bus or train in the past 14 days. 

I understand that Nova Scotia Public Health has asked individuals to maintain physical distancing of at least 2 metres (6 feet) whenever possible, but that it is not possible to maintain this distance and receive acupuncture treatment. 

I am informed that the clinic has implemented preventative measures intended to reduce the spread of COVID-19. However, given the nature of the virus, I understand there may be a risk of becoming infected with COVID-19 by proceeding with this treatment. 

I understand that Acupuncture, Herbal Medicines and other forms of Traditional Chinese Medicine are not substitutes for seeking medical care for COVID-19 

I release the clinic/practitioner from any legal claims should I become infected with COVID 19 

I promise to alert the clinic/practitioner should I test positive for COVID-19 within 14 days of treatment  I will alert my practitioner immediately  should I test positive for Covid-19 within 3 weeks of visiting the clinic.

I give permission to my practitioner to supply the Public Health Office with my Name and Contact information should it become necessary during “Contact Tracing” procedures by the government 

 I knowingly and willingly consent to the treatment with the full understanding and disclosure of the risks Associated with receiving care during the covid-19 pandemic. 

 I confirm all of my questions were answered to my Satisfaction.


Name of Patient (print) _______________________________________________

Signature of Patient _________________________________________________ Date: _____________

Signature of Practitioner ______________________________________________ Date:_____________




COVID-19 PATIENT PRE- SCREENING

Patients must be pre-screened 24 hours before the appointment, and then again right before the treatment starts: “Do you have any of the following symptoms for an unknown reason” if new or worsening symptoms, client should not have treatment and call 811 for advice.

Name 

Date 

fever, chills, sweats cough or worsening of previous cough 

sore throat 

headache 

Short-ness of breath 

muscle aches 

sneezing 

nasal congest. or runny nose 

hoarse voice 

diarrhea 

unusual fatigue 

 loss of taste, smell or taste 

red, purple or blueish lesions on feet or hands




COVID-19 Infection Prevention and Control Requirements – Clinical Checklist

This checklist has been organized by the hierarchy of controls. Controls are ways of reducing the risk of harm from a hazard, in this case transmission of COVID-19. There are generally four categories of controls. In order of effectiveness from most to least effective the controls are Elimination/Substitution, Engineering, Administrative, and Personal Protective Equipment. Controls work best when they are integrated into practice and used together. This checklist has been adapted from the College of Physiotherapists of Nova Scotia to help guide your practice as to what needs to be done in each area of your practice in order to prepare to open during the COVID-19 Pandemic.

[[PASTING TABLES IS NOT SUPPORTED]]

Check list completed by: ________________________________________________________________ Date:____________________________

Additional Comments / To-Do-List: _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________


COVID-19 Infection Prevention and Control Requirements – Clinical Checklist

This checklist has been organized by the hierarchy of controls. Controls are ways of reducing the risk of harm from a hazard, in this case transmission of COVID-19. There are generally four categories of controls. In order of effectiveness from most to least effective the controls are Elimination/Substitution, Engineering, Administrative, and Personal Protective Equipment. Controls work best when they are integrated into practice and used together. This checklist has been adapted from the College of Physiotherapists of Nova Scotia to help guide your practice as to what needs to be done in each area of your practice in order to prepare to open during the COVID-19 Pandemic.

Requirement Requirement Met? yes no n/a Notes

Elimination/Substitution

Limit non-essential travel The clinic/practice has a documented process for evaluating the potential for virtual care options

Virtual Care is available OR there is a written procedure for referral for virtual care when appropriate

Comments:

Engineering Controls

Facilitate social distancing and disinfection Barriers at front desk and other required areas

Signage for administrative controls posted

Waiting room meets requirements for social distancing

Equipment surfaces meet requirements for frequent cleaning and disinfection

Where necessary, surfaces easily maintained, impermeable, and durable to withstand frequent cleaning and disinfection

hand hygiene supplies readily available at clinic entrance and other required areas

Comments:

Administrative

The clinic maintains written infection prevention & control policies and procedures specific to reducing the transmission of COVID-19. Screening protocol - Staff

Screening protocol – Patients/companions

Screening protocol – Household members (Home care only)

Personal hygiene – Cough/sneeze etiquette

Hand hygiene

Selection and use of PPE

Environmental Cleaning and disinfection

Scheduling and staffing policy

Social Distancing policy

Procedure for inspecting equipment (ie tables)

Waiting room protocols (wait in car, etc.)

Comments:

Hand hygiene stations are present where necessary. Facility entrances and exits

Each patient care area

Staff lounges

Clean or sterile storage areas

Where personal protective equipment is donned or doffed

Soiled or utility areas

Other locations necessary to facilitate compliance with routine practices

Is a dedicated hand hygiene sink accessible if procedures with the potential to soil hands are performed?

Comments:

Hand hygiene sinks are adequately supplied. Are sinks equipped with warm running water, plain liquid soap, and paper towel dispensers?

Are sinks dedicated for handwashing (e.g. no equipment decontamination, waste disposal, food preparation, etc.)?

Hand hygiene is performed at the necessary times. Staff moments of hand hygiene

Patient moments of hand hygiene

Comments:

Physical Environment is adequately maintained Are surfaces clean and in good repair with a protocol to meet the required cleaning schedule?

Is equipment clean and in good repair with a protocol to meet the required cleaning schedule?

Are washrooms clean and in good repair with a protocol to meet the required cleaning schedule?

Is a hand hygiene sink with warm running water, plain liquid soap, and disposable paper towel dispenser available for handwashing (no alcohol-based hand rub)?

Is a no touch waste receptacle present?

Have required clinic adaptations been completed (removal of books, magazines, candy, toys, etc)?

Comments:

Applicable staff receive documented infection prevention & control training and education as necessary. Is there documented training in infection prevention & control for applicable staff?

Are staff aware of facility policies and procedures and where to access information on infection prevention & control?

Comments:

Personal Protective Equipment (PPE)

Personal Protective equipment readily available Is appropriate personal protective equipment available for all tasks performed?

Comments:

Personal protective equipment is appropriately used. Is personal protective equipment donned and doffed at the appropriate times?

Is personal protective equipment donned and doffed correctly?

Is single-use personal protective equipment discarded appropriately?

Is reusable personal protective equipment appropriately cleaned and disinfected in between use?

Comments:

Check list completed by: ________________________________________________________________ Date:____________________________

Additional Comments / To-Do-List: _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________





COVID-19 STAFF SELF SCREENING  

All staff members are required to self-screen before starting work each day and attest that they do not have any of the following symptoms for an unknown reason.   New or worsening symptoms should be reported to management and the staff members should not work. 

Name  Date    fever, chills, sweats   cough or worsening of previous cough      sore throat     headache            Short-ness of breath muscle aches sneezing         nasal congest. or runny nose          hoarse voice            diarrhea          unusual fatigue         loss of taste, smell or taste red, purple or blueish lesions on feet or hands

 

COVID-19 Back to Work Guidelines

1

Contents Introduction 2 Requirements 3 Patient screening 3 Screening questions that must be asked of patients and companions: 3 Hand hygiene 4 Hand hygiene is required to be performed by: 6 Environment cleaning and disinfection 6 Proper disinfectant products 7 Required clinic environment adaptations 8 Physical distancing 8 Requirements for managing clinical space: 8 Managing the clinical schedule: 9 Personal Protective Equipment 9 Staff and practitioner PPE 9 PPE requirements 10 Donning mask: 10 Doffing mask: 10 Patient provision of PPE 11 Clinic clothing 12 Exclusion or work restrictions in the case of staff or acupuncturist illness 12 Screening questions that must be asked with staff and acupuncturists, and a record kept: 12 Resources 1​4 General 1​4 Screening 1​4 Hand hygiene 1​4 Environmental cleaning and disinfection 1​4 Personal Protective Equipment 1​4 Exclusion or work restrictions during staff or acupuncturist illness 1​4

Approved by Nova Scotia Public Health Adopted by ATCMANS JUNE 2, 2020

COVID-19 Back to Work Guidelines

2

Introduction

Effective 05/05/2020 The Government of Nova Scotia introduced plans to “Re-Open Nova Scotia.” This directive defines the requirements acupuncturists must follow to ensure safe practice with pandemic public health measures as a result of COVID-19.

In response to the current environment, the circumstances and requirements asked of health providers when acupuncturists return to practice may change rapidly. Clinicians will need to respond quickly to changes signaled from government and the NSAA.

Note to acupuncturists: This directive is current as of the date of publication and reflects the rules and requirements for acupuncturists. In the event of a discrepancy between this information and the directives of provincial public health authorities, the directions of the provincial public health authority take precedence.

As non-regulated health professionals, acupuncturists are required to:

1. Follow all mandates and recommendations from Public Health and the Government of Nova Scotia regarding your personal and professional conduct. As a regulated health professional, you have a fiduciary responsibility to follow all civil orders that originate from any level of government. 2. Read and adhere to all communication from the NSAA.

The NSAA continues to consult with external stakeholders, including the Nova Scotia Department of Health and Wellness (DHW) and the Chief Medical Officer of Health (CMOH) and will adapt this directive based on expert recommendations. The NSAA exists to protect the public and its members, and this directive is created to ensure the health and safety of both the public and acupuncturists while instilling patient confidence as they safely access Oriental Medicine healthcare.

COVID-19 Back to Work Guidelines

3

Requirements This directive includes requirements regarding: 1. Screening 2. Hand hygiene 3. Environmental cleaning and disinfection 4. Physical distancing 5. Use of PPE 6. Exclusion or work restrictions during staff or acupuncturist illness

This directive must be completely reviewed and applied before you open your practice to the public. Acupuncturists and clinic owners are responsible to ensure that staff have read, and are able to ask questions regarding this directive. Staff must be trained and audited on the implementation of all policies and procedures. Each individual business is required to create their own workplace plan based on these back-to-work guidelines.

Patient screening

Acupuncturists must assess and screen patients for symptoms of COVID-19 as per the requirements of Public Health. Patients exhibiting signs and symptoms consistent with COVID-19 should not present for clinical services during the pandemic. Clinic staff should collect simple screening information ​at the time of booking the appointment and again in-person at the time of the patient’s visit to the clinic​. People who accompany patients, such as parents, caregivers or companions, must be screened with the same questions as the patient.

Screening questions that must be asked of patients and companions: 1.Do you have current symptoms of COVID-19, such as: a. a fever, b. a new or changed chronic cough, c. a sore throat that is not related to a known or preexisting condition d. a runny nose that is not related to a known or preexisting condition e. nasal congestion that is not related to a known or preexisting condition f. shortness of breath that is not related to a known or preexisting condition 2.Have you traveled outside of Nova Scotia within the last 14 days? 3. Have you had unprotected close contact with individuals who have a confirmed or

COVID-19 Back to Work Guidelines

4

presumptive diagnosis of COVID-19 (e.g. individuals exposed without appropriate PPE in use).

Patients and/or companions exhibiting symptoms should not receive treatment at this time and should be directed to call 811.

Signage indicating screening criteria should be posted in a location that is visible before entering the clinic.

A registry of all people entering the clinic should be kept to aid in contact tracing if required. This would include people in the clinic aside from patients (e.g. couriers, guardians accompanying a​ ​patient, etc). This is not an open sign-in book and should be kept and managed privately by the clinic. This registry must be kept while this directive remains in place.

If an acupuncturist encounters a patient who has gone through the screening process and enters a treatment room, yet still exhibits signs and symptoms consistent with COVID-19, the acupuncturist must:

o Establish and maintain a safe physical distance of two metres. o Have the patient complete hand hygiene. o Provide a new mask for the patient to don. o Segregate the patient from others in the clinic. o Explain the concern that they are symptomatic, discontinue treatment and reschedule the appointment. o Advise the patient they should self-isolate and call 811. o Clean and disinfect the practice area immediately. Acupuncturists must not attempt a differential diagnosis of patients who present with signs and symptoms of COVID-19.

Acupuncturists are required to call 811 to receive guidance if they are aware of a patient who has visited their clinic within the last 14 days and is now testing (or has tested) positive for COVID-19.

Hand hygiene

Hand hygiene is recognized as the single most important infection prevention and control (IPC) practice to break the chain of transmission of infectious diseases, including respiratory illness such as COVID-19.

COVID-19 Back to Work Guidelines

5

Hand hygiene can be accomplished by either washing hands with soap and water for at least 20 seconds then drying with single use cloth or paper towels, or using alcohol-based hand sanitizer. Alcohol-based hand sanitizer must be approved by Health Canada (DIN or NPN number), with a final concentration of 60-80 percent ethanol or 60-75 percent isopropanol.

When hands are visibly soiled, they must be cleaned with soap and water as opposed to using alcohol-based hand rub.

Single use cloth towels that are used in the clinic for hand hygiene must be laundered in hot water (above 60°C) with regular laundry soap and fully dried before being used again. Staff handling these towels should be gloved for both dirty and clean laundry processing. Staff must always use new gloves when handling clean laundry.

A significant component of hand hygiene is not touching your face. In addition to proper hand hygiene, acupuncturists and staff must also avoid touching their face and practice respiratory etiquette by coughing or sneezing into their elbow or covering coughs and sneezes with a facial tissue and then disposing of the tissue immediately. When contact with the face or a tissue is made, hand hygiene must occur before resuming any activities in the clinic environment.

COVID-19 Back to Work Guidelines

6

Hand hygiene is required to be performed by: Acupuncturists when: o entering the clinic o before contact with each patient o before clean/aseptic procedures o after body fluid exposure or risk of body fluid exposure o after contact with each patient o after contact with a patient’s surroundings or belongings o before donning PPE o after doffing PPE o after cleaning contaminated surfaces Staff when: o entering the clinic o before interaction with a patient o before clean/aseptic procedures o after body fluid exposure or risk of body fluid exposure o after interaction with a patient o before donning PPE o after doffing PPE o after cleaning contaminated surfaces o after financial transactions or administration of paperwork involving patients Patients when: o entering the clinic o entering the treatment area if the patient does not proceed directly to a treatment room upon entering the clinic o before and after use of weights, exercise equipment or similar shared equipment o prior to processing payment Environment cleaning and disinfection

Effective cleaning and disinfection is essential to avoid the possible spread of COVID-19, which is spread through contact with respiratory droplets or contact with contaminated surfaces. The COVID-19 virus can survive for differing periods of time depending on the surfaces it lands on. Frequent cleaning and disinfection is necessary to prevent spread of the disease.

Cleaning products remove soiling such as dirt, dust and oils, but do not always sanitize surfaces. Disinfectants are applied after cleaning to sanitize resulting in the destruction of germs.

COVID-19 Back to Work Guidelines

7

Read, understand and apply the cleaning standards from the Health Canada guide on cleaning and disinfecting public spaces during COVID-19.

Proper disinfectant products Disinfectants with an 8-digit Drug Identification Number (DIN) are approved for use by Health Canada. During the pandemic, only the Health Canada-approved disinfectants with a virucidal claim are appropriate for the elimination of viruses in the clinic environment. The disinfectant product manufacturer’s instructions must be followed for use, safety, contact time, storage and shelf life.

Alternatively, per NS Dept of Health and Wellness cleaning guidelines, you can make a 1000ppm bleach water solution by mixing 20 ml (4 teaspoons) of unscented, household bleach with 1000 ml (4 cups) of water. Ensure the surface remains wet with the bleach water solution for 1 minute. Vinegar, tea tree oil solutions, Thieves’ oil and similar solutions are ​not ​proven to be effective disinfectants and cannot be used in place of Health Canada-approved disinfectants. It is a requirement that only approved disinfectants with a virucidal claim are used to limit the spread of COVID-19.

Be sure you and your staff take appropriate precautions when using chemicals for cleaning and disinfecting. This can be done by consulting the Manufacturer’s Safety Data Sheets when using cleaners and disinfectants. Staff must be supplied with the appropriate safety equipment (gloves and masks) to protect themselves when they clean and disinfect.

The frequency of cleaning and disinfection is dependent on the nature of use/contact of the surface/item in question: Patient care/patient contact items must be cleaned and disinfected between each patient/use. Examples of patient contact items include but are not limited to: o treatment tables, all contact surfaces, and the entire headpiece/hand rests ● discontinue use of the central holding bar for headrest paper ● discontinue use of any permanent treatment material that cannot be cleaned and disinfected (e.g., upholstered cloth treatment tables where the cloth cannot be properly disinfected must not be used) o exercise equipment o therapeutic tools and devices o diagnostic tools and devices o procedural work surfaces Commonly touched areas must be cleaned and disinfected a minimum of twice daily or whenever visibly soiled. Commonly touched areas include but are not limited to: o light switches, doorknobs, toilets, taps, handrails, counter tops, touch screens/mobile devices, phones and keyboards

COVID-19 Back to Work Guidelines

8

o The payment machine must be cleaned after each patient encounter. o Clipboards that patients contact must be disinfected after each patient encounter. o Pens/pencils used by patients must be disinfected after each patient use or be single- use only Any cloth items, such as towels, sheets, headrest coverings, etc., that are used in the clinic must be laundered in hot water (above 60°C) with regular laundry soap before being dried and used again. Staff handling these items should be gloved for both dirty and clean laundry processing. Staff must always use new gloves when handling clean laundry.

Required clinic environment adaptations Books, magazines, toys and remote controls must be removed from patient areas. Discontinue patient-accessible literature displays and directly dispense to patients or move to electronic distribution. Self-serve candy dish, baked goods and other open or unsealed consumables are not permitted. Acupuncture/massage table surfaces with tears must be immediately repaired and then replaced as soon as reasonably possible. o At no time may patient care be provided on a table with exposed foam. o Duct tape is acceptable for emergency repair use only. It is expected that the arrangement for suitable long-term repair or replacement is initiated within two business days of the discovery of the tear. Cloth upholstery on furniture and treatment tables that can be properly disinfected may continue to be used. o If the cloth upholstery cannot be properly disinfected, it must be removed from the clinic environment. A regular schedule for periodic environmental cleaning must be established and documented.

Physical distancing

Requirements for managing clinical space: Physical distancing requirements take priority over occupancy limits. Members of the public must be two metres from each other. This applies in the following spaces: o treatment areas o waiting areas - seats must be spaced to maintain two metre distance o transition areas o people who live together are exempt from this requirement with each other

COVID-19 Back to Work Guidelines

9

o Caregivers and companions that are required to attend with patients are exempt from this requirement. Non-clinical employees and the public must be two metres from each other. o Reception and payment area - If two metres cannot be maintained at reception/payment area, either staff must be continuously masked or the installation of a plexiglass or plastic barrier must occur to protect reception staff. The treating practitioner must be two metres from the public when conversing. Restrict access to the practice environment to those who must be present, including patients, patient chaperones or companions, and staff members. Occupancy and gathering limits include all individuals in the office, including staff. To aid in physical distancing, give consideration to ​h​aving patients wait in vehicle until their appointment time.

Managing the clinical schedule: Ensure that booking practices (duration of treatment visits and number of patients in the practice at any given time) comply with ongoing CMOH directives on group gatherings and occupancy limits. This includes ensuring booking practices enable physical distancing between patients during treatment sessions and provide adequate time to clean and disinfect clinic equipment between patients. Deliveries and building maintenance, if possible, should be scheduled, and social distancing and hand hygiene must be adhered to. Always attempt to reduce the number of staff and practitioners in the clinic at one time. When scheduling, give consideration to dedicated and/or off-hours treatment for high risk populations (e.g., immune compromised, elderly, others with co-morbidities)

Personal Protective Equipment

Personal protective equipment (PPE) is an essential element in preventing the transmission of disease causing microorganisms. If used​incorrectly​, PPE will fail to prevent transmission and may facilitate the spread of disease.

Staff and practitioner PPE Given the highly infectious nature of the novel coronavirus, Covid-19, it is strongly recommended that all healthcare workers providing direct patient care wear a surgical/procedure mask continuously, at all

COVID-19 Back to Work Guidelines

10

times, and in all areas of the workplace if they are involved in direct patient contact or cannot maintain adequate physical distancing from patients and co-workers. This recommendation is to further limit the exhalation/droplet spread of the healthcare worker, further limiting the risk to patients and co-workers.

PPE requirements Surgical or procedure masks are the minimum acceptable standard. Acupuncturists and clinical staff must be masked at all times while providing patient care. Non-clinical staff must be masked when a physical distance of two metres cannot be maintained.

One mask may be used for the entire work shift, but must be discarded and replaced when wet, damaged or soiled, when taking a break and at the end of the day. N95 respirators are not required.

Situations for Acupuncturists to consider: - In the event that surgical mask supply is unavailable, a cloth mask of at least two layers is permitted until the practitioner can procure surgical masks - A cloth mask is not a long-term strategy, as they are not approved for health-care settings

PPE masks must be donned and doffed using the following specific sequence to prevent contamination. DHW has provided further instructions for health-care workers (please refer to the reference section at the end of this document).

Donning mask: 1. Perform hand hygiene. 2. Open mask fully to cover from ​nose to below chin. 3. Put on mask. 
4.Secure ties to head (top first) or elastic loops behind ears. 5. Mold the flexible band to the bridge of nose (if applicable). 6. Ensure snug fit to face and below chin with no gaping or venting.

Doffing mask: 1. Perform hand hygiene. 2. Do not touch the front of the mask. 3. Carefully remove mask by bending forward slightly, touching only the ties or elastic loops. Undo the bottom tie first then undo the top tie. 4. Discard the mask in the garbage. 5. If the mask itself is touched during doffing, perform hand hygiene. 6. Never reuse masks. It is essential that all acupuncturists and staff providing services in a clinic are aware of the proper

COVID-19 Back to Work Guidelines

11

donning and doffing of PPE. The use of PPE must be precise and ordered to limit the spread of COVID-19. NS DHW PPE Resources must be reviewed and understood before all acupuncturists, and staff, provide patient care. Training and practice of donning and doffing PPE within your facility are essential to ensure the proper use of PPE in support of limiting the spread of COVID-19.

Patient provision of PPE Clinics are not required to provide surgical masks for patients. However, acupuncturists may choose to provide masks for patients. If an acupuncturist chooses to provide masks for patients, the acupuncturist or staff must educate the patient on the proper donning and doffing of masks and observe that it occurs properly.

If an acupuncturist encounters a patient who has gone through the screening process and enters a treatment room yet still exhibits signs and symptoms consistent with COVID-19, the acupuncturist must:

o Establish and maintain a safe physical distance of two metres. o Have the patient complete hand hygiene. o Provide a new mask for the patient to don. o Segregate the patient from others in the clinic. o Explain the concern that they are symptomatic, discontinue treatment and reschedule the appointment. o Advise the patient they should self-isolate and call 811. o Clean and disinfect the practice area immediately.

Acupuncturists must not attempt a differential diagnosis of patients who present with signs and symptoms of COVID-19.

Situations for Acupuncturists to consider: - It is strongly recommended patients come to the clinic wearing a mask - There may be situations where a patient wearing a mask inhibits the practitioner to do their job (facial rejuvenation, Bell’s Palsy, etc). The possibility of putting public health at risk must be properly weighed with the ability to perform a safe and effective treatment - The preferred approach to tongue diagnosis is to have imagery provided by the patient ahead of time. Should imagery not be available, the practitioner must strictly adhere to PPE requirements.

COVID-19 Back to Work Guidelines

12

Clinic clothing Clean clothes must be worn by the practitioner and staff each day.

If the practitioner and staff drive directly from their home to the clinic, no change of clothes is required. However, if they stop at other locations on their way to the clinic, then donning new clean clothes in the clinic is required.

Clothes worn in the clinic must not be worn in public afterwards. Practitioners and staff must change into different clothes at the end of their shift.

To clean clothes worn in the clinic, wash clothing in hot water (above 60°C) with regular laundry soap.

Situations for Acupuncturists to consider: - Wearing a laboratory coat or scrubs is optional; however, is easily changed out of and easily laundered

Exclusion or work restrictions in the case of staff or acupuncturist illness Staff and acupuncturists must self-screen for symptoms before arrival at work with the same symptom screening questions used for patients. If screening is positive, staff and acupuncturists must not come to the clinic.

Staff and acupuncturists must complete a recorded formal screening upon arrival at work. This screening history must be kept while this directive remains in place.

Screening questions that must be asked with staff and acupuncturists, and a record kept: 1. Do you have current symptoms of COVID-19, such as: a. a fever, b. a new or changed chronic cough, c. a sore throat that is not related to a known or preexisting condition d. a runny nose that is not related to a known or preexisting condition e. Nasal congestion that is not related to a known or preexisting condition f. Shortness of breath that is not related to a known or preexisting condition 2. Have you traveled outside of Nova Scotia within the last 14 days? 3. Have you had unprotected close contact with individuals who have a confirmed or

COVID-19 Back to Work Guidelines

13

presumptive diagnosis of COVID-19 (e.g. individuals exposed without appropriate PPE in use).

Per the CMOH, acupuncturists and staff who screen positive for the questions above are not eligible to work. Current requirements from the NS Department of Health and Wellness state that self-isolation must continue, and workers must not return to work, until 10 days have passed from symptom onset or until symptoms resolve, whichever is longer.

Per the CMOH, acupuncturists and staff must also immediately inform their direct supervisor at the onset of any symptoms from the screening questions. acupuncturists who become symptomatic while treating patients must stop seeing patients immediately and follow self-isolation procedures.

This requirement is subject to change and acupuncturists are directed to stay up to date with the directives of the CMOH. Acupuncturists are reminded that employers may also set requirements for return to work, so long as those requirements are not less stringent than those established by the CMOH.

All workplaces must develop a workplace illness policy, as per the Government of Nova Scotia’s requirements. A link to a reference guide is included in the resource page at the back.

Acupuncturists are required to call 811 to receive guidance if they are aware of a patient who has visited their clinic in the last 14 days and is now testing (or has tested) positive for COVID-19.

COVID-19 Back to Work Guidelines

14

Resources

General ​∙ Nova Scotia's Novel Coronavirus (COVID-19) Disease Health System Protocol Screening ​∙ Screening checklist Hand hygiene Health Canada –​ ​Authorized list of hard-surface disinfectants and hand sanitizers Nova Scotia Coronavirus Resources -​ ​How to Hand Wash Nova Scotia Coronavirus Keeping Hands Clean​ ​- How to Use Alcohol-based Hand Rub

Environmental cleaning and disinfection Health Canada –​ ​Authorized list of hard-surface disinfectants and hand sanitizers ​∙ COVID-19 Public Health Recommendations for Environmental Cleaning of Public Facilities

Personal Protective Equipment ​∙ AHS Provided: Personal Protective Equipment (PPE): FAQs ​∙ Nova Scotia Donning/Doffing Mask Poster ​∙ AHS Provided: For Healthcare Workers: How to Wear a Mask

Exclusion or work restrictions during staff or acupuncturist illness ​∙ Screening checklist ​∙ COVID-19 assessment tool for health-care workers ​∙ COVID-19 information: Workplace Guidance for Business Owners