Warrior Sports Rehab Covid 19 Risk Assessment V6
Date -15/12/2021
Author - Tom Bradley - Lead Physiotherapist
Objective - Provide clear statutory guidelines for returning to work in the context of Covid 19.
Covid-19 is a new illness that can affect your lungs and airways. It is caused by a virus called Coronavirus. Symptoms can be mild, moderate, severe or fatal.
This is a Risk Assessment for dealing with the current Covid-19 situation in our workplace. It is subject to constant review. Please familiarize yourself with it, take responsibility to check it regularly for updates, and be accountable to the standards set out within it.
What are the hazards?
Spread of the coronavirus between team members, and to our patients, through direct droplet infection, or physical contact.
Who might be harmed
Staff, patients, visitors to our premises (eg cleaners, delivery drivers, other workers within Zetland House), anyone that comes into contact with us at work, or on our way to and from work
Special consideration
Anyone who has knowingly been in contact with a person with Covid 19 in the past 2 weeks.
Anyone with, high temperature (above 37.8), a new and continuous cough , loss of taste or smell, flu like symptoms
Anyone in the high or moderate risk categories
There are 2 levels of higher risk:
high risk (clinically extremely vulnerable)- these patients will be offered only virtual appointments
moderate risk (clinically vulnerable)- these patients will be triaged and treated remotely first. If face to face contact is deemed clinically necessary then the patient will need to discuss this with their GP before booking in.
those that care for or have close contact with people from the high and medium risk categories, and neither of these groups of people should be seen face to face in any circumstances.
Patients in these risk groups will be identified using a consent form that will be sent with every patient confirmation. Without these consent forms completed, the appointment cannot take place.
Health conditions that need to be screened for are as follows (both for the patient and those they may care for)
People at high risk (clinically extremely vulnerable)
People at high risk from coronavirus include people who:
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 leukaemia, 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 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 or immunosuppressant medicine)
have a serious heart condition and are pregnant
People at moderate risk (clinically vulnerable)
People at moderate risk from coronavirus include people who:
are 70 or older
have a lung condition that's not severe (such as asthma, COPD, emphysema or bronchitis)
have heart disease (such as heart failure)
have diabetes
have chronic kidney disease
have liver disease (such as hepatitis)
have a condition affecting the brain or nerves (such as Parkinson's disease, motor neurone disease, multiple sclerosis or cerebral palsy)
have a condition that means they have a high risk of getting infections
are taking medicine that can affect the immune system (such as low doses of steroids)
are very obese (a BMI of 40 or above)
are pregnant
Patients who are currently shielding due to a positive Antigen test or been in contact with a positive case , or been contacted by Track and Trace or are in quarantine after travel from restricted countries CANNOT be offered a face to face appointment.
The list of quarantine countries is changeable and will be monitored via : https://www.gov.uk/guidance/coronavirus-covid-19-countries-and-territories-exempt-from-advice-against-all-but-essential-international-travel
Controls Required
Self reporting of illness / Symptoms of Covid-19/ Clinician monitoring
Clinicians will take their own temperature using a non touch thermometer at the start of every shift. If this is above 37.8, the staff member cannot work. They will record their temperature and lateral rapid flow test result in the pre shift certification log on the shared drive.
Every patient will be emailed a Covid risk screen the day before their session offering a change from a face to face to a remote session and advising them not to attend if they have any Covid symptoms.
Before the session every patient will be asked to confirm they have not had symptoms for 10 days prior to their appointment. Their temperature will be taken before each appointment . If it is above 37.8 they cannot be treated. This will be done outside the clinic room.
From w/c 01 May 2021 each clinician will conduct a self administered rapid flow test twice per week at their own cost, or from local NHS testing centres
Most local authorities have testing centres for rapid flow tests for asymptomatic individuals. Key workers are encouraged to attend regularly at no cost to ensure they do not spread the virus, Information can be found on local borough websites.
If the clinician tests positive on a lateral flow test they will stay at home and contact the NHS for a PCR test within THREE days as the test is most sensitive to the virus in this time period. They MUST self isolate until they get the result .The isolation period includes the day their symptoms started (or the day their test was taken if they do not have symptoms) and the next 10 FULL DAYS.
https://www.gov.uk/government/publications/covid-19-management-of-exposed-healthcare-workers-and-patients-in-hospital-settings/covid-19-management-of-exposed-healthcare-workers-and-patients-in-hospital-settings
https://www.nhs.uk/conditions/coronavirus-covid-19/symptoms/
https://www.gov.uk/get-coronavirus-test
Clinicians will let the admin team know as soon as possible if they cannot come into work. No information will be given to patients regarding their Covid 19 status . Relevant patients who need to be contacted will be managed by NHS Track and Trace. Clinicians need NOT contact patients.
If anyone becomes unwell with a new continuous cough or a high temperature in the workplace they will be sent home wearing a mask and advised to avoid as much social contact as possible whilst commuting home. They will arrange immediately for a PCR test.
Line managers will maintain regular contact with staff members during this time.
Staff return to work criteria
If clinicians are symptomatic when tested
Staff who test negative for SARS-CoV-2 can return to work when they are medically fit to do so, following discussion with the manager and appropriate local risk assessment. Interpret negative results with caution together with clinical assessment.
Symptomatic staff who test positive for SARS-CoV-2 or who have an inconclusive test result, and symptomatic staff who have not had a test, can:
return to work no earlier than 10 days from symptom onset, provided clinical improvement has occurred and they have been afebrile (not feverish) without medication for 48 hours and they are medically fit to return
if a cough or a loss of or a change in normal sense of smell (anosmia) or taste is the only persistent symptom after 10 days (and they have been afebrile for 48 hours without medication), they can return to work if they are medically fit to return (these symptoms are known to persist for several weeks in some cases)
All members of a household shared with the individual should self-isolate for 10 days from the day the individual’s symptoms started. However, if any household member develops symptoms of COVID-19, they should isolate for at least 10 days from the onset of their symptoms, in line with the stay at home guidance.
If clinicians are asymptomatic when tested
The new policy of routine rapid lateral flow tests is now implemented at Warrior Sports Rehab .
Staff who test negative for SARS-CoV-2 and who were asymptomatic at the time of the test can remain at work or return to work immediately as long as they remain asymptomatic.
If they were tested as part of a contact tracing investigation then they should follow instructions from the local health protection team.
Staff who test positive for SARS-CoV-2 and who were asymptomatic at the time of the test must self-isolate for 10 full days following the date of the test. If they remain well, they can return to work after their isolation period.
If, during the 10 days isolation, they develop symptoms, they must self-isolate for 10 days from the day of symptom onset. They can:
return to work no earlier than 10 days from symptom onset, provided clinical improvement has occurred and they have been afebrile (not feverish) without medication for 48 hours and they are medically fit to return
if a cough or a loss of or a change in normal sense of smell (anosmia) or taste is the only persistent symptom after 10 days (and they have been afebrile for 48 hours without medication), they can return to work if they are medically fit to return (these symptoms are known to persist for several weeks in some cases)
All members of a household shared with the individual should self-isolate for 10 days from the day the individual’s test was taken. However, if any household member develops symptoms of COVID-19, they should isolate for at least 10 days from the onset of their symptoms, in line with the stay at home guidanc
SARS-CoV-2 PCR re-testing in staff
Immunocompetent staff who have tested positive for SARS-CoV-2 by PCR should be exempt from routine re-testing within a period of 90 days from their initial illness onset or test (if asymptomatic) unless they develop new COVID-19 symptoms. This is because fragments of inactive virus can be persistently detected by PCR in respiratory tract samples following infection – long after a person has completed their isolation period and is no longer infectious.
If a person is re-tested within 90 days from their initial illness onset or test date and found to still be positive for SARS-CoV-2, a clinically-led approach should be used to interpret the result and inform subsequent action taking into account several factors, such as:
COVID-19 symptoms
underlying clinical conditions
immunosuppressive treatments and conditions
additional information such as cycle threshold values
Seek advice from an infection specialist as required.
If a person is re-tested by PCR after 90 days from their initial illness onset or test and is found to be positive, this should be considered as a possible new infection. If they have developed new COVID-19 symptoms, they would need to self-isolate again and their contacts should be traced.
If staff have been notified that they are a contact of a confirmed case in a health and care setting
If clinicians are providing direct care to a patient with COVID-19 and are wearing the correct PPE in accordance with the current IPC guidance, they will not be considered as a contact for the purposes of contact tracing and isolation. They will also not be required to self-isolate for 10 days (organisations have agreed the standards for PPE specification, fit testing and regimes of use for clinical and care activities).
It is important to note that the effectiveness of the use of face masks, face coverings, or other PPE for prevention of transmission or acquisition of coronavirus infection cannot be guaranteed in settings other than the provision of direct care with patients
Therefore, the use of PPE in other settings, such as in common areas will not necessarily exclude an individual from being considered a close contact. In addition, if clinicians have been in contact with a COVID-19 case and are not following appropriate IPC, including wearing correct PPE, they will be considered as a contact for the purposes of contact tracing and isolation.
If a clinician is considered to be a contact, and the recommendation for them to self-isolate would have implications for the provision of the service, the line manager will need to escalate this for a risk- assessment to a Tier 1 contact tracer at the local Health Protection Team (HPT).
Advice about whether a risk assessment is needed may also be sought from the HPT. The risk assessment should take account of any PPEuse (including its type and situational appropriateness) and other mitigating factors that may reduce the risk of infection transmission to such an extent that the individual identified as a contact does not need to self-isolate.
All staff who come into contact with COVID-19 cases – whether or not they are protected by the use of PPE or by other factors – should remain vigilant to the possibility of contracting infection and should self-isolate immediately if they develop relevant symptoms.
If clinicians have been notified that they are a contact of a confirmed case in the community
If clinicians have been notified as a contact of a confirmed case of COVID-19 in the community (outside the clinic) , they should inform their line manager and self-isolate for 10 days.
This advice should be followed regardless of the results of any previous SARS-CoV-2 PCR test or antibody test results. A positive antibody result signifies previous exposure, but it is currently unknown whether this correlates with immunity, including protection against future infections.
Risk assessment for Covid 19 exposures in the clinic
If the clinician has come into close contact with a confirmed COVID-19 patient or one suspected of having COVID-19 while not wearing PPE, or had a breach in their PPE while providing treatment to that patient inform the line manager.
In assessing whether the clinician has had a breach of PPE, a risk assessment should be undertaken in conjunction with local infection prevention and control (IPC) policy. Take into consideration:
the severity of symptoms the patient has
the length of exposure
the proximity to the patient
the activities that took place when the clinician was in proximity (such as aerosol-generating procedures (AGPs), manual therapy , exercise inducing heavy breathing etc. )
whether the clinician had their eyes, nose or mouth exposed
If the risk assessment concludes there has been a significant breach or close contact without PPE, the clinician should remain off work for 10 days.
Examples that are unlikely to be considered breaches include if the clinician was not wearing gloves for a short period of time or their gloves tore – and they washed their hands immediately – or if their apron tore and this was replaced promptly.
If advised that a member of staff or public has developed Covid-19 and were recently on our premises (including where a member of staff has visited other work place premises such as domestic premises), the management team of the workplace will contact the Public Health Authority to discuss the case, identify people who have been in contact with them and will take advice on any actions or precautions that should be taken. https://www.publichealth.hscni.net/
Hand Washing
This is compulsory for both patients and staff before, during and after every contact
Hand washing facilities with soap and water in place.
Stringent hand washing taking place - see hand washing guidance.
Drying hands with paper towels, and disposing of paper towels immediately
Gel sanitisers in any area where washing facilities not readily available
Social Distancing
Wherever possible all appointments should take place remotely via videolink .
Therapists must complete a risk assessment, and make a clinically reasoned decision for offering either a face to face or remote consultation for each patient and for each of their planned contacts. They will follow the most recent CSP guidance
You must engage your patients in discussions regarding the rationale and preference for either remote or face-to-face consultations. If both parties deem it necessary to proceed with face-to-face care, the patient should be made aware of all current risks associated with this approach. They must give their consent and you must document these discussions and the outcome.
When working face to face with any patient PPE must be worn, please see section below on PPE
Z1 has space for rehabilitation to take place for 2 patients supervised by 2 therapists, with a 2m distance maintained.
Work schedules have been reviewed to ensure that two staff can work, without coming into contact of less than 2m with one another, or each other’s patients.
Therapists should try to commute by bicycle or walking where possible, and if they do have to use public transport, they should avoid peak rush hour times are avoided for commuting.
Shifts will designed to run staggered to avoid overlap at reception
There will always be a minimum 5 minute gap between patients
Where possible only one therapist will use one room each day . When this is not possible in exceptional circumstances there will be at least a 30 minute break where the room will be completely cleaned and ventilated.
Social distancing must also be adhered to in common areas of Zetland House, when accepting deliveries, or coming into contact with other people that work at Zetland house
Staff should where possible commute to work by walking, by bike or by car. Where this is not possible, and public transport has to be used, facemasks must be worn, and handwashing / hand sanitising protocols strictly adhered to. See also section below on clothing.
PPE
PPE equipment will be provided for staff. If stock levels fall, staff must inform management immediately to allow for resupply. If supplies of PPE run out, face to face appointments will cease immediately.
Staff will familiarise themselves with the correct donning and doffing procedures for PPE:
Video :
https://www.youtube.com/watch?v=-GncQ_ed-9w&feature=youtu.be
Standard Infection Control Measures for PPE for those not considered to be have a respiratory infection are:
Universal use of masks to remain as an IPC measure within healthcare clinical settings across the winter period.
Gloves: risk assess. Single use when risk for exposure to blood or body fluid (BBF), non-intact skin (NIS) or mucous membrane (MM), please note: excludes sweat.
Disposable aprons/gowns: risk assess. Used where exposure to BBF, NIS, MM is anticipated/likely.
Fluid-resistant gowns during aerosol generating procedures (AGPs): single use and changed immediately post treatment.
Eye protection during AGPs and/or likely splash exposure by BBF.
Where tolerated patients should wear a mask.
This means that all four home countries are now following the same guidance.
Clothing
Every staff member will carry clean clothes on their commute to change into and out of at the start and end of every shift or when they leave the clinic on breaks. All clothing must be washed according to government guidelines which in summary is :
Clinicians uniforms should be transported home in a disposable plastic bag or a reusable cloth bag that can be laundered. Hand hygiene should be performed after removing a uniform and placing it into a bag for transport. Plastic bags should be disposed of into the household waste stream. Cloth bags should be laundered with the uniform.
Uniforms should be laundered:
separately from other household linen
in a load of no more than half the machine capacity
at the maximum temperature the fabric can tolerate, then ironed or tumbled-dried
Note: It is best practice to change into and out of uniforms at work and not wear them when travelling. This is based on public perception rather than evidence of an infection risk. This does not apply to community health workers who are required to travel between patients in the same uniform.’
Eye/ face protection
All staff will wear eye protection as per guidelines for direct contact less than 2 metres.
Cleaning
Cleaning and disinfecting of fomites (objects and surfaces that are touched regularly particularly in areas of high use) between each and every patient will be done by staff, to avoid contractors coming into the workplace.
All furniture has been replaced with wipe clean surfaces, and should be regarded as potential fomites.
Fomites include but are not limited to door handles, light switches, card machine, reception area, weights, mats, taps, gym equipment
Staff will use the cleaning products provided- spray and a cloth/ paper towel
The floor area will be mopped at the end of each shift using the mop with disinfectant.
Rubbish bins will be changed at the end of every shift.
All relevant posters from this document will be displayed close to hand washing / sanitising facilities and PPE stations.
Other considerations
The main gym,and weights and boxing rooms are strictly off limits. Staff can only use the area of the clinic for work.
The main gym may be accessed for cleaning equipment and must be kept locked at all other times.
Neither staff nor patients can use the showers or changing area
Toilets are available near the key box using the blue fob
Bikes cannot be stored within Zetland house, the Vault or the clinic, by staff or patients, and must be locked outside using street furniture.