COVID-19 Related FAQs for Chiropodists/Podiatrists

We will continue to add to and amend these questions and answers as matters change.

Click here if you are a member of the public with questions regarding care during the COVID-19 Pandemic

GENERAL CARE
What patients can Chiropodists/Podiatrists currently treat and manage?

Currently, Directive #2 for Health Care Providers is in place. The directive states that “All deferred and non-essential and elective services carried out by Health Care Providers may be gradually restarted, subject to the requirements of this Directive.”

Members should continue to consider the four principles (proportionality, minimizing harm to patients, equity and reciprocity) under Directive #2 when deciding whether to provide care.

What about those of us that work in Family Health Teams or Hospitals?

COCOO can only instruct members of the College not employers such as FHTs. It is VERY wise to provide the College guidance to the employer in order that they can make decisions based on COCOO advice.

Can an employee refuse to work because of the coronavirus?

Yes, if the employee has reason to believe that the circumstances are a health and safety risk. Under the OHSA, an employee may refuse to work or do particular work where he or she has reason to believe that “the physical condition of the workplace or the part thereof in which he or she works or is to work is likely to endanger himself or herself.

Practical Tips:

  • Be proactive; identify and address the potential risks to employee health and safety (this would also be part of an employer’s duty to maintain a safe workplace for employees under occupational health and safety legislation).
  • Clearly communicate the steps the company has implemented for the protection of employees; provide regular updates based on developments in circumstances and the guidance from public health officials.”
Are members entitled to provide professional services to their patients via telephone and other electronic media.
The answer is YES with the caveat that you must ensure that the standards of practice of the profession are maintained including that you ensure that you are maintaining confidentiality about the communication of personal health information. Emails are not considered confidential unless appropriate measures have been taken to ensure that only the patient is able to retrieve/review the email.
I am a practitioner in a private community based office and have run out of PPE and therefore have effectively closed my office. What are my responsibilities to my patients who may need care?

First: try implementing virtual care to provide that care directly and ensure they get the care they need.

Second: try coordinating with colleagues to provide coverage. This may include colleagues whose scope of practice is different than yours, but who are able to provide assistance.

Third: while pharmacists are also currently experiencing the pressure of delivering care during the pandemic, they may be able to assist in some instances, like extending of renewing prescriptions.

Finally: avoid as much as possible simply redirecting patients to the Emergency Department of your local hospital. Hospitals are also being overwhelmed and finding means for providing care in the community as much as possible helps the entire system respond to this public health emergency. Instead, do your best to help patients navigate the system to find the care they need while you’re unavailable to them.

Can you give me a brief refresher on privacy issues regarding email and Skype or FaceTime conferencing with our patients? I’ve heard of some communicating with their patients in this manner and just want to make sure I am compliant and secure.

The College has taken  legal  advice but much of what you have asked is not legal in nature.

  • Legally/professionally members must ensure that all communications involving personal health information is confidential and limited to the patient and those with whom the patient has consented to share the information.  If the means of communication is done over a secure internet connection and the software uses encrypted connections, the communication should be private. It is our understanding that FaceTime and Skype are encrypted and therefore should be private.  We would suggest that emails not be used for communications involving personal health information as they are not private and there is no way to absolutely ensure that the information is only seen by the intended recipient.
Suggested Signage for Members

We want to assure patients who attend our office during this period that we are maintaining appropriate infection prevention and control procedures according to Public Health Ontario protocols.  We are also strongly advising our staff to follow the directions of the Government of Ontario regarding how to minimize the spread of the virus. It must be understood, however, that these are unprecedented times and despite screening all of our patients before they attend the office, it is impossible to give any assurances that the persons who do attend have not been exposed to the virus which could potentially put others at risk.

I have pairs of Prescription Custom Foot Orthoses (PCFO) that require dispensing. Are practitioners allowed to dispense while following PPE protocol?

Treatment for all patients can ONLY be provided if the Government’s legal directives are followed. Currently, Directive #2 for Health Care Providers is in place. Members should continue to consider the four principles (proportionality, minimizing harm to patients, equity and reciprocity) under Directive #2 when deciding whether to provide care.

For more information, refer to the Prescription Custom Foot Orthoses Standard.

I understand some members have built isolation rooms in their clinic's treatment room from plastic sheets to see patients during the COVID-19 pandemic. Is this something I should consider doing in my office?

No, the addition of extra items such as plastic sheeting into clinic treatment rooms can increase the amount of surfaces that will need disinfecting between patients. This does not meet current College IPAC standards of Practice or any advice provided by the College, PHO, CDC or WHO related to care of patients during the COVID-19 pandemic.

With the weather becoming colder, what should my patients do with their coats and belongings? Can a closet or coat rack in the waiting room be used?

Maintaining a common coat closet or coat rack in the office should be avoided. The Ministry of Health advises that best practice is to have the patient take their coat/belongings with them into the exam room providing this is not a room performing sterile procedures. In those situations, providing patients with a tote (plastic or other wipeable surface) to place their coat/belongings in is advised. Totes can be wiped after use.

What happens if a family member in my household gets sick or has symptoms of COVID-19? Can I work?

There are no specific protocols from the College that you would need to follow in this situation, but rather the provincial health guidelines. If this situation occurs, there should be protocols in place from the COVID-19 testing facility (or from the school/daycare/public health authority) to guide you. You’d have to wait and see what the direction from the authorities is; however, it’s safe to say be prepared to isolate until results are back if a member of your household has a test pending.

Important Links

The Ministry is looking for additional experienced health care providers to help provincial efforts to prevent and control the spread of COVID-19.

Specifically, they are looking for health care providers who may be working part-time and want to help and are prepared to increase their work hours or former healthcare providers who are retired, or on inactive status with their regulatory college; and are prepared to return to employment. The government is looking for health care providers (including those registered with health regulatory Colleges) who may be working part-time and are prepared to increase their work hours, or former healthcare providers who are retired, or on inactive status with their regulatory college and are prepared to return to employment.

For more information please visit the following sites:

In English:: http://www.healthforceontario.ca/en/M4/COVID19

In French: http://www.healthforceontario.ca/fr/M4/COVID19

 

For your information a link can also be found in the following locations on the Ministry Website

Link on the Ontario.ca/coronavirus

EN : https://www.ontario.ca/page/2019-novel-coronavirus#section-12

FR : https://www.ontario.ca/page/2019-novel-coronavirus#section-12

 

And on the COVID-19 page for providers on health.gov.on.ca

EN : http://www.health.gov.on.ca/en/pro/programs/publichealth/coronavirus/2019_guidance.aspx

FR : http://www.health.gov.on.ca/fr/pro/programs/publichealth/coronavirus/2019_guidance.aspx

FACE MASKS
Can I reuse my medical mask?

Ideally, masks are to be discarded once removed, but if supplies are limited, these may be re-used if they are not visibly soiled, contaminated, wet or otherwise damaged. A single mask may be worn for an extended period (e.g., donned at the beginning of the clinic, and continued to be worn) as long as it is not visibly soiled, damp, damaged or difficult to breathe through. Masks are to be discarded at the end of the clinic.

  • The mask is to be donned when entering the clinic and removed when eating or leaving the clinic
  • If a mask is to be reused, it must be kept from being contaminated by storing it in a clean paper bag, or in a cleanable container with a lid. Paper bags are to be discarded after each use. Reusable containers are to be cleaned and disinfected after each use.
  • Bags and containers are to be labelled with the individual’s name to prevent accidental misuse.
  • Do not store masks where they can become damaged or contaminated. Damage can impact the mask’s effectiveness.
  • Change the mask when it is wet or soiled.
  • Change the mask when it is hard to breathe through.
  • Change the mask when it becomes contaminated
Do I need to use a N95 Respirator?

According to College IPAC Standards of Practice, the purpose of N95 respirators in the profession is for nail debridement in the absence of dust extraction or water spray. N95 respirators are used when an AGMP (Aerosol Generating Medical Procedure) is being performed on a probable or confirmed case of COVID-19. The procedures under our scope of practice are not considered AGMP. Medical N95 respirators do not have valves. If the N95 respirator has a valve, you must wear a procedure mask over top to ensure droplet control as the valve only filters inhalation, not exhalation.

Can I reprocess (autoclave) face masks?

The reprocessing of face masks documented applies to N95 respirators ONLY.  This is not recommended. Reprocessing would require testing the efficacy of the N95 after reprocessing and the proof of effectiveness of removing the pathogens from the respirators. Due to the scope of practice, this should not be required as the use of such respirators is limited because of the very specific use.

Do my patients need to wear masks?

Use of masks/facial coverings by patients is a form of UNIVERSAL MASK USE. Masks/facial coverings are used to protect others from the wearer’s droplets. Patients MUST wear some form of facial covering during their visit to Members’ facilities, if tolerated. This is essential for droplet control originating from the patient, and therefore protection of the Member and others in the clinic space. Patients must be informed of this requirement at the time of procuring an appointment. The mask the patient wears is NOT required to be a medical/surgical mask. Examples could be as follows: homemade masks, scarves, bandanas, etc. If a Member has an adequate supply of face masks, they can provide the patient with a single use face mask should they arrive for their appointment without one. 

If the patient is unable to tolerate a mask due to a physical or mental disability and requests an exemption from wearing one, the Member has an obligation to accommodate the patient’s special needs up to the point where it would impose undue hardship on the Member. In Ontario, Members have a duty to provide chiropody services to the public free from discrimination, as is required by the Human Rights Code. Members are also required to do so under section 1(8) of the Professional Misconduct Regulation. Consequently, Members shall recognize that, while they have the right respecting choice of patients, they are still required to act in a manner consistent with the Human Rights Code (see the Patient Relations Standard).

Determining what is a reasonable accommodation is done on a case-by-case basis. Members will need to speak with patients about their needs, and work with the patient to determine what alternatives exist that can address those needs. For example, is it possible to waive the requirement for a mask for that patient, or for the patient to wear a face shield, or other steps that can be taken to address the risk?  If Members have questions as to how to comply with their human rights obligations, they should seek advice from legal counsel.

Can practitioners wear another type of mask (e.g. Homemade)?

NO. The replacement of standard PPE with items produced with materials not having the necessary requirements (e.g. cotton cloth masks to replace medical masks or respirators) has not been proven to be effective and is not acceptable.

EYE PROTECTION
Do I have to wear eye/facial protection for each patient?

The use of eye protection and facial protection is required as part of droplet precautions. Types of eye protection / facial shields are as follows:

  • Disposable face shields, goggles, and visors (attached to surgical masks) that are disposed after each patient interaction is the optimal choice
  • Reusable goggles, safety glasses (trauma glasses) with extensions to cover the side of the eyes, face shields (must be designed to cover the side of the face and to below the chin) that are removed after each patient treatment and reprocessed is the second choice.
  • Extended use of disposable face shields, goggles, and visors (attached to surgical masks)
  • Alternative – local production of face shields (risk is suboptimal quality, including inadequate shape to ensure face protection)
How do I reprocess my eye/facial protection?
  • The reuse of eye protection without appropriate decontamination / sterilization is strongly discouraged.
  • Clean goggles, safety glasses, face shields with soap/detergent followed by disinfection using either sodium hypochlorite 0.1% (followed by rinsing with clean water) or 70% alcohol wipes
  • Goggles, safety glasses, face shields may be cleaned immediately after removal and hand hygiene is performed OR placed in a designated closed container for later cleaning and disinfection.
  • Ensure cleaning of eye protection takes place on a clean surface by disinfecting the surface before cleaning of eye protection
  • Appropriate contact time with disinfectant (e.g. 10 minutes when using sodium hypochlorite 0.1%) should be adhered to before reuse of goggles, safety glasses, face shields.
  • After cleaning and disinfection, they must be stored in a clean area to avoid recontamination.
What precautions should I consider when removing the eye/facial protection?

Follow safe procedure for removal of goggles, safety glasses, face shields to prevent contamination of eyes.

  • Use of the same goggles, safety glasses, face shields by a health care worker between a patient with COVID-19 and a patient who does not have COVID-19 is not recommended due to the risk of transmission to another patient who would be susceptible to COVID-19
  • Remove, reprocess, and replace if goggles, safety glasses, face shields are contaminated by splash of chemicals, infectious substances, or body fluids
  • Remove, reprocess, and replace If goggles, safety glasses, face shields obstruct health care worker safety or visibility of health care environment or become loose
What are the potential risks of extended use of eye/facial protection?
  • The removal, storage, re-donning, and reuse of the same, potentially contaminated PPE items without adequate reprocessing is one of the principal sources of risk to health care workers.13
  • Extended use of goggles, safety glasses, face shields may increase the discomfort and fatigue of health care workers
  • Skin tissue damage may occur to face with prolonged use
GOWNS
Do I have to wear an isolation gown to treat ALL patients?

NO. Triple screening identifies COVID-19 negative patients. Use of universal masking and hand hygiene by patients will help to reduce the need for isolation gowns in potentially asymptomatic/pre-symptomatic patients. Use of environmental, structural and process controls along with disinfection protocols is also essential. However, you must utilise gown when contact precautions and individual risk assessment requires it.

Do I need to wear an isolation gown to perform a surgical procedure?

YES. The College IPAC Standards of Practice requires use of a gown.

If I do not have any isolation gowns, what are appropriate alternatives if I deem a patient care requires CONTACT precautions?

There are NO recommended alternatives at present approved by PHO. It is strongly recommended Members do NOT treat such patients if you do not have the appropriate PPE (i.e. isolation gown)

Can I wear a lab coat as an additional precaution over my clinical attire?

YES, HOWEVER clinical and laboratory coats or jackets are not a substitute for gowns where a gown is indicated. A lab coat is not considered a PPE but a form of clinical attire. It must be changed if soiled A lab coat cannot be used in place of an isolation gown for contact precautions.

I would like to wear a gown as a precaution. Can I wear the same gown between patients?

YES. The same gown may be worn between patients who have been screened and determination made that contact precautions are not required. This gown must be changed if soiled or damaged. HOWEVER, if upon screening it is determined that contact precautions are indicated for a patient, a gown required is required and should be disposed of immediately after providing care or reprocessed as per the guidelines below if of the reusable variety.

Can I make my own or use a home-made gown as a form of PPE?

NO. A home-made gown is not a form of PPE. Isolation gowns are deemed medical devices and as such all medical gowns are Class I medical devices. Class I devices must be manufactured by companies that hold a Medical Device Establishment Licence (MDEL).

What should I do with my ‘clinical attire’ when travelling to and from my clinic?

It is strongly recommended that clinical attire should ONLY be worn within the clinic setting. Members should change into their clinic attire when arriving and removing it prior to leaving the clinic. Clinical attire should be changed laundered daily unless soiled or contaminated in which case it should be changed at that time.

How do I launder reusable gowns and lab coats and clinical attire properly?
CDCWHOWHO
  1. Soaps and detergent
  2. Hot water of at least 160F (71C) for a minimum of 25 minutes
  3. Chlorine bleach
  4. Mild acid during the last rinse cycle
  1. Machine wash with warm water (60-90C)
  2. Laundry detergent
  1. Soak in hot water and soap
  2. Stir with a stick
  3. Soak with 0.05% chlorine for approximately 30 minutes
  4. Rinse with clean water
  5. Let dry in sunlight
LONG TERM CARE FACILITIES (LTCF's)
Advisory Relating to COVID-19 and the Provision of Chiropody/Podiatry Care in Long Term Care Facilities (LTCF’s)

June 16,2020 – If a Member is required to provide care at a LTCF, the Member must communicate directly with the administration of the LTCF prior to the visit to establish and ensure that all the LTCF protocols are in place including the requisite screening (of Member and resident), and that the Member has all required PPE or ensures that the facility will provide the required PPE.

Members should be fully aware of all the implications and responsibilities of providing care in long term care facilities and the potential risks associated with the transmission of COVID-19. Members must be fully aware of all policies for individual LTCF’s as well as directives from Public Health Ontario, the Ministry of Health (MOH) the Chief Medical Officer of Ontario and relevant Standards of Practice of the College of Chiropodists.

Resources
  1. Public Services Health and Safety Association, Health and Safety Guidance during COVID-19 for Long Term Care https://www.pshsa.ca/resources/health-and-safety-guidance-during-covid-19-for-long-term-ca
  2. Ministry of Health, COVID-19 Screening Tool for Long-Term Care Homes and Retirement Homes, Version 2 – April 24, 2020
  3. Ministry of Health, COVID-19 Outbreak Guidance for Long-Term Care Homes (LTCH), Version 2 – April 15, 2020: http://www.health.gov.on.ca/en/pro/programs/publichealth/coronavirus/docs/LTCH_outbreak_guidance.pdf
  4. Public Health Ontario, COVID-19: Infection Prevention and Control Checklist for Long-Term Care and Retirement Homes: https://www.publichealthontario.ca/-/media/documents/ncov/ipac/covid-19-ipack-checklist-ltcrh.pdf
  5. Ministry of Health, COVID-19 Guidance: Home and Community Care Providers, Version 4 – May 4, 2020: http://www.health.gov.on.ca/en/pro/programs/publichealth/coronavirus/docs/2019_home_community_care_guidance.pdf
  6. Ministry of Health – Ministry of Long-Term Care: COVID-19 Guidance for the Health Sector: http://www.health.gov.on.ca/en/pro/programs/publichealth/coronavirus/2019_guidance.aspx