Reopening Tool Kit | Practicing DPMs | APMA
Reopening Tool Kit

As you reopen your practice, increase your patient load, or get back into the operating room, you are going to want to protect yourself, your personnel, and non-COVID-19 patients accessing health care from infection. Considering that patients who are asymptomatic may still be COVID-19 infectious, it should be assumed that all patients can transmit disease. You must balance the need to provide necessary services while minimizing risk to patients and health-care personnel.

In general, you must follow and comply with local guidelines and recommendations related to reopening, including social distancing practices, hospital or surgery center guidelines for scheduling procedures, etc. We have a number of suggestions below related to your practice, infection prevention and control, patients, and staff.

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Office Operations
General Practice Considerations
Specific Practice Considerations
Infection Prevention & Control
What to Share with Patients
Staff Considerations
What To Do If Someone (Patient or Staff) Tests Positive
Vaccines and Masks

Office Operations

The CDC has published Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic.

  • Section 1 - Recommended routine infection prevention and control (IPC) practices during the COVID-19 pandemic includes, but is not limited to, information on the following:
    • Recommended practices that are intended to apply to all patients, not just those with suspected or confirmed COVID infection (Section 2 addresses recommendations for a patient with suspected or confirmed SARS-CoV-2 infection).
      • Implement telehealth and nurse triage protocols.
        • Advise patients they should put on their own well-fitting form of source control (face covering).
      • Screen and triage for signs and symptoms of COVID-19.
      • Implement universal source control measures.
      • Encourage physical distancing.
      • The CDC provides information on:
        • HCP working in facilities located in areas with moderate to substantial community transmission.
        • HCP working in areas with minimal to no community transmission.
      • Consider if elective procedures, surgeries, and non-urgent outpatient visits should be postponed in certain circumstances.

The CDC also has Infection Control after Vaccination information that applies to all HCP while at work and all patients and residents while they are being cared for in a health-care setting.

“Except as noted in the Updated Recommendations below, HCP should continue to follow all current infection prevention and control recommendations, including those addressing work restrictions, quarantine, testing, and use of personal protective equipment to protect themselves and others from SARS-CoV-2 infection.”

  • Of note from the Infection Control after Vaccine page:
    • Communal activities within a health-care setting
      • What infection prevention and control practices are recommended when planning for and allowing communal activities?
        • Healthcare Personnel (HCP)
          • In general, fully vaccinated HCP should continue to wear source control while at work. However, fully vaccinated HCP could dine and socialize together in break rooms and conduct in-person meetings without source control or physical distancing. If unvaccinated HCP are present, everyone should wear source control and unvaccinated HCP should physically distance from others.
    • Use of PPE

The CDC provides additional general Infection Control Guidance for Healthcare Professionals about Coronavirus (COVID-19).

On June 10, 2021, the US Department of Labor's Occupational Safety and Health Administration announced it will issue an emergency temporary standard (ETS) to protect healthcare workers from contracting coronavirus.

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General Practice Considerations

  • Prioritize services that, if deferred, are most likely to result in patient harm.
  • Know and follow your local guidelines. 
    • Check your state, county, city, hospital, or surgery center guidelines/recommendations.
  • Consider the local level of COVID-19 transmission when making decisions about the provision of medical services. Check out COVID-19 incidence by county:
  • Changes are happening rapidly—designate someone in your office to monitor changes to guidelines and keep the group up-to-date.
  • Create an office policy related to COVID-19 and how you will handle patients who present with fever or symptoms of COVID-19.
  • Meet with staff frequently to discuss the symptoms and spread of COVID-19; how to protect yourself and others; infection prevention and control; and any new policies, procedures, and/or protocols that are created for the office.
  • Limit points of entry and manage visitors.
  • Screen everyone (patients, staff, visitors, delivery personnel, etc.) for symptoms (Note: fever and symptom screening have proven to be relatively ineffective in identifying all infected individuals).
  • Implement source control (face coverings) for those entering your practice, regardless of symptoms.
  • Emphasize hand hygiene.
  • Install barriers to limit contact with patients at triage/reception points.
  • Know what your cleaning service vendor’s protocols are.

The CDC's Framework for Healthcare Systems Providing Non-COVID-19 Clinical Care During the Pandemic has additional information for healthcare systems to deliver non-COVID-19 health care during the COVID-19 pandemic that you might find useful.

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Specific Practice Considerations

  • Consider reaching out to patients who may be a higher risk of COVID-19-related complications such as the elderly, those with medical comorbidities, and potentially other persons who are at higher risk for complications from respiratory diseases, such as pregnant women, to ensure adherence to current medications and therapeutic regimens, confirm they have sufficient medication refills, and provide instructions to notify their provider by phone if they become ill.
  • Identify staff to conduct telephone interactions with patients.
    • Develop protocols so that staff can triage and assess patients quickly.
    • The Centers for Disease Control and Prevention created a COVID-19 Phone Script.
  • Instruct patients to call ahead and discuss the need to reschedule their appointment if they develop fever or symptoms of COVID-19 on or before the day of their scheduled appointment.
  • Ask about symptoms during appointment reminder calls.
  • Consider your communications.
    • To colleagues, patients, and staff.
    • In the form of letters, emails, website edits, answering machine messages, office hour postings, what conditions you are treating, etc.
  • Handle payment and reappointment over the phone.
  • Implement source control (face coverings) for everyone entering.
    • Require everyone entering the office to wear a cloth face covering (if tolerated) while in the building, regardless of symptoms.
    • Health-care personnel should wear a face mask (with eye shield/protection) at all times while in the facility.
  • Place reception area chairs six feet apart or remove altogether.
  • Remove communal reading materials.
  • Provide hand sanitizer, tissues, and no-touch receptacles for disposal at entrances, reception areas, and check-ins.
  • Install physical barriers at reception areas to limit close contact between triage personnel and potentially infectious patients.
  • Use non face-to-face services when possible.
    • Explore alternatives to face-to-face triage and visits. These can reduce in-person health-care visits and prevent transmission of respiratory viruses in your office.
      • Instruct patients to use available telephone advice lines, patient portals, and on-line self-assessment tools, or call and speak to an office/clinic health-care personnel if they become ill with symptoms such as fever, respiratory symptoms like cough or shortness of breath, or other symptoms of COVID-19.
      • Implement an algorithm to identify which patients have symptoms that may be due to COVID-19 and need to be advised to seek care with their PCP or 911 transport to an emergency department.
  • Consider triage stations outside the office to screen patients before entering. Create a process. Example steps in the process might be:
    • All patients should be asked about the presence of fever, symptoms of COVID-19, or contact with patients with possible COVID-19.
    • Check patient’s temperature (<100.4°F) with thermometer.
      • Touchless forehead scanning is convenient and produces less waste, though any thermometer is appropriate as long as it is cleaned appropriately between uses.
      • If elevated temperature is noted (≥100.4°F), supply patient with mask and instruct them how to don it; follow through with asking screening questions, and follow your office policy related to patients with fever (refer to PCP, ED, etc.)
    • Ensure triage personnel who will be taking vitals and assessing patients wear a respirator (or face mask if respirators are not available), eye protection, and gloves for the primary evaluation of all patients presenting for care until COVID-19 is deemed unlikely.
    • Triage personnel should have a supply of face masks or cloth face coverings; these should be provided to all patients who are not wearing their own cloth face covering at check-in, assuming a sufficient supply exists.
    • In some settings, patients might opt to wait in a personal vehicle or outside the health-care facility where they can be contacted by phone when it is their turn to be evaluated.
    • Limit visitors to only those essential for the patient’s physical or emotional well-being and care.
      • Encourage use of alternative mechanisms for patient and visitor interactions such as video-call applications on cell phones or tablets.
    • Do not allow entry into the building if fever or COVID-19 symptoms are present.
  • Health-care personnel should perform hand hygiene before and after all patient contact and before putting on and after removing PPE, including gloves.
  • Limit paperwork and medical documentation to clean areas only.
  • Consider covering keyboards with plastic wrap and change between patients.
  • No hand shaking or physical contact.
  • Clean and disinfect the room after patients leave.
    • Clean and disinfect frequently touched surfaces using EPA-registered disinfectants, including counters, chairs, seating, etc.
  • Eliminate patient penalties for cancellations and missed appointments related to respiratory illness.
  • Regularly inventory PPE supplies.

The CDC has additional information on evaluating and testing persons for COVID-19.

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Infection Prevention & Control

  • Print and share/place visual alerts, like these resources, to remind everyone of proper etiquette:
  • Environmental Infection Control
    • Ensure that environmental cleaning and disinfection procedures are followed consistently and correctly.
    • Routine cleaning and disinfection procedures (e.g., using cleaners and water to pre-clean surfaces prior to applying an EPA-registered, hospital-grade disinfectant to frequently touched surfaces or objects for appropriate contact times as indicated on the product’s label) are appropriate for SARS-CoV-2 in health-care settings, including those patient-care areas in which aerosol-generating procedures are performed.
    • Refer to the EPA’s List N for EPA-registered disinfectants that have qualified under the EPA’s emerging viral pathogen program for use against SARS-CoV-2.

Note that workers who perform cleaning and disinfection in health care may require PPE and/or other controls to protect them simultaneously from chemical hazards posed by disinfectants and from human blood, body fluids, and other potentially infectious materials to which they have occupational exposure in the health-care environment.

The CDC provides more information on cleaning and disinfecting your facility. The EPA also provides more information related to cleaning and disinfection for community facilities

The CDC provides more information on infection prevention and control recommendations for patients with suspected or confirmed COVID-19 in health-care settings.

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What to Share with Patients

  • Be transparent with what you are doing to ensure their safety.
  • Send a letter to let patients know of new practices, policies, and procedures they can expect when visiting your office.
  • Communicate about COVID-19 with your patients.
  • Provide information on face coverings.
    • Because cloth face coverings can become saturated with respiratory secretions, care should be taken to prevent self-contamination.
    • Face coverings should be changed if they become soiled, damp, or hard to breathe through, laundered regularly (e.g., daily and when soiled), and hand hygiene should be performed immediately before and after any contact with the cloth face covering.
    • Perform hand hygiene before and after adjusting face coverings.
    • Face masks and cloth face coverings should not be placed on young children under age 2, anyone who has trouble breathing, or anyone who is unconscious, incapacitated, or otherwise unable to remove the mask without assistance.
    • Patients may remove their cloth face covering when in their rooms but should put them back on when leaving their room or when others (e.g., health-care personnel, visitors) enter the room.
    • How to make a face covering:

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Staff Considerations

  • Communicate about COVID-19 with your staff. Share information about what is currently known about COVID-19, the potential for surge, and your practice's preparedness plans.
  • Show your support and share information with your staff on how to cope with stress and build resilience during the COVID-19 pandemic.
  • Provide your team with job- or task-specific education and training on preventing transmission of infectious agents, including refresher training.
  • Ensure that health-care personnel are educated, trained, and have practiced the appropriate use of PPE prior to caring for a patient, including attention to correct use of PPE and prevention of contamination of clothing, skin, and the environment during the process of removing such equipment.
    • Hand hygiene
      • Upon entry to the office.
      • Before and after any contact with patients.
      • After contact with contaminated surfaces or equipment.
      • After removing PPE.
    • How to wash hands and use sanitizer.
    • Personal Protective Equipment (PPE)
      • Who needs PPE?
      • How to don and doff PPE.
        • New England Journal of Medicine provides a video on donning and doffing PPE.
        • When available, face masks with eye protection are generally preferred over cloth face coverings for health-care personnel, as face masks with eye protection offer both source control and protection for the wearer against exposure to splashes and sprays of infectious material from others.
        • If there are shortages of face masks, they should be prioritized for health-care personnel who need them for PPE.
        • Cloth face coverings should not be worn instead of a respirator or face mask if more than source control is required.
        • Cloth face coverings are not considered PPE.
      • FAQs regarding PPE.
        • Given the potential for asymptomatic transmission of SARS-CoV-2, what PPE should be worn by health-care personnel providing care to patients who are not suspected to have COVID-19?
          • The potential for asymptomatic SARS-CoV-2 transmission underscores the importance of applying prevention practices to all patients, including social distancing, hand hygiene, surface decontamination, and having patients wear a cloth face covering or face mask (for source control) while in a health-care facility. To protect patients and co-workers, health-care personnel should wear a face mask at all times while they are in a health-care facility (i.e., practice source control). Use of a face mask, instead of a cloth face covering, is recommended for health-care personnel, because a face mask offers both source control and protection from exposure to splashes and sprays of infectious material from others.
  • Staff should regularly monitor themselves for fever and symptoms of COVID-19.
    • Advise employees to check for any signs of illness before reporting to work each day and notify their supervisor if they become ill.
    • Health-care personnel should be reminded to stay home when they are ill.
    • If health-care personnel develop fever (T≥100.4°F) or symptoms consistent with COVID-19 while at work they should keep their cloth face covering or face mask on, inform their supervisor, and leave the workplace.
      • Symptoms may appear 2–14 days after exposure to the virus.
      • People with these symptoms may have COVID-19:
        • Fever or chills
        • Cough
        • Shortness of breath or difficulty breathing
        • Fatigue
        • Muscle or body aches
        • Headache
        • New loss of taste or smell
        • Sore throat
        • Congestion or runny nose
        • Nausea or vomiting
        • Diarrhea
      • This list does not include all possible symptoms. CDC will continue to update this list as we learn more about COVID-19.
    • Screen all health-care personnel at the beginning of their shift for fever and symptoms consistent with COVID-19.
      • Actively take staff temperature and document absence of symptoms consistent with COVID-19.
        • If a staff member is ill, have them keep their cloth face covering or face mask on, and leave the workplace.
      • Consider implementing a daily health screening check point and log for all employees entering the office.
        • Ask all persons (employees/owners/associates) reporting to work the following questions, remembering to respect their confidentiality:
          • Do you have any of the following?
            • Fever or feeling feverish (chills, sweating). Not necessary if temperature taken, though ask about fever-reducing or symptom altering medications.
              • Employees who have symptoms of acute respiratory illness are recommended to notify their supervisor and stay home until they are free of fever (100.4° F or greater using an oral thermometer), have no signs of a fever, and any other symptoms for at least 24 hours, without the use of fever-reducing or other symptom-altering medicines (e.g., cough suppressants).
            • Shortness of breath (not severe)
            • Cough
          • Are you ill, or caring for someone who is ill?
            • Persons who are well but who have a sick family member at home with COVID-19 should notify their supervisor.
            • Address coming to work in your office policies, address sick leave absences as is appropriate for your office situation and size, and follow any federal and state employment law provisions.
            • If an employee is confirmed to have COVID-19, the employer should inform fellow employees of their possible exposure to COVID-19 in the workplace but maintain confidentiality as required by the Americans with Disabilities Act (ADA).
          • In the two weeks before you felt sick, did you:
            • Have contact with someone diagnosed with COVID-19?
            • Live in or visit a place where COVID-19 is spreading?
    • Note: Fever is either measured temperature 100.4°F or subjective fever. Fever may be intermittent or may not be present in some individuals, such as those who are elderly, immunosuppressed, or taking certain medications (e.g., NSAIDs). Respiratory symptoms consistent with COVID-19 include cough, shortness of breath, and sore throat. Medical evaluation may be recommended for lower temperatures (<100.4°F) or other symptoms consistent with COVID-19.
  • Health-care personnel with suspected COVID-19 should be prioritized for testing.
  • Make contingency plans for increased absenteeism caused by employee illness or illness in employees’ family members that would require them to stay home. Planning for absenteeism could include extending hours, cross-training current employees, or hiring temporary employees. Be prepared and refer to the Strategies to Mitigate Healthcare Personnel Staffing Shortages document for more information.

The CDC provides additional information regarding risk assessment and work restrictions for health-care personnel with potential exposure to COVID-19, and criteria for return to work for health-care personnel with suspected or confirmed COVID-19

OSHA also has recommendations of mandatory safety and health standards that are intended to assist employers in providing a safe and healthful workplace. 

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What To Do If Someone (Patient or Staff) Tests Positive

Vaccines and Masks

APMA has received questions about mask requirements and face coverings in podiatric offices in light of recent (May 16, 2021) CDC guidance for those fully vaccinated. APMA recommends that podiatric offices comply with state or local jurisdiction rules regarding face covering requirements as they apply to businesses and health-care settings.

You should encourage your unvaccinated patients to follow Prevention Measures Still Recommended for Unvaccinated People. APMA also recommends that podiatric physicians encourage eligible patients to get vaccinated.

Additional Guidance for Unvaccinated People regarding Doctor Visits and Getting Medicines and Updated Healthcare Infection Prevention and Control Recommendations in Response to COVID-19 Vaccination is available from the CDC.

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While these resources provide background information and practice solutions for podiatric physicians, APMA is not rendering legal or other professional advice. APMA encourages readers of these resources who need assistance to consult with an attorney duly licensed in your jurisdiction.

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