There are two things I am sure about; one is that Governments around the world will reduce the restrictions currently in place when it makes sense to do that. The second thing I am sure about is that just because they have relaxed those limits, does not mean that we no longer have to fear the virus. That means that every industry in the world needs to look at risk management and mitigation.
While we are on lockdown, it is worth considering how we can offer services when Governments loosen the restrictions. They will relax restrictions and begin to move towards a working economy in a stepped approach. I believe that there will be strict guidelines as before on social distancing. Many of the new normal things that we do now, such as queuing to access shops, and the protective measures in place to keep us apart will continue.
The danger will still exist
However, you need to understand that does not mean that the threat of the virus will go away. The danger of the infection will not recede until we vaccinate everyone, or, we discover a reliable treatment regime. It may be quite sometime before either of those things happen. If you listen to the experts, a vaccine may be as much as 18 months away. A reliable treatment regime may arrive sooner than that; however, no one can guarantee that.
That means that there will continue to be risk involved in every day to day activity that you undertake. That is everything from how you get to work, what you do there and finally how you get home. Risk is inherent in life; risk is inherent in most industries, the key to managing and mitigating risk is assessing it, understanding it, and where possible removing it.
Mitigating the risk
However, if you can not remove the risk, you need to take precautions to lower or mitigate the risk. The following is some thoughts on the mitigation of risk in our practices after lockdown restrictions have been relaxed. First I will discuss risk management strategies and why worst-case scenarios are what you need to focus on.
In any risk strategy, you need to assess everything involved using the information that is available to you. In this case, any risk strategy needs to be informed by the reliable science available. I will discuss possible risk mitigation strategies, and I will also detail why I feel they are warranted. I would hope that this approach will make the most sense. However, I would urge you to do your research and base your risk assessment and processes on that research.
We know that COVID-19 is a highly infectious respiratory virus. We know that at least up to now, it has been far deadlier by mortality rate than the common Flu. Up to recently, the thoughts were that the virus spreads through contact and larger droplets expelled from the mouth and nose.
More recently, there has been more significant worry about spread through aerosolization. This is an essential factor to consider, while they have not established that someone can spread the disease just through the act of breathing, we need to consider it as a worst-case scenario.
The understanding of how the virus spreads is a crucial start point; considering the worst-case scenario for the spread allows us to understand the steps needed to mitigate risk. The question is how do we use it and what strategies do we implement? More importantly, it is imperative that you understand the risk as present during your day, not during your work hours.
From the moment you leave the house
Risk of infection and cross-infection does not begin when people come into your practice. It starts the minute you leave your house to go to work. Therefore, it makes sense for us to look at our day and any possible encounters during it as part of our assessment. If for instance, your journey to work is in a private car on your own, well then the risk is minimal to non-existent.
If your journey is a combination of walking and public transport, well then your risk is exponentially higher. What you do needs to be based on the possibles, don’t think probably, think worst case possibles and plan from there.
Controlling the distance
Any situation where you can not control the distance between yourself and others is a risk. While up to now the standard distance discussed has been two metres, studies are showing that the distance may not be enough in certain circumstances. As I said, we need to work with worst-case scenarios, so if distancing is an issue, the suitable precaution to reduce risk is to mask up.
Masking up
According to any of the information I have seen available, FFP-3 masks offer the best protection available during long wear and high exposure. This is the mask type you need to consider wearing during your day from the moment you leave the house to the moment you return. If FFP-3 isn’t available to you, FFP-2 or N95 masks are acceptable but you need to change them during the day based on your possible exposure.
There are considerations to wearing your mask, including how you put it on and take it off as well as how you will disinfect it. I will cover none of that here, but mention them so that you are aware they exist. If we are to see people for consultation in our clinics, we need processes and procedures to allow that happen in the safest manner possible.
Pre-Screening
Before we undertake any appointment, we need to pre-screen the customer by phone. Pre-screening should ensure that no one with active symptoms or with exposure to someone with active symptoms will make an appointment. However, pre-screening will not eliminate the possibility that someone who is asymptomatic but infected will not attend.
Again, we must work on worst-case scenarios. Therefore, we need to work on the basis that everyone we see is infected. In this manner, and only in this manner can you work through the possibles and reduce the risk. That means that for any face to face consultations such as impressions, fitting hearing aids, providing hearing tests and removing earwax need to be undertaken under the belief that the person is infected.
How will we do it?
Finally, I can hear some of you say, what does that mean and what can we do. The first thing it means is that we need a robust PPE strategy. If we are to see people, we need adequate supplies of robust PPE to protect us, our staff and our customers. We also need buffer times between appointments for disinfection processes and airing out the room.
These steps are especially necessary if we work under the belief that the virus is genuinely aerosolised. That is another reason why we need PPE for the customer and a transparent process for using it. It would be best if you had a mask for the customer, and they need to be met at the door of the business and instructed how to wear it.
That is the only way that you can help to reduce the possible shedding of viral load in your room. It is also the only way that you can be sure that you are protecting your customer from potential cross-contamination by an aerosolised virus. A good quality surgical mask should reduce the chances of viral load shedding. If you can get your hands on a supply of FFP-2 or N95 masks, they would, of course, be better.
However, considering the amount of time that the customer is in your practice, a well fitted surgical mask should do. You also need to get your customer to use hand sanitiser to clean their hands. Again, you should do that at the door. It is important that the customer understands clearly that the mask does not come off until they have left the premises.
I need to be really clear here, we need to to ensure there is little risk for the customer to either breathe in or breathe out the virus. That means that you have to ensure they are masked. Either that or you use something like a Nocospray. That is an aerosolised hydrogen peroxide mix that fills the room and completely kills everything. It is a costly and lengthy process which involves some time to then clear the room of the spray.
If you are undertaking any procedure that brings you close to the customer, you need full PPE including your mask, goggles and a disposable apron or full gown. While there are advantages to wearing gloves, there are also disadvantages; you should decide what is best for you. One way or the other, that is the only way you can be safe, that is the only way you can mitigate the risk.
After you have touched a customer, you need to use hand sanitiser or wash your hands immediately or if wearing gloves, remove them and throw them away. It would be best if you did not touch anything else; you need to do it immediately.
When you have finished your consultation, you need to remove your gown or apron, and any gloves safely and dispose of them in a clinical waste bag. You also need to remove your goggles carefully and disinfect them. You then need to begin the process of cleaning the room and allowing it to air before you admit the next customer.
When the restrictions are eased, we need to consider what we are going to do and how. My advice to you is
This isn’t an instruction manual for the processes needed, I see it more as a clear outline for the identification and management of risk. Your job is to understand all the implications of the risk and set out your processes clearly and document them.
