Although our circumstances across the country will differ, our common goals of providing a safe environment for our patients and colleagues along with making sure our families are safe when we return home allow us to provide some recommendations. These recommendations come from the CDC, infectious disease experts, and major medical centers who are focused on returning to in-person care when appropriate in the safest manner possible.
The following recommendations are divided into (1) who should come in, (2) creating the safest environment including standard universal precautions as well as new precautions to implement, and (3) keeping our families safe.
Who Should Come In
As with other aspects of health care, we can resume the full scope of audiology services with a phase-in approach.
Initially—and going forward—we can consider that anyone who can be helped remotely could continue to be helped remotely. Patients can continue to drop off devices curbside or mail in devices in need of repair. Many minor hearing aid program changes can be accomplished remotely if your patient has a smartphone; work with manufacturers to update your knowledge in this area if needed. Anyone with an emergency such as sudden hearing loss, lack of hearing, etc. should be seen in person.
The next stage of in-person care will involve individuals where putting off care further will result in poor outcomes. This may include newly identified hearing loss in children, adults who are suffering from lack of communication, and initial cochlear implant simulations among other specific situations.
Finally, and no one can predict exactly when this will be, we will be more comfortable allowing any of our patients to be seen in person if that is their preference.
It is not enough for you to be ready to see patients in person; the patient must feel safe coming in to see you. This will vary by patient, and we want to be respectful and offer as much remote care as possible. You can reassure patients by outlining on your web page all that you are doing to ensure your patients’ and colleagues’ safety.
With each patient contact, ask yourself: Can this issue be taken care of via telehealth? Does putting off in-person care risk the patient’s health or well-being? If you determine that the patient should come in person, provide a COVID-19 telephone screening including:
- Have you traveled in the last 21 days?
- Have you had a fever, cough or shortness of breath?
- Have you been exposed to someone known to have COVID-19?
If the answer is “yes” to any of these questions, refer the patient to his primary care provider who will determine the need for COVID-19 testing. These individuals should not be seen in-person at this time if it can be avoided. Note, these questions and responses will change as we have increased testing and as more individuals have been exposed to and survived the virus.
Creating the Safest Possible Environment
In creating the safest possible in-person environment, you will want to consider the following recommendations.
The first set of recommendations are standard procedures that are not specific to the global pandemic.
- Hand washing should be the norm before and after each patient visit.
- All areas occupied by a patient (chairs, counters, etc.) should be disinfected using appropriate cleaners between patients. All equipment that touches the patient also should be disinfected between patient use. Devices that will be tested and will touch equipment should be disinfected prior to testing.
- All tools and equipment that are used with patients or their devices need to be cleaned with disinfectant between uses (consider disposable items if possible/appropriate).
New recommendations related to the global pandemic.
- Handwashing remains the primary recommendation for minimizing transmission. You may want to consider eliminating rings and bracelets at this time since they make it harder to wash hands well. Many medical centers are recommending the use of short sleeve tops for more thorough hand washing and asking clinicians in all specialties to eliminate the use of lab coats. You may want to wear scrubs with pockets which allow for short sleeves and for carrying necessary items.
- Universal masking. All health care providers and staff should be wearing surgical masks (changed each day unless soiled during the day) and all patients should be wearing masks whether cloth masks from home or a mask provided by your clinic.
- You will want signage throughout your space indicating that the expectation is that everyone is using a mask that covers their mouth and nose. You may want to consider purchasing FDA approved masks with the mouth area being see through for better communication.
- Health-care providers should use gloves that will be changed between patients.
- If you will be working with devices that you and the patient will be touching (e.g., device orientation), you may want to encourage your patient to wash their hands as well prior to the interaction.
- Equipment used by audiologists also should be wiped with disinfectant between use. You may want to eliminate headset use with audiometers in order to have less equipment touching people if that is possible in your setting.
- As we move back in to in-person care, we want to limit interaction among patients. Even though direct patient care doesn’t allow social distancing, we want to maintain social distancing among patients. Methods to accomplish this include careful scheduling that prevents patient overlap.
- Depending on your location you may have patients wait in their cars until called to come in. Consider rooming patients immediately with no time in the waiting room and all activities contained to the patient room. Implement as much “no touch” check in and check out as possible. Evaluate traffic flow in your clinic and consider designating hallways as “one-way” if possible, to prevent patients having to pass in confined spaces.
- Consider removing all items from the waiting room that might be touched by multiple people (e.g., magazines, pens). If waiting room areas are used, they need to be disinfected throughout the day.
- Since minimizing person-to-person contact is still advised, you will want to continue to limit visitors who accompany patients. Visitors should be encouraged to wait in the car while the individual receives in-person care. If you have a patient that must be accompanied by another person, that person will need to comply with all of your guidelines (i.e., wearing a mask, staying with the patient rather than sitting in the waiting area, etc.).
- Audiologists and staff should not report to work in person if they are ill, have COVID-19 symptoms, or have known exposure to someone infected with COVID-19. They should contact their PCP and ask for guidance related to care, self-quarantine, and return to work.
Making Sure Your Family Is Safe
As indicated above, you may want to consider implementing the use of scrubs as a work uniform for the time being. Short sleeves allow for proper hand washing while at work. Importantly, the use of scrubs and a specific set of shoes for work minimize contamination at home.
You can remove these items when you get home and easily wash the scrubs right away. Business attire which is commonly used in many of our practices is much more difficult to clean routinely and may require dry cleaning.
Washing hands thoroughly when arriving home is a good practice no matter where you have been. Showering may help you feel more comfortable to start your evening with the people you love and want to protect.