ACSLPA provided an initial resource on COVID-19 on March 16, 2020 (https://www.acslpa.ca/covid-19-information/). The following is intended to provide members with further guidance.
The ACSLPA office has been receiving many calls from members regarding SLP and audiologist practice during this pandemic. Most calls have been centred on two main topics: scope of practice as related to participation in nasal swabbing (COVID-19 testing) and whether it’s safe to continue to provide services (and by which medium). For information related to nasopharyngeal swabs, click here.
Service to Clients
Note that we all continue to take our guidance from the Chief Medical Officer of Health/Public Health in Alberta. At the time of writing (March 19, 2020 10:30am) there has not been a directive for SLPs and audiologists to discontinue their services and clinics/practices can remain open at the owner’s discretion. It is recognized that direction could change and members should stay abreast of information from public health daily.
Under the current Public Health Emergency, the Government of Alberta has the authority to declare if health-care facilities, including SLP and audiology clinics, must close. ACSLPA defers to experts in public health and recognizes their knowledge and expertise in this area.
SLPs and audiologists have always had a responsibility to help clients make informed decisions about their care. This responsibility is even more important now. ACSLPA members also have a responsibility to direct clients (and themselves) to reputable information. The sites included here are providing key information to Canadians and the world and are reputable sources of information.
Alberta Health Services
Public Health Agency of Canada
World Health Organization
For those members in a position to make a choice, the decision to continue to provide services should be made carefully, weighing the risks to clients and members alike. Some ACSLPA members may choose to discontinue services (i.e., those in private practice) if it’s appropriate to do so. In the case of COVID-19 the key public health focus is on limiting the spread of the disease between individuals. Members should be thinking about public safety in all situations. SLPs and audiologists must think about social distancing (and whether you can still accommodate services) and infection prevention and control practices and how you can adhere to enhanced environmental cleaning practices. Further considerations:
- Screening clients for signs and symptoms of COVID-19 prior to or upon arrival at their appointment.
- Rescheduling appointments for clients who:
- Are showing signs of respiratory illness including dry cough, fever, and fatigue/extreme tiredness,
- Have had contact with someone who is ill,
- Have been directed to self-isolate, or
- Have recently travelled internationally.
- Encouraging clients in high-risk groups to reschedule non-urgent appointments.
- Ensuring infection prevention and control (IPC) and Occupational Health and Safety (OH&S) practices are in place and adhered to (see below).
- Providing areas and/or sinks for clients (and caregivers) to clean their hands upon arrival at their appointment (either using soap and water or alcohol-based hand sanitizer).
- Cancelling group sessions (including parent education), particularly among higher-risk populations.
- If opting to continue group sessions, limiting the group size and increasing space between attendees (see Alberta Health recommendations for gatherings).
- Communicating measures that are in place within your practice to mitigate the risk of spreading infection.
- Providing service by telepractice (https://www.acslpa.ca/telepractice-information-for-acslpa-members/). Information about privacy considerations can be found via the Office of the Information and Privacy Commissioner. Some of the following may assist ACSLPA members in their decisions.
- Ensuring appropriate documentation. Specifically, relevant excerpts from the recently revised Clinical Documentation and Record Keeping Guidelines (expected to be approved in June or September, 2020) will be posted to the ACSLPA website in the coming days.
Infection Prevention Control
IPC measures must be very rigorous. The ACSLPA Standard of Practice 4.1 Safety and Risk Management states that regulated members “practice in compliance with occupational health, safety and risk management legislation and requirements, in all practice settings.” The legislation and requirements referred to includes the new ACLSPA Advisory Statement Infection Prevention Control: Single-Use and Reusable Medical Devices and corresponding standards developed by Alberta Health (links included within the Advisory Statement). Note that toys and similar objects when used for the purposes of assessment and treatment, fall within this advisory statement.
Some key points regarding environmental cleaning include:
- COVID-19 is currently thought to be spread through contact with respiratory droplets, either following a cough or sneeze, or from contact with contaminated surfaces where droplets reside.
- There is a difference between cleaning and disinfecting surfaces. Cleaning refers to the removal of visible dirt and debris. Disinfection inactivates disease producing micro-organisms. Effective environmental cleaning for COVID-19 requires both cleaning and disinfection. More information is included in the Alberta Health Standards for IPC (see the ACSLPA Advisory Statement for links).
- As part of routine clinical practice, SLPs and audiologists should already be cleaning and disinfecting surfaces and equipment between clients.
- Increased daily cleaning and disinfection of high touch surfaces such as doorknobs, light switches, staff rooms, desktops, washrooms, telephones, keyboards/mice, and shared pens.
- Removing items that cannot be easily cleaned (e.g., newspapers, magazines, stuffed toys) from waiting rooms and shared staff areas is advised.
- For more information, see the Government of Canada recommendations for community-based measures to limit the spread of COVID-19.
Occupational Health and Safety
ACSLPA members who are also business owners/operators should be considering a business continuity plan (how your business will continue to function in a crisis). Note that business owners are subject to Alberta’s Occupational Health and Safety Act, Code and Regulations (https://www.alberta.ca/ohs-legislation.aspx). This means that they must create a safe work environment and provide appropriate controls to address identified risks in the workplace. Meeting these requirements includes educating employees about risks, providing supplies necessary to mitigate risks, and encouraging appropriate use of supplies and behaviours to mitigate the risk of spread of COVID-19. Examples may include:
- Provision of PPE,
- Providing facilities for and encouraging frequent hand hygiene,
- Providing supplies for environmental cleaning, and
- Ensuring staff are aware of relevant sick leave policies, encouraging those who are ill to stay home.
Employers need to consider implementing the measures suggested by Health Canada to mitigate the spread of COVID-19 as appropriate for their work environment. These measures include enabling remote working where possible, staggering start and end times to reduce the need to travel at peak times and increasing space between workstations and treatment tables.
Employers should also keep abreast of information through the Government of Canada and the Government of Alberta regarding employment and wage supports available due to COVID-19.
March 19, 2020
Thank you to Physiotherapy Alberta College+Association for permission to utilize information from their website for the development of this information.