Dr Vincent Wong shares practical suggestions for returning to clinical practice
Note: This article was written and submitted on May 8, prior to the JCCP guidelines being released
The COVID-19 pandemic has affected healthcare, social and financial systems. Not only will this leave a mark on history, but will also play an influential role in setting new working and social norms. In the field of medical aesthetics, new measures must be taken to ensure maximum protection to both practitioners and the general public when lockdown measures are eased, despite being a low risk form of medicine with regards to viral transmission. Without official guidance from the Government for the aesthetic industry (at the time of writing), we must gather what relatable guidance we do have, as well as the current recommendations from different countries, which can then be adapted according to advice from local government.
As well as the information I have collated in this article, you can also read guidance from the Joint Council of Cosmetic Practitioners by clicking here.
COVID-19 is a new illness caused by a novel coronavirus (SARS-CoV-2). Many cases were reported in Wuhan in December 2019 and the disease has subsequently been declared as a pandemic by the World Health Organization (WHO) due to outbreaks globally, affecting more than 3.7 million people with at least 270,000 deaths.1 The virus can infect many animals and species, including bats, pigs, and humans. The virus cannot be effectively inactivated by chlorhexidine, but is sensitive to ultraviolet (UV) light and heat (56oC for 30 minutes), as well as certain chemical agents including 75% ethyl alcohol and 250mg/L chlorine disinfectant.1 The disease is transmitted through respiratory droplets and close contact with infected patients. According to WHO, the symptoms of COVID-19 include fever, dry cough, tiredness, aches and pains, sore throat, diarrhoea, conjunctivitis, headache, loss of taste or smell and a rash on skin, or discolouration of fingers or toes. In many cases, these symptoms progress to difficulty breathing, chest pain and loss of speech or movement.1 As asymptomatic infected people may also be a source of infection, this poses a great health risk to healthcare professionals (HCPs) in the aesthetics field and therefore calls for certain conditions with strict policies, procedures and protocols to be integrated into clinical practice.
According to guidelines from the Aesthetic and Anti-Ageing Medicine Society of South Africa, as well as personal experiences of cosmetic doctors in China, considerations when planning clinic reopening should include phased opening (e.g. half capacity to start with), listing services that you will be able to perform safely within the clinic and supply chain for Personal Protective Equipment (PPE) and cleaning supplies.
Communication about COVID-19 with all members of staff is crucial when preparing for re-opening. This should include sharing current and relevant information about the disease, potential ‘second wave’, reopening strategy and any new employee policies or role changes. Other key points include training, shift patterns, health status, and uniform.
The entire practice should be sterilised before re-opening. Special attention should be paid to soft furnishings, retail areas, bathrooms, reception and common areas and consultation rooms. 20ml of bleach in 1L of water is an inexpensive and effective disinfectant for common areas, floors, surfaces and door handles.4 Consultation rooms should be cleaned with appropriate viricidal/bactericidal products, such as 0.1% sodium hypochlorite and 75% ethyl alcohol.4 The entire practice should be thoroughly sterilised before opening and after closing every day.4
It is highly recommended that ventilation of medical settings be improved.5 This can be easily achieved by opening windows at least two to three times a day for over three hours. Additionally, timely cleaning and disinfection of consultation room is also important.5 Table tops, work surfaces, treatment couch, door handles and other relevant surfaces should be cleaned at the start of the day, in between patients and after the last patient of the day. Frequently-used personal belongings of the practitioner (e.g. mobile phones and keys) should be disinfected regularly, and disposal of sharps and clinical waste should be managed effectively. Patients should be advised to keep their personal belongings in their pockets. Large items such as bags should be left at a designated area to avoid spread and contamination.
Wearing masks and protective eyewear when taking care of patients may reduce touching facial mucous membranes for both physician and staff.6
Key points for Infection and Quality Control as currently recommended are summarised in the table below.6
In order for aesthetic practices to reopen and function is a safe environment for all, there is a strong need for triage and treatment algorithms. I have developed the following in-clinic algorithms developed based on current recommendations and WHO guidelines (Figure 2 & 3).8,9
Clinics should consider providing a pedal bin at the exit of the practice to allow patients to dispose of any disposable material such as tissues, gauzes etc. used during the appointment. Before leaving the practice, patients should be able to wash their hands once again with hand sanitiser. Clinics should also consider accepting payments through bank transfer to avoid handling cash. If card payments are accepted, the card reader should be disinfected after every use.
As included in the triage algorithm, HCPs should practice due diligence during the virtual/telephone follow-up appointment. Should the patient develop symptoms of COVID-19 or had contact with someone who tested positive for the disease (previously unknown prior to appointment), local guidance for contact tracing must be followed. As mentioned above, Public Health England is currently working on this.10
COVID-19 has a huge impact on the aesthetics industry, affecting both patients and HCPs. Although most aesthetic procedures are relatively straightforward and considered to be low risk in terms of contamination, the potential risk of transmitting COVID-19 is not negligible. Careful considerations should be made when planning for clinic reopening once lockdown measures are eased to ensure the safety of HCPs, staff members and patient. The algorithms described in this article may be adapted according to local guidelines to provide peace of mind for all and to ensure best practice as the world embraces the ‘new normal’.
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