Dorset Orthopaedic Covid-19 Safe Working Protocols
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Dorset Orthopaedic Covid-19 Safe Working
Protocols
Issue date: 8th March 2021
Issue Number: 005
If you have any questions about this document please contact Matt Hughes, matthewh@dorset-ortho.com
The main content of this document complies with current Public Health England guidance
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Dorset Orthopaedic Covid-19 Safe Working Protocols
Document Version: 005
Date of Release: 8th March 2021
Contents
1. About This Document
2. Core Principles
2.1 Social Distancing
2.2 Hand Hygiene
2.3 Self-isolation
2.4 Shielding
2.5 Remote Repairs
2.6 /Servicing
3. Patient and Visitor Protocols
4. Staff Protocols
4.1 All Staff
4.2 Clinical Staff
4.3 Administrative Staff
4.4 Technical Staff
4.5 Stores Staff
5. Personal Protective Equipment (PPE)
5.1 Clinical Use
5.2 Patient and Non-Clinical Staff PPE
6. Cleaning and Disinfection
7. Appendices
7.1 Putting on personal protective equipment
7.2 Taking off personal protective equipment
7.3 Best Practice: how to hand wash
7.4 Recommended PPE for primary, outpatient, community and social care setting, NHS and
independent sector
7.5 Routine decontamination of reusable non-invasive patient care equipment.
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Dorset Orthopaedic Covid-19 Safe Working Protocols
Document Version: 005
Date of Release: 8th March 2021
1. About this document
This document aims to cover our best working practise principles across all our sites to enable us to continue with
our clinical services ensuring the safety of our patients and staff. At present the clinical facilities open to patients
are:
The Southern Clinic (Ringwood, Hampshire)
The Midlands Clinic (Burton upon Trent, Staffordshire)
The London Clinic (Egham, Surrey)
The safety of both our staff and our patients is of paramount importance to us. We are aware that transmission
control measures only work if everyone follows and applies safe working practice, we would therefore ask you
where possible to follow and adhere to the guidance provided to make this possible.
This document is written and updated in line with current guidance from Public Health England and based on the
current lockdown measures in place around the UK.
For now and in the immediate future the way we deliver our clinical services will have to change and whilst this
evolves, we are very welcome to feedback and ideas on how you think this can be improved.
We believe that Dorset Orthopaedic provide a vital clinical service to our patients and have therefore endeavoured
to find a safe way to operate in line with current government advice and restrictions. We are aware of the clinical
responsibility that we have in assisting our patients to maintain their mobility and independence as well as assisting
them in their ongoing rehabilitation.
2. Core Principles
Under guidance from the UK government and Public Health England publications there are certain core principles
that must be maintained. These principles are relevant to anyone entering any of the clinics or sites of Dorset
Orthopaedic, including staff, patients and any other visitors.
2.1 Social Distancing
A minimum of 2 metres of space between all staff members and patients should be adhered to at all times except in
certain exceptions. These exceptions are:
Any members of the same household
Where a physical barrier has been put in place (e.g. a Perspex screen at reception)
When appropriate PPE is being worn by one or more of the parties.
To make practicing social distancing as easy as possible, clinical areas have floor markings to indicate appropriate
distances that must be maintained.
The number of people, both staff and patients, in each building at all times will be kept to a minimum where
possible.
Work spaces may alter or change as a result to accommodate safe social distancing.
For patients, appointment times will be staggered to minimise the chances of meeting other patients in reception
areas. Staff breaks will also be staggered to minimise the chance of crowding in any one area.
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Dorset Orthopaedic Covid-19 Safe Working Protocols
Document Version: 005
Date of Release: 8th March 2021
2.2 Hand Hygiene
Hand hygiene is essential to reduce the transmission of infection in health and other care settings. All staff, patients
and visitors should decontaminate their hands with soap and water or alcohol-based hand rub (ABHR) when entering
and leaving areas where patient care is being delivered.
The ability to wash hands will be readily available throughout all areas of all buildings. For details on proper hand
washing protocols please see Appendix
Technical teams must also comply with strict hand hygiene procedures at all times. Hand hygiene must be
performed immediately before every episode of direct patient care and after any activity or contact that potentially
results in hands becoming contaminated. This includes the removal of personal protective equipment (PPE),
equipment decontamination and waste handling.
All staff should increase their hand hygiene and be sure to wash before and after contact in any communal areas.
2.3 Self-isolation
Anyone, who according to the government’s current advice should be self-isolating, must not attend Dorset
Orthopaedic. This applies to all Staff, patients and visitors.
The current advice from government is that if anyone, or any member of their household, is unwell with COVID-19
symptoms (in particular a high temperature or fever, and/or a new persistent cough) you should be self-isolating and
therefore not attend Dorset Orthopaedic during this time.
This period of self-isolation is 10 days for you or anyone in your household. In this instance a test should be sought
either via a home testing kit or a test site appointment.
Stay at home while you are waiting for a home test kit or a test site appointment. A positive test result means you
must complete a 10-day isolation period from the day after you first became symptomatic, if you are still
symptomatic after 10 days please visit the gov.uk website to confirm what actions you should take.
If your test is negative, you can stop self-isolating as long as you are well and in this instance you could then attend
any one of our clinics for an appointment or return to work.
Please refer to the government’s website https://111.nhs.uk/covid-19/ to ensure the correct protocol for self-
isolation are being observed in your situation.
2.4 Shielding
As of now shielding for those who are clinically vulnerable has been extended until the end of March, therefore all
members of staff who fall in to this category will/should work from home unless otherwise agreed with their
manager.
We would recommend that any patient that has been advised to shield should think about whether their
appointment is urgent before attending any of our clinics. We will happily see and treat you at your discretion.
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Dorset Orthopaedic Covid-19 Safe Working Protocols
Document Version: 005
Date of Release: 8th March 20212.5 Remote repairs/servicing
We are aware that certain elements of patient care, production and manufacturing, and other tasks will require
individuals to attend a Dorset Orthopaedic clinic in person. There may be a range of patient interactions and work
processes that can be completed remotely, your clinician or clinic administrator will advise where possible. If
consultations/questions can be asked and answered remotely via telephone appointments or video appointments
these can be arranged through our clinical admin teams.
3. Patient and Visitor Protocols
Whilst implementing safeguarding protocols the visit to any of our Dorset Orthopaedic sites for patients and visitors
in the short term will be significantly altered, however rest assured the quality of care and the products you receive
will continue to be to our highest standard. Patients and their companions must adhere to the core principles
described in section 2 of this document. We at Dorset Orthopaedic will ensure all patients and visitors are aware of
these principles, and how to carry them out in practice whilst in the clinics.
In order to minimise the risk of transmission, patients will be asked to only bring companions with them into the
clinic when it is essential. The number of companions will be limited to one per patient.
Although all patients will be contacted the day before their appointment to ensure that they should not be self-
isolating, we would encourage patients to pro-actively contact the clinic to rearrange their appointments if this is the
case.
New protocols directly impacting on patients and visitors experience will include:
Staff will not shake hands with patients or visitors as they arrive or leave
Patients will be given a specific time for their appointment and asked not to arrive early. Patients ought to
remain in their car until the time of their appointment. If they arrive early, they can advise the clinic by
phone. The admin team will advise them if their clinician and clinic room are available earlier than the
scheduled time.
There will no longer be an option for waiting in the reception area, and patients will be shown straight to
their treatment room where possible.
Upon entering clinics we would ask patients and visitors to wear a face covering unless they have medical
exemption. Masks must be worn at all times for all appointment types.
Clinical areas will feature floor markings to assist maintaining social distancing rules.
Perspex screens will be present at reception desks; patients should only approach at the position of this
screen, and only if necessary to collect or handover something. Otherwise, patients must maintain social
distance from the receptionist by remaining behind the line as marked on the floor.
There will no longer be excess equipment in the clinic rooms (e.g. books, paperwork, chairs etc.) this
minimises surfaces for transmission and increases cleaning efficiency between appointments.
Although hot and cold drinks and snacks will still be available for patients these will no longer be available
for patients to help themselves, please ask a member of staff and they will happily organise this.
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Dorset Orthopaedic Covid-19 Safe Working Protocols
Document Version: 005
Date of Release: 8th March 20214. Staff Protocols
4.1 All Staff
All staff must adhere to the core principles as set out in section 2 of this document at all times.
Staff must adhere to a clean desk policy at all times and remove all unnecessary items from their desks or
workstations. Desks, work surfaces and door handles in working areas should be kept clear and wiped down with
appropriate surface wipes as provided by the company.
Desk policy – all non-essential items to be removed from staff desks
Work bench policy – only one job should be on any one work bench at any time, essential and regularly used tools
can be to hand, all other tools to be suitably stored. Communal tools to be returned to appropriate areas once used.
A high standard of personal hygiene and effective cleaning and disinfection is vital in all areas during the pandemic.
Any issues with this must be brought to the attention of management.
Staff must not offer to shake hands with each other or with patients. Breaks being taken throughout the day must be
staggered, and congregation in any one area of the building is to be avoided at all times.
4.2 Clinical Staff
Treating patients remotely
In line with core principle 2.5 clinicians will look to conduct treatment and support for their patients remotely
where possible and practical. This will involve making use of telephone, email, video conferencing, and courier
collections and deliveries.
Treating patients in attendance at the clinic
When treatment needs to be carried out in person it is the clinician’s responsibility to ensure that no non-essential
items are present in the clinic rooms and treatment areas at the start and end of each appointment (e.g., toys,
magazines, mugs, patient items)
Clinicians must utilise the floor marking to ensure that they remain at least 2m away from patients, except when
they are wearing the appropriate PPE. Clinicians must clearly explain to patients where they should be within the
room at any given time.
When a process needs to be completed that requires a staff member to come within 2m of a patient (or another
member of staff) they must don the appropriate PPE for the activity being carried out. PPE requirements are covered
in more detail in section 5 of this document but include the use of at least a disposable apron, disposable gloves,
fluid-resistant surgical mask (FRSM) and eye protection. PPE must be donned, doffed and disposed of in the correct
manner at all times, as described in section 5 and the appendices of this document. This includes the washing of
hands before donning PPE and following the removal of PPE.
After each patient departure it is the clinician’s responsibility to decontaminate all surfaces in the clinic rooms whilst
wearing appropriate PPE. All hard surfaces that came in to contact with people present in the room should be wiped
down with Clinell or similar antibacterial wipes, in any instance where these are not available then the use of a cloth
and warm soapy water can be substituted.
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Dorset Orthopaedic Covid-19 Safe Working Protocols
Document Version: 005
Date of Release: 8th March 2021Once room cleaning has been completed, the staff member responsible for undertaking it should advise the member
of staff at reception that it has been satisfactorily completed and added to the daily cleaning register.
Taking patient devices away from the clinic room
Any patient items (prostheses, liners, orthoses etc) being removed from the clinic room to the workshop or other
area of the clinic must be decontaminated (by the treating clinician, wearing PPE) before leaving the clinic room. The
decontamination process should comprise of wiping down any hard surfaces with a Clinell wipe or warm soapy
water, any soft porous surfaces such as cosmetic foams should be sprayed with the appropriately provided
antibacterial spray.
Any items that are difficult to fully decontaminate with the above process must be transported to the workshop in a
clear plastic bag clearly labelled and stating “not clean” so that Technical Staff know to use required PPE whilst
working on this device.
Treating Patients in their home setting (Domiciliary Visit)
Should it be agreed that it is necessary/appropriate for a clinical member of staff to undertake a DV to a patient’s
home all principles detailed above remain relevant. No member of staff should enter a patients home if they or
anyone they live with has COVID related symptoms or if they have been advised to self-isolate. When entering the
home the member of staff should wear an appropriate face mask and PPE.
The patient being treated should wear a mask along with any other members of their household who would need to
be present in the same room.
When within 2m of the patient the member of staff should as previously stated utilise appropriate PPE consisting of
at least a disposable apron, disposable gloves, fluid-resistant surgical mask (FRSM) and eye protection. PPE must be
donned, doffed and disposed of in the correct manner at all times, as described in section 5 and the appendices of
this document. This includes the washing of hands before donning PPE and following the removal of PPE. When
attending a DV please make sure you take with you a suitable clinical waste bag to place used PPE in to be sealed
and placed in a clinical waste bin when returning to your clinic.
DV’s should only be undertaken where clinically appropriate and treatment cannot be undertaken within clinic.
4.3 Administrative Staff
Contact all patients 24 hours prior to their scheduled appointment
Cancel appointments if the patient has symptoms such as fever, cough, or shortness of breath or is
displaying symptoms of the virus to include a persistent dry cough, high temperature or loss of
taste/smell
Request patients attend at their designated appointed time (not to come early) as the waiting area is
currently closed
Ensure patients are aware of protocols laid out in section 3 of this document
Advise patients to bring with them only essential companions as visitors (maximum 1)
Advise patients and visitors to bring face covering/mask. If they do turn up without, disposable surgical masks
can be supplied
Request patients clean their device/s before attending their appointment with warm soapy water.
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Dorset Orthopaedic Covid-19 Safe Working Protocols
Document Version: 005
Date of Release: 8th March 2021 If patients are “vulnerable” and are shielding determine if a friend/relative can bring the device into the
clinic, or it can be collected/dispatched by courier, if only repair is required.
Upon patient’s arrival at the Clinic:
Ask again if patients are displaying symptoms of Covid-19
Patients and visitors with confirmed or suspected symptoms, or who have been in contact with a confirmed
case of COVID-19 symptoms must not enter the clinic. Re-appoint to a later date.
Should the patient arrive early and their room is not yet free please ask them to wait in their vehicle if they
have driven to the clinic and advise them you will let them know when a room is free. Nobody should be
waiting in the reception area.
Request patients and companions wash or sanitise their hands upon entry to the clinic.
Remind patients and visitors of the need to wear face coverings unless medically exempt.
Direct the patient straight to their designated clinic room as the reception seating area is currently closed.
Ask patients to proceed directly to the seats located at the far end of the clinic room, beyond the furthest
line marked on the floor.
Sign-in patients and their visitors on their behalf, and note treatment room being used.
Maintain social distancing during patient interactions, and minimise the time spent with patients.
Please ask patients to refrain from helping themselves to drinks or snacks, they are very welcome to these
but should be provided by a member of staff.
Following each patient departure
Confirm with the clinician that the clinic room(s) used for the patient that has just left has been cleaned and
log this on the cleaning register.
4.4 Technical Staff
Before engaging in any project or repair technicians must:
Establish a workspace that limits contact with people, tools, and has easy to clean surfaces
Use a bench with a non-porous worktop, out of the traffic flow (i.e. personnel will not need to pass by
routinely)
Remove unnecessary tools, equipment, material/components stored on or around the bench to avoid
contamination
Establish a set of commonly used tools that are easy to clean, assign these to a particular workspace and
disinfect after every use
Only use tools in good working order, organise workspace so that devices/projects from no two patients will
touch
Materials and components needed for repairs or adjustment should be identified and prepared in advance,
whenever possible.
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Dorset Orthopaedic Covid-19 Safe Working Protocols
Document Version: 005
Date of Release: 8th March 2021When working on repairs or adjustments:
Ensure the device has been properly cleaned before beginning any work
If needed or unsure, clean devices thoroughly, as quickly as possible upon taking possession, using
antibacterial wipes provided or warm soapy water.
After cleaning the device, wash hands again.
If additional materials or equipment are needed whilst work is ongoing it may be necessary for a second
team member who is not in contact with the device to source items to avoid cross contamination of stock
and supplies.
Machine rooms, vacuum systems, and power tools are difficult to clean. However, these items must be
cleaned to best ability to minimise the exposure to these areas/tools.
Decontaminate hand tools before and after use on any project.
Try to only touch the device with hands (i.e., avoid whole-arm or body contact when seeking leverage, etc.)
After using or handling any tool, keep the tool away from others until work is complete and device is
cleaned.
Avoid touching your face with your hands or contact with the appliance.
Once the work is complete, the device must be cleaned once again and put back in to a clearly labelled
plastic bag and the treating clinician informed.
Whilst working in the technical setting on a device that is difficult to decontaminate:
Assistive devices with irregular surfaces may require decontamination in addition to wiping down. Soft and
porous materials are more difficult to effectively clean so extra care should be taken to plan repairs to
minimise contact even after the device has been cleaned.
All personnel should wash their hands (wash with soap and water for a minimum of 20 seconds), disinfect
the work surfaces and tools, and then repeat hand washing after task completion.
Wearing of PPE, as described in section 5 of this document, is required when decontamination has not been
possible, or where working within social distancing guidelines is unavoidable.
Clean devices as thoroughly as possible and as quickly as possible upon taking possession if this has not
already been carried out.
Once the work is complete, the device must be cleaned as much as possible once again and put back in to a
clearly labelled plastic bag and the treating clinician informed.
After assistive device has left the workshop
Wash hands and forearms with soap and warm water for a minimum of 20 seconds.
Decontaminate work surface and all tools used using antibacterial wipes and/or warm soapy water.
Wash hands again.
This must be repeated for every project, all day.
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Dorset Orthopaedic Covid-19 Safe Working Protocols
Document Version: 005
Date of Release: 8th March 20214.5 Stores Staff
All packages to be received in stores area as normal, practising social distancing guidelines at all times.
New components and stock products can be unpackaged and wiped down with anti-bacterial wipes provided
or warm soapy water and transferred to the relevant department.
Any products or devices that have been worn should be opened and placed in a clearly labelled clear bag and
marked as unclean, this should then be transferred to the appropriate department.
Hands should be thoroughly washed or sanitised between each of these processes.
5. Personal Protective Equipment (PPE)
This relates to COVID specific PPE requirements and does not
alter the need to use appropriate PPE as you would do under
normal circumstances.
5.1 Clinical Use
Any occasion when a member of staff must come within two metres of either a patient or a member of staff they
must wear appropriate PPE. For the clinical interventions being carried out by Dorset Orthopaedic, and since only
working on low risk asymptomatic patients the following PPE is required:
Fluid-Resistant Surgical Mask (FRSM) or FFP2 mask.
Disposable Apron.
Disposable Gloves.
Clean/disinfected Eye protection.
All PPE must be donned and doffed in compliance with the guidance provided from Public Health England, see
Appendix 7
Wash hands before fitting mask and immediately removing the mask.
When removing mask take great care not to touch your face as this is a potential contamination risk.
Remove and dispose of or clean personal protective equipment before eating, using the toilet, or leaving the
clinic room where it is being used.
After each day of use, employees must wash their work clothing thoroughly.
Fluid-Resistant Surgical Mask (FRSM) and FFP2 Mask
These masks are for single use or single session use and then must be disposed of as clinical waste.
These masks should be discarded and replaced and NOT be subject to continued use if it is damaged, soiled
(for example, with secretions, body fluids), it is damp, it is uncomfortable, it is difficult to breathe through
damaged.
Great care must be taken when removing masks, wash hands before and after removal and avoid touching
your face as this can present a risk of contamination.
Reusable Eye Protection
Reusable eye protection must be cleaned in hot soapy water and disinfected after sessional use.
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Dorset Orthopaedic Covid-19 Safe Working Protocols
Document Version: 005
Date of Release: 8th March 2021Disposable Aprons and Gloves
Disposable Aprons and Gloves are single use only.
Gloves and aprons should be replaced if they become damaged during clinical activities.
Hands must be cleaned on removal of gloves and aprons.
Single use: Aprons and gloves are subject to single use as per Standard Infection Control Precautions (SICPs), with
disposal in clinical waste bins and hand hygiene after each patient contact.
Single session use: refers to a period where a staff member is undertaking duties in a specific clinical care setting or
Exposure environment. A session ends when the member of staff leaves the clinical care setting or exposure
environment. The duration of a single session will vary depending on the clinical activity being undertaken, however
this period could be up to 4 hours. If a mask or protective eye wear becomes damaged during these periods they
should be removed and replaced in the case of the mask and washed and decontaminated in the case of the
protective eyewear.
All disposable PPE should be removed in guidance with the documents provided in the Appendix and disposed of in
appropriate clinical waste bins.
As of Monday January 11th all front facing clinical members of staff at all 3 clinics have been given Innova Rapid Flo
tests to test against COVID-19, these tests should be carried out twice a week prior to attending the work place.
* If a negative result is indicated you can go in to work as normal.
* If a negative result is indicated but you feel unwell or show any COVID-19 symptoms, particularly high
temperature, persistent dry cough or loss of taste/smell you should inform your line manager, stay away from work
and request a more accurate PCR test. Stay away from work until this result is confirmed, if negative please return,
if positive you will need to self-isolate as guided.
* If a positive rapid flo test result is indicated, self-isolate and request a PCR test to confirm. Again stay away from
the work place as guided.
5.2 Patient and Non-Clinical Staff PPE
Patient and non-clinical staff may wish to use PPE whilst at Dorset Orthopaedic. There will be no specific
requirement for this unless social distancing guidelines cannot be adhered to or if staff are in contact with a patient
device that has not been cleaned.
On occasions when a patient, visitor or non-clinical member of staff opts to wear a fluid resistant surgical mask this
can be supplied by DOC if needed. Patients and staff electing to wear optional PPE must adhere to safe PPE removal
and disposal practices if and when any PPE is removed.
Signage to show clear guidelines for hand washing, PPE available and how to dispose of PPE appropriately should be
visible where appropriate.
6. Cleaning and Disinfection
Before and after each patient attendance decontaminate all surfaces in the clinic rooms (doorknobs,
handlebars, desks, etc.).
All clinic, office and workshop areas cleaned professionally between practice days.
Clinic rooms cleaned thoroughly by clinicians wearing PPE after each patient departure.
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Dorset Orthopaedic Covid-19 Safe Working Protocols
Document Version: 005
Date of Release: 8th March 20217. Appendices
7.1 Putting on personal protective equipment
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Dorset Orthopaedic Covid-19 Safe Working Protocols
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Date of Release: 8th March 20217.2 Taking off personal protective equipment.
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Dorset Orthopaedic Covid-19 Safe Working Protocols
Document Version: 005
Date of Release: 8th March 20217.3 Best Practice: how to hand wash.
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Dorset Orthopaedic Covid-19 Safe Working Protocols
Document Version: 005
Date of Release: 8th March 20217.4 Recommended PPE for primary, outpatient, community and social
care setting, NHS and independent sector.
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Dorset Orthopaedic Covid-19 Safe Working Protocols
Document Version: 005
Date of Release: 8th March 20217.5 Routine decontamination of reusable non-invasive patient care
equipment.
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Dorset Orthopaedic Covid-19 Safe Working Protocols
Document Version: 005
Date of Release: 8th March 2021You can also read
