Frequently Asked Questions (FAQs) – Updated May 25, 2020

Below is a summary of the FAQs that have been sent out to members over the last six weeks, grouped by theme and updated where necessary.

 

Screening, essential workers and special circumstances

Screening questions that must be asked of patients and companions:

    Do you have current symptoms of COVID-19, such as:
    • a fever,
    • a new or changed chronic cough,
    • a sore throat that is not related to a known or preexisting condition
    • a runny nose that is not related to a known or preexisting condition
    • Nasal congestion that is not related to a known or preexisting condition
    • Shortness of breath that is not related to a known or preexisting condition
    • Have you traveled internationally within the last 14 days?
    • Have you had unprotected close contact with individuals who have a confirmed or presumptive diagnosis of COVID-19 (e.g. individuals exposed without appropriate PPE in use).
Answering yes to any of these questions indicates that an individual is symptomatic of COVID-19, or may have been exposed to COVID-19. Individuals should be told to self-isolate, and to call Health Link 811 if symptoms develop or worsen. If the individual is a patient, they are not eligible for treatment at this time. If the individual is a practitioner or staff, they are not eligible for work at this time.

 

Mandatory isolation is required for any Alberta resident who:

  • Has travelled internationally, including from the USA; or
  • Has been diagnosed with COVID-19; or
  • Has had close contact with a confirmed COVID-19 ACAC (includes household members).
For these three mandatory isolation situations, our directive remains clear that these patients are not to come into the clinic or receive chiropractic treatment. Mandatory isolation is not required if you have travelled within Canada. However, Alberta residents are advised to limit any non-essential travel outside of Alberta, with the exception of people who live in border communities and are commuting for work.

 

Can I treat essential workers?

A healthcare worker needs chiropractic care yet has been exposed to COVID-19 patients. They are asymptomatic, but do not pass the screening criteria. A truck driver needs chiropractic care, is asymptomatic, yet they have been travelling across provincial/US boundaries. Essential workers have several exemptions related to COVID-19 protocols. For example, truck drivers are exempt from the 14-day isolation period after returning to Alberta due to the key role they play in the supply chain.
Front-line health care workers who work with COVID-19 positive patients and were wearing the appropriate PPE for their role, are exempt from the 14-day isolation period. Your professional judgement comes into play when treating an essential worker such as a healthcare worker or truck driver. If the patient is not deemed to require mandatory self-isolation (e.g. tested positive) and are asymptomatic, use your professional judgement to weigh the risks. If you decide to treat them, implement additional safeguards and document them. For example, book these patients at the end of day when no other patients are present, ensure proper PPE is used by yourself and the patient, use a specific room with additional cleaning after patient contact, etc. Again, if the patient has tested positive, or is symptomatic, you should not treat the patient. It is important that our profession can safely care for essential workers who need chiropractic care to maintain their important roles.

 

What do I do if I know or suspect I have been exposed to COVID-19?

The requirements outlined in the ACAC directive will help mitigate the risk of exposures in your clinic. However, if you know or suspect you have been exposed to COVID-19, you are required to follow the Management of Health Care Workers (HCW) section of Alberta Health's Disease Management Guidelines for COVID-19, which are below. For this answer, understand that chiropractors are health care workers.
  • Management of Health Care Workers (HCW)
    • HCW who may have been exposed to COVID-19 should refer to the COVID-19 Self Assessment Tool for Healthcare Workers for more information.
    • HCW tested positive for COVID-19 shall by order be isolated for 10 days from onset of symptoms, or until symptoms have resolved, whichever is longer.
      • NOTE: HCW should NOT go back to work in a health care setting for 14 days from the onset of symptoms, or until symptoms resolve, whichever is longer.
    • A surgical/procedure mask and good hand hygiene is considered sufficient PPE for asymptomatic HCW working with asymptomatic patients including within the 48 hours prior developing symptoms.
      • If HCW becomes symptomatic, all the patients who they cared for (or co-workers) in the 48 hours prior to symptom onset in that HCW will NOT be considered close contacts if the HCW wore a surgical/procedure mask and practiced routine, frequent hand hygiene.
      • If a patient becomes symptomatic, all HCW that cared for the patient in the 48 hours prior to symptom onset in that patient, would NOT be considered close contacts if they were wearing a surgical/procedure mask and practiced good hand hygiene i.e., sufficient PPE.
    • If the time of symptom onset cannot be reliably ascertained (e.g. patient with cognitive impairment), the MOH should be consulted regarding period of communicability and its relationship to appropriate PPE use.
    • A surgical/procedure mask and good hand hygiene is NOT appropriate PPE for HCW caring for symptomatic patients.
Screening, continuous masking and appropriate hand hygiene are all required to ensure that you are as safe as possible while providing close contact care. Any onset of symptoms requires screening and contacting 811 for health care workers. This answer may change based on guidance from the CMOH and if it does we will inform you immediately. If you experience a unique COVID-19 exposure, immediately contact the ACAC for further direction.

 

What if we find out that a patient who we have provided treatment for tests positive for COVID-19?

Hand hygiene and masking is essential to practicing at this time. Properly observing PPE requirements protects chiropractors from mandatory self-isolation if they treat an asymptomatic patient who later tests positive for COVID-19.

 

What if a staff member tests positive for COVID-19?

If you or one of your staff test positive for COVID-19, public health will be involved in tracking all potential exposures. The Pandemic Practice Directive outlines how to properly record all visitors to the clinic to help with tracking.

 

A patient of mine has previously tested positive for COVID-19. How do I know it’s safe to provide care now?

This depends on where the patient is at in the timelines of their diagnosis and recovery. If a patient is diagnosed with COVID-19, then They are legally required under public health order to self-isolate. If the patient was instructed to self-isolate by public health, they will inform the patient when their isolation order is lifted.

 

Informed consent

What documentation should be recorded in the patient file regarding COVID-19 screening?

The ACAC directive and orders from the CMOH require that all patients be screened prior to care. The screening must be a part of the clinical record and demonstrate both negative and positive screenings. A logbook of all patients screened is not acceptable as a record of screening. However, beyond this consideration, the decision on how to keep a record of screening is at the chiropractor's discretion. Examples of ways that the screening could be recorded in the clinical record include:
  • An entry in the patient chart record that COVID-19 screening was performed and the patient screened asymptomatic prior to entering treatment room.
  • A separate sheet with the patient name, screens name and the date that is included in the patient’s chart.
  • Users of Electronic Health Records could capture this with electronic forms.
The key message is that a record of the screening must be kept, but the chiropractor can decide based on their individual record keeping approach how to best capture the screening in the clinical record. In a situation where a patient screening is positive for COVID-19, a chart record must also be kept and indicate the direction given to the patient to self-isolate and call 811.

 

Should I get my patients to sign a consent form or waiver stating they do not have COVID-19?

No. Having patients sign a “consent form” that states they do not have COVID-19 is most likely of no benefit, and could actually be used against you in a court action. These forms or waivers are not legally binding, nor are they legally robust. From a risk-management perspective, the best thing the practitioner can do is to follow the established guidelines around screening protocols, cleaning and disinfecting, physical distancing, PPE protocols, etc.

 

Should I obtain verbal informed consent for new patients and document their verbal consent rather than having them sign the informed consent to chiropractic treatment form?

No. Having the patient sign the consent form is still required. If the patient has entered the clinic and followed the proper hygiene protocol, and the chiropractor has done the same and is using appropriate PPE, then there should not be a risk that exceeds what has already occurred within the chiropractor-patient interaction to that point. As a further measure, it is recommended that the pen is wiped down before and after use. If the patient is concerned, they could also bring their own pen and follow the same sanitization protocol.

 

Cleaning and disinfecting

Are fabric chairs allowed in my waiting room or other clinic areas accessed by patients?

No. All surfaces need to have the ability to be cleaned and disinfected, so fabric chairs aren’t appropriate.

 

What cleaning and disinfecting products should I use?

Approved cleaning and disinfecting product guidelines are outlined in the ACAC COVID-19 Pandemic Practice Directive.

 

A local company is producing hand sanitizer. Can I use it?

Yes, as long as it meets the requirements in the COVID-19 Pandemic Practice Directive for alcohol-based hand sanitizer.

Why do I have to change out of my clinic clothes if I am going straight home?

Changing out of the clothes that you worked in is essential in limiting potential spread of COVID-19. During a workday you will interact with many people who have potentially been in contact with many other people, locations and surfaces.

Are there any special precautions we must take with products inside our clinics (e.g. nutrition and gels). Are patients allowed to access products, touch and purchase them?

All non-hard surface products must be out of patient reach. The lowest risk way to manage hard-surface products in the clinic would be to move the products out of the reach of patients. If moving hard-surface products out of the reach of patients is not possible, then signage should be used to ask patients not to touch. Product areas should be disinfected as part of the hard surface cleaning. 

 

Physical distancing

With the COVID-19 Pandemic Practice Directive are there any restrictions or extra measures to be taken when working with an open area treatment space with no walls between tables/beds? The same rules of physical distancing and infection prevention and control apply regardless of the space in which treatment is provided. A minimum distance of two metres must be maintained between all patients in your clinic.

 

How many patients can be in the clinic at one time? Does the ‘15 patients’ limit include staff?

Physical distancing rules apply in waiting rooms. Seats must be spaced to maintain a minimum distance of two metres between patients (exception for members of the same household). Unless you have a very large waiting room, you will not be able to accommodate 15 patients in your waiting area. Alternate options can be explored such as having patients wait in their cars until their appointment time, then proceeding right to the treatment room. Complete instructions surrounding physical distancing can be found in the Pandemic Practice Directive.

 

Is there a limit on the number of members and staff working at one time?

There is no limit set for the number of members and staff that can work at one time, however employers are encouraged to maintain physical distancing at work. The important thing is that the guidelines and requirements are met for your clinic, based on your unique operational requirements.

 

Is there a limit on the number of hours a clinic can be open?

There are no limits on hours of operation. Patient appointments should be scheduled to facilitate physical distancing, and to ensure that no more than 15 patients are in waiting areas if physical distancing allows within the space. Sufficient time must be provided between appointments for the area the patient occupied to be cleaned and disinfected.

Can I block book (schedule multiple appointments at the same time) patients?

Physical distancing must always be maintained. Clinics must manage the flow of patients in and out of the clinic environment. Transition areas such as entrances and exits are the hardest to manage for clinics with respect to physical distancing. The clinic must manage the schedule and bookings to always maintain physical distancing requirements. 

Do we need barriers for our reception desks?

Employees and the public should be two metres from each other. If two metres cannot be maintained at reception/payment area, other non-contact electronic payment means can be used, or installation of a plexiglass or plastic barrier can be used to protect reception staff. Many local companies are re-tooling to do installations of barriers in local businesses.

 

Personal Protective Equipment (PPE)

Do members need to wear masks when treating patients? Gloves? Gowns?

A surgical/procedure mask must be worn by the member when treating patients and a physical distance of two metres cannot be maintained. Single use gloves may be used but are not required. Gowns are not required.

 

What type of mask is required? Can I wear a cloth or homemade mask when treating patients? 

A standard healthcare grade procedure mask or surgical mask (e.g. Level 1) is required. N95 masks are not required for chiropractic care. Members may not use homemade or cloth masks, as they are not approved for healthcare settings.

 

Do staff need to wear a mask? Can reception staff wear cloth masks?

Reception staff may wear a cloth mask if they are not in direct contact with patients, for example dealing with patients at the reception area where two metres cannot be maintained. If clinic staff are working directly with patients, for example as chiropractic assistants, and are unable to maintain a two-metre distance, they will need a surgical/procedure mask similar to the chiropractor.

 

Do my patients have to wear masks? Can patients wear cloth masks? Can we supply patients with cloth masks?

Patient masking is not a requirement within the COVID-19 Pandemic Practice Directive, however some clinics may wish to request them of patients or supply them. Please note that cotton or homemade masks are acceptable for patient use, but not for chiropractor use.

 

Why aren’t masks required for patients?

The CMOH orders currently do not require masking for asymptomatic patients in primary care. As well, with limited supply of masks available, requiring asymptomatic patients to mask would put further strain on the PPE supplies which are required for health providers. The ACAC Pandemic Practice Directive requires the minimum standard, and clinics are welcome to ask their patients to mask. If patients are asked to mask, some considerations for the clinic include:
  • a reasonable risk assessment of which patients need a mask
  • whether or not the clinic will supply masks
  • whether lack of access to a mask will impede patient access to care

 

How do I secure PPE?

The Canadian Chiropractic Association (CCA) has secured a national distributor with access to appropriate masks, Health Canada approved hand sanitizer, and other PPE that you may wish to purchase. Go to www.officedeals.co and remember to enter CHIROSTRONG before checking out to receive your discount. You will also need your CCA member ID. Alberta Chiropractors who know or have been presented with other opportunities to procure PPE, provide that information to the ACAC for posting on the ACAC marketplace.

 

Can I practice acupuncture?

Chiropractors authorized to perform the restricted activity of acupuncture by the ACAC may currently practice this modality, provided they continue to employ the highest standards of aseptic practice. This change is reflected in the Introduction section of the directive.

 

Can I practice Telehealth?

Telehealth is part of the strategy to reduce in-person contact by providing treatments or consultations via telecommunication. To practice Telehealth, chiropractors must first obtain approval from the ACAC. 

 

Miscellaneous

Reminder from the Registrar on advertising

Chiropractors should avoid making any unsubstantiated claims concerning the role of chiropractic care in preventing or managing COVID-19, immunity or related viral infections, as per Standard of Practice 1.1. The ACAC is monitoring social media and online content to ensure compliance with advertising standards. Failure to comply may lead to a complaint.

 

Can I practice mobile chiropractic, such as house calls during the pandemic?

Effective May 25, 2020, upon motion from Council, mobile chiropractic during COVID-19 is permitted with compliance with the requirements of the Pandemic Practice Directive. Patient preference to receive mobile chiropractic does not mean mobile chiropractic is appropriate from a risk/benefit perspective. Considering COVID-19, the risks must be verbally disclosed to patients and how these risks are mitigated. If the risk cannot be mitigated for both patient and chiropractor, then treatment must not occur regardless of setting.

 

When does the COVID-19 Pandemic Practice Directive take effect?

The COVID-19 Pandemic Practice Directive took effect on May 4, when chiropractic clinics were able to re-open. Effective May 4, all clinics that re-open are required to follow the policy as well as the guidelines received from the Chief Medical Officer of Health.

 

Who should I contact if I have questions?

If you have questions, please contact the ACAC at office@albertachiro.com and we will respond to you as quickly as possible. If you have a question, it’s likely that other chiropractors are having the same question. We’ll answer your question if we can, follow up with the Government on anything that requires further investigation and continue to update you on any news.