More than PPE: Safety Precautions for Physical Therapists in the Age of COVID-19

As the world begins to resume operations, many physical therapy professionals are wondering how they can deliver the best possible care to their patients—without putting anyone at risk of contracting COVID-19 in the process. While we’ve all learned that the safest thing anyone can do is stay home, telehealth PT simply isn’t appropriate for all patients. Thus, for many therapists, delivering the best care does mean providing in-person treatments. 

We’ve created this article to help ensure you can serve your patients without putting them—or yourself—at unnecessary risk of infection. Given the nature of this novel virus, we are continually learning new things—and thus, new ways to prevent transmission. We hope you will comment below with your input and experiences as your own facilities reopen in this “new normal.”

Enact proper screening measures.

The best thing you can do for your team, your patients, and yourself is to stop potential infection points before they walk through the door—and that means adequately screening for any exposure to the novel coronavirus. There are many ways to screen patients. Here a few options to consider for your facility:

Quick Verbal Screens

Simply asking a few questions can keep potential infection sources from entering your facility. Examples include:

• Have you (or anyone with whom you’ve had contact) been ill in the last 14 days?
• Have you experienced any fever, feelings of fatigue, loss of taste or smell, shortness of breath, persistent coughing, or muscle pain in the last 14 days?

The trick with screening is for the screener(s) to know how to act if someone does come up as a possible infection point. The safest plan is to have these individuals return after they (or their housemates) have been symptom-free for 14 days.

Temperature Checks at the Door

Anyone with a temperature above 100.4 degrees Fahrenheit is considered to have a fever, and should be sent home. This goes for patients and staff members alike. You can ask people to self-report at the door, or you can have a designated temperature-taker to screen people before they enter the clinic. According to the Centers for Disease Control and Prevention (CDC), a person can return to the community when: 

• Three days have passed without a fever.
• Symptoms have improved.
• It has been 10 days since symptoms first appeared.

Ensure you have the PPE you need—and that staff members know how to use it.

It’s best to assume that everyone has COVID-19 when considering things like social distancing and hand hygiene, but the nationwide personal protective equipment (PPE) shortage makes things a bit trickier. Using a full-on COVID-19 setup for every post-TKA patient might be overkill, but there are basic precautions the CDC now recommends for everyone: namely, wearing a face mask when interacting with others. 

Masks are the minimum.

If you don’t have the appropriate minimum PPE for yourself, your staff, and your patients, then you should not be treating in-person. That means masks for every therapist and patient, as well as for any other staff members or essential caregivers who enter the clinic.

Cloth or disposable surgical masks are deemed acceptable for both practitioners and patients for normal care—but if you are immunocompromised, over 65, or have a condition that puts you at higher risk of complications from COVID-19 (such as severe asthma or severe heart disease), then you might consider wearing an N95 mask for all patient interactions. 

Proper PPE use and communication are key.

To be fully effective, masks and other PPE must be worn properly. Mouths and noses should be covered at all times. If you work in a hospital environment and use face shields, goggles, N95 masks, gowns, or other PPE for treating COVID-19 positive (or presumed positive) patients, being able to don and doff your equipment without self-contaminating is crucial. All facilities working with COVID-19 patients should ensure adequate signage denoting positive or pending cases is clearly visible. Also, make sure you have proper training protocols in place for all staff members (don’t forget PRN folks!). If you’re a staff member who does not feel you have received adequate training, speak up! This is a new experience, and it’s important that everyone feels safe and heard during this process.

Promote proper germ hygiene.

Most people realize that hand-washing is critical to preventing the spread of infection. But, it’s so easy to forget that others might have coughed into their hands, opened a door, and left those germs on the handle for you to inadvertently transfer into your eye when tucking your hair behind your ear. Here are some ways to promote germ hygiene in PT facilities:

Provide reminders.

Proper germ hygiene is not top-of-mind for everyone, which is why it’s critical to have reminders throughout the facility in the form of posters, flyers, or even videos in the waiting room. That way, people receive continual reminders to wash their hands and practice appropriate personal hygiene. 

Enact hand-washing policies.

This might seem obvious to some, but it’s vital to promote regular hand-washing among staff and patients. Posters and flyers encouraging hand-washing after bathroom use are helpful. Staff should wash hands before and after treating each patient—as well as after each sneeze or cough. 

Set up sanitizing stations.

If possible, add some hand-washing stations or sanitizer dispensers in the waiting area, at the check-in counter, and throughout the gym and treatment rooms.

Eschew outside food (temporarily!).

One of the great pleasures of working in PT is receiving a piping hot plate of home-baked cookies from a patient. Unfortunately, even though food itself does not seem to be a primary disease vector for the coronavirus, it’s just not worth the risk—after all, the plastic wrap and plate on which those cookies arrived could be lacquered in germs. Another unfortunate casualty of this pandemic will be potluck meals. To avoid hurt feelings and wasted food, be sure all patients and staff members are aware of the “no outside food” policy.

Prioritize social distancing. 

There’s a reason why social distancing has been a main focus throughout the entirety of the pandemic. Close proximity (under six feet of distance for 15 minutes or longer) seems to be a strong predictor of transmission, and that does not bode well for many of us considering the manner in which we do our jobs. Another issue many therapists face is patients bringing family members to appointments. While this practice can be distracting in non-pandemic times, it’s now become much more dangerous from a community health standpoint. Here are some ways to address these concerns:

Limit unnecessary people in the clinic.

Let patients know in advance that they should attend appointments alone, if at all possible. If they’re unable to do so, one “essential caregiver” may be permitted. This person should adhere to all of the same safety and infection control precautions that patients and staff members do.

Create partitioned rooms.

Whenever possible, treat in individual spaces with partitions. Ideally, use partitions that are easily sanitized (e.g., plastic sheets instead of cloth sheets) and wipe them down between each patient.

Slow down your schedules.

This might come as a disappointment for some patient mills, but safely treating patients means delivering one-on-one care with time allotted between each session to ensure infection protocols are met. 

Reduce congestion in the waiting room.

You might be doing a bang-up job of keeping the gym nicely spaced for social distance, but if the waiting room is packed like a can of sardines, you’re not doing your patients any favors. Be mindful of the fact that many patients arrive very early for appointments, which can lead to overcrowding in waiting areas. You can send out notices encouraging patients to wait outside, in their cars, or in nearby establishments if they arrive more than 30 minutes ahead of their scheduled appointment time. 

Minimize hands-on work when you can.

Some manual-based therapists might be dying a bit inside when they read this, but our first commitment to patients is to do no harm. So, while you might know that a shoulder mobilization will improve a patient’s range of motion, a few more degrees of flexion is probably not worth both of you risking your health. Whenever possible, use education and exercise-based interventions so your patients can benefit from your care—without the additional risk presented by physical touch. 

Regularly sanitize all touchpoints throughout the facility.

Because viruses love to travel from hands to eyes, noses, and mouths, it’s vital to keep all surfaces that might be touched by multiple parties as clean as possible. That means frequently cleaning all countertops, tables, doorknobs, gym equipment, documentation stations, and any other high-touch areas in your facility.

Shield the front desk.

The front desk staff should have a layer of plexiglass between them and patients who are checking in. Ideally, you’ll minimize staff-to-patient touchpoints by using touchless check-in systems or having patients pay for visits online. All counters, pens, tables, chairs, and other waiting-room equipment should be regularly cleaned.

Put someone in charge.

Perhaps the most important consideration is who will be doing the sanitizing. Will therapists clean between patients? Will this be a task for techs? Whoever is responsible should be fully trained on proper use of disinfectants, and there should be a clinic-wide protocol that is easily accessible to anyone on staff at any time. 

Revisit attendance policies and CDC guidelines.

In our nation, we have a chronic issue of going about our lives while sick. People show up to parties and spread their colds. They go to restaurants and give people the flu. Patients show up to appointments and get clinicians sick. Clinicians show up to work and get patients sick. Nobody wants to seem weak, and we don’t want to let others down. And, in far too many cases, we cannot stay home because of fear of retribution by our employers.

If this pandemic has shown us anything, it’s that many of our work policies are woefully outdated and unsafe, especially in times like this. Now is the perfect time to revisit the idea of silly policies like requiring a doctor’s note for taking sick time. And it’s a great time to let patients off the hook if they cancel at the last minute because they’re ill. 

To close, here are a few CDC resources you can use to further educate yourself:

• The CDC’s guidelines on how to handle a workplace COVID-19 exposure can be found on this page.
• The CDC’s guidelines on infection control in healthcare environments can be found in this FAQ.
• The CDC’s guidelines on how to optimize the supply of PPE can be found on this page.
• The CDC’s frequently asked questions for businesses can be found in this FAQ.

COVID-19 has forced us to look at our lives through an entirely new lens, but there could be some silver linings in the way of increased infection control in facilities, slower schedules to allow more personalized care, and much-needed changes to our outdated policies around sick leave. How has the pandemic affected patient care in your organization? We’d love to hear your tips!