Covid-19 Risk Assessment review September 2021

Tuesday 28th September 2021

Introduction

There have been a lot of legislative changes since the initial decision to close the practice to clients entering and the covid-19 situation has been very dynamic with constant changes to the advice and guidance given by different central government departments and veterinary bodies.  This has also been further complicated by the significant increase in pet ownership over the pandemic and national shortages in veterinary staff.  We have decided to review our current risk assessment with a view to allowing clients back into the practice.  This document highlights our findings, documents the reasoning behind our findings and sets a clear measurable pathway towards a safe reopening for everyone that is risk assessed and adaptable to the constantly changing risk, enabling closure of the practice again should the risk increase.

Legal factors

Although national covid restrictions have been eased for the general public, the government have moved responsibility for covid protocols to employers under the supervision of the Health and Safety Executive (HSE).  This means that risk assessment and covid protocols are still a legal requirement for businesses and employers and that it is now the responsibility of business owners to ensure compliance.  Failure for us to produce reasonable risk assessments and to comply with these can lead to legal action against us.  The guidance is not great and is open to a lot of interpretation. It also must be individually tailored to the business, taking into account the building, staffing levels and business nature, which not only is highly variable, but each business will interpret the guidelines in their own way.  For this reason you may see different protocols in place in different businesses and different veterinary practices.  PLEASE RESPECT THE OUTCOME OF OUR RISK ASSESSMENT AND ACCEPT IT MAY BE DIFFERENT TO OTHER BUSINESSES.

Staff and client factors

As an employer we need to ensure the safety of the staff and protect them as much as possible from the risks of covid-19.  We see that as taking steps to ensure that the risk of staff coming to work and contracting covid-19 is minimally different to the risk of staff contracting covid-19 by conducting their daily business outside of work.

The main risks to staff come from their interactions with other staff members and from their interactions with clients.  There is also a risk to staff from pets coming from covid-19 households as they can carry the virus on their fur.

We also have a duty as a business to protect the safety of the public as much as possible from the risks of covid-19.  There is a range of attitudes towards the virus with a mixture of clients potentially entering the building including:

  1. Vulnerable clients at higher risk of contracting the disease or having serious consequences of infection
  2. Cautious clients that may not be at increased risk but are concerned about contracting the disease themselves and who wish to take additional precautions
  3. Conscientious clients that may not be concerned about their risk of contracting the disease but are more concerned about being an unknown carrier that could infect one of the vulnerable clients
  4. Relaxed clients that may not have the same opinion about the risks others pose to them or that they potentially pose to others.

We need to ensure a policy that meets the expectations of as many clients as possible, while ensuring the health and safety of everyone.  Unfortunately no policy we make will appease everyone. PLEASE RESPECT OUR DECISION AND ACCEPT IT MAY BE DIFFERENT TO OTHER BUSINESSES.

Veterinary care factors

We have been able to operate a closed door policy for veterinary treatment for the majority of the pandemic and do not see a significant drop in the level of treatment being able to be offered to patients through our closed door policy.  We do not feel that the remote consulting during the peak of the pandemic enabled us to provide a good level of care to patients and do feel that a physical examination of pets is necessary for us to be able to provide the best level of care.  The lack of presence of the owner has not lead to a decline in patient care and is therefore not deemed essential.  The presence of the owner, however, does make communication more efficient and would free up nursing staff time to focus on other things, while enabling more clients to be seen and reducing pressure stresses on staff, so would enable the practice to provide a better level of service.

Standard Covid-19 risk reduction steps

There are 5 main areas in which we have all been advised to minimise the risk of Covid-19 transmission:

  1. Hands

Hand washing is standard practice in veterinary practice to prevent the transmission of infections between our patients.  This has not changed and we encourage clients to wash/sanitise their hands on a regular basis too.

2. Face

Face coverings have been recommended to reduce the spread of the virus. It will minimise the distance the virus particles spread when talking, coughing or sneezing making it less likely for an infected person to transmit the disease to other people.  A face covering helps to minimise risk inside, where there is poorer ventilation and when closer contact with people is necessary.  It is appreciated that face coverings are not always comfortable and the government advice has changed to make them voluntary in public places, yet businesses are able to choose whether or not they are required.  Given the limitations of some of the other reduction steps specific to Roker Park Vets, we have decided to continue with a mandatory face covering policy, however introducing  a traffic light system to enable voluntary face covering if the local covid-19 risk reduces.  We are not allowing any exceptions to the face covering policy, even for those with medical exemptions.  It is deemed that clients with medical exemptions for face coverings are likely to be more vulnerable to the effects of covid-19 and at a higher risk to themselves and others by entering the building.

3. Space

The ‘2m rule’ has some scientific evidence to show a reduction in risk.  This has been used in conjunction with the second area, ‘face’, to create a ‘1m plus’ rule, whereby additional steps should be taken when within 2m of other people, with face coverings being the main example.  Maintaining social distancing inside is challenging due to reduced space compared to outside. This also creates a limit as to the number of people recommended within different rooms.  We have decided to maintain social distancing where possible by reducing the number of people allowed in different rooms and keeping people socially distanced where possible.  We are also looking to introduce plastic screens at reception to further protect staff.

4. Fresh air

Ventilation is difficult to practically achieve in the veterinary setting in an old building like ours. Opening windows and doors creates an escape risk for our patients. As such, in order to protect our patients we do not feel we are increasing ventilation enough to go back to the same pre-covid protocols that clients are more familiar with and additional steps are being taken in other areas to keep the risk as manageable as possible.  As such, we are introducing a traffic light system to enable clients to return into the practice if the local covid-19 risk reduces.

5. Vaccination

We are insisting all staff are double vaccinated unless there is a medical reason why this should not be undertaken in order to protect other staff members as well as clients.  We feel it may be discriminatory to insist upon double vaccination for clients as there are some clients that may have a genuine clinical reason why not to vaccinate and the difficulties in proving vaccination status.  We do however strongly recommend clients ensure they are double vaccinated as this will ultimately reduce the local covid-19 risk and enable us to reduce the measures we have in place.

Local covid-19 risk

As of 27th September 2021 the new coronavirus cases were still showing signs of increasing with 350.9 cases per 100,000 nationally. Sunderland are currently above the national average, with 356.7 cases per 100,000, which has increased significantly over the last 2 weeks.

We have taken a measured approach to assess reopening on a traffic light risk level as below:

RED ALERT – Sunderland cases above 200 cases per 100,000

No change to current practice protocols

AMBER ALERT – Sunderland cases between 100 and 200 per 100,000

Clients are allowed to enter the practice

Face coverings are compulsory… No face covering, No entry

Clients are welcome to request outside consultation as previously with pet examined inside without them

Maximum of 5 client households in building at any one time with maximum of 3 in reception.

Maximum of 2 clients per household appointment (under 16’s exempt)

Screens need to be placed in reception prior to clients coming into the building

A one-way system around the reception area will be trialled

GREEN ALERT – Sunderland cases below 100 per 100,000

Clients are allowed to enter the practice

Face coverings are optional but recommended

Number of clients allowed in the building will be reviewed

Exceptions for exceptional circumstances during Red risk level

We have been making exceptions to our closed door policy for restricted cases.  If you are wanting a more confidential discussion about your pet, we are allowing consultations to take place in the kennel area with the doors open.  Owners are responsible for patient restraint and face coverings must be worn.  These consultations are not ideal as the room is not stocked as a consultation room and the increased ventilation increases the risk of pet escape, so examination in the main building without the owner is still recommended.

Euthanasia:.  We have developed a euthanasia protocol, which allows end of life treatment to be provided for euthanasia, whereby clients are able to stay with their pet for the procedure.  The protocol involves the pet being taken into the building to be placed on a drip.  Social distancing can then be adhered to by injecting the euthanasia drug into the drip line.  It also reduces the number of people in a small space by eliminating the need for a nurse to raise the vein at the same time

Summary

Clients must inform staff if they are coming from a covid positive household before making a journey to the surgery so the visit can be rearranged if necessary or additional safety precautions can taken if the visit is essential

Staff must wear a face covering if going to be less than 2m away from other staff members or clients*

Clients must wear a face covering if going to be less than 2m away from other staff members or other clients*

Continue to wash hands regularly

Maintain social distancing

Adhere to maximum number of clients in the building

Adaptations will be made to reception and a one-way system trialled

*Based on the traffic light system above

PLEASE RESPECT OUR DECISION AND ACCEPT IT MAY BE DIFFERENT TO OTHER BUSINESSES.