5/10/2020 UPDATE: Use Of PPE In Oregon Is No Longer Restricted To Diagnosis And Treatment Of
Elective and Non-Urgent Procedures (requiring PPE pre-COVID-19)
Governor Brown issued Executive Order No 20-22 effective May 1, 2020 allowing measured resumption of non-urgent health care procedures using personal protective equipment (PPE), and continuing restrictions on visitation in response to coronavirus (COVID-19) outbreaks.
Starting May 1, 2020, elective and non-urgent procedures across all healthcare settings that utilize PPE are allowed, but only to the extent they comply with guidance or administrative rules issued by the Oregon Health Authority (OHA). OHA issued “Guidance on Resumption of Non-Emergent and Elective Procedures in Medical and Dental Offices, and other Health Care Settings.”
In order for a healthcare office to provide non-urgent or elective procedures that require PPE, the healthcare office must comply with the strict Guidance published by OHA. Additional guidance can be found in this published FAQ.
Guidance in all Healthcare Settings Regardless of Procedure
If the procedure/treatment did not require PPE pre-COVID-19, you can continue offering it assuming you are complying with other screening, cleaning and social distancing requirements, but must consider the “Provisional Guidance: Clinical Care and Healthcare Infection Prevention and Control for COVID-19” published by OHA on May 9, 2020 which changes the recommendation to healthcare personnel (HCP) regarding the PPE they should use in all procedures and healthcare settings. Under the General Recommendations for All Healthcare Settings “Universal Source Control” OHA recommends facility masking policies to reduce the risk of spread from pre-symptomatic or asymptomatic individuals. It states medical-grade facemasks should be prioritized for HCP, and the CDC guidance it links to specifically states “As part of source control efforts, HCP should wear a facemask at all times while they are in the healthcare facility. When available, facemasks are generally preferred over cloth face coverings for HCP as facemasks offer both source control and protection for the wearer against exposure to splashes and sprays of infectious material from others.”
Please carefully review the guidelines and recommendations and consider how they apply to your practice. In general, for treatment which prior to COVID-19 did NOT require PPE provided to non-symptomatic patients, the new OHA and CDC recommendations are that HCP in all healthcare settings should wear facemask (surgical masks or procedure masks NOT cloth) when providing direct patient care if PPE is available. Staff who do not provide direct patient care should assess if they still have sufficient contact to require a facemask, otherwise they should wear cloth face coverings. Patients, regardless of symptoms, should be instructed to wear their own cloth face coverings and if they do not have any, ideally, face coverings should be offered upon entry in the clinic.
Use of PPE is only one way of reducing the spread of COVID-19. You should continue doing everything else to minimize the chance of exposure and implement aggressive source control measures such as screening patients and staff, sanitizing surface areas and equipment, increasing personal hygiene, enforcing social distancing and offering telehealth whenever possible.
The May 9, 2020 “Provisional Guidance: Clinical Care and Healthcare Infection Prevention and Control for COVID-19” linked above, also covers Extended Use of Personal Protective Equipment, Work Exclusion Determination for HCP, HCP Return to Work Considerations and Managing PPE Supply Issues. Links to additional CDC guidelines are found under each category. We recommend you carefully review these and all other rules and guidelines published and frequently updated by OHA, CDC, OBNM, Governor Brown’s website and OR-OSHA, etc.
Recommendations for Outpatient and Urgent-Care Settings
If you provide care to COVID-19 symptomatic patients, you must take additional precautions and follow all recommendations by OHA, CDC, OSHA, OBNM, and Oregon Governor regarding triage, evaluation, testing, reporting, and PPE Requirements. In addition, AANP’s Guidelines and Resources for Outpatient and Small Clinics is a good place to start.
Remember to document all your clinic policies and protocols and patient encounters (regardless of the method of delivering the care). In addition to a Supplemental Health Questionnaire, we also recommend a Supplemental Informed Consent for Care and Treatment in the Era of COVID-19.
PLEASE REMEMBER TO CHECK FOR UPDATES AND CHANGES FREQUENTLY AND USE YOUR BEST CLINICAL JUDGMENT TO KEEP YOUR PATIENTS, YOUR STAFF AND YOURSELF SAFE.
[A word of caution – we have noted a delay in the posting of guidelines and orders to the respective websites even though the date on the actual document is prior to it being uploaded. Additionally, links to documents previously checked, may link to an updated version when checked later. Please pay attention to updates and date published to make sure you are reviewing the latest guidance.]
Helpful links we recommend you check daily:
American Association of Naturopathic Physicians www.naturopathic.org which provides helpful Guidelines and Resources for Outpatient and Small Clinics including Sample Templates to be tailored to your own practice. Please make sure everything you incorporate into your practice is in compliance with Oregon Health Authority and OBNM’s rules and guidance.