COVID-19: Clinic Administration & Patient Care Guidance

Please note that all guidance or rules below are from Oregon Health Authority, CDC, and/or Oregon OSHA. The Oregon Veterinary Medical Association has not set these requirements. We offer this information below as a courtesy to our members to help keep them informed.

Oregon Health Authority recommends universal mask use for all public indoor settings Updated 7.28.21

In response to increased case counts due to the Delta variant, the Oregon Health Authority recommends that all Oregonians, regardless of vaccination status, wear masks when inside public places across the state.

  • The highly contagious Delta variant has increased tenfold in the past two weeks, and it is now estimated to be associated with 80% of the new cases in Oregon. The use of face masks provides significant protection for individuals who are unvaccinated as well as an additional level of protection from a small, but known, risk of infection by the virus for persons who have already been vaccinated.
  • According to the Centers for Disease Control and Prevention (CDC), people who are vaccinated with currently available vaccines are protected from the virus and the circulating variants, including the Delta variant.
  • OHA’s recommendation aligns with the CDC’s new guidance that everyone, including fully vaccinated persons, wear a mask in public indoor settings. OHA's recommendation applies statewide, and not just for areas with higher infections and high transmission, as cases have increased across the state in recent weeks due to the Delta variant.
  • OHA is continuing to call on local community and public health leaders, as well as businesses, to encourage vaccination and masking to prevent new outbreaks in areas of substantial and high transmission.

Note: There has not been any change to limit or restrict clients from entering veterinary clinics. Those limitations expired when Gov. Kate Brown rescinded her Executive Order on the pandemic and Oregon OSHA withdrew its workplace rules during COVID-19 (see below), which included a recommendation for curbside service. You have the discretion to adopt a policy that requires curbside service and/or the wearing of masks by clients when they enter your facility.

OSHA lifts workplace mask/distancing requirements

Oregon OSHA has repealed its permanent workplace requirements relating to physical distancing and the wearing of face coverings for all industries, including veterinary medicine, as of June 30, 2021. Although workers in “healthcare settings” and other designated areas must continue to wear face coverings while indoors, this designation does not apply to veterinary practices.

The veterinary-specific rule to use curbside service or to maintain distancing in the waiting room, as well as to restrict client access to the examination room, are part of the requirements that have been repealed as of June 30.

OSHA's COVID rule related to the use of Personal Protective Equipment by veterinary staff in certain treatment situations—the CDC's “Interim Infection Prevention and Control Guidance for Veterinary Clinics Treating Companion Animals During the COVID19 Response"—remains in place. (See page 40 of this document.)

The rule retains the provision that an employee who chooses to wear a mask, face shield, or face covering, even when it is not required, must be allowed to do so.

Going forward, you will have the discretion to choose how best to interact with your clients and see your patients. Although masking and physical distancing restrictions have been lifted, employers have the right to require that clients and their veterinary teams wear masks when inside the facility or in close contact with others while examining and/or treating a patient. You can also choose to continue with curbside service.

Your county jurisdiction may have requirements for businesses—which includes veterinary facilities—about masking or social distancing. Please check your county’s website regularly for any updated information about COVID-19 and requirements for businesses.

Oregon OSHA COVID-19 Rules as They Affect Veterinary Facilities

Summary of OSHA COVID-19 Rule Requirements Still in Place

Cleaning and Sanitation

The rule requires regular cleaning of all common areas, shared equipment, high-touch surfaces at least once every 24 hours if the workplace is occupied less than 12 hours a day or every 8 hours if the workplace is occupied for more than 12 hours per day.

Posting Requirements

The It's the Law poster must be permanently placed conspicuously in a central location. Any employee working remotely must be provided with a copy of the poster through electronic or equally effective means.

Special Requirements for Building Operators

Ensure that the sanitation requirements are met, and, as appropriate, post signs in areas where a building operaor chooses to require masks, face coverings, or face shields.

Ventilation Requirements

No later than January 6, 2021, HVAC maintenance must be performed to ensure the maximum amount of outside air recirculation to the extent of system capacity. This includes cleaning and maintaining filters, but it does not require the installation of new ventilation equipment.

All employers with more than 10 employees and an existing HVAC system must certify in writing that they are operating the system in accordance to the new rule, to the best of their knowledge. Note: The updated rule does not require employers to purchase new ventilation systems.

Conduct a COVID-19 Exposure and Risk Assessment

No later than December 7, 2020, all employers must perform a COVID-19 exposure risk assessment. The assessment must involve feedback and participation from employees via a safety meeting or a supervisor. Employers with >10 employees must document their exposure risk assessment using the OSHA questionnaire for each job title. Risk assessment must involve participation and feedback from employees via safety meeting, supervisor meeting, or any other similar interactive process. Keep this documentation on file in your practice; you do not have submit it to anyone at this time.

Infection Control Plan

No later than December 7, 2020, all employers must implement an infection control plan. For employers with > 10 employees, the plan must be in writing and available to employees. If an employer has multiple facilities, the plan may be formulated for facility type rather than individual facility. Keep this documentation on file in your practice; you do not have submit it to anyone at this time.

Note: You may also choose to complete the template developed by OVMA.

Employee Information and Training

No later than December 21, 2020, employers must provide workers with information and training on COVID-19 and ensure that employees are provided an opportunity for feedback about topics covered.

COVID-19 Infection Notification Process

Employers must establish a mechanism for notifying both exposed and affected employees within 24 hours of the employer’s knowledge of a potential COVID-19 workplace exposure (eg. an individual with COVID-19 in the workplace.)

COVID-19 Testing for Workers

Employers must cooperate with the Oregon Health Authority or local public health if workplace COVID-19 testing is indicated by those agencies (making employees and space available).  If testing is directed by employer (not OHA or a local public health agency), costs (test, employee time, travel expense) is to be borne by the employer requesting the testing.

Medical Removal

Whenever the Oregon Health Authority, local public health agency, or medical provider recommends an employee be restricted from work due to quarantine or isolation for COVID-19, such as through identification during contact tracing activities, the affected worker(s) must be directed to isolate at home and away from other non-quarantined individuals. Note: Other than the obligation to provide such direction and to remove such employees from the workplace, the employer has no obligation to enforce the employee’s quarantine or isolation.

Best Practices for the Profession During This Next Phase

As the state reopens and veterinary facilities begin to navigate this new reality, we encourage you to review the following considerations developed by Dr. Emilio DeBess, Oregon’s Public Health Veterinarian:

No standard approach to COVID-19 control exists that will address all situations and practice types. Veterinarians and veterinary clinics should evaluate and apply a number of considerations as needed. Please consider the following Best Practices, including a set of resources, tips, and guides to help employers prevent the spread of COVID-19 after the state reopening, to protect you and your staff.

Limit the number of people in the clinic

Maintaining a limited number of people in the clinic at any given time will reduce the risk of an infected person entering the clinic. It will also further reduce the risk of close contact between people and facilitate distancing and other control measures.

In-clinic visits can be focused on situations where client communication or patient care is improved by allowing an animal owner to enter the clinic.

TIP: A gradual re-introduction of in-clinic visits can be done by maintaining some degree of curbside care delivery, telemedicine, and hybrid appointments.

Maximize distancing

Whether it is a conversation between coworkers or while interacting with clients and staff, it is important to maximize distancing. Consider the flow of people within the clinic and how client visits are handled (i.e., are exam rooms used for appointments or do clients wait in an exam room while the patient is examined by clinical staff in a separate area?). A consistent guide for physical distancing is six feet.

TIP: Use both physical distancing AND additional measures (masking, ventilation) rather than choosing one or the other.

Ventilation

Ventilation is increasingly recognized as a critical and often overlooked control tool for COVID-19 infection.

TIP: Optimize ventilation. Increasing air flow is a critically protective factor, whether it is through utilizing the HVAC systems, opening windows, opening doors with the clinic, and/or using fans.

Vaccination

Effective vaccination is a core component of COVID-19 control. Individuals who are vaccinated against COVID-19 are well-protected after 14 days. Three vaccines have been approved for use in the U.S. to combat COVID-19: Both Moderna and Pfizer offer a two-dose series, while Johnson & Johnson offers a single-dose vaccine.

TIP: Encourage active participation in ensuring that both doses of vaccines have been obtained when possible.

Breakthrough cases

Vaccine breakthrough cases occur in only a small percentage of vaccinated people. Anyone, including veterinary personnel, who exhibits or develops clinical signs suggestive of COVID-19, should not enter the clinic. A medical evaluation should be recommended.

Use the following protocol for any clinic staff member who tests positive for COVID-19:

  • Non-vaccinated staff need to quarantine for:
    • 7 days, with testing at day 5 or 6. A daily temperature check should be taken at home, and a check for symptoms should be done before the staff member returns to the clinic.
    • 10 days without testing, taking a daily temperature at home, and checking for symptoms before the staff member returns to the clinic.
  • Vaccinated staff only need to check for symptoms and do not require quarantine. Testing should be performed only when symptoms compatible with COVID-19 appear.

Staff and client screening

As has been prominent since the start of the pandemic, screening of all people entering the clinic will remain a core control measure.

TIP: Do not allow staff or clients with clinical signs suggestive of COVID-19 to enter the facility. Allergy season will complicate this process. Use a cautious approach, however, as in-clinic exposures have occurred when staff dismissed signs as worsening of allergies.

General recommendations

Use the following measures to reduce the risk of acquiring or spreading COVID-19:

  • Limit the number of people that enter the clinic (and maximize care that does not involve the client entering the clinic).
  • Limit the number of people who are in the clinic at any given time.
  • Limit contact between animal owners and clinic personnel or other animal owners.
  • Minimize the duration of contact between animal owners and clinic personnel.
  • Minimize or avoid contact in closed spaces.
  • Maximize the use of Personal Protective Equipment (e.g. masks).
  • Use physical distancing.
  • Regularly clean and disinfect high-touch surfaces.
  • Use general infection prevention and control (e.g. washing hands).
  • Evaluate clinic personnel interactions (e.g. “clinic bubbles).
  • Maximize ventilation.

CDC PPE Guidance

Minimum Standards of Care

A reminder that nothing in these orders or guidance changes the minimum standards of care to which you must continue to adhere as licensees and veterinary facilities.

Telemedicine

  • When appropriate, consider the use of Veterinary Telemedicine to limit visits to the clinic.
  • Pursuant to the Governor's Executive Order 20-03, the OVMEB has determined that veterinarians have the option to provide treatment for the duration of the State of Emergency by Veterinary Telemedicine without first having to conduct a physical exam to establish a VCPR. Please note that all other portions of the VTM rule continue to apply.
  • When using telemedicine, you can issue prescriptions if you believe it is safe and appropriate to do so. You must ensure that the technology you are using is sufficient and of appropriate quality to provide accuracy of remote assessment and diagnosis of the patient. You must also ensure that medical information obtained via VTM is recorded completely in your patient’s medical record and meets all applicable requirements of current medical recordkeeping requirements.

Updated: 2021-07-28 07:00:00

Author: Oregon Veterinary Medical Association