COVID-19: Patient Care & Clinic Administration Guidance

We will continue to update Oregon veterinarians with important developments regarding COVID-19 that impact the veterinary community. We are all in this together. For employer-related financial issues such as new sick leave rules, business financial support programs, and related topics, visit our COVID-19 Employer Guidance page.

As medical professionals, veterinary practices can model appropriate and necessary behavior to clients, staff, and the general public during this public health crisis.

We encourage you to have clear guidelines in place which limit physical contact as much as possible. You can’t provide care to your patients without physically well staff and veterinarians.

Please consider the possibility that some of your veterinary team may become sick with COVID-19. Plan forward in this current situation to help avoid that outcome as best you can and to minimize the risk to other staff in the event that occurs.

Provide clear and timely communication to staff and clients about your policies during this time via social media, e-mail and signs on the doors of the clinic. Communicate daily with your healthcare team and answer their questions to support them in helping your patients and clients.

Oregon OSHA to Adopt a COVID-19 Standard with Implications for Veterinary Facilities

The state’s workplace and safety division will soon approve regulations that require all employers to implement risk-reducing measures to combat the spread of the novel coronavirus. The temporary rule, which could take effect no later than Monday, September 14, would remain in effect for 180 days. Read more.

Resumption of Elective and Non-Emergent Surgical Procedures

Excecutive Order 20-22, signed by Governor Brown on April 27, rescinds EO 20-10, the purpose of which was to limit elective procedures to conserve PPE. Veterinary elective and non-urgent procedures that use PPE may resume as of May 1, provided practices comply with guidance or administrative rules issued by Oregon Health Authority, as below:

It is important to read the guidance fully. The following are a few key points:

  1. You must have an adequate two-week supply of PPE that is appropriate to the number and types of procedures you will perform or you must have vendors that are able to provide you with a sustained supply of PPE (an open supply chain).
  2. PPE supplies must have been approved by NIOSH or the FDA.
  3. The guidance does not address the use of cloth face coverings in the practice. OHA recognizes that use of cloth face coverings may reduce the spread of virus and help prevent those who have the virus but do not have symptoms from passing it to others and they should be used outside of surgical procedures where PPE is indicated.
  4. You must adhere to strict infection control policies as recommended by the CDC and OSHA. CDC recommends PPE usage based upon the animal patient's possible exposure to COVID-19 and its symptoms. Because veterinarians are not subject to HIPAA regulations, attorney Joe Carlisle of Buckley Law PC says that it is acceptable to ask whether the patient (the animal) has been in contact with or exposed to anyone diagnosed with COVID-19, presumed to have COVID-19 or displaying COVD-19 symptoms prior to the animal receiving care. The CDC guidelines define the parameters of what constitutes a SARS-CoV-2 or COVID-19 exposure: "A SARS-CoV-2 or COVID-19 exposure in this context refers to the following conditions within the 14 days prior to presenting for veterinary care: Being within approximately 6 feet of a person with suspected or confirmed COVID-19; close contact can occur while an animal is living with, being pet, snuggled, giving kisses or licks, and/or sharing food or bedding with a person. * Having direct contact with infectious secretions from a person with suspected or confirmed COVID-19 (e.g., being coughed, sneezed or spit on, sharing food or consuming an object that was recently contaminated with an infected person’s mucous or saliva)."
  5. You must use a measured approach for resuming elective and non-urgent procedures. It remains important to limit and manage your caseload to the extent possible in order to minimize close physical contact with clients and healthcare team members.
  6. You must develop and follow a plan to reduce or stop elective and non-urgent procedures should there be:
    • A surge or resurgence of COVID-19 cases. Notice to reduce or cease procedures most likely will be a directive from the Governor’s Office or the Oregon Health Authority.
      -OR-
    • If you cannot meet the criteria outlined in Section I of the guidance regarding appropriate PPE supply.

Below is a list of additional recommendations to consider on how to approach the resumption of these services in a measured manner. We encourage the continuation of curbside drop-off and pick-up procedures to maintain physical distancing.

Service

Recommendation | Consideration

Wellness pet visits
(vaccines, exams)
 

Conversations with clients should be over the phone or via telemedicine. Clinic visits should be prioritized to pets needing vaccinations.

Preventives (heartworm, tick and parasiticide)

If the veterinarian determines that a physical exam is necessary to prescribe or refill medication, then the visit is recommended.

Dentistry

 

Recommended with a priority to those in immediate need of care, so long as PPE is available and physical distancing of staff is practiced.

Spay and neuters
 

Recommended so long as PPE is available and physical distancing of staff is practiced.

Other surgical procedures

 

Recommended with a priority to those in immediate need of care, so long as PPE is available and physical distancing of staff is practiced.

Euthanasia

Considered to be an essential activity and should continue.

Boarding and grooming
 

Resume slowly. Recommended so long as physical distancing of staff is practiced. 

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.

Physical Distancing

OSHA is taking enforcement of distancing requirements seriously and will not only be investigating complaints but conducting random spot checks of businesses, and this may include veterinary practices.

As every practice is different in terms of how the clinic is configured, what services it offers, and the size of staff, there is no one-size-fits-all set of guidelines to achieve optimal physical distancing.

Following are some best practices:

Limit Clinic Access to Staff Only

  • It is recommended to limit access to the clinic to staff only, with patient transfer happening outside. Meet clients at a safe distance in the parking lot. Appropriately protected staff can bring the animal into the practice for an examination and treatment. The veterinarian can discuss the diagnosis and/or treatment plan by telephone with the client who remains outside. Client communication, including transactions, can be handled by phone, text or e-mail.
  • Client Handout: Why Curbside Service?
  • Some clinics have clients remove collars, use the clinic's disposable leashes, and not have pets wear "outfits" to their visit to cut down on materials that might transmit the virus into the clinic.
  • Limit clients in the clinic to perhaps end-of-life care only, if even that. Consider performing euthanasias outside with physical distancing in place.
  • If you do allow clients to come into the clinic, attorney Joe Carlisle of Buckley Law PC suggests that practices adopt a policy that only one person accompany the patient and that the person should certify on the day of the appointment that they have not been diagnosed with, are presumed to have, or have displayed symptoms of COVID-19. The policy should also require clients to wear a facemask in the clinic.
  • People with respiratory disease and/or confirmed or pending results for COVID-19 should not come into a clinic. If a person with respiratory disease and/or pending COVID-19 results must come into the clinic (again, not recommended!), the person must wear a mask, and staff should wear protective gear as well.
  • AVMA Flowchart to Help Minimize Exposure
  • Owner Contact Guidelines (Dr. Scott Weese)
  • CDC Guidance for Type of PPE Needed for Procedures Based on Animal's History & Possible Contact with COVID-19 Infection

In-Clinic Physical Distancing

  • Re-work your in-clinic workflow to allow for adequate distancing between staff. Whenever possible, stay at least 6 feet apart.
  • Look at clinic layout and operations to see if people who normally sit near each other can be separated.For instance, if you have more than one person at reception and they are closer than 6 feet apart, think about what can be done to avoid this. It might mean moving someone to an office or lounge, or transitioning some activities to someone who can work at home.
  • Look at your practice's lounge, lunchroom or office spaces and try to move people around or schedule things so that only one person is in a small room at a time.
  • If a procedure will necessitate close contact between people (e.g. blood collection, catheter placement, pretty much anything that involves restraint), take a moment to step back and think about whether the procedure is really needed or if there are alternative ways of accomplishing the same thing that don’t require multiple people. Consider whether people can do tasks in steps with distancing between them.
  • When people have to be close together, be efficient. Get everything set up in advance so that whatever needs to be done can be done quickly.
  • Try to limit as much as possible interactions between various groupings of staff members. Some clinics have divided staff into teams who may work in shifts in an effort to limit interactions between the staff in general.
  • Engage your team in brainstorming solutions to this issue that work for your clinic.

Face Coverings

Medication/Food

  • Deliver medication refills and pet food orders to clients outside the clinic, maintaining personal distancing.
  • Direct clients to your online Rx and pet food portals for home delivery of needed items.

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.

Mobile Practices

  • Mobile veterinary practices face different challenges than brick-and-mortar facilities. Dr. Weese of Worms and Germs has some protocol suggestions for mobile veterinarians.

Equine Practitioners

Infection Control Procedures

  • The main transmission of COVID-19 is through close contact with a sick individual, including those who are asymptomatic.
  • COVID-19 can be spread from infected objects if you touch the surface and then touch your mouth, nose or eyes. The virus can live on cardboard for 24 hours and on plastic and stainless steel up to 72 hours.
  • Diligently practice routine infection control measures such as hand hygiene. Stay vigilant about cleaning and sanitizing all surfaces in the practice, including countertops, door knobs, cabinet handles, phones, etc.

Staff Wellness 

  • Make sure all staff are paying attention to their health and staying home if they are sick. Symptoms to watch for include: fever, cough, fatigue, shortness of breath, loss of taste or smell, and muscle pain and aches. Encourage all veterinary team members to be responsible with physical distancing outside of work to protect their families and coworkers.

Pooling Resources

  • Consider reaching out to clinics in your area to start a dialogue about pooling resources if the supply chain becomes challenged.

Surgical Mask and Gown (PPE) Conservation Strategies

Updated: 2020-09-08 07:00:00

Author: Oregon Veterinary Medical Association