COVID-19: Clinic Administration & Patient Care 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.

Oregon Health Authority Recommendations for Veterinary Facilities During COVID-19

The Oregon Health Authority has issued guidance for veterinary facilities to help safeguard veterinary staff health. In addition to medical advice or direction from the patient's healthcare provider and/or public health department, if you have specific questions about how a possible COVID-19 exposure or a confirmed case within your team or a team member's household could affect your practice, we encourage you to reach out to Dr. DeBess, State Public Health Veterinarian.

To ensure the health and safety of veterinary clinic staff and clients, the OHA recommends taking the following precautions:

  • Veterinary employees should take their temperature at home prior to work. (Note: Some clinics take the temperature of all working staff twice daily).
  • Upon arrival, staff should be asked about or report any symptoms such as:
    • Fever of 100.4 degrees F or more
    • New onset of cough or difficulty breathing
    • Sore throat
    • Fatigue or muscle aches
    • Headache
    • New loss of smell or taste
    • Diarrhea
    • Nausea or vomiting

If any of the symptoms mentioned above are present, staff should not be allowed to work.

Exposures

As the number of confirmed COVID-19 cases and related hospital admissions continue to rise, so does the does the risk of potential exposure. Any staff member exposed to a confirmed case within their household should not work and be quarantined for 14 days. Quarantine is mandatory even if an exposed person has a negative test. This means staying at home and away from other people for 14 days after the date of the exposure, while you monitor yourself for fever and other signs of infection. Note: The CDC recently changed this guidance to 10 days without a test and no symptoms and 7 days with a negative test and no symptoms. OHA guidance will follow and we will update when this happens.

What Constitutes an Exposure?

  • Close contact to COVID-19 occurs when you are within 6 feet of someone who is showing symptoms of the virus, for at least 15 minutes or more within a 24-hour period, or an infected person who is asymptomatic but later tests positive. This is considered an exposure, regardless of whether one or both parties were wearing a mask.
  • A confirmed case sneezed, coughed, or somehow got respiratory droplets on you.
  • You provided care at home to someone who is sick with COVID-19.

Addressing COVID-19 Cases in Veterinary Facilities

When veterinary staff test positive for SARS-CoV-19 in a veterinary setting, it is necessary to help the local health authority with contact tracing to identify those exposed to COVID-19.

  • Exposed individuals should be advised to get tested as per testing guidelines (page 3, section 3).
  • Exposed individuals may be quarantined for 14 days.
  • Only with the approval of the local health department under the guidance of the health officer and the state public health veterinarian, exposed individuals may to return to the workplace in accordance with CDC guidelines for medical staff. Any new workplace contact with exposed staff should be limited to the greatest extent that is feasible while maintaining essential operations.
  • Exposed individuals may not attend gatherings, outings or have extended contact with anyone else outside of their home during the 14 days.
  • When at home, exposed individuals should wear a face covering and follow OHA quarantine guidance for 14 days to limit exposure to other household members.
  • See also OSHA requirements below regarding work restriction and return to work.

Oregon OSHA COVID-19 Rules as They Affect Veterinary Facilities

Oregon OSHA announced continuation of the agency’s required rules for workplaces during the pandemic. This includes veterinary facilities across the state—and calls for ongoing curbside service.

The temporary rule that was in place for the past 180 days expired on May 4, in accordance with the Oregon Administrative Procedures Act. Unless otherwise indicated, the new rule will remain in effect permanently during the pandemic, with a review every two months to address whether all or part of the rule can and should be repealed. The initial review of the new rule will take place no later than July 2021.

Additional Resources:

Summary of OSHA COVID-19 Rule Requirements, Including Those Adopted 5.4.21

1. Physical Distancing Measures

As part of the requirement to ensure that workers can maintain appropriate physical distancing, as described in OAR 437-001-0744(3)(a), veterinary employers must also take the following specific steps:

1. Adopt a curbside model, bringing the animal patient into the facility while the owner remains in the vehicle, strictly enforce six-foot physical distancing in the waiting area, or employ a combination of the two.
2. Do not allow owners or caretakers into the facility exam room without appropriate source control and only when visit involves one of the following:

  • Euthanasia;
  • Receiving instruction as to providing home care for pets including, but not limited to, giving medication, providing fluids, or managing feeding tubes or catheters; or
  • Veterinary workers are examining or treating animals that may pose a threat to the veterinary worker.

3. Limit situations where any veterinarian workers are within six feet of other individuals to those necessary to safely handle and treat the animal patient.

2. Masks, Face Coverings, & Face Shields

To reduce the risk of transmission from potentially infected individuals, veterinary employers must implement the requirements of OAR 437-001-0744(3)(b). In addition, veterinary employers must provide and ensure the use of personal protective equipment in accordance with the table at the end of this appendix (page 43).

3. 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.

4. Posting Requirements

The COVID-19 Temporary Standards 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.

5. Special Requirements for Building Operators

No later than November 23, 2020, where feasible, building operators must ensure that the facility layout allows for appropriate physical distancing and that a “Masks Required” sign is posted in common areas including shared entrances, waiting rooms, corridors, examination and treatment rooms, etc.

6. 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.

Under the new rule (5/4/21), by June 3, 2021 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.

  • Although not required, such certifications can be made using the sample format provided by Oregon OSHA.
    • The certification must be dated and must include the name of the individual making the certification; and
    • Such certification records must be maintained as long as this rule is in effect.

7. 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.

8. 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.

9. 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.

  • Training must cover workplace requirements on physical distancing, masks/face coverings, sanitation, characteristics and methods of COVID-19 viral transmission, asymptomatic transmission, COVID-19 symptoms, employee reporting of COVID-19 signs and symptoms, workplace COVID-19 infection notification process, and safe and healthy work practices.
  • Oregon OSHA states it will provide sample training materials that can be used to complete this requirement. To the extent that an employer has already provided training before adoption of the final Rule, the employer does not have to repeat the training, but “may need to take steps to ensure that additional information is covered and that appropriate employee feedback can be provided.”
  • To help veterinary facilities comply with this new regulation, the OVMA has developed material that covers the essential aspects of Oregon OSHA’s expectations. You will want to review this material and modify the appropriate forms for your specific clinic operations, if necessary. Some of this important material was developed by Oregon OSHA and/or the Oregon Health Authority.
  • OSHA has developed a multimedia course designed to help employers meet 4 of the 10 employee training requirements found in OSHA’s COVID-19 Temporary Rule. The material covered in the multimedia course is also included (in a different format) in the OVMA material above.

10. 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.)

11. 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.

12. 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.

  • Whenever an employee participates in quarantine or isolation for COVID-19, the employer must allow the affected employee(s) to work at home if suitable work is available and the employee’s condition does not prevent it.
  • Whenever an employee participates in quarantine or isolation, whether as a result of the requirements of this rule or because the employer chooses to take additional precautions, the affected worker(s) must be notified that they are entitled to return to their previous job duties if still available without any adverse action as a result of participation in COVID-19 quarantine or isolation activities.
  • Effective June 3, 2021, the employee must be advised in writing of the right to return as described and should be provided any relevant information about the employer’s paid time off, sick leave, or any other available benefits in accordance with local, state, or federal law.

13. Transportation

The new rule encourages employers, if practical, to consider alternatives to transporting multiple people for work-related purposes. When employees share work vehicles, employers must ensure the following measures are taken:

  • When more than one person is in the vehicle, all occupants must wear a mask, face covering, or face shield;
  • Outside air must be increased (for example, by opening windows when weather conditions permit, by not recirculating cabin air, etc.); and
  • The separation of individuals in the vehicle must be maximized to the degree possible (for example, by the use of occupancy limits, by seating occupants in alternate seats, etc.). Note: The requirements do not apply when all occupants within the vehicle are members of the same family or household.

Vaccine Availability for the Oregon Veterinary Community

Mask Guidance

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: 2021-05-05 07:00:00

Author: Oregon Veterinary Medical Association