Each patient appointment in private healthcare facilities must be at least 40 minutes long to minimise crowding and ensure sufficient time to clean and disinfect clinics/ rooms, according to the guidelines for Phase 1 of the controlled lifting of Covid-19 restrictions.
The Ministry of Public Health (MoPH) has issued a set of detailed guidelines on the precautionary and preventive measures that are to be followed in this phase.
“Ensuring the adherence to precautions for the lifting of Covid-19 restrictions is a shared responsibility,” the MoPH stressed on social media.

Following are the guidelines mentioned in the ‘Private Healthcare Facilities’ section:

* Compliance officer
1. Appoint a designated employee to act as a ‘compliance officer’ to ensure implementation, compliance and monitoring of all guidance, including social distancing, hygiene and infection prevention and control.
2. The designated ‘compliance officer’ must stay abreast of, monitor and document compliance with all MoPH-issued directives, protocols and guidance.

* Covid-19 risk assessment and response plan
1. ?Develop and update a Covid-19 response plan to deal with suspected/confirmed cases of Covid-19 in the workplace and specify what is to be done if an employee displays symptoms during working hours.
2. Conduct a risk assessment on health and safety before any return to the workplace, and put in place relevant measures to ensure the health and safety of employees in line with MoPH guidance. The assessment should cover risks posed by facilities, services, working conditions and the composition of the workforce.
3. Based on the conducted risk assessment, develop a plan for resumption of services and staff return to work in line with the phases.
4. A log of all participants in any group activity or service that requires multiple staff (such as surgical procedures, group therapy sessions, etc) is kept to facilitate contact tracing if needed.
5. Consider completing a ‘return to work’ form for all staff before resuming duties.

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* Physical distancing
1. The occupancy rate of health facilities should not exceed 40% of the total capacity.
2. Maintain a 1.5m minimum distance between people (staff and patients).
3. Protective screens must be used to separate staff and patients unless it will impact delivery of services.
4. Reduce the number of employees working onsite as per the guidance in each phase.
5. Continue to provide tele-medicine services as possible.
6. Use floor and furniture markings to maintain appropriate social distancing for patients and staff.
7. Remind staff of distancing requirements with clear and visible signage.

* Infection prevention and control
1. All employees must undergo regular testing as per MoPH guidance (at employer cost).
2. Ehteraz app to be downloaded by all employees and customers, and entry will be allowed to only those with the ‘Green’ status.
3. Measure the body temperature of employees and patients on arrival. Set up separate pathway for patients with temperature above 38C as per Covid-19 protocols.
4. Hand sanitiser to be provided for employees and patients use at several locations within the facilities.
5. Masks to be worn by employees and patients at all times.
6. Personal Protective Equipment (PPE) to be provided to all health workers – full PPE for those making interventions that cause splashes, such as dental treatment or others.
7. Disposable gloves are mandatory for all staff as per the MoPH protocol, which need to be replaced after every patient encounter.
8. Avoid handshakes and all forms of physical greetings.
9. All regularly touched surfaces should be cleaned and disinfected regularly using standard disinfection products.
10. A cleaning and disinfection schedule of examination rooms, medical treatment rooms and waiting rooms between each patient should be followed and maintained.
11. A housekeeping log should be maintained.
12. Toilets are cleaned and disinfected after each use.

* Capacity restrictions
??1. All facilities must comply with capacity restrictions in each phase.
2. Consider alternating shifts or alternating clinic days to comply with capacity, 40-minute per patient appointment schedule and social distancing requirements.
* Appointments and scheduling
???1. Patients must have pre-booked appointments to be seen. No walk-ins allowed except for emergency and urgent care departments.?
2. Opening hours are from 8am to 8pm only.
3. Patients cannot be scheduled less than 40 minutes apart (i.e. each patient appointment must be for at least 40 minutes) to minimise crowding and ensure sufficient time to clean and disinfect clinics/ rooms.
4. Priority given to patients with complex or multiple chronic conditions.

* Waiting areas
???1. Patients should arrive health facilities only five minutes before the scheduled time.
2. Clinic waiting for areas to allow a minimum space of 9sqm per person.
3. Do not mix patients with respiratory infection symptoms or high temperature – provide a separate waiting room.
4. In-facility pharmacy waiting areas must comply with social distancing, floor and furniture markings. Plastic shields must be placed between chairs.?

* Elective surgical procedures
1. ???El?ective patients to undergo Covid-19 screening before procedures.
2. Avoid elective cases requiring blood transfusions or intensive care in the post-operative period during Phase 1 and Phase 2.
3. Full PPE to be worn and replaced after each procedure.?
* Home visits
???1. Continue to suspend home health services in various medical specialties (doctors, physical therapy, daily nursing, etc) except for nursing services provided through long-term contracts.
2. Home visits to prioritise patients with critical and complex conditions.
3. New full PPE must be worn prior to each visit and properly disposed of in specially marked containers following each visit.
4. All surfaces inside vehicles used to conduct home visits must be adequately cleaned and disinfected daily.

* ???Telehealth consultations
???1. Telehealth consultations and follow-ups, if established, should continue where it is appropriate, depending on the patient’s conditions. At-risk patients and vulnerable patients (those aged 60 and above, or having complex or multiple chronic conditions) should be prioritised.

* Money handling
1. Minimise any cash transactions.
2. Wipe down credit card readers and other payment methods after each patient/customer use.?

* PPE supplies
???1. All healthcare facilities must maintain sufficient PPE supplies, including masks, gloves, etc, to cover the needs of both patients and staff.

* Tools, supplies and equipment
???1. Single-use and disposable tools and supplies must be used whenever possible.
2. Any reusable tools and supplies must be changed after each use, procedure or patient encounter and properly contained using standard infection prevention and control practices.
3. All reusable tools and supplies must be properly sterilised using standard infection prevention and control practices.

* Vulnerable groups
1. Employees over the age of 60 years should be advised to work from home and/or delay return to work locations whenever possible.
2. Employees with chronic conditions should be advised to work from home and/or delay return to work whenever possible.
3. Require the completion of a ‘return to work’ form for vulnerable or at-risk employees.?

* Education and awareness
1. ???Communicate clearly and early with managers and staff on plans to reopen and any new guidance or policies that will be introduced.
2. Keep employees updated on Covid-19 safety and prevention information and guidelines.
3. Emphasis that protecting public health is paramount.
4. Use MoPH health messages and materials. Let patients know what steps are being taken to keep them safe.?

* Mental health awareness
1. ???Advise employees and patients, who may be experiencing stress or anxiety related to Covid-19 guidance to contact the mental health hotline, 16000. Refer patients according to the MoPH policy for ‘Addressing Mental Health and Psychosocial Aspects of Covid-19 Outbreak’.?
The complete set of guidelines is available here at the MoPH website.