FACE COVERINGS FOR PATIENTS, STAFF, AND DOCTORS
A new study that was released at the end of October is leading to several changes in guidelines related to face coverings and facemasks. These guideline changes are primarily for the public, but they also can be applied to the chiropractic office setting.
As you are all aware, face coverings are now required in “public indoor spaces,” which includes chiropractic physician offices. These face coverings can be N95 masks or simply cloth masks (new CDC guidance regarding mask layers should be followed – see below).
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As a result, the ICS recommends that all chiropractic physicians and staff wear face coverings AND require patients to wear face coverings.
Chiropractic Physicians and Staff:
All staff, physicians and non-physicians, in a chiropractic setting, should wear appropriate facemasks anytime the person will be with patients, with other staff members, or in an area that either another staff member or patient could enter. In short, facemasks should be worn unless the staff member is in a closed-door space with no one else in the room.
The ICS is receiving an increasing number of calls from chiropractic physicians about how to respond to COVID exposures within their offices. When these physicians query their local Departments of Public Health about a possible requirement to close or quarantine, the Public Health officials base their answers on the mask procedures followed by doctors, staff, and patients. Physician offices that have been compliant with facemask guidance are generally less restricted in their ability to continue operating their practices.
There are three different regulatory entities to consider when determining what is required: CDC, OSHA, and IDPH. All three have guidelines, and IDPH and OSHA currently have enforcement capability.
The CDC offers the most comprehensive information and guidance. They indicate that health care providers “should wear a facemask at all times while they are in the healthcare facility, including in breakrooms or other spaces where they might encounter co-workers.” This is for continued protection for the doctor, staff, and patients.
What Masks Should You Use in Your Office?
Based on current information from the CDC, OSHA, and IDPH, the type of mask depends largely on your overall risk. Most chiropractic physician offices would be considered “medium risk” by OSHA, and the CDC would indicate that you would primarily be concerned with source control. Source control refers to use of well-fitting cloth face masks or facemasks to cover a person’s mouth and nose to prevent spread of respiratory secretions when they are talking, sneezing, or coughing. Because of the potential for asymptomatic and pre-symptomatic transmission, source control measures are recommended for everyone in a healthcare facility, even if they do not have symptoms of COVID-19. However, if you are performing COVID-19 testing at your office, then your risk would increase to high or very high and you should be concerned with more than simply source control.
Surgical masks or procedure masks would be the preferred face covering in a chiropractic physician office. They should be FDA approved and used according to the labeling for tight fit. According to the CDC, physicians and staff “should consider continuing to wear the same…facemask throughout their entire work shift.”
Cloth face masks are not preferred. However, the CDC does allow for the consideration of PPE shortages by indicating that “when available, [surgical masks or procedure masks approved by the FDA] are preferred over cloth face masks for HCP as facemasks offer both source control and protection for the wearer against exposure to splashes and sprays of infectious material from others.” OSHA also weighs in and provides explanation for different masks and purposes here. Additional PPE should be considered according to OSHA that includes “some combination of gloves, a gown, a face mask, and/or a face shield or goggles.” Based on healthcare worker exposure information from the CDC, the most appropriate combination should include facemasks and eye protection (not glasses).
The CDC also has provided some updated information regarding mask wearing for the public. The ICS believes this information provides additional clarification for the requirements chiropractic physicians should impose on patients in their offices. Based on CDC guidance for mask wearing by the public, chiropractic practices should, of course, require face coverings for all patients. You should not risk your health and the health of your staff with leniency in this area. Additionally, in the unfortunate circumstance of a positive case exposure, work exclusions will apply if the patient is unmasked.
Here is the new CDC guidance for masks. One of the recent changes indicates that single layer cloth coverings are no longer acceptable. Please see the guidance for more information.
Enforcement:
The State of Illinois already has enforcement rules in place. If businesses and organizations are not enforcing social distancing rules and requiring face coverings for their employees and their patrons, they could face a fine. Enforcement will take place in three steps.
Step 1: The first step would allow an enforcing entity, such as law enforcement or local health department, to provide the business with written notice that they are not in compliance with rule. The business will be given time to correct the action.
Step 2: If the business continues to be non-complaint, the enforcing entity will be allowed to ask patrons of the business to leave until the business follows the rules.
Step 3: If the business continues to be non-compliant, the business could be liable for a Class A misdemeanor. For a business this penalty could be up to a $2,500 fine. For the fine to be implemented, the State’s Attorney would have to file charges and the court would agree to the fine amount.
The ICS therefore concludes that chiropractic physicians (and all staff) must continue to wear appropriate face coverings AND must require patients to wear face coverings. For additional clarification on guidance from the state, the massage therapy allowances in Phase 3 require both the therapist and customer to wear a mask during the massage.
If you or your patients need more information on face coverings, here are some resources:
CDC information on making cloth face coverings,
IDPH information on face coverings,
Shop towel face covering instructions.
ICS members can download a sign for the office front door here.
This article is part of our covid-19 article: Coronavirus (COVID-19) In the Chiropractic Physician Office.
