How do we reopen and

remain compliant with

government guidelines
April 25, 2020
 Disclosure
• This presentation occurred on April 25, 2020. Timelines
and recommendations are subject to change as we learn
more.
• These are recommendations for best practices, presenters
have cited their information where possible.
• Please check with your city & county health departments &
state orders for regulations and recommendations specific
to your clinic and state.
• Dates and information may change from the date of this
presentation.
 Speaker Bios
• Dr. Valerie Hobbs, DOAM, L.Ac - has been a practicing acupuncturist for
25 years. She is currently the Director of Postgraduate Doctoral Programs
at the American College of Traditional Medicine at the California Institute
of Integral Studies where she is also an Associate Professor. Prior to her
current position, she worked as the head administrator at Southwest
Acupuncture College in Boulder for eighteen years. She is a grateful
recipient of a lifetime membership in the Acupuncture Association of
Colorado in recognition for her work representing the profession in
legislative efforts, including obtaining licensure. Since 2008, she has
been the co-Chair of the Clean Needle Technique Committee for the
Council of College of Acupuncture and Oriental Medicine, and is the lead
author of the March 4 CCAOM Clinic Infection Control Advisory, an
advisory on infection control decision making for acupuncture clinics at
the onset of the Coronavirus epidemic.
 Speaker Bios
• Dr. Steve Shomo DAOM, L.Ac, AP, GCDMH, CSCS, ERYT, WFR - Steve Shomo is a Doctor
of Acupuncture and Oriental Medicine, NCCAOM board certified and dual licensed in
multiple states. He is an international leader and educator in the field of Integrative
Acupuncture with over 20 years of clinical and academic experience. He has completed
postgraduate studies in Japan and the United States with specializations in; oncology,
disaster mental health (traumatic stress & PTSD), public and global health, auricular
acupuncture, pain management, acupuncture injection therapy, dry needling, laser bio-
stimulation, TCM sports medicine and performance, emergency and disaster response.
Dr. Shomo is a wilderness first responder and instructor, certified strength and
conditioning specialist, Colorado Special Tactics and Rescue Team volunteer and the
Training and Logistics Coordinator for the Colorado Acupuncture Medical Reserve
Corps, the nation’s first acupuncture based federally approved MRC responding to
disasters and critical incidents. Dr. Shomo is VA provider and is credentialed and holds
numerous local hospital privileges, providing both in-patient and out-patient care. He
is faculty for several DAOM and Masters programs, has served or continues to serve on
various state acupuncture and global health association boards, and as a subject matter
expert for Veterans Administration (VA) and the Department of Defense (DOD).
 Colorado Providers
• Economic
• Provide care to existing patients
• Provide care for those on the front lines
• Our own physical, mental, emotional &
spiritual well being

Primum Non Nocere – DO NO HARM

 State/Local Public Health
Authority Announcements
• State of Colorado lifted April 27
• Acupuncturists opening extended by DORA to
May 1 using best practices
– https://content.govdelivery.com/accounts/
CODORA/bulletins/28821be
• Or LATER as determined by County or City
 Who Governs?

Local Health
LATER OPENING DATES

Department

DORA: Your license

State of Colorado
 Known Delayed Dates
Denver County
Jefferson County
Boulder County
Adams/Arapahoe
NOT UNTIL MAY 8

• NACCHO link to county health departments:

– https://www.naccho.org/membership/lhd-directory?
searchType=standard&lhd-search=&lhd-state=CO
 What We Know
• Nature of infection prevention or virus has not changed just
because we are reopening
• Duty of a health care provider is to keep their community safe
and follow directives of local public health and medical
facilities
• CNT Advisory: Safety Plan
– Facility settings, Availability of PPEs, Disinfection Procedures
• Use good clinic judgment – practitioners are accountable for
decisions
• Consider mental emotional health as we come back from
trauma
Requirements of Colorado
Governor’s Order
Open only
• On officially announced date
• When requirements CAN be fully
implemented
• When you can safely re-open
• When you choose to re-open
 CNT Advisory - Facts
• WHO issued international public health
emergency Jan. 30, 2020
• Earliest U.S. confirmed case Jan 19 (travel-
related)
• Earliest U.S. death Feb 6 (community-spread)
 CNT Advisory - Facts
• SARS-CoV-2 virus is shed in high concentration
before symptoms appear.
• Shedding is from upper respiratory (nose)
• Screening by temperature and symptom
tracking alone is INADEQUATE (NEJM)
• Facemasks are required
 What To Do
• Hold a Safety Meeting: document!!
• Assess your clinic SETTING and PROTOCOLS
• Use PPE
• Implement and/or maintain infection controls:
document!!
• Stay informed
 Office Space
• Analyze your own setting: entry,
treatment space, dispensary, staff area
– Screening
– Social distancing
– Hand hygiene
– Surface decontamination
 Office Space – Screening
• Begins with visual and audio alerts on website,
voicemail, posters
– Alert that COVID-19 symptomatic or positive
patients may not be treated on site
– Alert to social distancing procedures
– Reminder to bring face mask, pen
 Office Space – Screening
• Screening upon entry
– Temperature
– Symptom questions
– Perform hand hygiene
– Provide facemask if needed
 Office Space – Social
Distancing
• Analyze entry to your clinic for distancing
during screening
• Analyze treatment spaces
– Minimum 6 ft distance between patients
• Analyze staff spaces
– Minimum 6 ft distance/barriers
• Enact procedures to ensure distancing
 Office Space – Social
Distancing Procedures
• Utilize telehealth or phone intake as much as
possible
• Patients wait in car until taken directly to
treatment room
• People accompanying patient wait in car (no
kids alone!)
• Physically mark space
• Curbside delivery of herbs
Office Space – Hand Hygiene
• Provide posters on hand hygiene
• Must be carried out by each person upon entry
to clinic
• Provide hand sanitizer (min. 60% alcohol)
throughout space or immediate access to soap
and water
• Practice hand hygiene per CNT
 Office Space – Cough
Hygiene
• Provide posters on cough hygiene
• Provide tissues and no-touch waste
receptacles
 Office Space – Surface
Decontamination
• Analyze setting
– Minimize furnishings with cloth coverings
– Minimize non-essential objects in treatment
rooms, remove decorative items
– Place clean laundry in cabinet or sealed
storage container
– Create checklist for cleaning all items in a
treatment room
 Office Space – Surface
Decontamination
• All hard surfaces: clean and disinfect with EPA
registered disinfectant for Corona virus
according to label
https://www.epa.gov/pesticide-registration/list-n-
disinfectants-use-against-sars-cov-2

To kill virus, surface must remain wet for entire time

specified on label. Look for “contact time” or “dwell
time”
 Office Space – Surface
Decontamination
• Establish frequency of cleaning according to
how often surface is contacted
https://www.cdc.gov/coronavirus/2019-ncov/
community/disinfecting-building-facility.html
https://www1.nyc.gov/assets/doh/downloads/pdf/
imm/disinfection-guidance-for-businesses-
covid19.pdf
 Office Space – Surface
Decontamination
• Treatment table and any surface touched by
patient: after each patient
– Doorknobs, check out counters, sinks, handles of
hand sanitizer dispensers
• All surfaces in treatment room, including floor:
daily
• All frequently touched surfaces by staff: daily
• Office/dispensary surfaces and floors: weekly
 Office Space – Laundry
• Nothing may be used for multiple patients
– Table liners/pads, blankets, sheets, gowns, pillow
cases
• Hanging cloth room dividers
– See manufacturer label for frequency of washing
 Office Space – Checklist
• Create a checklist for cleaning after each
patient
• Create a checklist for daily/weekly cleaning
• Use checklist to create a grid with spaces to
initial and record dates of cleaning, post on
inside of cabinet in treatment room and initial
and date when completed. File sheet when
completed.
 PPE
• Eye Protection*
• Facemask
• Gloves
• Clinic apparel
– jewelry
 PPE - Facemasks
• Patients may wear DIY cloth mask
• Surgical masks are for HCP
• N95 for HCP treating COVID-19
 PPE - Facemask
• Can be worn for a day if (currently HCP are
reusing for up to 7 days)*
– They are clean and dry
– There is no visible defect
– You don’t touch them
 PPE - Facemask
• Can be “donned and duffed” between patients
• Wash hands before putting mask on
• Don’t touch interior
• Wash hands before taking mask off
• Place mask in a paper bag
• Wash hands before re-donning mask
 PPE - Gloves
• Gloves are not usually required for acupuncture
• Best advice is that gloves should be worn now, and
changed between patients
• Hands should be washed whenever gloves are
removed
• Gloves should be worn whenever handling patient
laundry and disposables
• Gloves should be worn to clean and disinfect
treatment rooms
 PPE – Clinic apparel
• Use a clinic coat or
• Strongly recommend wearing scrubs
• Keep change of clothes/scrubs on hand;
change if exposed to patient droplets
• Laundering of clinic apparel: daily
Before Opening - Protocols
• START WITH UNIVERSAL PRECAUTIONS – assume
every patient is a carrier
• Is your facility cleaned and equipped (safety
meeting)
• Do you have enough PPE for you and your staff
– is it sustainable
• Access to wash and/or sanitize station for providers
and patients*
• Payment exchange procedures?
 Screening - Protocols
• Phone screening recommended 24 prior to
appointment
– Is patient experiencing any fever or respiratory
issues?
– Secondary GI issues – last 30 days
• Day of service: Temperature, wash/sanitize
hands before entering clinic
– Direct to exam room (no waiting area)
– What happens if patient doesn’t bring mask to the
clinic?
TX & Schedule - Protocols
• Analyze treatment protocols for increased
infection by droplet
– Patient positioning

• Allow minimum of 30 between appointments

to disinfect exam/treatment room.
– If you run multiple rooms; limit to ONE room to
minimize risk (50% capacity equivalent)
 Treatment - Protocols
• Contactless payment
• Follow the above described disinfection
procedures (Treatment and Daily)
• Contact and prescreen next days patients if
back to back days
 Resources
• PPE Supplies are low and difficult to acquire
– Acupuncture and medical supply vendors
 Traumatic Stress
• COVID19 Patients
• Providers
• At Home

• Coming back from a place of trauma

– Transform FEAR into Calm, Clarity, and Creativity
• Self Care practices
 Referrals
• Refer to Western provider for any emerging
sign of potential infection
• National Jewish Hospital will provide antibody
testing ($95) without physician referral
• NJH Active COVID-19 nasal swab testing
available with physician referral
– Current testing has been to those patients with
symptoms that require hospitalization
– Healthcare providers
Questions