To assist physicians in safeguarding against the coronavirus disease 2019 (COVID-19) pandemic, the American Academy of Dermatology (AAD) has released a list of actions members can take to protect patients, staff, and themselves from possible infection.
The AAD recommends that “detailed and current guidance” be sought from the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO). The Academy also recommends that clinicians defer to their respective state and local government for guidance.
The AAD supports the current CDC directive that “patients being seen for non-essential or elective medical/surgical services should be rescheduled or offered telemedicine service irrespective of their exposure or symptom status,” and particularly patients at high risk for serious disease from COVID-19, patients aged ≥60 years, or those with chronic medical conditions.
When seeing a patient for an urgent or essential visit, a number of steps are recommended to reduce the risk for physician and staff exposure to the virus such as confirming the necessity of the appointment and seeking patient-report of any respiratory infection symptoms or exposure to individuals diagnosed or exposed to COVID-19. Rescheduling of non-urgent medical or surgical appointments is encouraged for these patients.
Although each dermatology practice is ultimately responsible for defining urgent and/or essential care in collaboration with the patient, the AAD cited a number of examples of what should be considered a priority visit. These are visits that:
· Prevent a patient from needing or seeking urgent or emergency care
· Reduce the risk for a poor outcome such as metastatic disease or other morbid condition
· Fulfill the need for an in-person diagnosis and/or therapeutic evaluation or procedure
When a patient schedules urgent or essential care, the AAD guidelines recommend that staff suggest that the patient arrive alone unless a companion is necessary, wait in their car for notification via cell phone that they can be seen, and if possible, that the companion wait in the car while the patient is seen by the dermatologist. Staff is also asked to consider the need for personal protective equipment (PPE) as it should be conserved during the pandemic; the same mask can be worn throughout the day. Currently, there are no recommendations to wear PPE when seeing nonsymptomatic patients. Hand washing or hand sanitizing is recommended before removing or adjusting PPE.
When seeing a patient with COVID-19 or possible exposure to the virus, the AAD suggests providing the patient with a mask, placing them in a closed room, and alerting all attending staff members. All patients should have limited points of entry and be reminded of appropriate respiratory and hand hygiene, and cough etiquette. Postsurgical follow-up visits can be reduced by the use of absorbable or buried skin sutures.
Between patient visits, examination tabletops, countertops, examination beds/tables, doorknobs, and light buttons and handles should be wiped with disinfectant containing sodium hypochlorite at 0.5%. Similarly, at the end of each day, the WHO recommends that all common high-touch areas such as buttons handles, arm rests, and countertops should be wiped, including those in the bathrooms, reception, offices, laboratory, kitchen/break room. Trash cans should be cleaned inside and out. A solution of 70% ethyl alcohol should be used to clean reusable, dedicated equipment such as thermometers.
Beyond placing hand sanitizers and wipes throughout the clinic and not greeting staff and patients with a handshake, additional measures to prevent the spread of the virus include reducing the number of chairs in the waiting room and spacing them appropriately, and removing magazine and reading materials from the patient care areas.
American Academy of Dermatology. Everyday health and preparedness steps in clinic. Accessed April 8, 2020.