QUESTIONS WE HAVE ANSWERED
What is the current guidance for Occupational Therapists practicing telehealth?
There are a number of best practice guidance documents currently available. We have summarised the information and guidance from the Irish COVID-19 Occupational Therapy in Acute Hospitals Interest Group, the Association of Occupational Therapists of Ireland, the World Federation of Occupational Therapists, the American Occupational Therapy Association and Occupational Therapy Australia (OTA).
Can the below tests be administered via telepractice?
- Beery-Buktenica Developmental Test of Visual-Motor Integration
- Detailed assessment of speed of handwriting (DASH)
Yes, both Beery and the DASH have publisher recommendations for administration via telepractice. Detailed instructions for the DASH can be found here and detailed instructions for the Beery can be found here.
Both tests are published by Pearson. The DASH telepractice information is available on the Pearson UK website but it does not appear on their US website. For the Beery, vice versa, the telepractice information is available on the Pearson US website and does not appear on their UK website.
What is the impact on return to work for patients with COVID-19 who have been hospitalised?
In Ireland, 3,676 people have been hospitalised because of COVID-19. There is no information on the consequent work status of these individuals. This is also the case on the global stage. There are indications from small scale studies and research on similar diseases (SARS & MERS) that some individuals hospitalised with COVID-19 will experience delayed return to work. Fatigue and breathlessness are the most common post-discharge symptoms. Scientists and professional bodies are calling for occupational therapists and other allied health professionals to prepare for the surge in demand for services but more research is needed to determine the long-term consequences of a COVID-19 hospitalisation and its impact on return to work.
The content of this document is correct as of 08/10/2020.
How can a person who is a ‘close contact’ without their own transport safely travel to a COVID-19 testing centre? Are there any specific arrangements for students or healthcare workers? Can they use public transport, taxi or is there any arrangement with the ambulance centre to support this?
A person who is a ‘close contact’, without their own car, should ask one person that they live with to drive them to the testing centre. If the ‘close contact’ does not live with anyone who has a car they should ask someone who they have been in close contact with very recently to drive them. They should follow the HSE guidance on how to safely travel in a car in such a circumstance. A person who is a close contact should not use public transport, this includes using a taxi service. There are no special arrangements in place for students or healthcare workers.
The content of this document is correct as of 10/11/2020.
Do I need to wear a mask if maintaining a 2m distance in a treatment room while delivering face-to-face CBT in Primary Care?
The National Public Health Emergency Team (NPHET) has recommended that healthcare workers use a surgical mask for all patient care activities when a safe distance (2m) cannot be maintained. This implies that when a 2m distance can be maintained a mask is not necessary. However, the NPHET guidance does not state this explicitly and does not address the issues of room size/occupancy or duration of contact. The European Centre for Disease Prevention and Control considers maintaining a 2m distance in a closed environment, such as a treatment room, as low-risk for exposure to COVID-19. The HSE Health Protection Surveillance Centre state that in low-risk circumstances, where wearing a mask may impact on patient care, a clear face visor is an acceptable alternative.
The content of this document is correct as of 30/09/2020.
These documents were used to answer this question:
- Health Protection Surveillance Centre (2020). Interim Guidance on Infection Prevention and Control for the Health Service Executive 2020 v1.2. HSE: September 2020.
- Health Protection Surveillance Centre (2020). Guiding principles for Infection Prevention and Control when returning to routine General Practice during pandemic COVID-19 v2.1. HSE: July 2020.
- European Centre for Disease Prevention and Control (2020). Public health management of persons having had contact with cases of novel coronavirus in the European Union. ECDC: February 2020.
Dr Liz Kingston, member of the RapidInfo4U Panel of Experienced Clinicians and Lecturer at the University of Limerick, with a clinical speciality in infection prevention and control, was consulted to answer this question.
Could you please provide clarity on the proper disposal of PPE?
What type of bin should be used? Can certain types of PPE be disposed in domestic bins (e.g. masks)?
If PPE is worn with a person who is known or suspected to have COVID-19 then it should be disposed of in a healthcare risk waste bin (yellow). If a healthcare risk waste bin is unavailable, the following procedure should be followed:
- All items of PPE should be disposed of into a plastic bag
- The bag should not be filled more than three quarters full
- The bag should be securely tied and placed inside another second, plastic bag (double bag)
- The bag should be stored securely for 72 hours and can then be disposed of with general domestic waste
If PPE is worn in the absence of a specific known risk of COVID-19 it can be discarded immediately as general domestic waste. There is no distinction made between different types of PPE in terms of disposal procedures.
The content of this document is correct as of 11/12/20.
1.Can a Classroom Feeding Observation for Dysphagia take place within a Pod?
2.When conducting a Classroom Feeding Observation for Dysphagia do parents of children in the same Pod as the patient need to be informed of, and consent to, the observation?
1.Yes, assuming local and national COVID-19 guidelines are followed including PPE and social distancing, a Classroom Feeding Observation for Dysphagia can take place within a Pod.
2.Yes, assuming local and national COVID-19 guidelines are followed including PPE and social distancing, a Classroom Feeding Observation for Dysphagia can take place within a Pod.
The content of this document is correct as of 18/09/2020.
This response was based on the Department of Education COVID-19 Response Plan for Reopening our Primary and Special Schools, version 2, published in August 2020. Access this document here.
- What is the evidence to support high flow nasal oxygen in COVID-19 management?
- Does high flow nasal oxygen result in increased droplet dispersion and aerosol generation in COVID-19 patients?
High flow nasal oxygen for the management of COVID-19 is a controversial topic due to a lack of high-quality research into its efficacy and its potential as an aerosol-generating procedure. Systematic reviews commissioned by the World Health Organization found that high-flow nasal cannulas may reduce the need for invasive ventilation and the escalation of treatments over conventional oxygen therapy in COVID-19 patients. However, they caution that this potential advantage must be weighed against the currently unknown risk of droplet and aerosol transmission: there is currently no research evidence directly examining the consequent dispersion of COVID-19 virus for this procedure. A number of actions can reduce any potential risk: deliver HFNO in negative-pressure rooms and/or ensure proper ventilation; use an increased area of precaution; ensure staff have protective PPE; and place surgical masks on patients receiving the HFNO.
The content of this document is correct as of 04/12/20.
- Is there any evidence to suggest chest physiotherapy is an aerosol-generating procedure?
- Does the evidence compare different types of chest physiotherapy treatment techniques – and whether certain treatments may be more aerosol generating than others? (i.e. positive pressure devices, oscillating devices, cough assist, breathing techniques, patient coughing, suction etc).
There is insufficient evidence to state that chest physiotherapy is an aerosol-generating procedure. However, absence of evidence is not evidence of absence. International and national professional physiotherapy bodies have endorsed guidelines for physiotherapy management during COVID-19 which state that chest physiotherapy interventions are potentially aerosol-generating procedures and strongly recommend using airborne precautions when delivering these interventions. Furthermore, a recent systematic review classified chest physiotherapy interventions as potentially aerosol-generating and recommended, for the purposes of selecting personal protective equipment, that such procedures be treated as aerosol-generating.
The content of this document is correct as of 04/12/20.
What is the latest evidence regarding conscious proning of COVID-19 patients?
At what level of oxygen is it best to commence proning?
When should you stop proning as the patient is improving?
The current evidence for conscious proning is of poor quality and fails to answer several key questions required to inform clinical practice, including the optimum conditions for commencing and ceasing proning. There are multiple RCTs underway that will address these gaps in knowledge over the coming months.
The content of this document is correct as of 27/11/2020.
1.What is current guidance for cleaning a room after a hands-on physiotherapy session?
2.What are the current recommended products for effectively cleaning surfaces?
3.Do I have to wait a certain amount of time to clean my treatment room after a session?
1.Clean with detergent and water followed by rinsing and drying. If a surface is suspected or known to have been contaminated by infectious material a disinfected should be used after cleaning.
2.A neutral detergent with water for cleaning and a chlorine-based product, such as sodium hypochlorite, for disinfecting.
3.HSPC cleaning protocols do not stipulate that a certain amount of time should be left between seeing a patient and cleaning. HSPC guidelines state that COVID-19 virus droplets produced by an infected patient will land on surfaces “within minutes” of production. They do not state how many minutes precisely. Research has found that large droplets fall within 1 second while smaller droplets can take up to 9 minutes to fall to the ground.
The content of this answer is correct as of 02/10/2020
When cleaning areas between patients are detergent wipes (e.g. Sanicloths) required or will a general detergent spray and disposable tissue suffice?
When disinfecting areas between patients are disinfectant wipes required or can we use disinfectant spray and disposable tissues?
The HSE Health Protection Surveillance Centre guidelines do not stipulate that wipes are required to clean or disinfect areas between patients. Disposable tissues, cloth, or paper towels are sufficient to use in conjunction with the appropriate detergent solution and disinfectant.
The content of this document is correct as of 06/11/2020.
This response was based on HSE Health Protection Surveillance Centre Interim Guidance on Infection Prevention and Control for the Health Service Executive 2020 v1.2. Available here.
Is there sufficient evidence to warrant a change in the established position (i.e. NICE guidelines of June 2020) regarding vitamin D for the prevention or treatment of COVID-19?
No, there is insufficient evidence to warrant a change in the established position (i.e. NICE guidelines of June 2020) regarding vitamin D for the prevention or treatment of COVID-19. Best practice remains maintaining recommended levels of Vitamin D, which may include supplementation of vitamin D in groups at high-risk of deficiency.
The content of this document is correct as of 17/09/2020.
CONTENT FROM SCIENTIFIC JOURNALS
This Letter to the editor highlights that the discourse on telehealth is lacking the acknowledgement that participating in telehealth is a complex occupation. It states that the professional values of occupational therapy of accessibility and person-centredness are important at this time.
Click here for letter
Occupational therapy in times of pandemic: social security and guaranties of possible everyday life for all
Malfitano, A. P. S., Cruz, D. M. C. D., & Lopes, R. E. (2020). Occupational therapy in times of pandemic: social security and guaranties of possible everyday life for all. Cadernos Brasileiros de Terapia Ocupacional, (AHEAD).
This editorial calls on occupational therapists to push themselves beyond the adaption or organisation of daily lives, to the building of relations between context, policies and lives.
It focuses on the World Federation of Occupational Therapists (WFOT) statement about the response of occupational therapists to the pandemic of COVID-19. It mentions the occupational therapy profession has been participating in this process through several initiatives, with the aim of caring for people daily life. It also mentions that occupational therapists need to approach the role of professionals in the Social Care System.
This editorial concludes that blended learning should remain the preferred approach beyond COVID‐19 and that research is required to establish what online components can remain to support the development of occupational therapy knowledge, skills, and competencies.
Click here for article
This open letter outlines the key role of occupational therapists in assisting the four different key sects of occupations that were majorly affected by the COVID-19 pandemic. These are the occupations of those who are or were COVID-positive, occupations of healthy individuals affected by COVID-19/lockdown, occupations of the population highly susceptible and vulnerable of contracting COVID-19 and occupations having a direct impact on global market, supply chain or economy.
Click here for letter
OTHER REPUTABLE REPOSITORIES & USEFUL CONTENT
The Association of Occupational Therapists of Ireland (AOTI) is the professional body serving, promoting and representing occupational therapists in the Republic of Ireland.
The AOTI have developed COVID-19 section on their website, where they have gathered a wide range of resources from reputable sources covering key areas such as:
- CORU updates
- Critical care
- Mental health/psychosocial
- Clinical topics
- Online learning
- Return to work
Visit the AOTI content on Occupational Therapy and the COVID-19 Pandemic here
The American Occupational Therapy Association (AOTA) is a national professional association established in 1917. In this online article the AOTA occupational therapists explain that routines and participation in meaningful activities are important for mental and physical wellness during a pandemic.
Click here for online article
The World Federation of Occupational Therapists (WFOT) is an international organisation for the occupational therapy profession. As such the WFOT engaged with the World Health Organization’s meetings, briefings and strategy development in relation to COVID-19.
The WFOT has established a dedicated free online platform to support requests to network, share and develop resources regarding the impact of COVID-19 and its relevance to the occupational therapy profession.
This platform is available here
RapidInfo4U is part of the Irish Government’s national coordinated research and innovation response to the COVID-19 pandemic. RapidInfo4U is funded by a Health Research Board COVID-19 Pandemic – Rapid response funding award and managed by the Health Implementation Science and Technology cluster at the University of Limerick.