Question

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?

Short answer

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

Question

Can the below tests be administered via telepractice?

• Beery-Buktenica Developmental Test of Visual-Motor Integration
• Detailed assessment of speed of handwriting (DASH)

Answer

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.

Question

What is the impact on return to work for patients with COVID-19 who have been hospitalised?

Short Answer

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.

QUESTION

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?

Short answer

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:

1. Health Protection Surveillance Centre (2020). Interim Guidance on Infection Prevention and Control for the Health Service Executive 2020 v1.2. HSE: September 2020.
2. 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.
3. 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.

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?

Short answer: No

The content of this document is correct as of 17/09/2020.

Haines, J, Esposito, K, Slinger, C, et al. UK consensus statement on the diagnosis of inducible laryngeal obstruction in light of the COVID‐19 pandemic. Clin Exp Allergy. 2020; 00: 1– 7.

Laryngoscopy is the mandatory gold standard for the accurate assessment and diagnosis of inducible laryngeal obstruction. However, it is considered an aerosol‐generating procedure and so in the context of COVID-19 the availability of laryngoscopy is reduced. 

This consensus statement aims to guide clinicians working with inducible laryngeal obstruction (ILO) patient populations in the context of COVID-19. It provides an agreed, recommended strategy for presumptive diagnosis in patients who cannot have laryngoscopy performed due to pandemic restrictions.

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Tohidast, S. A., Mansuri, B., Bagheri, R., & Azimi, H. (2020). Provision of speech-language pathology services for the treatment of speech and language disorders in children during the COVID-19 pandemic: Problems, concerns, and solutions. International journal of pediatric otorhinolaryngology, 138, 110262.

COVID-19 has interrupted the provision of Speech-Language Pathology (SLP) services to children due to the need for face-to-face communication between Speech and Language Pathologists (SLPs) and children during the evaluation and treatment processes.

This article describes the negative effects of COVID-19 on the provision of SLP services and discusses concerns raised by the families, the importance of providing SLP services during the critical period of speech and language development, telepractice services, the roles of speech-language-hearing related scientific associations, and the roles of SLPs during the COVID-19 crisis.

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Brodsky, M. B., & Gilbert, R. J. (2020). The Long-Term Effects of COVID-19 on Dysphagia Evaluation and Treatment. Archives of Physical Medicine and Rehabilitation.

This short editorial in the Archives of Physical Medicine and Rehabilitation discusses aerosol-generating procedures. Published June 10th, 2020.

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Patterson, J. M., Govender, R., Roe, J., Clunie, G., Murphy, J., Brady, G., … & Carding, P. (2020). COVID‐19 and ENT SLT services, workforce and research in the UK: A discussion paper. International journal of language & communication disorders.

The aim of this article is to discuss the threats and opportunities from the COVID-19 pandemic for SLTs in ENT/laryngology with specific reference to clinical practice, workforce and research leadership.

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Soldatova, L., Williams, C., Postma, G.N., Falk, G.W. and Mirza, N., 2020. Virtual Dysphagia Evaluation: Practical Guidelines for Dysphagia Management in the Context of the COVID-19 Pandemic. Otolaryngology–Head and Neck Surgery

With encouraging signs of pandemic containment nationwide, the promise of return to a full range of clinical practice is on the horizon. Clinicians are starting to prepare for a transition from limited evaluation of emergent and urgent complaints to  resumption of elective surgical procedures and routine office visits within the next few weeks to months. Otolaryngology as a speciality faces unique challenges when it comes to the COVID-19 pandemic due to the fact that a comprehensive head and neck examination requires aerosol generating endoscopic procedures. Since the COVID-19 pandemic is far from being over and the future may hold other highly communicable infectious threats that may require similar precautions, standard approaches to the clinical evaluation of common otolaryngology complaints will have to be modified. In this communication, we present practical recommendations for dysphagia evaluation with modifications to allow a safe and comprehensive assessment.

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Dimer, N. A., Canto-Soares, N., dos Santos-Teixeira, L., & de Goulart, B. N. G. (2020). The Covid-19 pandemic and the implementation of telehealth in speech-language and hearing therapy for patients at home: an experience report.

This is an experience report on the implementation of real-time telehealth in speech-language and hearing therapy for patients during the COVID-19 pandemic who were previously seen on an outpatient basis in a primary health care service.

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Aoyagi, Y., Ohashi, M., Funahashi, R., Otaka, Y. and Saitoh, E., 2020. Oropharyngeal Dysphagia and Aspiration Pneumonia Following Coronavirus Disease 2019: A Case Report. Dysphagia, pp.1-4.

Cranial nerve involvement is a finding often observed in patients infected with severe acute respiratory syndrome. To our knowledge, this is the first report of oropharyngeal dysphagia associated with COVID-19.

A 70-year-old male developed dysphagia and consequent aspiration pneumonia during recovery from severe COVID-19. He had altered sense of taste and absent gag reflex. Videoendoscopy, videofluorography, and high-resolution manometry revealed impaired pharyngolaryngeal sensation, silent aspiration, and mesopharyngeal contractile dysfunction. These findings suggested that glossopharyngeal and vagal neuropathy might have elicited dysphagia following COVID-19. The current case emphasizes the importance of presuming neurologic involvement and concurrent dysphagia, and that subsequent aspiration pneumonia might be overlooked in severe respiratory infection during COVID-19.

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Ku, P. K., Holsinger, F. C., Chan, J. Y., Yeung, Z. W., Chan, B. Y., Tong, M. C., & Starmer, H. M. (2020). Management of dysphagia in the patient with head and neck cancer during COVID‐19 pandemic: Practical strategy. Head & Neck.

Despite significant limitations in clinical service provision during the pandemic of COVID‐19, a safe and reasonable dysphagia care pathway can still be implemented with modifications of setup and application of newer technologies.

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Feldstein, L. R., Rose, E. B., Horwitz, S. M., Collins, J. P., Newhams, M. M., Son, M. B. F., … & Singh, A. R. (2020). Multisystem inflammatory syndrome in US children and adolescents. New England Journal of Medicine, 383(4), 334-346.

Understanding the epidemiology and clinical course of multisystem inflammatory syndrome in children (MIS-C) and its temporal association with coronavirus disease 2019 (Covid-19) is important, given the clinical and public health implications of the syndrome.

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