COVID-19: Clinic Administration & Patient Care Guidance

Please note that all guidance or rules below are from Oregon Health Authority, CDC, and/or Oregon OSHA. The Oregon Veterinary Medical Association has not set these requirements. We offer this information below as a courtesy to our members to help keep them informed.

Pfizer Vaccinated Veterinary Team Members Eligible for Booster

Oregon Health Authority’s Public Health Director Rachael Banks stated that health care workers who were in the state's 1-A category and received the Pfizer vaccine are eligible for a booster. The veterinary team was included in Oregon's 1-A phase in group 4.

According to Ms. Banks, "people who were in phases 1A and 1B during Oregon's roll-out of primary COVID-19 vaccinations last December and earlier this year are now eligible to receive the Pfizer booster if they want it, and they received their immunization at least six months ago." Dr. DeBess indicated that there is plenty of vaccine for everyone who is eligible to get a Pfizer booster to do so over time, but that it may take a few weeks to obtain an appointment or find supply at a local pharmacy or medical facility due to immediate booster demand and/or due to vaccinator staffing issues.

Read more about the availability and eligibility for the Pfizer booster shot.

Those who received the Moderna and Johnson & Johnson vaccine are not currently eligible for a booster, but data collection and analysis is ongoing and there are suggestions that booster recommendations for these vaccines may be forthcoming.

Meanwhile, no matter which vaccine you may have received, the Governor stressed that all provide excellent protection against hospitalization and death.

COVID-19 Vaccinations in the Workplace

With the highly infectious Delta variant of COVID-19 surging across Oregon, some veterinary clinic owners and practice managers are again asking the question if they are permitted to require vaccination of their employees. The Equal Employment Opportunity Commission (EEOC) has released guidance under federal law that makes it clear that employers may require employees to receive a COVID-19 vaccine, with limited exceptions. This also is true under Oregon law, according to the Oregon Bureau of Labor & Industries. Employers cannot require COVID-19 vaccinations in the workplace if they employ specific types of workers or have contractual limitations. Workers may make requests for exemptions or accommodations due to disability or religion.

Employees exempt by law

Most workplaces can require employees to get a COVID-19 vaccine, but some types of workers are exempt by law. Exempt workers include: firefighters, law enforcement officers, corrections officers, or parole and probation officers. See ORS 433.416(3). “Workers” mentioned there are defined at ORS 433.407(3).

Contractual limitations

For employers with a unionized workforce, a collective bargaining agreement could contain direct prohibitions on mandatory vaccines in the workplace. Although less common, individual employment contracts could present similar challenges.

Reasonable accommodations

Under civil rights and disability laws, employers with mandatory COVID-19 vaccine policies will need to consider requests for exceptions for individuals with either (1) sincerely held religious convictions, or (2) a disability that prevents them from receiving a COVID-19 vaccination. While employers are not required to grant the exception if it creates an “undue hardship” on the business or a “direct threat” to the safety of the employee or others, employers should engage with the employee to determine if a reasonable accommodation is possible.

I’d like to mandate vaccines for my employees. What are the first steps I should take to do so?

  • Provide employees with as much advance notice and information as possible. Information on the development and safety of COVID-19 vaccines is available on the CDC Web site.
  • Provide a path (or multiple paths) for questions. While few employees are exempt from required vaccinations, you want to ensure employees with a need for accommodation have a clear path to pursue that conversation.
  • Consider whether you want to provide the vaccination onsite/with a contractor or require employees to obtain the vaccination from their own health care provider. Requiring employees to obtain COVID-19 vaccination from their own providers reduces the possibility of pre-vaccination screening triggering ADA restrictions on disability-related inquiries.

Our clinic has required employees to receive vaccines, do we have to pay them for the time to go get the vaccine?

That depends. Receiving a vaccination is not a medical exam, but it likely amounts to medical attention. Under wage and hour law, time spent by an employee waiting for and receiving medical attention on the premises or at the direction of the employer during the employee’s normal working hours on days when the employee is working would need to be paid. OAR 839-020-0046(2). On the other hand, if an employee chooses to get a required vaccination off hours and off premises, the time need not be paid. An employee that opts to receive a required vaccination off premises, but during work hours, could use any available Oregon sick leave. Sick leave must be provided with pay by employers with 10 or more Oregon employees—six or more if the organization has an establishment in Portland.

Can employers offer a financial incentive to employees to get a COVID-19 vaccination?

The Oregon Legislature passed HB 2818 permitting employers to offer vaccine incentives without running afoul of Oregon’s pay equity law. Of course, employers may continue to offer incentive programs that don’t result in a pay differential as well. (e.g., all employees might get a bonus once a certain percentage of the workforce either obtains the vaccine or is exempted because of bona fide religious conviction or a disability). Regardless, employers need to ensure individuals are not retaliated against for their religion or disability.

Employee education is key

Just as employers have been educating workers throughout this pandemic—about masks, about handwashing, about social distancing—employers can proactively educate and encourage vaccination.

Masks required indoors regardless of vaccination status Updated 8.13.21

All Oregonians older than five years of age, regardless of vaccination status, are now required to wear masks in indoor public places. A veterinary facility is considered an indoor public place and, therefore, all employees and clients must wear a face covering. The new requirement does not place any restriction on clients entering a veterinary facility, such as the lobby or exam room.

OSHA lifts some requirements

Note: Gov. Brown has reinstated an indoor mask mandate, regardless of vaccination status, effective August 13, 2021.

As of June 30, 2021, Oregon OSHA repealed its permanent workplace requirements on physical distancing and the veterinary-specific rule to use curbside service or to maintain distancing in the waiting room, as well as to restrict client access to the examination room.

OSHA's COVID rule related to the use of Personal Protective Equipment by veterinary staff in certain treatment situations—the CDC's “Interim Infection Prevention and Control Guidance for Veterinary Clinics Treating Companion Animals During the COVID19 Response"—remains in place. (See page 40 of this document.)

Although physical distancing restrictions have been lifted, you can choose to continue with curbside service.

OSHA COVID-19 Rules as they affect veterinary facilities

Summary of OSHA COVID-19 requirements

Face Coverings

Per administrative order, face coverings are again required in all indoor public places—this includes veterinary clinics. UPDATED 8.13.21

Cleaning and Sanitation

The rule requires regular cleaning of all common areas, shared equipment, high-touch surfaces at least once every 24 hours if the workplace is occupied less than 12 hours a day or every 8 hours if the workplace is occupied for more than 12 hours per day.

Note: These cleaning and santitation requirements are no longer being enforced outside health care settings. Although the provisions remain in the rule, the general cleaning requirements are not considered “de minimis” violations and, therefore, are not being enforced. However, provisions related to providing employees with supplies and the reasonable time necessary to clean and to perform hand hygiene continue to be enforced.

Posting Requirements

The It's the Law poster must be permanently placed conspicuously in a central location. Any employee working remotely must be provided with a copy of the poster through electronic or equally effective means.

Special Requirements for Building Operators

Ensure that the sanitation requirements are met, and, as appropriate, post signs in areas where a building operaor chooses to require masks, face coverings, or face shields.

Ventilation Requirements

No later than January 6, 2021, HVAC maintenance must be performed to ensure the maximum amount of outside air recirculation to the extent of system capacity. This includes cleaning and maintaining filters, but it does not require the installation of new ventilation equipment.

All employers with more than 10 employees and an existing HVAC system must certify in writing that they are operating the system in accordance to the new rule, to the best of their knowledge. Note: The updated rule does not require employers to purchase new ventilation systems.

Conduct a COVID-19 Exposure and Risk Assessment

No later than December 7, 2020, all employers must perform a COVID-19 exposure risk assessment. The assessment must involve feedback and participation from employees via a safety meeting or a supervisor. Employers with >10 employees must document their exposure risk assessment using the OSHA questionnaire for each job title. Risk assessment must involve participation and feedback from employees via safety meeting, supervisor meeting, or any other similar interactive process. Keep this documentation on file in your practice; you do not have submit it to anyone at this time.

Infection Control Plan

No later than December 7, 2020, all employers must implement an infection control plan. For employers with > 10 employees, the plan must be in writing and available to employees. If an employer has multiple facilities, the plan may be formulated for facility type rather than individual facility. Keep this documentation on file in your practice; you do not have submit it to anyone at this time.

Note: You may also choose to complete the template developed by OVMA.

Employee Information and Training

No later than December 21, 2020, employers must provide workers with information and training on COVID-19 and ensure that employees are provided an opportunity for feedback about topics covered.

COVID-19 Infection Notification Process

Employers must establish a mechanism for notifying both exposed and affected employees within 24 hours of the employer’s knowledge of a potential COVID-19 workplace exposure (eg. an individual with COVID-19 in the workplace.)

COVID-19 Testing for Workers

Employers must cooperate with the Oregon Health Authority or local public health if workplace COVID-19 testing is indicated by those agencies (making employees and space available).  If testing is directed by employer (not OHA or a local public health agency), costs (test, employee time, travel expense) is to be borne by the employer requesting the testing.

Medical Removal

Whenever the Oregon Health Authority, local public health agency, or medical provider recommends an employee be restricted from work due to quarantine or isolation for COVID-19, such as through identification during contact tracing activities, the affected worker(s) must be directed to isolate at home and away from other non-quarantined individuals. Note: Other than the obligation to provide such direction and to remove such employees from the workplace, the employer has no obligation to enforce the employee’s quarantine or isolation.

Best practices for the profession

There is no standard approach to COVID-19 control in veterinary practice that would apply to all situations and practice types. There are a number of considerations that veterinarians and veterinary clinics must evaluate and apply as needed.

Below is a set of resources, tips, and best practices to help employers and employees prevent the spread of COVID-19 after re-opening. Please carefully consider these Best Practices to protect you and your staff

Vaccination

Vaccination is safe, effective, and is a core component of COVID-19 control. Individuals who are vaccinated against COVID-19 are well-protected after 14 days. Currently, there are three approved vaccines to combat COVID-19: Moderna and Pfizer both offer a two-dose series, and Johnson & Johnson offers a single-dose vaccine.

Masking

Masks are a simple barrier to help prevent your respiratory droplets from reaching others. Masks should be used both inside and outside. Masks should completely cover the nose and mouth and fit snugly against the sides of face without gaps.

Limit the number of people in the clinic

Minimizing the number of people in the clinic at any given time will reduce the risk of an infected person entering the clinic, further reducing the risk of close contact between people, and facilitate distancing and other control measures. A gradual re-introduction of in-clinic visits can be done by maintaining some degree of curbside care delivery, telemedicine, and hybrid appointments. In-clinic visits can be focused on situations where there are client communication or patient care benefits to allowing an animal owner to enter the building.

Maximize distancing

Whether it’s a conversation between coworkers or an interaction between clients and staff, it is important to maximize distancing between people. This requires consideration of person flow within the clinic and how client visits are handled (e.g. are exam rooms used for appointments or do clients wait in an exam room while the patient is examined by clinical staff in a separate area). Six feet distancing can consistently provide a guide for physical separation. Therefore, it is not an issue of distancing OR use of other measures (e.g. mask, ventilation). It is a matter of using distancing as much as possible ALONG with those measures.

Limit contact time

Risk increases with time of contact. There is a 15-minute limit used for consistency related to potential exposure. Contact times can be reduced by providing hybrid appointments, focusing on efficient delivery of care, and improving flow within the clinic to avoid personnel or client bottlenecks.

Ventilation

Ventilation is increasingly being recognized as a critical and often overlooked control tool. Clinics should optimize ventilation. Keep your ventilation system well maintained. Increasing air flow is a critically protective factor, whether it’s through utilizing the HVAC systems, opening windows, opening doors within the clinic, and/or using fans.

COVID-19 Case Management

Exposure: It is considered an exposure when there is contact with a confirmed case, remaining within 6 feet of someone for a cumulative total of 15 minutes or more over a 24-hour period.

A person in contact with an exposed individual is not considered to be exposed unless the exposed individual develops symptoms compatible with and tests positive for COVID-19. There are no restrictions for persons in contact with an exposed individual unless they test positive for COVID-19.

  • Quarantine: It applies to those in close contact with someone who has been diagnosed with COVID-19 and NOT fully vaccinated. Quarantine is 14 days.
  • Isolation: The time period that a person tests positive (antigen or PCR including home tests) regardless of symptoms. The person that has tested positive will isolate for 10 days and return to work on the 11th day as long as they are symptom-free for more than 24 hours.
  • Symptomatic personnel: If veterinary personnel develop clinical signs suggestive of COVID-19, they should not enter the clinic and seek a medical evaluation ASAP.
  • Unvaccinated personnel: Unvaccinated staff in close contact with someone with COVID-19 should stay home for 14 days after their last exposure to that person. People who are not fully vaccinated should be tested immediately after being identified, and, if negative, tested again in 5–7 days after last exposure or immediately if symptoms develop during quarantine.
  • Vaccinated staff: People who are fully vaccinated do NOT need to quarantine after contact with someone who had COVID-19 unless they have symptoms. Fully vaccinated people should get tested 3-5 days after their exposure, even if they don’t have symptoms and wear a mask indoors at all times. Check for symptoms for 14 days.
  • Return to work: A person may return to work after isolation (10 days) or quarantine (14 days) without a negative test. Because of the nature of the disease, it is not recommended to test after isolation or quarantine as long as they are symptom-free.

General Recommendations

Measures to reduce risk include:

  • Limiting the number of people that enter the clinic (and maximizing care that does not involve the client entering the clinic)
  • Limiting the number of people that are in the clinic at any given time
  • Limiting contact between animal owners and clinic personnel or other owners
  • Minimizing the duration of contact between animal owners and clinic personnel (< 15 minutes)
  • Minimizing or avoiding contact in closed spaces (< 15 minutes)
  • Maximizing the use of personal protective equipment (e.g., masks)
  • Physical distancing with clients when possible
  • Cleaning and disinfecting high-touch surfaces regularly
  • General infection prevention and control (e.g., washing hands)
  • Evaluating clinic personnel interactions (e.g., ‘clinic bubbles’)
  • Maximizing ventilation

CDC PPE guidance

Minimum standards of care

A reminder that nothing in these orders or guidance changes the minimum standards of care to which you must continue to adhere as licensees and veterinary facilities.

Updated: 2021-09-30 07:00:00

Author: Oregon Veterinary Medical Association