COVID-19: Patient Care & Clinic Administration Guidance

We will continue to update Oregon veterinarians with important developments regarding COVID-19 that impact the veterinary community. We are all in this together.

We have reorganized our COVID-19 guidance in an effort to provide more clarity. For employer-related financial issues such as new sick leave rules, business financial support programs, and related topics, visit our COVID-19 Employer Guidance page.

Patient Care & Clinic Administration Guidelines

As medical professionals, veterinary practices can model appropriate and necessary behavior to clients, staff, and the general public during this public health crisis.

We encourage you to have clear guidelines in place which limit physical contact as much as possible. You can’t provide care to your patients without physically well staff and veterinarians.

Please consider this possibility that some of your veterinary team may become sick with COVID-19. Plan forward in this current situation to help avoid that outcome as best you can and to minimize the risk to other staff in the event that occurs.

Provide clear and timely communication to staff and clients about your policies during this time via social media, e-mail and signs on the doors of the clinic. Communicate daily with your healthcare team and answer their questions to support them in helping your patients and clients.

Stay Home, Save Lives

By Executive Order 20-12, Governor Brown directed Oregonians to stay at home to the maximum extent possible. She added to the list of businesses that are to be temporarily closed to stem the spread of COVID-19. The order was effective immediately on March 23, and remains in effect until ended by the Governor. Veterinary practices are not included in the temporary business closure, but physical distancing measures in the practice should be implemented. Veterinary services are permitted to continue. Individuals are permitted to seek treatment and care for their animals.

Non-Emergency Surgical Procedures

By Executive Order 20-10, Governor Brown has directed veterinary hospitals to cease all elective and non-urgent procedures that utilize Personal Protective Equipment (PPE), in an effort to preserve PPE supplies for COVID-19 response. By March 23, veterinary practices are to stop performing any elective and non-urgent procedures to preserve PPE equipment. Those procedures may be rescheduled to occur not before June 15, but keep in mind they may need to be rescheduled again if her order remains in place at that time.

OHA Guidance on this Executive Rule provides further clarification. We encourage you to read the guidance. One area that we will highlight is that the guidance notes that essential PPE currently includes facemasks, N95 respirators, gowns and eye protection. At this time, exam and surgical gloves are not included in the list of essential PPE, so sterilization practices utilizing exam or surgical gloves may continue. If gloves become limited, any non-essential practices that require these supplies must be cancelled.

Per the guidance, shelters are permitted to continue procedures (such as spay/neuter) with reusable PPE, but the guidance does not allow veterinary practices to do the same. (The guidance refers to additional information forthcoming on care within the veterinary practice, but we have no timeframe for receiving this.)

The specific language of the order defining the affected procedures follows:

"A procedure or surgery is exempt from the limitations of set forth in paragraph 1(a) of this Executive Order if a three-month delay in the procedure or surgery would put the patient at risk of irreversible harms. Criteria for determining whether irreversible harm exists include but are not limited to:

  • (1) threat to the patient's life;
  • (2) threat of irreversible harm to the patient's physical or mental health;
  • (3) threat of permanent dysfunction of an extremity or organ system;
  • (4) risk of metastasis or progression of staging; and
  • (5) risk of rapidly worsening to severe symptoms (time sensitive)."

Non-Surgical Patient Care

Non-surgical patient care, such as examinations and vaccinations, can continue as it does not require PPE.

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.

Elective Services

There is no standard list of elective/essential procedures. However, essential procedures include those required to alleviate animal pain and suffering, to prevent imminent threat of death of the animal, and matters pertaining to public health. Other considerations may be involved, including supply availability, the ability of the clinic to practice appropriate social distancing, and factors related to management of specific cases either in the clinic, at home, or in the field. Read more about elective services in the time of COVID-19.

Physical Distancing

OSHA is taking enforcement of distancing requirements seriously and will not only be investigating complaints but conducting random spot checks of businesses, and this may include veterinary practices.

As every practice is different in terms of how the clinic is configured, what services it offers, and the size of staff, there is no one-size-fits-all set of guidelines to achieve optimal physical distancing.

Following are some best practices:

Limit Clinic Access to Staff Only

  • Limit access to the clinic to staff only, with patient transfer happening outside. Meet clients at a safe distance in the parking lot. Appropriately protected staff can bring the animal into the practice for an examination and treatment. The veterinarian can discuss the diagnosis and/or treatment plan by telephone with the client who remains outside. Client communication, including transactions, can be handled by phone, text or e-mail.
  • Some clinics have clients remove collars, use the clinic's disposable leashes, and not have pets wear "outfits" to their visit to cut down on materials that might transmit the virus into the clinic.
  • Limit clients in the clinic to perhaps end-of-life care only, if even that. Consider performing euthanasias outside with physical distancing in place.
  • People with respiratory disease and/or confirmed or pending results for COVID-19 should not come into a clinic. If a person with respiratory disease and/or pending COVID-19 results must come into the clinic (again, not recommended!), the person must wear a mask, and staff should wear protective gear as well.
  • AVMA Flowchart to Help Minimize Exposure
  • Owner Contact Guidelines (Dr. Scott Weese)

In-Clinic Physical Distancing

  • Re-work your in-clinic workflow to allow for adequate distancing between staff. Whenever possible, stay at least 6 feet apart. We can’t always do it but we need to make it the goal.
  • Look at clinic layout and operations to see if people who normally sit near each other can be separated.For instance, if you have more than one person at reception and they are closer than 6 feet apart, think about what can be done to avoid this. It might mean moving someone to an office or lounge, or transitioning some activities to someone who can work at home.
  • Look at your practice's lounge, lunchroom or office spaces and try to move people around or schedule things so that only one person is in a small room at a time.
  • If a procedure will necessitate close contact between people (e.g. blood collection, catheter placement, pretty much anything that involves restraint), take a moment to step back and think about whether the procedure is really needed or if there are alternative ways of accomplishing the same thing that don’t require multiple people. Consider whether people can do tasks in steps with distancing between them.
  • When people have to be close together, be efficient. Get everything set up in advance so that whatever needs to be done can be done quickly.
  • Try to limit as much as possible interactions between various groupings of staff members. Some clinics have divided staff into teams who may work in shifts in an effort to limit interactions between the staff in general.
  • Engage your team in brainstorming solutions to this issue.

Masks

  • Many practices have staff wearing homemade masks. While definitively not as effective as N95 masks, mask wearing may help reduce the risk of transmission of COVID-19 from asymptomatic carriers.
  • Please keep in mind that mask wearing is not a substitute for physical distancing practices.
  • Dr. DeBess has stated that using masks, perhaps such as surgical masks, for occasional close contact procedures (and ideally reusing that mask for the whole shift) isn’t unreasonable, but whether it’s worth the use of PPE is unclear.

Medication/Food

  • Deliver medication refills and pet food orders to clients outside the clinic, maintaining personal distancing.
  • Direct clients to your online Rx and pet food portals for home delivery of needed items.

Telemedicine

  • Use Veterinary Telemedicine to limit visits to the clinic.
  • Pursuant to the Governor's Executive Order 20-03, the OVMEB has determined that veterinarians have the option to provide treatment for the duration of the State of Emergency by Veterinary Telemedicine without first having to conduct a physical exam to establish a VCPR. Please note that all other portions of the VTM rule continue to apply.
  • When using telemedicine, you can issue prescriptions if you believe it is safe and appropriate to do so. You must ensure that the technology you are using is sufficient and of appropriate quality to provide accuracy of remote assessment and diagnosis of the patient. You must also ensure that medical information obtained via VTM is recorded completely in your patient’s medical record and meets all applicable requirements of current medical recordkeeping requirements.

Mobile Practice Physical Distancing

  • Mobile veterinary practices face different challenges than brick-and-mortar facilities. Dr. Weese of Worms and Germs has some protocol suggestions for mobile veterinarians.

Equine Practitioners

Infection Control Procedures

  • The main transmission of COVID-19 is by close contact with a sick individual, including those who are asymptomatic.
  • COVID-19 can be spread from infected objects if you touch the surface and then touch your mouth, nose or eyes. The virus can live on cardboard for 24 hours and on plastic and stainless steel up to 72 hours.
  • Diligently practice routine infection control measures such as hand hygiene. Stay vigilant about cleaning and sanitizing all surfaces in the practice, including countertops, door knobs, cabinet handles, phones, etc.

Staff Wellness 

  • Make sure all staff are paying attention to their health and staying home if they are sick. Symptoms to watch for include: fever, cough, fatigue, shortness of breath, and muscle pain and aches. Diarrhea and the loss of smell/taste are also reported symptoms in some cases. Encourage all veterinary team members to be responsible with physical distancing outside of work to protect their families and coworkers.

Pooling Resources

  • Consider reaching out to clinics in your area to start a dialogue about pooling resources if the supply chain becomes challenged.

Donate Surplus PPE

Gov. Brown has asked veterinarians to donate surplus PPE to the human health effort. Per EO 20-10, veterinarians shall assess their stock of PPE by March 27 and donate surplus, if any. If you have determined that you have surplus, please use this form to register your business/donation with the State Office of Emergency Management. Needed items:

  • NIOSH certified N95/P95/P100 masks
  • Surgical masks
  • Surgical face shields
  • Surgical gowns (disposable or reusable/autoclavable)
  • Non-surgical face masks/shields

Surgical Mask and Gown (PPE) Conservation Strategies

Updated: 2020-04-07 07:00:00

Author: Oregon Veterinary Medical Association