COVID-19 prevention strategies during the return to activities in a Speech Therapy Teaching Clinic

Vasconcelos, Karla; Almeida, Beatriz Paiva Bueno de; Barreto, Simone dos Santos

doi:10.1590/2317-1782/20202020225

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Original Article • CoDAS 33 (6) • 2021 • https://doi.org/10.1590/2317-1782/20202020225 linkcopy

COVID-19 prevention strategies during the return to activities in a Speech Therapy Teaching Clinic

Authorship SCIMAGO INSTITUTIONS RANKINGS

Purpose Describe the preventive strategies used during the COVID-19 pandemic in the return of academic and health care activities in a Speech Therapy Teaching Clinic at a Brazilian public university.

Methods This is a descriptive study based on documentary research. The strategies were based on official recommendations from national and international institutions and/or organizations to combat COVID-19 published between March and June 2020. The strategic plan included an analysis of the clinic’s infrastructure, material and human resources, and user profile. The results are presented descriptively.

Results Actions based on the health recommendations to face the COVID-19 pandemic published until then considered adaptations to the infrastructure, care for the environment, and planning and implementation of a new health care routine and a biosafety protocol. The technical-scientific support provided by professionals in the field of biosafety was essential to assess local risks and establish preventive measures.

Conclusion A detailed description of strategies is a guiding instrument for the return to activities in the safest manner. To be effective, strategies to combat infections of any nature should be formulated considering the particularities of each health care environment. The new routines should contemplate the local socioeconomic reality and fulfill the academic and social objectives of the Speech Therapy Teaching Clinic, but they should be revised by the management team periodically or as the local health situation evolves.

Keywords
Containment of Biohazards; Speech, Language and Hearing Sciences; Education, Continuing; Coronavirus Infections; Public Health

Source / Date	Type of publication / Title	Synthesis
World Health Organization (WHO)⁽⁸⁾/ March 2020	WHO guide / Guía para la elaboración a nivel local: Formulaciones recomendadas por la OMS para la desinfección de las manos	It provides guidance to pharmacists on the preparation of formulations and a summary of basic technical information on hand hygiene in health care
Brazilian Ministry of Education⁽⁵⁾ / March 2020	Ordinance no. 343 of 17 March 2020	It provides for the substitution of face-to-face classes with online classes during the COVID-19 pandemic
Federal Speech-language Pathology and Audiology Council (CFFa)⁽⁶⁾ / March 2020	Recommendation / Recomendação CFFa n° 19, de 19 de março de 2020	It provides for care with the disease caused by the novel SARS-CoV-2, COVID-19, declared a pandemic by the WHO, in the activities or care performed by speech therapists
Pan American Health Organization (PAHO)⁽⁹⁾/ April 2020	Interim guidance / Orientação sobre o uso de máscaras no contexto da COVID-19	It provides guidance on the use of masks in the community during home care and health services in regions with reported cases of COVID-19
PAHO⁽¹⁰⁾ / April 2020	Recommendation / Care for health workers exposed to the new coronavirus (COVID-19) in health facilities	It presents guidelines for the care of health professionals exposed to COVID-19 in health institutions and for the management of occupational exposure to the virus
Chin et al.⁽¹¹⁾ / April 2020	Scientific journal publication / Stability of SARS-CoV-2 in different environmental conditions	It reports on the stability of SARS-Cov-2 under different environmental conditions
van Doremalen et al.⁽¹²⁾ / April 2020	Scientific journal publication / Aerosol and Surface Stability of SARS-CoV-2 as compared with SARS-CoV-1	It analyzes the stability of SARS-CoV-1 and SARS-CoV-2 in aerosols and surfaces and their rate of infection decay
WHO⁽¹³⁾/ May 2020	Interim guidance / Cleaning and disinfection of environmental surfaces in the context of COVID-19	It presents guidelines for reducing any role that objects and materials may play in the transmission of COVID-19 in health and other care services
PAHO⁽¹⁴⁾/ May 2020	Checklist / Lista de verificación para la gestión de los trabajadores de salud durante la respuesta a la COVID-19	It complements the actions and interventions related to the management of human health resources described in the document: Marco de referencia de la red integrada de servicios de salud a la respuesta de COVID-19
National Health Surveillance Agency (ANVISA)⁽¹⁵⁾ / May 2020	Technical note / Orientações para serviços de saúde: medidas de prevenção e controle que devem ser adotadas durante a assistência aos casos suspeitos ou confirmados de infecção pelo Novo Coronavírus (SARS-CoV-2)	It addresses guidelines for health services on the prevention and control measures that should be adopted when assisting suspected or confirmed cases of infection with the novel SARS-CoV-2, according to the evidence available until 08 May 2020
Institute for Risk and Disaster Reduction of Pernambuco (IRRD)⁽²⁾ / June 2020	Guidance / Recomendações para profissionais de saúde	It provides recommendations on biosafety and clinical management during care for suspected or confirmed cases of COVID-19
Brazilian Academy of Audiology⁽¹⁶⁾ / June 2020	Technical note / Recomendações para o retorno da prática em Audiologia	It presents recommendations for speech therapists on using personal protective equipment (PPE), ensuring a safe work environment, and conducting audiological assessment during a pandemic period
PAHO⁽³⁾ / June 2020	Official website / Folha informativa – COVID-19 (doença causada pelo novo Coronavírus)	It provides information to the general population and health professionals on the disease caused by the novel SARS-CoV-2
PAHO⁽⁴⁾ / June 2020	Report / Rapid Assessment of service delivery for NDCs during the COVID-19 pandemic in the Americas	It presents a brief account of the impact that the COVID-19 pandemic had on services providing assistance to people with chronic noncommunicable diseases in the Americas during May 2020, when the region was considered the epicenter of the pandemic
Gallasch et al.⁽¹⁷⁾ / 2020	Scientific journal publication / Prevention related to the occupational exposure of health professional workers in the COVID-19 scenario	It describes the main recommendations on contagion prevention actions related to occupational exposure of health professionals working to combat COVID-19 available until March 2020
Zhang⁽⁷⁾ / 2020	E-book / Manual de Prevenção e Controle da COVID-19 segundo o Doutor Wenhong Zhang	It presents methods of prevention and control of infections caused by the novel SARS-CoV-2
Quadri et al.⁽¹⁸⁾/ 2020	Scientific journal publication / Deploying Medical Students to Combat Misinformation During the COVID-19 Pandemic	It reports on a strategy for the engagement of medical students in the sharing of knowledge about COVID-19 to the general population to contribute to the formation and assistance of the population's health and needs
Brazilian Ministry of Health⁽¹⁾ / 2020	Official website with information on COVID-19	It provides information and recommendations to the general population and specific guidance for health professionals

Axes of action	Strategies
Adaptations to infrastructure	- Installation of a locker room for teachers and students: space for changing clothes, gowning, and putting PPE on and off;
	- Installation of a sink in the external area of the clinic intended exclusively for hand hygiene before entering the clinic's premises;
	- Adaptation of a space intended exclusively for cleaning materials and equipment: area for cleaning and disinfecting therapeutic materials and equipment (games, toys, specula, ear tips, etc.) and PPE (face shield, safety glasses, etc.)
Care with the environment	- General care: cleaning must be performed at the end of each work shift, from the least to the most contaminated environment, from top to bottom, and from inside to outside;
	- Care of the waiting room and reception: delimitation of spaces that guarantee safe social distancing and cleaning after the work shift;
	- Care of the service rooms: removal of carpets, decorative objects or those of occasional use, to facilitate the cleaning of tables, chairs, floors, and other spaces;
	- Immediate cleaning after each consultation and three hours after end of service to ensure hygiene after the aerosols have settled;
	- Cleaning of the common environment of the Clinic at the end of each work shift (morning and afternoon);
	- Installation of bactericidal disinfectant mat at the clinic entrance door;
	- Acquisition of ultraviolet disinfection equipment for use inside the acoustic booth and in materials that cannot undergo the usual disinfection process, e.g., cardboard games;
	- Adaptation of the waiting room: spacing of 1.5 meters between chairs.
Planning and implementation of a new service routine	- Reduction in the number of visits so that the correct disinfection of the service environments can be ensured;
	-Reduction of the number of students aiming to avoid crowding: only students who are in priority academic activities, such as mandatory internships, should remain in the clinic;
	- Scheduling of appointments: 30 min interval between each appointment, considering all outpatient practices in operation in the work shift (single schedule);
	- Therapeutic kitchen activities: limited to only one person in the environment.
Planning and implementation of a biosafety protocol	- Wearing masks is mandatory for everyone during the entire stay in the Clinic. The use of fabric masks is permitted. During speech therapy, the use of surgical masks or N95/Pff2 respirators is mandatory depending on the procedure;
	- Hand hygiene: all regulars of the Clinic are instructed to wash their hands before entering the clinical environment and whenever they are dirty. For students and teachers, this instruction is added for before and after attending the user. Disinfection with 70% alcoholic solution should be performed after contact with objects and materials possibly contaminated and whenever deemed necessary;
	- Changing clothes: all students, teachers, and staff should change clothes and shoes when they arrive at the Clinic. Surgical gowns are recommended for teachers and students;
	- Gowning and use of PPE: students and teachers must wear caps, masks or respirators, disposable aprons, gloves, and face shields. The use of PPE must be in accordance with the speech therapy procedure and guided by the supervising professor;
	- Collective precaution: biosafety training, information posters, and reminders posted in the different spaces of the Clinic;
	- Production of the biosafety protocol booklet and training of students, staff, and teachers, with emphasis on the necessary conduct during the COVID-19 pandemic;
	- Implementation of a health management protocol for students, teachers, and staff at the Clinic.

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