Integrity Chiropractic’s COVID-19 Safety Measures
In the current environment, any trip outside the home carries an inherent risk of transmitting or acquiring the coronavirus as there is currently no better method to prevent this risk aside from remaining at home.
We encourage our patients to try to utilize the material we have created to treat themselves at home, however we understand there are instances where pain is acute and you must leave home to seek care in order to resume activities of daily living- even if it’s limited to working at home on a computer.
This page will explain and illustrate in detail the actions that Integrity Chiropractic has changed or implemented to help mitigate the risk of coronavirus transmission in our clinic. By no means is this an ideal system where the entrance to the facility requires going through a medical or military grade clean/decontamination room before entry.
However, we are acting in good faith to the best of our abilities and resources, in the ultimate interest of our patients. By showing you the concrete steps we have taken you will be able to make an informed risk assessment as to where and whom you seek care from.
Some of our operating procedures have been preexisting before the outbreak, but others are new.
We created this for you, so we implore you to read through this before you come to our clinic so that you are prepared and know what to expect before coming.
This page will be updated as we make changes.
Last Update: 05/15/2020
We thank you for your understanding and cooperation in advance.
Table of Contents
Internal Physical and Chemical Protective Measures
This section highlights the more direct measures we are taking to mitigate risk of coronavirus transmission in the clinic environment.
Personal Protective Equipment (PPE)
At the current moment, your team at Integrity Chiropractic has an adequate source of face masks to conduct operations. Our entire team will be wearing them throughout the day and we will be providing a new mask to every patient that comes to our office (see Clinic Entry Process below).
Your Kirkland chiropractor and massage therapist will also be wearing face shields for an additional barrier of protection when treating you. Based on the current supply/demand level of masks, we will be using one per day, but as supply levels increase with time, we will begin to change them after every patient.
Nitrile gloves will be used during chiropractic treatment and will be provided for you if we believe it is necessary during your treatment. The use of nitrile gloves is impractical for massage therapy techniques so we must rely on the use of diligent hand & arm washing practices along with hand sanitizer use.
Hand & Arm Hygiene Practices
We are following the recommended guidelines in washing our hands with soap and water for at least 20 seconds after seeing patients- but most of the time significantly longer, especially when arms are involved in your treatment.
We also have an adequate supply of alcohol-based hand sanitizer at the moment that we are using regularly throughout the day in the clinic. We have been actively working to acquire more stock to ensure we have enough to serve our team and patients.
Patients are encouraged to use the hand sanitizer when transitioning between rooms and leaving the clinic.
Chemical Cleaners & Disinfectants Used
The following are cleaning and disinfecting agents at Integrity Chiropractic and how we are using them. Clean and safe equipment has always been a priority at this clinic.
As the current environment is making it more difficult or challenging to obtain products that we normally use, we may look to other suitable products based on the EPA and manufacturer statements.
More specific applications of product use will be stated in our Updated & New Processes and Procedures section.
Lysol or Clorox Brand Disinfectant Wipes. This has been our primary agent used to clean and disinfect treatment tables, treatment tools, seats, and commonly touched objects (i.e. door knobs, pens, clipboards). Our clinic has utilized Lysol or Clorox brand wipes to clean and disinfect equipment since day 1. Currently we have an adequate supply of disinfectant wipes, but to help manage our inventory levels, we may substitute in the use of other cleaners below according to manufacturer usage instructions.
Lysol Multi-Surface Cleaner. We are using this according to manufacturer recommendations to soak small items for disinfection where immediate turnaround for reuse is not needed as the contact time for disinfection in this solution is 10 minutes for most viruses. Examples of items we would use this on are resistance bands or massage tools. Manufacturer usage guidelines.
Barbicide. This is used to disinfect non-porous hard surfaces and stainless steel instruments and parts. We utilize the wipes which have a contact time of 2 minutes and the concentrated solution which has a contact time of 10 minutes. Examples of items where we would use this are seats, massage blades, metallic table parts, exercise weights. Manufacturer usage guidelines.
70+% Alcohol. Primarily used to disinfect exercise mats and pads by standing evaporation as it is able to disinfect in a minute or less. It may occasionally be used to disinfect other surfaces by standing evaporation for convenience and accelerated drying time.
Hydrogen Peroxide. Hydrogen peroxide at 0.5% has some evidence of being effective at disinfection against coronaviruses with a contact time of 1 minute. We have 3% that we may dilute to 1-2% to use as an alternative for disinfecting rubber and plastic materials via full submersion as hydrogen peroxide may be less harsh to these materials than other cleaners over time.
Clorox Disinfecting Bleach. Used to mop & disinfect our luxury vinyl floors after massage treatments according to their usage guidelines which are to mix 0.5 cups or 8 ounces per 1 gallon of water to create a disinfecting solution that can disinfect in 5 minutes. We may also use this as an alternative for disinfecting rubber and plastic materials as well.
Simplifying the Office Environment
We have reduced the waiting room to just one (1) seat, necessary for new patients and patients that need re-evaluations to complete their paperwork. This seat is disinfected immediately after each time it is used.
We removed the beverage station in the waiting area. Please come hydrated or awake for your visit!
We have removed certain items from treatment rooms to reduce the amount of possible touch points and have put up signs to remind patients to not touch things.
The treatment rooms are all using plastic seats now as they are easy to disinfect.
Dedicated Linen Disposal & Clothes Changing Room
Whether you’re coming for chiropractic or massage therapy at Integrity Chiropractic, your practitioners will be changing their clothes after every appointment in a dedicated linen & changing room that we have created out of an additional room in our clinic.
Considering the close contact nature of our work as well as the post-treatment cleaning we are doing, we feel this is a necessary good faith practice to give peace of mind to our patients.
The room has been temporarily partitioned with one side serving as a location to drop off our used linens and to remove our used clothes while the other side serves as a place to change into clean clothes.
This room is only being used post-appointment and has a standard operating procedure (SOP) to ensure we flow through it in a step-by-step manner to ensure we exit as clean as possible.
For all massage sheets and the majority of hand towels, we utilize commercial laundry services that deliver clean and sanitized linens on a regular basis.
For throw over blankets, massage face cradles, and a small amount of hand towels we let them sit for 24 hours before they are carefully bagged with gloves and taken straight to our laundry machine at home where they are carefully pushed out of the bag into the drum, along with the bag to be washed using detergent, bleach, and a heavy duty hot water cycle.
Likewise, our used work clothes are left for 24 hours before they are carefully bagged with gloves and taken straight to our laundry machine at home where they are carefully pushed out of the bag into the drum, along with the bag to be washed in hot water with a heavy duty hot water cycle.
Scheduling Controls Implemented
We have implemented scheduling rules to support efforts to minimize human interaction, traffic in the clinic, ensure no corners are cut on cleaning, and manage PPE and cleaning supplies as they are currently more expensive and difficult to obtain due current supply/demand levels.
This is a team effort by the staff to ensure that all our efforts can be successful.
As of the last updated date, we are limiting the patients each practitioner sees a day to no more than 3-4 a day.
We are staggering appointments between your practitioners and spacing individual practitioner appointments with at least 30 minutes in between to prevent passing contact between patients, allow adequate time for disinfectants to actively perform their action, reset the rooms, and perform post-appointment administrative tasks. For example:
In this example Patient 3 would be treated in a different room and would only be allowed into the office to go to their room if they are a few minutes early or if patient 2 has already left.
We are currently not accepting new massage patients unless they are part of a motor vehicle accident injury case that is also being managed with chiropractic care.
We are only accepting one new chiropractic patient each day, and whenever possible, we will make this appointment be the last chiropractic appointment of the day as each new patient can be considered a “foreign body” to our active patient population.
We are only allowing existing massage patients to schedule appointments if they have pain that is significantly impairing their ability to function based on the state board guidelines here. The state guideline is somewhat ambiguous about defining acute pain. We are taking the position that if your worst pain(s) is less than a 5/10 in intensity and is not significantly limiting your day-to-day function, the massage can wait.
New & Updated Clinic Processes and Operating Procedures
The following sections will describe and illustrate how we have implemented or changed discrete work flows or processes to protect our patients and give them peace of mind.
Clinic Entry Process
This is a new process that we have implemented when we reopened for treatment on April 1st 2020.
The entire building entry is currently locked and only tenants of the building are able to come and go using their access keys or codes. We are asking patients to remain in their vehicle when they arrive, and are phoning them to come to the front door of the building when we are ready to receive them to prevent passing contact between patients.
Unless absolutely necessary, we are restricting other people from accompanying you during the appointment to further minimize human interaction and preserve our PPE.
If you have your own mask, we ask that you leave it in your vehicle so we can better control material flow in the office. We will provide a mask for you.
Upon arriving at the front door of the building, we are screening patients by asking if they are exhibiting any symptoms of COVID-19 as well as if they have been in contact with anyone with known symptoms.
We will then do a forehead temperature check with an external thermometer to see if you are less than or equal to 99.5 degrees Fahrenheit.
As the weather improves in Seattle, please refrain from strenuous exercise immediately before coming to an appointment as internal body heat in combination with sitting in a hot car can make this a difficult judgement call for us. Also, as we are trying to maintain good hygiene practices and ask you to do the same.
If you are equal or over the temperature limit, we will err on the side of caution and send you home. If you even have one symptom that you are questionable about, we ask that you call to cancel your appointment, seek testing and/or isolate yourself at home and avoid the inconvenience to yourself by driving to the office and having to be sent home. We'll follow up with you in 3-4 weeks time.
If you pass, we will escort you into the clinic and immediately disinfect the thermometer with a Lysol wipe.
We ask that you place any loose items: phone, purse, keys, wallet into a plastic basket that we are disinfecting with Lysol in between visits. This will be kept in the front office in a secure location during the duration of your visit.
The front clinic door will also be locked during business hours to further control unexpected or unauthorized access to the clinic.
If you are going to require your phone during the visit to obtain personal information from it for the visit, we will provide you a disinfectant wipe to clean it before you wash your hands.
We recommend that you bring no items into the clinic other than your phone, driver’s license, or credit card if possible.
We will then escort you into the clinic to our sink where you will wash your hands. Your practitioner will turn the water on and dispense the soap in your hand for you to wash your hands thoroughly for the recommended 20 seconds.
After you complete washing your hands, we will provide you with a fresh linen to completely dry your hands. Should we deem it necessary, we will provide you with nitrile gloves for your visit. The towel will be disposed into a receptacle next to the sink.
At this point, we will provide you with a sterile mask to cover your nose and mouth for the duration of the visit.
If you have paperwork that you must complete for your visit, you will then be taken to the seat in the front of the office to complete your paperwork.
The pen, seat, and clipboard will have been disinfected with Lysol prior to your arrival and will be ready for you to use. It will also be disinfected after you use it.
You are expected to have read the online version of our Privacy Practices and Policies if you are a new patient or are due for an update in your paperwork.
We will communicate this to you in advance as we are removing the in-office copy in order to remove a commonly shared item.
We can also provide you with a printed version as well, but we recommend viewing the online version in order to save paper.
Massage Therapy Process & Procedure Changes
This section describes how we are mitigating risk before, during and after massage appointments.
Entering the Room and Preparing for the Massage
Your massage therapist will open the door for you into the room for your appointment.
You will be directed to take a seat on the plastic chair and be instructed to place all your clothing in the plastic tub when you are undressing for your massage appointment.
The seat and tub will have already been disinfected with Lysol or a similar cleaner long before your appointment.
The hooks in the room are decommissioned for hanging clothes to reduce touch points.
Do not touch anything except the massage table, chair, and plastic tub for your clothes. There will be signs up reminding you.
If possible, we ask that you attempt to wear your mask during any face-down portions of your massage.
If you are unable to breathe, we will place your mask on the chair on top of a tissue while you are face down during your massage.
When you turn face up, you will be required to re-don the mask.
Restrictions & Precautions to Massage Techniques During Sessions
The following are changes we have made to our massage therapy practices while the coronavirus outbreak is active:
We will be avoiding any frontal scalp or facial work to avoid contact to the eyes, nose, or mouth.
We will also be avoiding massage to the hands or feet during this time.
Assisted floor stretching is currently unavailable.
Cupping will be offered on a very limited basis to preserve our stock of disinfectants as the time and amount needed to sanitize the cups thoroughly is significant.
For any massage tools used during your appointment, we are placing them into a receptacle to hold them for disinfection after your appointment.
Exiting the Massage Room
Aside from the hand sanitizer, you will be instructed to get dressed and not to touch anything except the linen that has been left for you to wipe any excess oil or gel when your session ends.
Please leave your towel on the chair or in the plastic tub when you are done using it.
Use the hand sanitizer after you get dressed and prepare to leave the room.
Leave the door open when you exit the room and proceed straight to the check out desk where the office manager will assist you with checkout and scheduling.
How We Are Cleaning & Disinfecting After Massage Appointments
When your massage session ends, your massage therapist will place a glove on to open the door handle and go to the sink to turn the faucet on.
They will dispose of the glove in the trash and immediately wash their hands and arms thoroughly with soap and water. This washing process has always taken about 2 minutes.
They will then wipe the surface of the sink edges, top, and handle with a Lysol wipe.
When you exit the room, your massage therapist will immediately walk back into the room and will carefully strip the table of the blanket, linens, and face cradle and place it into the plastic tote that your clothes were in to transport to the linen and changing room when they are done cleaning.
Using a combination of Lysol wipes and Lysol Multi-Surface Cleaner, your therapist will clean and disinfect the following:
Massage table heater controls
Massage table surfaces & face cradle assembly
Massage lotion bottles
Hand sanitizer bottle
The massage face cradle/armrest assemblies are items even more critical to disinfect and has always been a particular priority for us.
We have always cleaned the entire assembly thoroughly with Lysol or Clorox wipes since our clinic has opened.
We recently have purchased multiple face cradle assemblies to have the ability to swap out assemblies in the event that we must switch to a cleaning agent that requires full saturation and cannot completely dry in a reasonable time.
Integrity Chiropractic has two types of tables in our clinic where the armrest is dependent and independent from the face cradle.
The pictures below illustrate the 9 points that we clean on each type of assembly (click to magnify on mobile). The face cradles are also removable so that the surface area of the face cradle plate can be wiped easily.
After all the massage equipment and furniture has been cleaned, the last step will be to mop the room with a spray mop and removable cover.
This is where will utilize the manufacturer recommended concentrations of Clorox Bleach, Lysol Multi-Surface Cleaner, or Hydrogen Peroxide to mop and disinfect the floor in the order of most availability.
The mop shaft and handle will also be wiped with Lysol at the end of use.
The room cleaning is now complete and your massage therapist will now take the dirty linen tote to the linen & changing room dispose items and go through the process of changing their clothes to prepare for the new patient.
Resetting the Massage Tables
When the cleaning is completed by the massage therapist, the room will be left to allow all the cleaners and disinfectants to dry for 10+ minutes.
New linens, face covers, and blankets will be reset by the office manager who is not touching patients and also practicing good hand hygiene.
Chiropractic Process & Procedure Changes
This section describes how we are mitigating risk before, during and after chiropractic appointments.
The Beginning of the Chiropractic Appointment
The doctor will direct you to place any jackets or outer garments in the plastic tote when you enter the room for your appointment.
The hooks in the room are decommissioned for hanging clothes to reduce touch points.
You will be directed to take a seat on the plastic chair for your initial interview or to check in to see how you have been doing since your last appointment.
The plastic chair and tote will have already been disinfected with Lysol or a similar cleaner long before your appointment.
Do not touch anything except what the doctor directs you to.
Even though the head piece of the chiropractic table will be covered with face paper, we ask that you do your best to keep your mask on during any face-down portions of your examination or treatment on the chiropractic table.
Restrictions & Precautions to Treatment During Chiropractic Appointments
The following are changes we have made to our treatment practices while the coronavirus outbreak is active:
No treatments to the temporomandibular joint or TMJ will be performed to avoid contact to the face and mouth.
Cupping will be offered on a limited basis to preserve our stock of disinfectants as the amount needed as well as time to sanitize the cups is significant.
You may be asked to don nitrile gloves on during the exercise part of your treatment if we use exercise equipment that has handles that are not easily cleaned.
We have multiple quantities of commonly used items that are not easily cleaned and disinfected to ensure adequate disinfection between use and that each patient for the day gets to use a fresh clean item during their treatment. Examples are exercise bands and terry cloth covers used for heat.
Exiting the Chiropractic Treatment Room
When your appointment ends, you will be asked take your garments and jackets out of the plastic tote and put them back on.
Your doctor will open the room door for you to proceed to the front desk.
Use the hand sanitizer first and proceed directly to the check out desk without touching anything.
How We Are Cleaning & Disinfecting After Chiropractic Appointments
Because our chiropractic treatment is often comprehensive, it means our cleaning process also has to be as well.
When your treatment ends, your chiropractor will immediately begin the process of disinfecting every item touched and used in the process of treatment.
While every patient's visit will be different, your chiropractor will have an SOP to go through this approximate list each time to ensure nothing is missed:
Gather all exercise bands used and submerge into bucket with disinfectant solution of Lysol, Bleach, or Hydrogen Peroxide
Gather all small treatment tools used and submerge into disinfecting bucket solution or clean and disinfect with Lysol or Barbicide wipes
Wipe backet to hold small used items with Lysol wipes
Wipe chair with Barbicide wipe
Wipe plastic tote with Lysol wipe
Wipe accessory table next to chair with Lysol wipe.
Wipe keyboard, mouse, and computer table with Lysol wipe
Wipe doctor's work stool and chair with Lysol wipe
Wipe mechanical massage machine and chiropractic table control switch if used with Lysol wipe
Wipe all weights used for exercise with Barbicide or Lysol wipes
Spray all foam pads, mats, and foam rollers used with 70+% alcohol or wipe with Lysol wipes
Wipe any medicine or Swiss balls used with Lysol wipes
Cleaning and disinfecting the chiropractic treatment table has been important since day one. The current environment only adds the last 2 steps for us:
The foot and middle sections are wiped first with one wipe, including any adjustment knobs on the side of the table
The top section, arm rests, and head piece along with all reachable metal parts and knobs with another Lysol wipe
Spray Barbicide to coat the metal surfaces of the head piece and allow to drip and air dry
A final once over with a Lysol wipe for all upholstered surfaces to complete cleaning and disinfecting
Check Out Process Changes
When you complete your appointment, please head straight to the front of the check out desk where you left your items.
Do not stop or lean on the counters.
We will help you reschedule and pay for your appointment as usual.
Please use the hand sanitizer to disinfect your hands as you walk out the door.
After you leave, the following are disinfected with a Lysol wipes:
Point of sale system
The basket holding your items
Entry door handles
There is no question that the world will be long impacted going forward and that many of the operational changes we have adopted, or elements of them will remain in place for quite some time.
Implementing these measures do take time and effort, but we live and do business by the golden rule at Integrity Chiropractic.
We hope after going through this page that you can appreciate how serious we take patient safety and comfort.
If this level of dedication and detail is any insight to how we approach treatment with our patients, we invite you to support excellence in health care by choosing us as your Kirkland chiropractor and massage therapist.
We look forward to helping you enjoy the outdoors pain-free and relieving stress!
Thanks for reading to the end!