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How Your Local Ordinances or Emergency Orders on Face Masks Impact Your Practice
By FCA Asst. General Counsel Kim Driggers   
Wednesday, 01 July 2020
With the steady increase of COVID-19 cases and new and varied local government orders on face masks, members have asked whether the ordinances/orders apply to chiropractors in their own offices.  Compliance with the law will depend on your own regional order which you may find for free on this site.  The CDC’s recommended routine infection prevention and control (IPC) practices during the COVID-19 pandemic include all healthcare providers and their patients wear face coverings.

To see what your local government requires on face coverings, click your Region in the link above, and scroll to the facial coverings order.  By way of example of the differing orders based upon geography:

Pinellas County exempts health care facilities but, “encourages the health care facility to develop procedures to protect patients, their own employees and members of the public.”  

Orange County directs healthcare workers to, “abide by their particular sector/business-specific face covering protocols consistent with CDC guidelines.”   

Broward County mandates facial coverings for, “all establishments providing essential services, essential businesses, or amenities permitted to operate in Broward County. Social distancing requirements must be maintained whenever possible even when facial coverings are worn; facial coverings are in addition to, and not a substitute for, appropriate social distancing….” 

Broward County also mandates facial coverings to, “Members of the public when obtaining any good or service or otherwise visiting any business or establishment, including entering, exiting, and otherwise moving around within the establishment….” 

Aside from local orders, the CDC continues to recommend healthcare providers wear face masks as their routine infection prevention and control (IPC) practices during the COVID-19 pandemic.  “This guidance is applicable to all U.S. healthcare settings.”   Below are the general excerpts from the CDC routine infection prevention and control practices.  Complete and helpful details may be found here.
Recommended Routine Infection Prevention and Control (IPC) Practices During the COVID-19 Pandemic

These additional practices include:

1. Implement Telehealth and Nurse-Directed Triage Protocols
2. Screen and Triage Everyone Entering a Healthcare Facility for Signs and Symptoms of COVID-19
3. Re-evaluate admitted patients for signs and symptoms of COVID-19.
4. Implement Universal Source Control Measures.  Source control refers to use of cloth face coverings or facemasks to cover a person’s mouth and nose to prevent spread of respiratory secretions when they are talking, sneezing, or coughing. Because of the potential for asymptomatic and pre-symptomatic transmission, source control measures are recommended for everyone in a healthcare facility, even if they do not have symptoms of COVID-19.
Patients and visitors should, ideally, wear their own cloth face covering (if tolerated) upon arrival to and throughout their stay in the facility. If they do not have a face covering, they should be offered a facemask or cloth face covering, as supplies allow.
o Patients may remove their cloth face covering when in their rooms but should put it back on when around others (e.g., when visitors enter their room) or leaving their room.
o Facemasks and cloth face coverings should not be placed on young children under age 2, anyone who has trouble breathing, or anyone who is unconscious, incapacitated or otherwise unable to remove the mask without assistance.
HCP should wear a facemask at all times while they are in the healthcare facility, including in breakrooms or other spaces where they might encounter co-workers.
o When available, facemasks are preferred over cloth face coverings for HCP as facemasks offer both source control and protection for the wearer against exposure to splashes and sprays of infectious material from others.
Cloth face coverings should NOT be worn instead of a respirator or facemask if more than source control is needed.
o To reduce the number of times HCP must touch their face and potential risk for self-contamination, HCP should consider continuing to wear the same respirator or facemask (extended use) throughout their entire work shift, instead of intermittently switching back to their cloth face covering.
Respirators with an exhalation valve are not recommended for source control, as they allow unfiltered exhaled breath to escape.
o HCP should remove their respirator or facemask, perform hand hygiene, and put on their cloth face covering when leaving the facility at the end of their shift.
Educate patients, visitors, and HCP about the importance of performing hand hygiene immediately before and after any contact with their facemask or cloth face covering.
5. Encourage Physical Distancing
6. Implement Universal Use of Personal Protective Equipment
7. Consider Performing Targeted SARS-CoV-2 Testing of Patients Without Signs or Symptoms of COVID-19
8. Consider if elective procedures, surgeries, and non-urgent outpatient visits should be postponed in certain circumstances.
9. Create a Process to Respond to SARS-CoV-2 Exposures Among HCP and Others

If you are considering NOT wearing face masks, also consider the FCA’s recent post on When Staff or a Patient has Tested Positive for COVID-19.  In it you will see that the CDC exempts healthcare providers from shutting down their offices if particular PPEs such as face masks, are worn:  Guidance for Asymptomatic HCP Who Were Exposed to Individuals with Confirmed COVID-19.  Having to shut down your office for 14 days could be financially harmful to the practice.  See also:  Strategies to Mitigate Healthcare Personnel Staffing Shortages.

“CDC continues to study the spread and effects of the novel coronavirus across the United States.  We now know from recent studies that a significant portion of individuals with coronavirus lack symptoms (“asymptomatic”) and that even those who eventually develop symptoms (“pre-symptomatic”) can transmit the virus to others before showing symptoms.  This means that the virus can spread between people interacting in close proximity – for example, speaking, coughing, or sneezing – even if those people are not exhibiting symptoms.  In light of this new evidence, CDC recommends wearing cloth face coverings in public settings where other social distancing measures are difficult to maintain (e.g., grocery stores and pharmacies) especially in areas of significant community-based transmission.”

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