COVID-19 PATIENT PROTECTION POLICY

We believe the foundation of our relationship with our patients & staff is built on trust. We have been trusted by thousands of patients, over 30 years, to provide competent, compassionate care that empowers them to reach their full potential.

With so much unknown & uncertain in our situation today, one thing remains certain, our commitment to the health & safety of our patients. As such, we have created & implemented a policy based off of the current best practice guidelines from the CDC, CMS, Texas Medical Board, Governor of Texas Roadmap to Re-opening, the American Society of Plastic Surgeons, the American Society of Anesthesiologists, the Society for Ambulatory Anesthesia, AAAASF (surgical facility accreditation) and the Anesthesia Patient Safety Foundation. These policies will be updated as changes occur to recommended best practice guidelines.

SCREENING

Our screening process is based on current State of Texas and CDC guidelines and will be enforced on a regular, scheduled basis and will be documented.

Screening will include all patients, visitors, staff & physicians.

STAFF SCREENING

A safe & healthy environment for patients & visitors to our practice & surgical facility begins with a healthy staff. Currently in the greater Houston area, test for COVID-19 ANTIGEN is available and results are known typically in 3 days. We provide the opportunity for our staff to be tested. Results from the antigen test reflect the positive or negative status of the person tested, as of the day of testing. Staff includes all employees & physicians.

Daily Documented COVID-19 Screening for Staff on Arrival to Include:

• 20 second hand wash with soap & water.
• Temperature & Oxygen Saturation Recorded.
• Negative response to ALL screening questions to include:
• Symptoms of fever, cough, shortness of breath, difficulty breathing, chills, muscle aches, headaches, sore throat, loss of taste or smell, nausea, vomiting, diarrhea within prior 24 hours?
• Close personal contact with anyone known to have COVID-19, anyone suspected of having COVID-19 or provided care for someone with fever & respiratory symptoms?
• Travel within the U.S. or outside of the U.S.?
• Disinfection of cell phone on arrival.

Any staff with a fever, low oxygen saturation, positive symptoms, exposure or travel will not be permitted to work and will be processed according to State of Texas and CDC guidelines.

Staff are also expected to honor compliance with all local, state & federal best practices for minimizing the spread of COVID-19 outside of work.

Staff are also expected to report any positive screening events on a 24/7 basis to management in order to minimize the risk of a staff member entering the practice who may pose a risk to others.

PATIENT & VISITOR SCREENING

All patients & visitors will have documented screening for COVID-19 at EACH of the following encounter points:

• Scheduling an appointment
• When confirming an appointment
• Upon entry to the practice at the exterior front door
• Upon check-in at the front desk in the lobby
• During a pre-operative appointment
• On the morning of surgery at arrival
• During the post-operative period

Screening over the phone or via email, will include the following questions:

• Symptoms of fever, cough, shortness of breath, difficulty breathing, chills, muscle aches, headaches, sore throat, loss of taste or smell, nausea, vomiting, diarrhea within prior 24 hours?
• Close personal contact with anyone known to have COVID-19, anyone suspected of having COVID-19 or provided care for someone with fever & respiratory symptoms?
• Travel within the U.S. or outside of the U.S.?

Patients must be able to answer “NO” to all questions in order to be permitted into the practice and will be asked to re-schedule any visit to the practice should a situation occur where they would answer “YES” to any of the questions.

Screening in person for all patients & visitors will include all three of the questions above as well as documentation of temperature & oxygen saturation.

Anyone screened over the phone, email or in person who answers “YES” to any of the COVID-19 screening questions, has a fever or a low oxygen saturation will not be permitted into the practice. When necessary, further assessment & direction for each individual situation will be provided on a case by case basis.

EXPECTATIONS OF PATIENTS & VISITORS

Out of respect and concern for the health and safety of all, we ask that all patients & visitors comply with the Governor of Texas health protocol for individuals when in our practice.

This includes:

• We ask that patients & visitors maintain 6 ft of social distance, when possible, with anyone who did not accompany them to the practice.
• Patients may consider wearing a facial covering or mask. We are able to provide a mask to anyone who would like to have one upon check-in to our practice.
• Please be sure to remember to cover your nose & mouth when coughing or sneezing with a tissue or your inner elbow. Tissues are readily available throughout the office.
• Upon check-in, alcohol hand sanitizer will be provided for your use. Please remember good hand hygiene by frequently washing your hands with soap & water for 20 seconds and avoiding touching your face or surfaces with un-sanitized hands.
• Please re-schedule your appointment if you develop any symptoms of COVID-19, have exposure to a positive COVID-19 patient or travel within or outside of the U.S.

SOCIAL DISTANCING & SCHEDULING

CLINICAL VISITS

Scheduling clinic visits for new patients, existing patients, injectable patients and post-surgical patients has been altered to ensure an environment which will allow for compliance with social distancing and reduced numbers of people in the practice at any given time.

Additionally, new or existing patients who would prefer and are suitable for virtual consultations may be scheduled for a ZOOM virtual consultation with a staff member and/or Dr. Lapuerta as is necessary.

In order to satisfy these requirements, the number of appointments has been reduced and additional time has been added between arrival & departure of patients & visitors.

The total number of staff & patients in the practice will not exceed current best practice guidelines.

Patients are asked to arrive at their scheduled appointment time. Patients who arrive early will only be permitted entrance if the current number of people in the practice will allow both space to maintain social distancing & the allowed limit of people at any given time.

Patients are asked not to bring anyone with them to their appointment unless it is absolutely necessary for physical assistance during their appointment. New patient consultations may bring one adult visitor with them to their initial consultation. No children under the age of 18 will be permitted.

Any updates to best practices regarding these aspects will be immediately adopted and implemented.

SURGERY AT THE PLASTIC SURGERY INSTITUTE OF SE TEXAS (PSI), THE ON-SITE SURGICAL FACILITY

PRE-OPERATIVE APPOINTMENT

All patients scheduled for surgery with Dr. Lapuerta (regardless of facility) will:

• Have a COVID-19 ANTIGEN TEST within 3 days prior to surgery.
• Patients must agree to observe social distancing & limit the number of people & places they interact with (when possible) for the time period between testing & surgery. Ideally, patients will isolate themselves for the time period between testing and surgery. However, we understand that this may not be possible.
• Patients should understand that COVID-19 ANTIGEN testing provides a result that reflects the positive or negative result at the time of testing.

DAY OF SURGERY

Patients are encouraged to have someone drop them off on the day of surgery to minimize the number of unnecessary visitors to the office. If absolutely necessary, patients may bring one adult with them on the day of surgery. Both the patient and anyone with the patient will have documented screening according to practice protocol.

• Patients must have a confirmed, negative COVID-19 test within 3 days prior to surgery.
• Patients & visitors will be provided hand sanitizer to use at check-in.
• All patients will be provided a face mask that will be worn before & after surgery in recovery.
• The adult responsible for picking up the patient from surgery will be asked to call the office on arrival for pick up and park in the pick-up handicap parking spot.
• Post-operative instructions will be signed at drop off if the responsible party accompanies the patient or at pick up when the patient is taken to the car.

ANESTHESIA & SURGERY

In compliance with best practice, current guidelines for reducing potential risks associated with

COVID-19, Anesthesiologists should care for all patients while wearing a non-sterile gown, an N-95 surgical respirator mask & a face shield or goggles in addition to standard OR PPE (personal protective equipment).

Anesthesia should provide a longer period of pre-oxygenation prior to placing patients under anesthesia. The form of airway maintenance selected for the patient should be based on the patient’s medical history, planned surgery & a technique that will minimize aerosolization of potential harmful material from patient exhalation.

The patient should be protected with the use of a high level antibacterial & antiviral filter in addition to the normal heat exchange & exhalation filter used on the anesthesia machine’s circuit.

RECOVERY

All staff will care for patients in recovery while wearing the standard recommended PPE as well as a face mask. Patients will also have a face mask on when they are taken to recovery.

POST-OPERATIVE PERIOD

In addition to normal post-operative care, all patients will be screened for any potential signs or symptoms of COVID-19 and appropriate guidance & care will be provided on a case by case basis

CHANGES TO PHYSICAL SETTING IN THE CLINIC & OR

• Face masks will be worn by all staff during clinic.
• All patients will be asked to use the provided alcohol based hand sanitizer on arrival.
• Patients & visitors will be reminded & asked to allow for 6 ft of social distancing in the waiting room and throughout their visit. Anyone accompanying a patient may remain with them and is not required to be 6ft away.
• Staff will continue the practice of good hand hygiene by washing their hands with soap & water for 20 seconds or using alcohol hand sanitizer before & after seeing patients and on a regular basis throughout the day.
• Facial tissue & alcohol hand sanitizer will be out and readily available for all patients.
• All high touch materials such as magazines & pamphlets, business cards & candy bowls have been removed.
• All patients will be provided their own, new pen for use during their visit and will be for them to keep.

CHANGES TO CLEANING IN THE CLINIC & OR

• Front check-in and rear check-out counters will be cleaned frequently with disinfectant.
• All clipboards will be cleaned with disinfectant before they are provided to patients.
• All front office and clinic staff will practice good hand hygiene by using alcohol hand sanitizer frequently throughout the day.
• All high touch surfaces will be frequently cleaned with disinfectant wipes:

1. Door handles and push/pull plates
2. Light switches
3. Overhead light handles
4. Counters, exam tables, stool and chair seats
5. Sink handles
6. Toilet handles
7. Soap dispenser touch points in rooms & bathrooms

• Air filters in the office have been changed out for higher level HEPA filters that filter ultra fine bacteria & viral particles.
• In the evening, after clinic, a professional cleaning staff will use an EPA registered hospital grade disinfectant fine mist, fogger in all areas of the office, clinic & OR suite.
• The operating room will have increased cleaning frequency & additional time between cases to allow for enhanced cleaning to minimize risks.
• The operating room (OR) has a hospital designed air system that has a higher frequency of fresh air turnover in the OR. The air system also passes all of the air through hospital grade filters that trap ultra fine bacteria & viral particles.