Here are the highlights from the full-length COVID-19 Spay/Neuter and Wellness Clinic Guide which provides guidance on how to follow physical distancing guidelines while safely performing spay/neuter surgeries. Where possible, links from original document have been included. This guide is being updated regularly by a collaborative team of clinic experts and is hosted by Best Friends.
COMMUNITY PREPAREDNESS
Consult local authorities and stay up to date on the COVID-19 status in your community, as well as in other communities you might be traveling to. Key metrics in most states include rates of COVID-19 related hospitalizations in your area, access to testing, and availability of PPE for programs.
DECISION-MAKING TO CONTROL DISEASE TRANSMISSION
Provide for staff safety and support:
- Follow state and local guidelines for testing and self-quarantine of employees exposed to COVID-19.
- Have back-up staff on call and communicate your clinic’s operating status and action plan to all staff in case clinic closure is necessary.
- Have regular team check-ins at the start of each day that cover roles, strategies, challenges and other updates. See this sample checklist.
Create a clinic protocol for when a staff member tests positive for SARS-CoV2:
- Develop a protocol and share with staff BEFORE this happens. Read this guidance summary created from CDC recommendations for help writing protocols. Also visit the AVMA website.
- Have a plan to reassess staffing and adjust capacity, staff roles, and workload accordingly.
- Review the CARES ACT and be aware of what you are required to provide employees.
Train staff and volunteers in adapted clinic operations without compromising social distancing:
- Hold regular online (Zoom, Microsoft Teams, GoToMeetings) video meetings to discuss scheduling, etc.
- Give staff and volunteers a virtual tour of the clinic and new operation items.
PRIORITIZING PATIENTS
Determine how many surgeries your clinic is comfortable performing before you reopen. Consider phasing in services over time according to their priority.
Priority patients for spay/neuter services:
- pregnant animals or those at risk of becoming pregnant
- intact animals exhibiting problematic behaviors (i.e. male dogs humping/marking)
- those in need of emergency procedures
Priority clients include those:
- who are insecure about housing intact animals
- who are managing community cats
- who have recently adopted their animals
Priority considerations for vaccine and wellness clinics:
- puppies and kittens
- animals overdue for rabies vaccines
- those with conditions that will affect welfare if delayed
CAPACITY FOR CARE
The physical space available to work in will determine your staffing plan and surgical patients you can serve each day.
Physical capacity:
- Provide 60 square foot minimum (six-foot radius) per staff member/volunteers whenever possible.
- Assign one staff member per station.
- Staff should be six feet apart and not facing each other. Provide PPE when this is not possible
- Avoid sharing equipment like stethoscopes
- Mark out visual reminders on the floor: one-way traffic patterns; six-foot distances
- Re-purpose areas to make multiple intake and recovery areas that are individually staffed.
Staff capacity:
- Create multiple surgical teams that are scheduled at different times and/or work in different areas (Sample protocol: Creating Staff Teams for Spay/Neuter Clinics).
- Develop a schedule; identify how many hours staff can work and what risks they have; include time for scheduled deep cleaning when assessing how many days your team can do surgery safely.
- Assess volunteers the same as staff and consider reallocating remote jobs to employees and volunteers for whom working in the clinic poses a risk.
- Stagger break times. Limit the number of people allowed in the break room at the same time.
Surgical supplies and PPE:
- Inventory supplies to determine how many patients can be served.
- Expect ongoing shortages of surgical masks, surgical gloves, disposable drape materials, disposable gowns , and anesthetic drugs.
- Open accounts with multiple distributors (MWI, Patterson, Midwest) for increased access to supplies.
PPE:
- Expectation for PPE and hand hygiene in clinics:
- Make sinks easily accessible. Keep them stocked with soap and single use paper towels at all times. Provide hand sanitizer stations where sinks are not available.
- Train staff to avoid touching their face or each other and consistently disinfect shared equipment.
- Provide PPE for all staff and volunteers.
- Cloth masks are to be worn at all times in the clinic (one mask per 4 hours/washed daily and dried completely before reuse).
- Per CDC recommendations, clinic staff should wear goggles or face shield in addition to mask, gown, and gloves when handling animals with respiratory disease. Provide face shields for procedures requiring multiple people.
- Consider these innovative solutions when facing supply shortages.
ANESTHETIC CONSIDERATIONS
Capacity of pharmaceuticals, including anesthetics and analgesics
- Inventory all pharmaceuticals, including controlled drugs.
- Aim to use only veterinary-specific drugs as shortages in drugs shared with human medicine are anticipated. Here is up-to-date information on drug shortages
Alternative anesthetic protocols for spay/neuter:
- Alternative protocols providing multi-modal analgesics for spay/neuter are summarized here.
- Dosing charts for TTD (butorphanol, tiletamine-zolazepam, and dexmedetomidine) can be found here. TTD is preferred for cats (IM induction, less handling, better recoveries).
- Train staff in monitoring and safety parameters before implementing new protocols.
- Give anxiolytic medications at the beginning of the clinic to enable easier restraint and reduce stress. Options include: (1) oral trazodone and/or gabapentin to dogs, and (2) gabapentin for cats.
CLIENT COMMUNICATIONS
Provide clear instructions (website, social media, email, phone) for scheduling, payments, clinic check-in procedures, and social distancing. Sample signage: Sample 1, Sample 2, Sample 3
- Provide FAQS on how the clinic now works.
- Build payment collection into the appointment process.
- Communicate which services are being prioritized and those that are not currently being offered.
Scheduling and social distancing:
- Ask clients questions when scheduling to ascertain if the client is sick: Wait to schedule pets from COVID-positive households until those in the household are not contagious.
- Reduce the amount of time staff interacts with clients by taking appointments by phone or online ahead of time, pre-entering services requested, taking relevant medical history. Verify this information at check-in.
- Reduce paper handling by emailing or digitizing surgical consent/admin/intake forms to the clients ahead of time using software like Clinic HQ, or companies like DocuSign or HelloSign.
- Stagger check-in times by species to reduce the amount of people and pets in your parking lot.
- Utilize “touchless payments” (see CDC recommendation) wherever possible; either online (PayPal, Venmo) or by phone.
INTAKE PROTOCOLS AND SOCIAL DISTANCING
Curbside intake:
- Clients remain in vehicle while staff come to them to complete intake information. Communicate directions to clients (email, website, social media) ahead of time and post signage at parking lot entrances.
- Assign each car a number on a piece of paper and place under vehicle windshield wiper. Consider using online restaurant wait system like WaitlistMe.com or TablesReady.com.
- Provide tents to protect staff from rain and sun.
- Set up a table outside for leashes, pens, muzzles and sanitation wipes for carriers. Use of clipboards is not recommended.
- Pets in open-bed pickup trucks or cats not contained inside a carrier should move to the head of the line.
- Wipe the handle of the carrier or trap handle before and after transporting.
- Staff should wash their hands and arms when done with check-in and change clothes before working in the clinic.
- For vaccine and wellness clinics, owners can either wait in the car until services are completed or owners can drop off pets and return later to pick them up. Discuss treatment options with clients over the phone. Other ideas about vaccine clinics can be found here.
Contact-free or limited-contact client check-in:
- Start contact-free drop-off for shelter/rescue partners and TNR programs. Use a visual doorbell system (Ring) to announce arrival. Place empty carriers for partners to drop-off animals in the front vestibule or lobby.
- Limit drop-off to one person per pet. Limit the number of clients allowed in the clinic at one time.
- Mark lines six feet apart on the floor and provide signage as a reminder of social distancing.
- Discourage cash payments.
PAPERWORK AND RECORD-KEEPING
OPTION 1 – Minimal paper:
- Send consent forms ahead of time for signatures and use software capable of auto-populating (Clinic HQ, Microsoft Word) your admission document.
- For TNR clinics, label cats as Cat 1, Cat 2, Cat 3, etc. The color of the cat and/or trap ID number can be written on the document when cats are admitted to the clinic.
- Use a one-page surgical record or “treatment sheet” primarily written on by one staff member. to track drugs, surgery reports, and additional findings. Here is an example.
OPTION 2 – Paperless:
- Use a tablet in the parking lot in place of printed documents.
- Print the patient’s packet of information on the spot once the once the animal enters the clinic to ensure the correct paperwork stays with the animal.
- For an entirely paperless system, assign a scribe with a laptop to all record-keeping.
OPTION 3 – Paper with additional biosecurity:
- Handle paperwork as little as possible. Have a single staff member (wearing a face mask and gloves) handle and process paperwork from clients and paperwork going home.
- Sanitize items handled by the public (pens, clipboards, etc.) between use.
Discharge protocols and social distancing:
- Email discharge papers or text photo clients prior to pick-up, making sure they have enough data to not incur a charge from this. Call clients to discuss unplanned findings or procedures.
- If email or text are not an option, call clients and go over post-operative instructions. Mail vaccination certificates and other paperwork.
- Provide a link to a post-surgery video and post-op instructions on your website. Sample video.
- Structure pick-up in the same manner as intake.
POST-OPERATIVE CARE
Telemedicine:
- Offer rechecks virtually. Check the Veterinary Telemedicine Platform Facebook page for suggestions on platforms or consider other video conferencing platforms (Pet Connect).
- Check this site from the American Association of Veterinary State Boards for updated changes for individual states regarding telemedicine.
Pharmacy:
- Put take-home medications in labelled bottle, sanitize, put in clean bin, distribute at check-out.
- Use online pharmacy (Covetrus, Vetsource) to bill and send clients medications directly.
- Prescriptions can be filled at the clinic and either sent to client by mail or through contact-less pick up by placing them in labelled bottles and leaving them at pre-determined location.
Financial considerations and mitigating risk:
- Use this excel template for help revising budgetary plans.
- Consider opportunities to reduce supply costs yet still maintain high-quality care.
*The link to the COVID-19 Spay/Neuter and Vaccine Clinic Preparedness Guide Panel Discussion presented April 29, 2020 by Maddie’s Fund and the Million Cat Challenge can be found here.
