Acupuncture and Chinese Medicine After the Lockdown

What the public should expect from a CMIR practitioner

All members of the CMIR are required to follow our Code of Good Practice. This includes certain standards we expect in hygiene and safety that they should implement at all times to protect the safety of their patients and the reputation of their profession.

In the upcoming post-lockdown world of public-facing business the mandatory hygiene requirements are changing in accordance with the new national security measures.

Now, there are several steps that should be taken in addition to the essential high-standard health, safety and clinical hygiene procedures that the CMIR requires of all its members.

CMIR members should follow the guidance below to make sure they are ready to re-open their business doors to patients as soon as the UK Government permits.

Practitioners who are providing home treatment services should avoid visiting patients and protect themselves until the lockdown is completely lifted.

  • Eliminate the Risks  

We expect CMIR practitioners to take a risk assessment of their business premises. They must survey the treatment rooms, the waiting areas, common rooms and any other spaces. They must create a document of all their observations.

This document should be updated with information from regular surveys about the risks of infection across their company.

A risk assessment document should include evidence that the COSHH assessment is done to comply with the Control of Substances Hazardous to Health Regulations, and, evidence should be collected that the regulations are being followed by using the questions and resources set out by the Health and Safety Executive in their risk assessment and management guidelines.

  • 100% clean

The entire working environment of a CMIR member should be treated with a thorough clean before they can re-open to the public.

Members should follow these instructions from the Government to carry out a thorough decontamination with all the proper cleaning materials required.

  • Upgraded safety systems

All CMIR members must wear the necessary medical grade personal protective equipment (PPE). This includes medical masks, surgical gloves and medical gowns.

Where possible, masks and gloves should be offered to all patients, although everybody is expected to bring their own medial grade PPE. Patients should be given disposable shoe covers to wear as they enter the treatment rooms.

Please note that the majority of the PPE will have to be disposed and replaced at the end of the work day, if not sooner and more frequently. The objective is to stop the spread of potential infection. Therefore, all CMIR-registered practitioners should get plastic storage containers for clothing as well as contactless thermometer and contactless payment equipment.

We have written a letter on behalf of all CMIR members to Matt Hancock, the Secretary of State for Health. We asked him to help our members get the necessary personal protective equipment and hand sanitisers through a centralised procurement system that is efficient and fairly priced.

  • No confusion  

The social distancing rule is bound to stay in place for the foreseeable future, even after the lockdown is lifted.

Similarly, the CMIR members should use hand sanitisers, masks and gloves on their premises. For this reason the working space, including staff-only areas, must feature signage that clearly reminds everybody to follow the updated hygiene rules in line with the country's efforts to recover from the Covid19 pandemic.

Hand washing should be not only frequently reminded to everybody but allowed to happen. Hand sanitiser dispensers should be installed across the premises of all CMIR practitioners to help their patients take precautions with ease and convenience.

  • Safety - thorough and visible

All CMIR members should keep their clients posted about the efforts they are making to comply with the new clinical hygiene, health and safety guidelines.

Practitioners should use every communications platform available. Send emails; update the website; post on social media and ask patients to share the message; update leaflets and the rest of the marketing literature; send text messages to patients.

Everybody who uses a registered CMIR practitioner or is looking to find one should expect effective acupuncture treatment and Chinese herbal medicine where the appropriate qualifications permit. In addition, the public should expect CMIR members to demonstrate that the healthcare and medical services they offer will be delivered in a thoroughly safe environment – newly upgraded to protect them them from any possible infections.  

We strongly recommend that to remove doubt in anyone's mind, CMIR-registered practitioners should create a video message. They should use it to highlight their commitment to patient safety and to demonstrate the new sanitation steps they are taking to prepare their premises for a safe re-opening.

This video should be posted on every communications channel used, and mentioned in  emails to patients.

At the very least, the marketing materials used by CMIR practitioners (digital information as well as client-facing paperwork and literature) must make it clear that everything possible is being to enhance the safety of patients and the rest of the public.

As the CMIR practitioners welcome their patients back to their premises we expect them to continue to affirm public trust in the health and safety of their practice.

CMIR members should let themselves be seen how they follow their cleaning and sanitisation routines as their patients wait for treatment.

All members should be frequently disinfecting the surfaces in the reception area, across the waiting spaces and the treatment rooms. The patients should see these new routines being followed before and after treatments.

  • Protection from the COVID-19 – timely and discreet

All CMIR members have a duty of care to prevent the spread of disease.  

The CMIR-registered practitioners should formally and systematically ask all their patients, new and established, about their Covidstatus.

If anybody comes into a CMIR-registered practice having tested positive or displaying Covid19 symptoms we expect our members to ask the patient to call the NHS '111' number and follow the advice over the phone before seeing them again for treatment.

Before any physical contact, CMIR members should ask their patients to first wash their hands (use these instructions) and sanitise their hands, too – follow these instructions.

Before any treatment is given, all CMIR practitioners should take their patient's temperature with a contactless thermometer which should be acquired as part of the preparations for re-opening to the public. The temperature reading should be included in the patient's file. The objective in this procedure is to detect any health conditions in the patient that require medical attention from other specialists.

CMIR-registered practitioners must continue to ask their patients about any Covidsymptoms after the first post-lockdown appointment. This requires a new disclaimer in the patient form that explains to them the requirement to answer Covid-related questions in order to receive any treatments.

A CMIR member's duty of care also means a responsibility to check their temperature daily before they see any patients and keeping a record of any symptoms they notice during self-diagnosis.

We expect all our registered members to handle patient's file and other paperwork by themselves only, as much as possible. They should offer themselves to sign the welcome and check-out forms, disclaimers and any other documents on the behalf of the patient. Alternatively, members should ask their patients in advance to bring their own pens.    

  • Treatment rooms - secure and ventilated

All CMIR-registered practitioners must ensure their treatment rooms are well-ventillated and kept closed at all times.

Where possible, make this ventilation natural by keeping any windows open as much as possible. An extractor fan should be used instead of any air-conditioning units.

  • Safe beds and seats

All CMIR-registered practitioners should sterilise their treatment tables, beds and face cradles - or at least cover them with paper bed rolls instead of linens or towels – in preparation for each new treatment session.

We expect our members to use disposable covers between each appointment. Cot bedding sheets can be useful here due to their ease of washing and drying. Couch covers can only be used if they are replaced for each patient.

All used laundry should be kept inside a lidded container until it is washed. CMIR members should follow these guidelines from the NHS.

Patients should not be allowed to bring in their own bedding or towels.

All CMIR practitioners must wash all the linens, towels, uniforms and any other laundry used during a treatment session at high temperature. These materials should not be left to be used by the next patient.

The seats in the waiting room of a CMIR practitioner should be covered with a washable fabric and we expect our members to wash it regularly, or cover the seating with paper bed rolls.

All CMIR members are required to wear medical grade gloves and a mask whilst they carry out all cleaning activities.

  • Always Medical grade personal protective equipment (PPE)

All CMIR members should be wearing medical masks, surgical gloves and medical gowns – donned in the correct order.

We expect our members to use this list for guidance regarding what should be worn. We also expect our practitioners to be alert to changes in PPE requirements as the Covid19 pandemic unfolds.

People are expected to have their own PPE but we ask all our practitioners to consider offering masks and gloves to all their patients.  

CMIR members are expected to take the utmost care in dealing with used PPE at the end of the day, as these should be disposed of appropriately as non-recyclable waste. Face masks, gloves, aprons etc. must be stored for 72 hours before they can be taken out for collection.

All our practitioners should perform their treatments whilst taking maximum precaution – this means they should wear a face shield over their face as a cover against patient's breathing.

  • Everything is cleaned after every appointment

All CMIR members should use a disinfectant to clean their clothes and anything inside their treatment rooms, as well as the waiting areas used by their patients.

They must use the antimicrobial gel products that are effective against coronavirus and which include at least 60% alcohol.

We expect CMIR-registered practitioners to follow the instructions that come with each cleaning product as they carry out cleaning and disinfection, and to leave enough time for the products to work before touching the surface again.

All practitioners registered with the CMIR should record all their cleaning and sterilisation activities and keep the document in their files for future reference. This document should include a record of every daily cleaning and sterilisation session - clearly broken down into separate steps that are easy to follow by everybody across the team.

Practitioners and your colleagues should allocate enough time between appointments to do the cleaning thoroughly. We recommend cleaning sessions of 30 minutes while the patients are waiting outside.

All CMIR members are expected to wash hands and sanitise before and after every appointment with their patients.

On the premises of a CMIR-registered practitioner, patients should expect to have the opportunity to wash and sanitise their hands when they enter and leave the building.

CMIR patients should expect the waiting rooms to be free from unnecessary decorations, cushions and magazines. Water dispensers should be remove and we expect CMIR practitioners to ask their patients in advance to bring their own water.

The CMIR-registered practitioners should strive to minimise the chances of contamination by opening the doors to patients by themselves and to disinfect all the door handles at the end of the day or as soon as possible.

During the treatment sessions all CMIR practitioners must put their patient's clothes and possessions into a container which should then be sterilised between appointments. Members should find a separate container for storing their own belongings and which is sterilise daily.

In addition to their clinical tools, every surface that gets touched on the premises of a CMIR-registered practitioner should be sterilised at the end of each day. Not only the door handles and hand wash dispensers but taps and toilet facilities.

Practitioners must regularly and promptly sanitise the buttons on the payment card machines they use with their patients.  

We recommend that our practising members use a contactless PDQ machine and an electronic payment system to allow their patients to pay via a bank transfer or through PayPal.

We urge all CMIR practitioners to strive for win-win ways that nudge their patients towards paying for treatments in advance of visiting the premises. Members should think hard about finding and delivering meaningful incentives that encourage new and long-term patients to book treatments in advance over the Internet.  

To prevent queues and risks of infection in the waiting rooms, CMIR practitioners should take the process of checking in their patients and registering new ones online. As with payments, this should be contactless and done digitally.

CMIR members should meet their patients at the door to help them avoid touching the door handles. If any surfaces are touched they should be disinfected immediately.

They should set up the facilities that enable the patients to clean their hands, put on disposable shoe covers, masks and gloves.

The CMIR practitioners should give the check-out forms and any take-home products (e.g. herbal prescriptions) to the patient while they are still inside the treatment room.

When a patient is ready to leave a CMIR practice they should be escorted where they can discard their PPE in a covered container and use a hand sanitiser – away from any other patents or staff.

If cash payments cannot be avoided, the CMIR-registered practitioners should follow a new procedure with their patients: an envelope should be given in which the patient places their payment and leaves it in a designated spot. The practitioner should handle the envelope only once – a the end of the day – and wash their hands afterwards with a hand sanitiser.

All CMIR members must formally check with their new and current patients about any possible allergies they may have to cleaning products, latex and powder. This information should be recorded on each patient's file as an update along with a COVID-19 disclaimer (see above) that every patient must read and sign before they proceed for treatment.

Should the Government release any further guidelines or requirements for a post-lockdown relaunch, these will be added to this article and emailed in the Members' Newsletter.  

  • Further Information

- GOV.UK is a hub of the latest information and guidance from the UK Government.

- Official guidance on personal protective equipment (PPE)

- Governmental guidance on prevention and control of infections

- Guidelines for personal protective equipment use for non-aerosol generating procedures

- Guidance for households with possible coronavirus infection

- Social distancing and for vulnerable people

- COVID-19 guidance for educational settings

- How to assess risk in your working environment

- How to use hazardous substances at work

- How to prevent and control infections in the workplace

- How to wash hands effectively

- Important Covid-19 considerations for your PPE

- How to decontaminate patient care equipment

- How to wear PPE

- How to put on PPE in the correct order

- How to work safely during coronavirus

­- Recommendations on using PPE at your work

- Advice for healthcare professionals on how to control infections

- Advice for bodywork and massage professionals on returning to practice

- Advice on how to dispose of PPE infected with Covid-19

- Advice from the British Pain Society on how practitioners can respond during the COVID-19 outbreak

- Advice and resources for physiotherapists

- Latest information and advice from the Health and Safety Executive

- Advice and workplace guidelines from the CIPD on returning to work