Medspa COVID-19 Safety Procedures: A Checklist Review

01/22/2021

COVID-19 is a viral infection that spreads primarily by distribution of droplets from our mouths. When an infected person coughs, sneezes, breathes, drinks, eats, talks, sings, yells, etc., s/he is producing sprays and mists of saliva droplets that carry the virus. When another person inhales these droplets, s/he can then become infected. 

These droplets typically fall to the ground within minutes. There is evidence that very fine droplets, called aerosols, can stay in the air for much longer periods of time. 

There are also infection paths through the eyes, nose, and mouth by virus transfer from hands that were contaminated by touching contaminated surfaces. This is called fomite transmission. For example, a sick person coughs in their hand, and then opens a door, which leaves virus-contaminated droplets on the door knob. The next person opens the door and transfers virus to their hands. Then, if this person later touches their eyes, nose, or mouth, they can infect themselves. In the case of COVID-19, these fomite contamination rates seem considerably lower than infection by airborne inhalation.

These virus paths from a sick person to a healthy person are called “transmission vectors.”

The goal of implementing COVID-19 protection procedures in a MedSpa is to interrupt all potential COVID-19 virus transmission vectors. Unfortunately, since there are so many asymptomatic infections, a COVID-19 safety policy must assume all clients are infected with COVID-19.

Also, if a potential or actual infection was present in the Med Spa, there are additional steps to take to actively address public health pandemic tracing requirements.

Guidelines for Safety

This is not intended to be a safety procedure document for a MedSpa. MedSpas will vary in number of offices and office design, procedures, and staff. So, each MedSpa will have its own unique current COVID-19 safety procedure that reflects the needs of their particular situation.

This paper is to be used as a guide to review a MedSpa’s current COVID-19 safety procedures, or to help to identify the procedures that can be addressed in the development of a MedSpa COVID-19 safety procedure.

The COVID-19 Safety Procedure Steps section is a list of potential generic steps that a MedSpa might implement into a safety procedure to interrupt COVID-19 transmission vectors 

The next section is a reference COVID-19 Safety Procedure Step Analysis. In this section, the Objective of each procedure step is identified, and discussion presented to help assess the purpose of the COVID-19 safety steps identified. Reference this section to help clarify questions about the Procedure Steps proposed.

To use this document, review your MedSpa’s current COVID-19 safety procedure against each of the procedure steps identified within. If your current COVID-19 safety procedure is not implementing a form of the proposed procedure step, this gap should be reviewed and a decision made to update (or not) your existing COVID-19 safety procedure. Your implementation should be tailored to your particular MedSpa needs. 

COVID-19 Safety Procedure Steps

These safety steps are present in 4 groups:

  • Client behavior procedures to reduce transmission 
  • Staff behavior procedures to reduce transmission
  • Office modifications to reduce airborne and fomite (surface) transmission.
  • Supporting contact tracing efforts, if necessary

Client behavior procedures to reduce transmission 

  1. Pre-appointment questionnaire to screen for potential COVID-19 infected clients. Reschedule if client reports an issue, symptom or exposure. 
  2. Recheck for potential illness, symptom or exposure with a temperature check at client arrival. Reschedule if appropriate.
  3. Have clients wash or sanitize hands at entry
  4. Have clients put on disposable shoe covers at door or remove shoes and wear disposable slippers.
  5. Give clients a new rated surgical mask when they arrive in the practice
  6. Educate clients how to fit a new mask and how to safely put on and take off the provided mask.
  7. Inform clients to only remove masks when instructed to.
  8. Instruct clients on no talking when their masks are off.

Staff behavior procedures to reduce transmission

  1. Instruct staff on symptoms of COVID-19 and steps staff member to take if COVID-19 is suspected, or if staff is exposed to COVID-19.
  2. Test staff temperatures daily.
  3. Ensure staff can get COVID-19 testing with symptoms or exposure to COVID-19 without financial penalty.
  4. Try to implement MedSpa policies that reduce the economic impact of salary loss due to COVID-19 quarantine or illness. (short term disability compensation for example)
  5. Train staff on proper all day wearing of surgical masks with clients and other staff.
  6. Provide daily new “rated” surgical masks or respirators to your staff.
  7. Staff wears face shield (over masks) when working around the face of a client without a mask.
  8. Staff washes hands regularly during the day. 
  9. Staff eats and drinks alone, respecting social distance spacing.
  10. Train staff on how to put on, take off, and store masks.
  11. Train staff to wash up and change shoes before heading home
  12. Train staff on changing, bagging, and washing treatment scrubs or uniforms. (Don’t wear practice clothing back into the home)

Office modifications to reduce airborne and fomite (surface) transmission

  1. Install a HEPA air cleaner in treatment rooms. Run at highest rate of cleaning when mask less client face procedures are performed.
  2. Ensure physical social distancing between clients
  3. Provide Staff with easily accessible hand sanitizer or wash stations to use consistently during the day, particularly for before and after client treatments.
  4. Decontaminate surfaces around the client treatment area between clients.
  5. Ensure surface decontamination between patients is done properly by documenting the decontamination process.
  6. Properly dispose of or sanitize PPE (face shields for example) between patients.
  7. Document the final COVID-19 safety procedures, train staff, and enforce compliance.
  8. Document the MedSpa facility fomite surfaces to be regularly cleaned, the cleaning process and schedule.

Supporting contact tracing efforts, if necessary

  1. For contact tracing, keep records of all patients by date and time and their treatment staff. Keep records of all staff worked by date and time.

COVID-19 Safety Procedure Step Analysis

The above identified MedSpa COVID-19 safety procedure steps are organized and discussed in four groups of client behavior, staff behavior, facilities and contract tracing

The format followed is:

Objective: Purpose of implementing the procedure step(s)

Proposed COVID-19 safety procedure steps

Discussion: information, rationale, clarifications

Client behavior procedures to reduce transmission vectors 

Objective: Prevent sick clients from coming to MedSpa appointments.

Procedure Step 1: Pre-appointment questionnaire to screen for potential COVID-19 infected clients. Reschedule if client reports an issue, symptom or exposure.

Procedure Step 2: Recheck for potential illness, symptom or exposure with a temperature check at client arrival. Reschedule if appropriate.

Discussion: This is not perfect as there are many asymptomatic clients. To educate and save client time around this healthiness requirement, this should be presented in advance by email or phone screening, or maybe a website form. This check is done again at client arrival. If there is anything unusual, just reschedule at least 14 days weeks out, or for when the client can take and provide a negative COVID-19 test done within 4 days of the appointment. 

Objective: Minimize the COVID-19 virus a client might inadvertently bring into the MedSpa.

Procedure Step 3: Have clients wash or sanitize hands at entry

Procedure Step 4: Have clients put on disposable shoe covers at door, or remove shoes and wear disposable slippers.

Procedure Step 5: Give clients a new rated surgical mask when they arrive in the practice

Discussion: COVID-19 hot spots on a person are potentially their hands, soles of their shoes and, particularly, their current masks. Shoes are an issue as most COVID-19 droplets fall to the ground. This is why we want to clean their hands, cover the soles of their shoes, and give them new masks when they come into the practice. Have them bag their old mask in a brown paper bag if they want to save it. Cloth masks, in general are very risky. If a client wants to wear their own mask, they may under the MedSpa provided mask.

Objective: Maximize client’s mask effectiveness.

Procedure Step 6: Educate clients how to fit a new mask and how to safely put on and take off the provided mask.

Procedure Step 7: Inform clients to only remove masks when instructed to.

Discussion: A mask on a client face does not necessarily protect against COVID-19 transmission. Only a properly put on, worn, and removed client mask protects your staff and other clients.                                                                                                                                                                                                                                                                                                                                                                                 

Objective: Reduce client produced airborne droplets and aerosols created when client masks are removed for facial treatments.

Procedure Step 8: Instruct clients on no talking when their masks are off.

Discussion: Simply client breathing without a mask will push aerosols and fine droplets into the air. Talking increases the quantity, size and distance of droplet production, and COVID-19 transmission risk. 

Staff behavior procedures to reduce transmission vectors

Objective: Detect sick or COVID-19 exposed staff to quarantine them from working.

Procedure Step 9: Instruct staff on symptoms of COVID-19 and steps staff member to take if COVID-19 is suspected, or if staff is exposed to COVID.

Procedure Step 10: Test staff temperatures daily.

Objective: Remove monetary incentives for staff to come to work with potential COVID-19 infections.

Procedure Step 11: Ensure staff can get COVID-19 testing with symptoms or exposure to COVID-19 without financial penalty.

Procedure Step 12: Try to implement MedSpa policies that reduce the economic impact of salary loss due to COVID-19 quarantine or illness. (short term disability compensation for example)

Discussion: Staff will often work sick to avoid salary loss. Their decision will be affected by both management and government unemployment policies. Management should insure that conflicts between losing wages and required time off are reduced.

Objective: Prevent staff from exposing clients to their airborne droplets

Procedure Step 13: Train staff on proper all day wearing of surgical masks with clients and other staff.

Discussion: Essentially, once a mask goes on in the morning, it stays on, except to eat and drink.

Procedure Step 14: Provide daily new ‘rated’ surgical masks or respirators to your staff.

Discussion: Purchase quality, rated medical masks. No cloth. No vents. Provide a new mask every day if CDC mask reuse steps not followed. Cloth masks can be effective, if produced properly, but few are. If a person wants the comfort of cloth, put the surgical mask over the cloth mask.

Objective: Protect staff from droplet sprays to their faces when working on mask-less client faces.

Procedure Step 15: Staff wears face shield (over masks) when working around the face of a client without a mask.

Discussion: Clients without masks will potentially breathe, talk, or cough sprays of droplets into the faces of staff service providers. Protective face shields are often standard operating procedure for working around client faces to protect staff’s face and eyes. Consider upgrading the staff mask to a medical respirator mask when working directly with a mask-less client’s face. (3M models 1860, 1870 or 1804, or equivalent)

Objective: Prevent staff from contaminating surfaces

Procedure Step 16: Staff washes hands regularly during the day. 

Discussion: Infected hands that touch objects like switches and door knobs are the issue. Disposable gloves can be used, but, these need to be disposed of, or sanitized as you would your hands, regularly. It is assumed that there are separate, not specific to COVID-19, sanitizing requirements for treatments.

Objective: Prevent exposing other staff when mask is off while eating, drinking

Procedure Step 17: Staff eats and drinks alone, respecting social distance spacing.

Discussion: Eating and drinking are high droplet-producing activities. Talking while eating and drinking is worse. Break rooms where staff might eat, drink or chat without masks have been found to be major staff-to-staff transmission vectors in hospitals. Don’t let staff eat and drink together.

Objective: Prevent staff self-infection by mask removal or handling.

Procedure Step 18: Train staff on how to put on, take off, and store masks.

Discussion: It is approved to store masks. This is most often done with medical respirators that are costly. Store in paper bags. Store three days for 100 percent certainty that COVID-19 is dead. With rated surgical mask, that are cents each, normally one mask per day, then dispose. 

Objective: Prevent staff cross-contamination to (home) family

Procedure Step 19: Train staff to wash up and change shoes before heading home

Procedure Step 20: Train staff on changing, bagging, and washing treatment scrubs or uniforms. (Don’t wear practice clothing back into the home)

Discussion: Suggested to follow American Nursing Association scrub handling. Remember that shoes are a hot spot, as COVID-19 droplets will fall to the floor.

Office modifications to reduce airborne and fomite (surface) transmission

Objective: Reduce airborne COVID-19 aerosols

Procedure Step 21: Install a HEPA air cleaner in treatment rooms. Run at highest rate of cleaning when mask less client face procedures are performed.

Discussion: Treatment rooms are typically small enclosed areas with little ventilation where aerosols and fine droplets might build up over time and get past surgical masks, which have leakage paths. Adequate ventilation is a technical issue that will vary from facility to facility and improvements need to be expertly assessed. For example, running the HVAC system fan continuously with a high MERV filter may help.

Objective: Maintain client to client social distancing

Procedure Step 22: Ensure physical social distancing between clients

Discussion: CDC recommends six feet. Areas to pay attention to are waiting room and reception or payment lines. When there is simply not enough waiting room space to maintain social distancing, providers can request that patients wait outside in cars until called, and then enter to go directly to the treatment room.

Objective: Reduce the barriers to washing and/or sanitizing hands.

Procedure Step 23: Provide Staff with easily accessible hand sanitizer or wash stations to use consistently during the day, particularly for before and after client treatments.

Objective: Reduce possible surface transmissions between patients.

Procedure Step 24: Decontaminate surfaces around the treatment area between clients.

Discussion: Surface contamination seems to be a really low transmission vector. But, people seem to expect this, so just a good practice.

Procedure Step 25: Ensure surface decontamination between patients is done properly by documenting the decontamination process.

Procedure Step 26: Properly dispose of or sanitize PPE (face shields for example) between patients.

Discussion: Staff needs to be clearly taught that spray and soak for 4 minutes (assuming a bleach based product) is the proper decontamination process for all surfaces. The soaking kills COVID, not the wiping. Then wipe up to remove the disinfectant

Objective: Ensure the staff complies with COVID-19 safety procedures.

Procedure Step 27: Document the COVID-19 safety procedures, train staff, and enforce compliance.

Discussion: Process quality, for any process in a MedSpa, is simply conformance to process requirements. To assess the quality of Botox injections, for example, across staff, is to assess the conformance of each injector against documented procedures and process protocols. Note that if a MedSpa does not have document procedures and protocols, and does not assess its staff against these procedures, it is not possible to establish or claim process quality.

Objective: Regularly decontaminate potential COVID-19 (fomite) transmission surfaces.

Procedure Step 28: Document the MedSpa surfaces to be regularly cleaned, and the cleaning process and schedule.

Discussion: These are obvious things like door handles, keyboards and phones. Simply observe what staff and clients touch often, and document. Then decide on a schedule which reflects the frequency of contact. Remember staff hands are an important surface too. Some businesses have a periodic announcement reminding it is time for staff to sanitize or wash their hands.

Supporting contact tracing efforts, if necessary

Objective: Ensure sufficient records to support public health traceability 

Procedure Step 29: For contact tracing, keep records of all patients by date and time and their treatment staff. Keep records of all staff worked by date and time.

Discussion: The public health department may contact the MedSpa with a report of a positive COVID-19 client. The MedSpa needs to be able to provide all people the client came in contact with during the client visit.

Other Discussion:

There is no evidence that PRP or other blood processes create any additional risk of transmitting COVID-19. There is no evidence that laser processes create any additional risk of transmitting COVID-19.

The following references were used in developing this paper or provide additional information.

American Society of Dermatologic Surgery Association (ASDSA) and American Society for Laser Medicine & Surgery (ASLMS) Guidance for Cosmetic Dermatology Practices During COVID-19. 2020 (Accessed Oct, 2020, at https://aslms.org/for-professionals/professional-resources/aslms-asds-joint-webinar)

CDC. How COVID-19 Spreads. 2020. (Accessed 21 Oct, 2020, at https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/how-covid-spreads.html.)

CDC. Your Guide to Masks. (2020). Accessed 21 Dec, 2021, at https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/about-face-coverings.html

Gralton, J. Tovey, E., McLaws, M.L. & Rawlinson, W.D. (2011). The role of particle size in aerosolised pathogen transmission: A review, Journal of Infection, Volume 62, Issue 1, Pages 1-13, https://doi.org/10.1016/j.jinf.2010.11.010.

Hathway, E.A., Noakes, C.J., Sleigh, P.A. & Fletcher, L.A. (2011). CFD simulation of airborne pathogen transport due to human activities. Build. Environ., 46 (12), pp. 2500-2511

Johnson et al., (2011). Modality of human exposed aerosol size distributions. Journal of Aerosol Science, 42, pp. 839-851, 10.1016/j.jaerosci.2011.07.009

Kähler, C. J. & Hain, R. Fundamental protective mechanisms of face masks against droplet infections.  Journal of Aerosol Science, Volume 148, October 2020, 105617 https://doi.org/10.1016/j.jaerosci.2020.105617

Stadnytskyi, V., Bax, C.E., Bax, A., & Anfinrud, P.(2020). The airborne lifetime of small speech droplets and their potential importance in SARS-CoV-2 transmission. Proceedings of the National Academy of Sciences, 117 (22) 11875-11877; DOI: 10.1073/pnas.2006874117 

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