Table III.

General considerations for phased reopening of practices

Patient/staff screening	• Strict no visit/do not come to work, if sick • Routine temperature checks of staff and patients (consult CDC38, 39, 40 guidelines on temperature age ranges) • Screening questions regarding symptoms, sick contacts, and travel • Maintain vigilance of surroundings and community regarding infection and complication rates • Maintain vigilance of testing capabilities of the community • Have an isolation plan with PPE in place for COVID+ patients/patients under investigation still requiring office-based care, or who elude screening • Actively monitor and modify your scheduling template • Maintain a list for prioritizing in-person patient visits to manage a gradual increase in capacity • Plan for staff coverage if a staff member has a high-risk medical condition or if he or she has to self-isolate • For up-to-date information on office preparedness, please consult the CDC Web site41,42
PPE	• Use of at minimum cloth facial coverings or surgical masks for patients, except for very young children • Surgical mask/face shield in office for lower risk/standard risk contacts • N95-, P100-, or PAPR-level protection for aerosolizing procedures and/or known COVID+ patients/contacts/suspected contacts • Gowns, gloves, and hair nets where indicated • Clear donning and doffing procedures, and assessment of clinician and staff competency in these procedures • Please check with the CDC Web site43 for up-to-date guidance on PPE, which may change • Please refer to institutional, office, or local policies that may take governance for your particular situation
Social/physical distancing, examination room and waiting room issues	• Recommended 6 ft minimum distance between staff/patients/families. Limited number of persons • Smart space utilization and workflow, including use of tape/markers to facilitate spacing • Remove magazines or other sources of paper from the waiting and examination rooms • Real-time sanitizing of common surfaces in waiting room and examination rooms • Strict hand washing and hand sanitizing • Maximize use of telemedicine procedures to communicate with zatients to minimize time in the room • Be mindful to clean the office at regular intervals throughout the day • Follow CDC guidance43 on the use of disinfecting agents for particular office furniture or medical equipment
Spirometry/nitric oxide	• Carefully consider the reopening phase and utility of the information being gained from the procedure • Strict hand hygiene protocols before and after the procedure for patients and staff • Consider unique spacing issues between patient and tester, as well as ensure tester has proper PPE including an N95 or higher level mask, gown, face shield, hair net (if needed), additional eye protection if needed, and disposable gloves, in compliance with local/institutional policy. Staff should doff PPE used in the spirometry area before entering other office/clinical space • Ensure filter is in place, and maximize use of any single-use materials • Ensure equipment and room cleaning procedures are in place, as well as time needed to clean equipment in between procedures • Assess ability to provide a negative pressure room if indicated • In phases 1 and 2, consider using telemedicine for remote testing/instructions to limit face-to-face time in a room with an aerosolizing procedure. Use home peak flow meters to assist in asthma monitoring • Restrict use of in-office nebulized treatment in phases 1 and 2 to the extent possible • Defer spirometry in patients with acute respiratory symptoms • Defer methacholine challenge in phases 1 and 2 • Please refer to current ERS44 and ATS26 guidance

ATS, American Thoracic Society; ERS, European Respiratory Society.