COVID-19 Safe Office: Air Quality for Psychotherapy & Assessment Practice During the SARS-CoV-2 Epidemic
Image 1. A basic example of air treatment
This training focuses on airborne virus transmission risk management and mitigation, ways to discuss the topic with colleagues, educate patients, and how to provide informed consent. This training offers new information. It is a supplement to the training titled “Re-opening and Maintaining a Private Practice During the COVID-19 Pandemic” first offered in July 2020 (www.mentorresearch.org/covid-19-practice-training). This training can be completed without completing the earlier one, which is, however, highly recommended.
Applications examples and additional articles on SARS-CoV-2 air treatment
When you have completed the course you will be able to:
discuss different types of aerosolized virus-risk droplets and nuclei that may cause infection,
describe air treatment requirements and discuss when and why in-person therapy or teletherapy might be offered
identify and implement distance requirements for in-person sessions,
discuss the importance of office air exchange, ventilation and/or air filtration,
describe the office air treatment you can implement during and after in-person sessions,
discuss differences between non-medical and medical grade ventilations and air filtration,
explain to patients how your air ventilation, air exchange and/or air filtration systems work,
talk with patients about CO2, particle size and humidity monitoring if you need this and they are interested,
give examples that illustrate differences between absolute risk, relative risk, a safety factor and order of magnitude,
provide patients with a estimate of the risks of infection for your office (e.g. 1 chance in X) .
Based on the above considerations, participants will understand the incremental value of standalone medical grade filtration devices, an airwall, ventilation with outside air, and a dehumidifier. A mathematical model can be applied to the example model below (image 2) to establish a risk that can be compared to determine the relative risk of other options. Image 2 illustrates the risk of infection is at best 1 chance in 20220 without wearing masks. In contrast, you will better understand why the relative risk of infection is at best 1 chance in 8206 if only 2 filtration devices are properly used and you wear masks.
Here are a few considerations you will better understand in this training. Air treatment systems filter particles from 1 micron to as small as 0.003 microns. The SARS-CoV-2 virus is between 1 micron and 0.1 microns. A humidifier can remove airborne virus-carrying droplets to maintain a low humidity level. Humidity in the air clumps airborne virus which make them heavier, more likely to fall and more easily removed by a dehumidifier. Air exchange rates with outside air can be measured with an anemometer that measure ventilation or exchange air flow in ft/sec. This is a handy validator for air movement at a window or a filtration devise. A 12 inch window box fan can move about 150 to 250ft3 of air per minute. CO2 levels can be monitored to insure ventilation is adequate. Monitoring CO2 level is a way one to measure shared air (rebreathing the same air). Maintaining CO2 levels to background levels (between 380 and 450 particles per million, ppm) is an additional way to gauge room air clearance rate (RAC). Suspended air particle measurement in particle ft3/min is also a way to established room air clearance rate. The required RAC for a physician exam room is 6 air exchanges. That can be accomplished in a standard medical air treatment HVAC in about 16 minutes. Monitoring particles greater that 5.0 microns and greater than 2.5 microns, while larger than a coronavirus (0.1 microns), can be a direct measure of the effectiveness of room air clearance using a filtration system. Particles measurement devises, such as the Dylos 300, cost about $300.
The level of effort to create a COVID-19-Safe office and the risk of infection will vary based on physical characteristics of the office, characteristics of the local epidemic, office policy, building characteristics (share office space and shared air) and patient screening procedures.
Options, Considerations and Requirements Presented in this Training
Minimize shared air with other offices.
Consider creating 60 minutes between in-person appointments to insure appropriate air treatment.
Filter air to at least 0.1 microns.
Air exchange and/or ventilation of approximately 500ft3/min for a 500ft2 office
Physical distance between patient and providers at least 6ft and ideally10ft.
Use of an air-wall that has an air column of 4 inches by 36 inches.
Monitor CO2 levels to insure the office has adequate ventilation.
The office can be fogged with "human safe" atomized hydrogen peroxide.
Differing efficiencies of masks if worn should be at least 50%.
Monitoring temperature and humidity.
Dehumidifier "kill tank".
Acceptable volumes of speech.
Scheduled time to sanitize surfaces and conduct telehealth appointments.
Screening patients before appointments.
Adopt criteria for not meeting patients in-person.
Compassionate refusal to decline an in-person appointment with a patient.
Patients who do not meet objective and subjective criteria for in person services can be offered telehealth.
Responding to patients’ appreciation for your tangible action to make your office safe
Air ventilation, exchange and filtration are important considerations for reducing the risk of infection by airborne transmission. A mask is not adequate if there is extended contact between patient and provider, and especially so if in a small and there is no air treatment.
Implementation of an air treatment plan the considers these variables can mitigate the risk of infection to a level that is acceptable to the provider.
Psychotherapy Office
The office floor space in image 2 is 400 ft2. The Volume of atmosphere is 4000 ft3. The are 7 filtration devices and one ventilator that have a steady state air filtration and clearance of 570 ft3/minute on low speed. There is a complete air exchange every 9 minutes. The risk of infection in figure 2 is 1 chance 20220. If you have been vaccinated the risk that you will become infected is 1 chance in 404,400. That is virtually impossible if the provider adheres to the parameter of this model. The office currently has 6 filtration devices. (Note: During fire season in the summer of 2020 there were several large fires in Oregon. The outside air had nearly 670,000 particles/ft3. Eyes burned and people were coughing. The inside office, using 7 machines, had a count of 610 particle/ft3. That is a 99.9991% efficiency. There are no smell of smoke.)
Image 2. Extremely low risk COVID-19 airborne infection risk example.
Image 3 and 4 are photos of pre and post air treatment in a room that was fogged with particle approximately 5 microns in size. The room was cleared of particle in 23 minutes using two Air Doctors running at 320ft3/min each.
Image 3. Office visibility with high density atomized water droplets.
Image 4. Office visibility after 23 minutes using 2 air filtration systems. The clean Air Delivery Rate (CDAR) was 320 ft3/min per device.
This course is Empirically Supported and Evidence Based. CDC, WHO, State and Federal Publications, and Research internationally provide a pathway to re-open and maintain a private mental health practice safely by modeling a complex set of atmospheric factors and the use of air treatment methods.
Register Here
(This training will be available April 2021).
Registration will open soon-please bookmark this page and check back to enroll
WRITE DOWN your PASSWORD and DON’T misplace it.
(Videos may not work well if you use Safari or a newer iPad.
Email for PW reset may not be reliable if you use Apple mail, MSN email, or Hotmail)
You can work at your own pace. The system keeps track of what you need to do next if you stop and log in again later. The expectation is that you will complete the course within 2 weeks of enrollment. You will have access to the content of the course for one year after you complete it.
Course fee for mental health professionals (This training will be available August 2021).
Click here to register if you have NOT completed the training titled “Re-opening and Maintaining a Private Practice During the COVID-19 Pandemic.” (Cost is $35)
Click here to register if you have completed the training titled “Re-opening and Maintaining a Private Practice During the COVID-19 Pandemic.” (No Charge)
Click here to register if you have a financial hardship and have completed the training titled “Re-opening and Maintaining a Private Practice During the COVID-19 Pandemic.” (No Charge)
LOGIN Here
After You are Registered: Click here to Login & return to your course.
Or copy and paste this into your browser.
https://programs.mentorresearch.org/dashboard-programs/
1 hours of CE. Providers completing the 4 hour CE titled “Re-opening and Maintaining a Private Practice During the COVID-19 Pandemic” may take this CE at no charge.
Image 5. The SARS-CoV-2 virus is approximatel 0.1 microns
Image 6. AirDoctor ultraHEPA filtration
Image 7. An ionizing air fan used to create an “air-wall”.
Image 8. An integrated ventilation &/or air-exchange fan.
Image 9. An sterilizing solution atomizer suitable for disinfecting large offices, surfaces and air. This device is sometimes referred to a “fogger”.
For all mental health professionals the core ethical responsibilities must be maintained and refined to include awareness of new challenges to care, including competence building for telehealth services delivery, awareness of COVID-19's physical health risks and the necessary precautions for practitioner, patient/client and social safety if and when in-person services are offered
.
American Counseling Association
Course Purpose
This online training has been developed for mental health professionals currently meeting clients/patients in person or who intend to do so soon. Practicing in-person in a pandemic is beyond the training and experience of most mental health professionals. This course addresses important gaps in provider knowledge and experience.
Healthcare professionals are expected to obtain training to manage the requirements that COVID-19 places on medical and mental health practices. As licensed healthcare providers it is important that we appreciate our legal and ethical responsibilities, understand the risks, and gather information from local, State and Federal authorities. We must think through all elements of services provided in-person: client selection, physical proximity, client health status, infection risk, treatment modality, client/patient education, and provider and public safety. We must do all this before and while we address clinical issues! The good news is that this training, and the knowledge you gain, will help clients feel safe and have additional confidence in the care you provide.
Managing and reducing the risk of meeting patients in person requires new standards of practice and those standards must evolve as more is known about COVID-19 and the consequences of failing to develop or adopt a standard of practice.
Join a COVID-19 Discussion Forum - No Cost
Moderated by the Instructors and Mentor Research Institute.
Goto www.OregonTherapyForum.com
Enrollment in this course includes your opportunity to participate in OregonTherapyForum.com, a new online HIPAA secure TOPIC driven discussion Forum. Those who take this course are invited to participate the Forum area dedicated to COVID-19's impact on your ethical responsibilities, personal safety, clinical and insurance issues.
