Plan for Return to Clinical Practice in Respect of Covid-19

This plan was developed under the guidance of the PHO, CMTBC, RMTBC, and WorksafeBC with the goal of reducing the risk of exposure of the virus that causes Covid-19 for both patients and the practitioner within a clinical setting. Here, we identify the actions that the therapist at Melinda Registered Massage Therapy commits to, and that all patients with appointments must commit to, in order to resume massage therapy services.

“Coronavirus is transmitted via liquid droplets when a person coughs or sneezes. The virus can enter through these droplets through the eyes, nose, or throat if you are in close contact.

The virus is not known to be airborne (e.g. transmitted through the particles floating in the air) and it is not something that comes through the skin.

It can be spread by touch if a person has used their hands to cover their mouth or nose when they cough. That is why we recommend you cough or sneeze into your arm and wash your hands regularly.”

 

Source:  http://bccdc.ca/health-info/diseases-conditions/covid-19/about-covid-19/how-it-spreads

The overall aim of these protocols is to reduce potential coronavirus transmission by:

  • Requiring ongoing self-assessment for signs of Covid-19 related illness in both the patient and the therapist.

  • Reduce all physical, non-treatment related interactions amongst all people within the practice environment.

  • Hand hygiene requirements.

  • Avoiding face touching.

  • Enhanced cleaning and laundry protocols.

  • Appropriate use of personal protective equipment (PPE).

  • Meeting professional obligations, particularly related to informed consent and liability insurance.

Self-Assessment for Symptoms of Covid-19: For Patients and Therapists

Pre-Screening / Prior to Arrival

  • Patients will be informed about their responsibilities at the time of booking. A notice will be placed on the website, and the online booking software will send them a copy of these protocols as part of a Covid-19 specific consent form they will be required to sign electronically, prior to their appointment.

  • One day prior to their booked appointment, the patient will be required to complete the online BC COVID-19 Symptom Self-Assessment tool and to stay home if they experience any symptoms of Covid-19.

  • The tool can be found here:  https://bc.thrive.health/covid19/en

  • The therapist will contact the patient prior to their appointment as booked to discuss using the self-assessment tool, and to verify that it has been done.

  • The therapist will use the BC COVID-19 Self-Assessment tool herself, daily and commits to cancelling all appointments if symptoms appear.

  • Symptoms of Covid-19 are similar to other respiratory illnesses and seasonal allergies. An appointment must be cancelled immediately if either the patient or the therapist presents with even mild symptoms that may be signs of Covid-19 including:

    • Fever

    • Cough

    • Chills

    • Shortness of breath

    • Sore throat or pain with swallowing

    • Stuffy or runny nose

    • Loss of smell or taste

    • Headache

    • Unusual muscle aches

    • Fatigue

    • Loss of appetite

  • Covid-19 symptoms may range from mild to severe. Patients are required to cancel appointments if they experience what they determine to be ‘just sniffles’, ‘seasonal allergies’, or ‘just feeling under the weather’, on the day of their appointment.

  • Patients must confirm they have not been in contact with anyone displaying illness, or signs and symptoms of Covid-19 within 14 days prior to their treatment.

  • The patient will be required to sign (electronically) a consent and liability waiver in respect to Covid-19 prior to every appointment.

  • As part of the consent form, patients must commit to understanding that while we have taken all possible measures to minimize the risk of viral transmission, the nature of massage therapy means that physical distancing is not possible in the treatment room.

  • Patients with higher risk profiles and /or weakened immune systems should consider alternatives for care and postpone treatment.

  • The therapist and the patient must agree that the therapeutic benefit of massage therapy outweighs any potential consequence of treatment, including the possibility of viral transmission.

  • Patients who develop even mild illness or symptoms must cancel booked appointments, even without notice – they will not be charged a late cancellation fee if they cancel due to illness, at this time.

Upon Arrival

  • The therapist will advise the patient of her current results from online BC COVID 19 Symptom Self-Assessment tool.

  • Patients will be asked to confirm their own current results from online BC COVID Self-Assessment tool.

  • Patients MUST confirm that they have done a pre-screening and have no signs of COVID-19 as described here: http://www.bccdc.ca/health-info/diseases-conditions/covid-19/about-covid-19/symptoms

  • Masks are recommended to be worn during the entirety of the appointment. If the patient has a mask, they are asked to bring it with them and wear it when they arrive.

  • Patients must confirm that they have not travelled outside of British Columbia within 14 days of their appointment.

  • The treatment will be cancelled immediately if the patient does not meet the pre-screening criteria upon physical presentation.

Physical Distancing

Entry into Clinical Room

  • Only 1 patient/person is permitted in the treatment room at any given time. Patients must arrive unaccompanied. Minors will not be treated at this time.

  • The therapist is the only other person who will be within the clinic space throughout the duration of the patient's appointment.

  • The therapist and the patient will both maintain a space of 2 meters (6 feet) distance between each other in all areas outside the treatment room.

  • Nothing remains in the clinic space that cannot be disinfected after each touch.

  • Patients are not permitted to lounge in the reception area before or after the treatment.

  • Appointment times are scheduled to reduce the potential of patients crossing paths and to allow for time in-between sessions for enhanced cleaning.

  • Patients are asked to arrive on time and not early or late for their appointment.

  • Patients are required to wait in their vehicle or at the garage entry door until the therapist opens the door to call them in.

  • The clinic door will be opened for the patient by the therapist and will be locked behind them to prevent anyone else from entering the space during their treatment. The clinic door will be reopened by the therapist at the end of the appointment for the patient to leave without touching the doorknob.

 

Within the Treatment Room

  • It is not possible to maintain physical distancing in the treatment space.

  • Patients will be asked to keep all personal belongings within a plastic container, which can and will be sanitized between patients.

  • Patients will be asked to remove from the clinic everything that they bring with them.

Washroom for Patient Use

  • The washroom has been equipped with an automatic soap dispenser and proper handwashing guidelines. Small hand towels to dry their hands will be provided to each patient which immediately put into a sealed container to be laundered once finished.

  • Soap and fresh paper towels will be available at all times.

  • The bathroom will be cleaned after every use using the appropriate cleaning agent.

Hand Hygiene

Reception Area/ Entry into Clinic Space

  • Immediately upon entering the clinic space the patient must use hand sanitizer that will be provided by the entrance door.

  • If hands are visibly soiled the patient must opt to wash hands in a sink for a minimum of 20 seconds.

  • The therapist will wash hands and arms thoroughly for at least 20 seconds between patients, before and after disinfecting spaces, before donning gloves and after taking gloves off, and before donning or doffing other PPE like face masks.

  • Hand washing protocols will be posted visibly in the reception area and at sinks.

  • Payment occurs in the reception area. Cash will not be accepted at this time. A wireless POS system with Tap is available for card use. In the event that this does not work, an invoice may be emailed to the patient in order that they pay it online. The POS machine will be sanitized between each patient.

  • Receipts will be emailed, not printed. Invoices are saved at the time of treatment, so they are always available upon request

 

In the Treatment Room

  • The treatment room door will be open by the therapist to allow the patient to enter. The therapist will open/close the treatment room door before, during, and after the treatment as required – reducing the need for the patient to touch the door.

  • Patients will be permitted to open the door themselves after the treatment to let themselves out of the treatment room.

  • Tissue is available inside the treatment space.

  • Hand sanitizer is available within the treatment room; patients will be asked to sanitize their hands after treatment

Avoid Face Touching

  • The therapist will communicate with the patient that coronavirus can be transmitted by touch if droplets are on the hand when it touches the face, as it can transfer those infected droplets to the mouth, nose, or eyes.

  • Tissue will be available throughout the clinic: in the reception area, treatment room, and washroom in order that patients and the therapist may use the tissue to address an itch and/or touch the face for any other reason.

  • The therapist will excuse themselves to wash/ sanitize their hands if the therapist touches their face during treatment. 

  • The therapist will wear a mask and goggles at all times when the patient is in a supine or side-lying position.

  • Patients are required to wear face masks that always cover both the nose and mouth during the appointment.

  • Intra-oral and external TMJ treatments will not be conducted at this time. Unless in an emergency case by case basis.

  • Musculature of the face will not be palpated or treated at this time

Enhanced Cleaning

  • Additional time has been scheduled between patients to allow a thorough cleaning of the treatment room and reception/ entryway area.

  • All surfaces will be cleaned followed by disinfection with a Canada Health Approved for use against Covid-19 disinfectant as listed here https://www.canada.ca/en/health-canada/services/drugs-health-products/disinfectants/covid-19/list.html

  • Common areas will be cleaned and disinfected at least twice a day, including the washroom if not used. If the washroom has been used, then the therapist will disinfect all contact points immediately after.

  • All high touch surfaces will be cleaned and disinfected between patients, regardless of appearances. High touch surfaces include (but are not limited to): light switches, stool cover, chairs, door, doorknobs, POS machine, electronic devices, table surfaces, windows, faucets, treatment table, table levers, face cradle, goggles, lotion bottles and stabilizing straps.

  • No hydrotherapy supplies, thermophores, table warmers, or plush table covers will be used.

  • A Cleaning and Disinfectant for Clinical Settings Poster will be on display in the reception area.

  • All linens, including sheets, face rest covers, pillowcases and blankets are single-use only and will be laundered using high heat and detergent between each use.

  • Windows will be opened in between treatment sessions to air-out the rooms.

  • Plug-in air sanitizers will be turned on. 

  • A disinfected plastic bin has been placed in the treatment room. The patient will be asked to keep all their personal belongings in this bin during treatment. Post-treatment, this same bin will be used to carry used linens to the laundry room for washing.

  • Bins will be disinfected between each patient before cycling back into use.

  • Gloves, goggles, scrubs and masks will be used during laundering, and a strict schedule will be in place so there is no cross-contamination within the shared laundry room.

  • A daily cleaning and disinfecting log will be used and available upon request.

Personal Protective Equipment

  • The therapist will always wear a face mask and scrubs while working within the clinic space. Goggles will be used while the patient is in a supine or side-lying position.

  • The therapist's face mask and scrubs will be changed in-between appointments.

  • The therapist will wear non-latex gloves if/when appropriate.

  • Gloves may be appropriate when overuse of cleaning and/or chemicals causes skin irritation, or when the therapists' hands or skin of the hands are otherwise injured.

  • Hands will be washed prior to putting the gloves on and immediately after removing them.

  • Gloves are also considered appropriate and will be worn by the therapist at the patient's request.

  • Patients are required to wear a clean face mask that does not have an exhalation valve in the clinic at all times.

  • If patients have their own fabric/disposable face mask, they are requested to clean it prior to use, and to arrive wearing it.

  • If patients do not have a mask, a single-use non-medical mask will be provided at the time of their treatment, at the cost of $2 – not to be combined with direct billing – this is an out of pocket expense.

 

 

 

Professional Obligation

 

Liability Insurance

  • The therapist carries professional liability insurance through Wilson M. Beck as provided through the Registered Massage Therapist Association of BC.

  • The therapist is following all the health and safety guidelines outlined by the Registered Massage Therapists Association of BC (RMTBC), the College of Massage Therapists of British Columbia (CMTBC) and the Provincial Health Officer (PHO) and they are taking all reasonable precautions to clean and disinfect the clinic and all the surfaces in the treatment room.

  • No Guarantees have been made by the therapist, that the patient may not come in contact with COVID-19 at or during an appointment.

In the Event That a Patient Tests Positive for COVID-19 Having Been to a Massage Therapy Appointment Within the 14 days Prior to Onset of Symptoms

  • The patient will contact the therapist and inform her of positive test results and possible transmission of the virus immediately.

  • The therapist will immediately self-isolate.

  • The therapist will call public health at 8-1-1 to report the possible transmission and act on direction of Provincial Health.

 

In the Event That a Patient Alleges they Caught Covid-19 from The Therapist

  • The therapist will immediately call public health at 8-1-1 to report the alleged transmission, providing both the name of the RMT and the name and contact details of the patient.

  • The patient must agree to the release of this information under these circumstances in order to receive treatment.

  • All massage therapy appointments will be cancelled, and the therapist will cease to provide services until Public Health has investigated and provided direction.

  • The therapist will immediately self-isolate until Public Health has investigated and provided direction.

 

In the Event that the Therapist Catches Covid-19 or Displays Symptoms of Covid-19

  • The therapist will immediately self-isolate.

  • The therapist will call Public Health at 8-1-1 to report the symptoms and request access to Covid-19 testing.

If testing is granted:

  • All massage therapy appointments will be cancelled, and the therapist will cease to provide services until test results are returned negative.

  • If testing proves positive the therapist will follow Public Health directives in informing patients treated over the previous 14 days about potential transmission.

If testing is not granted:

  • All massage therapy appointments will be cancelled, and the therapist will cease to provide services for a minimum of 10 days beyond the onset of symptoms, and/or until symptoms cease.

In the Event that the Therapist Comes into Close Contact with Someone Showing Signs of Illness or Tests Positive for Covid-19

  • The therapist will immediately self-isolate.

  • All massage therapy appointments will be cancelled, and the therapist will cease to provide services until:

    • The close contact has been tested for Covid-19 and the results proved negative and the therapist is well.

    • OR after self-isolating for 14 days and having no symptoms of fever develop.

    • OR being cleared by a public health official.

Asymptomatic Spreaders

  • Asymptomatic transmission of the coronavirus is an unavoidable risk until we have acquired herd immunity, or there is an effective treatment or vaccine against Covid-19.

  • We have put into place protocols to help mitigate that risk as outlined in the preceding documentation.

  • No guarantees have been made by the therapist, that the patient may not come in contact with COVID-19 at or during an appointment.

 

Informed consent

In the current environment of Covid-19 risk, informed consent requires that the patient be informed and understands that:

  • Any massage therapy treatment involves some risk of Covid-19 transmission.

  • The therapist is following protocol to help reduce or mitigate risk where possible, but that risk cannot be reduced to zero.

  • The patient consents to the treatment despite some risk.

And the RMT will document the patient's consent in advance and at every treatment.