Plan for Return to Clinical Practice

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

This plan was developed with the goal of reducing the risk of exposure to the virus that causes Covid-19 for both patients and the practitioner within our clinical setting. All therapists and patients must commit to these procedures to resume Registered Massage Therapy Services. This plan is based on current recommendations from health and safety regulatory bodies. The content is subject to change due to the unknown characteristics of the Covid-19 and the global pandemic.

“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 in 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’s why we recommend you cough or sneeze into your arm and wash your hands regularly.”

Source: http://www.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:

Required ongoing self-assessment for signs of Covid-19 related illness in both the patient and the therapist
Reducing all physical, non-treatment related interactions amongst all people within the practice environment
Hand hygiene requirements
Avoiding face touching
Enhanced cleaning protocols
Appropriate and correct use of personal protective equipment (PPE)
Meeting professional obligations, particularly related to informed consent and liability insurance

Self-Assessment & 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 arriving at 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 by phone one day prior to their appointment to discuss using the self-assessment tool, and verify that it has been done. At that time the therapist will go over another series of questions to assess specific answers and confirm procedures implemented including – prior to arrival, during and post treatment protocol.
The therapist will use the BC COVID-19 Self-Assessment tool 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 sense of smell, headache, 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 the sniffles,’ ‘seasonal allergies’ or ‘just feeling under the weather,’ on the day of their appointment.
Patients must confirm that 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 with respect to Covid-19 prior to every appointment.
As a part of the consent form, patients must commit to understanding that while we have taken all possible measures to minimize 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 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.

Upon Arrival

Patients will wait in their car. Therapists will call/text when they are ready. If you walk please only arrive 2 to 3 minutes early and do not touch the door. It is automatically locked. The therapist will push a button that will trigger an auto door open feature when she is ready for you to enter.
Patients will enter and walk immediately to the marked sanitation station and use the touchless hand sanitizer as per posted instruction.
A single-use mask will be provided for the patient and is mandatory throughout the clinic including the common practice areas, treatment room, and restrooms, as well as to exit the clinic.
The patient will have their temperature taken with a contactless thermometer as discussed during the 1 Day Prior Screening Phone Call.
Patients will walk to the restroom, wash their hands for 20 seconds according to posted instructions, after they have used hand sanitizer and put on the provided single use mask and had their temperature taken.
The patient will be required to wear the provided single-mask the entire time during treatment except for when in prone (face down) when they can slide the mask under their nose or chin (whatever is preferred). The patient must slide it back over both mouth and nose prior to going supine (turning over). Hand sanitizer will be required each time the patient touches their mask.
The therapist will advise the patient of their own current results from the online BC COVID-19 Symptom Self-Assessment tool.
Patients must confirm that they have done a pre-screening and have no signs of Covid-19 as outlined here: http://www.bccdc.ca/health-info/diseases-conditions/covid-19/about-covid-19/symptoms
- Patients will be asked to confirm their own current results from online BC COVID-19 Symptom Self-Assessment tool.
Patient must confirm that they have not travelled outside British Columbia within 14 days prior to their appointment.
The treatment will be cancelled immediately if the patient does not meet the pre-screening criteria upon physical presentation at the clinic.

Physical Distancing -

Reception & Shared Clinic Space:

Only 1 patient is permitted in the clinic entrance at any given time. Patients must arrive unaccompanied unless patient is a minor who requires parent or guardian or infirm, and needs assistance.
Parent, guardian or any assistant needed, must follow and comply with all patient and clinic pre-screening and protocol including wearing a mask.
The therapist and the patient will both maintain a space of 2 meters (6 feet) distance between each other in all clinic areas that are outside the treatment room.
All fabric chairs have been removed from the waiting room. There is only one wood/metal chair left should a patient need to be seated.
Therapist will get a disposable cup of water for the patient if requested
- Patients must leave promptly after their appointment.
- All next appointments will be scheduled via JaneApp, email or phone.
Nothing remains in the clinic space that cannot be disinfected after each touch.
Appointment times are scheduled to reduce the potential of patients crossing paths, and to allow for enhanced cleaning between appointments.
Patients are asked to arrive on time and not early or late for appointments.
Patients are required to wait in their vehicles or outside the clinic, until the therapist calls, texts or acknowledges them through the glass door.
The clinic door will be opened for the patient by the auto door command and will lock behind them to prevent anyone else from entering the space. The clinic door will be triggered to open at the end of the appointment for the patient to leave without touching the front door handle.

Within the Treatment Room:

It is not possible to maintain physical distancing while in the treatment room.
Patients will be asked to keep all personal belongings in the disposable bag provided for their use, on the treatment room chair. The chair will be sanitized between patients.
Patients will be asked to limit the items they bring into the clinic, and remove from the clinic everything that they bring with them.

Restroom for Patient Use:

The restrooms have been equipped with no-touch soap dispensers, single use paper towels and proper hand washing instruction posters.
A waste bin is in each restroom next to the door, lined with a garbage bag for all paper towel/ Kleenex disposal.
The patient will use a paper towel to open the restroom door and deposit in the waste bin as they exit the restroom before re-entering the clinic space.

Hand Hygiene & Face-touching –

Reception & Shared Clinic Space:

Immediately upon entering the clinic space the patient must go to the marked sanitation station directly in front of them in the waiting room and use the touchless hand sanitizer as per posted instructions, donn (put on) the mask provided and have their temperature taken prior to walking to the restroom to wash hands thoroughly as per posted instructions.
The therapist will wash hands 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 or shields.
Hand washing protocols will be posted visibly at all sinks.
A tap payment system is available for card use and will be sanitized after each use. Receipts will be emailed, not printed.

In the Treatment Room:

The therapist will open the door to the treatment room and allow the patient to enter. The therapist will open/close the door before, during and after the treatment as required.
- Hand sanitizer is available within the treatment room; patients will be asked to wash or sanitize their hands after the 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 therapists may use tissue to address an itch and/or touch the face for any other reason.
Patients are required to wear provided face masks that cover both the nose and mouth at all times within the shared clinic space.
Therapists are required to wear face masks during all contact with patients; even when socially distanced.

Enhanced Cleaning Protocols -

Additional time has been scheduled between patients to allow for thorough cleaning of the treatment room.
Visibly soiled surfaces will be cleaned and disinfected 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 three times a day, including the restroom.
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, doorknobs, POS machine, electronic devices, table surfaces, chairs, stools, faucets, etc.
The treatment table, table levers, face cradle, lotion bottles will be disinfected immediately after each treatment.
Table warmers will only be used if covered with a heat-safe, washable vinyl cover.
A “Cleaning and Disinfectant for Clinic Setting” poster will be on display in the reception area, restroom and all treatment rooms.
All linens, including blankets and pillowcases are single use and will be laundered using high heat and detergent between each appointment.

Personal Protective Equipment -

The therapist’s disposable facemask will be changed in-between appointments or cleaned according to mask regulation for respirators/use.
The therapist will wear non-latex gloves if/when appropriate.
- Gloves may be appropriate when over-use of cleaning and/or chemicals causes skin irritation, or when the therapist’s 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 the single use face mask provided in the clinic immediately after sanitizing their hands, in all shared clinic spaces, the treatment room, restrooms and when exiting the clinic.

Professional Obligations -

Liability Insurance:

The therapist carries professional liability insurance.
The therapist is following all the health and safety guidelines outlined by the College of Massage Therapists of British Columbia (CMTBC), the Provincial Health Officer, WorkSafe BC and the Registered Massage Therapists Association of BC and they are taking all reasonable precautions to clean and disinfect the clinic and all the surfaces within 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.

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.

In the Event 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 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 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 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 of practice until we’ve acquired herd immunity; 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.

Thank you for your cooperation and understanding. The health of our entire staff, our RMTs, our patients and families as well as all those in the community, is of utmost importance to us and our greatest concern.