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

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. Here, we identify the actions that the therapists at RMT at The Woods commits to, and that all visiting patients 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 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 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 & 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 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 phone the patient one day before their booked appointment to discuss using the self-assessment tool and the verify that it has been done.  Patients must complete a telephone assessment with their therapist at least 24 hours BEFORE they receive in-person treatment. This is a non-negotiable requirement set out by the College of Massage Therapists of British Columbia. Your appointment will be cancelled if your phone assessment has not been completed in advance.

  • 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:

o Fever

o Cough

o Chills

o Shortness of breath

o Sore throat or pain with swallowing

o Stuffy or runny nose

o Loss of sense of smell

o Headache

o Muscle aches

o Fatigue

o 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 this consent form, patients must commit to understanding that while we’ve 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 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.

o They will not be charged a late cancellation fee if they cancel due to illness but the patient must notify the therapist. 

Upon Arrival

  • The therapist will advise patients of their 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 -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

  • Masks must be worn at all times within the clinic space. If the patient has a mask, they are asked to bring it with them and wear it when they arrive. If the patient does not have a mask, a single-use mask will be provided and they will be asked to wear it upon entering the clinic space.

  • 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

Within the Treatment Room

  • Only 1 patient/person is permitted in the clinic space at any given time. Patients must arrive unaccompanied.

o Minors may be accompanied by 1 parent/guardian.

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

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

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

  • Patients are required to wait in their vehicles until the therapist calls or text messages the patient. 

  • 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 the course of their treatment. The clinic door will be re-opened by the therapist at the end of the appointment for the patient to leave without touching the door knob.

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

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

Restroom for Patient Use

  • The restroom has been equipped with a soap dispenser, individual use wash cloths and proper hand washing guidelines.

  • Soap and individual use face cloths for drying will be available at all times.

  • A basket has been placed next to the restroom door so that patients may use their individual face cloth to open the door,and then place it in the bin before re-entering the treatment room.

Hand Hygiene

Entry into Clinic Space

  •  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 – reducing the need for the patient to touch the door.

    • Immediately upon entering the clinic space the patient must either:

      o Go directly to the bathroom sink without touching anything inside the clinic and wash their hands with soap and water for at least 20 seconds and then dry thoroughly, or

    • o The therapist will dispense hand sanitizer for the patient upon arrival.

  • If hands are visibly soiled, the patient must opt to wash hands at the bathroom sink.

  • The therapist will wash hands thoroughly for at least 20 seconds before and after treatments, 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 treatment room.

      • Receipts will be emailed, not printed.

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

      • The door and doorknobs will be disinfected between each patient.

    • We will now offer contactless payment via Jane Payments. We will be strongly encouraging contactless payment. Please add your credit card to your account so we can automatically bill you, to encourage contactless payment. Instructions how to add your credit card to your account here: https://jane.app/guide/payment-processing/add-a-credit-card-from-the-client-my-account-portal 

    • Debit and credit TAP payments through Square will be accepted if absolutely necessary. No cash payments will be accepted.

    • The Square device will be sanitized between each patient.

    • Cash will not be accepted at this time.

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 tissue to address an itch and/or touch the face for any other reason.

  • The therapist will wear a mask at all times.

  • Patients are required to wear face masks that cover both the nose and mouth at all times within the clinic space.

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

Enhanced Cleaning

  • Additional time has been scheduled between patients to allow for thorough cleaning and sanitization of the treatment room.

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

  • Common areas will be cleaned and disinfected after every appointment, 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):

o Light switches, door knobs, Square device, electronic devices, table surfaces, chairs, stools, window coverings, faucets, etc.

o The treatment table, table levers, face cradle, lotion bottles.

o No hydrotherapy supplies, thermophores, table warmers will be used.

o A Cleaning and Disinfectant for Clinic Setting Poster will be on Display in the treatment room and the restroom.

  • All linens, including blankets and pillow cases are single use only and will be laundered using hot water, detergent and bleach between each use. 

  • A Honeywell HEPA Air Purifier has been placed in the treatment room and will be utilized in between each patient and/or during the treatment.

  • A disinfected plastic bin has been placed in the treatment room. The patient will be asked to keep all of their personal belongings in this bin during the treatment. Post treatment,  used linens will be place into a washable laundry bag inside the laundry basket and carried to the laundry room for washing.

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

  • Laundry bag will be laundered.. 

Personal Protective Equipment

  • The therapist will wear a face mask at all times while working with a patient.

  • The therapist’s mask will be changed in between appointments.

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

o 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.

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

  • Patients are required to wear a face mask in the clinic at all time.

o If patients have their own fabric face mask, they are requested to bring it. If they do not have a fabric face mask, a single-use non-medical mask will be provided to them at the time of their treatment.

  • The therapist will change into a clean pair of scrubs after each treatment. 

  • Therapist will wear eye protection which will be sanitized after every treatment. 

Professional Obligations

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 Therapist Association of BC, College of Massage Therapists of BC, and the Provincial Health Officer and that 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 into contact with COVID-19 at or during an appointment.

In the Event That a Patient Tests Positive for COVD-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 them of positive test results and possible transmission of the virus immediately.

  • The therapist will immediately self isolate.

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

In the Event That a Patient Alleges the 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 COVD-19 testing. 

    • If testing is granted:

      • All massage therapy appointments will be cancelled and the therapist will cease to provide service 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 possible 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.

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. 

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;

  • The RMT will document the patient’s consent in advance and at every treatment.