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 my clinical setting. Here, we identify the actions that Julie Paul, RMT and 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 Julie will send them a copy of these protocols as part of a Covid-19 specific consent form they will be required to sign 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 prior to their appointment as booked to discuss using the self-assessment tool, and then 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:
o Shortness of breath
o Sore throat or pain with swallowing
o Stuffy or runny nose
o Loss of sense of smell
o Muscle aches
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 a Consent and Liability Waiver with respect to Covid-19 prior to being treated. This Liability Waiver will be saved on file.
• As a part of the 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.
• Patient will need to fill out a screening survey prior to their appointments. They must complete this survey in order to proceed with treatment, every treatment.
• 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.
• 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-19 Symptom Self-Assessment tool.
• Patients must complete a screening and consent form 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 for $2 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.
Reception Area / Entry into Clinic Space
• Only 1 patient/person is permitted in the clinic space at any given time. Patients must arrive unaccompanied.
• 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 clinic areas that are outside the treatment room, when possible.
• The fabric chairs have been removed from the reception area; they have been replaced by plastic chairs that are separated by a minimum of 6ft. Patients are not permitted to lounge in the clinic reception area before or after the treatment.
• 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 time in-between sessions for enhanced cleaning.
• 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 comes to the clinic 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 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.
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 within a plastic bin, which can and will be sanitized between patients.
• Patients will be asked to remove from the clinic everything that they bring with them.
• Water jug and glasses have been removed from the clinic reception area. Bottled water is available upon request. Please bring your own water when possible.
Restroom for Patient Use
• The restroom has been equipped with soap dispenser, paper towels and proper handwashing guidelines.
• Soap and fresh paper towels for drying will be available at all times.
• A waste bin has been placed next to the restroom door so that patients may use a paper towel to open the door, and then discard it before re-entering the clinic space.
Reception Area / Entry into Clinic Space
• Immediately upon entering the clinic space the patient must either:
• Go directly to the handwashing 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
• Use the hand sanitizer dispenser on the front desk, just inside the clinic door outside the treatment room
• If hands are visibly soiled, the patient must opt to wash hands at the handwashing sink.
• 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, if used, and before donning or doffing other PPE like face masks or shields.
• 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 Point of Sale system with Tap is available for card use. In the event that this does not work, an invoice can 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.
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 – reducing the need for the patient to touch the door.
• Patients will be permitted to open the door for themselves after the treatment to let themselves out of the treatment room.
• Tissue is available inside the treatment room that the patient may use as a barrier when opening the door.
• 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.
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.
• Intraoral and external TMJ treatments will not be conducted at this time.
• Musculature of the face will not be palpated or treated at this time.
• Additional time has been scheduled between patients to allow for thorough cleaning 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: 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 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, door knobs, POS machine, electronic devices, table surfaces, chairs, stools, window coverings, faucets, etc.
• The treatment table, table levers, face cradle, oil and lotion bottles will be disinfected immediately after each treatment.
• No hydrotherapy supplies, thermophores, table warmers or plush table covers will be used.
• A Cleaning and Disinfectant for Clinic Setting Poster will be on Display in the reception area.
• All linens, including blankets and pillow cases are single use only and will be laundered using high heat, detergent and bleach between each use.
• A HEPA Air Purifier has been placed in the treatment room and will be utilized in between each patient and/or during the treatment upon the agreement of both the patient and the therapist.
• 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, this same bin will be used to carry used linens to laundry hamper for washing.
• Bin will be disinfected between each patient before cycling back into use.
Personal Protective Equipment
• The therapist will wear a face mask at all times while working with a patient.
• The therapist’s face mask will be changed in-between appointments if it becomes moist.
• If requested, 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.
• 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 face mask, they are requested to clean it prior to use, and to arrive at the clinic wearing it.
• If patients do not have a fabric face mask, a single-use non-medical mask will be provided at the time of their treatment for $2.
• The therapist carries professional liability insurance through Lackner McLellan insurance.
• The therapist is following all the health and safety guidelines outlined by the Registered Massage Therapists Association of BC, the College of Massage Therapists of British Columbia 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 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 transmission of the coronavirus is an unavoidable risk of practice until we’ve 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.
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.