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COVID-19

Downtown Therapeutic Massage

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 that Downtown Therapeutic Massage 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 therapist will contact the patient prior to their appointment as booked to discuss using the self-assessment tool, and the verify that it has been done.
  • The therapist will use the BC COVID-19 Self-Assessment tool herself daily and commits to canceling all appointments if symptoms appear.
  • Symptoms: An appointment must be cancelled immediately if either the patient or the therapist presents with symptoms that may be signs of Covid-19 including:
    • Fever, Chills or atypical sweatiness
    • Shortness of breath
    • Loss of sense of smell or taste
    • Unusual Fatigue
    • Recurring Dry Cough
    • Sore throat or pain with swallowing
    • Flu-like Headache or Muscle aches
  • Covid-19 Symptoms may range from mild to severe. If you have seasonal allergies we will need to ask further questions about your other symptoms, your activities with and current ‘bubble’ and your physical distancing practices. If we can determine that your risk is low we may still be able to treat you. If there’s doubt or your risk level is unclear, then we’ll ask you to wait until your allergies have subsided.
  • 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 either electronically or in paper, 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’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 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 illness or symptoms must cancel booked appointments.
    • They will not be charged a late cancellation fee if they cancel due to illness. Patients are expected to give notice by email as soon as they notice they are having symptoms and to give the therapist as much notice as possible. It is difficult to fill appointments on short notice, meaning a loss of income for us and lost opportunity for another client to have the time. Please treat us as you would wish to be treated.
    • Patients that no-show and do not communicate regarding cancellation will be charged the late fee, even if they are sick.

 

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-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 clean reusable fabric 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

Reception Area / Entry into Clinic Space

  • 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 clinic areas that are outside the treatment room.
  • The fabric chairs in the reception area have been covered with sanitizeable plastic.
  • 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.
  • Unless otherwise directed, patients are asked to arrive on time and not early or late for appointments.
  • Patients may wait in the alcove at the end of the long hallway, chairs are placed there for comfort.
  • Every effort will be made to allow the patient to enter and exit the clinic without touching surfaces. The clinic door will be open to allow entry. At the end of the appointment the patient may open the treatment room door themselves (tissues are provided) or at patient request, the treatment room door may be opened for the patient by the therapist.

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 on the chair and table provided for their use 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

  • Our building’s bathrooms are common areas shared by multiple offices. We have no control over the hygiene in these areas. They are cleaned once daily. (Other high touch surfaces in the building common areas like elevator buttons are cleaned twice daily.)
  • Soap and fresh paper towels for drying will be available at all times.
  • A waste bin has been placed next to the washroom door so that patients may use a paper towel to open the door, and then discard it.

Hand Hygiene

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 touchless hand sanitizer dispenser (on your immediate left as you enter the reception area)
  • 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, touching linens, 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 will occur either in the treatment room or the reception area depending on the therapist. Cash is still accepted and will be sanitized on receipt. Patients may pay via Point of Sale terminal or via e-transfer and an invoice will be emailed to the patient once payment is received. The POS machine will be sanitized directly before and after each patient (twice between 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 – 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.
    • All high-touch areas including doorknobs will be disinfected between each patient.

Avoid Face Touching

  • 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 unless they are physically distanced (6 feet+) from the client.
  • Patients are required to wear face masks that cover both the nose and mouth at all times within the clinic space.

 

Enhanced Cleaning

  • 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
  • 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, lotion bottles will be disinfected immediately after each treatment.
  • 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.

Personal Protective Equipment

  • The therapist will wear a mask or face covering at all times while working with a patient.
  • The therapist’s face mask will be changed in-between appointments.
  • The therapist’s face shield, if worn, will be disinfected and/or changed in-between appointments.
  • 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 clean it prior to use, and to arrive at the clinic wearing it.
    • If a patient does not have their own face mask, they have two options:
  1. a clean and sterile reusable fabric mask will be provided for the duration of the treatment. The patient will remove and drop the mask into a bin with disinfectant upon the completion of their appointment.
  2. A single-use disposable non-medical mask will be available to the patient for a charge of $2.
  • Cleaning and sterilization: Fabric masks provided by the clinic will be washed with detergent, dried, folded inside tissue and then ironed. These clean masks will be kept in a sealed Ziploc bag until use.
  • Protective glasses are available on request for patient use during 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 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.
  • The therapist is following requirements to daily self-assess for Covid-19 and log for symptoms, and will suspend all treatments if they become symptomatic.
  • 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 Transmission of Covid-19 From a 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 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 Believes Themselves Exposed to COVID-19 by a Close Contact

  • 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 an effective vaccine is developed or the general population vaccine develops herd immunity.
  • We have put into place protocols to help mitigate that risk as detailed above.
  • 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.