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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 the clinical setting. Here, we identify the actions that the therapist, Megan Leverette 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. • Patient will be emailed a COVID-19 Screening Form Survey 24-hours prior to their appointments. They must complete this survey in order to proceed with treatment, every treatment. • The therapist will use the BC COVID-19 Self-Assessment tool herself, daily and commits to canceling 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 • 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. • If you have, AND you are a healthcare provider working with COVID-19 positive patients, have you adhered to strict personal protective equipment protocol? What is your role in working with COVID-19 positive patients? Practitioners will decide for themselves if they are comfortable treating Healthcare workers who are in direct contact with COVID-19 positive patients. Our doctors and nurses are very well trained in the use of personal protective equipment (PPE) and have strict protocol to follow when PPE fails. Practitioners who do decide to treat said healthcare workers will cancel the appointment if there has been a break in the healthcare workers PPE within 14 days prior to the appointment, OR if the healthcare worker does not meet any other criteria in the screening process. The practitioner will also disclose to ALL patients they are treating that they are treating healthcare workers who are in direct contact with COVID-19 positive patients. • The patient will be required to sign (electronically) a Consent and Liability Waiver with respect to COVID-19 prior being treated. This Liability Waiver will be saved on file. For subsequent treatments patients will be asked to verbally confirm their consent which will be documented in their 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. • 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
• 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. • Masks must be worn within the clinic space when physical distancing is not possible. If the patient has a clean 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 or clean cloth 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 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. Please come to your treatment on your own, people will not be able to wait for you in the entry hall or treatment room. • 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. • Appointment times are scheduled to reduce the potential of patients crossing paths, and to allow for time in-between sessions for enhanced cleaning. Clinic items and decoration which cannot be cleaned properly between patients have been removed. • Patients are asked to arrive on time and not early or late for appointments. Patients are required to wait in their vehicles or on the seat outside the clinic, until the therapist comes to the clinic door to call them in.
Physical Distancing Within the Treatment Room
• It is not possible to maintain physical distancing while in the treatment room. • Patients will be asked to remove from the clinic everything that they bring with them.
Hand Hygiene Reception Area / Entry into Clinic Space
• Hand sanitizer is at the front door to be used by the patient before entering the treatment space. Sanitizer is also located in the treatment room for patient use. • If hands are visibly soiled, the patient must opt to wash hands in the bathroom 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, and before donning or doffing other PPE like face masks or shields. • Payment occurs in the entry area. Patients are asked to upload their payment information (credit card, insurance numbers) to the Jane system to aid in speed of payment and reduced time in the clinic space. In the event that this does not happen, an invoice may be emailed to the patient in order that they may pay it online. • Receipts will be emailed, not printed.
Hand Hygiene 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.
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 within the clinic space when social distance cannot be maintained and when being treated in side-lying and face up positions.
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 • 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, door knobs, 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. • All linens, including blankets and pillow cases are single use only and will be laundered using high heat and detergent between each use. • An 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.
Personal Protective Equipment
• The therapist will wear a face mask at all times and possibly eye protection while working with a patient. • The therapist’s face mask will be changed in-between appointments. • 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 inured. 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 face mask, they are requested clean it prior to use, and to arrive at the clinic wearing it. If patients do not have a fabric face mask, they will be offered a freshly laundered fabric mask or a single-use non-medial mask to be wore during their treatment.
Professional Obligations Liability Insurance
• The therapist carries professional liability insurance through Preventative Health Services Group. • 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 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. • And the RMT will document the patient’s consent in advance and at every treatment.
