Lake City Wellness COVID-19 RMT Practice Guidelines

 

May.23/2020                                                                                               

 

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 practitioners within our clinical setting. Here, we identify the actions that the therapists at Lake City Wellness commit 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

 

Purpose:

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. They will  be emailed a link to a copy of the Lake City Wellness COVID-19 RMT practice guidelines. The guidelines will be available on lakecitywellness.ca website for viewing.

• 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.

• The therapist will use the BC COVID-19 Self-Assessment tool herself, daily and commits to canceling all appointments if symptoms appear. The therapist will keep track of their results.

• The therapist will cancel appointments if symptoms appear in their spouse or child.

• 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 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.

• In order for massage therapy treatment to commence 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 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.

• Patients with higher risk profiles and/or weakened immune systems should consider alternatives for care and postpone treatment.

  • The patient and the therapist must both agree that the benefits of massage therapy outweigh the potential risks involved.

• Patients who develop even mild illness or symptoms should cancel booked appointments, even without notice.

  • They will not be charged a late cancellation fee if they cancel due to illness.

 

Upon Arrival

• Upon arrival 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

• The therapist will advise patients of her current Self-Assessment results upon their arrival at the clinic. Patients will be asked to share their own results.

• 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.

• The therapists will keep all personal items in locked drawer behind the reception desk including extra clothing purses phones etc to avoid contaminating clean surfaces.

• Therapists meals and snacks will be eaten in their respective treatment rooms and the area will be disinfected after.

 

Physical Distancing

Reception Area / Entry into Clinic Space

• Patients must arrive unaccompanied.

  • Minors will not be treated at this time.

• Appointments will be staggered to avoid contact with other patients and therapists in the clinic.  If other therapists or patients are in the clinic social distancing will be in effect, 2 meters or 6 feet of space between individuals.

• The therapist and the patient will both maintain a space of 2 meters (6 feet) distance between each other in all clinic areas outside the treatment room.

• Waiting room chairs have been removed to allow for more space in the entryway.

  • Patients are not permitted to lounge in the clinic reception area before or after the treatment.

• Water is available upon request, the therapist will dispense water for the patient in a disposable cup to ensure less surfaces touched, and ensure disinfection.

• 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 asked to arrive on time and not early or late for appointments.

• Patients are required to wait in their vehicles until they receive a text message or call

from the therapist to enter the building. Online appointment check-in is available at lakecitywellness.janeapp.com/checkin

• 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 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 within a plastic basket, which can and will be sanitized between patients.

 

Restroom for Patient Use

• The restroom is shared with other businesses in the building. Patients are encouraged to use the washroom at home.  If using the onsite public washroom patients are asked to follow proper hand washing guidelines.

• Paper towel, hand soap and garbage near the door are available in washroom

• Hand washing sign posted in washroom

 

Laundry Room

• Only one therapist will be in the laundry room at a time

 

Hand Hygiene

Reception Area / Entry into Clinic Space

• The main building entry is shared with other businesses in the building.  Patients are asked to avoid touching surfaces in the elevator/stairs/doorways and maintain social distance.

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

  • Use the hand sanitizer at the entry of the reception area.

 

  • If the patients hands are visibly soiled they are instructed to go directly to the hand washing sink without touching anything inside the clinic and wash their hands with soap and water for at least 20 seconds and then dry thoroughly

• 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 in the reception area and at sinks.

• Cash will not be accepted at this time. Interac E-transfers or credit card payment only 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 therapists 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 door handles 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 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 while in the clinic.

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

• Interoral and external TMJ treatments will not be conducted at this time.

• 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 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 within the clinic will be cleaned and disinfected at least twice a day, as well as main entry door handle and elevator buttons

• 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 handles, 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.
  • No hydrotherapy supplies, thermophores, table warmers or covers will be used.
  • All touchless garbages including bags from the treatment rooms will be disposed of after each patient. And bins disinfected

• Main garbages will be emptied and removed from the clinic daily.

• A Cleaning and Disinfectant for Clinic Setting Poster will be on Display in the reception area and treatment room.

• A cleaning schedule checklist will be posted to ensure completion

• Treatment room floors will be cleaned at least twice a day.

• Rooms with cellular blinds have plastic coverings to allow cleaning after each patient.

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

• A disinfected single-use 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 the laundry room for washing.

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

• Gloves and glasses are available for therapists use in laundry room for handling cleaning products and laundry.

 

Personal Protective Equipment

• The therapist will wear a face mask at all times in the clinic.

• 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 face mask in the clinic at all time.

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

• A pedal opening garbage bin is in the common area for disposal of PPE, gloves, disposable masks etc.

 

Professional Obligations

Liability Insurance

• The therapists carry professional liability insurance through Wilson M. Beck or other professional liability insurer.

• 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 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.

• The therapist will immediately inform colleagues of the transmission risk.

 

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 get informed written consent at the initial appointment for the change in treatment. For follow up appointments the therapist will comply with the CMTBC Consent Standard of Practice and obtain verbal consent if anything has changed. If nothing has changed the therapist will remind the patient to ask questions about treatment at any time, or to end treatment if at any time the patient feels uncomfortable.

As we continue to receive guidance from the Provincial Health Officer, the College of Massage Therapists of BC and the Registered Massage Therapists Association of BC processes in this document may change as needed.