for Megan Walker, Registered Massage Therapist (RMT)
The BC government announced that RMTs would be included in Stage 2 of the province’s Restart Plan. In order to return safely, the College of Massage Therapists of BC has published guidelines that are consistent with safety protocols set by Worksafe BC and the Provincial Health Officer. The following return-to-work plan was developed with these guidelines in mind. From what we know:
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 purpose of this document is to address the detailed requirements for an ethical return to clinical practice that minimizes the risk of transmission of the virus that causes COVID-19. It is understood that due to the nature of massage therapy, physical distancing is not possible in the treatment room even when all reasonable steps have been taken to reduce this risk. Massage therapy may not be suitable for everyone at this time.
This document may change as new information on COVID-19 transmission becomes known and guidelines presented by the CMTBC, PHO, and invested insurers changes.
The return to practice guidelines includes:
Safety protocols that are consistent with the principles set out by BC’s Provincial Health Officer and by WorkSafeBC
Ongoing self-assessment for signs of COVID-19 related illness in the patient, therapist, and administrative staff
Physical distancing measures for all non-treatment interactions
Hand hygiene and avoidance of face touching
Enhanced cleaning protocols
Appropriate use of personal protective equipment (PPE)
Meeting all professional obligations, particularly related to informed consent and liability insurance
SELF ASSESSMENT FOR COVID-19 SYMPTOMS
BEFORE ARRIVAL
Patients will be informed of heightened protocols when booking an appointment. A shortened copy of these protocols will be published on the All Care Chiropractic and Massage website and the full copy made available on the Megan Walker Massage Facebook page. A full copy of protocols is available upon request.
Patients will be advised that informed consent is required before any treatment.
Patients will be informed about the therapist’s use and rationale of PPE. If they have a mask, they are asked to bring it with them and wear it when they arrive.
Patients must confirm they have not travelled outside of British Columbia in the previous 14 days.
Patients must confirm that they have not been in contact with anyone displaying illness, or signs and symptoms of COVID-19 prior to every appointment.
One day prior to their booked appointment, the therapist will call to personally connect with each patient and the patient will be required to complete the BC COVID-19 Symptom Self Assessment tool found here: https://bc.thrive.health/covid19/en. The therapist will confirm the patient’s understanding of new protocol in this call. If the patient cannot be reached by phone, the Assessment questions will be answered by email.
The patient will be instructed to stay home if experiencing any symptoms of COVID-19. If a patient experiences COVID-19 symptoms and has not been tested for COVID-19, testing and a phone call to 8-1-1 to follow up with a Public Health Nurse will be recommended. These symptoms include:
Fever, chills, cough, shortness of breath, sore throat, and loss of sense of smell.
The therapist and all staff working at All Care Chiropractic and Massage must use the BC COVID-19 Symptom Self-Assessment tool before starting every work shift. Staff must record assessment tool results and temperature (to be taken with the provided forehead thermometer) in the clinic log book.
Should the therapist or clinic staff experience COVID-19 symptoms, they are required to stay home/cancel all appointments.
Patients at greater risk and/or weakened immune system should consider postponing massage treatment due to the nature of massage therapy and the inability to receive treatment while physically distancing.
Late cancellation fees will be waived. No-shows/missed appointments without a phone call to the office will be charged the appointment fee.
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 and will complete symptom survey before entering treatment room.
Patients must confirm that they have done a pre-screening if no phone contact has been made and have no signs of Covid-19 as outlined here: http://www.bccdc.ca/health-info/diseases-conditions/covid-19/about-covid-19/symptoms
Patients are strongly recommended to wear a mask within the clinic space but are not required to. If the patient has their own 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.
The 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
Patients are asked to arrive at appointments no earlier than five minutes before their appointment start time.
Patients are asked to come to appointments alone unless assistance is required. Extra family members will be asked to wait in their vehicle. For patients who require a companion, the therapist will confirm that massage therapy is essential at this time and may postpone or refer to alternate care.
One patient is permitted to be in the reception area at one time. If a patient arrives early, they are directed to wait in their vehicle until.
Treatment times are staggered to allow for proper cleaning and sanitation between appointments.
All decor items have been removed from the reception area.
The therapist and patient will maintain a space of 2 metres (6 feet) apart outside of the treatment room.
Patients are advised to consider using contactless payment if possible. Debit PIN pads will be cleaned after each use. Receipts for treatment can be emailed.
THERAPISTS AND ADMINISTRATIVE STAFF SHARED AREAS
Practitioner workstations have been moved to dedicated office space to maintain social distancing measures.
The shared use of computers and phones is minimized as much as possible. The massage therapist will not be sharing pens or clipboards with other staff.
WASHROOM FOR PATIENT USE
The patient washroom located in the hallway will be available for patients to wash their hands with soap and hot water upon entering the office. Paper towels are provided to dry hands and are put into an open trash bin with a disposable bag. Handwashing signs will be posted. Washrooms will be thoroughly cleaned several times throughout the day.
IN THE TREATMENT ROOM
It is not possible to maintain physical distancing in the treatment room.
Pre-screening, physical distancing, hand hygiene, and enhanced cleaned help reduce the risk of transmission.
Patients will be provided with a sanitized plastic bin to hold all personal belongings during the treatment or may leave items on a chair, which is sanitized between each patient use.
HAND HYGIENE
RECEPTION
When entering the office each patient will be asked to wash their hands with soap and hot water thoroughly for at least 20 seconds followed by thorough drying in the patient bathroom. Hand sanitizer will also be provided at the front reception area.
The therapist must wash hands often, using soap and water for a minimum of 20 seconds each time. This includes before or after each treatment, after handling cleaners and disinfectants, after handling laundry, and when donning/doffing PPE.
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 educate the patient on how avoiding face touching will reduce the risk of transmission of the virus that causes COVID-19.
Tissue will be available for patient or therapist use if an itch must be addressed.
The therapist will wear a mask at all times.
Disposable masks will be made available for patient use during treatment and patients are invited to bring their own mask in.
ENHANCED CLEANING
Visibly soiled surfaces will be cleaned and disinfected with Canada Health Approved hard-surface disinfectants.
Common areas will be cleaned at least twice a day.
All high-touch surfaces in the treatment room will be cleaned between each patient. These include (but are not limited to):
light switches, door handles, countertops, chairs, stools, window treatments, table surfaces, massage table and levers, face cradle, armrests, lotion bottle
All table coverings that cannot be laundered have been removed from the treatment room including table padding and table warmer.
All linens, including blankets and pillowcases are single use only. Every item on the treatment table will be laundered after use.
A checklist of cleaned surfaces will be completed after each treatment.
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.
It is recommended that patients wear a mask while in the office. If they have their own mask, they are asked to bring it to the appointment and arrive at the clinic wearing it.
Paper or disposable masks will be made available to patients who do not bring a mask
The therapist will have safety glasses and gloves available for use during treatment if requested by the patient or in the event that the therapist injures the skin of the hands.
The therapist will wear a cotton apron overtop of clothing, which will be changed for each appointment.
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 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 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 canceled 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 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 COVIID-19
The therapist will immediately self-isolate.
All massage therapy appointments will be canceled 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 OF COVID-19
Asymptomatic transmission of the coronavirus is an unavoidable risk of practice until increased herd immunity is achieved or there is an effective treatment or vaccine against COVID-19.
The therapist follows best practice 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.
If the patient does not consent to new treatment guidelines, no fee will be charged for the appointment to encourage patients to stay home in the event that they feel uncomfortable with new procedures.