Return to Practice Guidelines

HOW COVID-19 SPREAD

“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.”

• COVID-19 can be spread by those who are both asymptomatic and symptomatic.
• COVID-19 symptoms are similar to those of a cold or flu.
• 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 two or more of 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

Source: http://www.bccdc.ca/health-info/diseases-conditions/covid-19/aboutcovid-19/how-it-spreads

Asymptomatic Spreaders

• Asymptomatic transmission of the coronavirus is an unavoidable risk of practice until we’ve acquired herd immunity, and there is an effective treatment or vaccine against COVID-19.
• We have put into place protocols to help mitigate that risk as outlined in this documentation. 
• No guarantees have been made by the therapist that the patient may not come into 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 protocols 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.

Self-Assessment for Symptoms of COVID-19: For Patients & Therapists

THERAPIST SCREENING

Daily self-monitoring for symptoms associated with COVID-19. 

• Daily temperature checks (normal is 37 degrees Celsius, 98.6 degrees Fahrenheit and can range as much as 0.6 degrees C or 1 degree F).
• Symptoms
• Number of contacts outside of the treatment room.
• Do not use fever reducing medication, especially within 4 hours of temperature taking.
• Therapists are discouraged from running errands on the way to work or during lunch to minimize risk of exposure during the day.
• If the therapist is not feeling well, or she is in doubt, she will stay home, reschedule her day, complete COVID-19 self assessment tool, and call 8-1-1 if it requires assistance. It is our duty to protect our colleagues, patients and community.
• http://www.bccdc.ca/Health-Info-Site/Documents/Self-isolation.pdf

PATIENT SCREENING

Pre-Screening / Prior to Arrival

• Patients will be informed about the new procedures and their responsibilities at the time of booking by email. 
• Patients are asked to arrive alone for their appointment, unless required for personal assistance or mobility issues, or if the patient is a minor and requires a parent/guardian.
• During the appointment reminder, the patient will be advised 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
• 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 every appointment, please remember to bring your reading glasses.
• As a part of this 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.

• The therapist and the patient must agree that the therapeutic benefit of massage therapy outweighs any potential consequence of treatment, including the possibility of viral transmission.

• Patients with higher risk profiles or compromised immune systems: those over 65, individuals in a care home or long term care facility, those with underlying medical conditions—particularly if not well controlled, those with chronic lung disease or moderate to severe asthma, those with heart conditions, those who are immune compromised, those who are severely obese, those with diabetes, those with chronic kidney disease undergoing dialysis and those with liver disease should consider alternatives for care and postpone treatment at this time.

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

• There will be no charges for a late cancellation fee if they cancel due to illness.  The no show policy will remain in effect.

Upon Arrival

• The therapist will advise the patient of her current results from the online BC COVID-19 Symptom Self-Assessment tool.
• Patients will be asked to confirm their own current results from the online BC COVID-19 Symptom Self-Assessment tool.
• Masks must be worn at all times within the treatment room as physical distancing is not possible. 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.
• Patients 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.

If you are unwell please self isolate and contact 8-1-1 or see below for self isolation Information:

• http://www.bccdc.ca/Health-Info-Site/Documents/Self-isolation.pdf

PHYSICAL DISTANCING

Reception Area / Entry into Clinic Space

• 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.
• Nothing remains in the treatment room that cannot be disinfected after each patient.
• 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 required to wait in their vehicles outside the clinic, until their appointment time, at which time, they may enter and wash their hands. 
• Patients are asked to arrive on time and not early or late for appointments,  if you are also a patient of Thiel Chiropractic and are receiving chiropractic care prior to your massage, you do not have to go back out to your vehicle, unless the massage therapist is not ready for you at that time.

Within the Treatment Room

• It is not possible to maintain physical distance while in the treatment room.
• Patients and therapists will wear a mask at all times in the treatment room.
• Patients will be asked to keep all personal belongings within a plastic container or on the chair, which can and will be sanitized between each patient. 
• There is a touchless hand sanitizer provided on the shelf in the treatment room.

Restroom for Patient Use

• The restroom has been equipped with proper handwashing guidelines.
• Soap and fresh paper towels for drying will be available at all times.
• The restroom is disinfected after every patient

HAND HYGIENE

Reception Area / Entry into Clinic Space

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

• Go directly to the bathroom 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 provided at the entry

• If hands are visibly soiled, the patient must opt to wash hands with soap.
• 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 masks and other PPE.
• Hand washing protocols will be posted visibly in the clinic. 
• Payment occurs in the reception area. Cash is not preferred at this time. A wireless Point of Sale system with Tap is available for card use and invoice may be emailed to the patient.  The POS machine is sanitized between each patient.
• http://www.bccdc.ca/Health-ProfessionalsSite/Documents/COVID19_Handwashing%20Poster_MD%20offices.pdf

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.
• Please use a tissue to address face touching when possible 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 treatment room.
• Intraoral and external TMJ treatments may not be conducted at this time.

Enhanced Cleaning

• Additional time has been scheduled between patients to allow for thorough cleaning of the treatment room between patients.
• 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-healthproducts/disinfectants/covid-19/list.html 
• Common areas will be cleaned and disinfected multiple times 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, 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 plush table covers will be used.
• All linens, including blankets and pillow cases are single use only and will be laundered 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.

 PERSONAL PROTECTIVE EQUIPMENT

• The therapist will wear a clean face mask in the treatment room where physical distancing is not possible.
• The therapist has other PPE that can be used upon request, or will be used as necessary depending on the situation.
• Safety glasses, gloves
• The therapist is wearing clothing covers, a protective layer of clothing that is changed for each patient.
• Patients are required to wear a clean face mask that does not have an exhalation valve in the treatment room at all times.
• If patients have their own fabric face mask, they are requested to bring it. If they do not have a face mask, a single-use non-medical mask will be provided to them at the time of their treatment.
• https://www.canada.ca/en/health-canada/services/video/personalprotective-equipment-lower-risk-exposure.html

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 as outlined by the Registered Massage Therapists Association of BC, the College of Massage Therapists of BC 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 into contact with COVID-19 at or during a massage therapy 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 the direction of Provincial Health.

In the Event That a Patient Alleges they Contacted 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 Tests Positive for 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.