Plan for Return to Clinical Practice with Respect to 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 my clinical setting. Here, I identify the actions that Marcia Maluk, RMT 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 emailed about their responsibilities at the time of booking. A COVID 19 Consent form will be sent to you.
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 contact the patient one day before their booked appointment to discuss using the self-assessment tool and then verify that it has been done. Patient must confirm that they do not have any symptoms.
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
New onset or worsening cough
Vomiting or diarrhea
Difficulty breathing
Sore throat or pain with swallowing
Sneezing, stuffy or runny nose
Loss of sense of smell or taste
Headache
Muscle aches
Severe fatigue

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.
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.
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.

The patient will be required to sign the consent and liability waiver with respect to COVID 19 at their initial treatment and will have to confirm that no symptoms are present before each treatment. The patient will be asked to provide their temperature which is recorded before each treatment. A forehead thermometer will be used at the clinic or you may take your temperature before leaving home and notify me upon arrival. Please see consent form, therapist will answer questions in blue column, patient will answer questions in pink column before every 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

The therapist will advise patient of her current results form online BC COVID 19 Symptoms Self-Assessment tool.

Patients will be asked to share their own current results form online BC COVID 19 Symptoms 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 cloth mask will be provided and they will be asked to wear it upon entering the clinic space. Hand Sanitizer is available outside for use before donning your mask.

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.
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 outside the treatment room.

Patients are not permitted to lounge in the clinic reception area before or after the treatment.
Nothing remains in the clinic space that cannot be disinfected after each touch.

There will be 45 minutes between appointment times 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 or outside the clinic, until called to the clinic door.

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 knob.

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, which can and will be sanitized between patients.
Please insure that you have taken all of your belongings.
Patient may want to consider wearing a top that is button up to prevent disturbing the mask once placed on their face.
Restroom for Patient Use

The washroom has been equipped with a soap dispenser and a towel to be used once, please use this towel to turn off the faucet and open the door. Proper hand washing guidelines will be posted. If you can, please use the washroom before leaving your home.
Hand Hygiene

Reception Area / Entry into Clinic Space

Immediately before entering the clinic space the patient must use:

The hand sanitizer dispenser that is outside the building.

If hands are visibly soiled, the patient must opt to wash hands at the hand washing sink in restroom.

The therapist will wash hands thoroughly for at least 20 seconds between patients, before and after disinfecting spaces, before donning or doffing other PPE like face masks or glasses.

Hand washing protocols will be posted visibly on the front door and at sink.

Etransfer is the preferred form of payment over cash or cheque.

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 upon request 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 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.

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 and glasses at all times.

Patients are required to wear a face mask that covers both the nose and mouth at all times within the clinic space.

Intraoral 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 disinfectant that has a drug identification number DIN and verified to be effective against SARS CoV-2 (the virus that causes COVID 19).

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, table surfaces, chair, stool, faucet, etc.

The treatment table, table levers, face cradle, lotion bottles and vinyl covered pillows will be immediately cleaned after each treatment.

No hydrotherapy supplies, thermophore (hot pack) will be used at this time, but the bed warmer is still available under a vinyl cover for warmth.

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

All linens, including blankets, towels, fabric face mask and face rest covers are single use only and will be laundered using high heat and detergent.

The ceiling fan and/or window will be open to maintain air exchange within the treatment room.

Personal Protective Equipment

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

The therapist will change her top after each patient.

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 fabric face mask, they are requested to bring it. If they do not have a fabric face mask, a fabric face mask will be provided to them at the time of their treatment.

Professional Obligations

Liability Insurance

The therapist carries professional liability insurance through Aon Reed Stenhouse as provided through the Natural Health Practitioners of Canada.

The therapist is following the health and safety guidelines outlined by Natural Health Practitioners of Canada, the College of Massage Therapy of BC and Provincial Health Officer and that they are taking all reasonable precautions to clean and disinfect the clinic all the surfaces within the treatment.

No guarantee has 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 treatment within 14 days prior to onset of symptoms

The patient will contact therapist immediately and inform her of positive test results and possible transmission of the virus.

Therapist will immediately self isolate.

The therapist will call public health 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 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 Even the Therapist Catches COVID 19 or Displays Symptoms of COVID 19The therapist will immediately self isolate.

The therapist will call public heathery ay 8-1-1 to report 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 is 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 service for a minimum of 10 days beyond the onset of symptoms, and/or until symptoms cease.

In the Event That the Therapist Comes in Close Contact with Someone Showing Signs of Illness or Tests Positive for COVD 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 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 Public Health Official.

Asymptomatic Spreaders

Asymptomatic transmission of the coronavirus is an unavoidable risk of practice until we’ve acquired herd immunity or 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.