Protocol & Guidelines for COVID times

 1. Self-assess for symptoms and return when healthy: For patients, RMTs, and clinic staff

PRE-SCREENING – PRIOR TO ARRIVAL

  • Patients will be informed about the new procedures we’ve implemented. Clear information is included on our website, online booking system, and phone message.
  • Informed consent is required. This means that our patients understand that while we’ve taken measures to minimize risk of viral transmission, the nature of massage therapy, osteopathy, and acupuncture, counselling, and movement therapies, means that physical distancing is not possible in the treatment room/studio.
  • Discuss use of personal protective equipment (PPE, see below), and our rationale.
  • Thorough and honest pre-screening for symptoms of COVID-19 will be completed, including information about recent travel.
  • Patients must confirm they have not travelled outside British Columbia in the previous 14 days.
  • One day prior to each appointment, we will contact to connect personally with each patient and ask them to complete the BC COVID-19 Symptom Self-Assessment. They are advised to stay home if they are experiencing any symptoms of COVID-19, including fever, chills, cough, shortness of breath, sore throat, loss of sense of smell. If they are experiencing these symptoms and have not been tested for COVID-19, we recommend that they do so; they start by calling 8-1-1.
  • All clinic staff must use the BC COVID-19 self-assessment tool daily, and stay home/cancel appointments if we are experiencing COVID-19 symptoms.
  • For patients at greater risk: we will take additional precautions, discuss alternatives for care, postpone treatment – explore options. Health practitioners may provide massage therapy when the patient and therapist agree that the benefits of care delivery outweigh the risk to the patient. 
  • Our cancellation policy has relaxed to ensure honesty and compliance with pre-screening questions. Fees will be waived at this time, however we ask to be given as much notice as possible to ensure that we can fill the scheduled time. Furthermore, we will do our best to ensure the patient is able to rebook within a reasonable amount of time. 

SCREENING UPON ARRIVAL

  • All practitioners who share the practice environment here at Santé Holistic Health Centre, have a common understanding and application of new operating procedures. Upon arrival, the practitioner and patient may run through self-assessment outcomes again – confirm safety and trust in moving forward.
  • The practitioner should cancel treatment if the patient doesn’t meet the pre-screening criteria on physical presentation at the practice environment.
  • Pre- and during clinic visit: We will do our best to ensure that the patient feels empowered to make their own decision on what they need to feel safe in order to receive treatment.
  • Patients at greater risk: if pre-screen results indicate “go ahead”, we may continue to assess necessary precautions upon arrival.

2. Physical Distancing

RECEPTION / entry

  • Physical distancing protocols are in effect – we all must maintain 2 metres / 6 feet of distance in clinic areas other than the treatment room, as best as possible within the practice setting.
  • Magazines, flyers and business cards have been removed.
  • Glasses at the water cooler have been removed. Patients may bring their own water bottle. If they must use a cup, the practitioner will wash with soap and water and dry thoroughly with disposable paper towel before and after use.
  • Traffic is reduced through staggered appointment start- and end- times.
  • Patients must arrive unaccompanied unless patient is a minor who requires parent/guardian, or infirm and needs assistance (see recommended protocol, below).
  • Patients arrive no more than 1-3 minutes ahead of their scheduled appointment time to avoid time spent in the reception area.
  • Practitioners will open doors for patients to avoid unnecessary touch. 
  • At end of treatment, practitioners will accompany patients to the exit and open the door for them (using a hand towel or other sanitized barrier).

THERAPISTS’ SHARED AREAS, multi-practitioner setting, e.g., kitchen, studio, washroom

  • Each practitioner will use their own personal devices to access scheduling and accounting programs. There are no shared computers or phones. 
  • Storage/meals/coats, extra clothes, etc., will be stored within each practice setting.

TREATMENT ROOM

  • It is not possible to maintain physical distancing in the treatment room.
  • Pre-screening, physical distancing, hand hygiene, and enhanced cleaning help reduce the risk of transmission, and enable treatment while minimizing risk of harm.

WASHROOM FOR PATIENT USE

  • Patients are encouraged to use the washroom at home to limit usage of clinic washroom.
  • Hand towels have been removed. 
  • Lights may be kept on to avoid touch to light switches. 
  • Door knobs, taps, air freshener are frequently sanitized. 

STAIRS TO ACCESS CLINIC

  • Guests are encouraged to use stairs one person at a time, allowing priority to elders and people who are experiencing less physical ability.

RECEPTION / entry

  • Gradual re-entry to practice is in place, we are making sure that the distancing measures put in place are sufficient, before increasing the number of patients/practitioners in the workplace at any one time.
  • Minimal seating is available. Chairs are placed at least 6 feet apart. 
  • Patients who require a companion present special challenges with regard to physical distancing from entry through treatment and departure. We must confirm that treatment is essential at this time; postpone or refer to alternate care if possible. If treatment goes ahead, the practitioner will help patient and companion navigate every step of the way.

THERAPISTS’ SHARED AREAS

  • Staggered arrival, departure and break times has been implemented to minimize the chances of incidental contact.
  • Practitioners avoid socializing in person in the practice environment. Physical distancing measures are rigorously applied.
  • Computers, tablets, phones, are not shared. 
  • Practitioners bring own water bottles and food containers to reduce use of shared dishes. If the dishes are used they are washed with soap and water before and after use, dried and put away. 

3. Hand Hygiene

RECEPTION / ENTRY

  • Patient washes hands upon entry with soap and water for at least 20 seconds, followed by thorough drying – must be done on arrival into and departure from the clinic, and before touching door/s.
  • Sanitation station with alcohol-based hand rubs for patient’s use on arrival and prior to departure is also available.
  • Practitioners must wash hands often, using soap and water for a minimum of 20 seconds each time.
  • Hand-washing protocols are posted visibly in reception area, at sinks, and in bathroom.
  • Payment will occur in the practitioners separate treatment area, or e-transfer payment will be arranged. Receipt is emailed to patient. Cash is not preferred but may be handled provided that anyone doing so washes their hands immediately afterwards.

IN THE TREATMENT ROOM

  • The practitioner opens the door to the treatment room and allows patient to enter; practitioner opens/closes door before, during, and after treatment as required, using hand towel/sanitized barrier as needed, and washing hands as appropriate.
  • Hand washing/drying and sanitization options should be available for practitioner and patient.
  • Hand washing will occur before and after treatment (both practitioner and patient).
  • Payment occurs in the treatment room, e-transfer or credit card on file for payment is prefered. Receipt is emailed to patient. Cash is not preferred but may be handled provided that anyone doing so washes their hands immediately afterwards.
  • Safety posters from BC Centre for Disease Control are displayed next to sink, setting out proper handwashing guidelines (soap and water, 20 seconds washing, and dry hands thoroughly).

4. Face Touching Avoidance – e.g., avoid touching eyes, mouth, nose

  • Share information about the reason for ‘no face touching’; coronavirus can be spread by touch if a person has used their hand/s to cover a cough or a sneeze.
  • Suggest patients use a tissue if an itch must be addressed.
  • Tissues are available for patient’s use in reception, treatment room, washroom.
  • Masks are available for patient and for practitioner, because masks are useful to avoid touching face.
  • Practitioner makes use of hand towel or tissue to touch or scratch face, or to sneeze into.

5. Enhanced Cleaning

  • Training for therapists and staff in sanitation processes
  • All high-touch surfaces are cleaned and disinfected in between patients, regardless of appearance.
  • Linens (including blankets) are single use only, then laundered in hot soapy water.
  • Frequently clean and disinfect common areas and high touch surfaces, at least twice a day, e.g. light switches, window coverings, cell phones, tablets, chairs, stools, table surfaces.
  • Frequently cleaned and disinfected (at least three times per day, more if possible):
    • handles: doors, cabinets, faucets, fridge, microwave, etc.
    • electronic device keyboards and mice, phones,
    • chairs,
    • desk and table surfaces,
    • water cooler.
  • Clean in view of patients so patients see the steps taken for safety.
  • Schedule additional time between patients to thoroughly clean treatment room.
  • Sanitize the treatment table and table adjustment levers after each treatment.
  • Clean the face cradle (one more time) in front of the patient, to maintain trust.
  • Clean equipment and supplies (table levers, lotion bottles, etc.) immediately after each patient.
  • Cease use of thermophores.
  • Attach Cleaning and Disinfectants for Clinic Settings poster from the BC Centre for Disease Control in reception area, washroom for patient’s use, treatment room.

WASHROOM FOR PATIENT USE

  • All contact areas must be cleaned and disinfected several times a day. Ensure that soap is available for hand washing, clean material for drying, and wipes (or paper towels, tissues) are available for doors and touch-surfaces.

STAIRS TO ACCESS CLINIC

  • All contact areas must be cleaned several times a day, e.g. doors, elevator buttons.
  • Provide wipes if available.
  • If wipes are unavailable, provide paper towels or tissues for patients to use as a barrier when contacting high-touch surfaces.
  • Window may be open to allow good air flow which is always important, (though in a low-risk environment created by pre-screening of RMTs’ and patients’ health, supported by good hand hygiene and cleaning protocols, there is minimal evidence that aerosolization of the virus increases the rate of transmission) but not obligatory. 

6. Personal Protective Equipment (PPE)

  • Clean masks are available for patient’s use if requested, and for the practitioner’s use if patient requests it. Cloth masks must be laundered after each use.
  • We respect a patient’s individual personal boundaries and support their requests for PPE to be worn by either individual.
  • If either party feels that additional risk mitigation is necessary, a decision to wear a mask at that point is one way forward.
  • Donning and doffing mask: wash hands with soap and water prior to putting on a mask, prior to taking off a mask, and after disposing of a mask in the laundry or garbage (cloth or paper/disposable).

7. Professional Obligations

  • Professional liability insurance:
    • Practitioners in practice are required by CMTBC’s Bylaws to carry professional liability insurance.
    • RMTs are advised to contact their insurer to determine whether or not they are covered for claims related to COVID-19, e.g. alleged transmission of the virus.
  • No duty or obligation to return to practice:
    • A return to practice protocol does not require practitioners to engage in practice if they individually assess the risk of practice as one they are not prepared to take.  
    • The decision to return to practice is a matter of individual judgment and requires following the guidance of CMTBC and governmental authorities
    • RMTs are bound by their obligation and duty to CMTBC, as each Health Professional is bound to their own regulatory body.
    • If a patient alleges they caught COVID-19 from a practitioner:
      – The practitioner must immediately call public health at 8-1-1 and report the alleged transmission, providing both the practitioner’s name and the name and contact information of the patient.
       – The practitioner must not provide any further massage therapy treatment to anyone until public health has investigated and has provided direction.
      – The practitioner must immediately self-isolate until the matter has been investigated and public health direction has been provided.
      – It is the practitioner’s duty to immediately inform his or her colleagues of transmission risk.
    • What about asymptomatic spreaders?
                 – This is an unavoidable risk of practice until there is either an effective treatment or an effective vaccine against COVID-19. 

      – Practitioner’s return to practice protocol has elements that mitigate risk:
      • screening – The practitioner should be prepared to share self-assessment information about themselves, as well.
      • related is the question of trust – the trust relationship goes both ways. 
      • cloth masks reduce transmission risk by discouraging face-touching;
      • very strict adherence to hand hygiene, by practitioner and by patient
    • The risk remains which is why the informed consent discussion at the outset of treatment is critically important.
    • Health professionals have a professional obligation to obtain informed consent to treatment, consistent with CMTBC’s Consent Standard of Practice.
    • In the current environment of COVID-19 risk, informed consent requires that the patient is informed that:
      • any treatment involves some risk of COVID-19 transmission;
      • the practitioner is following a protocol to reduce or mitigate risk, but that risk cannot be reduced to zero;
      • the patient consents to treatment despite some risk; and
      • the practitioner documents the patient’s consent.

Open communication

We are committed to ensuring that Santé Holistic Health Centre is as low-risk as possible. The safety of our guests is our top priority. Please feel free to contact us via phone 250 505 4233 or email: santé.holistichealthcentre@gmail.com if you have any questions or concerns, or if you would like to open a discussion further. If anything comes up for you, please let us know so that we may move forward, safely, together.