covid

Return to Practice Operational Plan

Town Health Solutions

November, 2020

** please forgive any formatting issues.  We are placing this online as quickly as possible for information.  We will correct any imperfections in the near future. 

Town Health Solutions remains committed to excellence in clinical practice, patient safety and the protection of the public.  It is essential to support our Chiropractors, RMTs, Physios/AT and others in delivering care safely in ordinary times, as well as in extraordinary times.  It is also a mandatory order by GNB Public Health to have this Operational Plan available for review by a Public Safety officer.

 

It is our collective commitment to safe patient care that will allow the company to adapt to our new reality. How care is delivered will need to change, and additional precautionary measures will have to be taken as our clinical staff return to practice but also permanently to enhance patient safety and infection control. These changes may be challenging at first, but we are confident that once implemented, the changes will simply enhance your ability to care for patients.

 

Responsibility as Regulated Professionals

 

Provincial governments have established legislative framework that govern the responsibilities of regulatory colleges which regulates professions in the public interest. Health regulatory colleges are responsible for ensuring that regulated health professionals provide health services in a safe, professional and ethical manner. Functions can include the development of Standards of Practice, guidelines and policies, as well as conduct investigations and where necessary discipline. Protection of the public is first priority.

 

COVID-19 Pandemic

 

The COVID-19 pandemic has changed how we care for our patients and operate our clinics. Moving forward, healthcare professionals and clinics will have to adapt to the new reality and expected public health practices. As a hands-on profession, we may face additional risks and providers and clinics alike will have to take the appropriate measures to protect patients, staff and providers’ health.

 

In preparation for return to practice, following regulatory body’s recommendation, especially the NBCA, Town Health Solutions is establishing a list of strong recommendations to help members prepare for return to practice. Recommendations are considered as best practices that should incorporated within your clinic. Recommendations are practices that could be considered especially during periods where the risk for respiratory infections are elevated. These recommendations were developed to be proactive in implementing public health measures now and in the future.   We are using the standard as set by the chiropractic regulatory college as it appears most complete and thorough, however please find affixed in Appendix 1 and 2, the requirements as set out by the Physiotherapy and Registered Massage Therapy colleges.

 

 

General strategy

 

Recommendations: Infection Prevention and Control

 

The need for infection prevention and control has always been imperative; however, the COVID-19 pandemic has heightened the need for comprehensive infection prevention and control measures. Below are some key terms and definitions that we will be using:

 

Infection Control: Measures used to prevent the spread, transmission and acquisition of agents or pathogens. These measures should be adapted to the clinic environment, patient population and the infectious agent.

 

Cleaning: Refers to the removal of visible soil, dirt or debris. Cleaning does not kill germs but is effective at removing them from a surface.

 

Disinfecting: Disinfecting refers to using a chemical/product to kill germs on a surface. Disinfecting is only effective after surfaces have been cleaned.

 

Sanitizing: Refers to making clean or disinfecting. Sanitizing efforts are primarily focused on personal hygiene.

 

 

 

 

 

 

 

Acceptable Use of Products

 

There is a wide array of products available on the market that claim to clean, disinfect and/or sanitize. However, not all products are appropriate for clinical use. Chiropractors and clinics should use products recognized and recommended by Health Canada. Hard surface disinfectants and hand sanitizers details can be found on the Health Canada website.

 

Standard Infection and Prevention Control Measures
	Action	When
Patients	Sanitize or wash hands	● ●        Upon entering the clinic (20 seconds) ●        Upon entering a treatment room (if in contact with another individual). ●
Administrative employees (not involved in patient care)	Sanitize or wash hands	● ●        Upon entering the clinic ●        Upon completion of a payment transaction ●
Practitioners and employees supporting patient care	Sanitize or wash hands	● ●        Upon entering the clinic ●        Upon entering a treatment room ●        Upon exiting a treatment room ●        After handling dirty laundry ●        After cleaning and/or disinfecting Patient contact surfaces ●        Before preparing patient contact services

 

*Hand sanitizing units should be installed at the clinic entrance, treatment room entrances and at the reception desk.

Treatment Surfaces
	Action(s)	Frequency
Chiropractic table head piece and thoracic piece	Use single use paper on both pieces to shield patient’s face	During every patient encounter
	Use the wipe-twice method to clean and disinfect head and thoracic pieces, following product guidelines on contact time to achieve proper disinfection	After every patient encounter
Face cushion (high risk due to proximity of patient’s mouth while in prone position)	Clean and disinfect face cushion, following product guidelines on contact time to achieve proper disinfection	After every patient encounter
Chiropractic table hand pieces	Clean and disinfect hand pieces, following product guidelines on contact time to achieve proper disinfection	After every patient encounter
Chiropractic table lumbar and pelvic pieces	Clean lumbar and pelvic pieces routinely	●        At least twice daily ●        After any patient exhibiting symptoms of infection ●
Central metal paper depressor bar (high risk of contaminating clean face paper)	●        Advise not using this central bar at all for headrest paper. ●        If used, clean and disinfect bar, following product guidelines on contact time to achieve proper disinfection ●	After every patient encounter, before new paper is pulled through
Therapeutic tools and devices (e.g. instruments used for soft tissue mobilization, handheld manipulation tools, lasers, shockwave, etc.)	Clean and disinfect, following product guidelines on contact time to achieve proper cleaning and disinfection	After every patient encounter
Surfaces that contact mucous membranes.  This may include but is not limited to diagnostic equipment such as otoscopes, or ophthalmoscopes.	Clean and disinfect, following product guidelines on contact time to achieve proper cleaning and disinfection	●        After any patient exhibiting symptoms of infection At end of each day
Therapeutic surfaces (e.g. exercise mats, therapy equipment such as weights, balls, etc.)	Clean and disinfect, following product guidelines on contact time to achieve proper cleaning and disinfection	After every patient encounter

 

 

 

 

 

 

 

 

 

Additional requirements to reduce risk of transmission:

 

• Table surface should be vinyl or other upholstery that can be cleaned and disinfected. Covering should be applied if the table is not a material that can be easily cleaned and disinfected.
• Any damage to a chiropractic table surface that exposes the inner material of the table renders that table quarantined until the damage is completely repaired. Duct tape is not considered an appropriate repair.
• Permanent cloth fabric covering can no longer be used on face, thoracic and hand pieces due to possibility of continuing the chain of infection caused by pathogens such as bacteria and viruses.
• Temporary fabric coverings may be used provided:
  • The temporary fabric covering is changed in between every patient encounter; and
  • The temporary fabric covering is properly laundered to eliminate bacteria and viruses.
  • Temporary fabric coverings do not alter the requirement to clean and disinfect the table.

 

Clinic Surfaces
	Action(s)	Frequency
High touch surfaces: ●        – Doorknobs ●        – Doorways ●        – Door frames ●        – Chair arms ●        – Waiting room tables	Clean and disinfect, following product guidelines on contact time to achieve proper cleaning and disinfection	●        At least twice daily ●        After any patient exhibiting symptoms of infection
Reception desk, including all equipment that the receptionist may contact or use.	Clean and disinfect, following product guidelines on contact time to achieve proper cleaning and disinfection   Plexiglass is being placed at the reception desk prior to admin staff returning on-site.   The debit machine will be covered with sticky wrap, and wiped down after every use, and replaced 2x/day.	●        Hourly ●        After any patient exhibiting symptoms of infection ●        At end of each day
Payment machine	Clean and disinfect according to payment machine provider instructions	●        After each patient interaction ●
Telephone	Clean and disinfect, following product guidelines on contact time to achieve proper cleaning and disinfection	●        When employee shifts change ●        At end of each day
Surfaces that contact mucous membranes.  This may include but is not limited to diagnostic equipment such as otoscopes, or ophthalmoscopes.	Clean and disinfect, following product guidelines on contact time to achieve proper cleaning and disinfection	●        After any patient exhibiting symptoms of infection ●        At end of each day
Washrooms	Clean and disinfect, following product guidelines on contact time to achieve proper cleaning and disinfection	●        At least twice daily ●        After any patient exhibiting symptoms of infection
Lunchroom	Clean and disinfect, following product guidelines on contact time to achieve proper cleaning and disinfection	●        At least twice daily, or more as required depending on use
Hard-surface toys	Clean and disinfect, following product guidelines on contact time to achieve proper cleaning and disinfection	●        These should remain and be open for use, only if they can be cleaned and disinfected ●        Hourly when children are present in the clinic ●        At end of each day ●
Office stationery used by the public	Clean and disinfect	●        With each use
iPad/Tablet	Clean and disinfect	●        With each use
Magazines	Discontinue
Books	Discontinue
Soft-surface toys	Discontinue

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Patient Management

 

In addition to infection prevention and control measures, clinics must rethink how they operate and overall patient management. This includes the scheduling of appointments, pre-screening, physical distancing, patient treatment options, practitioner adaptations, and clinic employee responsibilities.

 

All patients should be screened by phone or online at the time of booking. Symptomatic patients should be re-scheduled for a later date and re-screened prior to their appointment. Pre-screening should be done consistently without exception.

 

A patient should be asked the following questions upon booking and the result recorded in the cart: 1. Are you symptomatic 2. Have you travelled in the past 14 days, 3. Have you come in contact with anyone else who has been diagnosed with COVID-19.  This will be documented in the chart verbally.  The patient will then have their temperature taken (if we can procure infrared thermometers), and asked to wash their hands for 20 consecutive seconds.

 

 

These requirements and recommendations may change depending on the environment and the risks of infection.

Scheduling strategy:

 

The clinical schedule will remain ‘mostly’ unchanged, except for the staggering of visits, and the length of time for a visit.

 

Responsibility for scheduling is as follows:

 

1. Faith/Judy – Saint John all providers
2. Deb – Hampton: Erik and Amy
3. Judy/Raylene – St. Stephen: All providers

– all email and Hubspot/web requests ** these requests are considered a wait list and will be

Managed following all other appointments.

4. Tanis – Sussex: all providers.
5. Candice – Woodstock: all providers
6. Joanne – Fredericton: all providers

 

Staff related rescheduling begins Monday morning at 9am, for appointments beginning on Tuesday (St. Stephen only), and everywhere else on Wednesday.  Providers may privately book their appointments for earlier if wished.

 

 

	High-Risk Recommendations (first two weeks of practice)	Lower Risk Recommendations (2 weeks to one month)
Appointment scheduling	●        Adjust scheduling as needed to reduce number of patients in clinic at any given time Any two practitioners of the same Professions working simultaneously will have their schedules staggered. Chiro visits will be 30 minutes to allow for sterilization/booking. RMT visits 75 minutes Physio/AT at 45 minutes. Admin staff will not be on-site for the first two weeks of opening. Scheduling done by clinician.	●        Create blocks of time specific for high risk patients (elderly, immunocompromised) to be seen separately to reduce risk of exposure and transmission ●        Schedule symptomatic patients near end of clinic day to minimize exposure and risk of transmission to other patients ●
Patient pre-screening	●        Patient pre-screening by phone in advance of patient arrival at clinic, with rescheduling done as required ●        Ask the attached questions, and record the result in the patient’s chart. ●	●        Pre-screening could be done consistently to help build a patient culture around “safety first”
Physical distancing	●        To begin, patients will be taken from their cars straight to the treatment room. ●        Where possible, patients enter in one door, and exit another. ●	●        Build in physical distancing in waiting room as standard practice, which reinforces physical and psychological safety ●        Encourage symptomatic patients to wait in their cars until time for their appointment; clinics can call patients when ready
Patient treatment options	●        Limit supine cervical adjustments ●        Limit supine thoracic adjustments ●        Limit examinations that promote aerosolization (coughing or quick exhalation) ●        Limit treatment techniques that promote aerosolization, such as rapid exhalation ●	●        Strong recommendation to delay treatment of symptomatic patients until symptoms subside
Practitioner adaptations	●        PPE required for practitioner (goggles, mask and gloves) ●        Mask required for patient ●        Practitioner responsible for proper use of PPE for patient and practitioner. ●        N95 or KN95 recommended.  Surgical mask acceptable.  Cloth mask not recommended. ●	Strong recommendation is not to see symptomatic patients until symptoms subside
Clinic employee responsibilities	If employees are symptomatic (e.g. runny nose, cough, fever), they should not work.
Clothing	Your clinic clothing should be cleaned daily and patient care clothing should not leave your clinic except to be cleaned and potentially disinfected.	Employees and practitioners are practice in different clothes than they wear in the clinic. ●        The clothes that you wear to the clinic should not be the same as the clothes that you work in. ●        The clothes that you practice in should be cleaned each day. ●        You should change back into the clothes you wore to the clinic to return home in. ●        Long hair should be tied or away from one’s face during treatment.

 

Recommended Personal Protective Equipment (PPE):

We are providing the first round of PPE (masks, and gloves) to get everyone started.  Further rounds of PPE are at the contractors expense, but we will source them for you.

 

Masks:

• The standard mask must be an N95, KN95, or disposable surgical mask.
• The clinic will provide masks for patients, employees and practitioners as indicated in patient treatment options and employees and patient care delivery adaptations.
• Upon scheduling, all patients are asked to bring their own mask. If they do not, we will provide a surgical or cloth mask and ask them to store it safely and return with THE SAME mask.  If they return with no mask the second visit, they will be charged $5 for a new mask.  If they return a third time with no mask they will be provided a surgical mask and not be re-booked.
• The recommendation for the type of mask and usage of the mask may change based on recommendations from public health.

 

Gloves:

• Glove selection must be medical exam grade or better.
• Glove selection must consider patient safety for conditions such as latex allergies.
• Glove selection should consider the size of those who will need to wear them. Gloves that are too big or too small could increase risk of infection.

 

 

Other:

• Glasses/eye covering are recommended
• Scrubs, or lab coat, or at minimum, long sleeves, long pants, and high neck (no V necks).
• Clinicians/staff should change out of clinic clothes before heading home.
• Other personal protective equipment may be required based on provincial public health recommendations.
• PPE requirements for RMTs are slightly different and are available physically on site. We are awaiting recommendations from the NBPA.

 

The return to practice recommendations only speak to progressive return to operations, and not in the event of a resurgence of infection where clinics may be mandated to close. The NBCA and its members will be expected to comply with provincial directives and recommendations. However, generally, when clinics are closed except for urgent or emergency care, the following recommendations would apply:

 

• Only one patient is allowed in the treatment space at a time.
• Waiting rooms should be closed. Patients should remain in their cars or outside of the clinic.
• Patients who require assistance or guardianship must be accompanied by only one person.

 

In a multi-provider clinic, the higher standard, requirements or recommendations should precede.

 

We have sourced KN95 masks through a Chinese supplier, one that checks out with Health Canada.  The KN95 mask is equivalent to the N95 mask, and is superior to cloth and surgical.

Each provider has been given 10 masks.  Please use this carefully.  Further masks will be provided at cost.

Re-using masks:   Please note that it is not the manufacturer’s recommendation to re-use protective masks.  However, due to a lack of access to enough masks in the market place the following procedure has been deemed acceptable practice:

Wear the mask, and if it becomes soiled or damaged, discard.   If the mask remains clean and unsoiled, place in a Ziploc bag at the end of the shift, and mark the day.  Leave the mask for 7 days and wear on the same day on the following week.  So practitioners should have masks marked Monday-Friday.  Any virus particles will only remain on the surface for 5 days and the mask will be considered safe.

Gloves should be discarded at the end of the day, and washed between clients/patients.

 

 

 

 

 

 

 

 

APPENDIX 1: Physiotherapy adherence

PROCEDURES FOR RESUMING IN-PERSON CLINICAL TREATMENT IN PHYSIOTHERAPY

College has prepared a set of detailed, return-to-practice procedures to assist physiotherapists in the private sector throughout New Brunswick. The goal of these procedures is to protect clients, physiotherapists and members of the general public. The procedures will be adapted as the situation in New Brunswick changes and develops over time.

Current situation

According to the most recent mandatory order from the Province, “regulated health professionals are prohibited from providing in person services except those services they deem essential for the health and well-being of their clients.”

The College encourages the use of tele-rehabilitation for clients whose needs are not urgent in nature. Physiotherapists must use their professional judgement in gauging which clients would be best served via digital means. Visit www.cptnb.ca for more detail regarding tele -rehabilitation.

Public setting

Physiotherapists practicing in a public setting must follow the protocols established within their workplaces.

Private practice

PRIOR TO THE CLINICAL CONSULTATION

The client should be screened at the time of booking. The physiotherapist and the client should also be screened on the day of the appointment and should not come to the clinic if they meet even one of the following conditions:

• Signs or symptoms such as fever, cough, difficulty breathing, diarrhea, loss of taste or smell.
• Return from a trip outside the province within the last 14 days.
• Positive COVID-19 test within the last month or awaiting the results of a COVID19 test.
• Close contact with a confirmed or probable case of COVID 19 within the last 14 days.

On the day of the appointment, the physiotherapist must document the client’s COVID-19 screen was completed and negative.

CLINIC CONSULTATION

If in-person presence is required for assessment, reassessment, care requiring physical contact with the client, emergency or care immediately required, special techniques, etc., please adhere to the following:

• Limit the presence of others accompanying the client to the strict minimum. This may vary depending on the needs of each client.
• Adopt rules for physical distancing between clients and staff, excluding the therapist: 2 meters (or 6 feet) apart. • Modify seating in waiting and changing areas so there is appropriate space between seats, or divide/block sections off as required.
• Clearly mark proper physical distancing on the floor of the reception area in the event the client arrives early.
• Post reminders of measures to reduce the spread of COVID-19.
• Follow the steps detailed below and communicate the content to the client prior to the appointment:

Client reception

Positioned behind an optional barrier (e.g. plexiglass), dressed in a procedure mask, isolation gown or lab coat, the receptionist must:

• Space the arrival times of clients to ensure they can easily remain at a safe distance from each other.
• Upon arrival, ask the client to wash their hands for at least 20 seconds with an alcohol-based disinfectant, or with soap and water.
• Direct the client immediately to the treatment area to prevent unnecessary movement from one area to another.
• Wash hands between each client if passing paper, pens etc.

 During the consultation

The physiotherapist must:

• Wash their hands for at least 20 seconds with soap and water, or an alcohol-based disinfectant before each visit. Wearing gloves is also an option, but hands must still be washed to avoid cross contamination

. Follow these instructions for Personal Protective Equipment (PPE):

• Always wear a procedure mask when carrying out interventions as it is impossible to maintain proper distancing.
• Routine precautions are recommended if there is risk of exposure to biological liquids during the intervention. This would include gloves, glasses or visor, gown or long-sleeved lab coat, as well as the procedure mask.
• Apply the rules to properly put on PPE.

After the consultation

The physiotherapist must:

• Instruct the client to wash their hands for at least 20 seconds with soap and water or an alcohol-based disinfectant before departure.
• Wash their own hands for at least 20 seconds with soap and water or an alcohol-based disinfectant. If wearing gloves, change them after each consultation and then wash hands again.
• If soiled, change the procedure mask, gown or lab coat after the consultation. Clean glasses if required.
• Apply rules for the removal of PPE.
• Ensure that all items (chair/table/plinth/instruments) with which the client came into contact are cleaned thoroughly with a surface disinfectant before and after each consultation. Change all linens.

Other recommendations

• Ensure other staff members wear a procedure mask and follow routine precautions as required.
• Be sure staff members properly put on and remove their PPE.
• If possible, make protective glasses or visors available to staff members who wish to use them.
• Clean and disinfect more frequently during opening hours and at the end of the day.
• Apply the rules to properly put on PPE. After the consultation The physiotherapist must:
• Instruct the client to wash their hands for at least 20 seconds with soap and water or an alcohol-based disinfectant before departure. • Wash their own hands for at least 20 seconds with soap and water or an alcohol-based disinfectant. If wearing gloves, change them after each consultation and then wash hands again.
• If soiled, change the procedure mask, gown or lab coat after the consultation. Clean glasses if required.
• Apply rules for the removal of PPE.
• Ensure that all items

(chair/table/plinth/instruments) with which the client came into contact are cleaned thoroughly with a surface disinfectant before and after each consultation. Change all linens.

Other recommendations

• Ensure other staff members wear a procedure mask and follow routine precautions as required.
• Be sure staff members properly put on and remove their PPE.
• If possible, make protective glasses or visors available to staff members who wish to use them.
• Clean and disinfect more frequently during opening hours and at the end of the day
• Make disinfectant pumps available, especially at reception, and in all places that require contact with objects (e.g. signing forms, etc.).
• Actively promote contactless payment.
• Ensure that employees receive adequate training on hygiene measures to be applied during a pandemic.

Sourcing equipment

The College recommends that registrants contact the various suppliers of physiotherapy medical equipment.

Resources Office of the Chief Medical Officer of Health: Health and Allied Health Professionals

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Appendix 2 (RMT member adherence):

 

Return to Practice Framework For Regulated Massage Therapist

 Timeline, Tasks/Requirements & Particulars

 Prepare for return to practice

 Purchase product / equipment

 Masks (required / recommended) May be home sewn but must be properly fitted

         ^{Surgical style, fabric or disposable masks are acceptable for the RMT  (required}

and client (recommended). Must be washed, sanitized or changed in between clients.

 

Eye protection (recommended)

Prescription eye glasses are not sufficient. Wrap around safety

Glasses, a shield, or clips that fit on eye glasses that block entrance to the sides are recommended when an RMT is in close contact with the patients’ breath. Must be washed, sanitized or changed in between clients.

Hospital style gown or lab coat (required) May be home sewn

• Must fasten in the front, the back or button up to reduce cross contamination and allow for proper hand washing technique to the elbows. Must be washed, sanitized or changed in between clients.

Sheets, linens, face cradle covers, towels, blankets and any wool table/face cradle covers, vinyl covers (required)

• RMTs must be able to sanitize or have enough supplies to be able to change all linens, blankets, coverings, etc. between each client.

Gloves (recommended / required)

• Gloves are required when performing intraoral techniques or if the RMT has lesions or open wounds.

Hair covering (recommended / required) May be home sewn

• Is required for intraoral techniques that could induce coughing or for RMTs with long hair that is not tied back to prevent from having to touch one’s hair during treatment. Must be washed, sanitized or changed in between clients.

Air purifier (recommended)

• In the treatment room and reception area.

Face shield (required)

•  For all intraoral techniques that could induce coughing. Must be

washed, sanitized or changed in between clients.

Access to hot water and soap or hand sanitizer (required)

• Must be available in the entrance of the clinic and in the treatment area. Print and post the correct handwashing and hand sanitizing techniques at each hand washing station.

Low levels of disinfectant or commercial cleaners (required)

 Low levels of disinfectant as defined by the Infection Control for Regulated Professionals are 3% hydrogen peroxide solution, or 1:1000 hypochlorite bleach solution. Commercial cleaners that contain a disinfectant may also be used.

Plexiglas / Barrier at reception area (recommended)

• This recommendation is for a multi – RMT / Professional Clinic employing a receptionist.

Remove all magazines, pamphlets and toys in any waiting or treatment rooms.

Prepare Screening Information

Passive Client Screening – UPDATE

Print the client posters and post in the entrance of the clinic

Protect yourself and others How to self monitor.

Active client screening

• Print an active screening questionnaire for the client to be

completed by the RMT prior to the treatment date.

Return to practice Screening

 Active client screening

• An RMT must fill out the active screening questionnaire with their client 3 – 5 days prior to the scheduled appointment by telephone. This questionnaire must be signed and dated by the RMT and added to the client file. Please recommend payment be made by debit or credit card when possible.

Physical distancing requirements

 Client appointments

• A practice with one RMT should advise their client to only present themselves 5 minutes  prior to their appointment and wait in their vehicle to be called in.              .
• A practice with several RMTs / Multi-disciplinary teams must adhere to the required 2 meters physical distancing in the waiting / reception area.
• The clinic must limit the presence of others accompanying the client to the strict minimum. This may vary depending on the needs of each client.
• The clinic must modify the seating in the waiting area to adhere to the required 2 meters physical distancing.
• The clinic must clearly mark proper physical distancing on the floor of the reception area.
• Health professionals must adhere to the required 2 meters physical distancing with co-workers and individuals in the facility that are not their clients.
• When possible provide a separate entry and exit door for clients in the facility. When this is not possible there must be controlled access to assure the required 2 meters physical distancing is adhered to at the entry of the facility.
• RMTs/Employers/Operators are responsible to assure the required 2 meters physical distancing is adhered to in the facility.
• In large clinic settings one individual in the facility is responsible to assure chairs, washrooms, door handles, etc. in the waiting/reception/entry areas are sanitized after each client use as infection control cleaning practices need to be maintained between clients.

 

Greeting the client / Screening

• RMT self assessment for COVID-19 symptoms
• An RMT should self-assess for COVID-19 symptoms daily prior to treating clients.

Client screening

• When greeting the client, confirm there are no changes to their health / symptoms since the active screening questionnaire was completed by telephone. Please direct the client to read the poster in the clinic entrance and to wash or sanitize hands upon entry.

 

 MASSAGE THERAPY TREATMENT

The CMTNB Communication and Public Health Standard

 

• Standard 1.  Prepare the Treatment Area

 

• Standard 3. Wash Your Hands and Any Surface that Has/Will Come in Contact with the Patient

 

• Standard 5. Risk Identification and Management for an Outbreak of Infectious Disease

 

• Standard 15. Use of Personal Protective Equipment during a treatment

All the required massage therapy treatment tasks listed below are referenced from the CMTNB Communication and Public Health Standards 1, 3, 5 and 15 which can be found in their entirety on the CMTNB website www.cmtnb.ca under the resources tab within the Standards of Practice document.

 

• All massage equipment should be cleaned between each patient, including tables, face cradle, bolsters, etc. Items that cannot be washed between each appointment including pillows or table warmers should have a vinyl cover that can be wiped down and sanitized containing a disinfectant may

Examples of low-level disinfectant as defined by The Infection Control for Regulated Professionals are 3% hydrogen peroxide solution, or 1:1000 hypochlorite bleach solution.

Commercial cleaners are also used.

• All linens should be washed or changed between each patient. This includes all sheets, face cradle covers, towels, blankets, and any wool table/face cradle covers. Any fabric that cannot be wiped to sanitize
• All surfaces the patient comes in contact with must be sanitized between each patient, including chairs, counters, door knobs, debit machines, pens, washrooms, waiting area furniture, etc.
• The pump for your lubricant (Oil/lotion/gel) should be wiped with sanitizer between each patient. Holsters for lotion/oil are not recommended unless they are changed with each patient.

All protective gear is to be changed and either disposed of, or sanitized (as per the products specifications) between each patient as per all other massage equipment that has come in contact with the patient.

• It is recommended that your clinic shoes be left at the clinic and not brought home.

Mobile Massage

•  Ensure that used sheets and safety equipment is secured in the client’s home in a bag prior to being placed in the trunk of  the RMT’s vehicle away from other materials.
• The RMT must also wipe down any door knobs or surfaces that were touched in the client’s home. Shoe covers are recommended and must be changed between each client.

 

Points to remember The purchase of materials

 

• RMTs must wash hands before and after each treatment. RMTs must wash hands when in contact with dirty sheets. RMTs must wash hands prior to folding clean sheets. RMTs must wash hands prior to setting up the treatment room for the next patient.
• Supplies can be purchased at the following website. https://knowyourbodybest.com
• All equipment and surfaces must be changed, washed or sanitized between clients
• Client appointments must be staggered to maintain social distancing
• Client screening is required prior to scheduled appointments.

 

The CMTNB strongly recommends RMTs do not treat individuals with COVID-19 symptoms.

Resources

How to put on Personal Protective Equipment

How to remove Personal Protective Equipment About Coronavirus Protect yourself and others

 

CMTNB Return to Practice Framework April 2020_Updated May 13, 2020 6