Marlies Russell, RMT, BA

Patients will be required to fill out the new Covid-19 consent form prior to treatment but it must be signed with your RMT as a witness in the clinic. Please read and familiarize yourself with the document first.: COVID-19 Consent Form

Plan for Return to Clinical Practice in Respect of 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 our clinical setting.  Here, we identify the actions that the therapist at Interactive Flex Health & Wellness 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 informed about their responsibilities at the time of booking. A notice will be placed on the website, and the online booking software will send them a copy of these protocols as part of a COVID-19 specific consent form. The patient must be familiar with all of the questions in the consent form as, upon arrival at their first appointment, when the clinic reopens, they will be required to sign their consent.
  • Prior to every appointment, the therapist will contact the patient one day in advance to go over the COVID-19 screening assessment tool (Part 1 only of the initial consent) and to verify the self-assessment has been completed and to stay home if they experience any symptoms of COVID-19.
  • The therapist will use the BC COVID-19 Self-Assessment tool herself, daily and commits to cancelling 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
    • 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
  • 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.

  • As a tacit part of the assessment survey, patients must understand that while we have 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.
  • Patients with higher risk profiles and/or weakened immune systems should consider alternatives for care and postpone treatment.
  • 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 who develop even mild illness or symptoms must 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 the patient of her current results from online BC COVID-19 symptom self-assessment tool.
  • Patients must reconfirm that there is no change to the assessment survey from 24 hours ago and that they 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 before entering the building. If the patient does not have a mask, a single-use mask will be provided for a $2 fee and they will be asked to wear it upon entering the clinic space.
  • 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 is permitted in the treatment room at any given time. Patients are asked to arrive unaccompanied and if a Caregiver is required, that person will follow all the same protocols as a patient would.
    • Minors will not be treated at this time.
  • The therapist is the only other person who will be within the treatment room 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 that are outside the treatment room.
  • The fabric chairs have been covered with vinyl for ease of sanitizing.
    • Patients are not permitted to lounge in the clinic reception area before or after the treatment.
  • Tea and water are not available and have been removed from the clinic reception area.
  • Nothing remains in the treatment room that cannot be disinfected after each touch.
  • Appointment times are scheduled to reduce the potential of patients crossing paths, and to allow for time in-between sessions for enhanced cleaning.
  • Patients are asked to arrive on time and no earlier than 5 minutes before the appointment.
  • The clinic door will be opened for the patient to enter. 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 within a plastic basket, which can and will be sanitized between patients.
  • Patients will be asked to remove from the clinic everything that they bring with them including garbage and their disposable mask.

Restroom for patient use

  • The restroom has been equipped with touchless soap dispenser and paper towels and proper handwashing guidelines.
  • The door to the restroom will remain open so that patients do not have to touch the door knob.
  • The bathroom stalls, toilets and taps will be disinfected a minimum of twice a day.

Hand Hygiene

Reception area / Entry into clinic space

  • Immediately upon entering the building and before entering the clinic space, the patient must either:
    • Go directly to the washroom and wash their hands with soap and water for at least 20 seconds and then dry thoroughly, (preferred) or
    • Use the touchless hand sanitizer dispenser just inside the clinic door outside the treatment room
  • 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 other PPE like facemasks or shields.
  • Hand washing protocols will be posted visibly in the washroom at sinks.
  • Payment options are via Etransfer (preferred) or chip / pin pad prior to the appointment. The POS unit will be disinfected between patient use and 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.
    • Patients will be permitted to open the door for themselves after the treatment to let themselves out of the treatment room.
    • 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

  • COVID-19 virus 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.
  • Tissue will be available throughout the clinic in order that 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 a face shield at all times.
  • Patients are required to wear face masks that cover both nose and mouth at all times within the clinic space except when prone on the table. To assist with droplet containment while prone (face down) on the table, a pillowcase will be draped around the headpiece.
  • There will be no Intraoral and external TMJ treatments at this time, nor will the face be palpated.

Enhanced Cleaning

  • Additional time has been scheduled between patients to allow for thorough cleaning of the clinic.
  • 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-health-products/disinfectants/COVID–19/list.html
  • 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, POS machine, electronic devices, table surfaces, chairs, stools,
    • The treatment table, table levers, face cradle, oil/lotion bottles.
    • No hydrotherapy supplies or thermophores, will be used.
  • All linens, including blankets and pillow cases are single use only and will be laundered using high heat and detergent between each use. Blankets will only be used upon request.
  • A Levoit Air Purifier with True HEPA filter and active carbon filtration has been placed in the treatment room.
  • A disinfected 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 face mask and face shield at all times while working with a patient.
  • The therapist’s face shield will be disinfected in between appointments.
  • The therapist will wear non-latex gloves if/when 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.
    • At the patient’s request.
  • Patients are required to wear a clean facemask that does not have an exhalation valve in the clinic at all times.
    • If patients have their own clean fabric facemask, they are requested to arrive at the clinic wearing it.
    • If patients do not have a fabric facemask, or their own single-use non-medical mask, a single use mask will be provided at the time of their treatment for a $2 fee.

Professional Obligations

Liability insurance

  • The therapist carries professional liability insurance through BFL CANADA Risk and Insurance Services Inc.
  • 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 is 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 tests positive for COVID-19 having been to a Massage Therapy appointment within the 14-days prior to onset of symptoms

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

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 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 catches 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 symptoms and request 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 contact with someone showing signs 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.

Asymptomatic spreaders

  • Asymptomatic transmission of the COVID-19 virus is an unavoidable risk of practice until we’ve acquired herd immunity, there is an effective treatment or a 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.

Marlies is a member in good standing with the College of Massage Therapists of BC.