COVID-19 Pandemic – Practice Guidance for Therapists

CLOTH MASKS ARE NO LONGER ACCEPTED IN STUDIO. Please wear a medical mask or one can be provided to you for $1.00. Masks must be worn at all times in studio including during classes.

Cleaning and Disinfecting 

1. Cleaning removes visible soiling, while disinfecting uses chemicals to kill germs once a surface is cleaned. A “wipe-twice” method (wipe once to clean, wipe again to disinfect) must be used to both clean and disinfect surfaces.
2. Only use products approved by Health Canada by cross-referencing the Drug Identification Number (DIN) on the product container.
3. High-touch surfaces will be cleaned and disinfected at least twice per day, and when visibly soiled. High touch surfaces include: doorknobs, light switches, washrooms including toilet handles, counters, handrails, arm rests, and electronics.  These surfaces and areas will be cleaned prior to the start of your day.  You are responsible for cleaning these surfaces and areas throughout the day and after your last client/patient.
4. The treatment room and its equipment must be cleaned and disinfected after each use and between clients.
   1. All equipment must be in good condition (no tears or rips) to allow for proper cleaning and disinfecting.
   2. Pay special attention to the container of topical products (e.g. oil bottle), stool and the massage table.
   3. Clean and disinfect the face cradle after each client.
   4. Change any face cradle cover after each client.
5. Items that are frequently shared, difficult to clean (e.g. upholstered furniture), and/or not necessary to achieving treatment outcomes will be removed from treatment rooms and reception area. Some examples may include: magazines and other entertainment items; water service, and snacks; product samples or testers; and reusable hand towels. We will continue with our single use hand towels in all washrooms.
6. Scheduling will be shared to help avoid clients arriving and leaving the studio at the same time.
7. Each therapist will be “assigned” a washroom for themselves and their client/patient.  Please only use the assigned washroom during your scheduled time in the studio and clean between each client use.
8. Items in the treatment room that cannot be cleaned and disinfected between clients are required to be removed.
9. Linens, blankets and pillows must be changed between clients, and washed and dried in the highest heat possible. Linens used by clients should be stored in a closed bag or container with a lid until they are washed.  All laundry continues to be the responsibility of each therapist. 
10. As we are responsible for additional cleaning and disinfecting between clients/patients, more time is required in between each scheduled appointment.
11. All cleaning must be logged.

Preparing Practice

1. Clear, visible signage will be on display at all entrances and within the practice environment that outline the signs and symptoms of COVID-19, what to do if one is at risk, and how to limit transmission (i.e. hand hygiene, physical distancing and safely covering coughs and sneezes). The Ontario Government has provided signage in English for both patients/clients and visitors that can be posted on entrances, and a poster for within your setting.
2. Signage will be posted at the entrance and at reception areas requiring all clients/patients to wear a mask, perform hand hygiene.
3. Our waiting/reception area will essentially be “closed”.  The door will remain locked at all times.  One chair will be available in reception for arriving or leaving clients/patients and must be cleaned if used. We are all responsible for collecting payment and completing and booking appointments.  If the reception desk is used it must be properly disinfected at the end of your scheduled day.  If the debit machine is used, it must be properly disinfected between use. 

Booking Appointments

1. Before booking an appointment, the therapist must screen the client virtually for risk of COVID-19 by following the MOH’s COVID-19 Patient Screening Document Guidance and the COVID-19 Reference Document for Symptoms. If the client does not pass this basic COVID-19 screening, the therapist cannot provide treatment, regardless of the rationale for treatment as they will not be permitted inside our facility. Advise the client that they should self-isolate and complete the online self-assessment tool before calling their primary care provider or Telehealth Ontario at 1-866-797-0000. 
2. Inform clients/patients of any public health measures that have been implemented in advance of the appointment.
3. The therapist must instruct the client/patient to come to the appointment wearing a clean disposable or reusable mask that can be worn throughout the treatment, otherwise one will be provided for them. If the client cannot wear a mask (e.g. due to a health condition or difficulty breathing), the therapist must use their professional judgement to assess the risk of providing or continuing treatment.  Masks are required to be worn in all common areas in the facility.
4. Ask clients/patients to arrive alone (where possible) and as close to their appointment time as possible. If a client is unable to arrive alone, advise the client that the person accompanying them will be screened at arrival to the appointment and will be asked to provide their name and number upon arrival for contact tracing purposes. The person accompanying the client should also be instructed to arrive at the appointment wearing a clean disposable or reusable mask.
5. Schedule appointments in a way that allows enough time between clients to implement new cleaning, disinfecting and screening protocol.

The Appointment

1. Clients/patients are required to wait outside or in their vehicle. Ask the client if they would like to receive a phone call or text message when they can enter the clinic.
2. We will maintain a roster of all people entering the space (including their name and phone number) to assist with contact tracing, ensuring client confidentiality is maintained. In addition to clients, this may include couriers, guardians, and support people/workers. Explain to visitors that this information will be used for contact tracing only, should someone who visited the setting later be diagnosed with COVID-19, and that visitors can refuse to provide their name and telephone number.
3. Ensure the client washes or sanitizes their hands upon arrival and after treatment.
4. All therapists must thoroughly wash their hands (including forearms and elbows) with soap and water before each treatment.
5. Immediately prior to treatment before the client/patient enters the facility, the therapist must screen the client/patient to ensure the client’s COVID-19 status has not changed  using the same criteria COVID-19 Pandemic as when the client booked the appointment.
6. We must screen ourselves using the same criteria COVID-19 Pandemic as when the client booked the appointment. This screening must be documented in the client’s health record. If immediately before treatment, either the client or the therapist does not pass screening, the therapist must not provide treatment.
7. If the therapist encounters a client who has gone through the screening process and enters the setting, yet exhibits signs and symptoms consistent with COVID-19, they must:
   1. establish and maintain a safe physical distance of two (2) metres;
   2. have the client complete hand hygiene;
   3. if the client is not wearing a mask, provide the client with a clean mask,
   4. segregate the client from others in the clinic;
   5. explain the concern that they are symptomatic, discontinue treatment and reschedule the appointment;
   6. advise the client that they should self-isolate and complete the online self assessment tool before calling their primary care provider or Telehealth Ontario;
   7. clean and disinfect the practice area and anywhere the client is likely to have touched immediately; and,
   8. ensure a record is kept of all close contacts of the symptomatic client and other visitors and staff in the clinic at the time of the visit. This information will be necessary for contact tracing if the client later tests positive symptomatic for COVID-19.

Personal Protective Equipment (PPE)

1. All therapists must wear a surgical/procedure mask (not cloth) during treatment and whenever within two (2) metres of clients. Masks should be changed after each client and must be changed whenever wet, damaged or soiled.
2. The therapist must instruct the client to come to the appointment wearing a clean disposable or reusable mask to be worn throughout the treatment. We may also (if PPE supplies permit), provide a surgical/procedure mask to be used by the client during treatment. In either case, the therapist will advise the client how to properly put on and take off the mask to limit possible transmission of COVID-19. If the client cannot wear a mask (e.g. due to a health condition or difficulty breathing), the therapist must use their professional judgement to assess the risk of providing or continuing treatment.
3. Ensure clients and visitors do not leave their masks in waiting or common areas.
4. Single use gloves may be used but are not required for most treatments. Gloves do not preclude the need for proper hand hygiene. If used, gloves must be disposed of and changed between each client. Be aware of potential interaction with gloves and topical products; if gloves are used, the use of nitrile gloves is recommended with oil- or water-based products or latex gloves (unless the therapist or client has latex allergy) with water-based products. Vinyl gloves are not recommended as they may not be durable enough for manual work. Monitor glove use with client feedback and be sensitive to clients’ preferences.
5. Therapists are expected to use their professional judgement and conduct individual risk assessments to determine if additional PPE (e.g. face shields, goggles) is warranted due to elevated risk.
6. Therapists may consider taking precautions regarding their own clothing, such as wearing disposable coverings or changing their personal clothing between clients. Clothing should be washed and dried regularly and carefully on as high a heat setting as possible.