Safety Plan for Reopening – COVID-19

This plan was developed with the goal of reducing the risk of exposure to the virus that causes COVID-19 for patients, practitioners and administrative (admin) staff within our clinical setting. Here, we identify the actions that the registered massage therapists (RMTs) and staff at Left Coast Health commit to, and that all visiting patients must commit to, in order to resume massage therapy services.

This plan will be posted onsite at our clinic in accordance with the order of the Provincial Health Officer. This plan will change as circumstances surrounding COVID-19 change. Please check our website (https://leftcoasthealth.com/) for a link to the latest version.

We confirm that we will be meeting the WorkSafeBC Health Professionals: Protocols for returning to operation and therefore the College of Massage Therapists of BC (CMTBC) requirements to reopen clinical practice.

If you have a fever, cough or difficulty breathing or any other symptoms that may be a sign of COVID-19, please do not come in to your appointment. Please stay home and call 8-1-1 for testing information if you have not done so already.

The overall aim of these protocols is to reduce potential COVID-19 transmission by:

Required ongoing self-assessment for signs of COVID-19 related illness in the patient, the therapist and the administrative staff.
Reducing all physical, non-treatment related interactions amongst all people within the practice environment.
Following hand hygiene requirements.
Avoiding face touching.
Performing enhanced cleaning protocols.
Appropriate use of personal protective equipment (PPE).
Meeting professional obligations, particularly related to informed consent and liability insurance.

1) Self-Assessment for Symptoms of COVID-19: For Patients, Therapists and Admin Staff

Pre-Screening – Prior to Arrival

We will inform patients about new procedures we have implemented. This will be done through our website, on our online booking website and in our online booking emails. Admin staff who perform reminder phone calls for the next day’s appointments will direct patients to our website for full details.
We will inform patients of our PPE procedures and our rationale for choosing them in this plan (below) and in our postings on our website.
Patients will be contacted the day before their treatment and asked to perform the BC COVID-19 Self-Assessment Tool, which can be found here: https://bc.thrive.health/covid19/en They will be told to stay home if experiencing any symptoms of COVID-19 and if they have not been tested for COVID-19, it is recommended that they do so and start the process by calling 8-1-1.
On our website, online booking website and in appointment reminder emails will be warned that if they have travelled outside of BC in the last 14 days or have been in contact with anyone displaying illness, or signs and symptoms of COVID-19 within 14 days prior to their treatment, the RMT may defer their treatment to a later date.
Via the reminder phone call, website posts, online booking website and in appointment reminder emails and calls, patients will be told to stay home if experiencing any symptoms of COVID-19, including fever, chills, cough, shortness of breath, sore throat, loss of sense of smell. If patients are experiencing these symptoms and have not been tested for COVID-19, they will be recommend to do so; they start by calling 8-1-1.
RMTs and clinic staff will use the BC COVID-19 self-assessment tool daily, and stay home/cancel appointments if experiencing any COVID-19 symptoms.
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:
1. 1. 1. Fever
    2. Cough
    3. Chills
    4. Shortness of breath
    5. Sore throat or pain with swallowing
    6. Stuffy or runny nose
    7. Loss of sense of smell
    8. Headache
    9. Muscle aches
    10. Fatigue
    11. Loss of appetite

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.
Our 24-hour cancelation policy (getting charged a ‘Missed Appointment Fee’) will be more lenient to ensure honesty and compliance with pre-screening questions and voluntary cancelation of appointments with no advanced notice.

Pre-Screening – Upon Arrival

The RMT and patient will each go over their self-assessment outcomes.
Patients will also have to confirm that they have not travelled outside BC in the last 14 days. If they have travelled outside of BC in the last 14 days, the RMT may choose to defer the treatment until a later date (once a minimum of 14 symptom-free days has transpired).
Patients must confirm that they have not been in contact with anyone displaying illness, or signs and symptoms of COVID-19 within the 14 days prior to their treatment. If they have been in contact with anyone displaying illness or signs and symptoms of COVID-19 within the past 14 days, the RMT may choose to defer the treatment until a later date (once a minimum of 14 symptom-free days has transpired).
The treatment will be cancelled immediately if the patient does not meet the pre-screening criteria upon physical presentation at the clinic.
If all pre-screening has been performed with satisfactory results, the RMT and patient will confirm safety and trust in moving forward.
The patient must complete a Signed Informed Consent – COVID-19 form. Patients will be asked to complete this form before arriving for their first visit since our clinic reopening. This form will come in the guise of an ‘Intake Form’. A link to it will be emailed to them. If they have not completed one before they arrive, they will do so at this point. As a part of this consent form, patients must commit to understanding 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 and thus, that any massage therapy treatment involves some risk of COVID-19 transmission.
Pre- and during clinic visit: Through open and honest communication the RMT will attempt to empower the patient to make their own decision on what they need to feel safe in order to receive treatment. The RMT will encourage the patient to speak up at any time and let the RMT know if they would like to change something about the treatment or cease it completely.

2) Physical Distancing

Reception/Entry

Admin staff, RMT and patients must maintain 2 metres / 6 feet of distance in clinic areas other than the treatment room, as best as possible within the practice setting.
Appointment times are staggered by 15 minutes to reduce traffic.
Patient must arrive unaccompanied unless patient is a minor who requires parent/guardian, or is infirm and needs assistance. Patients who are infirm and require a companion present special challenges with regard to physical distancing from entry through treatment and departure. Confirmation that massage therapy is essential at this time will be obtained, the appointment will be postponed, or the patient will be referred to alternate care if possible. If treatment goes ahead, the RMT will help patient and companion navigate every step of the way.
The patient is required to wait outside Saanich Commonwealth Place (in their car or at least 2 metres from the door that leads to the second floor Health Services on the North side of the building) and not inside the building. There is a large black and white Health Services sign on the exterior wall beside the door. Please wait in front of the Left Coast Health sandwich board that is two metres from this door. Feel free to wait here close to your appointment time and we will be able to look down and see you. Or if there is inclement weather, you can wait in your car and the RMT will call you to let you know that they are ready to meet you at the door described above.
The RMT will open the exterior building door and greet the waiting patient. NOTE: PRE-SCREENING PROTOCOLS WILL BE PERFORMED AT THIS TIME.
The patient is asked not to touch any doors enroute to or from the clinic treatment room.
RMTs will ask that patients touch as few surfaces as possible, preferably none, enroute to the clinic treatment room.
At the end of treatment, the RMT will accompany the patient to the exit and open all doors for them (using a tissue or other sanitized barrier) enroute.

Therapists’ Shared Areas

Only one therapist will be working at a time in the clinic space.
Therapists will be using their own computers for charting, phones for music and lotion for manual therapy. There will be no sharing of any devices or supplies.

Treatment Room

It is not possible to maintain physical distancing in the treatment room while manual therapy modalities are being performed.
When manual therapy modalities are not being performed, the RMT and patient will maintain 2 metres of separation.
Patients will be asked to keep all personal belongings within a provided plastic bin, which will be sanitized between patients. Patients are asked to bring as few personal items as is necessary.

Washroom for Patient Use

The patient washroom is a limited to two users at any one time, thus providing ample space to maintain physical distancing.

Elevator/Stairs/Other

The RMT and patient will maintain 2 metres of physical distance as they go up the stairs to the reception area and treatment room.
The elevator is large enough that the RMT and patient can maintain physical distancing should its use be needed.
Physical Distancing posters from the BC Centre for Disease Control and BC Ministry of Health will be posted in the stairwell and elevator.

3) Hand Hygiene

Reception/Entry

There will be a sanitation station with an alcohol-based hand sanitizer outside of the treatment room that the patient will be required to use on arrival. After the treatment is complete, the patient will be asked to clean their hands with an alcohol-based sanitizer from the sanitation station inside the treatment room (before using a tissue to open the door).
If the patient’s hands are visibly soiled, patient must use a wipe, then alcohol-based hand rub prior to moving to the treatment room.
Patients will also have access to a washroom where they can wash their hands thoroughly with soap and water for at least 20 seconds.
At a minimum, the therapist will wash hands thoroughly with soap and water for at least 20 seconds between patients.
RMTs will also wash hands thoroughly with soap and water for at least 20 seconds at other times throughout the day as appropriate.
Hand hygiene posters from the BC Centre for Disease Control and BC Ministry of Health will be posted at the sanitation stations in the reception area, treatment room and in the washroom.

Treatment Room

The RMT will open the door to the treatment room and allow the patient to enter; The RMT will open/close the door before, during, and after treatment as required, using hand towel/sanitized barrier as needed, and washing hands as appropriate.
After the treatment is complete, the patient will be asked to clean their hands with an alcohol-based sanitizer from the sanitation station inside the treatment room.
The patient will use a tissue as a sanitation barrier to open the treatment room door when they are ready for the RMT to re-enter the room after the treatment.
Tissue is available inside the treatment room that the patient may use as a barrier when opening the door.
The door and doorknobs will be disinfected between each patient (see Enhanced Cleaning).
As outlined above, RMTs will wash their hands before and after treatment with soap and water for 20 seconds at a minimum. They will also be washing them at other times as appropriate.
Touchless payment. Until further notice, credit card payments for treatment will be performed through our online booking software that has a touchless credit card payment app called Jane Payments.
Patients will be asked to enter their credit card information into their Jane account. This information will be securely stored in Jane Payments, which is Payment Card Industry Data Security Standard compliant.
This only has to be performed once and would preferably be done by the patient at home anytime before coming into their first treatment after we reopen. To register a credit card to their Jane account profile, follow the simple instructions in this link (simply click on the words): ‘Add a Credit Card from the Client My Account Portal’
If the patient has not done this ahead of time, it will need to be done at the conclusion of the treatment. Preferably, the patient will dictate the information for the RMT to enter so there is not cross-contamination of the computer keyboard or tablet screen. If the patient insists on typing it in, the RMT will disinfect the keyboard or tablet screen immediately before and after with Health Canada approved hard-surface disinfectant wipes.
If credit card payment is a challenge, the patient can pay via e-transfer to admin@leftcoasthealth.com.
Until further notice, receipts will only be emailed to the patient not printed.
Cash is not accepted at this time.

Washroom for Patient Use

Soap will be available for hand washing, clean material for drying, and paper towels or tissues for doors and touch surfaces.

4) Face Touching Avoidance

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.
Tissue or paper towel will be available throughout the clinic: in the reception area, treatment room and washroom in order that patients and the therapist may use tissue or paper towel to address an itch and/or touch the face for any other reason.
Masks will be available for the patient and for the RMT.
Until further notice, structures of the face will not be palpated or treated.
Coronavirus Prevention posters from the BC Centre for Disease Control and BC Ministry of Health will be posted in the reception area, inside the treatment room and in the patient washroom.

5) Enhanced Cleaning

General

All staff and RMTs will be trained in all sanitation processes.
Additional time has been scheduled between patients to allow for thorough cleaning of the treatment room and other high touch surfaces.
Cleaning products used by Left Coast Health are found on Health Canada’s list of Hard-surface disinfectants and hand sanitizers (COVID-19): List of disinfectants with evidence for use against COVID-19.
All linens, including blankets and pillowcases are single use only and will be laundered with hot water and detergent between each use.
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, doorknobs, handles, POS devices, electronic devices, phones, desks, table surfaces, chairs, armrests, stools, etc.
  - The treatment table, table levers, face cradle and lotion bottles will be cleaned immediately after each treatment.
A disinfected single-use 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. This will be disinfected between each patient. Patients are asked to bring as few personal items as possible into the room.
No hydrotherapy supplies, thermophores, table warmers or covers will be used.Cleaning and Disinfectants for Clinic Settings posters from the BC Centre for Disease Control will be posted in the reception area, the washrooms and the treatment room.

Washroom for Patient Use

All contact areas will be cleaned and disinfected several times a day. Soap is available for hand washing, clean material for drying, and paper towels are available for doors and touch-surfaces.
Patients are encouraged to use a washroom at home before their appointment to cut down on touch points.

Elevator/Stairs/Other

Patients are asked to touch as few surfaces as possible, preferably none, enroute to and from the treatment room. RMTs will press the buttons and open and close doors.
All contact areas will be cleaned several times a day, e.g. doors, elevator buttons.
Paper towels or tissues will be available for patients to use when contacting high-touch surfaces.

6) Personal Protective Equipment (PPE)

Masks

Left Coast Health RMTs will be wearing a mask at all times.
Patients will be required to wear a mask during their visit to the clinic.
The RMT and patient will address the issue of mask use so there are no misunderstandings.
If the patient has their own clean mask, they are encouraged to bring it for use during their session.
RMTs have paper/disposable (surgical) masks available for the patient’s use if requested.
Therapists have been trained in donning and doffing a mask: wash hands with soap and water (or alcohol-based hand sanitizer if water and soap are not available) prior to putting on a mask, prior to taking off a mask, and after disposing of a mask in the garbage.

Gloves

Brand new, unused non-latex (nitrile) gloves will be available to be worn by the RMT during the patient’s treatment. Left Coast Health will not be supplying gloves to patients.
The patient and RMT will make a mutual informed decision about whether or not the RMT will wear gloves during the treatment.
The patient may wear gloves if they choose.

Eye Protection

The RMT may wear eye protection during the patient’s treatment if they choose.
Left Coast Health will not be supplying eye protection to patients.
The patient may wear eye protection if they choose.

7) Professional Obligations

Liability Insurance

The RMTs at Left Coast Health carry professional liability insurance through Wilson M. Beck Insurance Services.

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 their therapist and inform him/her of the positive test results and possible transmission of the virus.
The therapist will immediately self-isolate.
The therapist will call public health at 8-1-1 to report the possible transmission and act on direction of public health.
The therapist will inform the health and safety representative at Left Coast Health who will inform the District of Saanich of the situation and both parties will act on the direction of public health.

Patient Alleges They Caught COVID-19 from RMT

The RMT will immediately call public health at 8-1-1 and report the alleged transmission, providing both the RMT’s name and the name and contact information of the patient.
The patient must agree to the release of this information under these circumstances in order to receive treatment
The RMT will immediately self-isolate until the matter has been investigated and public health direction has been provided.
The therapist will inform the health and safety representative at Left Coast Health who will inform the District of Saanich of the situation and both parties will act on the direction of public health.

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 the symptoms and request access to COVID-19 testing.
The therapist will inform the health and safety representative at Left Coast Health who will inform the District of Saanich of the situation and both parties will act on the direction of public health.

In the Event That the Therapist Comes into Close Contact with Someone Showing Signs of Illness or Tests Positive for COVID-19

The therapist will immediately self-isolate.
The therapist will inform the health and safety representative at Left Coast Health who will inform the District of Saanich of the situation and both parties will act on the direction of public health.

Asymptomatic Spreaders

This is an unavoidable risk of practice until there is either an effective treatment or an effective vaccine against COVID-19.
We have put into place protocols to help mitigate that risk as outlined in the preceding documentation.

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 protocols 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 via electronic or paper signature.
Preferably, the patient would sign their Signed Informed Consent – COVID-19 form before arriving at their first treatment after the clinic reopens. This will minimize the risk of transmission through touching pen and paper on the day of the appointment.

Left Coast Health. May 30, 2020.