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Interim Guidelines for Return to Practice (COVID-19)

June 30, 2021 (with updates made on October 15, 2021, indicated in red font)

The Big Picture

  • Premier John Horgan, Minister Adrian Dix, Minister Ravi Kahlon and Dr. Bonnie Henry announced on June 29, 2021 that the province is transitioning gradually to Step 3 of BC’s Restart Plan on July 1, 2021.
  • Step 3 represents a change in focus from COVID-19 safety plans to communicable disease prevention.
  • Guidance and targeted restrictions will replace previous orders and restrictions.
  • Communicable disease prevention involves assessing the level of risk in your practice environment, applying fundamental safety practices (below), communicating your protocols to everyone who enters your practice environment, and updating measures and safeguards as required.
  • Foundational elements of communicable disease prevention include:
    • No one should enter the clinic if they show signs of communicable disease; they should be tested for COVID-19.
    • Masks are required by public health authorities in all public indoor settings. (updated September 15, 2021)
    • Physical distancing in waiting rooms and other high traffic areas is advised (it is likely that you do not know the vaccination status of everyone in the practice environment).
    • Hand hygiene must be followed.
    • RMTs must not provide in-person care if they are waiting for the results of a COVID-19 test.
    • Maintain a clean work environment.
    • Ensure adequate ventilation.
  • See how WorkSafeBC and the Provincial Health Officer outline Step 3 of BC’s Restart Plan.
  • RMTs are reminded that CMTBC’s Practice Environment Standard of Practice is in effect. The Practice Environment Standard promotes patient and practitioner safety through all aspects of treatment delivery.

Communicable Disease Prevention

Starting July 1, 2021, RMTs will transition to a communicable disease prevention plan. RMTs are expected to take reasonable steps to manage health and safety for everyone in their practice environment; this includes preventing the transmission of communicable diseases.

While a written or posted communicable disease prevention plan is not required, WorkSafeBC may inspect your clinic for measures you have put in place to prevent the transmission of communicable diseases.

RMTs may refer to Communicable disease prevention: A guide for employers, from WorkSafeBC.

Transition from safety plans to communicable disease prevention for RMTs in practice in BC

Your professional judgment and choices will determine whether and how you implement additional measures specific to your practice setting, your professional insurance requirements, and your patients’ needs.

Pillars of responsible care that support the goal of communicable disease prevention are outlined in this section.

1. Prior to the appointment: Communicate with patients and all who enter the practice environment.

  • Prior to arrival at the clinic and/or at the time of booking, patients should be informed of the following:
    • Patients must arrive at their appointment with no signs of communicable disease. If they have signs of COVID-19, they are to contact public health at 8-1-1 and arrange to be tested.
    • Advise patients of available options regarding the use of personal protective equipment, including masks. Masks are required by public health authorities in all public indoor settings for individuals aged 5+. (updated October 15, 2021)
    • Advise individuals of additional requirements they will be asked to meet on arrival at the appointment (e.g., hand washing upon arrival, arriving on-time for appointment).
    • Explain the rationale for ongoing compliance with safety protocols. Step 3 of BC’s Restart Plan is a careful, graded transition that relies on honest communication and consistent safety protocols.

2. Physical Distancing

  • Physical distancing helps decrease transmission of the novel coronavirus as well as other communicable diseases.
  • Physical distancing of 2 metres/6 feet should be maintained in clinic areas other than the treatment room, as best as possible within the practice setting.
  • Physical distancing considerations include:
    • Reducing congestion in high traffic areas (e.g., waiting room),
    • Encouraging patients to arrive on-time for their appointment,
    • Encouraging patients to arrive unaccompanied unless the patient requires parent/guardian, or needs assistance.

 3. Hand Hygiene

  • Patient cleans their hands upon entry to the practice environment.
  • RMT washes their hands often, as appropriate.
  • Hand-washing protocols are posted in reception area, in the treatment room, and at sinks (including bathroom for patient’s use if applicable).

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

  • Share information about the reason for ‘no face touching’.
  • Provide tissues if an itch must be addressed; tissues must be available in reception, treatment room, washroom.
  • If RMT is accustomed to sweating during her or his work, a head band should be used, or a hand towel should be available to wipe the forehead and face as required to avoid sweat from dripping into eyes, necessitating touch.

5. Enhanced Cleaning

  • All therapists and staff will practice consistent cleaning protocols.
  • Clean visibly soiled surfaces, followed by disinfection.
  • Linens must be single use only.
  • Remove all clutter, fabric furnishings and decorations that cannot be sanitized.
  • Frequently clean and disinfect:
    • handles: doors, cabinets, faucets, fridge, microwave, etc.,
    • electronic devices and phones,
    • arm rests of chairs,
    • desks and table surfaces,
    • water coolers,
    • washrooms.
  • Ensure the treatment room is thoroughly cleaned between patients:
    • Clean equipment and supplies (table, table levers, lotion bottles, hydrotherapy supplies, etc.) after each patient.
  • Air purifier / filter in the treatment room may be helpful if the room has no windows or external air exchange. Use of an air purifier/filter is at the RMT’s preference and discretion. View WorkSafeBC resources about ventilation and air circulation.

6. Personal Protective Equipment (PPE) and mask use

September 2021: Mask are required by public health authorities in all public indoor settings for individuals aged 5+. (updated October 15, 2021)

An RMT may decide whether to use additional PPE for themselves and/or for their patient/s.

  • The RMT must have masks available for patient and RMT use.
  • An RMT must adjust treatment positioning and make other accommodations as required for patient comfort to accommodate patients wearing a mask.
  • The RMT may refuse to treat a patient who refuses to wear a mask provided that (1) this is communicated to the patient in advance of the appointment, and (2) the RMT considers accommodations or provides alternatives for patients who are unable to wear a mask.
  • It is the RMT’s responsibility to use and clean or replace their mask correctly. There are many kinds of masks in use and CMTBC is not prescriptive about protocols; please follow BCCDC recommendations.
  • RMTs may use their professional judgment to decide whether to use other commercially available PPE.

7. Professional Obligations

  • RMTs are reminded that if they are exhibiting signs of a communicable disease or if they are waiting for a COVID test result, they must not provide in-person care and should not be in attendance at clinics or other practice settings where other staff and patients are present.
  • CMTBC regulates massage therapists, and not clinics. CMTBC’s guidelines apply to RMTs and RMT-practice; it is an RMT’s responsibility to clarify the guidelines in their practice, rather than rely upon clinic owners to do so.
  • RMTs who practice at multiple locations, including mobile, must be particularly conscientious about others’ safety protocols while also maintaining their own protocol.
  • Professional liability insurance:
    • RMTs in practice are required by CMTBC’s Bylaws to carry professional liability insurance.
    • The coverage terms of policies can vary.
    • RMTs are advised to follow the guidelines or requirements of their insurance provider as long as the insurer’s guidelines do not conflict with or contradict CMTBC’s guidelines.
  • RMTs who are employees of a clinic, spa, or who have employment contracts:
    • RMTs are bound as health professionals by their obligation and duty to CMTBC, irrespective of employment agreements.
    • RMTs in this work setting must clarify their relationship with their employer.
    • An RMT should consult legal counsel if needed, as CMTBC does not provide legal advice; or, alternatively, if the RMT is a member of a professional association, the association may provide advice and/or support.

Resources

Additional Resources

RMTs should also consult the following:

CMTBC’s Interim Guidelines for Return to Practice were developed in consultation with Iridia Medical Inc. (team led by Dr. Allan Holmes, MD, FRCP), and a panel of RMTs.

Please note that CMTBC’s Interim Guidelines contain many links to resources on external websites which are frequently updated. If you encounter a broken link, please email [email protected] to advise CMTBC.

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