COVID-19

Hello dear valued patients,

We are so excited to be able to see you and be part of your healthcare again!

Navigating this virus and reopening paramedical healthcare services is something that will require a calculated process, and you may notice that things are looking a little different around here. Our intention with the following restart our practices planis to be able to provide much needed therapies while maintaining safe practices and minimizing the risk of exposure to COVID-19.

Upon reopening of Boulder Mountain Massage Studio, the following procedures will be implemented. Its a lot of information, but we recommend you read through the information below, and contact us if you have any questions. It is important to understand the risks associated with receiving treatment are at this time, and what we can and will do to mitigate those risks.

We understand this will be a strange new way of operating, but we strongly feel that if we are proactive with our safety measures, we will decrease the risk for you and our team. We look forward to providing you with a safe and healing environment! 

Best,

Your Boulder Mountain Massage Team

Boulder Mountain Massage Studio Restart Plan 

Please see link here to Self-Assessment tool: https://bc.thrive.health/covid19/en

Return to Practice During COVID-19 Pandemic

INTRODUCTION

For a safe return to practice our practitioners remain committed to safety protocols in six different practice areas:

1. Good personal practices Understand how COVID-19 is transmitted and remain committed to behaviours that prevent the spread of COVID-19 both in practice settings and in ones personal life.

2. Therapist screening Daily therapist self-monitoring for symptoms and consideration of ones personal circumstances is important in determining whether working is appropriate.

3. Patient Screening Every patient is screened carefully to reduce the likelihood of someone coming into the clinic with COVID-19. Further, being aware of the risk factors present with each patient is important. Patients that have new or emerging symptoms of cold or flu are not to be treated, and measures are in place to prevent their attendance in the clinic.

4. Procurement of needed supplies and equipment to make the treatment environment safe.

5. Therapist Infection Control Practices Factors considered in creating the safest treatment environment possible. The supplies needed to practice safely, the modifications to our treatment environment and cleaning process.

6. Facility practices Strategies we are implementing to maximize social distancing, keep common areas clean and sanitized and create the safest possible space for patients.

GOOD PERSONAL PRACTICES

A return to work is not a return to normal. It is important that therapists and patients move about in their work and personal environments consciously. These rules apply to everyone as you do your part to help slow the spread of COVID-19.

HOW COVID-19 SPREADS

Health experts believe that Coronavirus is transmitted via liquid droplets when a person coughs, sneezes or talks within a close proximity.
It is believed that COVID-19 spreads when infected droplets reach the eyes, nose or mouth.
The virus is not known to be transmitted through airborne transmission (by much smaller evaporated particles containing the microorganism floating in the air for long periods of time).
Coronavirus does not transmit through the skin.
The virus can be spread by touch if a person has used their hands to cover their mouth or nose when they cough.
Be aware that COVID-19 may be spread by those not showing symptoms.

To minimize personal risk of exposure, everyone should:

Wash your hands often with soap and water for at least 20 seconds especially after you have been in a public place, after blowing your nose, coughing or sneezing.
If soap and water are not readily available a hand sanitizer that contains at least 60% alcohol can be used. Cover all surfaces of your hands and rub them together until they feel dry.
Avoid touching your eyes, nose and mouth with unwashed hands.
Clean and disinfect high touch surfaces frequently.
Keep 2 meters or 6 feet apart where possible (social distancing).

For measures on prevention see http://www.bccdc.ca/health-info/diseases-conditions/covid-19/prevention-risks or for a brief summary see: http://www.bccdc.ca/Health-Info-Site/Documents/COVID19-Prevention.pdf

AVOIDING CLOSE CONTACT

We will always avoid close contact with people who are sick.
Other than when we are actively treating we will put at least 2 meter distance between ourselves and other people.
We will be particularly mindful of those who are at the highest risk of getting very sick: those over 65, individuals
in a care home or long term care facility, those with underlying medical conditions particularly if not
well controlled, those with chronic lung disease or moderate to severe asthma, those with heart
conditions, those who are immunocompromised, those who are severely obese, those with diabetes,
those with chronic kidney disease undergoing dialysis and those with liver disease.

COVERING MOUTH AND NOSE

In all scenarios of life, including work, home and public environments, practitioners will:

Be aware they could spread COVID-19 to others even if they do not feel sick.
Use masks to act as a barrier to help prevent them from spreading tiny droplets to others when they are unable to practice social distancing.
Even with a mask, when possible they will do their best to keep 6 feet between themselves and others the mask is not a substitute for social distancing. For more information on masks please see: http://www.bccdc.ca/health-info/diseases-conditions/covid-19/prevention-risks/masks

COVERING COUGHS AND SNEEZES

 Practitioners will:

Always cover their mouth and nose with a tissue when they cough or sneeze, even while wearing a mask.
Throw used tissues in the trash.
Immediately wash hands with soap and water for at least 20 seconds. If soap and water are not readily available, they will clean their hands with hand sanitizer that contains at least 60% alcohol.

CLEANING AND DISINFECTING

Practitioners will:

Commit to cleaning and disinfecting touched surfaces and maintaining the cleaning guidelines laid out by BC Center for Disease Control at home as well as at work. Further details about cleaning protocols while at work are found in this restart plan.

THERAPIST SCREENING

GENERAL

What we do in our day to day life matters. We recognize that in order to work safely it is important to think ahead about what we can do to stay healthy and prevent the spread of COVID-19 within our practice and our community.

Practitioners commit to:

Be conscious of the number of places you are going to before and after work and on your days off.
Avoid non-essential trips within your community.
Do not gather in groups.
Limit contact with those at high risk.
Go outside to exercise but stay close to home.
Practice social distancing (stay at least 2 meters apart) outside of your home to the best of your ability.
All travel outside BC requires a 14-day quarantine upon returning home that must be strictly adhered to.

DAILY SELF-MONITORING

Symptoms associated with a COVID-19 infection may range significantly and be similar to that of a cold or flu. Both those who are asymptomatic and those who are symptomatic may transmit the virus to others.

Symptoms have included cough, fever, difficulty breathing, and pneumonia in both lungs.

Practitioners will self-monitor by recording their temperature, symptoms, and number of contacts each day outside of the treatment room.
They will not to use medicines that reduce fever e.g. acetaminophen or ibuprofen. If they have taken a fever reducing medicine they will wait at least 4 hours after their last dose to take their temperature.

Other symptoms may include muscle aches, fatigue, sore throat, headache, loss of appetite, chills, runny nose, nausea and vomiting, diarrhea, loss of sense of smell or taste. 

Practitioners will:

Take their temperature every day before work.
Record the number of places visited or stopped at outside of work.
Disclose their number of contacts to their patients with full transparency.

 

PRACTITIONER NOT FEELING WELL

Practitioners will not go to work if they are not feeling well even if their symptoms are mild and they are uncertain of whether it

is COVID-19 or not. Practitioners are committed to protecting their colleagues and their patients and will stay home if there is any doubt in their mind. Practitioners expect to miss more work than usual to make sure that they are taking care of their self, their colleagues, and their community.

Practitioners commit to:

If they feel mildly ill, staying home, not going to work, not going to public places, not using public transit, taxis, or ride shares. Not having visitors to their home.
Calling their family physician, a walk-in clinic, local public health unit, complete the COVID-19 self-assessment by visiting https://bc.thrive.health/ or calling 811 and following their instructions.
If they live with others they will stay and sleep in a separate room and use a separate bathroom if possible.
If they test negative but still arent well they will stay home until they are better to protect their patients and
colleagues from falling ill.
If they test positive for COVID19 they will contact patients to inform them to monitor for symptoms. For instructions on how to isolate follow the instructions of public health officials. For more information see http://www.bccdc.ca/Health-Info-Site/Documents/Self-isolation.pdf
If they become ill with COVID-19 they will stay away from work for at least 10 days beyond the onset of symptoms, AND until the fever is gone without medication, AND they are feeling better AND they have been cleared by a public health official.

ILLNESS AMONG CLOSE CONTACTS

If a close contact, a spouse, those they live with or their child becomes ill they will stay home and self-isolate with their

family. They will follow the instructions from the BC Centre for Disease Control: http://www.bccdc.ca/Health-Info-Site/Documents/Self-isolation_caregivers.pdf

Practitioners will only return to work when:

Their close contact has been tested and the results for COVID-19 come back negative and they are well.
OR after self-isolating for 14 days and having no symptoms or fever develop.
OR being cleared by a public health official.

PATIENT SCREENING AND ARRIVAL INSTRUCTIONS

After confirming that the therapist is well, careful screening of all visitors that enter the clinic provides an extra level of safety to the clinic, its staff, and patients. Be aware that practice will look and feel different to patients. Clear communication before individuals enter the clinic will help patients understand the new process and what to expect at their visit.

THREE SCREENS

It is imperative that there be a protocol in place so that patients are screened multiple times, including at least one screen prior to arriving at their appointment. Practitioners will ensure 3 screening procedures with each patient for each appointment:

1. At appointment booking, or at appointment reminder email via a screening form or the BC Symptom Self-Assessment Tool

2. During a phone call up to 24 hours prior to the appointment

3. When they first enter the treatment room

Practitioners will document that the screening was done. Practitioners will refuse to treat if their patient refuses to participate in any of the 3 screening processes.

SCREENING QUESTIONS

For the safety of all practitioners and patients the patient must answer these questions to the best of their ability. This screening is subject to change as we learn more about Coronavirus and will be updated as such. This screening is based on the BC Symptom Self-Assessment Tool, which practitioners may direct patients to using instead of the clinic online screening form if they choose.

1. Do any of the following apply to yourself, or anyone in your household? Please check all that apply and list the member of your household as well as any other relevant information: Heart conditions, Undergoing cancer treatment, Moderate / severe asthma, A habitual smoker, Chronic lung disease, Poorly controlled HIV / AIDS, Type I or type II diabetes, Severely obese, Liver disease, Over the age of 65, Chronic kidney disease undergoing dialysis, Live in a nursing home or long-term care facility, Recent bone marrow or organ transplantation, Currently pregnant, Corticosteroids / other immune weakening medications use (type and duration), Any other Immune deficiencies or pre-existing conditions (please explain)

Practitioners will discuss the risks versus the benefits of anyone who selected any of the above. The choice to continue with the appointment will only occur when the practitioner and the patient fully understand the nature of the patients health condition, the possible added risk of COVID to that patient, and both the practitioner and the patient are comfortable with the precautions in place.

2. Approximately how many social contacts outside your household have you had in the past week? Some examples of a social contact are: getting groceries, going for a walk with a friend, going to work with colleagues also present, etc. (even with social distancing measures taken).

The practitioner will also disclose their social contacts, giving the practitioner and the patient the opportunity to discuss and establish trust in each othersapproach to safety regarding COVID-19.

3. Have you, or has someone in your household, ever been diagnosed with COVID-19? If yes, please list the date of last symptoms.

If the answer is yes and the date is less than 10 days prior to the appointment date, the practitioner will cancel the appointment and re-book the patient in for a date at least 10 days after last symptoms.

4. Have you, or has someone in your household, provided care or had close contact with a person with confirmed or presumed diagnosis of COVID-19? If yes, please list the date of resolution of that patients symptoms, or the date of last contact with that patient. 

If the answer is yes and the the date of resolution of symptoms, or the date of last contact is less than 14 days prior to the appointment date the practitioner will cancel the appointment and re-book the patient in for a date at least 14 days after resolution of symptoms or last contact. 

If yes, AND you are a healthcare provider working with COVID positive patients, have you adhered to strict personal protective equipment protocol? What is your role in working with COVID positive patients?

Practitioners will decide for themselves if they are comfortable treating Healthcare workers who are in direct contact with COVID positive patients. Our doctors and nurses are very well trained in the use of personal protective equipment (PPE) and have strict protocol to follow when PPE fails. Practitioners who do decide to treat said healthcare workers will cancel the appointment if there has been a break in the healthcare workers PPE  within 14 days prior to the appointment, OR if the healthcare worker does not meet any other criteria in the screening process. The practitioner will also disclose to ALL patients they are treating that they are treating healthcare workers who are in direct contact with COVID positive patients.

5. Have you, or has someone in your household, traveled outside British Columbia within the last 14 days?

If the answer is yes practitioners will cancel the appointment and re-book the appointment for at least 14 days after the patients return home.

6.  Are you, or is someone in your household, experiencing any of the following, please check all that apply: Severe difficulty breathing (e.g. struggling to breathe or speaking in single words), Severe chest pain, Having a very hard time waking up, Feeling confused, Losing consciousness, Mild to moderate shortness of breath, Inability to lie down because of difficulty breathing, Chronic health conditions that you are having difficulty managing because of difficulty breathing.

If the answer is yes to any of the above the practitioner will cancel the appointment and direct the patient to do one of the following: call 811, go to https://bc.thrive.health/ or to contact their physician for further guidance and advice. The patient can reschedule later after they are safe to be treated.

7. Are you, or is someone in your household, experiencing any of the following cold, flu or COVID-19-like symptoms, even mild ones? If yes, please note if this is due to an existing condition (provide the name of the condition), or is a regularly experienced symptom. Fever, Chills, Cough, Shortness of breath, Sore throat and painful swallowing, Stuffy or runny nose, Loss of sense of smell, Headache, Unusual muscle aches, Fatigue, Loss of appetite.

If the response to any 2 of these questions is yes, the patient cannot have a treatment. Practitioners will cancel the appointment and direct the patient to do one of the following: call 811, go to https://bc.thrive.health/ or to contact their physician for further guidance and advice. The patient can reschedule later after they are safe to be treated.

PATIENT ARRIVAL AT CLINIC AND INSTRUCTIONS

Practitioners will:

Ask patients to remain in their vehicle or at the outside waiting area until their practitioner collects them at their appointment time. 
Ask patients to come into the facility alone and not bring spouses or children, unless required for mobility or personal assistance. This is important to promote social distancing in treatment rooms and the larger clinic space.
Ask patients to have their mask on prior to entry and upon entry into the clinic, ask patients to wash their hands or use the provided hand sanitizer. 
Explain to their patients that bringing their own mask is recommended, but disposable are available for a fee. 

SUPPLIES CONSIDERATIONS AND PROCUREMENT

The current global risk of COVID-19 has made procurement of many items difficult or impossible. The following considerations have been taken to ensure an environment that is as safe as possible for practitioners, patients, and the public. If items listed, or suitable replacements, can not be found Eaglewind Health will cancel appointments until those items can be procured.

TREATMENT ROOM CONSIDERATIONS

The following furnishing considerations have been implemented:

Laundry hampers that are easy to disinfect, with washable liners
No touch garbage bins in common areas and treatment rooms
Cleanable patient chairs in waiting and treatment rooms
All furnishings in the treatment room and common areas washable
Dedicated cleanable areas for patients possessions

CLEANING SUPPLIES  AND EQUIPMENT

Vital Oxide OR Spray Nine: Hard surface cleaner and vinyl cleaner/disinfectant approved
and listed on the government of Canadas website. Found at https://www.canada.ca/en/health-canada/services/drugs-health-products/disinfectants/COVID-19/list.html
Cleaning cloths: Reusable cloths for disinfecting and available for door opening washed after every use.
Spray bottles: for hard surface cleaner, vinyl surface cleaner Large bottles for in between appointments and small bottles for practitioners to carry with them for use on frequent touch areas.
Non-porous surface covers for all bolsters, pillows, heating pads, for easy cleaning.
Linens to be washed between every appointment in approved sanitization process.
Hand soap with touchless or cleanable pump dispenser in the washroom.
Freshly laundered hand towels for single use drying hands.
Hand sanitizer (at least 60% alcohol) in touchless or cleanable pump dispensers at front door and in each treatment room.

THERAPIST INFECTION CONTROL PRACTICES

From a risk management perspective therapeutic treatment takes place in an enclosed space where the therapist and patient are unable to socially distance. Further cross transmission is a risk given that practitioners will interact with a number of patients in a day. No in person appointment is risk free even if the patient and massage therapist appear well. It is essential that health care

workers are kept healthy, safe, and able to perform their work in providing care and service in all settings. As such practitioners will adhere to the following recommendations and requirements.

TREATMENT ROOM

All clutter, decorations, and items that cannot be washed/wiped and sanitized are removed from the treatment space.
 All pillows, linens and items that are not being used for the treatment in question are not in the treatment room or are enclosed in a cabinet.
Every surface that the therapist or the patient touches is to be cleaned and sanitized between every treatment. This includes oil bottles, treatment tools, linens, the treatment table (surface and table legs near the face rest), desks, chairs, exercise equipment, doorknobs, light switches, etc.
Chair and side table to be used as a cleanable space for patients to store their clothing and personal items during treatment. Hanging clothes on hooks will be discouraged, and if used will also be disinfected.
There will be towels available for practitioners and patients to use when opening doors. There are high-efficiency particulate air (HEPA) purifiers in each treatment room and in the common area to reduce dust, allergens, cleaner fumes, and any other potential causes for sneezing. While we can not be sure HEPA filters will filter Coronavirus, we aim to keep the air as clean and safe to breathe as possible.

CLEANING PROCEDURE

The practitioner will:

1. Between every appointment use approved disinfectant in a spray bottle to spray clockwise from the door around the entire treatment room all touch surfaces, including:

Door handle inside and out
Cabinet handles/touch open areas
Desk, devices/pens used
Stool
Massage table with special attention to the head rest cradle, headrest cushion, and table legs near the headrest
Chair
Side table
Any other surfaces touched by the patient or their belongings
Exercise equipment, or walls touched in self-care demonstrations
Floor

2. Between every appointment carry a small spray bottle around with them to disinfect all high touch areas in the common space, including:

Door handles
Faucet/sink
Toilet handle and seat
Washing machine
Laundry basket
Cabinet open areas
Front desk
Chair/stool
Closet handles

3. At least twice daily disinfect the entire common area floor and bathroom on a schedule followed by all practitioners.

4. Launder all linens, blankets, and hand towels after every use.

PERSONAL PROTECTIVE EQUIPMENT (PPE)

Practitioners will place street clothes in an enclosed bin and implement the following PPE protocol:

Required: Procedural/surgical or cloth masks worn in common areas and changed between treatments.

Depending on comfort (practitioner will have this available for use as needed for the comfort of the patient OR the practitioner): Safety glasses/goggles or shield

Depending on comfort (practitioner will have this available for use as needed for the comfort of the patient OR the practitioner): Bibs, clothing covers, scrubs or changes of clothes to be changed between treatments.

Required: A disposable paper mask for the patient (they can either bring their own or the clinic will provide one for a fee to those who do not have one.

Depending on comfort (practitioner will have this available for use as needed for the comfort of the patient OR the practitioner): Gloves*

*Note Gloves do not offer any protection over regular and rigorous hand washing that is typical of massage therapy

practice. Gloves are recommended during cleaning, intra-oral work (as per normal practice), and in the case of cuts

or open injuries on the patient or the therapist (as per normal practice). Gloves are always discarded after every

use. If the patient is comforted by the use of gloves, they can be used.

TREATMENT MODIFICATIONS

Scheduling considerations for safety:

Appointments are to be staggered between practitioners to ensure that at any one time there is only one practitioner and one patient in the common area.
Appointments are less than 1 hour to reduce the amount of time of exposure between practitioners and patients.
Appointments will start and end on time as much as possible to ensure proper staggering of people in the common areas.
Appointments have adequate cleaning time scheduled in between.
Aerosol producing postural drainage techniques beneficial to the patients health will be referred to a more appropriate medical setting.

FACILITY PRACTICES

Our common area is quite small and it is not possible to have a single direction of movement through the hallway, or to maintain 2 meters distance with more than 2 people present at one time.

SOCIAL DISTANCING:

To reduce the need for prolonged use of our common area and to reduce touch surfaces needing disinfecting, we are implementing the following practices:

Patients will be asked to fill out all intake forms online at least 24 hours prior to their appointment to limit time spent in the common areas, as well as shared objects touched such as pens and paper.
Patients will be asked to wait in their car or in the outside waiting area until their therapist is ready for them.
Patients and practitioners will be asked to wear masks in the common areas, and in the treatment rooms as needed for comfort to aid in social distancing.
Patients will be asked to share all direct billing and payment details prior to their appointment to limit the time spent in the common area.
Practitioners will issue an electronic receipt to limit shared objects touched, such as paper and pens.
Doors to treatment rooms and bathroom will be left open when the rooms are not in use to reduce door handle touching.
Patients will be asked to be efficient in their preparation to leave the clinic to limit time spent in the common areas and to give the practitioner time to prepare a safe space for the next patient.
Water is available on request and will be given in a filled glass after both practitioner and patient have sanitized their hands.

ADMINISTRATION

Due to the extraordinary circumstances we find ourselves in, no charge of penalties will be levied for cancelled appointments due to patient illness, or due to the patient being denied treatment in the screening process. There will still be a charge of fees for an appointment missed with no notice or explanation of the reason, and for reasons other than illness.

WASHROOMS

A hand washing sign is placed in the washroom to educate patients on proper hand washing. There are freshly laundered towels provided to dry hands with in a single use with a receptacle for disposal. Touch less trash receptacles and a touch less or easily cleaned soap dispenser is available for use. Washrooms will be more thoroughly cleaned at least twice per day with common contact

points wiped down each time a therapist uses the washroom to wash their own hands.

LAUNDRY

Contaminated linens can transmit disease via direct contact or by aerosols of contaminated lint generated during sorting, and handling of contaminated items. Practitioners will:

Avoid shaking out laundry before placing into the washing machine it may create aerosolized particles.
Use proper hand washing after touching and processing dirty laundry, as well as cleaning and disinfecting of the buttons, knobs, and doors of the laundry area.
Linens, scrubs, and cleaning items will be washed using regular laundry soap and hot water (60-90 degrees Celsius) and put through a dryer cycle until completely dried.
Clean linens will be stored in washable bins.

REFERENCES

Public Health Agency of Canada [PHAC]. 2016. Routine Practices and Additional Precautions for Preventing the

Transmission of Infection in Healthcare Settings (1-100-22038-0, 978-1-100-22038-3). Retrieved May 2020 from: https://www.rmtbc.ca/wp-content/uploads/2020/04/routine-practices-precautions-healthcare-associated-infections-2016-FINAL-eng.pdf 

BC Centre for Disease Control. Accessed May 2020 from: http://covid19.bccdc.ca/

WorkSafeBC https://www.worksafebc.com/en/about-us/covid-19-updates/covid-19-industry-information/health-care

Saskatchewan (April 2020). Re-Open Saskatchewan. A plan to re-open the provincial economy. Saskatchewan.ca/COVID19. Retrieved April 26th from: https://www.saskatchewan.ca/government/health-care-administration-and-provider-resources/treatment-procedures-and-guidelines/emerging-public-health-issues/2019-novel-coronavirus/re-open-saskatchewan-plan/re-open-saskatchewan

Government of Ontario COVID-19 http://www.health.gov.on.ca/en/pro/programs/publichealth/coronavirus/docs/2019_patient_screening_guidance.pdf

Washington State Department of Health COVID-19 Alert for Massage Therapists. Accessed May 11, 2020 from: https://www.doh.wa.gov/Portals/1/Documents/1600/coronavirus/COVID19LMTRecommendations.pdf