** WE ARE CURRENTLY IN THE PROCESS OF UPDATING OUR COVID-19 PLAN (BELOW) TO A COMMUNICABLE DISEASE PREVENTION PLAN. **

To Our Valued Patients….

Thank you for your patience and understanding during our last few months of closure. We are all chomping at the bit to reopen and begin providing our services for your therapeutic needs, but not before we have all the necessary protective equipment, supplies and protocols in place.

There is no exact date for re-opening yet, however we are aiming for a soft-opening sometime in early June. Once all necessary items are procured, and staff are familiarized with the new protocols, we will be contacting you directly to begin the process of booking your appointments.

The first step is announcing our restart plan! This is a comprehensive and detailed plan, so pour yourself a coffee and read though the very important information below. There will be notable differences to how we operated before, however these alterations and safety measures are to ensure that risk is mitigated for yourself, the practitioners and the staff at DMTW.

Stay Well. Stay Safe.

The Dominelli Massage Therapy & Wellness Team

Dominelli Massage Therapy & Wellness Restart Plan

Getting Back To Work During the COVID-19 Pandemic

POSTED: 24 May 2020 – UPDATED: 29 Jan 2021

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. Identified below are the actions that Dominelli Massage Therapy & Wellness commits to, and that all visiting patients must commit to, in order to resume massage therapy services.

For a safe return to practice our staff and practitioners are committed to safety protocols in the following areas:

  1. Personal Practices – Understanding of how COVID-19 is transmitted and remaining committed to behaviours that prevent the spread of COVID-19 both in practice settings and in one’s personal life.
  2. Therapist Screening –Daily therapist self-monitoring for symptoms and consideration of one’s personal circumstances is important in determining whether working is appropriate.
  3. Patient Screening & Arrival – 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. Supplies: Considerations and Procurement – 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 & Logistics – Strategies we are implementing to maximize social distancing, keep common areas clean and sanitized and create the safest possible space for patients.

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

To minimize personal risk of exposure, everyone should:

How Covid-19 Spreads – http://www.bccdc.ca/health-info/diseases-conditions/covid-19/about- covid-19/how-it-spreads

For measures on prevention – http://www.bccdc.ca/health-info/diseases-conditions/covid-19/prevention-risks

For a brief summary –  http://www.bccdc.ca/Health-Info-Site/Documents/COVID19-Prevention.pdf

AVOIDING CLOSE CONTACT

COVERING MOUTH AND NOSE

In all scenarios of life, our practitioners and staff will:

Note: Masks are not a substitute for social distancing.
For more information on masks: http://www.bccdc.ca/health-info/diseases-conditions/covid-19/ prevention-risks/masks

COVERING COUGHS AND SNEEZES

Practitioners and staff will:

CLEANING AND DISINFECTING

Our practitioners and staff will commit to cleaning and disinfecting touched surfaces and maintaining the cleaning guidelines laid out by BC Center for Disease Control, both at home and in clinic. Further details about cleaning protocols are presented in this restart plan.

THERAPIST SCREENING

GENERAL

What we do in our day-to-day life matters. We recognize the importance to think ahead about how we can stay healthy and prevent the spread of COVID-19 within our practice and our community. Everyone does this by committing to the following:

DAILY SELF-MONITORING

Symptoms associated with a COVID-19 infection have included cough, fever, difficulty breathing, and pneumonia in both lungs. These symptoms may range in severity, and act similarly to that of a cold or flu. Both asymptomatic and symptomatic individuals may transmit the virus to others. Our staff and practitioners will self-monitor by:

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. In addition to self-monitoring, our staff and practitioners will:

NOT FEELING WELL

Practitioners and staff will not go to work if they are not feeling well, even if their symptoms are mild and they are uncertain of whether or not it is COVID-19. We are committed to protecting our colleagues and patients, and will stay home if there is any doubt in mind. Furthermore, we expect to miss more work than usual to make sure that they are taking care of ourselves, our colleagues, and our community.

Our commitments:

ILLNESS AMONG CLOSE CONTACTS

In the event a close contact (e.g. spouse; child; household member) becomes ill, that individual will stay home, self-isolate and follow the instructions from the BC Centre for Disease Control – http:// www.bccdc.ca/Health-Info-Site/Documents/Self-isolation_caregivers.pdf

Our staff and practitioners will only return to work:

In the event a patient alleges they were exposed to COVID-19 at an appointment, or around the time of having an appointment with a practitioner, and the practitioner has had an appointment with that patient within the past 14 days, the practitioner will immediately self-isolate and cancel all appointments. Regardless of when the last appointment occurred, the practitioner will call public health at 8-1-1 and report the alleged transmission, providing both the practitioner’s name and the name and contact information of the patient.

In this case, our practitioners will only return to work:

In the event a patient has tested positive for COVID-19, and the case is proven true following investigation, the clinic/practitioner will immediately notify all patients seen since the last appointment or the past 14 days (whichever is longer).

PATIENT SCREENING & ARRIVAL

Diligent screening of all visitors entering the clinic helps to ensure safety to the clinic, its staff, and patients. In the interim, the clinic will look and feel different to its patients. Clear communication prior to entering the clinic will help everyone understand the new process and what to expect during their visit.

THREE SCREENS

It is paramount that this protocol is in place. Patients will be screened multiple times, including at least one screen prior to arriving at their appointment. Our staff and practitioners will ensure these three screening procedures will occur with each patient for each appointment:

1. At appointment booking, or appointment reminder email, using our clinic screening form or the BC Symptom Self-Assessment Tool;
2. During a phone call within 24 hours prior to the appointment;
3. When they first enter the clinic and/or the treatment room.

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

SCREENING QUESTIONS

For the safety of visitors to the clinic, the patient must answer these questions to the best of their ability. This screening, based on the BC Symptom Self-Assessment Tool, is subject to updates as we learn more about COVID-19. If they choose, our practitioners and staff may direct patients to use our clinic screening form instead.

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; Habitual Smoker; Chronic Lung Disease; Poorly Controlled HIV/AIDS; Type I or Type II Diabetes; Severe Obesity: Liver Disease: Age over 65; Chronic Kidney Disease (and undergoing dialysis); Nursing Home or Long-Term Care Facility Residency; Recent Bone Marrow or Organ Transplant; Current Pregnancy (# of weeks; complications; etc.); Corticosteroids or Other Immune Weakening Medications (type and duration), Other Immune System Deficiencies or Pre-Existing Conditions;

Practitioners will discuss the risks versus the benefits of anyone who selected any of the above. The decision to continue with the appointment will only occur when both the practitioner and patient fully understand the nature of the patient’s health condition, the possible added risk of COVID-19 to that patient, and both individuals are comfortable with the precautions in place.

2. Approximately how many social contacts outside your household have you had in the past week? Note: One social contact is one place or action visited outside your home. (e.g. grocery store; 2 meter apart walk with a friend; going to work; etc.)

The practitioner will also disclose their social contacts, giving the practitioner and the patient the opportunity to discuss and establish trust in each others’ approach 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 or staff member will cancel the appointment and re-book for a date at least 10 days after last symptoms.

4. Have you, or someone in your household, had close contact (whether or not for providing care) with a person having a presumed or confirmed diagnosis of COVID-19? If yes, please list the date of resolution of that person’s symptoms and/or the date of last contact with that person.

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

5. If your answer to question #4 was yes, AND you are a healthcare provider working with COVID-19 positive patients, have you adhered to strict personal protective equipment protocol? What is your role in working with COVID-19 positive patients?

Our practitioners will individually decide if they are comfortable treating healthcare workers who are in direct contact with COVID-19 positive patients. We completely understand and honour that 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. Our practitioners who decide to treat healthcare workers will cancel the appointment if there has been a failure in the healthcare worker’s 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 or their patients that they are currently treating healthcare workers who are in direct contact with COVID-19 positive patients.

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

If the answer is yes, our practitioners and staff will cancel the appointment and re-book at least 14 days after the patient’s (or household member’s) return home.

7. Are you, or someone in your household, experiencing any of the following symptoms (Please check all that apply):

Moderate-Severe Difficulty Breathing (e.g. struggling to breathe; speaking in single words; etc.); Severe Chest Pain; Difficulty Waking Up; Confusion; Losing Consciousness; Mild-Moderate Shortness of Breath, Inability to Lie Down AND/OR Manage a Chronic Health Condition because of Breathing Difficulties.

If the answer is yes to any of the above, the practitioner or staff member will cancel the appointment and direct the patient to do one of the following: 1) Call 8-1-1; 2) Go to https://bc.thrive.health/; OR 3) Contact their physician for further guidance and advice. The patient can reschedule later after they are safe to be treated.

8. 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 indicate 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: 1) Call 8-1-1; 2) Go to https://bc.thrive.health/; OR 3) Contact their physician for further guidance and advice. The patient can reschedule later after they are safe to be treated.

PATIENT ARRIVAL AT CLINIC

Patients arriving for their appointments will be instructed by practitioners and staff to do the following:

SUPPLIES: CONSIDERATIONS AND PROCUREMENT

The current risk of COVID-19 has made procurement of many items difficult or impossible. Below are considerations taken to ensure our clinic environment as safe as possible all visitors. If we find difficulty meeting our considerations and supplies can not be found, Dominelli Massage Therapy & Wellness will remain closed or temporarily cancel appointments until those necessities are in place.

TREATMENT ROOM, LOBBY & SUPPLY ROOM

The following furnishing considerations will be implemented:

CLEANING SUPPLIES AND EQUIPMENT

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 provide care and service in all settings. As such, practitioners will adhere to the infection control requirements listed below.

TREATMENT ROOM

CLEANING PROCEDURE

The practitioners and staff will be following these cleaning protocols listed below:

1. Between every appointment, using approved disinfectants and cleaning supplies on all touch surfaces, moving clockwise from the door around the entire treatment room, including but not exclusive to:

2. Between appointments using approved disinfectants and cleaning supplies on all touch surfaces, disinfect all high touch areas in the common spaces, including but not exclusive to:

3. At least once daily, a full cleaning and disinfecting the entire common area floor.

4. Throughout the working day, laundering of all linens, blankets, and hand towels after every use.

PERSONAL PROTECTIVE EQUIPMENT (PPE)

Practitioners will place street clothes in an enclosed drawer, change into a fresh set of attire, and implement the following PPE protocol:

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

• Depending on practitioner OR patient comfort: Safety glasses/goggles or shield

• Depending on practitioner OR patient comfort: Bibs, clothing covers, scrubs, or changes of clothes to be changed between treatments.

• Required: A cloth or disposable paper mask for the patient, supplied by the patient or provided by the clinic for a fee.

• Depending on practitioner OR patient comfort: Gloves*

*Note: Gloves do not offer any protection over regular and rigorous hand washing that is typical of massage therapy practice. Gloves are normally used during cleaning, intra-oral work, and in the case of cuts or open injuries on the patient or the therapist. Gloves are always discarded after every use. If the patient is comforted by the use of gloves, they can be used.

TREATMENT MODIFICATIONS

We are adopting the following scheduling considerations for safety:

FACILITY PRACTICES & LOGISTICS

Our common area is quite small and it is challenging to maintain two meters distance with more than three 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:

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. Missed appointments with no notice or explanation of the reason, or for reasons other than illness and cancelled within 24 hours of the appointment time will be charged the full treatment fee (without exceptions). This will be strictly enforced.

WASHROOMS

Washrooms on the premises are shared by patrons and staff from other clinics on the same floor. Signs educating for safe use and hand washing are posted on the washroom doors. It is encouraged that patients use their own washrooms prior to arrival at the clinic, in order to avoid using the shared washrooms on site. However, in case of absolute need, a staff member or practitioner will provide a key on request. The key and key holder are cleanable, and will be disinfected before the patient is provided the key and after the patient returns it.

LAUNDRY

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

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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