CMTNL Back to Work Document

For Phase 2

Purpose:  To provide guidelines for RMTs that will ensure safe return to work during the COVID 19 pandemic

The main goal of these guidelines is to protect the public and aide RMTs as health professionals in working in correspondence with the Department of Health (DOH) recommendations, in order to prevent the spread of COVID-19 while treating clients.

These guidelines are mandatory requirements and recommendations. The CMTNL reserves the right to investigate any RMT’s workspace and practices for compliance of the guidelines.

Guidelines are derived from COMMUNICATION / PUBLIC HEALTH STANDARD 5Risk Identification and Management for an Outbreak of Infectious Diseases and up to date Canadian and Provincial health resources.

http://www.cmtnl.ca/wp-content/uploads/2018/10/Standards-of-Practice.pdf

https://www.gov.nl.ca/covid-19/for-health-professionals-2/

https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection/guidance-documents/risk-informed-decision-making-workplaces-businesses-covid-19-pandemic.html

https://www.gov.nl.ca/covid-19/files/Risk-Informed-Decision-Making-Guidance-for-Employers-Operating-During-COVID-19.pdf

Phases

The CMTNL strongly believes that in order to protect the public, clients and Registered Massage Therapists in the midst of a pandemic, phasing back to work is best practice. Slowly allowing both therapists and clients to return to treatments with these new guidelines is the safest way to monitor the situation and make necessary changes when needed.

RMTs will be permitted to begin in phase 2. The CMTNL will change phases based on therapists’ feedbacks, public complaints, Department of Health direction and provincial COVID-19 cases/outbreaks/situation. Once a new phase is open the therapist decides if they are comfortable to treat or not according to the new Phase.  Any therapist who wishes to treat according to Phase 1 may do so

http://www.cmtnl.ca/wp-content/uploads/2020/05/CMTNL-Back-to-Work-Phases-Updates-9305.pdf

Guidelines for Phase 2

Therapist

  • Self-monitoring for symptoms and overall health prior to treating is imperative to protect your clients, the public and yourself. Each day check temperature and complete a self-assessment before deciding to treat.
  • Treating in the middle of a pandemic with new guidelines, added pressure and risks can be difficult emotionally. Take advantage of resources that are available, take breaks and seek help when necessary.

http://cmhanl.ca, https://www.bridgethegapp.ca/adult/service-directory/

  • Any therapist who feels they are being forced to work in an unsafe environment can contact the CMTNL COVID committee for guidance and assistance.

Client Interaction

  • Clients must be contacted prior to treatment and entering the clinic space to determine if they are experiencing any possible COVID symptoms: cough, fever/signs of fever(temperature of 37.8°C or greater), headache, sore throat, hoarse voice, nasal congestion, shortness of breath, difficulty swallowing   or runny nose. No client with these symptoms should be permitted to enter the clinic space and must be advised to contact 811 to be assessed by public health.
  • Please see COVID-19 Client Screening Guidance document and printable screening report

http://www.cmtnl.ca/wp-content/uploads/2020/05/CMTNL-COVID-Screening-Guidance-Document8884.pdf

http://www.cmtnl.ca/wp-content/uploads/2020/05/CMTNL-COVID-Screening-Checklist8887.pdf

  • Social distancing must be implemented in all areas of the clinic space, between receptionist, other clients and other staff.
  • Clients should be scheduled at least 30 minutes apart, to ensure social distancing and time for proper cleaning/disinfecting.
  • Where possible, invoices are to be sent electronically;
  • Where possible, payments are to be contactless (no cash)
  • Any client in a vulnerable demographic with secondary health conditions, autoimmune conditions, over the age of 60 or resides in a residential home is strongly recommended to forgo treatment due to the increased risk. Clients who decide to proceed with treatment are then making an informed decision

https://www.gov.nl.ca/covid-19/files/Information-for-Adults-over-60-and-Individuals-with-Chronic-Conditions.pdf

  • Treatments should be kept to a maximum of 60 minutes
  • 6 treatments per day is a recommendation to decrease overall exposure
  • Clients must be made aware of precautionary measures prior to treatment. Any client who refuses to comply with these measures can be refused treatment due to safety concerns and not referred to another therapist for treatment. It is strongly recommended that you develop a Risk Communication Plan and Pandemic Preparedness Plan                                 

http://www.cmtnl.ca/wp-content/uploads/2020/05/CMTNL-Risk-Communication-and-Pandemic-Plans8885.pdf

  • Place signage at entrance to ensure anyone with symptoms does not enter your clinic space, any client who arrives to your clinic with symptoms can be refused treatment.

http://www.cmtnl.ca/wp-content/uploads/2020/05/Clinic-ATTENTI0N-Document8889.pdf

Waiting area/Treatment Space

  • Eliminate the waiting room if possible. If that’s not possible, at least, ensure removal of all unnecessary items (Such as: magazines, water dispenser, business cards, pens, etc.) from the waiting area and treatment area to reduce the number of contact surfaces.
  • Client alone should arrive for appointment.
  • Remove all objects that are not easily cleaned between clients (Such as: cushions, rugs, table warmers, slippers, soft chairs and etc.)
  • Vinyl tabletops or headrests with tears must be repaired/replaced before use or must have a plastic covering
  • Proper cleaning and precautions must be taken between clients including disinfecting all surfaces (Such as: doorknobs, keyboards, chairs, table, head rest, lotion/oil bottle, telephones, faucets, debit machine keypads, cash registers, pens, mouse, switches)
  • Soiled linens must be placed in a sealed bag until washed and only handled with gloved hands, where possible use one-time use head rest covers.
  • Blankets/flannels MUST be changed for every client
  • Private bathrooms must be disinfected after each use. Public bathrooms must be disinfected regularly and should have a notice for clients indicating that the bathroom is used by others and asking them to use caution.
  • Use of proper cleaners and disinfectant must be used, such as: diluted bleach prepared according to the instructions on the label or in a ratio of
    • 1 teaspoon bleach (5 mL) per cup of water (250 mL) or
    • 4 teaspoons bleach (20 mL) per litre of water (1000 mL)
    • assuming bleach is 5 % sodium hypochlorite, to give a 0.1 % sodium hypochlorite solution
    • Solution must be allowed to dry for at least 5 minutes to be effective.

*Always use caution when using cleaners and disinfectants, follow recommendation and allow for proper ventilation

https://www.canada.ca/en/health-canada/services/drugs-health-products/disinfectants/covid-19/list.html

https://nlpb.ca/media/Covid19-Hand-washing-Poster.pdf

Personal Protection Equipment (PPE)

  • Clients are required to wear a well fitted face mask that covers their nose and mouth. Homemade masks are permitted if they meet the requirements mentioned. Masks are to be worn for the entire visit.  Therapists reserve the right to provide clients with a mask to wear upon arriving to the clinic.

https://www.gov.nl.ca/covid-19/files/Guidance-on-Cloth-Masks-Non-Medical-Masks.pdf

  • Therapists are required to wear a 3 ply or 2 ply medical mask (Not N-95), homemade masks are not permitted. Masks to be changed changed when taken off once, becomes contaminated, risk of contamination or end of day
  • Therapists are required to wear a form of eye protection such as face shield or goggles while treating or in close proximity (less then 2 ft) to client.
  • Gloves are strongly recommended especially with treatments near the face
  • Those who decide not to use gloves must disinfect hands prior to leaving the treatment room to avoid cross contamination throughout the clinic space AND still must wash hands
  • Use of elbow and forearm skin on skin is permitted with extremely good hygiene practices before and after treatment
  • Clients may refuse skin on skin contact and therapist should include this in their informed consent
  • Therapists must wear a gown/clinic coat/covering/apron(which covers front of body from neck to mid- thigh) that can be changed between clients when becomes contaminated or soiled from client transfer of lotion/oil
  • Extreme caution and proper protocols must be used when removing, washing and discarding of PPE. The area where PPE is put on should be separated as much as possible from the area where it is removed and discarded.
  • Must use 60% alcohol-based hand sanitizer
  • Frequent and proper hand washing remains critical even when using PPE

https://www.gov.nl.ca/covid-19/files/How-to-Safely-Remove-Your-Disposable-Gloves.pdf

https://www.health.gov.nl.ca/health/publichealth/cdc/PPE_Putting_It_On.pdf

https://www.health.gov.nl.ca/health/publichealth/cdc/PPE_Taking_It_Off.pdf

https://nlpb.ca/media/Covid19-Hand-washing-Poster.pdf

Prior to beginning Treatment

The CMTNL is requesting that all Active RMTs sign up with the COVID Committee before beginning treatments.

This new committee has been formed for Active RMTs, so that they may remain in direct contact with the CMTNL to have issues or concerns addressed. The committee will be available to answer questions, provide clarifications and links; Aide with and/or review your Risk Communication Plan and Pandemic Preparedness Plan, compile a list of RMTs available for treatments for the public and provide all Active RMTs with a supply of 50 masks and one face shield complements of the CMTNL. Please see the survey monkey link to sign up with the committee.

http://www.cmtnl.ca/wp-content/uploads/2020/05/CMTNL-Risk-Communication-and-Pandemic-Plans8885.pdf

https://www.surveymonkey.com/r/GP2XQ3H

The College has developed a Covid Q&A sheet to help answer some questions you may have, and we believe this committee will assist us to remain in contact with those treating in order to better monitor the situation and provide assistance. In order to make communication easier and straight forward we ask that you use the new covid@cmtnl.ca email for any questions and concerns.

http://www.cmtnl.ca/wp-content/uploads/2020/05/CMTNL-COVID-19-QA-Document8886.pdf

Failure to follow Guidelines

Failure to follow these guidelines could result in one or more of the following actions:

  • Temporary suspension of practice during the current Phase of Return to work, until the RMT has made the appropriate safety modifications to their practice, as directed by the Support Committee
  • Suspension of practice during entire COVID-19 pandemic Return to Work Phases, if failure to comply with Support Committee occurs
  • Suspension of registration if subsequent failure to comply occurs
  • Investigation of complaint by disciplinary committee, should the Registrar and/or Support Committee deem necessary
  • Report Therapist to the Department of Health and Community Services

Please note that, the CMTNL is aware that the guidelines and phasing schedule may appear to be more rigid and stricter than other professions. However, these guidelines are reflective of the severity of the current situation and are subject to change at any time. It is our opinion that Massage Therapists, given the nature of your very close contact treatments (skin on skin) will be operating at a high risk until the pandemic is over. We would rather be too cautious in order to protect the public. Be aware that as more and new information become available, the guidelines and phases will be updated accordingly. The virus is novel, and the situation is fluid.

This document is not a mandate for Registered Massage Therapists to return to work. If a Therapist cannot safely treat a client according to the guidelines for any reason or if they fear for the safety of their client, family or themselves, the therapist should not return to work. This is fully supported by the CMTNL and Department of Health and Community Services.