Safe Practice Guidelines For Back At It During COVID-19 Pandemic

Safe Practice Guidelines For Back At Therapists During COVID-19 Pandemic

Association/College Guidelines

Each association has separate guidelines. Our clinic currently has 6 associations, of which, we have been reading and reviewing their individual guidelines. We have spent numerous hours contacting associations to determine if the guidelines are Mandatory vs Recommended. If you have any questions or concerns that Back At It’s Safe Practice Guidelines are not matching your association’s guidelines, please talk to us.

Additional Rules 

• No Group bookings at this time, please ask to book individually online so each person can read & sign the COVID-19 waiver.
• We will accept our usual methods of payments. If handling cash please wash hands directly after handling the cash. 
• Your thoughts on covid and safety may be different than your colleagues and clients. You MUST be considerate of others around you.
• If you are concerned about clothes during your shift, wear an apron or scrubs.
• Therapists MUST ask clients if their contact information is up to date in JANE-in the event that a patient who has visited the clinic in the last 14 days has tested positive for COVID-19.
• Ask Client’s NOT to sit in chairs, if clients need to sit on a chair (old age, injured clients, or acupuncture/naturopathy consultations) please put a sheet on the chairs in treatments rooms-wash after each client.
• Clients must put clothes in bins in the treatment rooms. Bins must be sanitized after each client.
• Daily records to be signed and dated at the start and end of shifts- ‘Therapist self assessment’ and ‘Disinfecting Report’.
• Call to EVERY NEW client to check in and screen prior to entering the clinic.
• Don’t clean another therapists room or help each other with changing sheets-The less cross contamination the better.

Disclaimer

YOU need to know we have gone over every scenario that our procedures are based on, assuming clients do NOT have COVID-19. Pre-screening with a phone call for first time clients, signing waivers every treatment from clients and therapists, extensive NEW hand hygiene & disinfectant protocols & changes in scheduling is our due diligence, however unknown circumstances could arise. We understand that this plan is not fool proof and we cannot fully guarantee that these guidelines will cover every scenario and 100% protect you from transmitting or contracting COVID-19. If you are unclear about any policies or procedures just ask for clarification.

During Therapist Shifts

• Do not arrive to work earlier than 30 min before your shift to avoid overlap in the staff room.
• Avoid more than 3 people in the staff room: if more, then wait in your treatment room.
• Do not let more than 1 therapist and 1 client near the front desk post treatment: at the end of treatment ask the client to crack the door to indicate they are ready, and wait till the therapist comes to get them.
• Do not take up time at the front desk to rebook, take laptop into room to rebook clients. 
• When treatment ends ask client to crack the door open slightly when they are ready and that you will come and get them to proceed to waiting room. Do your homecare and re-booking appointments on the computer/laptop in the treatment room (IF CLINIC IS BUSY).

Sick Protocol

• Contact 811 and walk through the protocols whether or not you should be COVID-19 tested.
• DO NOT come to work if you have any of the following signs or symptoms:

1. Dry cough
2. Fever
3. Sore Throat
4. Difficulty Breathing

• If you present with any of the following symptoms you must self isolate for 10 days Or if you did test positive for COVID-19 you must follow self-quarantine rules set by Alberta Health.  If you have symptoms in the middle of shift you are done for the day, notify V,R,A to cancel your day. Sanitize your room and contact the next therapist in the shift so they are aware.
• If you have a condition that has similar symptoms as COVID-19 such as allergies, asthma, sinus infection, you must contact your doctor to get a note. 

Therapists Must Self Assess Each Shift, Upon Arrival To The Clinic

• Sign and date ‘The Therapist Self Assessment Form’ each shift indicating the therapist has self assessed and does not have any COVID-19 symptoms.
• If you have a condition that has similar symptoms as COVID-19 such as allergies, asthma, sinus infection, you must contact your doctor to get a note. 

Client Cancellation Policy

For no-shows where there has been no contact from the client, then $50 charge applies. If a client calls last minute because of symptoms/sickness, NO cancellation fee. 

We will have a log sheet of clients who cancel due to illness that must be dated and filled out, the client will not be allowed to rebook until they have self isolated for 10 days and produce no symptoms. Please put a note in their file in Jane as well. Please read that list often and check in Jane before your shift to make sure your client did not call in sick and rebook 2 days later. 

In The Reminder Email, Clients Have Been Provided With This Info

We have taken some measures to keep our patients and therapists safe:

Sanitization: We have created a clinic-wide policy with new disinfecting rules. 

PPE: Our therapists will be following the guidelines set by Alberta Health and associated associations. 

Therapist Self-Assessment: To ensure that our therapists are healthy and safe to come to work, all therapists will be filling out a ‘Self Assessment Form’ each shift.

Decrease Traffic: To minimize the number of people in the clinic we have increased the time between each appointment. We have also set the therapists schedule to minimize cross over of therapists and clients.

Possible Rescheduling: There may be some rollbacks if further surges of COVID-19 are noticed, which may result in rescheduling or cancellations.

What We Need From You

1. Only enter the clinic if you have an appointment.

2. Please do not bring other individuals with you to your appointment.

3. Wearing a mask is Mandatory. Back At It will supply you with a mask if you do not have one.

4. Only come into the clinic five minutes before your appointment (or please wait outside or in your car).

5. Only come for your appointment if you are symptom-free and have cleared the COVID-19 screening questions.

When Client/Patient Arrives

• Direct them to the hand sanitizer as soon as they enter or you enter in the office/waitroom.
• Shoes-clients can leave their shoes in the waiting room or wear them into the treatment rooms. Whatever they are comfortable with.
• COVID-19 Screening Waiver: Have client date and sign EVERY treatment.
• Ask patients to bring & wear their own face masks. (This is indicated when they book the appointment). If they arrive without one we will provide a mask. Client masks are mandatory. Enter the building wearing a mask. If client has difficulty breathing while face down during treatment, the mask may be removed. When client turns onto their back please put your mask back on and then the therapist will provide client with hand sanitizer. (this information is provided by Alberta Gov.)

Product

• A sign is on Product shelves “Do Not Touch, please ask a Therapist to help you”
• Clients must not touch products. All testers will be removed. If they want to purchase a product they must ask the therapist for help.

MANDATORY PROCEDURES

Face Mask Protocols 

• Surgical masks – MANDATORY
• ALL therapists MUST complete Alberta Health’s PPE online course.
• Masks for clients are mandatory. Enter the building wearing a mask. If client has difficulty breathing while face down during treatment, the mask may be removed. When client turns onto their back please put your mask back on and then the therapist will provide client with hand sanitizer. (this information is provided by Alberta Gov.)
• If a client says ‘I am comfortable if you don’t want to wear a mask (Or PPE). We must say ‘I see a lot of people in a day, I will keep it on thanks’. We would be liable if we did not have mask protection. If there is an outbreak we can confirm BAIM took all of the precautions to prevent spread.
• Wash hands before putting on and immediately after taking off the mask. 
• Ensure a snug fit over the nose and under the chin. 
• Wear the mask with the moisture-absorbing side against the skin. 
• Change the mask when it is moist or soiled. 
• Only touch the elastic or ties when removing the mask. 
• Do not wear the mask around the neck. 
• Discard single-use masks in a waste container that has a garbage bag.

If a client is hearing impaired and relies on lip reading, plastic masks will be available.

Hand Washing Protocols 

• As soon as you enter the clinic wash hands.
• Wash hands for 30 seconds minimum – this is MANDATORY.
• Before handling PPE equipment.
• Before entering the treatment room.
• Anytime the therapist is between treatments and goes back into the treatment room.
• After treatments.
• After the patient/client has left the front desk area.
• After moving soiled sheets from the laundry basket into the washing machine. 
• You can use the grey hand towels to dry your hands, one time use. If no gray towels use disposable paper towels. 
• The micro fiber cloths are ok to use to sanitize/clean. They must only be used once and then washed on high temps OR use a paper towel and dispose after one use. (As per the Public Health Agency of Canada).

Disinfecting Protocols

• Sign and date the ‘Disinfecting Report’ at the end of each shift.  
• Disinfectant is approved by health Canada (8 digit DIN number) or 100ml of bleach to 900ml of water.
• There will be hand sanitizer and liquid disinfectant in all of the rooms, laundry room, front desk and office. 
• There will be sanitizing wipes in the laundry room and front desk.
• Do NOT fill the disinfectant bottles. This will be taken care of by Van, Rob, Ash. 
• END OF SHIFT MOP – All staff MUST wear footwear during treatment and around the clinic.  
• After shift, wash blanket, and replace with spares. 
• SPRAY on paper towel/Microfiber cloth and then wipe – Do NOT spray on the object and then wipe.
• Acu and Naturopath must clean with “double wipe’ technique.

Mandatory Disinfecting Checklist Between Clients

• Front door knob
• Waiting room door knob
• Treatment room door knob
• Light switch
• Surface of any counter top
• Face cradle chin bar
• Treatment table
• Plastic pillow cases must be wiped
• Bolster
• Stool
• Lotion/Gel/Japanese mint oil bottles
• Check floor under face cradle for saliva/drool, please use disinfectant and wipe with paper towel
• Front desk
• POS terminal
• Key board, mouse
• Ipad/Laptop after use
• Counter around sink
• Sink taps
• Bin for client’s clothes
• The phone after use

Laundry

• As per normal laundry-washer & dryer must be on HIGH HEAT – above 60 degrees.
• After moving soiled sheets from the laundry basket into the washing machine, wash hands.
• Wash hands before removing laundry from the washer and dryer.

Cupping/Tools

• Using cups/ tools will be up to the therapist during this time.
• We will need to disinfect the cups/tools with BLEACH after every client.
• Glass cups will be fine but any plastic cups/tools will start to break down over time so it is up to the therapist if they want to sacrifice a set of cups/tools to the Corona monster.
• If you don’t already have one, please get a small plastic/glass bowl or container to place soiled cups in so you can transport them from your treatment room to the back sink (something that you can disinfect when done).
• PLEASE DO NOT dump all of your soiled cups in the sink to clean, instead, keep them in your container and clean one by one.
• Dry cups with PAPER TOWELS only.

Cup Cleaning Procedure:

Front Door Protocol

• Canmore – front door of the clinic heading into the waiting room will be propped open. 
• Banff- Waiting room door left open as per usual. Treatment side door closed but sanitized after EACH client. 

Waiver/Screening

• All clients MUST sign a waiver EVERY visit. Waiver will be on a clipboard by the front desk. BRING clipboard to client after they have sanitized their hands 
• Disinfect clipboard and pen every time.
• Signed waiver will be filed by date into a dedicated binder immediately, don’t leave these hanging around.
• Call to EVERY NEW client to check in and screen prior to entering the clinic.

Treatment Room Chairs

• Chairs in tx rooms must be covered by an apron or sheet and changed and washed after each client. 

Treatment Tables

• Blankets can be used on the tables BUT must ensure the sheet is folded over the blanket at the top. Use your own discretion if they must be changed.
• No face fuzzies on face cradles. 
• No fitted sheets.
• Tables disinfected after each client.
• Heating pads can be used-it must be covered with a pillow case and washed after 1x use.

 Receiving Payment

• Encourage clients to use Payfirma payment or Tap credit card.
• Cash payments are acceptable BUT you must wash hands immediately after touching cash.

Extra PPE if Use is Preferred or Necessary 

by Association 

Disposable Gloves

• Massage: NO Disposable gloves are not mandatory during treatments.
• ND: Required to wear gloves when in direct contact with clients.
• ACU: NO. Disposable gloves are not mandatory during treatments. Acupuncturists must practice routine hand hygiene consistent with Alberta Health Services 4 Moments of Hand Hygiene as per their association guidelines.

Aprons/Scrubs

• ND: Not required for ND-unless working with a patient population where this would be appropriate.
• Massage: NO.
• ACU: NO.
• If you choose to wear an apron- it goes on once you collect your client. Stays on until you finish treatment, take off before washing hands.

Eye Protection

• ND: Not required, unless working with a patient population where this would be appropriate.
• Massage: Recommended for massage but not mandatory.
• ACU: Not required.
• If you choose to wear eye protection-glasses, they should go on once you collect your client. They stay on until you finish treatment, take off before washing hands, disinfect, then set down to dry.
• Cleaning Process for Those Choosing to Wear Eyeglasses:

• 1 minute in bleach solution.
• Rinse with water.
• Dry with paper towel.
• Leave cleaned glasses on counter to let the bleach fumes/smell dissipate. 
• Grab a new pair of glasses for next client. 

Temperature Taking

• ND: NO 
• Acu: NO
• Massage: NO

Protocol If Client Or Therapist Has Tested Positive For COVID-19

• We will be contacted by Alberta Health Services (AHS) or the client/Therapist directly. Direct this person to Vanessa or Robyn immediately.
• The clinic will be closed immediately for a thorough clean & disinfecting. All treatments will be cancelled. We will resume operations 48 hours later. 
• We will provide all of the necessary information for contact tracing from JANE, the Therapist Self Assessment Form and the client waivers.
• AHS will contact all of the necessary persons exposed to COVID-19:

1. By law, you must self-isolate for at least 10 days after the test, even if you do not have any symptoms.
2.  If you get any symptoms, you must stay in self-isolation for 10 days after your symptoms appear. 
3. Anyone who has been in close contact with you must also, by law, self isolate for at least 14 days and watch for symptoms. 

• As per AHS: Any Albertan who wants to be tested can now be tested, even if they don’t have symptoms. Symptoms & Testing. However, even if your results are negative, you must stay on self-isolation for a full 14 days and monitor for new symptoms. 
• We will stay in close contact with our therapists and clients regarding their health, mental health status and return to work protocols.