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

UPDATE: Nov. 20th to COVID-19 Guidelines

We’ve worked so incredibly hard during this pandemic to keep our therapists and clients safe. 

We have high expectations that our clients will help protect us too!

Running a business at a time like this is a logistical nightmare and we are constantly changing and adapting.

Here are some of our NEW or adapted COVID guidelines:

• regardless of rapid testing therapist who have travelled internationally will not be allowed back to work until 14 days have passed
• regardless of rapid testing clients who have travelled internationally will not be allowed to receive treatment until 14 days have passed
• Back At It will not allow therapists to work with ANY cold or flu like symptoms (despite AHS updated COVID symptoms)
• Back At It will not provide treatments for clients with ANY cold or flu like symptoms
• We will NOT provide treatments for any clients that have been to a social gathering of 15 or more within 14 days.
• We require ALL clients to fill out a COVID survey online 2 hours before their appointment.
• Cancellations due to illness or uncertainty of COVID exposure (primary contact or even secondary) will not be subject to a cancellation fee

The nature of our work is within 2 meters therefore it is imperative that we operate our clinics with extremely high standards. 

We feel that transparency is essential to operating our business. It is important for you the client, to have an understanding on what goes on behind the scenes. We hope that by reading this we will instill confidence in you that we are doing our best to keep you safe.

Safe Practice Guidelines For Back At Therapists:

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.
• 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.
• 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.
• At this time we are NOT offering intra-oral TMJ treatments. Despite association guidelines Back At It will not offer TMJ intra-oral Treatment under any circumstances.

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.

If after reading these guidelines you are not comfortable, then you are not suited to work during a global pandemic.  We support your decision either way.

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.
• Maintain 2 meters distance in the staff room. And wear a mask at all times unless to eat or drink water.
• 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 cold or flu like symptoms Regardless of Alberta Health Guidelines, Back At It’s standard is that no one with cold or flu symptoms may come to work or receive treatments. This is to stop the spread of common cold and flu, which could potentially force more therapists to take time off. We also don’t want our clients to see a therapist with symptoms and question whether or not we are taking this seriously.
• Back At It will not treat clients with ANY cold or flu like symptoms
• If you need to cancel your clients because you are ill. YOU must contact management staff. Management staff will call and cancel all of your clients for you. DO NOT cancel clients yourself.
• Primary Symptoms: If you have any of these primary symptoms, you need to isolate for at least 10 days from the start of your symptoms or until they are gone, whichever is longer, or until you test negative for COVID-19. Cough, Fever, Shortness of Breath, Runny Nose, Sore Throat.
• Secondary Symptoms: Quarantine and limit contact with others until symptoms are gone. Testing is recommended. Stuffy nose, Painful swallowing, Chills, Headache, Muscle or Joint Aches, Feeling unwell or fatigue, Nausea, vomiting, diarrhea or unexplained loss of appetite, Loss of sense of smell or taste, Conjunctivitis, also known as pink eye

• If you have symptoms in the middle of shift you are done for the day, notify management to cancel your day. Sanitize your room and contact the next therapist in the shift so they are aware.
• Regardless of rapid testing therapist who have travelled internationally will not be allowed back to work until 14 days have passed
• Regardless of rapid testing clients who have travelled internationally will not be allowed to receive treatment until 14 days have passed
• Isolate means locked in your room of your house with no contact with anyone. Isolate when: you are sick with fever, cough, shortness of breath, sore throat* or runny nose* and have not been tested.
• Quarantine means stay home for 14 days. This is to limit spread if you have had contact with a positive COVID case, but don’t have symptoms.
• The nature of our work is within 2 meters therefore it is imperative that we operate our clinics with extremely high standards.
• 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. 

You must write the date and a note a client calls/emails to cancel in the client’s profile in “Notes” So we can track  if a client has symptoms or is waiting for COVID test results.

Clients Have Been Provided With This Info:

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

• A phone call must be made to EVERY NEW client to COVID prescreen prior to entering the clinic.
• Our online Jane system automatically emails clients 2 hours before appointment time to fill out self assessment form.
• Therapist MUST check that waiver has been filled out online EVERY treatment. If not a paper COIVID waiver must be filled out upon arrival.
• Client’s must always wear a mask. If they have trouble breathing while prone they are allowed to remove mask off of mouth. When supine client must wear mask and hand sanitize again.
• We ask the client to: Only come into the clinic five minutes before appointment (or wait outside or in car)

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.

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.
• COVID-19 Screening Waiver: Have client date and sign EVERY treatment.

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 are MANDATORY for therapists. Reusable masks are not allowed to be worn by therapists in the clinic.
• Masks for clients are mandatory.
• Clients refusing to wear masks will be refused treatment.
• 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.

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. 
• Dry your hands with the 1 time use small towels or paper towel

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 – A bleach solution will be used to clean floors. 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:

1. WASH YOUR HANDS.
2. Wash cup/tool with warm/hot water and dish detergent to remove oil (as you normally would). 
3. Place cup/tool in bleach solution for 1 minute (management will provide specific instructions for measuring bleach/water solution).
4. Remove cup/tool (with tongs) and place in the rinsing container (management will supply).

           Set the rinsing container to the side. 

5. Rinse remaining bleach solution from cups/tools in the sink with warm water.
6. Cups/tools can either air dry on a paper towel or can be dried with a paper towel. 
7. Spray Disinfectant in and around the sink and wipe down after use. 
8. WASH YOUR HANDS.

Waiver/Screening

• All clients MUST sign a waiver EVERY visit. Waivers are emailed to the client 2 hours berfore appointment. 
• Completed waivers are found in Jane charts
• Waiver that have not been filled out online must be filled out on paper found on clipboard by the front desk. BRING clipboard to client after they have sanitized their hands 
• Disinfect clipboard and pen every time.
• 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 a plastic sheet OR covered with a 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.
• All tables have a plastic top cover over table heaters that MUST be disinfected between each client

 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.

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 management immediately.
• We will provide all of the necessary information for contact tracing from JANE (our online booking system), the Therapist Self Assessment Form and the client waivers . 
• AHS will contact all of the necessary persons exposed to COVID-19:
  • By law, you must self-isolate for at least 14 days, even if you do not have any symptoms.
  • If you get any symptoms, you must stay in self-isolation for 10 days after your symptoms appear. 
  • Anyone who has been in close contact with you must also, by law, self isolate for at least 14 days and watch for symptoms. 
• We will stay in close contact with our therapists and clients regarding their health, mental health status and return to work protocols.