PANDEMIC PRACTICE PROTOCOLS FOR MASSAGE THERAPISTS AND WHOLISTIC PRACTITIONERS

These protocols are in place to help mitigate some of the risk in providing treatment during the COVID-19 Pandemic and to support the health and safety of practitioners, clients, and co-workers.

This guidance document has been prepared based on the information from Health Canada and Nova Scotia Public Health. It includes both mandatory provincial health and safety measures and recommendations MTWPAM have developed and adapted after surveying and consulting with our association and submitting these protocols to the Government of Nova Scotia for approval.

Although MTWPAM has done its best to provide accurate, up-to-date information and recommendations, ultimately massage therapists remain responsible for ensuring that their practices and treatment processes are done safely, and in accordance with any current or future Public Health Orders and mandatory health and safety practices. MTWPAM is not liable for any misunderstanding, misapplication or refusal to comply with these protocols, nor for any omissions or errors in these protocols which were made with the best information on hand at the date of creation, June 3 2020.

Mandatory: Practitioners are required to use these protocols in conjunction with the current Public Health Order to develop a site-specific plan for your individual situation and/ or workplace.

Note: Multidisciplinary clinics, settings and spas, should follow a combination of best practices from all sectors working in the same business.

1. GENERAL INSTRUCTIONS

• Be familiar with and adhere to the Public Health Order -- at all times -- inside your workplace and in your daily life: Nova Scotia: Public Health Directives.
• Check your email and association website daily to stay compliant with any changes to the protocols that may occur.
• Refer to these Nova Scotia specific Public Health guidelines for re-opening that apply to all health care settings:
• • Re-Opening Guidance for Healthcare Settings (PDF: May 27th, Updated June 03rd)
  • Communicable Disease Prevention and Control
• Keep a physical distance of 2 meters/ 6 feet between yourself and clients and others at all times when not providing client care.
• Staff and clients should not come into the workplace if they are feeling unwell. They should stay home and use the 811 online assessment.
• A registry of all people entering the clinic should be kept to aid in contact-tracing if required. This would include people in the clinic aside from patients (e.g. couriers, guardians accompanying a patient, etc.). This is not an open sign-in book and should be kept and managed privately by the clinic. This registry must be kept while this directive remains in place.
• When a client is paying for their service, contactless payment and billing is preferable when possible. Some options for this include:
• • Interac/Debit tap options;
  • Online payment options;
  • Direct billing when applicable;
  • Emailing the client a copy of their receipts;
  • Wash your hands after handling payments, receipts, or money to/from a client; and,

Additional guidelines for employers/businesses:

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.

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2. PUBLIC HEALTH REQUIREMENTS

Re-opening Guidance for Health Care Services Settings

Updated Guidance - Prepared May 27, 2020 (updated June 03, 2020)

The following is guidance to support the re-opening of access to previously restricted health care services. All health care services providers must continue to take measures as outlined by Nova Scotia’s Chief Medical Officer of Health.

• Virtual care through telephone or video consultation should remain the first choice to protect health care professionals, staff and patients. Screening should occur prior to any in-office care.
• If an in-person visit is deemed essential for care, consideration should be given to planning an initial virtual care visit with patients prior to the in-person visit. This will ensure that patients are only seen in-person for the portion of their care that requires direct assessment.
• Screening for the current presence of COVID-19 symptoms or exposure to someone who tested positive for COVID-19 in the past 14 days should happen prior to any in-office care. Ideally, this should be done virtually before the patient comes to the office. Patients should also be informed of public health measures within the office space prior to arrival.
• A suggested way to screen patients virtually is to have patients complete the 811 online assessment before they come to the office: https://when-to-call-about-covid19.novascotia.ca/en
• If screening is done in another manner, any patient who currently has one or more of the symptoms compatible with COVID-19 should be directed to call 811 to arrange for COVID-19 testing. An in-person appointment should not be booked until testing for COVID-19 is negative.
• Anyone who arrives for an in-person office appointment and is experiencing COVID-19 symptoms should immediately be asked to wear a surgical/procedure mask and isolated in a space within the office away from others. Patients should be referred to 811 to arrange for COVID-19 testing.
• To facilitate potential Public Health contact tracing, health care services settings should maintain a client and staff registry documenting patient/staff names, patient/staff contact information, date and time of patient visit and staff work schedules.

Health care professionals and office staff must stay home if they are ill or experiencing symptoms compatible with COVID-19.

• All  health care professionals and staff must self-monitor for symptoms.
• If a health care professional/ staff develops symptoms of COVID-19 in the workplace s/he must immediately apply a surgical/ procedure mask and be excluded from work. The individuals should be directed to call 811 to arrange for COVID-19 testing
• Adjust absenteeism policies to enable staff to stay home when ill, in quarantine (self-isolation), or if they are taking care of children or someone who is ill.
• Ensure plans are in place for increased worker absences due to illness or isolation.
• Consider posting accessible signage to discourage staff/ patients with symptoms of or exposure to COVID-19 in the past 14 days from entering the office.

Promote and facilitate personal public health measures. Everyone plays a part in making the office space and clinical assessment areas safer, including employers, staff, patients, and all others who interact with workplaces/businesses.

• Keep staff informed about public health advice applicable to your office.
• Promote the use of individual measures (e.g. frequent hand hygiene, avoid touching face, respiratory etiquette, disinfect frequently touched surfaces).
• Post signage to remind staff/ patients to practice good hygiene that is appropriate for the staff/ patient age, ability, literacy level and language preferences.
• Provide increased access to handwashing facilities (e.g. by placing hand sanitizer dispensers in at office entrance, treatment room entrances and at reception desk) and ensure accessibility for staff/ patients with disabilities or other accommodation needs.
• Promote, at a minimum, twice daily increased environmental cleaning of staff work environments (e.g. provide sanitizing wipes so staff can clean their own workspace).
• Ensure all external service providers and suppliers adhere to provincial COVID-19 health and safety requirements when entering your office. Implement strategies to maintain physical distancing and hygiene practices. Physical distancing is 2 metres or 6 feet.
• Masks are *not* a substitute for physical distancing but are considered a mitigation strategy when performing a procedure.   
  

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Promote physical distancing (keeping a distance of 2 metres/ 6 feet from others), which is proven to be one of the most effective ways to reduce the spread of illness.

• Reinforce general practices to maintain physical distancing, such as avoiding greetings like Handshakes.
• Establish 2 metre/ 6 feet separation between staff (e.g. desks).
• Schedule in-person appointments in a way to limit the number of people within waiting rooms in keeping with a separation of 2 metres/6 feet. Physical distancing is 2 metres or 6 feet. 
• Masks are not a substitute for physical distancing but are considered a mitigation strategy when performing a procedure.
• Alternative solutions to waiting in the office should be considered, such as asking people to wait in vehicles and text messaging or calling when appointments are ready.
• Use visual cues (i.e. floor markings) to promote 2 metre/6 feet physical distancing to establish directional flow throughout the office space.
• Seats in waiting areas must be spaced to maintain a minimum physical distance of 2 metres/6 feet. Household contacts are not required to sit separately.
• Identify a space where staff or patients can be isolated from others if they have symptoms of COVID-19.
• Install physical separations between staff at reception/patients (e.g. physical barriers like a plexiglass window).
• Offices that have lab, diagnostic and ancillary services within their clinic should consider pre-booked appointments and other measures to maintain public health requirements for physical distancing.

Health care professionals should understand indications for the use of medical and non-medical masks.

• Non-medical masks can be considered in the workplace if a physical barrier (e.g. plexiglass at reception desk) is not in place or if physical distancing of 2 metres/ 6 feet cannot be maintained. Physical distancing is 2 metres or 6 feet.
• Masks are not a substitute for physical distancing but are considered a mitigation strategy when performing a procedure.
• Non-medical masks are recommended for individuals in the community while travelling to access health care services and experiencing symptoms or if they will be in close contact with others while symptomatic.
• Consideration should be given to the use of a non-medical mask by anyone in situations when exposure to crowded public spaces is unavoidable and consistent physical distancing is not possible. Health care professionals may want to consider non-medical mask use for patients and accompanying support persons as a requirement in the office setting.
• Information regarding appropriate use of non-medical masks may be found through the Public Health Agency of Canada’s website.
• Surgical/ procedure masks should be considered in the workplace for all health care professionals and staff providing direct patient care.

Reduce risks from exposure to high-touch surfaces (i.e. surfaces frequently touched by others).

• Reduce the number of common surfaces that need to be touched (e.g. no-touch waste containers).
• Offer contactless payment methods (i.e. avoid use of cash), if possible.
• Non-essential items should be removed from patient waiting areas, including magazines, toys, and remote controls.
• Clean and disinfect essential shared equipment (medical and non-medical) before and after use.
• Commonly touched areas should be cleaned and disinfected at least twice daily or whenever visibly soiled. Commonly touched areas include light switches, door handles, toilets, taps, handrails, counter tops, touch screens/ mobile devices, keyboards, reception counters, seating areas (including clinic room seats) and objects or machines used in therapies.
• Wherever possible, discourage staff from sharing phones, desks, offices and other tools and equipment. If not possible, clean between use and at the end of the day.
• Cleaning and sanitizing information is available at: https://novascotia.ca/coronavirus/staying-healthy/#clean
• Staff should be provided access to tissues, no-touch trash receptacles, hand soap, alcohol-based hand sanitizers approved by Health Canada (DIN or NPN number), disinfectants and disposable towels.
• Limit the exchange of papers. If documents must be exchanged, leave them on a clear surface while maintaining a 2 metre distance. Avoid sharing pens and office equipment. Disinfect after each use.

Source: https://novascotia.ca/dhw/cdpc/documents/Re-opening-Guidance-HCP.pdf

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Hygiene, Cleaning and Disinfecting

Keep Your Hands Clean

• Wash or sanitize hands often, particularly:
• Before and after preparing or eating food.
• • After touching pets.
  • After handling waste or dirty laundry or using the bathroom.
  • Whenever your hands look dirty.
• Washing your hands with soap and water is best.
• Rubbing your hands together when you wash them removes visible dirt and germs.
• Disposable paper towels are best for drying your hands if you have some. If not available, use a reusable towel that gets washed often.

If soap and water are not available, and your hands are not visibly dirty, use an alcohol-based hand sanitizer with at least 60% alcohol. Use enough to cover the fronts and backs of both hands and between all your fingers. Rub your hands together until they feel dry.

Cough and Sneeze Etiquette

Cover coughs and sneezes with a tissue. Throw the used tissue in the garbage and wash your hands or use an alcohol-based hand rub immediately.

• If you do not have a tissue, cough and sneeze into your elbow, not your hand.
• Avoid touching your eyes, nose and mouth. If you need to touch your face, wash your hands first.

Cleaning and Disinfecting

• Viruses can live on surfaces for several days. You can reduce the number of germs and reduce your risk of infection by cleaning and disinfecting every day.
• You should clean the surfaces and objects you touch most frequently at least once a day, or more if needed.
• Clean and disinfect things like doorknobs, light switches, railings, toilets and tabletops every day. Wash with soapy water first. Then disinfect with household cleaning products, following the directions on the label.
• If household cleaning products are not available, you can make a diluted bleach solution following the instructions on the bleach label. Or you can make a solution 5 mL of bleach per 250 mL of water, or 20mL per litre.
• You need to mix a fresh batch of the bleach mixture every day for it to work properly.
• Disinfect phones, remote controls, computers and other handheld devices with 70% alcohol or wipes.
• Wash or launder clothing, sheets and towels regularly.
• Take your garbage out regularly. Wash your hands after.

Source: https://novascotia.ca/coronavirus/staying-healthy/#clean

How Coronavirus Spreads

Human coronaviruses cause infections of the nose, throat and lungs. They are most commonly spread from an infected person through:

• Respiratory droplets generated when you cough or sneeze.
• Close, prolonged personal contact, such as touching or shaking hands.
• Touching something with the virus on it, then touching your mouth, nose or eyes before washing your hands.
• Current evidence suggests person-to-person spread is efficient when there is close contact. 

Source: Health Canada: Coronavirus Disease (COVID-19): Prevention and Risks

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Client Screening

Please follow the directions for pre-appointment and in-person screening again before treatment takes place.

These Client Screening initiatives are described fully in the Public Health Requirements section. Public Health Directives → Re-Opening Guidance for Healthcare Settings (PDF: May 27th). While recent adjustments have been made for provincial public screening MTWPAM does not advise changing your screening protocols at this time (September 25th)

• Client intake should be done online if possible, at least 3-5 days in advance -- to allow time for any possible COVID-19 symptoms to appear -- and to allow for any necessary cancellation.
• Cancellation fees due to COVID-19 symptoms are strongly discouraged during the pandemic.
• Have a pre-treatment conversation by phone in advance 3 - 5 days before their visit to discuss the reason they are seeking treatment and go over your proposed treatment plan to minimize long conversations in the enclosed treatment room.

The screening questions are as follows:

• Do you have any one of the following symptoms?
• • Pre-existing conditions or co-morbidities?
  • Fever (i.e. chills, sweats)
  • Cough or worsening of a previous cough
  • Sore throat
  • Headache
  • Shortness of breath
  • Muscle aches
  • Sneezing
  • Nasal congestion/runny nose
  • Hoarse voice
  • Diarrhea
  • Unusual fatigue
  • Loss of sense of smell or taste
  • Red, purple or bluish lesions, on the feet, toes or fingers without clear cause

Inform the client during the pre-assessment screening of the new policies and procedures in place at your practice so they are prepared when they arrive.

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Use of Masks

Clients are to arrive already wearing a clean mask of their choice. They should enter the business already wearing their mask. You can email them instructions on how to don/doff their mask safely in the pre-screening phone call/email.

If a client does not have a mask on arrival, please have them sanitize their hands and don a mask that you provide. Maintain physical distancing to remain 6 feet away as they don/doff the mask.

It is mandatory that both practitioner and client wear a mask during the entire appointment.

3. ASSOCIATION SPECIFIC RECOMMENDATIONS

The recommendations below have been developed by MTWPAM with the goal of best protecting the health of massage therapists and their clients.

Supplies and PPE

Masks

• Medical/Surgical grade masks are preferred for therapist use.
• A new mask must be worn for every appointment to avoid bacteria and microbe buildup.
• Masks must be made available for clients who may not have one on arrival.
• Non-Medical masks may be used for therapist or client as long as they are changed after each appointment and promptly laundered.
• Masks are mandatory for both clients and therapists

Clothing/ Coverings

• Washable clothing covering for the therapist that covers any area that may inadvertently come in contact with the client while performing the treatment.
• May be short-sleeved and must come down to below the hips.
• This may be a smock, lab coat, apron or long shirt of your choice as long as it covers any areas that may contact the client or massage table.
• Must have buttons or a zipper to avoid the potential of transferal of viral particles to your face when donning/ doffing.
• A new clothing covering must be worn for each client.

Goggles and Face Shields

• Goggles and/or face shields should be worn when working with clients and must be disinfected between each client.

Gloves

• Gloves must always be available. The practitioner may use gloves if they prefer.
• Please note that gloves do not replace the requirement for proper hand hygiene and must be changed using proper donning and doffing techniques between clients.
• Clients also have the right to request that the therapist wear gloves for the duration of their treatment.

Note on Mask use by Therapists

Therapists may remove their mask when not in treatment as long as they can maintain physical distancing with others in the workplace if they feel comfortable in doing so (so they can breathe naturally).

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Other Specific Items

• Foot-pedal garbage cans must be in every treatment room, bathroom, and waiting room, staff area.
• Solid (no-holes) laundry hampers, with a solid lid for every treatment room, that can be cleaned between appointments:
• • May be lined with a garbage bag or completely cleaned and disinfected after each use.
  • For laundry that must be taken home to wash, tie the bag and place it in your trunk. 
  • Apply the same caution to avoid cross contamination, dispose of the garbage bag immediately after placing your linen in the washer. Wash your hands.
• Tissues must be available throughout the entire space and in each treatment room.
• Hand sanitizer that is 60% alcohol or higher must be available inside the entry to the business, each treatment room, and staff area at all times.
• Sufficient paper towels must be available for drying hands at all sinks.
• Hand towels that get washed and reused are not recommended at this time.

Ventilation of the Treatment Area

MTWPAM strongly believes massage therapists and clients are best protected by practicing in well-ventilated treatment areas until such time as the global COVID-19 pandemic is no longer a threat to health.

• The treatment room must have a sufficient amount of fresh, clean air at all times.
• HVAC systems must be clean and kept in good order.
• Air conditioning and fans that blow air around the treatment room are not recommended without a purification system in place.
• If your treatment spaces are/were hot and stuffy then MTWPAM feels they could lack sufficient air flow and could possibly lead to an increased risk of transmission of COVID-19 or other respiratory issues.

To mitigate this, we recommend all treatment rooms have a Health Canada approved air purifier with a HEPA filter capable of filtering down to a minimum safe level.

MTWPAM strongly recommend a technology such as Aerus ActivePure technology for all treatment settings due to the unavoidable fact that we will be spending a significant amount of time in close contact with our clients in an enclosed space. Physical distancing cannot be maintained and for that reason air cleanliness becomes a need to reduce potential viral load. http://www.beyondbyaerus.com/Site/Products

We do not recommend therapists work in enclosed rooms with poor air circulation and/or lack of windows during the COVID-19 pandemic unless protective air quality devices have been installed in every treatment room or in the central HVAC system to protect the entire workplace. MTWPAM feels this is a public health and safety concern and a health risk to the therapist and the public.

MTWPAM wants to make members and their employers/contractors aware of Occupational Health and Safety Regulation 15 (in particular 15(2)) which addresses an employer’s responsibility to ensure general ventilation requirements are adhered to.

Schedule Management During COVID-19

Client appointments must be scheduled with a 60-minute space between them IF the therapist is responsible for patient billing, increased cleaning protocols, laundry and disinfection. 60 minutes will allow the therapist time to remove used laundry from the room safely, clean and then disinfect all surfaces, take off their protective equipment and replace it with clean PPE, allow them time to complete treatment notes, and allow time for self-care (stretching, hydration, bathroom breaks, snacks, and break from using PPE) throughout the day.

IF the business has a staff member dedicated to the cleaning and disinfecting of the treatment rooms and handling laundry so that the therapist can focus on their treatment notes and PPE procedures 30 minutes between appointments is allowable.

Increased time between clients also allows the air to clear, and cleaning/ disinfection product smells to dissipate.

15 minutes between client appointments is not acceptable for practice during the pandemic as it will lead to human error.

30 - 60-minute spaces will also allow for less chance of clients being in the main areas of the business together and easier staggering of appointments. Clients should not be arriving for treatment at the same time if multiple practitioners are working at the same time.

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The Treatment Room Set-Up

• All unnecessary items must be removed for faster and more thorough cleaning of surfaces.
• Table warmers and fleece pads must be covered with a professional-grade vinyl table cover that can be cleaned and disinfected after every use or must be removed.
• Pillows covered in a vinyl protector.
• New blanket per treatment
• Clean linens may not be stored in the treatment room, they must be kept in a closed cabinet in another area of the business to avoid cross-contamination.
• An empty laundry hamper must be in the treatment room so the used linens can be deposited immediately post treatment. Linens must be rolled up carefully, never shaken, to avoid dispersing particles into the air.
• Each client must have a paper cup or individual receptacle for lotions, creams or oils. Pump bottles, holsters, or squeeze type dispensers can harbor bacteria and pathogens and should be avoided.
• Consider having a large receptacle for client clothing and personal items. This will also be disinfected post-treatment.

The Treatment: How is it Different Now?

Clients may not feel comfortable lying in a prone position with their mask on for very long periods.

Nasal drip can also pose an issue in that their mask would then be considered soiled and require changing.

• Treatment can be adapted by using a side-lying position and the client must wear a mask the entire time they are in the treatment.
• Pillowcase pockets in prone are not recommended as it would require the client to remove and replace their mask, which could possibly spread droplets. (i.e., if they turn their head and cough suddenly with no mask on)

Shortened Treatments and Communication

Therapists may wish to keep treatments short (in the 30 to 45-minute range) as they return to practice in our new way of doing things. This is up to the therapist whether they are an employee or contractor. An employer cannot insist that a therapist perform 60-minute or 90-minute treatments if the therapist is uncomfortable with that amount of client contact. (Strongly recommended)

Client/therapist communication during treatment should be limited to client feedback on pain/pressure/effectiveness and the therapist checking in to make sure the client is comfortable during techniques or to give instructions on positioning.

Use of Specialized Tools (August 31st Amended)

Tools such as hot stones, cups, gua sha, bamboo, warming cabinets, and hot towels are permitted with the following provisions: (Revised)

• Tools should be only be used if they are of a material that can be cleaned and disinfected.
• Tools should be kept in good condition and any tools that are no longer smooth and cleanable should be removed from service as they cannot be cleaned and disinfected properly (if there are cracks or crevices, et cetera).
• Members must thoroughly clean their tools with warm/hot water and soap before disinfecting them with a Health Canada approved solution effective against COVID-19.
• The solution must be left on for the recommended time for full effect.
• Once clean and dry please keep tools stored in a container with a cover until ready for use.
• Do not leave tools out on shelving or counters in the treatment room.

Other Considerations

couples Treatments

“Couples” or multiple-client treatments in the same space are prohibited at this time to preserve physical distancing and client/therapist safety.

Intra-Oral Work

Intra-oral work is contraindicated at this time due to the high-risk nature of being face to face with the client unmasked.

The muscles of the jaw may still be worked on externally in areas the mask is not covering, with gloves, if you are trained in techniques that do not pull the skin (i.e. pin and stretch, myofascial release, et cetera). Only perform this if the client is seeking treatment for this issue and you explain the protocol beforehand.

Remove gloves by carefully peeling them off and immediately wash hands appropriately.

Massage of Face, Scalp and Feet

Massage of the face and scalp is contraindicated at this time. The client mask must stay in place which makes facial massage impractical.

Spending a long time seated at the head of the table is not advisable at this time.

For Foot Massage the therapist may wish to use gloves, or leave the feet until last, and sanitize hands with hand sanitizer immediately after.

Food and Beverages

Water or other drinks should not be provided to clients at this time. Having bottled water on hand to provide them with as they leave to consume outside may be a nice gesture.

A Note on Treating Headache/ Muscle Soreness/ Fatigue

These commonly treated symptoms are on the list for referral to 811.

Use your professional judgement and intake skills to determine if these came on very suddenly, or are chronic issues they have had in the past, or have recently done something that could have possibly caused the symptom, or if there have been other signs and symptoms associated with their current issue.

• A full body ache without cause should always be referred to 811 for assessment.
• Also remember that whenever in doubt, refer out to 811 and have them reschedule at a later date.
• This is for the benefit of their health and for the community.

Post-Treatment Cleaning

• After linens have been removed, wash all surfaces of the table and headrest with warm, soapy water.
• Spray a disinfectant and leave on the surfaces for the recommended time indicated on the label.
• This is a good time to place your linens in the washing machine if one is on-site. See Laundry Protocol.
• Be sure to disinfect any surface that has been touched by therapist or client during the appointment.

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Laundry Protocol

Linens include massage sheets, face rest, covers, pillow cases, bolster covers, hand towels, bath sheets or towels, bath or shower mats, hair wraps, bathrobes, blankets, and any other cloth material used to cover surfaces or cover the client during a massage session.

Soiled linens are defined as any cloth material used during a massage session that makes contact with the client’s skin or hair. Any linen that touches a client’s skin or hair must be properly laundered before use with another client.

• Wear a face mask and gloves and smock while handling soiled items post-treatment. Store these linens in a leak-proof container and/or plastic bag.
• At the conclusion of a treatment, gather up and remove all soiled linens from the session room. Do not leave used linens in the treatment room.
• Do not shake used linens as this may disperse droplets into the air.
• You can add your used smock directly to this load and then wash your hands again up to the elbows.
• Wash linens with detergent in hot water, fabric-safe bleach (or alternative) and dry on the highest heat setting possible for your linens.
• Wash linens promptly at the end of your workday.
• Always wash and/or disinfect your hands after handling used/soiled linens and before resetting your treatment table with clean linens.
• Clean linens are stored outside the treatment room apart from any location where they may come into contact soiled linens (in an enclosed cabinet and/or container to avoid cross-contamination).

Mobile/ Outcall Treatments

• Residential Mobile/ Outcall Treatment is not recommended by MTWPAM at this time. Practitioners are unable to control the cleanliness or disinfection practices at client homes, exposing the practitioner to increased risk of infection.
• At corporate on-site settings practitioners are still subject to the same cleanliness and disinfection protocols as other massage business locations, to the proper management of linens, to pertinent client policies and procedures, and to practitioner hygiene, and PPE requirements.

Populations Susceptible/Vulnerable to Increased Risk of Complications due to COVID-19*

It is the professional opinion of MTWPAM that these populations should not receive full body circulatory techniques such as general swedish massage or deep tissue therapy due to increasing concerns in the medical field surrounding blood clotting issues that could be present if a client was a pre-symptomatic or asymptomatic carrier of COVID-19. This may be seen as an extreme caution, but it is here to protect the public and our integrity as Health care providers that keep the client’s best interests at heart.

For more Information: https://thrombosiscanada.ca/blood-clots-and-covid-19/

We recommend that you use alternative techniques that do not greatly increase circulation if you are trained in these modalities. Please refer these clients to a practitioner that can address their treatment needs in a different way; i.e. chiropractic, physiotherapy, or acupuncture, osteopathy, another therapist.

 Please refer to Health Canada: People who are at High-Risk for Severe Illness

Who is at high risk should they contract COVID 19?*
People with medical conditions including:

• • Heart disease
  • Hypertension (high blood pressure)
  • Lung disease
  • Diabetes
  • Cancer
  • People with weakened immune systems from a medical condition or treatment, such as chemotherapy
  • Older adults
  • Children under the age of 13 and infants (MTWPAM added recommendation)
  • High-risk prenatal clients (MTWPAM added recommendation)

* This provision may be updated as the pandemic conditions evolve.

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For Therapists

• We recommend showering before work and donning clean clothes to go directly to your workplace.
• We recommend leaving work shoes outside of your home upon returning and place your clothes directly into the washing machine and shower again.
• Have hand sanitizer in your car or bag at all times.
• Keep your nails short and hair tied back to avoid touching around the face.
• Remember to take time throughout the day to hydrate and eat.
• Maintain contact with your family doctor and monitor your state of well-being daily.

4. INFORMATION SOURCES AND LINKS

It is your responsibility to review the following resources before resuming practice and to check regularly for updates during this pandemic:

q  Nova Scotia: Health Protection Order - What it means for Nova Scotians.

q  Nova Scotia: Preparing to Reopen Nova Scotia

q  Nova Scotia: Occupational Health and Safety Guidance

q  Nova Scotia: Stay Healthy (Cleaning Disinfection and Hygiene Protocols)

q  Nova Scotia: Signs and Posters

q  Health Canada: Vulnerable populations and COVID-19

q  Health Canada: People who are at High-Risk for Severe Illness

q  Health Canada: Risk Informed Decision-Making Guidelines for Workplaces

q  Health Canada: Canada COVID-19 Statistics Dashboard

q  Health Canada: Hard-Surface Disinfectants and Hand Sanitizers (COVID-19)

q  Health Canada: Personal Protective Equipment and Medical Supplies

q  Health Canada: Video Presentations: Using Non-Medical Masks, Gloves, Hand-washing Videos…

q  World Health Organization: COVID-10 Pandemic Portal

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5. Amendments

Number	Section	Page	Section Title	Amended	DHW Approval
01	03	13	The Treatment: How is it Different Now?	08/24/2020	08/30/2020

Location in Document:

Use of Specialized Tools

Amendment Text

Amendment to Pandemic Protocol for the use of tools (such as those used in Cupping, Stonework, Gua Sha, IASTM, et alia). MTWPAM is removing the recommendation to avoid the use of tools as Fomite (surface) Transmission risk has been identified as a lower transmission concern than originally thought. ______________________________________________ Tools such as hot stones, cups, gua sha, bamboo, warming cabinets, and hot towels are permitted with the following provisions: (Revised) Tools should be only be used if they are of a material that can be cleaned and disinfected. Tools should be kept in good condition and any tools that are no longer smooth and cleanable should be removed from service as they cannot be cleaned and disinfected properly (if there are cracks or crevices, et cetera). Members must thoroughly clean their tools with warm/hot water and soap before disinfecting them with a Health Canada approved solution effective against COVID-19. The solution must be left on for the recommended time for full effect. Once clean and dry please keep tools stored in a container with a cover until ready for use. Do not leave tools out on shelving or counters in the treatment room.

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