What further education has been completed by the RMT in preparation for reopening the clinic?

RMTs must obtain appropriate training on safely using and disposing of PPE, related to droplet and contact precautions by completing the resources offered by Public Health Ontario’s “Infection Prevention and Control (IPAC) Fundamentals” that include: 10 Core Competency Modules and Hand Hygiene E-Learning.

Will RMTs be screening clients virtually for risk of COVID-19?

Before accepting an appointment, the RMT will screen the client virtually for risk of COVID-19. If the client does not pass this basic COVID-19 screening, the RMT cannot provide treatment, regardless of the rationale. The RMT will advise the client that they should self-isolate and complete the online self-assessment tool before calling their primary care provider or Telehealth Ontario at 1-866-797-0000. This information will be documented in the client health record and the RMT will not treat the client for at least 14 days, until the client is asymptomatic, and has been cleared by their primary care provider or Telehealth Ontario of any concern of COVID-19.

Are RMTs required to wear masks while providing Massage Therapy treatment?

Yes, RMTs are required to wear surgical/procedure masks while within two metres of clients including while providing treatment.

CMTO requires that RMTs wear surgical/procedure masks due to the risk of COVID-19 transmission during Massage Therapy treatment.

RMTs and clients are not able to physically distance (stay two metres away from each other) during Massage Therapy treatment, and Massage Therapy treatment often involves the RMT working closely with the client in a way that would allow smaller respiratory droplets to suspend and accumulate in the air and larger droplets to fall onto the client (or vice versa) both of which create a higher risk of transmission. Government and public health organizations have indicated masks should be used when two metres of physical distance cannot be maintained, even if all parties have screened negative and do not have any COVID-19 symptoms.

Masks will be changed after each client and will be changed whenever wet, damaged or soiled. RMTs must wash their hands before and after touching, adjusting, putting on, or removing their mask.

Are clients required to wear masks during treatment?

In accordance with the Ontario Ministry of Health’s recommendation to wear masks whenever physical distancing is not possible, the RMT must instruct the client to come to the appointment wearing a clean disposable or reusable mask to be worn throughout the treatment. RMTs may also (if PPE supplies permit) provide a surgical/procedure mask to be used by the client during treatment. In either case, the RMT will advise the client how to properly put on and take off the mask to limit possible transmission of COVID-19. Even if the client arrives wearing a mask the RMT, as a healthcare professional, should show the client proper procedures for future use.

If the client cannot wear a mask (e.g. due to a health condition or difficulty breathing), the RMT must use their professional judgement to assess the risk of providing or continuing treatment. If the RMT determines it is not safe to provide treatment without the client wearing a mask, the RMT can refuse to treat the client. The RMT must clearly document this in the client health record.

What types of masks are acceptable for RMTs to wear?

RMTs will wear surgical/procedure masks approved for medical use. These masks are manufactured using multiple layers and designed to prevent droplet contamination of the environment from the wearer in a medical setting. They also may provide some protection for the wearer from inhalation of droplets and particles. COVID-19 is spread primarily via droplets.

What types of gloves are acceptable?

RMTs do not need to use gloves for most treatments. Glove use is not a substitute for proper hand washing. Hand washing is an extremely important measure in preventing the spread of COVID-19.

If gloves are used (for example, during treatments that pose a higher risk of transmission, such as intraoral treatments), the gloves should be single-use non-sterile nitrile or latex examination or medical gloves. These gloves are an effective barrier for disease transmission, are durable enough for manual work, and provide a fit that allows for high dexterity.

Latex gloves should only be used with water-based topical products and when the client and RMT do not have a latex allergy or sensitivity.

Nitrile gloves can be used for all clients with oil or water-based topical products.

Vinyl gloves are not recommended because they may not be durable enough for manual work.

Can RMTs wear cloth masks?                  

No, RMTs should not wear cloth masks when within two metres of a client or during treatment. COVID-19 is spread primarily via droplets. Cloth masks may be significantly less effective at containing droplets than surgical/procedure masks, particularly when damp or moist. They are also significantly less likely to protect the wearer against inhalation of droplets or particles.

What level of hand hygiene will be incorporated into the practice?

RMTs will ensure the client washes or sanitizes their hands using approved Health Canada (alcohol-based sanitizer at 60%-90% alcohol) upon arrival and after treatment.

RMTs must thoroughly wash their hands (including forearms and elbows) with soap and water before each treatment.

What type of cleaning and disinfecting agents will RMTs use?

RMTs must use products approved by Health Canada by cross-referencing the Drug Identification Number (DIN) on the product container with the list on the Health Canada website.

The Ontario Government has provided clear visible signage to be displayed at all entrances and within the practice environment that outline the signs and symptoms of COVID-19, what to do if one is at risk, and how to limit transmission (i.e. hand hygiene, physical distancing and safely covering coughs and sneezes).

What will RMTs be cleaning and disinfecting prior to and after an appointment?

Cleaning removes visible soiling, while disinfecting uses chemicals to kill germs once a surface is cleaned. A “wipe-twice” method (wipe once to clean, wipe again to disinfect) will be used to both clean and disinfect surfaces.

RMTs must only use products approved by Health Canada by cross-referencing the Drug Identification Number (DIN) on the product container.

In addition to routine procedures, high-touch surfaces will be cleaned and disinfected at between every client, and when visibly soiled. High touch surfaces include: doorknobs, light switches, washrooms including toilet handles, counters, handrails, arm rests, and electronics etc.

The treatment room and its equipment will be cleaned and disinfected after each use and between clients. The RMT will pay special attention to the container of topical products (e.g. lotion bottle), stool and the massage table. Continued cleaning and disinfecting of the the face cradle and change of any face cradle covers after each client.

Items that are frequently shared, difficult to clean (e.g. upholstered furniture), and/or not necessary to achieving treatment outcomes will be removed. Some examples may include: clothing basket, and coffee service.

Items in the treatment room that cannot be cleaned and disinfected between clients will be removed. (e.g. holsters to hold topical products).

Linens, blankets and pillows will be changed between clients, and washed and dried in the highest heat possible. Linens used by clients will be stored out of site in a closed bag or container with a lid until they are washed.

RMTs must create and maintain records of general infection prevention and control practices they have implemented. These records should reflect the date of and frequency with which the measures were applied. RMTs may choose to retain the infection prevention and control records within their existing equipment record (log), or as a separate record.

Are RMTs required to clean and disinfect pillows after each use?

To reduce the risks of contact and droplet transmission associated with COVID-19, RMTs must wash and dry all linens, blankets and pillows used in treatment in the highest heat possible after every client.

If the pillow is made of, or covered entirely by a plastic or otherwise non-porous material, it must be cleaned and disinfected between clients using products approved by Health Canada.

Items that cannot be cleaned and disinfected after every client should be removed from the treatment room.

Are there any additional considerations for record keeping?

In addition to the routine requirements for record keeping, RMTs must record all new procedures related to the client in the client health record, including but not limited to:

  • screening dates and results;
  • PPE used during treatment;
  • modifications to treatment; and
  • details of infection prevention and control measures used to prepare for, during, and after each treatment.

In addition to the documentation in the client health record, RMTs must also maintain a general infection prevention and control record/log for the practice and roster of all people entering the space for contact tracing purposes. Documentation should be kept for 10 years.

COVID-19 Update

Due to the State of Emergency announced in Waterloo Region this past week and the mandate put forth by PHA and my governing college (CMTO), I will be temporarily keeping my Massage Therapy Clinic closed at this time. As I am unsure as to when it will be safe to reopen, I will be contacting clients on a weekly basis who have an upcoming appointment to cancel their treatments and will be placing them on a rebook list for when this outbreak has passed.