Plan for Return to Clinical Practice in Respect of Covid-19

This plan was developed with
the goal of reducing the risk of exposure to the virus that causes Covid-19 for
both patients and the practitioner within our clinical  and spa setting.  Here, we identify the actions that the
therapist at Avora Skin Spa (Registered Massage Therapist, Registered
Acupuncturist) and esthetician commits to, and that all visiting patients must
commit to, in order to resume our services.

“Coronavirus
is transmitted via liquid droplets when a person coughs or sneezes. The virus
can enter through these droplets through the eyes, nose or throat if you are in
close contact.

The
virus is not known to be airborne (e.g. transmitted through the particles
floating in the air) and it is not something that comes in through the skin.

It
can be spread by touch if a person has used their hands to cover their mouth or
nose when they cough. That’s why we recommend you cough or sneeze into your arm
and wash your hands regularly.”

Source: http://www.bccdc.ca/health-info/diseases-conditions/covid-19/about-covid-19/how-it-spreads

The overall aim of these
protocols is to reduce potential coronavirus transmission by:

• Required ongoing
  self-assessment for signs of Covid-19 related illness in both the patient and
  the therapist
• Reducing all
  physical, non-treatment related interactions amongst all people within the
  practice environment
• Hand hygiene requirements
• Avoiding face
  touching
• Enhanced
  cleaning protocols
• Appropriate use
  of personal protective equipment (PPE)
• Meeting
  professional obligations, particularly related to informed consent and
  liability insurance

Self-Assessment for Symptoms
of Covid-19: For Patients & Therapists

Pre-Screening / Prior to
Arrival

• Patients will be
  informed about their responsibilities at the time of booking. A notice will be
  placed on the website, and the online booking software ( coming soon) will send
  them a copy of these protocols as part of a Covid-19 specific consent form they
  will be required to sign electronically, prior to arriving at their
  appointment.
• One day prior to
  their booked appointment, the patient will be required to complete the online
  BC COVID-19 Symptom Self-Assessment tool and to stay home if they experience
  any symptoms of Covid-19.
  • The tool can be
    found here: https://bc.thrive.health/covid19/en
• The therapist
  will phone the patient one day before their booked appointment to discuss using
  the self-assessment tool and to verify that it has been done.
• The therapist
  will use the BC COVID-19 Self-Assessment tool herself, daily and commits to cancelling
  all appointments if symptoms appear.
• Symptoms of
  Covid-19 are similar to other respiratory illnesses and seasonal
  allergies.  An appointment must be
  cancelled immediately if either the patient or the therapist presents with even
  mild symptoms that may be signs of Covid-19 including:
  • Fever
  • Cough
  • Chills
  • Shortness of
    breath
  • Sore throat or
    pain with swallowing
  • Stuffy or runny
    nose
  • Loss of sense of
    smell
  • Headache
  • Muscle aches
  • Fatigue
  • Loss of appetite
• Covid-19
  Symptoms may range from mild to severe. Patients are required to cancel
  appointments if they experience what they determine to be ‘just the sniffles,’
  ‘seasonal allergies’ or ‘just feeling under the weather,’ on the day of their
  appointment.
• As a part of
  this consent form, patients must commit to understanding that while we’ve taken
  all possible measures to minimize risk of viral transmission, the nature of
  massage therapy, acupuncture and spa facials, and other services at Avora Skin
  Spa Clinic means that physical distancing is not possible in the treatment
  room.
• Patients with
  higher risk profiles and/or weakened immune systems should consider
  alternatives for care and postpone treatment. 
  • The patient and
    the therapist must both agree that the benefits of massage therapy outweigh the
    potential risks involved.
• Patients who
  develop even mild illness or symptoms should cancel booked appointments, even
  without notice.
  • They will not be
    charged a late cancellation fee if they cancel due to illness.

Upon Arrival

• As required we
  are By Appointment only
• The therapist
  will advise patients of her current Self-Assessment results upon their arrival
  at the clinic. Patients will be asked to share their own results. 
• Please arrive 5
  minutes early for your scheduled appointment and remain in your car or line up
  in front of our window, keeping social distance.
• Upon arrival
  patients must confirm that they have done a pre-screening and have no signs of
  Covid-19 as outlined here: http://www.bccdc.ca/health-info/diseases-conditions/covid-19/about-covid-19/symptoms
• Masks
  must be worn at all times within the clinic space. If the patient does not have a mask, a single-use mask will be
  provided to for a $2 fee and they will be asked to wear it upon entering the
  clinic space.
• The treatment
  will be cancelled immediately if the patient does not meet the pre-screening
  criteria upon physical presentation at the clinic.

Physical Distancing

Reception Area / Entry into
Clinic Space

• Only 1
  patient/person is permitted in the clinic space at any given time. Patients
  must arrive unaccompanied.
  • Minors will not
    be treated at this time.
• The therapist
  and the patient will both maintain a space of 2 meters (6 feet) distance
  between each other in all clinic areas outside the treatment room.
• Patients are not
  permitted to lounge in the clinic reception area before or after the treatment.
• Appointment
  times are staggered to reduce the potential of patients crossing paths, and to
  allow for time in-between appointments for enhanced cleaning and disinfection.
• Patients are
  asked to arrive on time and not early or late for appointments.
• Patients are
  required to wait in their vehicles or outside the clinic until the therapists invite
  them in.
• The clinic door
  will be opened for the patient by the specialist (therapist) and will be locked
  behind them. We are By Appointment only facility
  (Including products purchase) as requested by Work Safe BC and Provincial
  Health Authority.  The clinic door will
  be re-opened by the therapist at the end of the appointment for the patient to
  leave without touching the door knob.
•  Please use the hand sanitizer located next to the
  reception desk.
•  If possible bring your own pen to
  fill in the pre-screening form, when complete place it in the folder as
  indicated by your therapist

Within the Treatment Room

• It is not
  possible to maintain physical distancing while in the treatment room. All
  health practitioners will be wearing a surgical mask for mutual protection.
  Please keep your own mask on if your positioning will be face-up on the table.
• Patients will be
  asked to keep all personal belongings within a plastic basket, which can and
  will be sanitized between patients.
•   All chairs,
  doorknobs, desk surfaces, treatment tables, and face cradles will be
  disinfected between each patient.  Treatment table linens will as always
  be laundered and changed after each visit.
•  Please keep all personal
  belongings together on the chair provided with shoes tucked under the chair.
•  All other common high contact
  surfaces will be disinfected.

Restroom for Patient Use

• Please keep in mind that our washroom is public and treat it as
  such. It may be used and not cleaned immediately as we may all be in
  treatment.
• If possible avoid use altogether
• The restroom has
  been equipped with touchless soap dispenser and towels and proper handwashing
  guidelines.
• Soap and fresh
  towels for drying will be available at all times.
• A waste bin has
  been placed next to the restroom door so that patients may use a paper towel to
  open the door, and then discard of it before re-entering the clinic space.
• Please take care to avoid contact. 
• After using the toilet please 
  wash your hands well with soap and water, use the small towel to dry
  hands, with the same towel in hand turn off the tap and flush toilet in that
  order.  Then open the door and throw small hand towel in wash basket
  provided.
• Disinfector spray and paper towels are provided

Hand Hygiene

Reception Area / Entry into
Clinic Space

• Immediately upon
  entering the clinic space the patient must either:
  • Go directly to
    the handwashing sink without touching anything inside the clinic and wash their
    hands with soap and water for at least 20 seconds and then dry thoroughly, or
  • Use the hand
    sanitizer dispenser that is fixed to the wall just inside the clinic door
    outside the treatment room
• The therapist
  will wash hands thoroughly for at least 20 seconds between patients, before and
  after disinfecting spaces, before donning gloves and after taking gloves off,
  and before donning or doffing other PPE like facemasks or shields.
• Hand washing
  protocols will be posted visibly in the reception area and at sinks.
• Payment occurs
  in the reception area. If payment is required, our strong preference would be
  that you pay your therapist using E-TRANSFER.
  That would be our best no-touch solution for payments.
• A Point of Sale
  system with Tap is available for card use. In the event that this does not
  work, and invoice may be emailed to the patient in order that they pay it
  online.  The POS machine will be sanitized between each patient. If the card terminal is required then please
  remain in front of the plexiglass, until your therapist prepares the card
  terminal for you.
• Receipts will be
  emailed, not printed.

In the Treatment Room

• The therapist
  will open the door to the treatment room and allow the patient to enter. The
  therapist will open/close the door before, during and after the treatment as
  required – reducing the need for the patient to touch the door.
  • Patients will be
    permitted to open the door for themselves after the treatment to let themselves
    out of the treatment room. 
  • Tissue is
    available inside the treatment room that the patient may use as a barrier when
    opening the door.
  • Hand sanitizer
    is available within the treatment room; patients will be asked to wash or
    sanitize their hands after the treatment.
  • The door and
    doorknobs will be disinfected between each patient.

Avoid Face Touching

• The therapist
  will communicate with the patient that coronavirus can be transmitted by touch
  if droplets are on the hand when it touches the face, as it can transfer those
  infected droplets to the mouth, nose or eyes.
• Tissue will be
  available throughout the clinic: in the reception area, treatment room and
  washroom in order that patients and the therapist may use tissue to address an
  itch and/or touch the face for any other reason.
• The therapist
  will wear a mask and a face shield at all times. 
• Patients are
  required to wear face masks that cover both the nose and mouth at all times
  within the clinic space.

Enhanced Cleaning

• Additional time
  has been scheduled between patients to allow for thorough cleaning of the
  treatment room.
• Visibly soiled
  surfaces will be cleaned followed by disinfection with a Canada Health Approved
  for use against Covid-19 disinfectant as listed here: https://www.canada.ca/en/health-canada/services/drugs-health-products/disinfectants/covid-19/list.html
• Common areas
  will be cleaned and disinfected at least twice a day, including the restroom.
• All high touch
  surfaces will be cleaned and disinfected between patients, regardless of
  appearances. High touch surfaces include (but are not limited to):
  • Light switches,
    door knobs, POS machine, electronic devices, table surfaces, chairs,
    stools, window coverings, faucets, etc.
  • The treatment
    table, table levers, face cradle, lotion bottles will be immediately after each
    treatment.
  • No hydrotherapy
    supplies, thermophores, table warmers or covers will be used.
  • A Cleaning and
    Disinfectant for Clinic Setting Poster will be on Display in the reception
    area, patient restroom and treatment room.
• All linens,
  including blankets and pillow cases are single use only and will be laundered
  using high heat, detergent and bleach between each use.
• A disinfected
  single-use plastic bin has been placed in the treatment room. The patient will
  be asked to keep all of their personal belongings in this bin during the
  treatment. Post treatment, this same bin will be used to carry used linens to
  the laundry room for washing. 
• Bins will be
  disinfected between each patient before cycling back into use.

Personal Protective Equipment

• The therapist
  will wear a face mask and face shield at all times in the clinic.
• The therapist
  will wear non-latex gloves if/when appropriate.
  • Gloves may be
    appropriate when over-use of cleaning and/or chemicals causes skin irritation,
    or when the therapist’s hands or skin of the hands are otherwise inured.
  • Hands will be
    washed prior to putting the gloves on and immediately after removing them.
  • Gloves are also
    considered appropriate and will be worn by the therapist at the patient’s
    request.
• Patients are
  required to wear a facemask in the clinic at all time.
  • If patients have
    their own fabric facemask, they are requested to bring it. If they do not have
    a fabric face mask, a single-use non-medial mask will be provided to them at
    the time of their treatment.

Professional Obligations

Liability Insurance

• The therapist
  carries professional liability insurance through Wilson M. Beck as provided
  through the Registered Massage Therapist Association of BC.

Asymptomatic Spreaders

• Asymptomatic
  transmission of the coronavirus is an unavoidable risk of practice until we’ve
  acquired herd immunity, there is an effective treatment or vaccine against
  Covid-19.
• We have put into
  place protocols to help mitigate that risk as outlined in the preceding
  documentation.

Informed Consent

In the current environment
of Covid-19 risk, informed consent requires that the patient be informed and
understands that:

• Any personal
  services  involves some risk of Covid-19
  transmission;
• All our therapists
  and practitioners are following protocol to help reduce or mitigate risk where
  possible, but that risk cannot be reduced to zero;
• The patient
  consents to the treatment despite some risk;
• And we at Avora
  Skin Spa will document the patient’s consent in advance and at every treatment.

We
will continue to update our Safety Plan as new information becomes available
from the Public Health Officer and our professional associations.  If you
have any questions or concerns about our Safety Plan or your upcoming
appointment, please let us know.