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 airborne. 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
• or 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 $1 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 2 patients/persons is permitted in the clinic space at any given time. Patients must arrive unaccompanied.
• 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.