COVID-19 RETURN TO WORK GUIDELINES AND PROTOCOLS FOR NOVA SCOTIA THERAPISTS - CMMOTA
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COVID-19
RETURN TO WORK
GUIDELINES AND
PROTOCOLS
FOR
NOVA SCOTIA
THERAPISTS
June 25, 2020 Edition
COVID-19 Return to Work Guidelines and Protocols – Nova Scotia ©2020 CMMOTA, All Rights Reserved.Table of Contents
Introduction …………………………………………………………………………………………………………………….…….… 4
SECTION 1 MANDATORY REQUIREMENTS ……………………………………………….………. 5
Introduction Statement ……………………………………………………………………………………………………………. 5
Pre-Screening and Appointment Booking ………………………………………………………………………………… 6
Waiting rooms and payments ………………………………………………………………………………………. 7
Patients and accompanying person must wash hands upon arrival …………………………… 7
Infection and Disease Prevention Measures ……………………………………………………………………………. 8
Cough Etiquette ……………………………………………………………………………………………………………. 8
Hand Hygiene ……………………………………………………………………………………………………………….. 8
Environment Cleaning and Disinfection …………………………………………………………………………………… 9
Proper disinfectant products ……………………………………………………………………………………….. 9
Physical Distancing ………………………………………………………………………………………………………………… 10
Requirements for managing clinical space ………………………………………………………………… 10
Managing the clinical schedule …………………………………………………………………………………… 11
Personal Protective Equipment ………………………………………………………………………………………………. 11
Therapist and staff PPE ………………………………………………………………………………………………. 11
PPE Requirements ………………………………………………………………………………………………………. 11
Supply Chain Issues …………………………………………………………………………………………………… 12
Patient Provision of PPE ……………………………………………………………………………………………… 12
Ventilation and Air Purifiers ……………………………………………………………………………………………………. 13
Clinic Clothing ………………………………………………………………………………………………………………………… 13
Retail Store …………………………………………………………………………………………………………………………….. 13
Waste Management ……………………………………………………………………………………………………………….. 13
Exclusion or work restrictions in the case of staff or Therapist Illness ………………………………… 14
Screening questions that must be asked with staff and therapist,
and a record kept ………………………………………………………………………………………………………… 14
Mobile Massage ………………………………………………………………………………………………………………………. 15
Screening ……………………………………………………………………………………………………………………. 15
Personal Hygiene and PPE ………………………………………………………………………………………….. 15
Environmental cleaning and disinfection …………………………………………………………………… 15
Social Distancing ………………………………………………………………………………………………………… 15
Policies, Procedures, and training ………………………………………………………………………………. 16
Resources ………………………………………………………………………………………………………………………………. 16
SECTION 2 – RECOMMENDED BEST PRACTICES ………………………………………..……. 17
General Workspace Protocols ……………………..……………………………………….……………………………….. 18
Infection and Prevention Control Protocols …………………………………………………….…………….………. 19
PPE Requirements for Therapists …………………………….……………………………………….………….………. 20
PPE Requirements for Clientele ………………..…………………………………………………………..……….……… 21
PPE Requirements for Support Staff ……..…………………….……………………………………………………….. 22
COVID-19 Return to Work Guidelines and Protocols – Nova Scotia ©2020 CMMOTA, All Rights Reserved.
P a g e |2PPE Protocols for Putting on PPE …………………………………………..………………………………………………. 23
PPE Protocols for Removal of PPE …………………………………………………….………………….………………… 23
Hand Hygiene Protocols for Therapists ……………………………….………………………….……………………… 23
Hand Hygiene Protocols for Clientele …………………..……………………………………………………………..… 24
Guidelines for Booking Appointments and Pre-Screening Clientele ……………………………………… 24
Pre-Appointment Task Guidelines ……………………………………………………………………….……………….. 25
Appointment Protocols …………………………………………………………………………………………….……………. 25
Protocols for Screening of Therapist………………..…………………………………………………….……………… 28
Protocols for a Sick Therapist ………………..…………………………………………………….……………………..… 28
Environmental Cleaning and Disinfection Protocols ………………………………………….………………….. 29
Workplace Bathroom and Shower Cleaning and Disinfection Protocols ….…………………….……… 30
Treatment Tools Cleaning and Disinfection Protocols ……………………………………………….…………… 31
Treatment Room Cleaning and Disinfection Protocols ………………………………………………………….. 31
Linen and Laundry Protocols ………………………………………………………………………………………………..… 32
Other General Business Protocols ……………………………………………….………………………………………… 32
COVID-19 Return to Work Guidelines and Protocols – Nova Scotia ©2020 CMMOTA, All Rights Reserved.
P a g e |3Introduction
The year 2020 will be long remembered in the history books as a year of change. COVID-19
is a virus that has caused a great amount of upheaval and chaos around the globe. From the
first cases reported in China in late 2019, to the eventual declaration by the World Health
Organization of a pandemic, it has affected not only the lives of those who have contracted
the virus, but also the lives of all humanity. As Canadian governments in all provinces and
territories sought to slow the virus down, Massage Therapists and Manual Osteopathic
Therapists were among those professions and businesses that were closed to help prevent
the spread of the virus and flatten the curve.
As those same provincial and territorial governments now implement their various back to
work plans and strategies, so too must we plan to adapt to the new normal of living with
COVID-19.
As an Association of Massage and Manual Osteopathic Therapists that represents members in
Canada from Coast to Coast to Coast, throughout this document we have endeavoured to
provide best practices recommendations that meet or exceed standards laid out by Provincial
and Territorial governments in their return to work guidelines as restrictions ease following
the shutdown that stemmed from COVID 19.
This document is to be used as our provincial standard for all Nova Scotia members of the
Canadian Massage and Manual Osteopathic Therapists Association (CMMOTA) who practice
massage or manual osteopathic therapy in their return to work post COVID 19 shutdowns. All
members who practice massage or manual osteopathic therapy are required to follow the
protocols laid out in Section 1 of this document until further notice. If a provincial or territorial
requirement is of a higher standard than is contained in this document, the provincial or
territorial standard must be adhered to. Failure to follow these protocols, or higher standards
imposed by a provincial government in which the member resides, would bring a member
into violation of the CMMOTA Bylaws, and may result in disciplinary action up to and including
the removal of membership in the Association.
Section 2 of this document contains Best Practices Protocols, which the CMMOTA fully supports
implementation of in all CMMOTA therapists practices, however, at this time they are not
mandatory requirements of government, and therefore have not been adopted as mandatory
requirements of the Association.
At the time of the writing and initial approval of this document, not all jurisdictions across the
country have released their requirements for return to work. As those requirements are
released the CMMOTA will continue to monitor them, and will adjust and update this document
COVID-19 Return to Work Guidelines and Protocols – Nova Scotia ©2020 CMMOTA, All Rights Reserved.
P a g e |4as necessary, so that in the end the recommended best practices will meet or exceed each
province or territorial standard nationwide.
Likewise, as those guidelines change and requirements on items like PPE are relaxed, the
CMMOTA will continue to monitor them, and will adjust and update this document, as
necessary.
We do not anticipate that these guidelines and protocols will be in place for all time, and we
recognized that they will continue to evolve as the current situation evolves.
When changes to this document are made by the CMMOTA, we will forward those changes to
all those who are members of the CMMOTA in Nova Scotia.
These Guidelines and Protocols are in addition to, and not a replacement of Code of Ethics,
Standards of Practice and Scope of Practice Documents.
As the bans on massage and manual osteopathic therapy are lifted, all members are reminded
that you do have the right to decide when to return to your practice. There is no need to rush
yourself. You have the right to wait until you feel safe, well equipped, confident, and ready to
return to your practice.
As always, if you have questions or concerns, please contact the CMMOTA office for
clarification by phone to (403)356-1160 or by email to info@cmmota.com.
SECTION 1 – MANDATORY REQUIREMENTS
All items in this section are mandatory for all Nova Scotia CMMOTA Therapists, they come out
of the MTANS COVID 19 Return to Work Protocols, which the Government of Nova Scotia
asked CMMOTA to adopt as our mandatory requirements for Nova Scotia Therapists. They
have been approved by CMMOTA under the guidance of the CMMOTA Board of Directors Policy
and Procedure: COVID-19 Return to Work Policy. In the case where Federal, Provincial,
Territorial, or Municipal government requirements exceed the requirements in this section,
the rules of Government must be followed, and supersede this directive.
INTRODUCTION STATEMENT
CMMOTA, in conjunction with the Nova Scotia Department of Health and Wellness have
agreed to us the guidelines provided by the Massage Therapists’ Association of Nova Scotia
(MTANS), who have provided the following protocols to guide Nova Scotia CMMOTA
members through the process of returning to work after the State of Emergency is lifted.
COVID-19 Return to Work Guidelines and Protocols – Nova Scotia ©2020 CMMOTA, All Rights Reserved.
P a g e |5These protocols serve as a base requirement for all Nova Scotia CMMOTA members. Any
additional precautions members wish to pursue based off of Section 2 in this document are
at their own discretion. Due to the rapid evolution of information, policies may change
quickly to best suit the safety of our members and the public.
All members are responsible for adhering to the guidelines and statements set forth in this
protocol. The protocols serve to assist in stopping the spread of COVID-19 and to protect
the health and safety of all Canadians. Using these guidelines, each workplace must develop
their own site-specific return to work plan. The following provincial website offers some tips
and advice: https://novascotia.ca/reopening-nova-scotia.
The practice of massage therapy is not permitted in the province of Nova Scotia until the
Chief Medical Officer of Health (CMOH) lifts the restriction. At that time, members who are
able to abide by the protocols and restrictions may resume working. Members who are
unable to adhere to these protocols will not be permitted to do so. If you feel that you are
not able to return to work safely and confidently, you may return at your own pace.
Together we can prevent the spread of COVID-19 and keep our province healthy.
PRE-SCREENING AND APPOINTMENT
BOOKING
• A safe environment for both the client and the massage therapist are the primary
concern of these protocols. Safety begins before your client arrives at your workplace.
Providing an initial pre-screening process with all clients prior to booking an appointment
assists in ensuring the health and safety of everyone.
• Pre-visit screen clients when they make an appointment by advising them that they
cannot attend if they are feeling unwell the day of the appointment. The client should
also be advised to use the 811 on-line self-assessment if they are unwell,
https://811.novascotia.ca.
• When a client wishes to book an appointment, he/she/they should be asked the
following questions:
o Have you tested positive for COVID-19 that you have not fully recovered from?
o Are you experiencing any of the following symptoms? *(Not related to a previously
documented health concern) https://novascotia.ca/coronavirus/when-to-seek-help.
▪ 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
COVID-19 Return to Work Guidelines and Protocols – Nova Scotia ©2020 CMMOTA, All Rights Reserved.
P a g e |6▪ diarrhea
▪ unusual fatigue
▪ loss of sense of smell or taste
▪ red, purple or blueish lesions on the feet, toes, or fingers without clear cause
o Have you traveled outside of Nova Scotia within the last 14 days?
o Have you had unprotected close contact with individuals who have a confirmed or
presumptive diagnosis of COVID-19 (e.g. individuals exposed without appropriate
PPE in use)?
• If the client answers yes to any of the above questions or if they become symptomatic
at any point prior to their scheduled appointment, ask them to postpone their treatment
until they are well and symptom free. They should also be advised to use the 811 on-
line self-assessment https://811.novascotia.ca if they are unwell the day of the
appointment and only attend if they are not told they need to be tested for COVID-19.
• Clinic staff should also screen again at the time of the patient’s in-person visit to the
clinic. People who accompany patients (if applicable), such as parents, caregivers, or
companions, must be screened with the same questions as the patient. Patients and/or
companions exhibiting symptoms 4 should not receive treatment at this time and should
be directed to use the 811 online self assessment tool. Only one parent, caregiver or
companion is permitted to accompany the patient.
• Signage indicating screening criteria should be posted in a location that is visible before
entering the clinic.
• 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.
Waiting Rooms and Payments
• When possible, ask clients to arrive at the time of their appointment and not in advance.
This allows for less contact between individuals and increases the ability to physical
distance. It is important to remind clients to practice physical distancing. Proper signage
should be posted at your workplace. Adequate time between treatments is necessary to
provide mandatory cleaning. (i.e. 30 minutes between each scheduled appointment).
• Upon arrival, the client and any accompanying person should again be asked if they are
feeling well. If they are not, they must be asked to cancel the appointment as well as to
go home and complete the 811 online self-assessment.
https://novascotia.ca/coronavirus/when-to-seek-help, https://811.novascotia.ca.
Patients and accompanying person must wash their hands upon
arrival.
• When a client is paying for their service, contactless payment and billing is preferable
when possible. Some options for this include:
o Interac/Debit tap option
o Online payment options
o Direct billing when applicable
COVID-19 Return to Work Guidelines and Protocols – Nova Scotia ©2020 CMMOTA, All Rights Reserved.
P a g e |7o Emailing the client their receipt
• Wash your hands after handling payments, receipts, or money to/from a client.
• Waiting and common areas should be rid of high-touch items and soft surfaces that are
unable to be properly cleaned and sanitized. (magazines, brochures, shared pens, water
coolers etc.)
INFECTION AND DISEASE PREVENTION
MEASURES
• COVID-19 is known to be spread through respiratory droplets, either from a cough,
sneeze or via surface that has been contaminated by droplets. It is important to take
additional measures to prevent the spread of COVID-19 within your work environment.
Prior to returning to work, make sure you are up to date on COVID-19 information
provided by the Federal Department of Health.
• The following are criteria that you must follow at your workplace:
o Develop and comply with infection prevention and control polices and procedures
o Provide infection control training to all staff members
o Meet provincial infection control guidelines for hand hygiene, environmental cleaning,
and disinfecting
o Comply with provincial requirements for PPE
Cough Etiquette
• Cover coughs and sneezes with a tissue. Dispose used tissues in the garbage and wash
your hands or use an alcohol-based hand rub immediately after or Cough/sneeze into
your elbow, not your hand.
• Avoid touching your eyes, nose, and mouth with unwashed hands.
Hand Hygiene
• Proper hand washing is recommended to stop the spread of COVID-19. Ensure that you
are up to date with proper handwashing procedure and have posters available near
every handwashing area.
o Wash you hands for at least 20-30 seconds using an adequate amount of soap
o Ensure you are cleaning all necessary areas including, thumbs, wrists, forearms, and
elbows if necessary
o Turn off tap and dry hands with a single use towel or disposable paper towel
o Alcohol based sanitizers (70% or above) may be used when hands are not visibly
soiled
o Sanitizer and handwashing should be available to all clients upon entry to the
workplace and within all regions and treatment rooms
o The use of gloves does not substitute proper handwashing
Hand hygiene is required to be performed by:
• Massage therapist when:
o entering the clinic/home setting (mobile massage)/spa o before contact with each
patient o before clean/aseptic procedures
COVID-19 Return to Work Guidelines and Protocols – Nova Scotia ©2020 CMMOTA, All Rights Reserved.
P a g e |8o after contact with each patient o after contact with a patient’s surroundings or
belongings
o before donning PPE
o after doffing PPE
o after cleaning contaminated surfaces
• Staff when:
o entering the clinic
o before interaction with a patient
o before clean/aseptic procedures
o after interaction with a patient
o before donning PPE
o after doffing PPE
o after cleaning contaminated surfaces
o after financial transactions or administration of paperwork involving patients
• Patients when:
o entering the clinic/spa/before treatment in their home (mobile massage)
o entering the treatment area if the patient does not proceed directly to a treatment
room upon entering the clinic
o prior to processing payment
ENVIRONMENTAL CLEANING AND
DISINFECTING
• Effective cleaning and disinfection are essential to avoid the possible spread of COVID-
19, which is spread through contact with respiratory droplets or contact with
contaminated surfaces. The COVID-19 virus can survive for differing periods of time
depending on the surfaces it lands on. Frequent cleaning and disinfection are necessary
to prevent spread of the disease.
• Cleaning products remove soiling such as dirt, dust, and oils, but do not always sanitize
surfaces. Disinfectants are applied after cleaning to sanitize resulting in the destruction
of germs.
• Read, understand, and apply the cleaning standards from the Health Canada guide on
cleaning and disinfecting public spaces during COVID-19.
Proper disinfectant products:
• Disinfectants with an 8-digit Drug Identification Number (DIN) are approved for use by
Health Canada. During the pandemic, only the Health Canada-approved disinfectants
with a viricidal claim are appropriate for the elimination of viruses in the clinic
environment. The disinfectant product manufacturer’s instructions must be followed for
use, safety, contact time, storage, and shelf life.
• Alternatively, per NS Dept of Health and Wellness cleaning guidelines, you can make a
1000ppm bleach water solution by mixing 20 ml (4 teaspoons) of unscented, household
bleach with 1000 ml (4 cups) of water. Ensure the surface remains wet with the bleach
water solution for 1 minute.
COVID-19 Return to Work Guidelines and Protocols – Nova Scotia ©2020 CMMOTA, All Rights Reserved.
P a g e |9• Vinegar, tea tree oil solutions, Thieves’ oil, essential oils, and similar solutions are not
proven to be effective disinfectants and cannot be used in place of Health Canada-
approved disinfectants. It is a requirement that only approved disinfectants with a
viricidal claim are used to limit the spread of COVID-19.
• Be sure you/your staff take appropriate precautions when using chemicals for cleaning
and disinfecting. This can be done by consulting the Manufacturer’s Safety Data Sheets
when using cleaners and disinfectants. Staff (if applicable), must be supplied with the
appropriate safety equipment (gloves and masks), to protect themselves when they
clean and disinfect.
• The frequency of cleaning and disinfection is dependent on the nature of use/contact of
the surface/item in question:
o Patient care/patient contact items must be cleaned and disinfected between each
patient/use. Examples of patient contact items include but are not limited to:
▪ treatment tables, all contact surfaces including pillows, and the entire
headpiece/hand rests
▪ procedural work surfaces
o Commonly touched areas must be cleaned and disinfected a minimum of twice daily
or whenever visibly soiled. Commonly touched areas include but are not limited to:
▪ Light switches, doorknobs, toilets, taps, handrails, counter tops, touch
screens/mobile devices, phones, and keyboards
▪ Clipboards that patients contact must be disinfected after each patient
encounter.
▪ Pens/pencils used by patients must be disinfected after each patient use or be
single use only
▪ Shared equipment such as computers, photocopiers, fax machines should also be
regularly cleaned.
o Any cloth items, such as towels, sheets, headrest coverings, etc., that are used in
the clinic must be laundered in hot water (above 60°C) with regular laundry soap
before being dried and used again. Therapists and or staff should wash their hands
after handling used soiled items and before handling clean laundry. Laundry taken
offsite should be transported using separate bags, e.g., one for clean/soiled linens.
• A regular schedule for periodic environmental cleaning must be established and
documented.
PHYSICAL DISTANCING
Requirements for managing clinical space
• Physical distancing requirements take priority over occupancy limits.
• Members of the public must be two metres from each other. This applies in the following
spaces:
o Waiting areas - seats must be spaced to maintain two metre distance
o Transition areas
• Non-clinical employees and the public must be two metres from each other.
COVID-19 Return to Work Guidelines and Protocols – Nova Scotia ©2020 CMMOTA, All Rights Reserved.
P a g e | 10o Reception and payment area - If two metres cannot be maintained at
reception/payment area, either staff must be continuously masked, or the installation
of a plexiglass or plastic barrier must occur to protect reception staff
• The treating therapist must be two metres from the public when conversing
• Restrict access to the practice environment to only those who must be present
• Occupancy and gathering limits include all individuals in the office, including staff and
are not to exceed the mandatory limit provided by the CMOH
• To aid in physical distancing, give consideration to:
o Having patients wait in vehicle until their appointment time
o Limit of 1 guest to only those receiving treatment when able: i.e. client
spouse/partner, ride etc.
Managing the clinical schedule:
• Ensure that booking practices (duration of treatment visits and number of patients in the
practice at any given time), comply with ongoing CMOH directives on group gatherings
and occupancy limits. This includes:
o ensuring booking practices enable physical distancing between patients during
treatment sessions and
o provide adequate time to clean and disinfect clinic equipment between patients ex:
30 minutes
o when possible consider as dedicated treatment space for each therapist
• When scheduling, consider dedicated and/or off hours treatment for high risk population
(e.g., immune compromised, elderly, others with co-morbidities).
• Staff and therapists’ breaks/mealtimes should be staggered to allow for social
distancing.
PERSONAL PROTECTIVE EQUIPMENT
• Personal protective equipment (PPE) is an essential element in preventing the
transmission of disease-causing microorganisms. If used incorrectly, PPE will fail to
prevent transmission and may facilitate the spread of disease.
Therapist and Staff PPE:
• Given the highly infectious nature of the novel coronavirus, Covid-19, healthcare
workers providing direct patient care must wear a surgical/procedure mask
continuously, at all times, and in all areas of the workplace if they are involved in direct
patient contact or cannot maintain adequate physical distancing from patients and co-
workers. This recommendation is to further limit the exhalation/droplet spread of the
healthcare worker, further limiting the risk to patients and coworkers.
PPE requirements:
• For therapists, surgical or procedure masks are the minimum acceptable standard.
• Therapists and clinical staff who are not able to maintain the 2m physical distancing
while providing patient care must wear a mask.
COVID-19 Return to Work Guidelines and Protocols – Nova Scotia ©2020 CMMOTA, All Rights Reserved.
P a g e | 11• Non-clinical staff must use a non-medical mask when a physical distance of two
metres cannot be maintained. It is highly recommended that clients wear a mask for the
duration of their visit.
• One mask may be used for the entire work shift, but must be discarded and replaced
when wet, damaged or soiled, when taking a break and at the end of the day. N95
respirators are not required. Masks must be donned and doffed using the following
specific sequence to prevent contamination.
• DHW has provided further instructions for health-care workers (please refer to the
reference section at the end of this document).
Donning mask:
1. Perform hand hygiene
2. Open mask fully to cover from nose to below chin
3. Put on mask
4. Secure ties to head (top first) or elastic loops behind ears
5. Mold the flexible band to the bridge of nose (if applicable)
6. Ensure snug fit to face and below chin with no gaping or venting
Doffing mask:
1. Perform hand hygiene
2. Do not touch the front of the mask
3. Carefully remove mask by bending forward slightly, touching only the ties
or elastic loops. Undo the bottom tie first then undo the top tie
4. Discard the mask in the garbage
5. If the mask itself is touched during doffing, perform hand hygiene.
• It is essential that all therapists and staff providing services in a clinic are aware of the
proper donning and doffing of PPE. The use of PPE must be precise and ordered to limit
the spread of COVID-19. Nova Scotia Department of Health and Wellness PPE resources
must be reviewed and understood before all massage therapists, and staff provide
patient care. Training and practice of donning and doffing PPE within your facility are
essential to ensure the proper use of PPE in support of limiting the spread of COVID-19.
Supply Chain Issues:
• In the event of supply chain issues related to PPE, massage therapists should be
prepared to use nonmedical grade masks. Supply chain issues could be related to Public
Health orders to secure adequate supplies for the public health system, or market
conditions. If non-medical grade masks are used by Massage Therapists, the mask must
meet the current recommendations of Public Health at the time they are used. Public
Health’s recommendations for laundering must also be met.
Patient provision of PPE:
• Clinics are not required to provide surgical masks for patients. However, therapists may
choose to provide non-medical masks for patients. If a therapist chooses to provide
these masks for patients, the therapist or staff must educate the patient on the proper
donning and doffing of masks and observe that it occurs properly.
• If a therapist encounters a patient who has gone through the screening process and
enters a treatment room yet still exhibits signs and symptoms consistent with COVID-
19, the therapist must:
COVID-19 Return to Work Guidelines and Protocols – Nova Scotia ©2020 CMMOTA, All Rights Reserved.
P a g e | 12o Establish and maintain a safe physical distance of two metres
o Segregate the patient from others in the clinic
o Explain the concern that they are symptomatic, discontinue treatment and
reschedule the appointment.
o Advise the patient they should self-isolate and
o Clean and disinfect the practice area immediately
VENTILATION AND AIR PURIFIERS
• COVID-19 is transmitted through droplets activity. Once the droplets have fallen, they
attach to the surface and do not become airborne in the environment. Although air
purifiers can provide additional assistance in airborne diseases such as common colds or
flu, they are not necessary or required for COVID-19. Any air filtration systems currently
installed in your workplace should be regularly maintained in accordance with the
manufacturer.
CLINIC CLOTHING
• Clean clothes must be worn by the practitioner and staff each day. If the practitioner
and staff drive directly from their home to the clinic, no change of clothes is required.
However, if they stop at other locations on their way to the clinic, then donning new
clean clothes in the clinic is required.
• Clothes worn in the clinic must not be worn in public afterwards. Practitioners and staff
must change into different clothes at the end of their shift.
• To clean clothes worn in the clinic, wash clothing in hot water (above 60°C) with regular
laundry soap.
RETAIL STORE
• Items for retail sale should be kept behind a counter or in a case with only minimal
handling by staff when conducting a transaction.
WASTE MANAGEMENT
• All wastepaper bins/garbage receptacles must contain garbage bags. It is strongly
recommended that the waste bins/receptacles used have a lid and foot pedal. At the end
of the working day, all bins must be emptied and placed outside in a proper garbage
receptacle. Staff/therapist must thoroughly wash their hands after completing this task.
COVID-19 Return to Work Guidelines and Protocols – Nova Scotia ©2020 CMMOTA, All Rights Reserved.
P a g e | 13EXCLUSION OR WORK RESTRICTIONS IN THE
CASE OF STAFF OR THERAPIST ILLNESS
• Staff and therapists must self-screen for symptoms before arrival at work with the same
symptom screening questions used for patients. If screening is positive, staff and
therapists cannot enter the clinic/work and use 811 online assessment.
• Staff and therapists must complete a recorded formal screening upon arrival at work.
This screening history must be kept while this directive remains in place.
Screening questions that must be asked with staff and therapist and
a record kept:
1. Do you have current symptoms of COVID-19, such as: https://811.novascotia.ca
a. fever, (i.e. chills, sweats)
b. cough or worsening of a previous cough
c. sore throat
d. headache
e. shortness of breath
f. muscle aches
g. sneezing
h. nasal congestion/runny nose
i. hoarse voice
j. diarrhea
k. unusual fatigue
l. loss of sense of smell or taste
m. red, purple or blueish lesions on the feet, toes, or fingers without clear
cause
2. Have you traveled outside of Nova Scotia within the last 14 days?
3. Have you had unprotected close contact with individuals who have a confirmed or
presumptive diagnosis of COVID-19 (e.g. individuals exposed without appropriate
PPE in use)?
• Per the CMOH, therapists and staff who screen positive for the questions above are not
eligible to work. Current requirements from the NS Department of Health and Wellness
state that self isolation must continue, and workers must not return to work until 14
days have passed from symptom onset or until symptoms resolve, whichever is longer.
https://novascotia.ca/coronavirus/.
• Per the CMOH, therapists and staff must also immediately inform their direct supervisor
at the onset of any symptoms from the screening questions. Therapists who become
symptomatic while treating patients must stop seeing patients immediately, use 811
online assessment https://811.novascotia.ca and follow self-isolation procedures.
• This requirement is subject to change and therapists are directed to stay up to date with
the directives of the CMOH. Massage therapists are reminded that employers may also
set requirements for return to work, so long as those requirements are not less stringent
than those established by the CMOH.
COVID-19 Return to Work Guidelines and Protocols – Nova Scotia ©2020 CMMOTA, All Rights Reserved.
P a g e | 14• All workplaces must adopt written policies and procedures that meet or exceed the
requirements outlined in this document. All staff must be made aware of the policies and
receive appropriate training (i.e. correct use of PPE). Policies may refer directly to this
document but must be made applicable to the particular risk profile/details of the
setting/organization.
MOBILE MASSAGE
• Providing care in patient’s homes has the potential for elevated risk due to the variability
of the environments in which the care is provided and the relative lack of control the
care provider has compared to a clinic setting. Largely, the requirements for in home
care are consistent with the clinic setting.
Screening
• Patients/companions – When able to call ahead prior to providing care, have the client
complete the self-assessment online or ask them the questions over the phone. When
the practitioner arrives at a client’s home, always do a point of care risk assessment,
and ask the self-assessment questions again. All household members must complete the
self-assessment prior to providing client care. If any individuals are experiencing
symptoms, recommend the individual contact 811 for direction and reschedule
treatment. If no symptoms are reported, don appropriate PPE for entry to the residence.
When you’re calling clients to complete the Pre-Screening, ask them to place a small
garbage can by the front door so you can doff and dispose of your PPE safely. Let the
client know they’ll need to dispose of your PPE/mask.
Personal Hygiene and PPE
• Cough/Sneeze etiquette – As per clinic procedure
• Hand Hygiene – As per clinic procedure
Environmental cleaning and disinfection
• Proper disinfectant products – all reusable equipment must be disinfected as per Health
Canada’s guidelines. Consideration should be given to providing dedicated equipment
whenever possible.
• Required clinic environment adaptations – all applicable risk assessments should be
completed to identify and mitigate hazards and risks within the patient’s home.
Social Distancing
• All household members should be instructed to maintain social distancing from the care
provider of 2m during the entire visit. Social distancing should be maintained when
applicable by the practitioner to the extent possible during the visit.
• Use of PPE – as per clinic procedure with the following additional procedures:
o When proceeding with client care (all risk assessments/screening procedures have
been completed) practitioners must wear a surgical/procedure mask at all times if
they are involved in direct client contact and cannot maintain adequate
social/physical distancing from residents.
o Clients should also wear a mask. A nonmedical mask is acceptable.
COVID-19 Return to Work Guidelines and Protocols – Nova Scotia ©2020 CMMOTA, All Rights Reserved.
P a g e | 15o The surgical/procedure mask should be immediately changed and safely disposed of
whenever it is soiled or wet or whenever the therapist feels it may have become
contaminated.
o All patients should wear a mask if receiving in-person care (a Non-medical grade
mask but should meet Public Health Guidelines). If providing masks for patients, the
therapist must educate the patient on the proper donning and doffing of masks and
observe that it occurs properly.
o Masks need to be disposed of upon leaving the client’s home. Follow procedures to
doff appropriate PPE.
o To dispose of appropriate PPE, surgical/procedural masks when completing a home
visit:
▪ When you’re calling clients to complete the Pre-Screening, ask them to place a
small garbage can by the front door so you can doff and dispose of your PPE
safely. Let the client know they’ll need to dispose of your PPE/mask.
▪ Before you doff your PPE, make sure to ask clients and anyone else in the home
to remain 6 feet/2 metres back.
▪ Put mask in black garbage bag and dispose of in client’s garbage can.
▪ If either of these cannot be done, remove PPE once you’re outside of the client’s
home. Dispose of the PPE/masks by double bagging black garbage bags. If
nonmedical masks are being used due to supply chain issues provision for safely
transporting and laundering soiled masks to minimize opportunity for cross
contamination (i.e. separate, labeled)
Policies, Procedures and Training
• All mobile massage therapy practices must adopt written policies and procedures that
meet or exceed the requirements outlined in this document. Policies may refer directly
to this document but must be made applicable to the particular risk profile/details of the
setting/organization. Appropriate records kept.
RESOURCES
General
• https://novascotia.ca/dhw/cdpc/coronavirus-documents.asp
• https://811.novascotia.ca
• https://when-to-call-about-covid19.novascotia.ca/en
• https://covid19-employer-assessment.novascotia.ca/en
• https://novascotia.ca/coronavirus/working-during-covid-19/
• https://novascotia.ca/coronavirus/
• https://novascotia.ca/reopening-nova-scotia
Hand hygiene
• Health Canada – Authorized list of hard-surface disinfectants and hand sanitizers -
https://www.canada.ca/en/health-canada/services/drugs-health-
products/disinfectants/covid-19/list.html
COVID-19 Return to Work Guidelines and Protocols – Nova Scotia ©2020 CMMOTA, All Rights Reserved.
P a g e | 16• Nova Scotia Coronavirus Resources - How to Hand Wash -
https://novascotia.ca/coronavirus/docs/Hand-Washing-Poster.pdf
• Nova Scotia Coronavirus Keeping Hands Clean - How to Use Alcohol-based Hand Rub -
https://novascotia.ca/coronavirus/staying-healthy/#hands-clean
Environmental cleaning and disinfection
• Health Canada – Authorized list of hard-surface disinfectants and hand sanitizers -
https://www.canada.ca/en/health-canada/services/drugs-health-
products/disinfectants/covid-19/list.html
• COVID-19 Public Health Recommendations for Environmental Cleaning of Public Facilities -
https://www.canada.ca/en/public-health/services/publications/diseases-conditions/cleaning-
disinfecting-public-spaces.html
Personal Protective Equipment
• AHS Provided: Personal Protective Equipment (PPE): FAQs -
https://www.albertahealthservices.ca/assets/info/ppih/if-ppih-covid-19-ppe-faq.pdf
• Nova Scotia Donning/Doffing Mask Poster - https://ltc-ns.cupe.ca/wp-
content/uploads/sites/13/2020/04/How-To-Wear-A-Procedural-Mask-Poster-
e1587134540651.jpg
• AHS Provided: For Healthcare Workers: How to Wear a Mask -
https://www.albertahealthservices.ca/assets/info/ppih/if-ppih-covid-19-hcw-masks.pdf
Exclusion or work restrictions during staff or Massage therapist
illness
• https://811.novascotia.ca
• https://when-to-call-about-covid19.novascotia.ca/en
• COVID-19 assessment tool for health-care workers -
https://www.alberta.ca/assets/documents/COVID-19-assessment-tool-for-health-care-
workers-and-public-health-enforcement.pdf
• COVID-19 information: Workplace Guidance for Business Owners -
https://novascotia.ca/coronavirus/working-during-covid-19/
SECTION 2 – RECOMMENDED BEST
PRACTICES
All items in this section are recommended best practices. They are not mandatory; however,
they are in the best interest of the therapist, the client, and society as a whole and have been
approved under the guidance of the CMMOTA Board of Directors Policy and Procedure: COVID-
19 Return to Work Policy.
COVID-19 Return to Work Guidelines and Protocols – Nova Scotia ©2020 CMMOTA, All Rights Reserved.
P a g e | 17GENERAL WORKSPACE PROTOCOLS
• Businesses should post external signs indicating COVID-19 physical distancing protocols,
along with floor markings where service is provided or lines form.
• Businesses should maintain a single point of entry.
• Besides clients, businesses should limit business-related visitors to essential services
only. This may include tradespeople, pest control or compliance officers.
• Clients should maintain a distance of at least two metres, except when receiving service
or for brief exchanges.
• Hand Sanitizer Stations should be placed by the entrance to the clinic, and in each
treatment room, lunchroom, washroom, and any other common use areas.
• All communal items, such as water coolers, candy, magazines, complementary phone
chargers, etc. should be removed from the workspace.
• The entire workspace should be kept free from clutter.
• Beverages (coffee, tea, water, etc.) should not be offered at this time. If necessary,
water may be supplied in bottled form for the client to take with them and consume
outside of the clinic space.
• Waiting area seating should be spaced so that clients are a minimum of two metres
apart. Alternate 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.
No more than 5 people may gather in common areas. Should scheduling errors result in
more than 5 people, alternate waiting areas should be planned, or the client should be
asked to wait outside the establishment, or in their vehicle.
• Play areas within waiting areas should be closed.
• Staffrooms and break rooms should be arranged to follow physical distancing practices.
Break times should be staggered to reduce employee gathering numbers. No more than
5 people may gather in common areas.
• In businesses where meals are provided to employees, meal service in common eating
areas should occur in rotations to minimize the number of people in the room. Physical
distancing of 2 metres should be practiced at all times. Food services staff should serve
all food, and common touch items should be removed.
• Retail space should be modified to implement physical distancing requirements. Where
possible, discourage browsing of retail products and support online or telephone
purchases with in-clinic pick-up and enforce strict no return policies. All samples or
testers should be removed.
• Mobile therapists’ workspace is found in the home or businesses of their clientele, as
such, the client controls the workspace, and the client is responsible for maintaining
their own space.
COVID-19 Return to Work Guidelines and Protocols – Nova Scotia ©2020 CMMOTA, All Rights Reserved.
P a g e | 18You can also read
