RETURN TO PRACTICE GUIDELINES
Updated January 7, 2022

Since the beginning of this challenging situation, MTAM has worked diligently to ensure that information was posted to the website as quickly as possible so that members had access to updates as they occurred. As an additional resource for MTAM Members we have assembled the most essential return-to-pratice information here for your convenience. This is meant to help you safely remain open or re-open your practice as you are able.

These guidelines and best practices follow the Restoring Safe Services guidelines and offer additional measures that MTAM recommends to enhance safety procedures. They will help you manage your practice as you navigate the ongoing pandemic.

MTAM strongly recommends that you follow these guidelines to help keep your practice safe for your patients and yourselves.

RMTs should regularly refer to the Pandemic Response System regional risk levels and current Public Health Orders (including self-isolation and travel restrictions) and follow any additional protocols that may be added from time to time.

It is imperative that RMTs follow these guidelines, to help continue to reduce the risk virus transmission and protect yourself and your patients.

Throughout this unprecedented crisis, MTAM will continue to be here to provide support for members and answer your questions as well as those from the public and the media.

Please contact MTAM at info@mtam.mb.ca | 204-927-7979 | 1-866-605-1433

Screening, Sheduling & Appointments

Manitoba's Chief Public Health Officer has reinforced that the best way to control the spread of COVID-19 is for all Manitobans to stay home if they are ill, follow strict hand hygiene and cough etiquette, avoid touching your face, and avoid all unnecessary travel. If you or your patient are in a higher-risk category, extra caution should be used.

MTAM members must ensure that proper screening of all staff and patients occurs.

Staff should screen themselves prior to arriving at work. Patients should be screened when scheduling an appointment and prior to arriving for their appointment, to ensure that symptomatic individuals are not entering the clinic.

Please use the online Shared Health Screening Tool for all patients and staff.

Any symptomatic individual may report to a testing facility without a referral. TESTING LOCATIONS

If you or your patients have any questions or concerns after having used the screening tool please contact Health Links – Info Santé (204-788-8200 or toll-free at 1-888-315-9257) for clarification.

To help manage the flow of traffic outside and within your clinic consider the following strategies:

Ask patients to wait in their vehicles until you text or call them to enter the clinic
Schedule patients in a way that avoids having too many people in your clinic at any given time
Remind patients to arrive just before their appointment time and not bring any additional people with them

When creating your schedule leave sufficient time between patients to allow for proper cleaning and sanitizing.

While there are no current business occupancy restrictions for RMTs, you must still be diligent in creating a schedule that continues to allow for proper sanitization and physical distancing.

Reconfigure your reception/waiting room to allow for proper physical distancing and to facilitate easier cleaning.

Remove high-touch, unnecessary and self-serve items (magazines/brochures, water coolers/treats, extra seating, etc.).

Add hand sanitizer near the entrance/exit.

Place posters in high-visibility areas to remind patients of screening procedures, physical distancing, hand hygiene and cough etiquette. Other sources of posters are Government of Manitoba and Signs.com.

As public health orders are updated, ensure you have discussed any new policies and procedures with everyone in your clinic. Advise your patients in advance of all new policies and procedures that will apply to them. Give them an opportunity to ask questions and reassure them of the steps you are taking to minimize risk of exposure and help protect everyone attending your clinic.

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Risk Management, Sanitation & Hygiene

RMTs must be aware of the mode of transmission for COVID-19. The virus can be spread through close contact (within two metres or six feet) with an infected person who is coughing or sneezing. You can also get COVID-19 by touching objects contaminated with the virus and then touching your mouth, eyes or nose. For more information please refer to the Government of Canada website.

As always, MTAM Members must follow the MTAM Standards of Practice.

Standards 1, 3, 5, 9 and 15 specifically apply to public health, hygiene, risk management for infectious diseases, and the use of personal protective equipment (PPE). These Standards are always in place and should be followed regardless of the presence of the COVID-19 outbreak.

The additional guidelines as outlined in Phase 1 of the Restoring Safe Services plan must also be followed.
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Use of Instruments and Tools in Your Practice

Any tools used in your practice including but not limited to IASTM tools, cups and hot stones, must be able to be sanitized.

Tools that are made of porous materials may not be able to be properly sanitized and should not be used.

IASTM Tools and Cups:

Wash your tools and cups thoroughly with soap and water.
Sanitize tools and cups in a bath of one of the following chemicals:
- 6 to 7.5% hydrogen peroxide;
- 2% glutaraldehyde;
- 0.2% peracetic acid; or
- 2 to 7% enhanced action formulation hydrogen peroxide and 0.55% ortho-phthalaldehyde (OPA).

Once the tools/cups have soaked in the chemical bath of your choice for the contact time indicated by the manufacturer or the table listed in either of the two references below, then the instruments can be removed from the bath, rinsed with water and left to dry. Once dry, they are ready for re-use.
Click here for more details

Ontario Agency for Health Protection and Promotion (Public Health Ontario). Provincial Infectious Diseases Advisory Committee. Best Practices for Environmental Cleaning for Prevention and Control of Infections in All Health Care Settings, 3rd ed. Toronto, ON: Queen’s Printer for Ontario: April 2018 https://www.publichealthontario.ca/-/media/documents/bp-environmental-cleaning.pdf?la=en

Centers for Disease Control and Prevention. U.S. Department of Health & Human Services. Guideline for Disinfection and Sterilization in Healthcare Facilities. (2008): February 2017 https://www.cdc.gov/infectioncontrol/guidelines/disinfection/tables/table1.html

Hot Stones:

Allocate 20 minutes for sanitizing stones after each hot stone treatment.
Add 1 TBSP (15 ml) of bleach to mild dish soap or stone wash and hot water.
Place stones in the sink or basin. Wash and scrub each stone. The small amount of bleach will kill bacteria.
Drain and rinse stones well with clean, hot water.
Lay all stones on a clean towel and allow to air dry.
Prior to use, heat stones at 56 °C / 130-140 °F. Use a few drops of tea tree essential oil in your tank for additional anti-bacterial and cleansing properties.

Alternatively you may also place the stones in a dishwasher on the sanitize cycle.
Click here for more information and to read full article.

Hydrocollators: MTAM contacted one of the larger manufacturers of hydrocollators (Chattanooga/DJ Orthopedics) to inquire about sanitization procedures. Their response is as follows:

If you keep the hydrocollator unit set at the recommended temperature (160F) at all times no additional sanitization is needed in relation to the covid situation.
Covers should be laundered between every use and the packs themselves can be cleaned with soap and water.

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Hand Hygiene - Proper hand washing/sanitizing is key to preventing the spread of COVID-19

Have hand sanitizer available at the entrance/exit for patient and staff use.
Be aware of hand sanitizers which have been recalled by Health Canada. Some hand sanitizers were found to contain industrial-grade ethanol which has not been tested or authorized for use in hand sanitizers in Canada.
- View Recall List.
- View Approved Hand Sanitizer list.
Follow proper hand washing protocols:
- upon entering and exiting the practice environment
- before and after providing direct care
- after handling dirty laundry
- before and after putting on and taking off personal protective equipment
- after cleaning client contact surfaces
- after handling files, paperwork and other administrative tasks
- after completing patient payment transactions
Post hand washing/santizing information and verbally remind patients to wash or sanitize their hands when entering the clinic as needed while attending your clinic

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Cleaning and Sanitizing the Workspace and Restrooms - It is not certain how long COVID-19 survives on surfaces, but it seems to behave like other coronaviruses. Preliminary information on COVID-19 suggests that the virus may persist on surfaces for a few hours or up to several days depending on different conditions, such as:

temperature
type of surface
humidity of the environment

Clean and sanitize all patient and RMT contact surfaces after each patient as well as frequently throughout the day and remove unnecessary or hard to clean items.

Develop infection prevention and control policies and procedures specific to your practice
Provide infection prevention and control training to all staff
Remove all items that cannot be easily cleaned, such as magazines and water coolers, from the treatment room or reception area
Work/service areas are cleaned and sanitized after each patient, including but not limited to:
- reception desks, counters, telephones, PIN pads, tablets, computers, pens, shelves, door handles, door frames, light switches, lubricant dispensers, treatment tools and equipment, exercise equipment, chairs, etc.
Clean and sanitize frequently touched surfaces and equipment after contact, even when they are not visibly soiled
Clean and sanitize shared facilities frequently such as washrooms, staff rooms, laundry rooms, handrails and elevators
Launder and thoroughly dry clothing, linens and fabric equipment covers on the highest temperature setting possible
Store clean linens away from soiled linens. Enclosed cabinets or covered storage bins are recommended
Clean linens must be used for each and every patient regardless of whether they directly contacted the linen or not
Any fabric surfaces (table warmers, pillows, bolsters etc.) that can be covered with a wipeable cover that can be sanitized, must be covered and sanitized between each patient use

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What is the difference between cleaning and sanitizing?

Cleaning is designed to remove all visible dirt, soil, chemical residues and allergens from equipment and work surfaces.

Sanitizing is designed to reduce the number of microorganisms to a safe level. Sanitizing is performed after cleaning. Unclean surfaces will reduce the effectiveness of sanitizing. All surfaces that come into contact with patients must be cleaned and sanitized regularly.

Clean surfaces first with a cleaner, then apply a disinfectant to kill germs
For the most effective cleaning and sanitization always follow product manufacturer guidelines and use as directed.
Use only disinfectants that have a Drug Identification Number (DIN), an 8-digit number given by Health Canada to approved hard-surface disinfectants.
For high-touch hard surfaces such as door handles and phones, we recommend cleaning these often with either regular household cleaners or diluted bleach according to the label directions. Use bleach in a well-ventilated area and never mix with other chemical products. To prepare diluted bleach for a solution to disinfect high-touch hard surfaces, do so according to instructions on the label or in a ratio* of:
- 250 mL (1 cup) of water per 5 mL (1 teaspoon) bleach, or
- 1 litre of water (4 cups) per 20 mL (4 teaspoons) bleach

* assuming bleach is 5 % sodium hypochlorite, to give a 0.1 % sodium hypochlorite solution

Vinegar, tea tree oil, etc., are not effective disinfectants against COVID-19.

Additional resources:

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PERSONAL PROTECTIVE EQUIPMENT (PPE)

RMTs are in close contact (less than two metres) with patients and may need to take extra precautions to minimize exposure and prevent transmission of COVID-19. The use of personal protective equipment (PPE) will help protect both the RMT and the patient.

Your workplace should have protocols in place for safely putting on, removing, and disposing of PPE. For assistance in creating protocols visit Shared Health Manitoba.

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Masks

Masks can provide a barrier to protect a practitioner’s eyes, nose, and mouth from coming into contact with sprayed or aerosolized body fluids.

Shared Health Manitoba protocols state that masks should be worn by the healthcare provider in all practice environments.

Federal and Provincial medical professionals state that the person wearing the mask does so to protect others. Therefore, to reduce risk for both RMTs and patients, both need to be wearing a mask.

Direct patient care
MTAM strongly recommends that all RMTs use a medical-grade mask when providing direct patient care as per Shared Health guidelines:

Extended use of same mask is permitted for repeated interactions with multiple patients for maximum of one complete shift. Masks that have been removed during breaks should be properly stored in a paper bag or envelop. Paper bags/envelops must be discarded after each use and may not be reused.
Additional Precautions for respiratory viruses. Change procedure mask if it becomes wet, damaged, or soiled and/or at breaks, or if you've touched it without washing your hands first.
Eye protection to be used throughout the shift with appropriate cleaning and disinfecting protocols. Remove and clean/disinfect at breaks and at end of shift. Full face shield is recommended. Wherever possible, retain lenses and/or frames and disinfect eye protection at the end of the shift.

Non-direct patient care - in all areas where contact with other staff occurs and physical distancing (6 feet/2 metres) is unable to be maintained:

Non-medical masks may be used
Eye protection is not required

If physical distance cannot be maintained - a medical-grade mask and eye protection should be worn

See our PPE Resource list in the Return to Practice Guidelines for several sources of face masks and eye protection.

MTAM also recommends that you strongly encourage your patients to wear a mask when they attend your clinic and during treatment as appropriate.

Inform patients before they arrive for their appointment mask protocols for your clinic. If a client is uncomfortable wearing a mask during treatment in a prone position, consider using side-lying positioning instead.

Masks may be temporarily removed when receiving a service or to establish identity. It is possible for the client to remove their mask when lying prone. RMTs shoud take additional precautions to minimize risk at any time the client has removed their mask.

Health Canada has guidelines for the use of non-medical masks, including those that are home-made, providing general information, directions for how to put on, remove and clean masks, and sew/no sew instructions.

A note about non-medical masks: Non-medical face masks do not provide complete protection from virus particles because they may not fit properly or may not be made of appropriate materials. Please follow Health Canada guidelines for non-medical masks to optimize the effectiveness of your non-medical mask.

Guidance on the Removal, Storage and Extended Wear of Face Masks (Shared Health Manitoba)

Donning and Doffing Face Masks (MTAM Video)
https://sharedhealthmb.ca/files/extended-use-of-face-masks.pdf
Storage of extended use face masks (Video)

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Eye Protection

MTAM strongly recommends that practitioners wear eye protection when providing intra-oral treatment (TMJ/TMD) or prolonged work around the head and neck. Shared Health Manitoba guidelines for the use of eye protection:

Eye protection should be used in high risk situations, with appropriate cleaning and disinfecting protocols.
Remove and clean/disinfect at breaks and at end of shift.
Wherever possible, retain face shields, lenses and/or frames and disinfect eye protection at the end of the shift.

Eye protection (safety glasses, goggles, or a face shield) may be sourced from a hardware or medical supply store. Prescription eyeglasses alone do not provide sufficient protection from COVID-19.

Donning and Doffing of Eye Protection (MTAM Video)
COVID-19 Tips for Extended PPE Use

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Gloves

Gloves are not required for every patient interaction; however, meticulous attention to hand hygiene is required.

Individual practitioners may prefer to wear gloves during the treatment session as an extra safety measure and to help reassure their patients.

If you work in a long-term care facility or provide mobile massage, you may be required to wear gloves for each patient.

When wearing gloves:

Wash your hands properly before you put on gloves and after you remove them
Use a new pair of gloves for each patient
Remove and replace your gloves when they become heavily soiled and when switching between dirty and clean tasks
Remove gloves carefully, using only glove-to-glove or skin-to-skin technique to prevent contaminating your hands.

You should also wear gloves when:

Cleaning contaminated items and linens
Handling waste
Working with immunocompromised clients
A health alert requires you to wear them
If you, the practitioner have a skin condition, cuts, scrapes or other type of wound on your hands
Any time the patient has a contagious condition

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Aprons and Gowns

Aprons and gowns may help protect practitioners’ clothes from contamination when providing treatments. They are not required under the Phase 1 guidelines, nor are they universally required under Shared Health guidelines.

MTAM recommends that mobile RMTs (making home-visits) and those working in long-term care facilities wear aprons or gowns for all patient interactions.

If you must wear or choose to wear aprons or gowns, they can be either cloth or plastic; cloth aprons/gowns must be changed between clients and laundered on the hottest setting, while plastic aprons must be cleaned and disinfected between clients.

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Additional PPE Resources

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Visit the COVID-19 Updates section of the Member Portal for COVID-19 Clinic Documents, FAQs, webinars and other member resources.