• Hand Hygiene
• Cleaning and Disinfecting
• Preparing Your Practice
• Booking Appointments
• The Appointment
• After the Appointment
• Personal Protective Equipment (PPE)
• Other Considerations
• For Employers
• RMTs must thoroughly wash their hands (including forearms and elbows) with soap and water between clients.
• RMTs must encourage frequent and proper hand hygiene for all people present in the practice environment. RMTs should:
• Set up hand washing and sanitization stations
• Post signage instructing on proper hand washing techniques
• Require everyone, including staff, clients and visitors to wash their hands upon arrival
• Ensure there are enough supplies within the practice environment for proper hand hygiene.
• Hand sanitizer approved by Health Canada (alcohol-based sanitizer at 60%-90% alcohol) may be used by others in the clinic if soap and water are not available to all.
• Gloves are not a substitute for proper hand washing.
Cleaning and Disinfecting
• 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) must be used to both clean and disinfect surfaces.
• 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 should be cleaned and disinfected at least twice per day, and when visibly soiled. High touch surfaces include: doorknobs, light switches, washrooms including toilet handles, counters, handrails, arm rests, and electronics.
• The treatment room and its equipment must be cleaned and disinfected after each use and between clients.
• All equipment must be in good condition (no tears or rips) to allow for proper cleaning and disinfecting.
• Pay special attention to the container of topical products (e.g. oil bottle), stool and the massage table.
• Clean and disinfect the face cradle after each client.
• Change any face cradle cover after each client.
• Items that are frequently shared, difficult to clean (e.g. upholstered furniture), and/or not necessary to achieving treatment outcomes should be removed. Some examples may include: magazines and other entertainment items; water service, tea service, and snacks; product samples or testers; complimentary phone chargers or electronics; and re-usable hand towels.
• Consider altering the space as much as possible to discourage touching shared surfaces. For example, use garbage bins with step peddles.
• Items in the treatment room that cannot be cleaned and disinfected between clients should be removed. Some examples include table warmers/pads and holsters to hold topical products.
• Linens, blankets and pillows must be changed between clients, and washed and dried in the highest heat possible. Linens used by clients should be stored in a closed bag or container with a lid until they are washed.
• As RMTs are responsible for additional cleaning and disinfecting between clients, clinics may need to allow more time between clients.
• 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.
Preparing your Practice
• Display clear, visible signage 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). The Ontario Government has provided signage in English for both patients/clients and visitors that can be posted on entrances, and a poster for within your setting. Several Public Health Units also have similar resources.
• Signage should be posted at the entrance and at reception areas requiring all clients and visitors to wear a mask (if tolerated), perform hand hygiene and then report to reception to identify themselves.
• Redesign physical settings and interactions to minimize contact between individuals where possible (e.g. separate seats in waiting areas by at least two (2) meters to ensure physical distancing of non-household members, consider traffic flow for common spaces, consider installing plexiglass barrier at reception).
• Develop a process for clients to safely and hygienically provide written consent for treatment of sensitive areas, should the need arise. Plan to disinfect any equipment used during this process (e.g. pens, tablets).
• Document all new procedures, including but not limited to cleaning and disinfecting schedules and responsibilities.
• Before accepting an appointment, the RMT must screen the client virtually for risk of COVID-19 by following the MOH’s COVID-19 Patient Screening Document Guidance and the COVID-19 Reference Document for Symptoms. If the client does not pass this basic COVID-19 screening, the RMT cannot provide treatment, regardless of the rationale for Massage Therapy treatment. 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 should be documented in the client health record and the RMT should 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.
• RMTs must use their professional judgement when providing care outside of an environment they can control, such as providing home visits. For information on precautions for entering a client’s environment, please review the
Ministry of Health’s COVID-19 Guidance: Home and Community Care Providers. • Inform clients of any public health measures that have been implemented in advance of the appointment.
• The RMT must instruct the client to come to the appointment wearing a clean disposable or reusable mask that can be worn throughout the treatment. 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.
• Ask clients to arrive alone (where possible) and as close to their appointment time as possible. If a client is unable to arrive alone, advise the client that the person accompanying them will be screened at arrival to the appointment and will be asked to provide their name and number upon arrival for contact tracing purposes. The person accompanying the client should also be instructed to arrive at the appointment wearing a clean disposable or reusable mask.
• Schedule appointments in a way that allows enough time between clients to implement new cleaning and disinfecting protocol.
• Develop a system to have clients wait outside or in their vehicle if possible. For example, ask the client if they would like to receive a phone call or text message when they can enter the clinic.
• Maintain a roster of all people entering the space (including their name and phone number) to assist with contact tracing if required, ensuring client confidentially is maintained. In addition to clients, this may include couriers, guardians, and support people/workers. Explain to visitors that this information will be used for contact tracing only, should someone who visited the setting later be diagnosed with COVID-19, and that visitors can refuse to provide their name and telephone number.
• Ensure the client washes or sanitizes their hands upon arrival and after treatment.
• RMTs must thoroughly wash their hands (including forearms and elbows) with soap and water before each treatment.
• Immediately prior to treatment, the RMT must screen the client to ensure the client’s COVID-19 status has not changed, and must screen themselves using the same criteria COVID-19 Pandemic – Practice Guidance for Massage Therapists 7
May 27, 2020
as when the client booked the appointment. This screening must be documented in the client’s health record.
• If immediately before treatment, either the client or the RMT does not pass screening, the RMT must not provide treatment.
• If the RMT encounters a client who has gone through the screening process and enters the setting, yet exhibits signs and symptoms consistent with COVID-19, they must:
• establish and maintain a safe physical distance of two (2) meters;
• have the client complete hand hygiene;
• if the client is not wearing a mask, provide the client with a clean mask, if possible;
• segregate the client from others in the clinic;
• explain the concern that they are symptomatic, discontinue treatment and reschedule the appointment;
• advise the client that they should self-isolate and complete the online self-assessment tool before calling their primary care provider or Telehealth Ontario;
• clean and disinfect the practice area and anywhere the client is likely to have touched immediately; and,
• ensure a record is kept of all close contacts of the symptomatic client and other visitors and staff in the clinic at the time of the visit. This information will be necessary for contact tracing if the client later tests positive symptomatic for COVID-19.
After the Appointment
• RMTs must thoroughly wash their hands (including forearms and elbows) with soap and water after each treatment and before and after disinfecting.
• Clean and disinfect anything used during the appointment.
• Document 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 and any modifications to treatment.
Personal Protective Equipment (PPE)
• RMTs must obtain appropriate training on safely using and disposing of PPE, related to droplet and contact precautions (including at minimum by completing the resources offered by Public Health Ontario’s “Infection Prevention and Control Fundamentals”. If you encounter technical difficulties, please refer to
Public Health Ontario’s Online Learning - How Do I Guide) •
RMTs must wear a surgical/procedure mask (not cloth) during treatment and whenever within two (2) meters of clients. Masks should be changed after each client (if available) and must be changed whenever wet, damaged or soiled.
• 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 should advise the client how to properly put on and take off the mask to limit possible transmission of COVID-19. 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.
• Ensure clients and visitors do not leave their masks in waiting or common areas.
• Single use gloves may be used but are not required for most treatments. Gloves do not preclude the need for proper hand hygiene. If used, gloves must be disposed of and changed between each client. Be aware of potential interaction with gloves and topical products; if gloves are used, CMTO recommends using nitrile gloves with oil- or water- based products or latex gloves (unless the RMT or client has latex allergy) with water-based products. Vinyl gloves are not recommended as they may not be durable enough for manual work. Monitor glove use with client feedback and be sensitive to clients’ preferences.
• RMTs are expected to use their professional judgement and conduct individual risk assessments to determine if additional PPE (e.g. face shields, goggles) is warranted due to elevated risk.
• RMTs may consider taking precautions regarding their own clothing, such as wearing disposable coverings or changing their personal clothing between clients. Clothing should be washed and dried regularly and carefully on as high a heat setting as possible.
• Though needed for draping, a cloth sheet is likely not sufficiently thick or layered to be an effective transmission barrier for COVID-19.
• Remember that barriers become less effective at preventing transmission when dampened or moistened. Since all fabrics present during treatment (masks, linens, pillows) may become dampened or moistened by the topical product(s) used during treatment, the RMT should be aware of the elevated risk of transmission and take relevant precautions.
• Please note, this guidance details three additional documentation requirements;
• a general infection prevention and control record/log for the practice,
•• a notation of COVID-19 infection precautions taken for each client in the client health record, and
• a roster of all people entering the space for contact tracing purposes.
Documentation should be kept for 10 years.
• If there are any confirmed cases of COVID-19 in a provider, staff, client or visitor of the practice, the RMT should promptly report it to their local Public Health Unit for advice on their potential exposure and implications for continuation of work.
For more information click the link below
Please note masks are mandatory, table is cleaned 2x prior to treatment, screening is done virtually about 24hrs prior to appointment and the day of at your house prior to entry. Uncompleted forms will cancel your appointment and you will be billed as a no show at 50%.
Thank you for your understanding.