COVID-19 and the Use of Additional PPE

Winter 2021

The following scenario is provided to assist Registered Massage Therapists (RMTs/MTs) who are considering what personal protective equipment (PPE) to use when providing in-person treatment during the COVID-19 pandemic. At a minimum, RMTs must wear surgical/procedure masks approved for medical use in all practice situations where physical distancing is not possible. Based on the Ministry of Health’s recommendations, RMTs should also consider using eye protection (goggles or a face shield) while practising. For information about the fundamentals of infection prevention and control (IPAC), including how to properly use PPE in healthcare, please review the Public Health Ontario’s Infection Prevention and Control Fundamentals resource.

RMTs’ decisions on using PPE beyond the required surgical/procedure mask should be informed by a risk assessment for exposure and transmission of COVID-19 specific to their practice setting and treatment modalities used, as well as whether the client or RMT may be at higher risk of severe outcomes due to COVID-19 infection and the RMT’s personal health situation. For more information on risk assessment, please see Assessing Risk During the COVID-19 Pandemic.


Meera is an RMT working in a multidisciplinary clinic. She is considering whether she should provide in-person treatment to her client Costa. While Meera’s clinic is open, she realizes that during the pandemic, it is her responsibility to only provide treatment to those clients where the anticipated benefits outweigh the risks.

Costa is a returning client with chronic back, neck and shoulder pain due to a serious fall from a ladder two years ago. At the time of booking Costa notified reception that due to a disability, he would not be able to wear a mask during treatment. To understand more about the nature of Costa’s disability and health needs, Meera calls him asking for more information. Costa shares that he is experiencing worsening severe neck and shoulder pain, is no longer able to work and is having trouble sleeping. Due to disability from his injury, Costa is not able to reach up to his head to put on, take off, or adjust a mask. He shares that he does not feel safe wearing a mask and would like an exemption.

In determining whether to provide in-person treatment to Costa, Meera considers the following:

  • Meera is practising in a region that is in zone Orange – Restrict. Meera knows this means that the risk of transmission may be higher.
  • Meera considers the fact that both herself and Costa have screened negative for COVID-19, and she will screen him again immediately prior to treatment.
  • Meera reviews Costa’s health history information along with the information he provided about his current health needs. Meera determines that Costa is requesting treatment for symptoms that appear to be worsening over time. She believes that postponing Costa’s treatment may cause his symptoms to worsen and become more acute, resulting in further decline of physical dysfunction. In her professional opinion, delaying Costa’s treatment could cause unnecessary harm.
  • Meera considered the fact that environmental risks within the practice setting are controlled because she is following required infection prevention and control (IPAC) measures. Meera knows that additional risk is created because Costa is unable to safely wear a mask.

Meera determines that she should proceed with in-person treatment, but knows she will need to wear additional PPE to mitigate the risk associated with Costa not wearing a mask.

Following this rationale, Meera determines that it would be appropriate to also wear a gown over her work clothes in addition to wearing a surgical/procedural mask and a face shield. Meera contacts Costa to confirm the appointment. Meera books Costa’s appointment at end of day to allow for additional cleaning following the appointment. She explains to Costa that during treatment she will be wearing a surgical/procedure mask, a face shield and a gown.  She explains to Costa that she is taking these additional precautions because of the high risk of community spread and the fact the Costa is unable to wear a mask. In her treatment notes,

Meera outlines her rationale for providing in-person treatment and the additional PPE she decided to use because Costa is unable to wear a mask.

Other Protective Measures and Resources

Along with the appropriate use of PPE, RMTs must remain vigilant in screening, cleaning and disinfecting, and adhering to Ministry of Health and CMTO guidance to prevent the spread of COVID-19.

For additional information and resources, including CMTO’s guidance and Frequently Asked Questions, please visit our COVID-19 webpage. If you have further questions, please contact our Practice Specialist at or by phone at 416-489-2626/1-800-465-1933 extension 4124.

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