COVID-19

Comme le gouvernement de l’Ontario a récemment annoncé la fin des mandats relatifs au port du masque ainsi que l’abrogation des ordres et des directives, l’Ordre des massothérapeutes de l’Ontario a abrogé son Guide de bonnes pratiques liées à la COVID-19 à l’intention des massothérapeutes autorisés. Consultez la nouvelle version du guide.

Updated April 22, 2022

As COVID-19 evolves, the provincial government continues to update resources and guidance. Registered Massage Therapists (RMTs/MTs) are encouraged to review the Ministry of Health’s Guidance for the health sector, the Ministry’s Orders, Directives and Memorandums, and the latest public health measures for the most accurate and up-to-date information. CMTO will continue to monitor developments and provide updates as and when needed.

Current situation and guidance

  • On April 22, 2022, the Ontario Government announced an extension to masking mandates in health care settings (see below under “Masking” for more information).
  • As society adjusts to a new normal, Registered Massage Therapists (RMTs/MTs) will want to prioritize client-centred care and risk assessments in daily practice.
  • On March 21, 2022, CMTO updated its COVID-19 guidance for RMTs. As of March 21, 2022, CMTO’s COVID-19 Practice Guidance for Massage Therapists is no longer in effect. The updated COVID-19 guidance is as follows:

Guidance for RMTs

As of April 22, 2022, masks continue to be required in selected settings until June 11, 2022. This includes health care settings, public transit, long-term care homes, retirement homes, and shelters and other congregate care settings. CMTO considers all RMT practice settings to be health care settings for the purposes of the masking mandate. RMTs will continue to wear surgical/procedural masks and clients will be expected to wear a mask until June 11, 2022.

Clients may have strong and different views on masking, making for difficult conversations. RMTs should continue conducting risk assessments before every client interaction and only provide treatment when the anticipated benefits outweigh the risks. If clients are unable to mask, RMTs can use their risk assessment to determine whether to postpone treatment or use additional personal protective equipment.

When mandatory masking is removed, CMTO expects that some clients will wish to remain masked, some will want their RMT to be masked, and some RMTs may request that a client wear a mask. RMTs should use a client-centred approach, mask if they wish and mask at the client’s request. RMTs should communicate any masking preferences ahead of the appointment to allow clients to prepare accordingly. Risk assessment, careful communication, tolerance and professional judgement will continue to guide RMTs’ decisions on treatment and use of personal protective equipment.

Screening needs to take place once – just before treatment. RMTs should continue screening clients using the Ministry of Health’s Patient Screening Guidance Document. RMTs are responsible for ensuring the screening (and other relevant information) is documented in the client’s health record. If the client does not pass screening, the RMT cannot provide treatment. Signage should continue to be posted at the entrance to the practice location.

RMTs must monitor themselves for COVID-19 symptoms and not practise if they are feeling ill. If an RMT develops symptoms while at work, they must complete the Ministry of Health’s online Self-Assessment Tool and follow the instructions.

RMTs should refer to the Ministry of Health’s Management of Cases and Contacts of COVID-19 in Ontario (released April 11, 2022) for guidance on notifying contacts of potential exposure. Maintaining a roster of all visitors and asking clients to arrive alone, or wait in their vehicles, is no longer required.

In addition to the requirements above, RMTs should use professional judgement in considering client comfort and preference as public health measures are lifted (e.g., making hand sanitizer available and spacing out seating). CMTO also continues to strongly encourage that all RMTs be vaccinated against COVID-19.

If you have any questions, please contact the Practice Specialist at practicespecialist@cmto.com or by phone at 416-489-2626/1-800-465-1933 extension 4124.

Information for Clients

If you are attending a massage therapy appointment, you can expect your Registered Massage Therapist (RMT/MT) to implement measures to keep you both safe. Your RMT will follow the guidance noted above, and any guidelines from the Ontario Ministry of Health. If you are at a higher risk of contracting COVID-19, your RMT may discuss options with you, such as wearing additional personal protective equipment (PPE) or scheduling treatment at the beginning or end of the day.

CMTO does not have the authority to order RMTs to be vaccinated against COVID-19, but CMTO does strongly encourage RMT vaccination. Clients also do not need to be vaccinated to attend healthcare appointments. RMT employers may implement their own vaccination policies, and RMTs in some settings (e.g., long-term care) may be subject to certain vaccination policies. The latest information on the province’s vaccination efforts can be found on the COVID-19 Vaccines for Ontario webpage.

FAQs

Masking

Yes. RMTs and clients must continue to wear face masks during Massage Therapy appointments. Current provincial regulations continue to require face masks in healthcare settings. CMTO considers Massage Therapy as healthcare in every type of practice setting.

At a minimum, RMTs must wear a surgical/procedure mask approved for medical use. There are three classifications of surgical/procedure masks under American Society for Testing and Materials (ASTM) International Standards (Level 1, 2 and 3). Approved surgical/procedure masks of all levels and number of layers are acceptable for use by RMTs.

It is best practice for RMTs to change surgical/procedure masks after every client, and masks must be changed whenever wet, damaged or soiled. Please wash your hands before and after touching, adjusting, putting on or removing a mask.

You may also choose to take additional precautions, which could include wearing:

  • A higher grade of mask than a medical/procedure mask;
  • Isolation gown; and
  • Gloves.

You must incorporate the risk factors of a client not wearing a mask into your risk assessment. Learn more about assessing risk. If after conducting your risk assessment you determine that the risks outweigh the benefits, you may postpone treatment. If you determine that the benefits outweigh the risks and you would like to proceed with treatment, you must wear additional PPE. Please see Public Heath Ontario’s Infection Prevention and Control Fundamentals for more information.

Client/RMT screening and potential exposure

Not specifically. Should you encounter a situation where you must notify clients of exposure to a confirmed case of COVID-19, please refer to the Ministry of Health’s Management of Cases and Contacts of COVID-19 in Ontario (released April 11, 2022) for guidance.

RMTs can only provide treatment when clients screen as negative according to the current version of the Ministry of Health’s Patient Screening Guidance Document.

RMTs must assess their situation according to the Ministry of Health’s Management of Cases and Contacts of COVID-19 in Ontario (released April 11, 2022) and follow the instructions provided. RMTs cannot practise if they are required to self-isolate and until they have completed self-isolation.

Individual employers and higher-risk settings may have more stringent policies to be followed around return to work.

In addition to the minimum isolation requirements advised in the Interim Guidance document, RMTs should also conduct risk assessments when determining when to return to work, including their vaccination status, practice setting and/or client population. For example, RMTs can consider delaying treatment of clients who are at higher risk of negative outcomes from COVID-19 immediately after the RMTs’ required isolation. Learn more about assessing risk.

RMTs should refer to the Ministry of Health’s Management of Cases and Contacts of COVID-19 in Ontario (released April 11, 2022) for guidance on notifying contacts of exposure to a confirmed case.

Providing treatment

Your risk assessment before any client interaction must include an assessment of the risks posed by using any modality, technique or tool that you would like to apply in the treatment. Learn more about assessing risk.

Certain techniques or modalities may present a higher risk of transmission or exposure to COVID-19. You must determine whether it is appropriate to use these techniques/modalities given the increased risk of COVID-19 transmission/exposure. Some potential areas of risk may include:

  • Techniques requiring direct contact with areas close to the client’s mouth, nose, eyes or ears.
  • Techniques that cause prolonged vibration, such as tapotement, as this may loosen phlegm or mucus leading to an increased risk of coughing.
  • Techniques that require removing or adjusting the client’s mask, such as intraoral massage. This increases the risk of exposure to respiratory droplets and can increase the risk of coughing.
  • Hydrotherapy, due to the use of the equipment and/or the increased risk of exposure to fluids that may be contaminated.

If your risk assessment determines there is a benefit to providing a higher risk treatment, you must also wear eye protection (face shield or goggles). You may also choose to wear a higher grade of mask than a medical/procedure mask and should determine whether additional PPE, beyond the mask and eye protection, is warranted, such as a gown and/or full contact/droplet protection, as outlined in Public Health Ontario’s Routine Practices and Additional Precautions in All Health Care Settings (Appendix B) on pages 57-58.

In the case of intraoral treatment, RMTs must wear, at minimum, a surgical/procedural mask, eye protection (face shield or goggles) and gloves.

For more information on the proper use of PPE in healthcare, please see Public Heath Ontario’s Infection Prevention and Control Fundamentals.

Vaccination

No. However, CMTO strongly encourages RMTs to be vaccinated against COVID-19.  As healthcare professionals, RMTs have an ethical obligation to serve their clients’ best interests and protect them from harm. Getting vaccinated is an extension of this commitment. You can find more information about booking a vaccine on the Ontario Government’s COVID-19 vaccine booking page.

CMTO cannot comment on an employer’s vaccination policies and cannot provide advice to RMTs about their obligation to employers. Employers in some settings, such as long-term care homes, hospitals, and home and community care may have their own vaccination policies. RMTs can consider seeking legal advice or contacting the Registered Massage Therapists’ Association of Ontario (RMTAO) about adhering to workplace health and safety policies, including policies about vaccination.

COVID-19 vaccination is an important topic of conversation in healthcare settings and may come up as part of discussions with clients. However, vaccination status is personal health information and RMTs can choose whether to disclose their vaccination status and may determine that it is important to do so in some instances (e.g., when working with immunocompromised clients).

You must base your decisions about in-person treatment on the results of active screening and a risk assessment. While vaccination status may be relevant to a risk assessment and decisions on the use of PPE, it is not the only factor that determines whether in-person treatment should proceed. RMTs must postpone in-person treatment when clients screen as positive to the Ministry of Health’s Patient Screening Guidance document, or when the risk of providing treatment outweighs the benefit.

If a client has been vaccinated but screens positive for symptoms of COVID-19, according to the Ministry of Health’s COVID-19 Patient Screening Guidance Document, you cannot provide in-person treatment at that time. If a client screens positive, you must instruct them to use the Self-Assessment Tool for further guidance.

As healthcare professionals, CMTO strongly encourages RMTs to support the Government of Ontario’s evidence-informed vaccination campaign. While discussing the COVID-19 vaccine in detail or providing advice about types of vaccines is not within the Scope of Practice for Massage Therapy, RMTs are encouraged to help counter vaccine hesitancy. RMTs can refer clients to their primary healthcare provider or the Ontario Ministry of Health’s COVID-19 vaccines for Ontario webpage for information.

Mental Health Resources

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