Coronavirus (COVID-19) - Tips

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Health Clinics (Physiotherapists, chiropractors, massage therapists, etc.)

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Introduction

This document is intended for employers, workers, and clients/patients of health services with an overview of potential hazards in the workplace due to COVID-19.

For general COVID-19 prevention practices for both employers and workers refer to these CCOHS documents: Protect Yourself and Others from COVID-19, COVID-19 Health and Safety Planning for Employers and COVID-19 Prevention for Workers

Meet your legal occupational health and safety obligations by doing everything reasonably possible under the circumstances to protect the health and safety of your workers. In all cases, guidance from local public health authorities must be followed. Also refer to current guidance from the Public Health Agency of Canada (PHAC), your jurisdictional occupational health and safety regulator, and applicable business associations.

Considerations When Assessing Risk

The risk of COVID-19 transmission increases when you are in closed spaces with poor ventilation, and crowded places with people outside of your immediate household. The risk is higher in settings where these factors overlap and/or involve activities such as close-range conversations, singing, shouting or heavy breathing (e.g., exercising).

Working in health clinics typically involves close contact with clients /patients and co-workers, which can increase the risk of COVID-19 transmission. Make sure staff and others know the preventative measures in place before they arrive on-site. Consider:

  • The ability of your clients and patients to follow the recommended personal preventative measures based on their health, age, disability, developmental status, or other socio-economic and demographic circumstances.
  • Frequent contact with high-touch surfaces or shared items such as tools and equipment, handheld payment devices, touchscreens, door handles, chairs, tables, faucets, barriers, etc.
  • Availability of supplies and facilities necessary for frequent hand hygiene, cleaning, and disinfection.
  • Risk of severe illness of your employees, clients or patients if they belong to a higher risk group.

Control Measures to Help Reduce the Risk of COVID-19 Transmission

Each workplace is unique. It is important for employers to work with their health and safety committee or representative (if available) to assess the risks of COVID-19 for their specific workplace. Implement appropriate hazard controls using the hierarchy of controls (i.e., elimination, substitution, engineering controls, administrative policies, and the use of personal protective equipment (PPE). Use a layered approach by including multiple personal preventative measures to protect yourself and others from COVID-19.

Communication

  • Inform and train all employees on the risks of COVID-19, symptoms, and the measures to help control transmission.
  • Post workplace-specific information and include your safety plan. See CCOHS’s Fact Checking COVID-19 Information for tips on choosing COVID-19 resources.
  • Provide mental health resources to employees, including access to your employee assistance program (EAP) program, if available.
  • Encourage employees to report any concerns about COVID-19 to their supervisor or employer. They can also report concerns to their health and safety committee or representative, if available.
  • Inform all employees, clients/patients in advance about any new measures that are in place. This information can be shared online, through advertisements, with notices at the front doors, and verbally by staff. Help clients/patients understand that protective measures are necessary, and that their experience might be different than what they are used to. Ask them to be considerate of your staff and others.
  • Post signs throughout the facility to encourage physical distancing, use of non-medical masks, cleaning and disinfecting of equipment, and proper hand hygiene and respiratory etiquette.
  • Ensure information is provided in a way that meets accessibility needs (age, reading level, language, etc.).
  • Consider an online or phone-based booking system to help manage the number of people on site and to reduce waiting. Where possible, send any necessary forms electronically, rather than handling paperwork. Use contactless payment methods, such as pre-pay, tap, or e-transfer.
  • Ask clients/patients to arrive at their appointment time and to leave promptly after their appointment/service. Ask them not to bring any guests or non-essential visitors.
  • Record the names and contact information of all persons entering the facility to assist with contact tracing if needed. Make sure that privacy is protected, and the list is only used for contact tracing purposes.

Screening

  • Encourage employees to stay home if they are sick or might be sick. Follow self-assessment steps from the Public Health Agency of Canada or your local public health authority.
  • Screen your employees and clients/patients before they enter your workplace, following the recommendations provided by your local public health authority. Customers/clients could be asked about illness and exposure risks when they are booking their appointments and again at reception when arriving at the premises.
  • “Active screening” may be legally mandated in some jurisdictions and involves asking questions about a person’s health and possible exposures. Use a checklist or questionnaire provided by your local public health authority.
  • Some organizations are using point of care rapid antigen detection tests (RADTs) as part of their active screening. Refer to CCOHS Rapid Testing for COVID-19 document for further details. In all cases, consider keeping a record of the names and contact information for your employees who enter your workplace for contact tracing purposes. Maintain confidentiality and ensure the information is gathered, used, stored and destroyed in accordance with your privacy laws.
  • Consider revising your appointment cancellation policy to encourage clients/patients to stay home if they have symptoms (e.g., no fee for cancelling appointments).
  • Anyone who does not pass screening should not enter the facility, should wear a medical mask, if available (otherwise, wear a well-constructed and well-fitting non-medical mask), return home (while avoiding public transit as much as possible), contact their health care provider or local public health authority and follow their advice.

Physical Distancing

  • Follow your jurisdictional occupancy limits to determine the number of people allowed in your facility
  • Maintain the greatest distance possible (at least 2 metres) from others wherever possible.
  • Limit how many people are allowed in work and common areas (e.g., break room). Stagger shifts, break times, and appointments where possible.
  • Rearrange workstations, common areas, reception areas, break rooms and chairs to promote physical distancing. Consider using multiple break areas for staff, including outdoors, if available.
  • Consider how people will use or travel through shared spaces, such as hallways and washrooms. Establish one-way routes where appropriate, using floor markings, signage, and other visual cues.
  • Have administrative staff work from home whenever possible.

Engineering Controls

Barriers:

  • Consider installing physical barriers (e.g., at reception, between workstations) to separate people and help prevent droplet spread.
  • Physical barriers may include counter-mounted or freestanding plexiglass, curtains, or dividers. Walls are also a barrier and can be added made of wood, steel, or glass. Avoid materials such as plants, porous fabrics, paper, etc. as as they will not adequately prevent COVID-19 transmission.
  • Ensure the use of barriers meets legislative requirements (e.g. fire and building codes) and consider any impacts if any, to the heating, ventilation, and air conditioning (HVAC) system (i.e., reduced air flow).
  • Physical barriers should always be used in conjunction with other COVID-19 control measures (e.g., reduced occupancy, adequate ventilation, use of non-medical masks, etc.).

Ventilation :

  • Make sure that heating, ventilation and air conditioning (HVAC) systems operate properly.
  • Increase circulation of outdoor air as much as possible by opening windows and doors or other methods. However, do not open windows and doors if it poses a safety risk.
  • Make sure exhaust fans in restrooms are fully functional, operating at maximum capacity, and remain on.
  • Avoid blowing or circulating air from one person to another using powerful portable cooling fans as it might increase the spread of COVID-19. Adjust building ventilation systems and air conditioning units instead.
  • Adjust ventilation systems to:
    • Increase filtration efficiency to the highest level appropriate for the system.
    • Increase fresh air flow/percentage of outdoor air (increase percentage of outdoor air in HVAC air supply, open windows, and doors, etc.).
    • Avoid recirculation of stale indoor air.
    • Limit use of demand-controlled ventilation; keep system running at the optimal setting.
    • Explore the use of portable high efficiency particulate air (HEPA) filtration units.
  • Consult an HVAC professional before making changes to the ventilation system(s).
  • For additional detailed information on ventilation, please refer to the Government of Canada website COVID-19: Guidance on Indoor Ventilation During the Pandemic and the CCOHS document COVID-19 Tip Sheet: Ventilation.

Personal Hygiene

  • Post signs at entrances, in washrooms, and other areas throughout the workplace to promote good hand hygiene and respiratory etiquette.
  • Avoid touching your face (eyes, nose, and mouth), especially when working with clients/patients.
  • Hand wash or hand sanitizer stations should be well stocked and easy to find, near the entrance and other appropriate areas.
  • Regularly wash your hands for at least 20 seconds with soap and warm water, or use alcohol-based hand sanitizer containing at least 60% alcohol if soap and water are not available:
    • at the beginning and at the end of your shift
    • before and after work breaks
    • after blowing your nose, coughing, or sneezing
    • before putting on, touching or after removing non-medical masks and personal protective equipment
    • before eating or drinking
    • after using the washroom
    • before after contact with others and between clients/patients
    • after touching shared surfaces and items
    • after handling used towels, garments, etc.
    • after handling garbage.
  • Employees should change out of work clothes before going home. Uniforms, aprons, etc., and clothing should be laundered as soon as possible after every shift.

Cleaning and Disinfecting

  • Viruses can remain on objects for a few hours to days depending on the type of surface and environmental conditions.
  • Develop a cleaning schedule and follow your standard operating procedures for cleaning and disinfecting commonly touched surfaces (door handles, light switches, chairs, etc.) and equipment (e.g., tables, weights, bands, etc.)
  • Clean and disinfect common areas and equipment between clients/patients. If using barriers, clean and disinfect both sides of the barrier frequently throughout the day.
  • Make sure washrooms are cleaned and disinfected frequently and stocked with soap and paper towels.
  • Train staff on cleaning and disinfecting procedures including applicable workplace hazardous materials information system (WHMIS), legislation and provide adequate supplies and personal protective equipment (PPE).
    • Use approved hard-surface disinfectants that have a Drug Identification Number (DIN). This number means that it has been approved for use in Canada.
    • Read and follow manufacturer’s instructions for safe use of cleaning and disinfection products (e.g., wear gloves, use in well-ventilated area, allow enough contact time for disinfectant to kill germs based on the product being used).
    • If approved household or commercial disinfectant cleaning products are not available, hard surfaces can be disinfected using a mixture of 5 mL of bleach (5% sodium hypochlorite) and 250 mL of water. Test surfaces before using a bleach solution.
    • Bleach can be corrosive. Follow instructions for safe handling of bleach.
    • Follow the manufacturer’s instructions for cleaning high touch electronics (e.g., touch screens, pin pads, keyboards, tablets). If liquids can be withstood, disinfect with alcohol or disinfectant wipes containing 70% alcohol.
  • Used cleaning cloths, towels, garments, and linens must be properly handled to prevent contamination, changed between clients, and laundered after every use (use disposable single use items where possible).
  • When doing the laundry, use detergent and dry laundry completely. Do not shake dirty laundry and consider using disposable gloves.
  • Hampers and bins used for storing laundry must be clean and disinfected. Perform hand hygiene afterwards.
  • Replace garbage bins with no-touch receptacles or remove lids that require contact to open. Line garbage cans for safe and convenient disposal of contaminated items, such as used personal protective equipment (PPE), tissues, and cleaning materials.
  • Dispose of garbage at least daily and make sure it is done safely.

Personal Protective Equipment (PPE)

  • Continue to use Personal Protective Equipment (PPE) for existing occupational safety hazards and emergencies as directed by applicable laws and your employer.
  • Staff should use PPE (e.g., disposal gloves, safety goggles) when other preventative controls are not possible or do not offer enough protection (e.g., when cleaning and disinfecting).
  • When selecting the correct PPE to use, it is important to perform an assessment of all the activities that will be done and what products that will be used. This makes sure that appropriate protection is provided, and additional hazards are not created.
  • Develop procedures and train staff on the selection, use, wearing, removal, disposal, cleaning, maintenance, and storage of PPE. Improper use of PPE can increase the risk of infection.
  • PPE should not be shared unless recommended by manufacturer. Clean and disinfect PPE that is shared between users.
  • Clean hands before putting on PPE and after removing PPE.

Use of Non-Medical Masks (NMMs)

  • Follow the recommendations for types of masks and ages as issued by your public health authority. Children under the age of 2 should not wear a non-medical mask or face covering. Children between the ages of 2 and 5 may be able to wear a mask if supervised. Children older than the age of 5 should follow the same advice for adults on when to wear a non-medical mask or face covering.
  • Masks should be well constructed and well fitting, fully covering the nose, mouth, and chin without gaps. Encourage people not to touch their face or mask with unwashed hands.
  • Masks should not be worn by anyone who is unable to remove the mask without assistance (e.g., due to their age, ability, or developmental status).
  • Be aware that non-medical masks have limitations, and improper mask use and disposal can increase the risk of infection.
  • Change your mask if it becomes wet or soiled. For example, you may wish to bring a second mask, and store in a clean paper bag, envelope, or container that does not trap moisture. Store reusable soiled masks in a separate bag or container. Do not touch the outside of the mask while removing it and wash your hands when you are finished.
  • Do not allow the mask to be a hazard to other activities, such as getting caught on moving machinery or playground equipment.
  • For some people, not being able to see another person’s face and mouth clearly may cause difficulties (e.g., young children, people who are deaf or hard of hearing). Consider using a transparent mask in those situations.
  • Employees may also opt for eye protection (such as face shields) when in close physical contact with others. They are not a suitable replacement for face masks but can provide eye protection. Continue to wear a non-medical mask when using a face shield. Stay informed as guidance is evolving regarding the use of face shields.

Additional Considerations

  • Information on the risks of COVID-19 transmission may change as the pandemic continues to evolve. Keep informed by continuing to follow trusted sources including the Public Health Agency of Canada and your local public health authority.
  • Employers must continue to conduct risk assessments on how COVID-19 can be transmitted in their workplaces and use the hierarchy of controls to provide a layered approach to reducing the risk. Continue with physical distancing, engineering controls, ventilation, cleaning, and disinfecting, using personal protective equipment (PPE) and wearing non-medical masks as part of your health and safety plan. Ensure no new health and safety risks are created (e.g., propping open fire doors).
  • Consider installing the COVID Alert App on your phone. This app is designed to let Canadians know whether they may have been exposed to COVID-19. The app maintains your privacy; it does not record or share your geographic location.
  • Discuss the benefits of COVID-19 vaccination with your staff.

It is important that mental health resources and support are provided to all workers, including access to an employee assistance program, if available.

For further information on COVID-19, refer to the Public Health Agency of Canada.

Note that this guidance is just some of the adjustments organizations can make during a pandemic. Adapt this list by adding your own good practices and policies to meet your organization’s specific needs.

Disclaimer: As public and occupational health and safety information is changing rapidly, local public health authorities should be consulted for specific, regional guidance. This information is not intended to replace medical advice or legislated health and safety obligations. Although every effort is made to ensure the accuracy, currency and completeness of the information, CCOHS does not guarantee, warrant, represent or undertake that the information provided is correct, accurate or current. CCOHS is not liable for any loss, claim, or demand arising directly or indirectly from any use or reliance upon the information.

Document last updated March 26, 2021