COVID Safety Procedures - what to do

Jennifer Wallenfels, LMT — Spiral Massage & Bodywork
COVID SAFETY PROCEDURES
Revised 6/11/20

These new precautions are for everyone’s safety. Thank you so much for your understanding and cooperation. 

Treatment:

• Expect a pre-screening by phone or text sometime the day before.

• Cancel if you develop any symptoms of possible illness before the appointment (no fee will be charged).

• Please come to your appointment alone (unless client is a minor).

• When you arrive, please text and wait in your car until I have indicated that the office is ready for you to enter. 

• Please don your mask before entering the office (or, I will provide a fresh disposable mask for you).

• A temperature check will be performed upon entry. People with temperatures 100.4 or above will not be treated.

• I will ask you to wash or sanitize your hands prior to the treatment. 

• If possible, pay by a touchless option. (Requires setup on your phone beforehand.)

Options:

• I will have a face shield available for you by request, but it’s not required. 

• I will not wear gloves by default, but I will be happy to, if you request it.

Post-Treatment:

Contact me as soon as possible if you or anyone in your household: 


• Develops possible COVID-19 symptoms, 

• Tests positive for COVID-19, 

• Or is notified they have been exposed to COVID-19.

COVID-19 Exposure Control Plan

Jennifer Wallenfels, LMT — Spiral Massage & Bodywork
COVID-19 Exposure Control, Mitigation and Recovery Plan
Revised 6/30/20

This plan was prepared by compiling recommendations from the following organizations: the Washington State Department of Health, OSHA, the CDC, and several professional massage organizations: the ABMP, the AMTA, the WSMTA, and the FSMTB.

GENERAL PROCEDURES
During Phase 2 of Safe Start, the clinic is operating at 50% occupancy by the two practitioners alternating days. Jody Ruhberg, LAc is working on Monday, Thursday, and Saturday; Jennifer Wallenfels, LMT is working Tuesday, Wednesday, and Friday.

In future phases the practitioners will attempt to stagger client arrivals and departures. In the event that this is not possible, they may take payment and reschedule in the treatment room.

The clinic will now:

• Monitor surge capacity daily through the state’s risk assessment dashboard.
• Encourage at-risk clients to wait longer to return to treatment.
• Ask all clients to sign an addendum to their informed consent - see attached COVID Addendum to Informed Consent.
• Post notices in office reminding about temperature checks, handwashing, respiratory etiquette and social distancing between clients.
• Conduct a pre-screening the day before treatment. If client has symptoms or reason to suspect exposure, treatment will be rescheduled - see attached Screening Checklist.

PHYSICAL DISTANCING
During phase 2 we are taking clients one at a time, so there is no client-to-client contact, or contact between practitioners. As the county moves into further phases, and both practitioners begin to both see clients on the same day, we will implement social distancing in the office by attempting to stagger appointment times. When this is impossible, practitioners may take payment and reschedule in the treatment room, rather than bringing the clients into the shared lobby after the treatment.

RECEIVING CLIENTS

• Clients are asked to attend the appointment alone (unless the client is a minor).
• Clients are asked to text upon arrival, and wait in their vehicles until notified to come in.
• Clients are asked to don a mask before entry. Disposable masks are available.
• A temperature check will be performed upon entry. If client temperature is 100.4 or above, treatment will not be performed that day. Client’s temperature is documented in the chart.
• Clients are asked to sanitize or wash their hands before the treatment.
• Clients are asked to sanitize their hands before leaving the treatment room.
• The office is cleaned and disinfected after each treatment - see attached Cleaning & Sanitizing Procedures.
• The practitioner will document in the chart that that the safety procedures were followed with the client.

TAKING PAYMENT

• Touchless pay systems (Apple Pay and Google Pay) are preferred.
• If a physical card is presented, the reader should be held for the client to insert and remove their own card.
• The signature requirement has been turned off so client does not need to touch the phone.
• If cash or check is presented, it shall be put directly into the day’s deposit envelope.
• After taking payments, the practitioner will perform hand hygiene.

PPE

• Client and practitioner will both wear face masks or coverings, except when the client is prone.
• When the client is prone, a pillowcase draping the face cradle will be used in lieu of a mask.
• The practitioner will wear scrubs, and a cloth face covering, which are changed and washed after each client.
• The practitioner will wear a face shield during treatment. The client is not required to wear one, but one is available upon request.
• Face shields are disinfected with 70% alcohol after each use.
• The practitioner will not wear gloves by default, but are available upon request.
• The practitioner will observe proper hand hygiene before donning and doffing PPE, and don/doff in the proper order & manner.

HYGIENE

• Handwashing is the preferred method of hand hygiene, but if hands are not dirty, hand sanitizer is also acceptable.
• Clients are asked to sanitize or wash hands upon entering the office, and use hand sanitizer after the treatment. Handwashing instructions are posted in the bathroom.
• As customary, handwashing is always performed directly before and after treatment, washing up to the elbows and using a nail brush.
• The face shield may be removed and set aside for disinfection, but the practitioner will not remove their face mask until after the client leaves and the office is ventilated. The practitioner will practice proper hand hygiene when doffing PPE.
• The practitioner will perform office cleaning and disinfection before changing into clean scrubs and dressing the table.

CLEANING AND DISINFECTION

• Unnecessary items have been removed from the office for easier cleaning and disinfection.
• 45 minutes is being allowed between treatments for thorough ventilation, cleaning and disinfection.
• Ventilation, cleaning and disinfection with EPA-approved disinfectant will be performed on the lobby, bathroom, treatment room and laundry immediately after each client — see attached Cleaning & Sanitizing Procedure.


     Ventilation:

• HEPA air filters have been added in the treatment room and lobby which run continuously.
• A window will be open during treatment for increased ventilation.
• Windows will be opened for ventilation directly after each treatment.

      Cleaning and Disinfection:

• If surfaces are visibly soiled: clean, then disinfect. If surfaces are not soiled: just disinfection is acceptable.
• The preferred cleaner is soap and water (or Simple Green).
• The preferred disinfectant is 3% Hydrogen Peroxide (or commercial disinfectant wipes).
• The preferred disinfectant for electronic items is 70% isopropyl alcohol.
• The practitioner shall wear gloves to prevent skin irritation when sanitizing.
• Paper towels, disinfectant, alcohol, and hand sanitizer are now stocked at the front desk and treatment room, as well as the laundry area. As customary, tissues are also available in these locations.
• The treatment room and bathroom trash bins have been changed to foot pedal-operated, lidded cans using liners which are emptied daily.
• As customary, dirty linens are stored in the laundry room, and washed same day in hot water with peroxide. Clean linens and scrubs are stored covered in the treatment room.
• The practitioner will perform hand hygiene after handling dirty laundry and doing cleaning or disinfection.
• As customary, waterproof covers are used on all pillows and heating pads.
• As customary, linens are completely changed between each client, including any blankets used.

SYMPTOM MONITORING
Practitioners will self-check their temperature at start of each day, or if symptoms develop.
If a practitioner has temperature of 100.4 or above, or develops symptoms, the practitioner shall cancel appointments, leave the premises, and refer to the Incident Response section of this document.



SAFETY TRAINING
As this office has two solo practitioners, we have conducted our own safety training through self-education, by drawing on the resources listed at the beginning of this document. We are also continuously monitoring the latest scientific understanding of the transmission of COVID-19.


INCIDENT/EXPOSURE RESPONSE
Clients are requested to contact their practitioner as soon as possible if they:

1. Develop symptoms of COVID-19 in the two weeks after a treatment
2. Test positive for COVID-19 in the two weeks after a treatment
3. Get notified that they were exposed to COVID-19 in the two weeks prior to a treatment.

Clients give written consent that the Washington State Department of Health may be informed for contact tracing purposes only - see attached COVID Addendum to Informed Consent.

If clients develop symptoms and notify the practitioner, they shall be encouraged to self-isolate for 14 days, seek testing, contact their primary care physician, and notify their contacts and the DOH (or have a household member do so on their behalf).


POST-EXPOSURE RECOVERY PLAN
In the unfortunate event that Jennifer Wallenfels, LMT learns she was exposed to COVID-19, or comes down with symptoms, she will self-isolate for 14 days, and get tested as soon as possible. If she tests positive, she will notify all her clients and other contacts for the prior two weeks, as well as Jody Ruhberg, LAc, as soon as possible. She must also cancel all her upcoming appointments until recovered.

Her treatment room will be closed for a minimum of three days and the lobby, bathroom and laundry areas must be thoroughly cleaned.

In the extreme case that Jennifer Wallenfels, LMT is hospitalized or too ill to notify her own clients of exposure or cancellation, Jody Ruhberg, LAc is granted permission to contact clients and the DOH on her behalf. Contact the state COVID Information line at 1-800-525-0127.

***

Jennifer Wallenfels, LMT
COVID SCREENING CHECKLIST

Have you or anyone in your household ever tested positive for COVID-19, or been exposed to anyone in the last two weeks who has COVID-19?

Have you or anyone in your household had any of these symptoms:

• Cough or sore throat?
• Difficulty breathing or shortness of breath?
• Fever, chills or shaking?
• Unfamiliar muscle pain or headache?
• Sudden loss of taste and/or smell?

Have you or anyone in your household attended a large gathering? If so, what protections were employed?

***

If you have recovered from COVID-19,

• Are you having any lingering symptoms or conditions related to it?
• Are there any restrictions on your physical activity? Any new discomfort with exertion?
• Do you have unfamiliar and severe, deep pain?
• Do you have skin marks, rashes, or “COVID toes?”
• Are you taking drugs to manage blood clotting?

***

Jennifer Wallenfels, LMT
COVID-19 Addendum to Consent for Massage Therapy

I am following guidelines from the CDC, Washington State Department of Health, and protocols from professional organizations to lessen the potential for disease transmission. I appreciate your understanding and compliance with the policies and procedures.

However, the Washington State Department of Health points out that there is no method to completely remove the risk of person-to-person spread of COVID-19 during a massage. No in-person appointment is risk-free. Telehealth sessions are an alternative to in-person appointments, and are recommended for those who are high-risk.

Please initial the following:

________ I understand that if a patient or practitioner of this facility tests positive for COVID-19 and it could have been transmitted to me, I will be informed. If this occurs, my name and contact information may be shared with the state Department of Health for contact tracing purposes only.

________ If I develop any symptoms of illness after my session, test positive for COVID-19, or discover a household member or contact has tested positive for COVID-19, I will inform Jennifer Wallenfels as soon as possible.

________ I understand no cancellation fee will be charged if I cancel an appointment due to symptoms of illness.


I have read and understand the disclosures, policies and procedures of Jennifer Wallenfels, LMT. I give my consent to receive massage treatment.



Print Name  _________________________________


Signature ___________________________________        Date _________________



 ***

Jennifer Wallenfels, LMT
CLEANING & SANITIZING PROCEDURE

If surfaces are visibly soiled: clean, then disinfect.
If surfaces are not soiled: just disinfection is acceptable.

Start of day
Empty all trashes & replace liners (mitigating exposure by leaving overnight)

After each treatment
Entry: Front door handle, countertop, phone/reader, pen/stylus, water cup, turn up air filter
Bathroom: turn on fan for ventilation, doorknob, lightswitch, toilet handle & seat, sink & dispenser handles
Treatment room: Ventilation (open windows & turn up air filter), doorknob, client chair, table, and dish; my desk & stool; dresser, vibrating massager, hot cabi, bolsters, pillow covers, table cover, table warmer switch, heater controls. Any crystals used, my glasses, pens, clipboard and client clipboard.
After cleaning protocol complete: remove scrubs, perform hand hygiene, put on new scrubs (or street clothes at end of day) and set new table linens

End of day
Do laundry
all light switches
Front desk surfaces, computer and peripherals, pens, glasses
Bathroom: include cleaning entire sink & toilet bowl
Laundry room: change laundry liner, doorknob, countertop, hamper lids, sink & dispenser handles, laundry control panels, drawer & doors, laundry bottle handles, laundry baskets, cabinet pulls

Weekly
Vacuum (with HEPA filter) all floors. Vacuum at start of day to mitigate exposure
Mop hard floors
Sanitize tools after use
Dust all surfaces that have not been cleaned throughout week
Water plants


After each treatment

Entry:
Turn up air filter/open window
Front door pull
Countertop
Thermometer
Phone/reader/stylus
Water cup

Bathroom:
Turn on fan/clean switch
Doorknob
Lightswitch
Toilet handle, lid & seat
Sink handles & soap/lotion dispenser handles

Treatment room:
Remove sheets, cups & oil bottle. Perform hand hygiene
Open windows & turn up air filter
Doorknob, heater control
Client chair & bin, table, and dish
My desk & stool
My glasses, pens, clipboard and client clipboard
Dresser drawers
Hot cabinet
Bolsters & pillow covers
Face cradle & table
Heating pad and table warmer switches
Vibrating massager, crystals, tuning forks

After cleaning complete:
Perform hand hygiene; remove scrubs
Perform hand hygiene; put on new scrubs or street clothes
Set new table linens

Hi everyone. I wanted to share with you the Washington State Department of Health's latest recommendations on massage. As you can see below, as of a few days ago they are still recommending that we hold off on giving massages except in the most dire cases. Additionally, getting a massage is going to look quite different than it used to, at least for a while.



Updated April 27, 2020
COVID-19 Health Alert for Massage Therapists

Massage therapists should be aware that there is:

--Widespread person-to-person transmission of COVID-19 in Washington. People with COVID-19 can spread the illness even when they feel or look well.
--High risk of severe COVID-19 illness in people older than 60 years or with underlying health conditions.
--No method to completely remove the risk of person-to-person spread of COVID-19 in a massage setting.

Governor Inslee’s proclamation 20-25 allows health care providers to continue essential health services. Many services massage therapists provide are considered non-essential and most are considered non-urgent. No in-person appointment is risk-free, even if the patient and massage therapist appear well. To help control the spread of COVID-19, treatment should be limited to patients with a clear and documented urgent medical need.

While the proclamation allows massage therapists to continue providing essential health services, they are not required to do so. Massage therapists should weigh their own and their patients’ health risk when deciding whether to provide in-person services.

Actions requested before providing services:
--Provide massage only to patients with urgent medical issues. Examples include, but are not limited to, lymphatic overwhelm issues, severe whiplash, and acute pain control. Simply having a prescription for massage is not sufficient to establish urgent care
-- Cancel non-urgent massage appointments.
-- When appropriate, consider providing self-care ideas to your patients and reinforcing the self-care instructions you provided prior to current restrictions on non-essential services.
-- When treatment is urgently medically necessary, ask the patient if they have symptoms of respiratory illness (e.g., fever, cough, difficulty breathing) before they enter your practice. If a patient has a fever or respiratory symptoms, do not provide treatment. Instead, suggest the patient contact their primary care provider.
-- Make sure patients practice social distancing of six feet in waiting rooms and other areas of the practice. Consider having patients wait outside rather than in a waiting room so complete cleaning can occur between patients.
-- Remind sick employees to stay home. Do not require them to work. Allow all employees who are uncomfortable with continuing to work in the clinic to stay home.


Actions requested when providing services:
-- Familiarize yourself with standard, contact and droplet precautions.
-- Ensure that massage therapists have the following personal protective equipment (PPE) and are familiar with its use: facemask (surgical mask with ear loops or mask with ties), eye protection (for example, goggles or disposable face shield that covers front and sides of face), gown, and
clean, nonsterile gloves. Alternatively to a gown or other covering, massage therapists can change clothes after each massage.
-- CDC’s Optimizing the Use of PPE provides guidance on actions to take when PPE is short or you do not have PPE, including contingency and crisis strategies. Using crisis measures is not ideal and could put health care providers at risk for disease.
-- Provide a face mask or cloth face covering for each patient to wear during the entire treatment.

Environmental cleaning and disinfection actions:
-- Between all patients, clean with soap and water or other cleaning agent to disinfect surfaces touched by the patient. This includes: the massage table’s face cradle, table legs and bolsters, and bathrooms, if used by the patient.
-- Use clean linens, including blankets, for each patient. Launder linens in hot water and dry completely.
-- Throughout the day, wipe high-touch areas (door knobs, handrails, etc.) with a disinfectant.
-- Use EPA-approved disinfectant from List N along with CDC guidance for cleaning and disinfection.
-- Diluted household bleach (at least 1,000 ppm sodium hypochlorite: 5 tablespoons [1/3 cup] bleach per gallon of water or 4 teaspoons bleach per quart of water) can be used to disinfect on surfaces not damaged by bleach.
-- Read the label before use of any disinfectant and follow the label’s instructions. Never mix household bleach with ammonia or any other cleanser.

Background:
The virus causing coronavirus disease-2019 (COVID-19), emerged in December 2019 and has since spread around the world, causing a global pandemic. Eighty percent of cases are mild, but severe disease and deaths are more common in the elderly (older than 60 years) and in those with underlying health conditions. Health experts are concerned that increasing transmission in our state and an increase in severe disease will limit the ability of our health care system to provide urgent care to all who require it.

Additional resources for massage therapists:
DOH Workplace Recommendations
DOH Coronavirus (COVID-19) Web Page
CDC Coronavirus (COVID-19) Web Page
CDC Practice Preparedness Resources

To request this document in another format, call 1-800-525-0127. Deaf or hard of hearing customers, please call 711 (Washington Relay) or email civil.rights@doh.wa.gov.

Topical Pain Relief:  Magic Oil & Biofreeze

Because I focus on pain relief massage, there are two products I use a lot in treatment: what I call "Magic Oil" (arnica oil) and Biofreeze. I also sell them, so that people can have something to use for relief between massages. People often ask what the difference is, and what's better to use. The answer is: it depends on what's causing the pain. I'll compare and contrast the products here.

Magic Oil is for soreness due to overuse and injury. Biofreeze is a temporary pain blocker - an alternative to aspirin.

Magic Oil is an anti-inflammatory, specific for tissue trauma. It takes effect over several hours; but the effect will not "wear off." It is great for soreness due to:
    -Muscle soreness (from working out, doing unusual activities, etc)
    -Soreness from deep tissue massage
    -Pulled muscles, or sprains of tendons and ligaments
    -Injury or bruising - this includes auto accidents and surgery, as well as minor bumps & bruises.

Biofreeze is a non-drug, temporary pain blocker - the effect begins instantly, but wears off after a while, like aspirin. (It can be used up to four times each day.) It may work better for pain unrelated to tissue trauma, for instance: 
    -Arthritis
    -Pinched nerves, such as sciatica
    -Chronic neck & shoulder, or low back pain.

Magic Oil is simply olive oil infused with arnica flowers. There are many topical preparations of arnica out there - available in any health food store - and I have used many of them. I like to tell the story about how Magic Oil became my favorite. I had some very deep tissue work done on my ribs, and I was extremely sore. I used my favorite arnica product, but it didn't even touch the soreness - it was just as bad the next day! By coincidence, I received my first order of Magic Oil just then. So I tried it out, using a mere two drops on each side of my ribs, rubbing it in well. The next day, the soreness was completely gone! I was hooked, and haven't bought another product since.

Biofreeze is similar in action to Ben Gay, Icy Hot, Tiger Balm, capsaicin cream, and good old-fashioned liniment. These products work by a principle called "counter-irritation." It works like this: the brain can only process so many sensations at once. By applying something which causes either a cooling or heating sensation to the skin, it may override pain signals from the muscles and nerves underneath.

I prefer Biofreeze to the other products I mentioned above for several reasons. Unlike other products:
    -It's non-greasy, so it doesn't soak into your clothes
    -The scent vanishes after a few minutes, so you don't smell strange all day, and
    -The new hands-free applicator makes it perfect for applying to achy knuckles.

Although these are general guidelines, "your mileage may vary." Some of my clients actually prefer the Magic Oil for arthritic joints, for instance. And I find that Biofreeze seems to work on some types of pain better than others. The best way to find out is to experiment and see for yourself.

If you're interested in either one, just ask me about it next time you're in. We can try them in treatment, and I also have Biofreeze samples you can take home.

Magic Oil 1/2 oz  $15,  1 oz $25
Biofreeze 4 oz $17.50
(Prices include tax)

Eggs as bad as smoking? What a Yolk!

EGG STUDY HAS CRACKED LOGIC

I'm sure most of you have heard this week's headline about "Egg Yolks are as Bad as Smoking" for your arteries. If you actually look at the study, though, you will see that it is SERIOUSLY flawed.

From an article at ABC news: “’This is very poor quality research that should not influence patient’s dietary choices,’ said Dr. Steven Nissen, who chairs the department of Cardiovascular Medicine at the Cleveland Clinic Foundation, in an email. ‘It is extremely important to understand the differences between ‘association’ and ‘causation’.’”

All the study participants ALREADY had cardiovascular disease, or were at risk for it. This study relied on people's memory (which is notoriously unreliable) as to how many egg yolks they ate. But worst of all, this study did NOT take into account the other elements in people's diets, their excercise habits, or sleep habits. It also didn't look at whether they are an "apple" or a "pear," or whether they are a "Type A."

Therefore, this study has made the mistake of mixing up CORRELATION and CAUSATION.  For example, more people go to the beach when it's sunny. But you would be mistaken in thinking that it becomes sunny when enough people show up at the beach. 

I'd guess that people who eat less egg yolks are generally more health-conscious (since egg yolks have recieved such a bad rap for the last 30 years). It may well be that they also eat less sugar, eat more veggies, excercise more, sleep more, use more stress-reduction techniques, drink and smoke less, etc. And those people who ate more egg yolks may well have been eating more Twinkies and drinking beer while being couch potatos.

The study could have looked, for instance, at people's sugar consumption, or their consumption of refined foods, and might have found the same correlation. Then we'd have been seeing headlines that say, "Sugar is as Bad as Smoking!" 

But as many of you have heard me say: it's never just one thing. Most health conditions are caused by a combination of factors.

Let's just be logical for a moment. A hundred years ago, people consumed lots of eggs. Nobody even thought about just eating the white. And our heart disease rate was much, much lower than it is now! Nowadays many Americans eat mostly packaged, processed food. We also consume vast quantities of sugar compared to the past. And these researchers are trying to blame poor little eggs for our clogged arteries?

Not to mention, it doesn't usually turn out to be a good idea to take a whole food and eat just part of it. For example, white flour or white rice aren't exactly known as being healthful foods. In the case of an egg, there is protein in the white, but all the other good stuff like antioxidants, lethicin, and omega-3s are in the yolk.

On top of all that: The underlying assumption is if you eat more cholesterol, more plaque builds up on your arteries. Well, that was disproven many years ago! Your own body actually produces cholesterol, and your levels have little to do with how much you consume. It's more about your genes.

For example, I once took classes from a young and healthy aerobics instructor who taught three classes a day. She was eating less than 10% of calories from fat, and consuming no animal products (so no cholesterol). Her cholesterol was still over 300 - twice as high as normal!  (If I knew then what I know now, I'd have suggested she take up meditation.)

Eggs with their yolks are a healthy, nutritious, whole food that have been consumed by humans for millions of years. Unless you are allergic to them, please go ahead and eat them.  Some feel that soft-cooked, unbroken yolks are particularly healthy (unbroken yolks maximize the antioxidants.) Although, I should mention the FDA doesn't recommend you eat them soft-cooked because of salmonella concerns. I eat them soft anyway. (Salmonella is usually on the shell; cracking your eggs on a plate rather than the edge of a bowl minimizes shell-to-egg contact.)

It's my opinion that 1) exercise that you enjoy and gets your blood moving, and 2) stress-reduction techniques such as deep breathing, meditation and progressive relaxation, are probably the most important things we can do to lower our risk of cardiovascular disease.

Here are some links if you want to read more.

ABC News: "Egg Study Not All It's Cracked Up To Be"
"Your Doctor's Orders" website on the egg study
"Your Doctor's Orders" website on dietary fat