Developing a Return to In-Person Practice Plan

Develop a return to work plan to help you identify and implement the combination of Infection Prevention and Control (IPAC) measures that will be required in your setting. Bear in mind that as sectors return to work, there will be new demands on our systems and supply chains and it is possible that personal protective equipment (PPE), such as masks or face shields, will be of limited availability.

The following are IPAC measures that can be implemented in your setting. Measures that are expected when providing in-person services are marked with an asterisk (*).

Setting & Those Who Interact There

• Continue to provide services remotely if appropriate infection prevention is not possible, using communications technologies.
• *Move furniture based on physical distancing recommendations.
• Put physical barriers in place, such as plexiglass in front of administrative areas, where appropriate.

• *Maintain a confidential log of all persons coming into the setting, including staff, clients and visitors, to facilitate contact tracing should a case of COVID-19 be associated with your practice. Log should include names and arrival and departure times.
• *Close waiting rooms, encourage clients to wait outside or in their car, notifying them by text or phone call when you are ready to see them.
• *Reduce or eliminate face-to-face meetings
• *Restrict staff and visitors to those who are essential only, while ensuring enough staffing to meet service needs
• *Space out appointments, including to accommodate cleaning of high-touch surfaces between clients
• Restrict use of office kitchen or other shared spaces; stagger breaks in those spaces
• Stagger staff schedules

• Remove high touch objects, such as magazines, toys, decorations, and products for sale
• Sanitize high touch surfaces between clients
• Increase cleaning schedules
• Increase ventilation

• *Remind staff, clients and visitors to self-assess for symptoms before coming into the setting
• *Relax cancellation policies
• *Place sanitizer and tissues in a prominent area
• *Post signage regarding cough/sneeze etiquette and hand washing
• *Post signage regarding self-assessment of  COVID-19 symptoms
• Encourage clients to use an appropriate non-medical mask or face covering during their session and consider having a supply of disposable masks available for clients

• *Establish and provide training in organizational policies and protocols regarding: self-assessment, self-isolation & self-quarantine, hygiene practices, symptom screening, appropriate use of PPE (including correct techniques for putting on and taking off equipment)
• *Apply occupational health and safety standardsas applicable, including reporting to Workplace Safety and Insurance Board and public health units
• *Understand reciprocal obligations of employer and employee to promote the safety and well-being of those working in the setting during a pandemic

• Refrain from using equipment unless necessary
• *Use appropriate PPE if the use of equipment will bring you into contact with or within 2 meters of the client
• *Establish sterilizing or sanitizing procedures and document these as appropriate

• When working with children, those with disabilities and other vulnerable persons
• When providing services in home-based settings
• When providing therapy that involves animals
• Refrain from bodywork or any technique that requires contact with or proximity to the client, unless PPE is used as described in the Occupational Health and Safety section of the COVID-19 Operational Requirements

Working with Clients

• Develop a protocol based on appropriate resources
• Recognize that clients with certain pre-existing conditions may suffer the most severe symptoms if they become infected

• *Encourage clients and visitors to self-screen in communications with them and in posted signage.
• *Conduct phone screening before appointments and in-person upon client arrival -various screening tools available here.
• Defer in-person appointments for clients who fail screening
• *Develop a policy for managing clients who show a positive screening result. The policy should identify that, unless it is essential the client receives in-person services, a client who has a positive screening cannot attend their scheduled session in-person and alternate arrangements will be made. If a client with a positive screening requires face-to-face services, the plan must identify what PPE protocols will be employed.
• *If a client shows a positive screening result onsite, require they wear a surgical/procedure mask, isolate them from others in the setting, consider whether it is possible to make alternate arrangements for their scheduled session, and engage in a deep cleaning of the room. In all cases, clients who show a positive screening result should be encouraged to seek COVID-19 testing at the assessment centre nearest to them.

• Limit or prohibit early arrival and use of common spaces
• Limit the circumstances in which another person can accompany a client to a session, and the number of individuals who may accompany a client
• Employing hygiene practices in the setting or use of PPE (such as non-medical face masks)
• Manage care of clients who have pre-existing conditions that place them at higher risk of serious complications or death (e.g., age, underlying chronic illness, compromised immune systems)
• Manage care of clients who fail the screening test
• Adjust payment procedures to reduce contact

• Recognize the impact of the content, timing and the communication method employed
• Manage client questions and concerns
• Update practice websites
• *Make pre-screening and point-of-care of clients a standard of care and use it as an opportunity to reinforce understanding of infection and prevention control measures

• *Assess self for symptoms daily
• *Refrain from going into the work setting if symptoms are present, and report as necessary to employers or public health units
• *Refrain from physical contact, including handshakes
• *Disinfect high touch surfaces after each client
• Refrain from sharing office equipment
• *Engage in frequent hand washing
• *Use PPE appropriately, for example, by donning a surgical/procedure mask when providing services to a client, as described in the Occupational Health and Safety section of the COVID-19 Operational Requirements

Managing Resources

• *Maintain a list of supplies and determine their general availability, including the use of surgical, procedural masks that will be distributed to clients and visitors who do not come with their own non-medical mask
• Identify credible, reliable suppliers of workplace PPE
• Communicate with suppliers to anticipate and manage shortages

• Maintain an updated list of available supplies
• Identify appropriate substitutions
• Change session format, rebooking or cancelling sessions

• Manage communications with clients and others working in the setting
• Develop a contingency plan for your practice