On May 26, 2020, Directive #2 from Ontario’s Chief Medical Officer of Health was revoked and replaced, providing authorization via the new Directive #2 for the beginning of the gradual restart of deferred, non-essential and elective services. As an organization and as health professionals, we are required to follow the directives set out by the Ministry of Health (MOH) and Public Health Ontario (PHO).

This safety plan also follows any additional guidance provided our regulatory bodies.

Toronto Children’s Therapy Centre COVID19 Safety Plan

Virtual Therapy Sessions

We offer virtual care for clients whenever possible. Additional information on virtual care can be accessed by clicking here.

 

Options for In-Person Therapy Sessions

In-person services are available for children in which virtual services are not feasible.    The following option are available for in-person therapy:

  1.  Clinic appointments – We are located at 658 Danforth Avenue, suite 203 in Toronto, Ontario. We currently have a reduced capacity for appointments at our clinic as therapists are required to allow for time to disinfect all toys, supplies, furniture and touch surfaces following each appointment.  In addition, we stagger appointments in order to avoid any congestion when entering or exiting our clinic.  The following measures are in place to maximize safety at our clinic. Additional measures to maximize the safety of our families and therapist are as follows:
  2. Backyard therapy sessions will resume in late spring as weather permits and we currently have limited appointments available at our clinic in order to stagger entry and exits for each child as well As per COTO guidelines: “In-person services must only proceed when the anticipated benefits of the services outweigh the risks to the patient/client, the occupational therapist and, where applicable, other organizational staff.

For a child friendly version of our COVID19 protocols please watch the video:

 

In-person clinic sessions should only be offered when virtual therapy is not an option for the client and as long as the therapist and parents agree to:

  • Complete the Therapist Daily COVID Screen form to self-monitor for symptoms.
  • Complete the caregiver two-step screening process before the appointment.
  • Follow safety guidelines for disinfection and personal protection before and
    after the appointment as per the TCTC clinic cleaning checklist.
  • Restrict entry to the clinic to one parent and the child for whom the service is
    being provided.
  • Follow the staggered scheduling format to reduce congestion at the entrance.
  • Follow hand hygiene and mask protocols and enforce same with both the
    parent and child.

I.               SCREENING

 

Therapist Self-Monitoring Process

All care providers providing services via TCTC will conduct self-monitoring practices for COVID-19 and complete the Daily Therapist COVID Screen form on days in which the therapist will be doing in-person sessions (backyard or at the clinic).

If a therapist has screened positive, they should:

  1. Cancel their in-person appointments for the day.
  2. Inform Lizette Alexander or Jacquie Martin.
  3. Contact their primary care provider or Telehealth Ontario (1-866-797-0000)
    for further direction on clinical assessment for testing.
  4. If testing and self-isolation is recommended by the primary health provider and/or Telehealth Ontario, after testing, cancel all subsequent appointments until negative test results are obtained or the self-isolation period has expired.
  5. If the therapist has tested positive for COVID-19, then the therapist must follow instructions from their family health provider and contact all families for which in-person service has been provided in the previous two weeks. Each family will be asked to contact their own primary health care provider or Telehealth Ontario for instructions on next steps. The therapist should document each communication.

 

 

Client Screening Process

All clients will be asked to complete the Jane App Patient Screen Checklist twice:

  • The first screen will be emailed to the caregiver via Jane 36 hours before their scheduled appointment. A reminder call from the client’s therapist may be required the evening before or the morning of the appointment if the form hasn’t been completed.

 

  • The second screen will be completed by the therapist via telephone with the caregiver prior to having the client enter the premises for a clinic appointment or prior to the therapist entering the client’s backyard. In the event that the client arrives at the clinic without telephoning, the screen can be completed while they stand on the distancing mat at the door and with the therapist standing two meters/six feet behind the distancing gate.
  • If a client and/or their caregiver has screened positive, they should:
    • Be advised to call their primary care provider or Telehealth Ontario
      (1-866-797-0000) for further clinical assessment.
    • If a client is very ill and requires acute care, the care provider should
      call 911 and let them know that the client has symptoms of COVID-19.
    • Services should be placed on hold until the client has either tested negative or their period of self-isolation has expired. Their appointment spot will be held for three weeks.
    • Therapist should document this as the reason for cancelling the session. 

       

 

 

II.            OCCUPATIONAL HEALTH & SAFETY

Occupational therapists should familiarize themselves with the guidance prepared by the Government of Canada to help organizations and healthcare professionals determine appropriate PPE for providing services to people with disabilities.

TCTC will provide cleaning supplies, disinfectant wipes, hand sanitizer and gloves to all therapists at the clinic. Backyard therapists will be reimbursed for a bottle of disinfectant wipes, a bottle of hand sanitizer and gloves upon submission of a receipt once a month or every two months, depending on the number of appointments completed.

At the clinic, please advise Lizette Alexander when supplies are running low with notice. It may not be feasible to obtain cleaning and disinfecting products and PPE on short notice. Therefore, to avoid disruption of service for families, we should maintain a healthy inventory of items.

All TCTC therapists will be responsible for purchasing their own surgical masks. Lizette Alexander will maintain a supply for purchase at $1 per mask or $2 per mask for parents.

1.    Masks

The Therapist

Therapists should wear surgical/procedure masks at all times during the entirety of all in-person backyard and clinic appointments.

TCTC recommends that a new clean mask should be donned after every three clients, irrespective of whether it appears soiled or damaged.

Hand hygiene should be completed before and after donning and removing a mask. Please refer to the mask wearing instructions and hand hygiene handout for guidelines in the Team COVID folder in Dropbox.

As per the Ministry: under extreme personal protective equipment (PPE) supply limitations, a single mask can be worn for an extended period of time, unless it is visibly soiled, damp, damaged or difficult to breathe through.

When reusing a mask, prevent the mask from contamination by storing it in a clean paper bag or cleanable container with a lid. Paper bags should be discarded after each use. Reusable containers should be labeled with the therapist’s name to prevent accidental misuse. After discarding the mask, wash the container thoroughly with soap and water or disinfecting wipes before placing a new mask in the container.

If appropriate PPE is not available, in-person patient services must be deferred.

An exception can be made at the clinic when both the therapist and the client can safely remain behind the provided plexiglass barrier or two meters apart. This decision will ultimately be left to the therapist’s discretion. However, if there is any question as to whether a child can consistently remain behind the plexiglass panel, or whether the child can maintain a two-meter distance, then masks should be worn at all times by default.

The Client and Caregiver

The client and caregiver should wear a cloth mask for the duration of the appointment if they are within two meters of the therapist. An exception can be made if the child is sitting opposite to the therapist behind the plexiglass and a) they can remain seated and b) can remove and don the mask safely by the elastics or obtain assistance from a parent. If the child’s mask is removed, it should be set down on a paper towel with the exterior facing down or in a paper bag. The child should perform hand hygiene before and after removing and donning a mask.

 

2.    Hand Hygiene

The Therapist

All therapists should complete frequent hand hygiene as per the hand hygiene guidelines in the Team COVID folder in Dropbox and at a minimum:

  • Before and after donning and removing masks
  • Before and after each session
  • Before and after cleaning/disinfecting

 

In addition, sufficient time has been scheduled between clients at the clinic to wash hands at the sink in the main floor bathroom. Soap will be provided by the building, however, the therapist can consider bringing their own if they have a preference. Paper towels for drying is preferred and is stocked by the building in the bathroom.

Refer to the following government guidelines for approved hand sanitizers:
www.canada.ca/en/health-canada/services/drugs-healthproducts/disinfectants/covid-19/hand-sanitizer.html

The Client and Caregiver

Both the client and caregiver are expected to sanitize their hands at a minimum:

  1. Upon entering the clinic or at the beginning of a backyard therapy session.
    This a good opportunity for the therapist to model and coach the child.
  2. Before exiting the clinic or at the end of the backyard therapy session.

A hand sanitation station with visual aids/infographic will be set up at the entrance in the group room.

 

3. Gloves

Gloves will be available for use in the clinic at the therapist’s discretion. Please note that many regulatory colleges do not recommend gloves as they may lead to cross contamination. The best approach is to sanitize the hands frequently; however, in some situations where the therapist may need to touch the child frequently, gloves may be appropriate.

Gloves should be discarded after each client in the receptacle provided. Please refer to the handout on donning and doffing gloves in the Team COVID folder in Dropbox for guidance.

 

4. Plexiglass Cough Guard

A plexiglass cough guard will be available in the therapy room to be used at the therapist’s discretion. The plexiglass cough guard can be placed between the child and therapist as follows:

  • In lieu of masks when the child is able to safely remain seated behind the cough guard.
  • In addition to the use of a mask for added safety.

III.          CLEANING AND DISINFECTING

Definition as per COTO instructions: “Cleaning refers to the removal of visible soil. Cleaning does not kill germs but is highly effective at removing them from a surface. Disinfecting refers to using a chemical to kill germs on a surface. Disinfecting is only effective after surfaces have been cleaned.

The following government guidelines for recommended disinfected will be followed: www.canada.ca/en/health-canada/services/drugs-healthproducts/disinfectants/covid-19/list.html

 

Therapist’s Responsibilities in the Clinic

  • Use a “wipe-twice” method to clean and disinfect. Wipe surfaces with a cleaning agent such as Method multipurpose cleaner to clean off soil and then wipe again with a disinfectant. Regular household cleaning and disinfecting products are effective against COVID-19 when used according to the directions on the label. For backyard therapy, the parents will be asked to provide a clean table and chairs that the therapist will disinfect upon arrival.
  • TCTC will have disinfecting wipes available at the clinic when they can be sourced or a bleach-water solution with 100 mL of bleach to 900 mL water. Backyard therapists can use the bleach-water solution or government-approved disinfecting wipes.
  • After every client appointment, all surfaces that were within two meters of the client should be cleaned and disinfected before another client is seen (walls, counters, doorknobs, light switches, desks, etc.).
  • Cleaning activities should be documented in the client’s chart in the OT visit note.
  • At the end of the shift, the last therapist to leave the office will be responsible for taking the garbage to the garbage dump located in the garage using the back elevators or stairs. The second last therapist will tie up their own garbage and leave it ready for the last therapist leaving the clinic. Please disinfect your hands with hand sanitizer after completing this task.

 

TCTC’s Responsibilities

  • Remove all cloth and non-wipeable items from the therapy rooms and group room and secure them in the gym for storage.
  • Remove all clutter from the therapy rooms and group room to minimize cleaning.
  • Provide each client with a pencil and paper kit which will be disinfected by the therapist following each use and kept in a Ziploc bag in order to avoid sharing between clients. The kit will include a pencil, pencil grip, eraser, scissors and paper/worksheets or workbook. If theraputty is needed, then the parent can purchase their own at the pharmacy to be kept in the kit.
  • The first floor public bathroom will be maintained and cleaned by the building property managers.
  • Provide a dedicated, covered, foot pedal and clearly marked garbage can for
    the disposal of masks, gloves, facial tissues, paper towels, etc. in each therapy room and by the sanitation station.
  • Set up office stations in the gym at least two meters apart to avoid contamination of therapists’ computers and office supplies during their appointments. Each therapist is responsible for bringing their own laptops to the office for use,
    as equipment cannot be shared.
  • The printer will be moved into the gym/therapists’ office for use; however,
    please note that the printer controls and any touchpoints should be cleaned
    after each use.

 

 

 

 

 

 

IV.         TRAINING

 

1. WHMIS

Therapists providing in-person therapy sessions should take the Workplace Hazardous Materials Information System (WHMIS) course, unless they have already completed this course through another employer. Upon completion of the course, the therapist should keep a certificate in their documents. Please notify Lizette Alexander of the date of completion for this course.

To take the course online for $15, go to:  www.ccohs.ca/products/courses/whmis_workers/

 

2. Infection Prevention and Control Fundamentals

Complete the resources offered by Public Health Ontario’s at: www.publichealthontario.ca//media/documents/ncov/ipac/ipac-fundamentals.pdf  

 

 

 

 

 

 

 

 

 

V.            NEW DOCUMENTATION AND REPORTING/COMMUNICATION RESPONSIBILITIES

 

In addition to the regular charting of each appointment following a visit, the therapist will be responsible for the following COVID-related documentation:

·       Risks of In-Person Therapy

The therapist who is scheduling the first appointment is responsible for verbally discussing the risks associated with in-person sessions, including the risks of public transport if applicable. This will then be documented in the intake form on Jane.

In addition, parents will affirm that they are aware of the risks of in-person sessions with the completion of each 24-hour COVID appointment screen.

·       24-hour COVID Screen

It is the responsibility of the therapist to check that the form was completed in Jane on the morning of the scheduled appointment. A copy of this form will be automatically uploaded into the client’s chart by our Jane App system.

·       Appointment COVID Screen

To be completed by the therapist in the client’s chart.

·       Cleaning Routine

To be completed after each appointment in the client’s chart in the OT visit note.

·       Visitors Log

In order to maintain a confidential register of all people entering the clinic, as per the College guidelines, the therapist should note in the OT visit note who the child arrived with at the clinic. Only the scheduled child, the child’s caregiver and the scheduled therapist will be permitted in the clinic. No other persons including an unscheduled therapist from TCTC should enter the clinic, other than Lizette. Lizette will note her entry and exit in the calendar for each scheduled therapist that day using the break button.

Allowing only the scheduled child, therapist and caregiver in the clinic will allow
us to complete contact tracing with ease should someone be diagnosed with
COVID-19.

·       Pick-Up  

If any items (for example an assessment tool) need to be borrowed from the clinic by a therapist who is not scheduled for that day, email Lizette to arrange for pick-up. Only the scheduled therapist is allowed in the clinic to avoid confusion with contact tracing.

·       Drop-Off   

Any borrowed assessment tool or other item can be dropped off at Lizette’s home or inside the entrance of the office to be put away by the scheduled therapist.

 

Intake and Booking Process

The therapist who contacts the family to complete intake and schedule the first appointment should:

  • Inform the parent of the risks associated with in-person sessions including travel to the clinic as it relates to COVID-19. Discuss alternative options such as backyard therapy and/or teletherapy. Document the discussion and rationale for the decision for service provision.
  • Inform the caregiver over the phone that we are following public health measures including PPE, cleaning and disinfection, scheduling and social distancing. Instructions will also be emailed to the caregiver with their welcome letter.
  • Inform caregivers of the expectations to wear a cloth mask and complete both screens prior to the appointment arrival, as well as the hand hygiene expectations before and after the appointment.
  • Inform caregivers that only one caregiver will be allowed into the clinic and that they also must wear a mask, complete the two screening processes, and follow hand hygiene before and after the appointment.
  • Advise the client that they should arrive at most five minutes before the appointment to minimize their wait time. Late arrivals will lose therapy time since the therapist must complete the cleaning and disinfection regimen to support the safety of the next client.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

VI.         APPOINTMENT FLOW

 

Before the Appointment

  • The caregiver will receive an automatic mandatory 24-hour COVID screen via our Jane App 36 hours before the appointment. The completed form will upload to the child’s chart automatically.
  • The morning of the appointment, the therapist will check that the screen has been completed. If the caregiver did not complete the screen, then the therapist will contact the parent and request that the screen be completed that morning.
  • Should the client decline or forget to complete the screen, then the appointment will be cancelled by therapist.
  • The client will be advised to call the therapist upon arrival at the building, either from their car or from a safe location. The therapist will then complete the second screen with the client by telephone. Use the template in the child’s chart titled “COVID Screen 2”. In the event that the client arrives at the clinic without calling, then the COVID Screen 2 can be completed from two meters/six feet, with the client standing on the office entrance distance mat and the therapist behind
    the gate.
  • Advise the client when you will be ready for them to come into the office if they call early. Ask the client to wait in their car or a location outdoors where they can safely social distance.
  • Once the client has arrived, they should first visit the sanitation station for hand hygiene in the group room and then don their masks. Both parent and child will need to wear a mask before approaching the therapist within two meters.
  • The parent can support the child in the therapy room during the session or wait in a designated chair in the group room for the duration of the session.

 

During the Appointment

At any point in time, if the therapist determines that the child or caregiver is not able to participate in an in-person therapy session safely, the session should be discontinued immediately without penalty. Examples of where this may occur include:

  • Child is placing toys or other items in their mouth.
  • Caregiver reported that the child or themselves did not have any COVID symptoms, however evidence of a cough or runny nose is observed by the therapist.

The therapist should explain the reason for discontinuation and the risk associated with these symptoms. The caregiver will be advised that they should go home, self-isolate and call their primary care provider or Telehealth Ontario at 1-866-797-0000 for further clinical assessment. The therapist should clean and disinfect the practice area immediately, including all areas the client may have touched. Then document the interaction in case contact tracing is required.

 

After the Appointment

  • The therapist, client and caregiver are expected to either wash their hands or use an alcohol-based sanitizer before exiting.
  • Clean and disinfect all items on the cleaning checklist and document that this has been done in the child’s chart following each visit.

 

 

 

 

 

 

 

VII.       SELF-MONITORING AND COVID-POSITIVE RESULTS

 

Self-Monitoring

  • If the therapist is sick, please stay home.
  • If you start experiencing symptoms while you are at work, please cancel your appointments and go home.
  • If you have symptoms, think you may have been exposed to COVID-19 or have travelled outside of Canada within the last 14 days, notify Lizette or Jacquie immediately, complete the self-assessment screen and follow the instructions provided.
  • Maintain a log of your travels and all the individuals you have been in contact with each day. The log should identify the time and date of contact, the individual’s name and the location. This log is confidential and personal, and does not have to be posted anywhere. However, it should be available for contact tracing in the event of a positive COVID-19 result.

COVID-Positive Therapist

In the event that a therapist’s COVID test results in a positive test, the following steps will be completed at TCTC:

  1. Notify Lizette Alexander of the COVID test results. Please note that, unless required by COTO and/or MOH, TCTC will not provide specific information on who was positive.
  2. All TCTC families and staff that have come into contact with the COVID-positive therapist in the last two weeks will be contacted by Lizette Alexander. According to COTO, the therapist has a responsibility to contact all personal contacts within the last weeks.
  3. Families will be advised to contact their primary healthcare provider or Telehealth Ontario for direction on testing and/or self-isolation.
  4. Lizette will notify any other therapist who was on the same shift as the COVID-positive therapist, and the therapist will be asked to undergo testing.
  5. TCTC will close the clinic for 72 hours in order to ensure that any possible COVID has time to disintegrate; after 72 hours, all surfaces in the clinic will be disinfected.

 

COVID-Positive Client

In the event that a client’s COVID test results in a positive test, the following steps will be completed at TCTC:

  1. Contact Lizette Alexander or Jacquie Martin via email to report a COVID-19 positive case. Please provide the client’s name and file number.
  2. Contact local public health unit:COVID-19 is designated as a disease of public health significance (O. Reg. 135/18) and thus reportable under the Health Protection and Promotion Act (HPPA). Where a home and community care provider is required to report a disease of public health significance under section 25 of the HPPA, they must contact their local public health unit to report a person who has or may have COVID-19.
  3. The therapist who was in contact with the COVID-positive client will contact all families that they came into contact with in the last three weeks. According to COTO, the therapist also has a responsibility to contact all personal contacts within the last weeks.
  4. Families will be advised to contact their primary healthcare provider or Telehealth Ontario for direction on testing and/or self-isolation.
  5. Lizette will notify any other therapist who was on the same shift as the therapist who saw the COVID-positive client, and the therapist will be asked to undergo testing.
  6. TCTC will close the clinic for 72 hours in order to ensure that any possible COVID has time to disintegrate; after 72 hours, all surfaces in the clinic will be disinfected.
  7. Document: Document in the child’s Jane chart using the COVID-19 Positive Case template.