With the announcements from Chief Medical Officer of Health (CMOH), Dr. Hinshaw, that health professionals delivering close contact in-person services must wear masks continuously and that members of the public should wear masks when in public spaces and unable to maintain two-meter physical distancing, Physiotherapy Alberta has received an increased number of calls regarding mask use. The answers to some of our most frequently asked questions are below.
What is required?
Continuous masking is an infection prevention and control measure employed in addition to other measures to prevent the spread of COVID-19. These other measures include screening patients prior to their attendance at a clinical setting, completing a point-of-care risk assessment, and frequent hand hygiene consistent with the WHO’s “5 Moments for Hand Hygiene.”
The CMOH has directed that health professionals wear masks when providing services and two-meter physical distancing cannot be maintained. The purpose of mask use is to prevent pre-symptomatic or asymptomatic spread of COVID-19 during the provision of close-contact health services.
When treating patients with confirmed or suspected COVID-19, masking is used in conjunction with other personal protective equipment (PPE), such as eye protection, gloves and gowns.
When treating patients who are asymptomatic and not suspected of having COVID-19, masking is in addition to the routine practices employed based on the nature of the patient’s physiotherapy care (e.g., use of gloves when providing pelvic health services). Physiotherapists are not expected to don eye protection, gloves and gowns when treating patients who are asymptomatic and not suspected of having COVID-19 unless the nature of their physiotherapy care would lead to the routine use of this equipment.
Why do I need to wear a mask?
As indicated in Alberta Public Health Disease Management Guidelines Coronavirus – COVID-19 (Section 7) a physiotherapist who may have been exposed to COVID-19 while working with an asymptomatic patient (e.g., a patient who later developed symptoms) is not considered a close contact of the patient IF they were using a surgical/procedure mask and routine, frequent hand hygiene.
This is important. If the physiotherapist was deemed to be a close contact of the patient, the physiotherapist would be required to self-isolate for 14 days from the time of exposure.
In addition, if a physiotherapist were to develop symptoms of COVID-19 but had been using a surgical/procedure mask and routine, frequent hand hygiene, the patients they had provided care to in the 48-hours prior to symptom development would not be considered close contacts of the physiotherapist and would not be required to self-isolate.
Wearing a mask and engaging in routine, frequent hand hygiene means that you may be able to continue to provide services even if one of your patients later develops symptoms and tests positive for COVID-19, and decreases the risk of you transmitting COVID-19 to your patients before you know you are ill.
What does continuous masking mean?
It means wearing a mask at all times and in all areas of the workplace, when in direct contact with patients or if you cannot maintain a two-meter physical distance from patients and others in the practice setting at all times. In other words, put a mask on at the start of your workday and wear a mask for the duration of your time at work, removing it only to replace it with a new, clean mask.
How often and when do I need to change my mask?
If you are treating patients who are asymptomatic and who do not have confirmed or suspected COVID-19, you can wear the same mask for as long as the duration of your shift.
However, you must change the mask if it becomes wet, soiled, or contaminated. Your mask must be changed if you touch or adjust it, as touching the mask contaminates it.
Do you mean that I don’t get to eat or drink for the duration of my eight-hour shift?
Moving your mask down or to the side so you can eat or drink requires contact with the mask and contaminates it. If you need to eat or drink, remove your mask while in a non-patient care area and while maintaining two-meters distance between yourself and anyone else in the area, discard your mask in a lined garbage can and replace the mask with a new one when you are done eating or drinking.
What type of mask should I wear?
The CMOH has indicated that health professionals must wear surgical or procedure masks. It is not acceptable to use a cloth mask or industrial mask in place of a medical-grade mask. Look for labelling indicating an American Society for Testing and Materials (ATSM) rating on the mask packaging or similar information indicating the mask is designed for medical use. For more information about masks, visit the Health Canada website.
This poster provides step-by-step directions on how to don and doff a procedure mask.
If you do not have a medical grade surgical or procedure mask you must cease to deliver in-person services until more masks have been obtained.
Physiotherapy Alberta recognizes the many implications this requirement will have on the ability to deliver in-person services to patients, which is why we continue to encourage the use of telerehabilitation to deliver physiotherapy services whenever possible.
Why can’t I use a cloth mask if I don’t have a surgical or procedure mask?
The effectiveness of cloth masks to prevent virus transmission has not been established scientifically and varies depending on the nature of the cloth used and the fit of the mask. In contrast, medical-grade surgical or procedure masks are tested and their effectiveness has been established in laboratory environments.
Directions from the CMOH that members of the public should wear a cloth mask when in public and unable to maintain a two-meter distance from others are based on the thought that a cloth mask may provide some barrier to transmission. For health-care professionals the standard of protection is higher.
Who needs to wear a mask?
Anyone who is delivering direct patient care, who is in a patient care area, or who cannot maintain a two-meter distance from others at all times must mask continuously.
- Physiotherapists and physiotherapist assistants who participate in patient care must mask continuously.
- Administrative staff, such as those working only in a reception area, must wear a mask unless there is a physical barrier between the staff member and others (patients and staff) in the setting, or they can maintain a two-meter physical distance between themselves and others.
Can I use a full-face visor instead of a mask?
Visors are classified as eye protection and are used as an alternate for safety glasses or goggles. Eye protection is required when working with patients with a known or suspected diagnosis of COVID-19 and is used in conjunction with a mask. Eye protection is not currently required when working with patients who are asymptomatic and not suspected of having COVID-19. Visors are not replacements for masks.
Do I need an N95 mask?
That depends on the context of your practice and the activities you are engaging in, but if you work in a private physiotherapy clinic providing orthopedic services, probably not.
N95 masks are required when performing aerosol generating procedures. Aerosol generating procedures include such activities as intubation, CPR, open suctioning, non-invasive ventilation, and the use of high-speed drills in dentistry.
Outpatient physiotherapy practice does not typically include any aerosol generating procedures, therefore private practice environments should not require N95 masks.
Physiotherapists working in hospital or other public facilities should discuss the activities they perform and the risk profile of those activities with infection prevention and control experts to determine if an N95 mask is required.
What about patients and masks?
The CMOH has indicated that members of the public should wear masks when in public spaces or unable to maintain two-meter physical distancing from others. This means that patients should wear masks when receiving in-person physiotherapy treatment.
However, the CMOH has also made it clear that medical-grade surgical or procedure masks must be reserved for use by health-care professionals, therefore the patient should be wearing either a cloth mask or an industrial (non-medical grade) mask.
Can I require that my patients wear masks?
At this time, the CMOH has not ordered members of the public to wear masks. A physiotherapist can educate their patients about the CMOH recommendations regarding mask use and suggest or request that the patient wear a mask while attending their physiotherapy appointment. However, it is questionable whether the physiotherapist can require that a patient wear a mask or decline to provide services if the patient refuses to wear a mask.
If a physiotherapist requires a patient wear a mask, there are also implications regarding the physiotherapist’s responsibility to provide a mask for patient use which has implications for PPE availability.
If you are considering a policy of refusing to provide care if a patient declines to wear a mask, Physiotherapy Alberta strongly recommends that you contact a lawyer to discuss the human rights and other legal considerations related to such a policy.
Can I provide masks for my patients to wear?
As already indicated, medical-grade surgical or procedure masks must be reserved for use by health-care professionals.
If you choose to provide masks for patient use, they must not be taken from this supply.
You may choose to provide industrial masks (non-medical grade) for patient use at your own discretion, however this is not a requirement of Physiotherapy Alberta at this time.
Where can I find masks?
Physiotherapy business owners are encouraged to procure masks through their regular clinic supply chain whenever possible.
In the event that those suppliers are not able to furnish the masks required, Physiotherapy Alberta registrants are directed to seek supplies through the links on the Alberta Biz Connect website. Numerous suppliers of medical grade masks (for health-care provider use) and industrial masks (for patient use) are listed on both the Rapid Response Platform and ATB Nexus platform linked to from the Biz Connect website.
For a limited time, the Government of Alberta is also allowing community health professionals to request masks from the Government of Alberta’s provincial repository. Some things that physiotherapists need to know before making these requests:
- Only one representative from each practice may make a request to the repository.
- You must access your pre-existing clinic suppliers and exhaust your supply chain prior to accessing the repository.
- All requests will be reviewed and provision of supplies is not guaranteed.
- Submitted requests must only be for a two-week supply
- There is a delay between request and receipt of equipment.
Registrants are advised that effective May 25, 2020 the Government of Alberta will be charging for products distributed through the provincial repository.
Please note the following information from the Government of Alberta:
- Fees charged will be based on average observed market prices.
- Fees will be charged on any supplies delivered from May 25th onwards.
- If you received PPE prior to May 25th, you will not be required to pay.
Effective June 30, 2020, access to the provincial repository will come to an end for community-based health professionals including physiotherapists.
After June 30th, physiotherapists and physiotherapy business owners will need to obtain these supplies through their normal supply chains. Physiotherapists working for Alberta Health Services and long-term care facilities will not be affected by this change and will continue to receive masks and other PPE through their employers.
My employer is telling me that we do not have enough masks and is asking me to reuse my masks from one day to the next. What do I do?
Occupational Health and Safety legislation requires that employers put measures in place to address identified risks within a work environment. Due to the nature of physiotherapy practice and the directions from the CMOH, this includes provision of PPE appropriate for the patient population served and treatment methods used. At a minimum surgical/procedure masks must be provided for staff use. If PPE supplies are insufficient to protect staff, in-person services must be discontinued until sufficient masks are available.
At present, there is no approved method to re-process surgical/procedure masks. Used masks are a potential reservoir of infectious agents and must be discarded in a lined garbage can immediately after doffing. Retaining used masks or reusing masks is not acceptable practice.
If you have concerns about the risks and measures in place to protect you in the work environment, discuss them with your employer. If that doesn’t work or you still have concerns, you can contact the Government of Alberta OHS Contact Center. For more information about concerns regarding unsafe work, visit the Government of Alberta website.
It is essential that physiotherapists remember that masks are only one layer of protection, one measure that must be put in place to limit the spread of COVID-19. Masks are only effective if worn, donned and doffed appropriately and if used in conjunction with other measures such as routine, effective hand hygiene, environmental cleaning, physical distancing and patient screening.