Physiotherapist Use of Masks
Chief Medical Officer of Health, Dr Hinshaw announced on June 22, 2021 that continuous masking will continue to be required in continuing care centers and acute care facilities. On June 29, Dr. Hinshaw announced that the continuous masking requirement will be extended to all AHS and Covenant Health community facilities (e.g. COVID-19 testing centres, vaccination clinics, and labs).
At this time, Physiotherapy Alberta strongly recommends physiotherapists in all practice settings continue to wear medical grade surgical or procedure masks at all times and in all areas of the workplace if they are either providing direct patient care or cannot maintain two-meter distance from patients and co-workers. This recommendation is consistent with the guidance on use of masks contained in the Alberta Public Health Disease Management Guidelines: Coronavirus – COVID-19.
The further rationale for ongoing mask use is as follows:
- Data suggests that although the B1.1.7 variant is currently the dominant strain of COVID-19 in Alberta, the B1.617 variant (also known as the delta variant) is increasing in prevalence.
- The delta variant is more transmissible than the original virus or prior variants.5
- Some data suggests that a single dose of vaccine is not sufficient to prevent illness from the delta variant.6
- There is a lack of data regarding whether an asymptomatic, fully vaccinated person, can transmit COVID-19 to others whom they come in close contact with.7
- Many patients accessing community health settings will not have had the opportunity to receive both vaccine doses at the time of Stage 3 re-opening.
Use of masks in community health settings helps to prevent clinicians from exposure to COVID-19 from asymptomatic carriers of the virus, including those who have been fully vaccinated. This in turn, may help to prevent onward spread by the physiotherapist to other patients, colleagues in the practice setting, and personal contacts.
Use of masks in community health settings also helps to prevent the spread of the virus from clinicians who may be fully vaccinated, but who also could conceivably be asymptomatic carriers of the virus, to patients who are not fully vaccinated.
Physiotherapists are reminded that employers can establish higher expectations and requirements than those of Physiotherapy Alberta. As such, an employer may establish a requirement for continuous masking in a community health setting in order to fulfill their legislative responsibilities under OHS law and to mitigate the risks within the work environment.
Physiotherapists working with patients known or suspected of having COVID-19 (e.g., in ICU or acute care environments) are to follow their employer’s directions regarding PPE use with this patient population and for the tasks performed.
Patient Use of Masks
Comments made on June 22, 2021, by the CMOH appear to indicate that ongoing mask use in continuing care and acute care environments will apply to all individuals in those environments including patients and visitors.
At this time, patient use of masks in community health settings has not been mandated by the CMOH. As such, physiotherapists may question whether they can require masking as a condition of service.
As Physiotherapy Alberta has stated previously, according to the Legislative Responsibilities Standard of Practice, physiotherapists are required to be knowledgeable of and compliant with the legislation relevant to their practice. This includes having knowledge of any CMOH Orders which require indoor mask use, and municipal bylaws regarding mask use that may remain in effect when the provincial order is rescinded.
At the same time, the Code of Ethical Conduct states that members of the physiotherapy profession have an ethical responsibility to “Act in a respectful manner and do not refuse care or treatment to any client on the prohibited grounds of discrimination as specified in the Canadian Human Rights Act as well as on the grounds of social or health status.”
Declining to provide care is a serious matter. There are conflicting needs, values and rights involved in such a decision, including:
- The patient’s right to access to care and the requirement that access not be denied on the basis of a protected ground or health status, including health conditions that may preclude the use of a mask.
- The physiotherapist’s duty to comply with legislation relevant to their practice.
- Patients’ expectations that they will receive safe care, as stated in the Safety Standard of Practice.
- The health and safety of everyone that enters the practice environment.
Physiotherapists and physiotherapy business owners should understand the many implications of refusing to provide care to a patient who declines to wear a mask in the practice setting. They should also consider the other measures in place and options available to provide care to patients who decline to wear masks, including the use of other public health measures to limit risk, the use of telerehabilitation to deliver physiotherapy services, and limiting access to the practice setting for unmasked patients to designated times.
Alberta Health recommends the use of eye protection as an additional layer of protection for all patient interactions within two metres, in areas where there are ongoing high levels of community transmission.
Eye protection is intended to protect the health-care provider from potential COVID exposures arising from interactions with patients who had symptoms that were not recognized to be COVID-19 at the time of their appointment (e.g., due to patient confusion).
However, Alberta Health continues to indicate that “continuous masking (medical/surgical masks) and proper hand hygiene is considered to offer sufficient protection for HCWs who have cared for patients with presymptomatic/asymptomatic COVID-19 infection.”
Further, the current situation in Alberta is one in which community transmission levels are no longer considered to be high. As such, use of eye protection, during routine clinical care may not be necessary, depending on the Point of Care Risk Assessment performed by the treating physiotherapist.
Examples of appropriate eye protection include safety glasses, reusable goggles, face shields or face masks with built-in eye shields. Vision correcting eyeglasses are not classified as eye protection and do not address PPE recommendations.
Some eye protection is single use, while other products are reusable following cleaning and disinfection. Follow manufacturer instructions regarding whether eye protection is reusable and the approved cleaning and disinfecting products for the eye protection in use.
For physiotherapists working with patients who are not symptomatic, eye protection may be worn continuously and changed when a mask is changed, or when the eye protection becomes wet or soiled.
Physiotherapists working with patients with known or presumed COVID-19 must follow the directions of Infection Prevention and Control officials regarding PPE use and when PPE must be changed or discarded.