Much of what you know about sanitation and hygiene will remain in place, but there are several new considerations to navigate, including taking a client’s temperature, working with a mask, and making sure the client is comfortable while wearing a mask.

Practitioner Preparedness

• Hygiene protocols remain standard and customary. The CDC recommends you take steps to ensure everyone adheres to respiratory hygiene, cough etiquette, and hand hygiene. Provide supplies for respiratory hygiene and cough etiquette, including alcohol-based hand rub (ABHR) with 60%–95% alcohol, tissues, and no-touch receptacles for trash disposal.
• Have your mask on and adjusted before your client arrives. To further protect yourself and clients, consider wearing clothing that can be changed out between clients. Keep hair up and away from your face. All other practitioner hygienic protocols apply—no long nails, jewelry, open-toe shoes, flip flops, or sandals.
• Practitioners should take their own temperature before each work day begins to ensure they are not presenting with any coronavirus symptoms.
• Avoid shaking hands with clients or hugging. Consider sharing with clients that you'll eliminate casual conversation and remain in minimal necessary in-session conversation mode through the duration of the session.
• Treatment table setup will look largely the same, but linens/bedding will be turned over completely for each client. Use products with nonpermeable barriers, like mattress pads, to cover your table, table warmers, etc. On top of that barrier you can layer your washable fleece pads, sheet sets, blankets, etc. Put similar nonpermeable coverings on bolsters and pillows. Apply a ready-made disposable face-cradle cover to your face cradle, and top it with a pillowcase, leaving a large hammock-type pocket underneath that could catch client aerosols when they are prone. Each client will receive a completely new table setup.
• Consider opening treatment room windows if feasible. If using a high-efficiency particulate air (HEPA) purifier, make sure it is on before your client arrives.

Client Arrival and Intake

• Assume Standard Precautions for all client care: www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html.
• Use a no-contact thermometer to take the client’s temperature upon arrival; ask the client to reschedule if their temperature is 100°F or higher. If the client is not wearing a mask as you requested during the reminder phone call, offer them a cloth mask at this time before continuing.
• Initiate doorway screening checklist questions:
  
  • Have you had a fever in the last 24 hours of 100°F or above?
  • Do you now, or have you recently had, any respiratory or flu symptoms, sore throat, or shortness of breath?
  • Have you been in contact with anyone in the last 14 days who has been diagnosed with COVID-19 or has coronavirus-type symptoms?
• Leave time for proper health history overview with new clients and updates with existing clients. Watch this ABMP video with pathology expert Ruth Werner on how to do effective Intake Interviews.
• After the health history overview, discuss with the client their comfort in wearing a face covering during the session. Remember that face masks, including the homemade variety, protect other people from getting sick from you; but unless the client is also wearing a face mask, the practitioner is not protected. If the client is unable to wear a mask for health or comfort reasons, consider using an N95 medical mask for yourself once they return to the marketplace in sufficient supplies.
• Ask clients to use hand sanitizer (per CDC, at least 60% alcohol) before going to the treatment room and ensure that it’s applied liberally and properly, Give instruction on how to proceed with the session, including new direction on where to place clothing, the availability of hand sanitizer in the room, and the cleaning protocols you want to share to put clients at ease. Explain to clients that the room has been fully sanitized, but to put them fully at ease, they are also welcome to wipe down any surfaces again.
• Facial massage—Confirm with the client that they are comfortable with you applying hands-on work to their face; working through their face covering as needed to address sinuses, muscles around the temporomandibular joints, or lymph nodes in this area (if doing lymphatic drainage work), consider using gloves for this part of the treatment. Or, prior to the session, include this type of massage among the work you will not conduct during this time.
• Deliver customary pre-massage instructions to clients before leaving them to disrobe to their level of comfort. Wash hands thoroughly, up to the elbows, using WHO guidelines for best practices before returning.

During the Session

• Before leaving the treatment room, remove gloves (if applicable), apply a generous amount of hand sanitizer per CDC application guidelines (at least 60% alcohol), and use a previously readied paper towel to open and close the treatment room door while leaving the room.
• Prone positions could be uncomfortable for clients who are wearing face coverings. Consider topping your face cradle and face cradle cover with a cotton pillowcase. Drape it so that it creates a contained hammock under the face cradle that could semi-effectively capture aerosols expelled by a client who is unable to comfortably wear a face covering during face-down positioning. When switching from prone to supine position with this client, ask them to put their face covering on before they turn over into the supine position.
• Noting the potential discomfort clients may have wearing a mask in prone position, consider using side-lying positioning to address the lateral and posterior aspects of the body.
• Hand massage—Leave any hand work for the final part of your treatment protocol.