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Spas and Wellness Centres

These guidelines apply to spas and wellness centres, including those within tourist facilities and the various activities which take place in these (collective and individual) such as: mud therapy, mud balneotherapy, individual or swimming pool balneotherapy, vaginal douches, rhinogenous deafness (insufflation), hydrothermal services for patients with peripheral vascular disease, inhalation cures (inhalations, nebulisation, aerosol, humages), hydroponic therapy, neuro-motor rehabilitation cures and motor re-education in the motion-impaired and respiratory function rehabilitation, cave therapy (grottoes and stoves), related therapies (massage therapy, hydro-massage, saunas and steam baths).

Prior to centre re-opening and spa bath therapies, adequate water system risk prevention and monitoring must be done (e.g. Legionnaire’s disease).

These guidelines are to be supplemented, in specific contexts, by those relating to swimming pools, tourist facilities and personal services.

GENERAL GUIDELINES

▪    Suitable information must be provided to raise user awareness of the health and behavioural measures suitable to containing SARS-CoV-2 transmission by appealing to individual common sense and with the involvement of the medical director and/or spa doctor, where these exist. Messages must be easy to understand for non-Italian speaking users and may take the form of signs and information panels and notices promoting and encouraging health measures by staff.

▪    Before entering spa baths or wellness centres body temperature must be measured and access denied to those with temperatures of over 37.5°C. For patients measurements must be taken during medical access consultancies.

▪    Activity programmes should be planned to avoid gatherings as far as possible and regulate numbers of people in the shared use spaces, waiting and other areas to foster social distancing of at least one metre, with the exception of people between whom interpersonal distancing is not currently required, with this latter being a matter of personal responsibility. Where possible separate entrances and exits should be provided.

▪    Access to facilities and individual services via booking is to be preferred with attendance lists to be kept for 14 days.

▪    Facilities should be equipped with hydro-alcohol solution dispensers for user hand cleansing at visible points near the entrance and in strategic areas, with use these for hand cleansing on entering being mandatory. Magazines and info material for multiple use must be removed.

▪    Cash and reception desks must be equipped with physical barriers (e.g. screens). In the absence of these staff must wear masks and have hydro-alcohol solutions available. Electronic payment methods must, in any case, be encouraged, possibly at the booking stage. Reception staff must clean their work surfaces and check-in/check-out equipment used at the end of every shift.

▪    In indoor common-use areas masks must be worn when interpersonal distances of at least one metre cannot be respected and staff must wear masks at all times when in proximity to clients and when interpersonal distances of at least one metre cannot be ensured.

▪    Changing rooms and showers and other spaces should be organised in such a way as to ensure distances of at least one metre (for example alternate use stations or barriers to separate them). In changing rooms or special changing areas all personal clothing and objects must be kept in personal bags even where these are stored in lockers. Generalised use of the lockers is best avoided and bags should be made available for personal effects.

▪    For spa bath services requiring them by current regulations, special attention should be paid to suspected COVID-19 symptoms in the medical access phase. For general and specialist medical consultancies inside spa baths, the safe health services guidelines should be referred to.


▪    Equipment use (deck chairs, beds) should be regulated via specific trajectories in such a way as to guarantee distances of at least 1.5 metres between equipment and promote interpersonal distancing of at least one metre between those not belonging to the same family unit or cohabiting. Equipment must be disinfected on each personal or family changeover. In any case these must be disinfected at the end of the day.

▪    Use of objects and linen by more than one person is to be avoided: users should bring what they need with them, preferably supplied them by the facility. Personal towels are recommended for all activity sessions in the various contexts.

▪    The greatest possible distance must be ensured between sun umbrellas in the solarium and for specific services in these and a minimum surface area of 10 metres must be ensured between sun umbrellas in each row or between rows. Where other shade systems are used distancing on a par with that between sun umbrellas should be guaranteed.

▪    The usual hygiene regulations applying to swimming pools and wellness centres apply as do those precautions taken prior to personal treatments: prior to entry visitors should take a thorough shower and soap down fully.

▪    Common areas, changing rooms, cabins, showers, toilets and equipment (deck chairs, chairs, beds, including floating equipment) should be cleaned and disinfected regularly with special attention to objects and surfaces touched most frequently (e.g. handles, switches, handrails, etc.).

▪    Staff should receive adequate training.

▪    For food service specific themed information sheets should be referred to. Food consumption in spa bath and wellness centre areas is, in any case, not allowed unless services on a par with restaurants can be guaranteed.

▪    In covered spaces, air circulation must be ensured. As regards air conditioning, where technically possible all air circulation must be totally excluded. Where this is not technically possible natural air circulation measures must be reinforced and air filters cleaned when the air conditioning is switched off, to maintain adequate filtering/removal standards in line with Istituto Superiore di Sanità document technical guidelines.

PERSONAL TREATMENTS (e.g. mud-balneotherapy, massage therapy)

▪    Clients and staff must wear airway protection masks where an interpersonal distance of less than a metre is required (in addition, for staff, to individual protection such as FFP2 masks or protection visors as well as gloves, single-use aprons and so on linked to the specific risks associated with their professions. Where services require personal proximity, in particular, staff must wear protection visors and FFP2 valve-less masks.

▪    Staff must wash their hands frequently and always before and after each client service. Possible single use overalls/aprons must be worn. Different gloves must be used in treatments from those used in the normal environment.

▪    Massaging without gloves is permitted as long as staff wash and disinfect their hands and forearms before and after clients and do not touch their faces, noses, mouth and eyes during massages. This also applies to the use of disposable gloves.

▪    Single-use sheets are recommended for all personal treatments and always for mud therapy. Massage beds and
surfaces and any non-single-use objects must be cleaned and disinfected on completion of treatments.

▪    Rooms/spaces used for treatments must be individual or reserved to families of cohabiting people (with the exception of inhalation therapy for which see the next point). Common use rooms/spaces must in any case be large enough to guarantee interpersonal distances of at least one metre between clients and staff during services.


▪    Between one treatment and another spaces must be aired and surfaces and spaces cleaned and disinfected with special attention to those touched most frequently (e.g. handles, switches, handrails, etc.).

▪    Clients must use airway protection masks during treatment (except spa water showers and where mud is applied to the face) and clean their hands thoroughly before and after treatment.


SPA POOLS

▪    Quota systems should be used for access to pools with special attention to indoor spaces and enclosed areas. Where possible mandatory entrance and exit trajectories to pools and green areas should be used.

▪    Client pool density is to be calculated according to a 7 square metres of water surface per person ratio for pools whose size and rules allow for swimming. Where swimming is not allowed a 4 square metres of water surface per person ratio is allowable. Managers are thus required to calculate and manage numbers on the basis of the area available to them.

▪    Outdoor pools are to be preferred for collective activities (e.g. acquabike, acquagym) and indoor space use should be limited. During collective activities, limiting participant numbers for the purposes of guaranteeing interpersonal distancing of at least two metres is required with special attention to the most intense physical exercise. Indoors there must be a gap of at least one hour between one collective activity and the next and spaces must be aired.

▪    Hydro-massage baths and areas which cannot respect the water to person ratios listed above must be used by one bather at a time only, with the exception of family or cohabiting groups, people sharing the same room and those not required to respect interpersonal distancing. This latter aspect is a matter of personal responsibility.

▪    Hydrokinesitherapy must be done as far as possible in special pools allowing staff to guide client movement whilst themselves remaining outside the water with the exception of cases in which staff presence in the water is indispensable (e.g. disabled clients). In such cases, if possible, staff and clients must wear airway protection masks. At the end of each session, any equipment used must be disinfected.

▪    Required disinfectant levels should be maintained, where present, within the recommended limits and in accordance with international norms and standards, preferably in the upper range limits. Alternatively physical treatment at the upper range limit or maximum water exchange in the pool should be implemented in accordance with maximum uptake capacity.

WELLNESS CENTRES

▪    Quota systems should be used to limit access in order to maintain interpersonal distancing of at least two metres in all indoor spaces except between members of the same family and those cohabiting, people sharing a room or those not required to comply with interpersonal distancing under current regulations. This latter aspect is a matter of personal responsibility.

▪    Extremely warm and humid environments should be limited access (e.g. steam baths) and saunas. Access to these may be permitted only where they are exclusive services for guests in a single room.

▪    For clients, masks are obligatory in internal waiting areas and in any case in accordance with the regulations displayed.


INHALATION TREATMENTS

▪    As regards inhalation therapies included in the LEAs designed to treat ear nose and throat conditions and breathing problems which are individual, facilities must guarantee both very careful medical check-ups specific to COVID-19 symptoms and any contact with known COVID-19 cases and the following measures:


- all therapies must ensure interpersonal distancing (with alternate work station occupation);

- work stations must be disinfected carefully between one treatment and the next with monitoring protocols as regards disinfection effectiveness;

- spaces must be effectively aired as required by the regulations and ISS guidelines in order to ensure air circulation.

▪    Collective inhalation treatments, cave therapy in stoves or grottoes and steam jet inhalations are forbidden unless facilities have individual, isolated work stations and can fully disinfect spaces between patients.