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Aseptic Methods for Massage Therapists (2 Continuing Education Hours)

This course is approved for 2 hours of Continuing Education for Massage Therapists by the Texas Department of State Health Services: Approved Provider: MARK SCOTT URIDEL CE0009. Mark S. Uridel is approved by the National Certification Board for Therapeutic Massage and Bodywork (NCBTMB) as a continuing education provider.

Learning Objectives: After reading this course, you will...

  1. be able to explain the importance of aseptic methods in the practice of massage therapy.
  2. be able to list the various types of infectious agents that are associated with skin contact.
  3. be able to describe how these various infectious agents are transmitted from host to host.
  4. be able to describe the different methods for preventing the spread of infectious diseases.


Because Massage Therapists work so intimately with clients and patients, it is essential that they practice appropriate aseptic methods (ways to prevent the spread of infectious agents) and cleanliness in their work.  This includes personal hygiene, effective hand washing and proper infection control procedures with contact surfaces and linens.  Infectious agents can be spread from the client to the therapist or from the therapist to the client.  Massage therapists should be familiar with common infectious agents, know how to practice proper infection control procedures and understand the specific implications of practicing cleanliness and aseptic methods for the massage profession.

Infectious Agents
There are numerous agents that can infect the human body.  According to the Center for Disease Control (CDC), normal skin is an effective barrier against infection of most common bacteria and viruses.  However, mucus membranes and any break in the skin are considered susceptible to infection.  It is paramount that any open wound or break in the skin is treated as a serious threat of infection.  There are colonies of bacteria on everyone’s skin and when a breach in the skin occurs, the underlying tissues are at risk of becoming a breeding ground for these parasites.  The following represents a list of common infectious agents that might be encountered while practicing massage and hands-on therapy.

There are good bacteria (saprophytes) and bad bacteria (parasites).  The most common parasitic bacteria include:

  • Staphylococcus, which are clusters of round bacteria responsible for skin infections, acne and boils.  These bacteria have mutated into thousands of strains that are resistant to antibiotics and therefore difficult to treat.  Prevention of infection is paramount.
  • Streptococcus, which are chains of round bacteria responsible for systemic infections, strep throat and blood poisoning.  These have mutated into resistant strains, also.
  • Gonococcus, which causes gonorrhea.
  • Diplococcus, which causes pneumonia.
  • Bacilli are rod-shaped bacteria that reproduce through spores that have outer shells that resist environmental threats, including chemicals.  They are responsible for anthrax, tuberculosis, typhoid fever, tetanus and diphtheria.
  • Spirochetes, spiral-shaped bacteria, responsible for syphilis, Lyme disease and peptic ulcers.

Although technically not living organisms, viruses change living cells into reproduction centers for more viruses.  Outside the body, certain viruses can survive several hours.  The main viruses that Massage Therapists have to be concerned about are herpes simplex and hepatitis B.

  • Herpes Simplex causes oral and genital herpes.  Originally thought to be two separate strains, recent documentation reports instances of crossover.  In the acute stage, blisters filled with clear fluid are highly contagious.  If a client has fever blisters around their mouth, thighs or buttocks, consider them a local contraindication to massage or manual therapy.  The virus can remain active on surfaces, clothing or linens for several hours.  Any contact with surfaces, including doorknobs, toilet seats, face cradles or treatment surfaces should be treated as a potential risk to infection and sterilized as soon as possible.  All linens should be isolated from other linens immediately for disinfecting.  If you have herpes, use your professional judgment and proper infection control techniques when handling clients, equipment and linens so that you do not transmit the virus.
  • Hepatitis B is transmitted through intimate contact or sharing of fluids, including saliva, lymph or blood.   Avoid direct contact with open wounds or breaks in the skin, body fluids and protect yourself if you have any cuts or scrapes.  It is extremely virulent and hardy and is the leading cause of work-related deaths in nurses.  A vaccine is available for hepatitis B and healthcare professionals should consider being vaccinated. 

The main fungi to be aware of related to massage and hands-on care are dermatophytes, skin fungal infectious agents.  Tinea corporis (body ringworm), tinea capitis (head ringworm), tinea cruris (jock itch), and tinea pedis (athlete’s foot) are the main skin fungal infections to be aware of.  Tinea infections present as red, slightly raised skin lesions often in “rings.”  Although they tend to favor hidden areas, fungal infections can be anywhere on the body.  These fungal infections are highly contagious, especially for people with compromised immune systems.  Also, fungal infections can take several weeks to gestate, which means the infected person can transmit the fungus to other people during that time.  By practicing proper aseptic methods, the therapist can avoid contracting or transmitting a fungal infection.

Animal Parasites
Although there are a number of parasites that can infect the body, the three most common animal parasites are:

  • Head Lice, arthropods that live in head hair, attach to the hair shaft and feed on blood from the scalp.  They can spread by physical contact or contact with clothes, hats, or surfaces, such as chairs, hat hooks and can even jump to another host.  You can identify a head lice infestation by the white eggs (nits) that stick to the base of hair shafts.
  • Body Lice live in pubic hair, armpit hair, body hair, even eyebrows and eyelashes.  They appear as small white crabs that can spread through physical contact or contact with clothes, sheets, etc. and cause a great deal of itching.
  • Scabies are microscopic mites that burrow under the skin and cause small blisters with reddish or gray lines.  The lesions are most likely found in warm moist places like the groin, armpits, elbows, knees or between fingers and toes.  The lesions are itchy and often misdiagnosed due to the inability to see the mites.

Prions  are mis-folded protein infectious agents associated with Creutzfeldt-Jakob Disease (CJD), the same agent that causes mad cow disease in cattle.  These diseases are untreatable and always fatal.  The abnormal structure of the proteins makes these agents particularly stable and resistant to denaturation by chemicals and physical sterilization methods.  Containment, decontamination and disposal of these agents is difficult and requires special handling.

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