Aseptic Methods
Now that you have some idea of the possible infectious agents, we will look at how to prevent the spread of infections to you and your clients.

Cleaning
Cleaning, according to the CDC Guidelines for Disinfection and Sterilization in Healthcare Facilities 2008,is the removal of visible soil (e.g., organic and inorganic material) from objects and surfaces and normally is accomplished manually or mechanically using water with detergents or enzymatic products. Thorough cleaning is essential before high-level disinfection and sterilization because inorganic and organic materials that remain on surfaces interfere with the effectiveness of these processes.  Decontamination removes pathogenic microorganisms from objects so they are safe to handle, use, or discard.” 
“Terms with the suffix cide or cidal for killing action are commonly used.  For example, a germicide is an agent that can kill microorganisms, particularly pathogenic organisms (“germs”). The term germicide includes both antiseptics and disinfectants. Antiseptics are germicides applied to living tissue and skin; disinfectants are antimicrobials applied only to inanimate objects. In general, antiseptics are used only on the skin and not for surface disinfection, and disinfectants are not used for skin antisepsis because they can injure skin and other tissues. Virucide, fungicide, bactericide, sporicide, and tuberculocide can kill the type of microorganism identified by the prefix. For example, a bactericide is an agent that kills bacteria.”

Antiseptics
These substances represent the weakest methods of preventing the spread of infectious agents.  However, they are also the most practical and when used properly, can offer the best frontline defense against infection.  Antiseptics, which are safe to use on the skin, create a harsh environment for bacteria, but are often not strong enough to kill them.  Alcohol, iodine and hydrogen peroxide, which used to be considered disinfectants, can no longer kill resistant bacteria.  None of these antiseptics can kill bacilli spores because of their protective shells. 

  • Hand Soap can create a harsh environment for germs, but it will often not kill bacteria.  Soap with special antiseptic chemicals can do a better job, but it is often the friction of manual scrubbing and rinsing that removes the germs.   According to the research, proper hand-washing technique is more important than the type of soap used.
  • Rubbing Alcohol is effective at killing many bacteria in a 70% solution.  It is actually less effective at higher concentrations because a certain amount of water is needed.  Alcohol ineffective at killing viruses and bacilli.
  • Hydrogen Peroxide, used in a 3% solution, is a mild antiseptic.

Disinfectants
According to the CDC Guidelines, “Disinfection describes a process that eliminates many or all pathogenic microorganisms, except bacterial spores.”  Disinfectants are substances like germicides and bactericides that are effective against viruses and bacteria, except bacilli.  According to the CDC Guidelines, “disinfection is not sporicidal.  A few disinfectants will kill spores with prolonged exposure times (3–12 hours); these are called chemical sterilants.  At similar concentrations but with shorter exposure periods (e.g., 20 minutes for 2% glutaraldehyde), these same disinfectants will kill all microorganisms except large numbers of bacterial spores; they are called high-level disinfectantsLow-level disinfectants can kill most vegetative bacteria, some fungi, and some viruses in a practical period of time (<10 minutes).  Intermediate-level disinfectants might be cidal for mycobacteria, vegetative bacteria, most viruses, and most fungi but do not necessarily kill bacterial spores.  Germicides differ markedly, primarily in their antimicrobial spectrum and rapidity of action.”  Disinfectants are too strong to be used directly on the skin, but may be used to clean surfaces or linens.

  • Bleach in a 10% solution can be used to disinfect surfaces and 1 cup per wash load to disinfect linens.  However, to effectively kill certain bacteria strains, bleach should be used in a 1/5 ratio (1 part bleach/ 5 parts water).  In this concentration, it is considered the industry standard for disinfecting surfaces exposed to bacteria and viruses. 
  • Phenol in a 10% solution is used on surfaces, but is not used on skin because it is caustic.  It is also caustic to the lungs and requires special precautions.  Phenol kills bacteria, fungi, herpes and viruses.
  • Quaternary Ammonium Compounds (Quats) are professional grade chemical compounds that are specifically designed for “cold sterilization” of equipment that cannot be sterilized in an autoclave (see below).

Sterilization
According to CDC Guidelines, “Sterilization describes a process that destroys or eliminates all forms of microbial life and is carried out in health-care facilities by physical or chemical methods. Steam under pressure, dry heat, EtO gas, hydrogen peroxide gas plasma, and liquid chemicals are the principal sterilizing agents used in health-care facilities.”  These aseptic methods kill all living organisms.  Massage therapists cannot sterilize themselves or their clients, but they could sterilize certain equipment or linens, if necessary.  Below are the most common methods of sterilization.

  • Baking involves subjecting the equipment to 350 degrees Fahrenheit for 1 hour.  This effectively kills all living organisms.  Of course, this can only be used for certain equipment that can withstand the temperature.  According to the CDC guidelines, the microwaves produced by a "home-type" microwave oven (2.45 GHz) completely inactivate bacterial cultures, mycobacteria, viruses, and G. stearothermophilus spores within 60 seconds to 5 minutes depending on the challenge organism, however, a commercial microwave would be needed to sterilize items.  Also, there may be areas that do not get sufficiently hot in a microwave to disinfect.
  • Boiling involves immersing the contaminated objects in water at 212 degrees Fahrenheit for 20 minutes.  This effectively kills all vegetative microbes and viruses, but NOT bacterial and fungal spores.  It may be best to discard severely contaminated linens due to trapped infectious agents and spores and because boiling linens may weaken the fabric to the point of failure.
  • Autoclave (steam cabinet) sterilization is the gold standard for medical tools and equipment.  Items are steamed at <15psi at 250 degrees Fahrenheit for 30 minutes.   

Table 1: Decreasing order of resistance of microorganisms to disinfection and sterilization (Russell, 1998)

INFECTIOUS AGENT

LEVEL OF ASEPTIC DECONTAMINATION

Prions (Creutzfeldt-Jakob Disease)

Prion Reprocessing

Bacterial Spores (Bacillis atrophaeus)

Sterilization

Coccidia (Cryptosporidium)

Sterilization

Mycobacteria (M. tuberculosis, M. terrae)

High-Level Disinfectants

Non-Lipid or Small Viruses (polio, coxsackie)

Intermediate-Level Disinfectants

Fungi (Aspergillis, Candida)

Intermediate-Level Disinfectants

Vegetative Bacteria (S. aureus, P. aeruginosa)

Low-Level Disinfectants

Lipid and Medium-Sized Viruses (HIV, herpes, hepatitis B)

Low-Level Disinfectants

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