Practical Cleanliness and Aseptic Methods for Massage Therapists

Hand washing is perhaps the single most important aseptic method for Massage Therapists.  Viruses and bacteria are transmitted very efficiently by hand contact.  The transmission of infectious agents by hand contact is well documented by the CDC.

  • Remove all jewelry, including rings, bracelets and watches, before washing hands.
  • Wash hands before direct contact with linens, as when placing linens on the massage table. 
  • Wash hands before direct contact with clients.
  • Wash hands after direct contact with clients, this includes after the massage and after touching the client in any way.
  • Wash hands after handling dirty linens or touching anything that bodily fluids have come in contact with.
  • When washing hands with soap and water, wet hands first with water, apply an amount of product recommended by the manufacturer to hands, and rub hands together vigorously for at least 15 seconds, covering all surfaces of the hands and fingers.
  • Rinse hands with water and dry thoroughly with a disposable towel.  Multiple-use cloth towels are not recommended for use in healthcare settings.  Use a disposable towel to turn off the faucet.  
  • Hot water has no added bactericidal effect, so avoid using hot water because repeated exposure to hot water may increase the risk of dermatitis.
  • Use an antimicrobial soap with water or an alcohol-based hand rub for the most effective decontamination.  If using regular soap with water, rub hands thoroughly with friction for at least 15 seconds and rinse thoroughly.
  • When decontaminating hands with an alcohol-based hand rub, apply product to palm of one hand and rub hands together, covering all surfaces of hands and fingers, until hands are dry.  If you believe you have come in contact with bacilli or spores, use hand washing guidelines because bacilli and spores are not effectively killed by alcohol.
  • Never touch your face, open skin or mucous membranes during a massage or after touching linens or contact services that may have been touched by clients or have bodily fluids on them.  Wash hands and any area touched immediately to avoid contamination.

Manicured and clean fingernails are an important part of a massage therapist’s aseptic protocol.  Long fingernails are a potential site for trapped dirt and bacteria to hide.  Un-manicured sharp nails also represent a potential danger for unintentional breaking of the skin, which exposes the client to infection.  Cut fingernails short and file down sharp edges to avoid the risk of cutting the client.  When washing hands, scrub under nails to remove dirt and germs.

Clothing can be a potential carrier of germs.  Shirts, pants, uniforms, jackets and aprons should all be washed regularly with bleach to sanitize.  If clothing comes in contact with the client during therapy, then this clothing should be treated just as dirty linens…removed and placed in a separate container for cleaning.  If contact with the same clothing is made by multiple clients, the risk of spreading infectious agents is high. 

Broken skin represents the highest threat to infection.  Avoid contact with areas on the client where the skin is broken (or with aforementioned skin lesions).  Make sure to cover broken skin or lesions that you may have are covered so as not to endanger your clients.  Surgical gloves are appropriate if you have cuts on your fingers or hands or if the client has suspect areas you want to avoid.  Always use diplomacy when dealing with these sensitive issues and keep the client’s and your safety as the prime concern.      

Proper handling of linens is an important part of the massage therapist’s aseptic protocol.  Linens include sheets, pillow cases, face covers, towels, heating pad covers, bolster covers, anything that comes in contact with the patient’s skin or bodily fluids.  Blankets, mattress pads and other items that do not come in contact with the client’s skin do not need to be treated as linens.

  • Clean linens should be stored in a closed cabinet and dirty linens should be stored in a closed container.   It is important to have a second container to isolate “hot” sheets or clothes that have been contaminated or are suspected to have come in contact with infectious agents.
  • Wash sheets promptly so they do not spread infection or become rancid.  
  • Bleach used in a 10% solution (1 cup bleach per wash load) can be used as an effective disinfectant for most applications.  Remember that certain bacteria, bacilli and spores are not killed by this dilute solution and require a higher concentration (1 part bleach to 5 parts water).
  • When linens have come in contact with a serious infectious agent, isolate items immediately and discard contaminated linens as a biohazard through a biohazard disposal service.

Massage Lotions and Creams should be stored in clean containers that dispense the lubricant without contaminating it.  The outside of the container needs to be kept disinfected and if a massage oil bottle is used during a massage, wash the bottle at the same time as washing your hands.  If any lubricant is contaminated, it needs to be thrown away and if a known infectious agent has come in contact with the lubricant, then appropriate biohazard isolation and disposal should be used.

Massage Tables, Equipment and Contact Surfaces should be cleaned after each client.  This includes face cradles, table and counter surfaces, door knobs, toilet seats, etc.  Use a 70% concentration alcohol solution to wipe down any the massage table and all equipment that may have come in contact with the client or their bodily fluids.

References

Werner R. A massage therapist’s guide to pathology. Lippincott Williams & Wilkins. 2002. 

Rutula WA, Weber DJ, et al. Guideline for disinfection and sterilization in healthcare facilities. CDC Dept. of Health and Human Services. 2008.

Simmons BP. CDC guidelines for the prevention and control of nosocomial infections. Guideline for hospital environmental control. Am. J. Infect. Control. 1983;11:97-120.

Patrick DR, Findon G, Miller TE. Residual moisture determines the level of touch-contact-associated bacterial transfer following hand washing.  Epidemiol Infect. 1997;119:319–25.

Larson E. A causal link between handwashing and risk of infection?  Examination of the evidence. Infect Control Hosp Epidemiol. 1988;9:28–36.

Larson EL, Eke PI, Laughon BE. Efficacy of alcohol-based hand rinses under frequent-use conditions. Antimicrob Agents Chemother. 1986;30:542–4.

Salisbury DM, Hutfilz P, Treen LM, Bollin GE, Gautam S. The effect of rings on microbial load of health care workers’ hands. Am J Infect Control.  1997;25:24–7.

Taylor LJ. An evaluation of handwashing techniques. Nursing Times. 1978:54–5.

Russell AD. Bacterial resistance to disinfectants: present knowledge and future problems. J. Hosp. Infect. 1998;43:S57-68.

TAKE THE TEST

1... 2 (previous)...Page 3

©2010 Healing Arts Continuing Education. All Rights Reserved.