By Ruth Werner
Every now and then, readers clamor for a basic hygienic practice’s refresher article. In this column, we will look at the actions of an entirely fictional massage therapist who is in a hurry and makes a few unfortunate errors in how she sets up her office for the day.
Meet Myrtle
Myrtle the massage therapist was running late on a Monday morning. Fortunately, on Friday she had started to launder her favorite colorful flannel sheets and face cradle covers. She is conscientious about energy use, so she washed them all in cold water, but she used extra non-chlorine bleach, so they would be really clean. The wet laundry sat in her washing machine for a couple of days, but she luckily remembered to put it all in the dryer early in the morning. She hoped her first client would not notice that her uniform shirt was still a little damp.
Grabbing her armful of unfolded laundry, Myrtle hustled into her session room. Her table was marked with oily handprints—not the kind of impression she wanted to make. Dropping her sheets on the floor, she grabbed a translucent bottle of 10 percent bleach solution off her open shelf and spritzed her table and quickly wiped it off with a paper towel.
She adjusted one fitted sheet, then realized that with six clients on the books, her time to dress her table between appointments would be extremely limited. So, she used an old trick: she layered the rest of the fitted sheets on top of the first, so she could simply peel them off one by one. She quickly folded the extra, slightly damp flat sheets and stacked them on her open shelves.
As Myrtle fitted her face cradle into the top of the table, she realized it was a little sticky. From the top drawer of her desk, she grabbed an alcohol-soaked towelette. She quickly wiped down the face cradle before stacking six covers on it. Then she used the moist towelette to wipe her doorknob, the light switch plate, her bottle of lubricant and lastly, her own hands to greet her first client.
How many mistakes did Myrtle make? Let us look.
Principles of Hygiene
Universal Precautions are a set of protocols that were introduced in 1987 (after HIV/AIDS and hepatitis B had become major public health issues) to create some uniformity in how medical professionals could limit contact with body fluids in the working environment. Standard precautions were added to include guidelines on how to avoid all potentially harmful body fluids. Obviously, massage therapists are unlikely to be exposed to plural fluids, but some of these others are not outside the range of possibilities, especially blood, blood-tinged saliva and vomit. It is important to note that sweat and tears—perhaps the fluids that massage therapists are exposed to most often—are not described as infectious fluids.
The methods that infectious agents use to jump the gap from one host to another have been exhaustively studied. The process essentially boils down to three issues: a reservoir or source of the infectious agent, a mode of transport, and a susceptible new host. Possible reservoirs can include other humans, or inanimate habitats like contaminated computer keyboards, foods or cash that may be handled by hundreds of people. The susceptibility of a new host depends on several variables, from species to inborn immunity, to variable resistance. Finally, the mode of transport can be direct or indirect through the air with respiratory secretions, or by way of an intermediate object like a doorknob or a light switch.
The benefits of good hygienic practice go beyond conveying a sense of professionalism. Massage therapists work with skin-to-skin contact, and the risk of picking up an inadvertent infection, or of spreading one to another client.
If Myrtle had the following information, she could improve her hygienic practices, and reduce the risk for harm to herself and her clients.
1. Disposable Bed sheets / Multi Roll
By far the most recommended product on the market for ultimate hygiene replacing towels and linen will be best, also to protect linen and towels it can be covered with product. Less on laundry and electricity expenses. www.hygienedisposablewear.co.za
2. Laundry
1. Standard laundering has good antimicrobial effect with water temperatures between 71°F –77°F (21.6°C–25°C), if the detergent is used according to the manufacturer’s directions. This is adequate for most situations.
2. If chlorine bleach is added to the wash, it becomes most active at temperatures above 135°F (62.7°C). Most home hot water heaters heat water to 120°F–140°F (48.4°C–60°C), so bleach in a home washing machine may not reach its full antimicrobial potential.
4. Laundry must not be left damp: mildew can begin growing within 24 hours.
5. Clean laundry must be packaged to keep it clean until its next use. It should be wrapped in plastic, or stored in a clean, closed container.
3. Session Room
1. For cleaning high-touch surfaces like massage tables and face cradles, the Centres for Disease Control and Prevention (CDC) recommends a freshly mixed 10 percent bleach solution; this is inexpensive and easily available. Bleach-infused wipes can be useful in this application, but it is important to read the labels for best results: some of them require at least 10 minutes of uninterrupted exposure to be effective.
2. Alcohol and alcohol-soaked towelettes are specifically not recommended for cleaning surfaces, because alcohol evaporates quickly; it works best with prolonged contact against targeted pathogens.
3. Stacking sheets and face cradle covers is simply a bad idea. Clients sweat, they may use strong-smelling soap or scents, and sometimes they have open and uncovered cuts.
What is practical?
Disposable Bed sheets / Covers, by far the best method to stop cross contamination and protection of surfaces.
The hygienic practice guidelines provided here are drawn from recommendations by the CDC and other resources for health-care professionals in hospital, dental, and home-care settings. These recommendations may be more strict or stringent than many people find practical, but our job as professionals is to be more careful than is necessary. The goal of this article is to promote the creation of a setting in which the surfaces that one client touches are cleaned or replaced before the next client comes in. This means sheets are removed and replaced, and bolster covers, face cradle covers, uniforms, and other fabrics are also refreshed. Non-fabric surfaces like the table, doorknob, and switch plates are also cleaned regularly. If a therapist uses thermal packs, stones, or other massage tools, these must also be disinfected between clients.
Taking care of our equipment, our working environment, and ourselves takes time, energy, and investment in good cleaners. But it can give us the good health and longevity to more effectively take care of our clients.
Ruth Werner is a writer and educator approved by the NCBTMB as a provider of continuing education. She wrote A Massage Therapist’s Guide to Pathology (Lippincott Williams & Wilkins, 2012), now in its fifth edition, which is used in massage schools worldwide.
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