Precautions should become a routine part of the massage practice. These will assist the therapist in meeting the NCBTMB’s Standard of Practice I (g): “use standard precautions to insure professional hygienic practices …”
The strategy involves 3 steps (WAS):
Step 1: Wash
Frequent hand, wrist and forearm washing is the most basic step, particularly after finishing a massage. The proper way to wash hands includes:
Hand washing is a relatively new technique. In the late1840s, medical students in a Vienna hospital were walking from autopsy practice to delivering babies without stopping by the sink. Dr. Semmelweis instituted hand washing and many fewer patients in the maternity ward died. The doctor was derided. Fifteen years later, when he died, hand washing was still regarded as a crackpot idea, even though it worked.
Today the federal Centers for Disease Control quote hand washing as “the single most effective way to prevent the transmission of disease.” Still, about a third of Americans leave public restrooms without washing their hands. If they had the MRSA bacteria on their hands they could have easily washed it off. It is a simple way to avoid a health hazard.
Wash hands before touching cleaning equipment to avoid cross-contamination. Gloves should be worn while disinfecting. Wash hands after removing gloves.
(Therapists with active MRSA infections should desist from giving massages until the infection is healed, both to aid in their recovery and to protect others.)
While massage therapists do not treat people who have a cough, sometimes we do not know they are ill until the massage is in progress. If the client coughs on the therapist’s skin, it may be appropriate to interrupt the massage to wash the skin. If the cough hits the therapist’s clothes, the material should be regarded as possibly contaminated and removed for washing at the earliest opportunity.
Health departments are urging athletes participating in sports with close personal contact (wrestling, football) to shower (and presumably change clothes) afterwards, partially to reduce the possibility of MRSA. It may seem overkill to request of your clients who are coming from the gym or a contact sport to shower before arriving. However it is worth considering as you would not want a client dragging MRSA into your establishment.
Clients should be encouraged to shower before
treatment. In some establishments it is a standard requirement. This will help remove any CA-MRSA germs residing on the client’s skin, resulting in a safer surface for the therapist to work on.
There are specific recommendations for washing linen (in water of at least 160 degrees Fahrenheit, with bleach, for minimally 25 minutes) and drying it. If the shop’s linen is outsourced, it may be worthwhile to determine if the linen service is meeting the standards to kill CA-MRSA. Linen companies that handle hospital laundry have to comply with rigid temperature standards. Laundry services that only handle beauty salons and so forth do not always have to meet those standards depending on regulations usually monitored by the county health department.
When handling laundry, the therapist should hold dirty linen away from the body to avoid contaminating clothes and wash hands immediately afterwards. Hands should always be washed after handling used linen (even if gloves were worn) but particularly so when moving from that activity to the food area.
CA-MRSA has the potential for contaminating food. So the food storage or food preparation area should not be located near where dirty linen is stored.
Step 2: Avoid
Never touch broken skin, pimples, boils, rashes or what appear to be spider bites. If the therapist suspects the client has a staph skin infection, it may be appropriate to terminate the massage and suggest they have it checked by their doctor. Asking the client beforehand if they have any of the symptoms would save the therapist the awkwardness of terminating the treatment or, even worse, continuing. This can be done either vocally or in a questionnaire,
The therapist is required to “refer to other professionals when in the best interest of the client and practitioner” by the NCBTMB’s Standard I (m). (Remember that in a medical setting, personnel treating a known MRSA patient would be gowned and gloved—that is the level of seriousness with MRSA.)
Step 3: Swab
The massage table should be seriously swabbed with a disinfectant after each use.(There are products on the market that can safely be used on vinyl.) When removing the used sheet, avoid waving it in the air as this could spread MRSA germs if any are present.
Since disinfection requires five to ten minutes, it will probably not be possible to disinfect all the surfaces a client touches—doorknobs, doors, chairs, walls, light switches, toilet, toilet handle, faucet and shower knobs, and benches before someone else uses them. Still, it would be wise to swab all these surfaces with a disinfectant before the next client or, next best, frequently. Showers, too, should be cleaned often and disinfected daily, if that isn’t already being done.
K.T. Berger in 1988 wrote a book called Zen Driving, advocating being very aware of one’s now while driving. Therapists might do well to become especially conscious of everywhere a client touches so these areas can be kept germ free.
Surfaces which require daily disinfecting include floors, steam rooms and saunas (which must also be dried daily), hot tubs and benches. (If the therapist inadvertently allows a person with a wound—whether or covered not—to use the hot tub, the tub must be closed to further use until disinfected.)
Surfaces which might not ordinarily be disinfected, such as desks or lobby counters, should at least be sanitized or dusted, even if they are not touched by other people. This is because people shed skin which can contain CA-MRSA. Sanitizing is not as effective as disinfecting, however not everything can withstand disinfectant products. Dust contains many skin particles. Dust with a swab that captures the dust rather than sends it floating into the air.
In this book, the development of MRSA from its fighting antibiotics in the early 1960s to the emergence outside hospitals 20 years later has been traced. While CA-MRSA represents only 1/5 of MRSA cases, its numbers are growing, it spreads very easily and it is potentially more deadly than the previous kind (HA-MRSA). Nonetheless, there are steps which can be taken to thwart CA-MRSA. By exercising these precautions, the therapist will help protect clients, co-workers, self and ultimately others from these serious germs.