Health and Hygiene

Learning Objectives

Upon completion of this class, the student will be able to:
• Describe the universal precautions for contact with blood and other body fluids
• Explain the correct way to wash hands.
• Create an effective disinfectant solution.
• Describe how diseases are transmitted.
• Explain the difference between clean, sanitized, and sterilized.
• Explain the correct way to clean and sanitize the massage table and other equipment.
• Discuss self-care.
• Discuss how to keep one's immune system healthy.

How Diseases Spread

Germs, such as viruses, bacteria, and parasites, cause infectious diseases. Contagious or communicable diseases are those that can be spread from one person to another. In order for germs to be spread from one person to another, three things must happen.

Germs must be present in the environment, either through a person carrying the germ or through infectious body fluids, such as discharge from the eye, nose, mouth, or digestive (gastrointestinal) tract, blood, mother's milk, semen, vaginal secretions; in the air; or on a surface.

A person who is not immune to the germ must come in contact with or be exposed to the germs.

The germ must enter the body through the eyes, nose, or mouth for instance, or through openings in the skin such as scratches or sores. The common cold or flu, for instance, can result from simply shaking hands with a contagious person and then touching one's eyes, nose or mouth.

As the table shows,
• Skin infections can be spread by touching the infected area, or infected fluids
• Infections, usually respiratory, can be spread through the air, mainly through coughing and sneezing. Another person can inhale the droplets in the air, or the infection can enter the body when a person comes in contact with the germs and then touches his face, eyes, nose or mouth.
• Intestinal tract infections, such as diarrhea, are spread through contact with feces. An unsuspecting person can come into contact with intestinal germs when objects such as toys become contaminated with undetectable amounts of feces which are then transmitted into the body through the mouth. Fecal-oral contamination can also happen to food, when food-handlers fail to wash their hands properly, or through prepared foods made from animals and not cooked properly.
• Some infections, may be spread through direct exposure to infected animals.
• Blood infections are spread when blood (or sometimes other body fluids) from a person with an infection gets into the bloodstream of an uninfected person. This can happen when infected blood or body fluid enters the body of an uninfected person through cuts or openings in the skin, the mucous membrane that lines body cavities, such as the nose and eye; or directly into the bloodstream, as with a needle.
• Some diseases, such as chickenpox, impetigo, and hand-foot-and mouth disease, can have more than one transmission route. For example, they may be spread through air or by direct contact with the infectious germ.

Hand Washing, Sanitizing Linens and Equipment

Always wash your hands thoroughly with soap and water before and after every massage. Take at least thirty seconds to wash your hands and lower arms. Scrub between the fingers and under the nails. Do not touch the sink. Rinse thoroughly, dry with a paper towel and use the paper towel to turn off the faucet. Use a barrier cream as added protection against any bacteria or chemicals. Never give a massage if you have any open areas on your hands - cuts, abrasions, infected nails, etc. unless you wear gloves. Do not massage any area of your client's body where there are sores, scratches, abrasions, and/or infections. Wear gloves when you wash dishes, work in the garden, and for any other work that may damage your hands. Wash your oil bottle when you wash your hands as it becomes contaminated during massage.

When you remove dirty linen from the massage table, do not let it touch your clothing. Place in the hamper, but do not push your hands and arms into the container to compact the linen. Wash and dry hands before touching clean linen. Do not let the clean linen touch your clothing or the floor. Dirty linen should be washed in hot soapy water with bleach and dried in a dryer to completely kill all bacteria. Wash the massage table surface frequently with hot soapy water with bleach. Check the table for damage once a week and repair any cracks, missing screws, or other problems immediately.

Put on clean work clothes just before beginning to massage. Do not smoke cigarettes, or stand near anyone who is smoking, since massage clients are often very sensitive to smells. For the same reason, do not wear perfumes or essential oils when giving massage. Remove your massage clothing as soon as you are finished working, or as soon as you get home, and wash the clothing in hot soapy water and dry in the dryer or sunlight.

Self Care

Keep yourself healthy. A strong, functioning immune system is your best defense against any disease. The immune system can be weakened by such factors as fatigue, stress, poor diet, lack of exercise, lack of sunshine, depression, and other factors that are within the control of the therapist. Be sure to get enough sleep. Eat a healthy diet with vegetables and fruit. Get some exercise every day OUTSIDE, even if it's just a 10-minute walk.

Massage therapists tend to be service-oriented, and feel very responsible to take care of their clients. As a result, some do not have good boundaries and they find themselves working all the time. This will lead to burnout. Therapists should be sure to schedule their time so that they have reasonable amounts of rest, recreation and fun, and spend time with people who are not their clients.

Self-care is important; therapists should be sure to stretch after giving massage, vary the kinds of massage given to avoid overuse injuries, limit the number of massages they will give in one day, and exercise to build strength.

Avoid lifting clients, as this can lead to severe back injuries. If a client needs assistance getting on or off the massage table, ask the client to bring an attendant who can assist. Therapists can assist by offering support for balance, but not by carrying the client's entire weight.

Learn good body mechanics in order to prevent back strain. Learn how to use larger muscles when massaging, to avoid straining smaller, weaker hand muscles. Learn how to stand and move around the massage table to protect your body and muscles while working. This can best be learned from an instructor who can demonstrate correct body mechanics and then watch and correct students until good body mechanics become a habit.

Learn more about diseases such as AIDS, hepatitis and tuberculosis. The more you know about them, the more you can protect yourself. For instance, you may know that AIDS is transmitted in body fluids. Do you know which body fluids? The fluids to avoid are blood, semen, vaginal secretions, and mother's milk. It is possible, in the course of a massage, for a client to discharge one of these fluids. Nursing mothers, for instance, often struggle with leaking nipples and the discharge could be present during a massage.

What Are Universal Precautions?

Universal Precautions are a standard set of procedures developed by the Center for Disease Control and the Occupational Safety and Health Administration. They are used to limit the spread of blood-borne diseases such as Hepatitis B and HIV. Understanding and practicing universal precautions helps the massage therapist to avoid contact with serious diseases.

Why Follow Universal Precautions?

Some bacteria and viruses that cause disease are carried in the blood or in body fluids that contain blood. Hepatitis B and HIV are two examples. Although your skin is an effective barrier against the spread of blood-borne diseases, skin that is broken by a cut, abrasion or chafing can provide an entry point. Any massage client could have one of these infections without showing symptoms. It's best to act as if all clients could possibly be ill and able to transmit one of these diseases without showing any outward signs of contagion.

The likelihood of blood-borne pathogens being transmitted through most body fluids is low, unless they contain visible blood. Nevertheless, fluids such as saliva, urine, tears,vomit, mucus, feces and breast milk can transmit other types of diseases, so massage therapists should use universal precautions to avoid contact with these fluids.

Avoid contact with body fluids:

Although the public may tend to think of HIV or hepatitis B as being sexually transmitted diseases, this is not the only way the disease can be transferred from one person to another. HIV and Hepatitis B are spread through contact with certain body fluids, including blood, semen, vaginal secretions or mother's milk. If any of these fluids, containing HIV or hepatitis B, contacts an open area on the therapist's skin, such as scratches or sores, there is the possibility of infection.

It isn't common, but it is possible to find any of these fluids on the massage table. For instance, a nursing mother's breasts may leak, or a client may develop a bloody nose. If this happens, it is important to follow universal precautions as described below.

Clean and disinfect the area with a ten percent solution of bleach in hot soapy water. Wear gloves to clean and disinfect the area. Place fluid contaminated materials in a plastic bag secured with a twist tie until they can be washed in hot soapy water with bleach and dried in a dryer. Dispose of tissues and other disposable materials in a plastic bag secured with a twist tie. After removing the gloves, wash your hands thoroughly for at least 20 seconds.

Wear gloves if you give first aid for any cut, scrape or wound, including those that have no visible blood. Bacteria and viruses can be on the surface of the injured area, and in any fluid that is present.

Care for Equipment and Linens:

Wash all linens in hot soapy water with bleach. Blood or other body fluids on the massage table maybe cleaned with a solution of one part bleach to ten parts hot soapy water. Cleaning the massage table with alcohol or other disinfectant is not as effective as a simple solution of bleach and hot soapy water. Disposable vinyl or latex gloves should be worn when handling linens contaminated with blood or other body fluid.

Thorough Hand Washing:

The primary precaution against infection is thorough hand washing. It is important to include the area between the fingers, the thumbs, the wrists and even the forearms. Hand washing should be done before and after each massage session, as well as during the session if necessary. After washing, use a paper towel to turn off the water, and also to open the door if necessary. Bacteria and viruses can be found on faucets, door handles, and light switches.

When to Use Gloves:

Wear gloves if you have a cut or open sore on your hands. Finger cots may be used for small abrasions or hangnails. If the client has herpes or other lesions that are weeping, postpone the massage. If that is not possible, wear gloves and wash any area you touch where fluid has spread. Do not wash or massage over the lesions. Work only on unaffected areas.

Give yourself permission to wear gloves if you are not comfortable without them. In all cases, be sure to explain to your clients why you are wearing the gloves, and get agreement with them that it's all right to do so. Clients may worry if they see the massage therapist wearing gloves, unless it is explained to them.

Don't touch the outside of the gloves when removing them. Use fingers of one hand to grasp the palm of the glove on the other hand and pull it off. Dispose of safely. Use fingers of ungloved hand to slide into the other glove. Pull down the glove from the inside, turning it inside out, and dispose of it safely. Wash your hands after removing the gloves.

When to Use Masks:

If your client has a cough, especially a wet- producing cough, the client could possibly have a communicable disease such as tuberculosis. The best procedure is to postpone the massage until the client has been treated for the illness. If your client is coughing significantly, wear a mask even if the client denies being ill. And of course, if the therapist is coughing, he or she should not be giving massage until the condition is resolved. If the therapist is coughing or has other symptoms due to allergies, which are not contagious, he/she may still want to wear a mask to reassure the client.

CONCLUSION

1. Talk to your clients about their health. Take a health history. Ask questions.
2. Learn the contraindications thoroughly. Do not be afraid to refuse a massage if appropriate.
3. Learn the indications, contraindications and effects of each kind of massage or body treatment you plan to use, including wraps, scrubs, and aromatherapy.
4. Wash your hands before and after every massage. Wash your oil bottle every time you wash your hands. Learn not to touch your face once you have washed your hands. Use a barrier cream. Keep your hands whole, free of injuries.
5. Keep yourself and your space clean. Wear clean clothes, shower frequently (massage is a sweaty business), and use clean linen. Clean your equipment regularly, wipe doors, switch plates, tape deck, etc. with soapy water and bleach. Wash down your massage table regularly.
6. Keep linen (clean and dirty) in closed containers. Store oils and lotions in the refrigerator to prevent rancidity.
7. Do not work when you are sick. Do not work on anyone with a contagious condition.
8. Do not lift clients. If they need help getting on or off the table, into and out of a wheel chair, ask them to bring along someone to help them.
9. Get enough rest, good food, exercise outside every day, have some fun. Stretch regularly. Get regular massages.

Study Questions

1. What are Universal Precautions?
2. Why should massage therapists follow Universal Precautions?
3. What is the correct way to wash hands?
4. What is the best protection against transmission of infection?
5. What three conditions are necessary for the transmission of disease?
6. What body fluids present a risk to massage therapists?
7. What is an effective cleaning solution for body fluids?
8. What is the difference between clean, sanitized and sterilized?
9. What is the best way to keep massage equipment and supplies clean?
10. What is the best way to sanitize massage equipment and supplies?
11. How can a massage therapist maintain a healthy immune system?