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Ch. 8 Infection Control and Safety for Massage Practitioners

Learning Objectives for Infection Control and Safety

Upon mastering this chapter, you will be able to:

  • Define infection control.
  • Explain the necessity of laws enforcing strict infection control practices.
  • Describe the path of infection for common pathogens.
  • Differentiate between pathogenic and nonpathogenic bacteria.
  • Explain the importance of personal and environmental cleanliness to prevent disease spread.
  • Demonstrate the optimal method for cleaning hands and nails.
  • Describe the effective use of various disinfectants, antiseptics, and other cleaning products.
  • Explain the role of safety in the massage therapy business.

Why Study Infection Control and Safety Practices?

Massage practitioners must have a thorough understanding of infection control principles and safety practices for several reasons:

  • Professional Requirement: To be a knowledgeable, responsible, and professional practitioner, one must understand types of infections and safety risks encountered in a massage business.
  • Health Protection: Basic understanding and adherence to cleaning and disinfecting practices safeguard both the practitioner's and the client's health.
  • Risk Reduction: Cultivating a safety-first attitude minimizes dangerous situations, reduces injury risks, and protects the health and safety of everyone involved.

Introduction to Infection Control

Infection control and safety involve protecting therapists and clients from injury or disease. Practitioners are responsible for providing a clean and safe facility, as clients expect and depend on this, and will not return to unsafe or dirty environments. Awareness and elimination of hazardous conditions prevent injuries, while infection control practices reduce or eliminate the spread of infectious agents, preventing illness.

  • Infection Control Defined: The methods used to eliminate or reduce the transmission of infectious organisms.
  • Disease Defined: An abnormal condition affecting all or part of the body, or its systems or organs, rendering the body incapable of normal function.

Legal Requirements for Infection Control

Every state mandates infection control practices to protect public health in personal service professions. The extent of required procedures varies by profession:

  • Cosmetology: Combs or brushes used on one client must be thoroughly cleansed and disinfected before reuse.
  • Esthetics (Skin Care): Products must be applied with clean applicators.
  • Massage Therapy: While implements may differ, constant impeccable cleanliness is vital. Contagious diseases and skin infections can spread via unclean hands, fingernails, equipment, and supplies. Therefore, any item (e.g., linens, apparatus, massage stones) that contacts the client, directly or indirectly, must be clean.
  • Hand Hygiene: Practitioner's hands must be cleaned before touching each client by washing with soap and warm water or using an alcohol-based hand sanitizer if soap and water are unavailable.
  • Premises Cleanliness: The facility must be clean at all times.

Understanding the Paths of Disease and Infection

Diseases can stem from various causes:

  • Genetic: Inherited predispositions.

  • Metabolic: Issues with the body's chemical processes.

  • Infectious: Caused by minute living organisms (pathogens).

  • Deficiency: Lack of essential nutrients.

  • Traumatic Event: Physical injury.

  • Congenital (kahn-JEN-uh-tul) Conditions: Present from birth.

  • Autoimmune Diseases: Occur when the body's immune system attacks its own healthy cells.

  • Pathogens: Minute living organisms capable of causing disease; disease-producing microorganisms.

Transmission of Infectious Diseases

Pathogens can be transmitted from an infected host to a new host through two primary ways:

  • Direct Transmission: Occurs when an infected host physically contacts another subject, directly transferring pathogens.

  • Indirect Transmission: Happens when a pathogen from a host is deposited on an object, or fomite, (e.g., doorknob, clothing, towel) and then later picked up by a new host.

  • Fomite Defined: An object or material capable of carrying an infection, such as a dirty countertop, clothing, dirty linens, or used hypodermic needles.

Modes of Pathogen Entry (Mode of Transmission)

For a pathogen to infect a new host, it must make contact with (contaminate) and enter the organism. Common modes of transmission include:

  • Ingestion: Consuming contaminated food or water can lead to illnesses like food poisoning, hepatitis, and typhoid.
  • Inhalation: Inhaling tiny airborne pathogens (e.g., from coughing, sneezing, talking) can cause respiratory infections affecting the upper respiratory tract or lungs.
  • Direct Contact with Mucous Membranes: Eyes, nose, and mouth membranes readily pick up infections. Sexual organ mucous membranes are sites for sexually transmitted diseases (e.g., herpes, warts, syphilis, gonorrhea, HIV) via direct contact with infected tissue or body fluids.
  • Skin Contact: Healthy intact skin is a major defense, but certain infectious agents can cause infections or exacerbate conditions (e.g., fungal infections, scabies).
  • Invasion Through Broken Skin: Cuts and wounds drastically increase the possibility of pathogenic invasion and must be cleaned, covered, and cared for to prevent infection.

In massage practice, the most common pathogens are bacteria, viruses, fungi, lice, and mites. The most frequent method of transmission is by unwashed hands.

Types of Microorganisms and Differentiation

Massage therapists must be concerned with four main types of microorganisms:

  • Bacteria
  • Viruses
  • Fungi
  • Parasites

Bacteria

  • Bacteria Defined: Minute, unicellular microorganisms exhibiting characteristics of both plants and animals. Also known as germs or microbes. They are most numerous in dirt, refuse, unclean water, and diseased tissues. Bacteria are ubiquitous, found on skin, in air, body secretions, and under nails. Hundreds of different types exist, visible only under a microscope.

Bacteria are classified as either nonpathogenic or pathogenic.

  • Nonpathogenic Bacteria: (Harmless microorganisms) These are beneficial and harmless, performing useful functions like aiding digestion. However, they can become pathogenic if transferred to an area of the body where they do not belong (e.g., colon bacteria entering the bladder).
  • Pathogenic Bacteria: (Capable of producing disease) Although less numerous, these are a greater concern as they can cause illness.

General Forms of Bacteria (Figure 8-1):

  • Cocci (KOCK-sigh): Round-shaped bacteria.
  • Bacilli (ba-SIL-eye): Rod-shaped bacteria.
  • Spirilla (spy-RIL-uh): Spiral or corkscrew-shaped bacteria.

Groupings of Bacteria (Figure 8-2):

  • Diplococci: Cocci that grow in pairs (e.g., associated with pneumonia).
  • Streptococci: Cocci that grow in chains (e.g., associated with blood poisoning).
  • Staphylococci: Cocci that grow in clusters like grapes (e.g., associated with abscesses, pustules, boils).

Pathogenic Bacteria and Associated Diseases (Figure 8-3):

  • Staphylococci (Cocci): Abscesses, Pustules, Boils.
  • Streptococci (Cocci): Blood Poisoning.
  • Diplococci (Cocci): Pneumonia.
  • Bacilli (Rod): Typhoid, Typhoid Fever, Tubercle (Tuberculosis), Tetanus (lockjaw), Diphtheria.
  • Microspira (Spirilla): Cholera.
  • Spirochaeta / Treponema pallidum (Spirilla): Syphilis.

Viruses

  • Virus Defined: A parasitic submicroscopic particle that infects and resides in cells of biological organisms. Capable of replication only by taking over the host cell's reproductive function.
  • Mechanism: Viruses thrive only within living host cells (plant, animal, human). They invade cells, control their activity to produce more viruses, often with toxic substances. The infected cell then dies, releasing new viruses to invade other cells (Figure 8-4).
  • Antigenic Property: A virus can act as an antigen (ANT-ih-jin), a foreign substance or toxin that initiates an immune response like antibody creation.
  • Resistance: Viruses can change characteristics rapidly, making viral infections difficult to treat chemically. Antibiotics are ineffective against viruses.
  • Common Viral Diseases: Common cold, smallpox, some forms of pneumonia, mumps, measles, and HIV infection.

Fungi

  • Fungi (FUN-ji) Defined: Diverse group of organisms, potentially disease-causing, that thrive in warm, moist environments, mostly found on human skin and mucous membranes. Some are parasitic, depending on their host for food. Molds and yeasts are types of fungi.
  • Treatment Difficulty: Fungal infections are often tenacious and resist treatment.
  • Common Fungal Infections: Athlete's foot, ringworm, candida, and vaginal yeast infections.

Parasites

  • Parasites Defined: Organisms that grow, feed, and shelter on or in another organism (the host) while contributing nothing to its survival. They require a host to survive and can live on or inside humans and animals. They are also found in food, on plants, and in water.
  • Parasites Affecting Humans: Ticks, fleas, and mites.
  • Head Lice (Figure 8-5): Easily transmitted from person to person. They cause itching, secondary skin irritation, and sleep loss, though generally do not carry disease.
  • Scabies (SKAY-beez): A contagious skin condition caused by the itch mite, which burrows under the skin.
  • Treatment: Contagious diseases and conditions caused by parasites require medical treatment by a doctor.

Immunity: The Body's Defense System

  • Immunity Defined: The body's natural ability to destroy and resist infection by harmful bacteria and viruses after they have entered the body. Immunity can be natural or acquired and is a sign of good health.
  • Resistance: Healthy individuals resist infection better than those with low resistance or compromised immune systems.
  • Key Defenses:
    • Healthy Intact Skin: One of the most critical defenses against pathogen invasion.
    • Fine Hairs in Nostrils, Mucous Membranes, Tears: Help defend against pathogens.
  • Inflammation: Redness and swelling indicate that white blood cells (leukocytes) are working to destroy invading microorganisms.
  • Antibodies Defined: A class of proteins the body produces in response to contact with antigens (e.g., toxins, enzymes). Antibodies inhibit or destroy harmful microorganisms and increase the body's resistance against specific antigens.

Practitioner's Role in Immunity and Infection

  • Client Precautions: Special precautions are necessary if a client shows signs or symptoms of infection; recommend medical consultation.
  • Self-Protection: Practitioners must protect their own health. Uncleaned hands can pick up bacteria from a client's skin and spread it to the practitioner or other contacts.

Maintaining Infection Control

The best defense against infectious disease spread is maintaining personal and environmental cleanliness (Figure 8-6). High infection control standards require constant supervision and adherence to health board regulations.

It is impractical to eliminate all pathogens, but infection control procedures significantly reduce infection spread. One primary method is decontamination.

  • Decontamination Defined: The removal of blood or other potentially infectious materials from an item's surface and the removal of visible debris (e.g., dust, hair, skin).

Infection Control Terminology

For massage practice, the distinction between terms is critical:

  • Clean (Cleaning) Defined: A mechanical process (scrubbing) using soap and water or detergent and water to remove all visible dirt, debris, and many disease-causing germs. Cleaning also removes invisible debris that interferes with disinfection.
    • Note: Infection control professionals prefer