Massage & Bodywork

MAY | JUNE 2016

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light switches, or—from a massage therapy perspective—unswabbed face cradles. In many ways, indirect contact is a more potent mechanism for disease transmission than direct contact, because it can be much more difficult to control. In some cases, humans can be the vectors that transfer pathogens by way of indirect contact. Think of a parent whose toddler has impetigo: this is a very common, very contagious bacterial skin infection. When this person takes a break from caring for a fussy child and comes in for a massage with unwashed hands, the practitioner may unknowingly be exposed to this infection, or the client could leave some potent bacteria on the doorknob for the next client to pick up. Other conditions that may spread through indirect contact include conjunctivitis (pinkeye), herpes simplex, hepatitis A and B, and many others. TRANSMISSION INTERRUPTED Pathogenic bacteria are good at finding ways to be transmitted from one person to another. As keepers of a safe environment, it is our job to create barriers to that transmission. This all begins with proper hand hygiene. Countless resources exist to explain what good hand hygiene looks like, but in a nutshell, it is this: warm running water with plain soap for 30 seconds, with manual friction that addresses all surfaces of the hand, including between the fingers, the cuticles, and under the nails. This is followed by thorough drying with a clean, single-use towel. And this happens before and after every skin-to-skin interaction. If this is not practical, an alternative is the use of an alcohol-based hand gel, using a palmful of gel, and manual friction that mimics handwashing until all the gel has evaporated. This reduces the number of active bacteria on the hands, but it will not necessarily remove the 42 m a s s a g e & b o d y w o r k m a y / j u n e 2 0 1 6 Resources Fuller, C. et al. "'The Dirty Hand in the Latex Glove': A Study of Hand Hygiene Compliance When Gloves are Worn." Infection Control and Hospital Epidemiology 32, no. 12 (December 2011): 1,194–99. Machalek, A., and A. MacLachlan. "Armpits, Belly Buttons & Chronic Wounds: The ABCs of Body Bacteria." Accessed March 2016. microbiome-nigms.html. Occupational Safety & Health Administration. "Bloodborne Pathogens." Accessed March 2016. table=STANDARDS&p_id=10051. World Health Organization. "Hand Hygiene: Why, How & When?" Accessed March 2016. dirt, so it is not a complete substitute for washing with soap and water. Obviously, nail and cuticle care is critical for massage therapists. These are potential vulnerabilities, as even short nails can harbor bacterial colonies, and minor hangnails can become delicious portals of entry for hungry bacteria. These hygiene practices should be completely ingrained in every massage therapist. Sadly, we probably have all seen circumstances in which these protocols are not followed carefully. For a quick review of what not to do in hygienic practices, take a look at "Hygiene Fact and Fiction" (Massage & Bodywork, May/June 2012, page 36). BUILDING A BARRIER When a weak point is obvious— maybe because the practitioner has a scraped knuckle, or the client has a large abrasion, it is necessary to put a physical barrier between the two surfaces so that the massage can occur. That physical barrier can take several forms, but the most common options include local bandages, liquid bandages, finger cots, and gloves. We will look at advantages and disadvantages of each. • Bandages: From gauze-and-tape from a first-aid kit to store-bought Band-Aids, these devices cover open wounds with the purpose of reducing the risk of infection and stopping bleeding. They can be effective, but in a massage setting, they are easily dislodged and the vulnerable area may become contaminated. As a mechanism to protect any area that might be contacted during a massage session, they are not appropriate. • Liquid bandages: This is typically a chemical that is applied to a dry wound (not a fresh, bleeding one). The chemical creates a barrier and holds the edges of the wound together. Liquid bandages are not impermeable, and the use of oils or lotions may dissolve the chemical seal. They can be safe for wounds that are not part of skin-to-skin contact during massage, but they are not effective barriers to direct contact. • Finger cots: These are single-use individual sheaths that cover single fingers. The most easily available finger cots are made of latex, but vinyl or nitrile finger cots may be purchased through medical suppliers. Finger cots can be effective protection for hangnails and scraped knuckles—the bane of massage therapists everywhere— but if they don't fit well they can be uncomfortable, or they can easily slip off, leaving the lesion uncovered.

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