Circle No: 59 "Antisepsis in Touch Therapy"

Massage therapists, PTs, OTs, Visceral Mobilization, lymphatic work, craniosacral work includes lots of skin-on-skin touch techniques. In the age of COVID-19 and the influenza season here are some precautions:

1. Reschedule or refer to doctor a client who presents with fever, persistent cough, sinus drainage or other obvious signs of communicable infection. When scheduling new patients, ask how they are feeling, refer if appropriate, (sick).
2. Wash your hands (lots) before and after each patient/client, meals, bathroom breaks before using office computer or devices. Handwashings are scrubs, front and back of hands, around finger nails and past the middle of the forearm. Wash hands first thing coming to work, last thing leaving work.
3. Wear short sleeve tops, shirts so you can wash (scrub) to the mid forearm before and after sessions. Change tops daily.
4. Once in session do not touch your own face, eyes, ears, hair or clothing.
5. Use masks if coughing begins for you or your client. Masks help keep germs in and other germs out. Use gloves as needed for all mouth work, with infants, and any time when deemed appropriate (skin lesions, rashes, hygiene issues, questionable illness assessments). Never reuse gloves. Don't put used gloves in your pocket. Remove gloves inside out, and throw away immediately.
6. In session, move away from a pending cough or sneeze if you can. Encourage the client to turn toward their elbow if possible. AND REMEMBER; you can stop a session if coughing ensues or if either you or your client become uncomfortable or have concern.
7. Use single-use washable linens, pillow cases and towel covers for plinths, treatment tables, massage chairs and especially head and face cradles.
8. Alcohol or sanitizer wipe tables, chair arms, door knobs, head rests, face cradles as well as hand-held exercise equipment, weights, canes, crutches and walkers. Wipe your cell phone with a baby wipe at least three times a day. Also wipe your file draw handles, counter tops, stapler, land phone (if you still have one) and the pen you use to do notes. Also periodically do bathroom door, railings, sink and toilet handles. Keep clean any surface in your clinic where hands go.
9. Have everyone in your home use a wipe on their hands before they come in. Wash clothes often. Give the kids a small hand sanitizer for school and drill them in how to use it.  Keep anyone who is sick at home. Contact doctor if conditions worsen, especially if fever, headache and breathing difficulties increase to concern levels.
10. Use hand sanitizer lotion with grocery carts, public handles, gas pumps, card swipe buttons, open doors with your elbow when possible. Use less cash. 

So if it seems like a lot, it is. But I remember MERS, SARS, HIV, West Nile, Zika. We will manage and make it through this. Remember, most people just get sick, some don't even know they are sick. Elderly with pre-existing conditions seem to be the most severely affected. Our job is to not spread it to those coming to us for therapy. Many are elderly and therefore need the extra precautions you see here. Sanitizing agents include but are not limited to; baby wipes, commercial sanitizing lotion, isopropyl alcohol wipes, or alcohol applied to Kleenex, solution of bleach and water (one teaspoon to 16 ounces of water)* applied to paper towel or Kleenex. Avoid eyes with all wipes, flush with straight water if irritated or itchy. If you are sick, remember the value of water -- stay hydrated and stay home. Water makes up more than 90 percent of blood, CSF, and lymph. To consider the importance of water, where would soap be without it??

Finally, remain compassionate. Don't avoid touch, but do it in a way that is kind and caring, safe and healing, while ethically reducing the chance of spreading communicable disease to you, your patients or your community. In a society where touch is often inhibited we must continue our caring touch, but in public we must be extra safe in times of community infections. We can and should lead by example as we move CST forward in a world that is in need of CST now more than ever. Stay kind, stay smart, stay strong. Please share far and wide to fellow colleagues, friends and family.

Don Ash, PT, CSTA-CP

* Statistics from the New Hampshire Department of Health and Human Services:

The sanitation range of bleach/water ratio solutions is 50 to 200 parts per million.

This means:
one teaspoon bleach per pint (16 oz.) water or 5 ml. bleach per 500 ml. water
1 - 2 tablespoons bleach per gallon (128 oz.) or 15 ml. - 30 ml. bleach per 3785 ml. water