Key Point

• Standard Precautions have changed over the years as agencies have attempted to limit exposure to pathogens.

In massage therapy education and practice, we often throw around the term Standard Precautions like it means the same thing to all people. That turns out not to be true: Recommendations vary according to setting and risks, and no single list of rules or recommendations for massage therapy has ever been published by a government agency. 

A Little History

In 1985, the HIV/AIDS epidemic had already established a strong foothold in the US. At this time, US health agencies finally began to acknowledge that the infection was a real problem—specifically for health-care providers who were at risk for accidental exposure to the infection through needle sticks. This prompted the development of the first stringent and widely applied infection-control protocols for blood-borne pathogens. These were called Universal Precautions, and they were built mainly around trying to prevent the spread of HIV in health-care settings. It was quickly found that these recommendations were inadequate, so in 1987 the idea of Body Substance Isolation was introduced. The purpose of this guidance was to “avoid direct physical contact with all moist and potentially infectious body substances, even if blood is not visible.”¹ Again, the focus was on blood-borne pathogens, especially HIV and varieties of hepatitis viruses, although the use of masks against airborne infections for nurses was also introduced at this time.

Between 1987 and 1996, we learned much more about HIV, and hepatitis, along with the transmission mechanisms of other infections, and the Healthcare Infection Control Practices Advisory Committee put out the first version of what we now call Standard Precautions. In its early days, the emphasis remained on limiting exposure to blood. The Occupational Safety and Health Administration (OSHA), a branch of the US Department of Labor, filled in some details of Standard Precautions with their identification of “other potentially infectious materials,” or OPIM. According to OSHA, OPIMs include:

• semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, amniotic fluid, saliva during dental procedures, and fluid visibly contaminated with blood, any fluid for which it is difficult to determine

• unfixed tissue or organ (outside of intact skin)

• HIV-containing tissue cultures or other solutions from humans or animals infected with HIV or HBV 

Interestingly, OPIMs don’t include tears, sweat, saliva (unless it is blood-tinged), nasal secretions, vomit, feces, or urine.

Standard Precautions Today

The main emphasis in Standard Precautions is still blood-borne infections. However, as we have learned more about disease transmission, the Centers for Disease Control and Prevention (CDC) and other agencies have added protocols to limit direct, indirect, and airborne exposures to pathogens. 

The same precautions are not listed for all situations, though; recommendations vary according to settings. The rules for dealing with a hospital patient under isolation for a dangerous and contagious disease are different from those for patients at a walk-in outpatient clinic. This flexibility is practical, given that health care is practiced in many different settings. But it has also given rise to some confusion about best practices for various health-care professions. 

To date, no specific protocols have been published by any governing body for massage therapists or massage therapy schools. This makes sense because massage is practiced in so many different settings and with many different types of clients. While some hygienic practices should be followed in every setting every time (e.g., changing sheets, washing hands, etc.), other details may vary depending on whether the massage session is offered in a hospital, outpatient clinic, spa, or home office. I suggest visiting the Standard Precautions page on the CDC website, specifically the sections on hand hygiene, PPE, respiratory and cough etiquette, equipment and devices, environmental surfaces, and textiles and laundry for the information most relevant to massage therapy practice. 

Beyond Standard Precautions for Massage Therapists

In addition to these Standard Precautions, I have three suggestions. 

Hand Cleaning Stations

I recommend the institution of hand cleaning stations in massage therapy sessions for clients and other staff—not for massage therapists, who must use warm running water and antimicrobial liquid soap.

Foot-Operated Trash Cans

These allow contaminated tissues and other debris to be discarded easily and separated from the rest of the environment. 

Air Quality Maintenance

Given what we learned about COVID-19 and other airborne infections, massage therapists should invest in air purifiers that are the right size and power for their workspace. This not only reduces the risk of infection, but it also lessens the impact of allergens, smoke, perfume, or other air contaminants. Air quality control has not yet appeared as a part of Standard Precautions for most health-care settings, but this is one place we can raise the bar for ourselves, our clients, and our profession. 

Note

1. Ian M. Broussard and Chad I. Kahwaji, Universal Precautions (Treasure Island, Florida: StatPearls Publishing, 2024), www.ncbi.nlm.nih.gov/books/NBK470223.

Find Out More 

Douedi, S. and H. Douedi. Precautions, Bloodborne, Contact, and Droplet. Treasure Island, Florida: StatPearls Publishing, September 4, 2023. www.ncbi.nlm.nih.gov/books/NBK551555.  

Centers for Disease Control and Prevention. “Standard Precautions for All Patient Care.” Last modified January 26, 2016. www.cdc.gov/infectioncontrol/basics/standard-precautions.html.  

Segal, Phenelle. “The Evolution of Isolation Precautions.” March 19, 2018. www.infectioncontroltoday.com/view/evolution-isolation-precautions.  

US Department of Labor. Occupational Safety and Health Administration. “Bloodborne Pathogens.” Accessed January 22, 2024. www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.1030.