It is impossible to know if a client who walks through the door of your business is infected with a pathogen. Similarly, you may be infected and not know it. Because pathogens that cause serious illness are all around us, good sanitation and hygiene practices are required at all times to prevent the spread of disease. These practices include therapist hygiene and the use of standard (universal) precautions. 

Cleanliness of Body and Hair 

Shower daily and wash your hair on workdays. Avoid the use of scented aftershaves, antiperspirants, body care products, colognes, and perfumes because these may cause sensitivity or allergies in some clients. Hair can act as a reservoir for pathogens like Staphylococcus aureus, and must be tied back so it does not touch the client during massage. Men should shave before each work shift or keep facial hair neatly trimmed. If you touch your own hair during a session, including facial hair, you must sanitize your hands before touching the client. 

Keep your nails short, natural, and filed to a smooth edge. Long nails, nail polish, and artificial nails are breeding grounds for pathogens and may scratch a client; they are best avoided. Brush and floss your teeth before the shift and directly after eating food during breaks in the day. Because therapists and clients come into close contact during massage, it is a good idea to rinse your mouth with mouthwash before each new client. 

Therapists who perspire heavily while giving massage can wear sweatbands on the forehead and wrist to prevent droplets of perspiration from falling onto the client. A clean towel can be used to absorb perspiration throughout the massage if necessary. 

Clean and Appropriate Clothing 

Launder your work uniform or clothing at the end of each working day. Short sleeves are better for massage, because long sleeves may touch the client’s skin, become contaminated, and contaminate the next client. While many therapists like to work barefoot, this is not advised. Your feet may harbor an undetected fungal infection that can be spread to an unknowing client getting on and off the massage table. For clients with suppressed immunity, this may cause serious complications. Remove jewelry, including rings, wristwatches, bracelets, and necklaces, as these items contain small crevices and sharp edges that can harbor bacteria or potentially scratch a client. Small earrings that will not touch the client are fine. 

Proper Hand Washing 

Proper sanitation of the hands is probably the single most important part of the sanitation protocol for therapists. You want to clean your nails carefully and use foaming liquid soap to thoroughly wash your hands up to your elbows. An alcohol-based hand rub is recommended for decontaminating the hands before massage, before or after certain treatment steps, and at the end of a massage. Nonalcohol-based hand rubs have not been adequately evaluated by the US Centers for Disease Control and Prevention (CDC) and are therefore not recommended. 

Decontaminate your hands with an alcohol rub before moving from a potentially contaminated body area (such as the feet) to a clean body area (such as the face) during massage. Do the same when moving from contact with an unsanitized inanimate object (e.g., a product container) to the client. 

Implementation of Standard Precautions 

Standard precautions is the term for the CDC policy on blood and body fluids. You should practice standard precautions if a client has broken skin, if you have cuts or hangnails on your hands, or if you are exposed to a client’s body fluids. 

The purpose of standard precautions is to ensure that health-care workers protect themselves from blood-borne diseases transmitted through broken skin, mucus membranes, or contact with blood and body fluid. Massage therapists rarely make contact with clients’ body fluids in practice, but in some situations a therapist may be exposed and therefore be at risk for infection. 

Standard precautions are an approach to infection control in which all blood and body fluids are treated as if infected with HIV, hepatitis, or another blood-borne pathogen. Important components of the policy include: 

• Correctly using gloves.

• Properly cleaning linen soiled with blood or body fluids.

• Properly cleaning surfaces contaminated with blood or body fluids.

Because new information about communicable diseases is issued often, keep up to date about the most recent standards and guidelines issued by the CDC at www.cdc.gov. 

Anne Williams is the director of education for Associated Bodywork & Massage Professionals and author of Massage Mastery: from Student to Professional (Lippincott Williams & Wilkins, 2012), from which this article was adapted, and Spa Bodywork: A Guide to Massage Therapists (Lippincott Williams & Wilkins, 2006). She can be reached at anne@abmp.com.

Not Feeling Well?

A therapist who is ill or may have a contagious infection must protect clients by rescheduling all massage appointments. The common cold is caused by a large number of different viruses and is easily transmitted through the air or by direct contact. In general, the viruses that cause colds incubate in the body for 12 hours to five days and then become contagious 23 hours before the onset of symptoms. The person remains contagious for about five days after the onset of symptoms.

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