Distance Education -> Prevention of Medical Errors for the Massage Therapist -> Chapter: 07

Implementation of Universal Precautions

“Universal precautions,” as defined by CDC, are a set of precautions designed to prevent transmission of human immunodeficiency virus (HIV), hepatitis B virus (HBV), and other blood borne pathogens when providing first aid or health care. Under universal precautions, blood and certain body fluids are considered potentially infectious for HIV, HBV and other blood borne pathogens. Universal precautions were developed initially to prevent the spread of these potentially infectious pathogens. The massage professional should maintain the sanitation guidelines as stated in chapter 7 of this document. They must also consider the nature of our work, and have concern for the spread of all types of disease. Universal precautions should be implemented for the protection of the client as well as the massage professional.

Universal precautions apply to blood, other body fluids containing visible blood, semen, and vaginal secretions. Contact with other body secretions such as feces, nasal secretions, sputum, sweat, tears, urine, and vomitus, should be avoided especially if they contain visible blood.

Universal Precautions

        1.        The use of protective barriers such as gloves, gowns, aprons, masks, or protective eyewear. The protective barriers reduce the                     risk of exposure of the health care worker's skin or mucous membranes to potentially infective materials.
        2.        Precautions to prevent injuries caused by needles, scalpels, and other sharp instruments or devices.
        3.        A 10% bleach solution (one part bleach to nine parts water) should be used to clean up spills of body fluids. Stronger bleach                        solutions should be used if excessive amounts of blood or other substances are present.
        4.        Linens should be rolled away from you and double bagged in plastic, separately from other soiled linens. The outside bag                            should be labeled, “contaminated with body fluids.” Universal precautions must be present when working with clients who are more susceptible to infection.  This includes client or patients that may be infected with a blood borne pathogen like HIV or HBV or other contagious conditions, as well as conditions that cause immune suppression, including excessive stress.

A medical error would occur if a client and/or therapist were inadvertently exposed to a blood borne or other contagious pathogen as a result of universal precautions not being implemented. The best recommendation for massage therapy and bodywork professional is to make universal precautions a permanent part of their practice. For the massage and bodywork professional, this includes:

1.    The use of gloves. Gloves should be used if the skin of a client or massage therapist has a rash, cut abrasion, infection or any other condition that would allow for the transmission of body fluids. In some instances, a regional contraindication may apply. If no skin conditions were present gloves would not be necessary.

2.    The use of a mask. A mask may be necessary if transmission of an airborne pathogen, like the flu virus is a concern. A mask worn by a therapist can also protect the client from the therapist's airborne pathogens, if the client has any form of immune suppression. The immune suppression makes the client more susceptible to infection.

3.    Hand washing. Proper hand washing may be the single most effective deterrent to the transmission of disease. The massage and bodywork professional must wash their hands before and after each massage. This would also include after blowing their nose, coughing into their hands, and using the toilet. Hands should be washed in hot water, preferably with an anti-bacterial soap, starting from forearms to hands always holding hands down so as not to re-infect, then dried the same way (from forearms to hands) with a clean disposable paper towel. The towel should be used to turn off the water at the faucet.

4.    Sanitation of the environment. Equipment that is used within the context of the massage session should also be cleaned before and after the massage session. This includes the door handles of the massage room, the lotion/oil bottle, the bottle holster if one is used, Hydrocollator units, hot/cold packs, and any other equipment that the therapist or the client comes into direct contact with. In other words, anything that may assist in the spread of a contagion from one client to another, or between client and therapist.

PRACTICE QUESTIONS FOR CHAPTERS 7.

1. Which choice should be used to clean up spills of body fluids?

             a. Soap and water
             b. Hot water
             c. At least a 10% bleach solution.

2. Which choice may be necessary to prevent the transmission of an airborne pathogen?
   
            a. Gloves
            b. Mask
            c. Hand washing

3. Which choice may be necessary to prevent the transmission of body fluids when a rash, cut or abrasion is present?

            a. Gloves
            b. Mask
            c. Hand washing

15    Internet Citation: Universal Precautions for Prevention of Transmission of HIV and Other Blood borne Infections , CDC Division of                 Healthcare Quality Promotion, www.cdc.gov , 1987