Use of Personal Protective Equipment (PPE) for Massage Therapists

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By Karrie Osborn

The use of personal protective equipment (PPE) will be central to moving forward and reopening your practice when the time comes. There is currently a shortage of PPE, with most supplies being redirected—rightly so—to frontline workers and health assistance staff (nursing homes, home health aides, etc.) who are still operating without the proper supply of equipment they need to work safely. ABMP believes it’s professionally unethical to divert supplies from this delicate supply chain for non-emergency equipment requests at this time. Consider other options for face coverings for you and your clients in the interim.

Following is more information about PPE from the Centers for Disease Control and Prevention (CDC). For ABMP's full overview of guidelines and considerations, go to www.abmp.com/back-to-practice.

Facial Protection

There are three types of facial protection, as defined by the CDC:

1. Cloth face covering. “Textile (cloth) covers that are intended to keep the person wearing one from spreading respiratory secretions when talking, sneezing, or coughing. They are not PPE, and it is uncertain whether cloth face coverings protect the wearer.”

2. Face mask. “Face masks are PPE and are often referred to as surgical masks or procedure masks. Use face masks according to product labeling and local, state, and federal requirements. FDA-cleared surgical masks are designed to protect against splashes and sprays and are prioritized for use when such exposures are anticipated, including surgical procedures.”

3. Respirator. “A respirator is a personal protective device that is worn on the face, covers at least the nose and mouth, and is used to reduce the wearer’s risk of inhaling hazardous airborne particles (including dust particles and infectious agents), gases, or vapors. Respirators are certified by the CDC/National Institute for Occupational Safety and Health, including those intended for use in health care.”

• The much-talked-about N95 face mask is in this category and is necessary, and currently scarce, equipment for those treating COVID-19 patients in medical settings.

• In a massage or bodywork setting, if a client is asymptomatic but unknowingly has COVID-19, then wearing an N95 face mask should protect a therapist. However, N95 masks are not available to the general public at this time.

Gloves

Nonsterile, disposable gloves, which are used for routine patient care in health-care settings, are appropriate for use in your facility. Gloves can be used to make taking payments safer for clients and practitioners. You might also consider using them during sanitation protocols and if administering any facial work during your sessions with clients.

Gowns

Disposable gowns are used to protect health-care providers when working with patients in isolation, when delivering aerosol-generating procedures, and when delivering high-contact patient care activities like dressing, bathing, or transferring patients.

For hands-on modalities, having a standard uniform top, or scrub-like attire that can be changed between clients is a logical approach while working with clients during this time.

Eye Protection

For health-care providers, this category would include goggles and face shields. According to the CDC, “Personal eyeglasses and contact lenses are NOT considered adequate eye protection.” If using eye protection in a massage or bodywork setting, remove the goggles before leaving the client room or care area. According to the CDC, “Reusable eye protection (e.g., goggles) must be cleaned and disinfected according to manufacturer’s reprocessing instructions prior to re-use. Disposable eye protection should be discarded after use unless following protocols for extended use or reuse.”

“Donning and Doffing” of PPE

The value of wearing PPE is only as good as the protocols and quality control around putting it on and taking it off. The CDC offers very regimented guidance on these procedures. Following are some aspects of those protocols to be aware of:

• Per the CDC, a reusable cloth mask should be washed after each wearing, whether that’s per client or per day. Have several cloth masks available for use throughout the day for yourself and clients.

• Once your face covering or face mask is on, don’t touch it. According to the CDC, if you must touch or adjust your cloth face covering, you should perform hand hygiene immediately before and after.

• When you take off your mask, fold it in half to contain the inner secretions and deposit it into the lidded laundry bin, if you aren’t able to wash it immediately. These can be washed and dried with other laundry.

• Protocols for reusing single-use surgical masks are crisis-based; health-care workers are storing their masks in paper bags and then reusing them. Conserve any PPE you might have stored in your practice and reuse until supply chains return to normal. This advice from the Food and Drug Administration (FDA) gives governance on PPE conservation strategies.

Additional PPE Information

• Here are CDC guidelines for cleaning PPE

Here is your risk, with and without wearing PPE: It is important to understand the risks you are taking, even when wearing PPE. The CDC offers this risk assessment with various PPE scenarios, and assuming that health-care personnel are working with COVID-19 patients.

• PPE for employees: Guidelines from the Occupational Safety and Health Administration state that employers are obligated to provide their workers with PPE needed to keep them safe while performing their jobs. Find the document here.

Here is information from the CDC on how to make a mask.

This is information you can share with clients regarding the use of homemade masks and directions on how to easily make your own. Make sure homemade face masks cover both your nose and mouth in alignment with updated CDC guidelines.

For more information, visit the CDC at www.cdc.gov/coronavirus/2019-nCoV/index.html.

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Comments

I like how the information gave me how to make the mask and additional information by just clicking on the highlight give a lot more details

The mask and gloves I can understand, the way I massage they eyewear and the surgical dress would get in the way. I wear glasses and I wear short sleeves when I massage

I have read reports that state the COVID-19 virus may have circulated though heating and A/C ducts. If this is so wouldn't some extra filtering be necessary for individual treatment rooms?

I ordered an air purifier for my small treatment room. I also plan on trying to buy a far UV-c sanitizing unit. I just hope I can afford it. The hospital grade ones are thousands of dollars.

Thank you, excellent article.

One thing that isn't really clear from the article: Cloth masks are inferior protection. They don't protect the wearer, but may prevent the spread to others, per the CDC. The reason they are being promoted is that real PPE masks, like the N95 ones, are very scarce right now. For protection of BOTH the client and practitioner, it is essential that both people wear masks if they are cloth.

I recently purchased a hand held forehead thermometer for future use.

At some point when larger events (stage 4) in California becomes a reality, we massage therapists (stage 3).

The guidelines are very helpful. Because I purchased my N95 masks back in February, it is also good to know the cleaning protocol on cloth N95 masks.

Will I need to wear disposable gloves for all massages?

I've been wrestling with this question myself. I've already seen 2 clients without gloves.

My past experience includes hospital massage. We used gloves when infection precautions were in effect for a patient, either due to compromised immunity or the contagious infection they had. With compromised immune function, the gloves are another layer of protection for a fragile patient. With contagion, they're protection for the therapist as well as protection against spreading the contagion outside of the patient's room--community protection.

I'm not sure why, in my home practice which is currently limited to a very small circle of known and trusted clients, gloves are better than the meticulous hand-washing + both of us masked protocol. Hands and arms are scrbbed up to the elbow immediately before and immediately after the session.  The danger is in getting the SARS-CoV-2 into the respiratory tract. Any hand to therapist's face, gloved or not, is dangerous.

I do understand using gloves while setting up to keep the environment as clean as possible for the client.  And for taking payment under some conditions.

Some in our profession are advocating gloved massage period. I can see how it could protect the therapist a bit more, but I'm not convinced it's necessary. Gloves alter the massage, so I want to wear them only when necessary.  

Is there something I'm missing?  If so, please explain.

I too am confused on the glove thing. I work for a chiropractor and he has never came to me and told me to wear them, so I have not been. However, the other massage therapist who works there INSISTS i wear them. I wash my hands between every massage along with all other safety protocols. My clients/patients feel it would make the massage awkward and weird, thus not helping with their healing. 

It's my understanding that when we take off a mask after contact with others that could include spread of contagion, the OUTSIDE of the mask is considered contaminated.  You, the wearer, have been literally drawing outside air through it and hopefully catching some contagion in the fabric. Therefore, when it's time to take it off, handling from the ear elastics you fold the outside of the mask onto itself. Then put it in the laundry and wash your hands.  The inner side that has contact with your breath would be contaminated to another person, but not to you.  You, the breather, are not too worried about touching the inside of your own mask--when you're taking it off.

In my opinion, best practice is a fresh mask for every client.  Ditto clean clothing or scrubs.

I was hoping you would help provide us with a general letter or statement for our clients about washing and keeping us safe.

This is a global issue - I hoped I wouldn't have to make this all myself. I can edit it for my own needs, but as our organization why haven't you helped us by having a protocol for clients.

Hi Jodi,

In our extensive Back to Practice resources at https://www.abmp.com/back-to-practice, we have client and practitioner protocols for pre-session, in-session, and post-session. I hope you find them useful!

I finally found "back to practice" information.

This was not readily available and not in the initial COVID information.  Please make this easier to find by adding it to your Back to Practice Statement. Thank you 

Im a massage therapist at ME in NJ,  They are planning to reopen and the protocol is clients have a choice on whether or not to wear a face mask. Massaging in a face mask is challenging enough, I did a test run at home and had to move my mask up and down to breath.  I feel that clients in supine should wear face mask.  Is this a incorrect. Can a spa decide whether or not a client wear a mask.

Just read from Consumer Affairs/Law, Public Safety it's not an option.. clients are to wear face masks on massage table.. they can remove while prone, but definitely supine ia mandatory

Mr. Rodriguez, NJ Div. Consumer Affairs/Law and Public Safety outlines face masks for employees and CLIENTS  in #4 of the declaration

Hello, I've been a member of ABMP for some years as an Alexander Technique teacher.  I wanted to let people who need surgical masks know that I have them available through my baby cloth diaper company.  www.coquibaby.com  They are 59 cents each and are sold in packs of 50.  We are listed on Dun and Bradstreet under Ennvo Inc.  If you need a discount, let me know.  I can work with you.  We source from our manufacturers in China which we have worked with since 2012.

Hello, I've been a member of ABMP for some years as an Alexander Technique teacher.  I wanted to let people who need surgical masks know that I have them available through my baby cloth diaper company.  www.coquibaby.com  They are 59 cents each and are sold in packs of 50.  We are listed on Dun and Bradstreet under Ennvo Inc.  If you need a discount, let me know.  I can work with you.  We source from our manufacturers in China which we have worked with since 2012.

I too wish they had a readily available tab for us to use or a link for updating our websites. Unfortunately we are left to read through multiple pages and links. Which don't get me wrong the forms are helpful, but some sort of 'what to expect' or 'guidelines for clients' would of been quite the time saver for us. I am going to refer to my county's guidelines to see if that saves me some time.