How Massage Facilities can Elevate their Disinfection Protocols - Massage Magazine

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Enjoy the Webinar on How Massage Facilities can Elevate their Disinfection Protocols for the Fight Against Infection.



Webinar Transcription


Karen: Hi, everyone, and welcome to this webinar from Virox Technologies, makers of Rejuvenate disinfectant. So you’re going to learn how massage facilities can elevate their disinfection protocols for the fight against infection. Our presenter today is Matt Buccioni. Matt serves as the infection prevention and biosecurity specialist at Virox. In this role, he is involved with providing education and technical support to a wide range of industries on preventing infections through cleaning and disinfection. So please feel free to add your questions on the Q&A tab on your screen, and please make sure to check the chat screen before you leave for a link to a special offer for a disinfection kit. Welcome, Matt.

Matt: Thank you so much, Karen, for the introduction. And thanks to all of you for joining in today. So as Karen mentioned, my name is Matt Buccioni, infection prevention specialist with Virox ProBeauty. And today I’m going to be talking about, really, how massage practices can take their disinfection protocol to the next level for the ongoing fight against infection. So I want to start by asking whether or not you’re currently using a disinfectant in your practice. And if you are, I’m really hoping that you’ll think about how some of the points that we talk about today apply to whatever it is the product that you’re using in your practice. And if you happen to have the product nearby and you want to grab it and follow along as we’re going through, by all means, you’re more than welcome to do so. But even if you don’t, I’m hoping that you’ll kind of next time you’re using your product or you’re disinfecting throughout your practice, that you’ll think a little bit about some of the points that we go over today. So what we’re going to talk about today is we’re going to start really, with the so what? You know, why should we care about disinfection? Why is disinfection so important in massage therapy? And then we’re going to break down disinfection into three main steps. So the first step is making a plan, and then really how to choose the right disinfectant for your practice, and then really tying it all together by how to apply that disinfectant in a way to get the best results.

So when we think about things like seasonal cold and flu, folliculitis, athlete’s foot, COVID-19, you know, these conditions are all quite different, and there’s not really a whole lot that they all have in common. But there’s one common thread, one important thread that really ties all these things together. And that’s that these are all examples of infections that are caused by pathogens. So, you know, definitely, COVID-19 has really been getting all the spotlight over the past year and a half and certainly, has been dominating the headlines whenever we think about infection. But, you know, as we know, COVID is definitely not the only infection that we’re concerned about in our day-to-day lives, particularly in massage practices. And, in fact, we’re really battling this invisible army of pathogens all the time. And so we’ll get into what these different types of pathogens are. So the first major category are viruses. And these, you know, examples that you might be familiar with include, influenza, things like norovirus, coronavirus, not only the COVID-19 coronavirus, but also various other coronaviruses that are circulating all the time. And things like Hepatitis B and C as well. And the different types of infections you might be familiar with include, of course, seasonal cold and flu, which probably a lot of us have a personal experience with at some point or another. But also, potentially more serious infections like blood-borne infections that we could get from Hepatitis B and C, or even HIV is another example of a blood-borne virus. So the next major group of pathogens are bacteria. And, you know, you may have heard of outbreaks of food-borne disease caused by things like E. coli, salmonella, and food recalls as a result of that. So those are examples of types of bacteria that can make us sick. But bacteria are also relevant to massage practices as well. And one type that you might be familiar with, in particular, are staphylococcus, and we know that this type of bacteria can cause various infections. So folliculitis, hair follicle infection is one particular example. And also infections like MRSA, which we know can really be quite serious. And then our last group or our last major group of pathogens that we’re going to talk about are fungi. And, you know, fungi are a little bit different because they’re not necessarily things that we even normally think of as being pathogens because fungi even would include mushrooms that we can eat and stuff like that. But there are definitely certain types of fungi that are capable of causing infection and causing disease in people.

And one common example of that is trichophyton. So if you ever hear about athlete’s foot or various skin infections, trichophyton quite often is going to be the culprit for that. So now that we’ve talked a little bit about what are those different types of pathogens that are out there that we might need to be concerned about in massage facilities, let’s talk a little bit about how they’re actually getting around. How are they actually spreading from one person to the next? And there’s a few ways for this to happen. So the one major way is through airborne and droplet transmission. So we know that when we cough and sneeze, we can actually put out these infectious particles out into the air, that can then be inhaled directly by other people. And certainly, you know, during COVID, we’ve heard a lot about this. A lot about these droplets and the need to, you know, stay physically distanced, wear face coverings really to prevent that type of transmission. But another main way that they can be spread is through our hands. So, you know, if we’re touching somebody or if you’re touching a client directly, potentially, and then contacting somebody else, our hands can be a major source of the spread of pathogens, as well.

Now, all these things that we talked about, so airborne transmission, droplets, and our hands, although they can transmit germs to other people directly, they’re also capable of depositing these pathogens onto surfaces. And once those pathogens are on surfaces, they can then be picked up by somebody else and that can lead to the spread of infection. And when we talk about surfaces that can transmit infection, these surfaces are what we call fomites. So anytime we talk about fomites, what we’re really talking about is a surface that’s capable of transmitting pathogens from one person to the next. So where does disinfection come in to all of this? And it really goes back to what we’re just talking about, about fomite transmission. So disinfection is what we’re doing when we want to kill pathogens, including bacteria, viruses, and fungi on surfaces. And I really want to make this important distinction, that disinfecting is not the same thing as sanitizing. You’ll often hear people talk about disinfecting and sanitizing almost interchangeably, but the terms really actually mean something quite different. So when we talk about sanitizing, we’re talking about reducing the amount of bacteria on a surface to a safe level, to a level that’s considered safe. And the real difference here is that we’re not dealing with other types of pathogens like viruses or fungi. And we’re not getting as big, as high a level of kill than we would with disinfection. So sanitizing might be appropriate for some types of environments like food service settings, but for massage therapy, for massage practices, we really want to be focusing on routine disinfection to prevent infections. Because we don’t only care about reducing bacteria, we want to make sure that we’re also being able to kill viruses and fungi on surfaces.

So the first step in building out our protocols is making a plan. So we talked about, you know, the potential for fomites to transmit infection in massage practice, but what are those fomites that you might be dealing with on a daily basis? And so we can think about these in a couple of different categories. The first one are those surfaces that are going to be used for client appointments on a regular basis. So thinking about things like massage tables, face cradles, tools that are used during client appointments, like cups, stones, rollers, things of that nature, you know, warmers, and work surfaces that you may be touching on a regular basis throughout appointments. And then the other type of surfaces are those other high touch surfaces in the area, whether we’re dealing with door handles, or if you work in a facility that uses point of sale equipment like debit PIN pads, things like that, that are being touched by clients multiple times throughout the day. Those are all surfaces that could be examples of fomites within massage practices. So once you have that list established, of those potential surfaces that are going to need to be disinfected, the next step is figuring out the frequency of disinfection that you’re going to need.

And this really depends on the risk level of the surface for infection. So we can think about our high-risk surfaces, these are going to be surfaces like the ones that we talked about, that are being touched frequently throughout the day. So those client contact surfaces or appointment surfaces, other high touch surfaces throughout the facility. And so those might need to be disinfected more frequently. So for example, face cradles, if you’re using them for every client appointment, they may be disinfected after each appointment. Whereas, you know, things like flooring, storage areas that just aren’t seeing that much traffic, that really aren’t being touched a whole lot, are going to be lower risk for infection and may only be disinfected every once in a while rather than more frequently. And so really it comes down to, you know, there is no one-size-fits-all for disinfection protocols, it’s really about making a plan that works for your practice, whatever that might look like. And if you’re working with a team of people and you’re based in a facility, you know, making sure that you’re assigning roles and responsibilities, and really making sure that everybody knows what they’re responsible for and making the protocols a success.

So once you have that, that list of surfaces and frequency and that schedule built out, the next step, of course, is choosing the right disinfectant for your practice. And we’ll break down some of the things to think about when going through that process. So, overall, just some key points about what to look for. So the disinfectant that you choose should be EPA-registered, first and foremost. Obviously, you want it to be effective against the pathogens that you’re concerned about in your facility, you want it to be fast-acting, but without trading off on safety. So we also want it to be non-irritating and gentle on clients and gentle on, of course, you and anyone else who you work with. And also gentle on your surfaces and tools, and that’s one that we’ll definitely get into a little bit later. And finally, easy to use, just to make the experience as easy as possible and make it as easy as possible to achieve compliance, to make sure that you’re executing those protocols successfully. So as I said, it’s really important that we’re looking to make sure that the disinfectant that we use is EPA-registered. So all of disinfectants that are used in the United States should be registered with the EPA. And really, almost all or the vast majority of state guidelines are really going to require that an EPA-registered disinfectant is used. And so, the way that you can tell this by looking at your product label is for looking for an EPA registration number. So every disinfectant should have this number right on the product label. And if you don’t see an EPA registration number on there, this could be definitely a red flag that the product is not registered properly. So I’m actually going to show you a little bit of a clip of what this looks like. So that if you’re looking at your own products, you can get a sense of kind of what to look for.

So here’s the product label, and then we’re going to zoom in, and you see there’s that EPA registration number right there on the product label. So once you’ve confirmed that the product is EPA-registered, the next thing to look at is, is it effective against the pathogens that you’re concerned about in your practice? And so there’s a couple of things that you can look at to really kind of help make that decision. So we talked about the different types of pathogens, you know, a little while ago, and we want to make sure that all of these pathogens are represented on your product label. So we want to make sure that it’s bactericidal, that it says it’s bactericidal on the product label. And more specifically, we want to look for a hospital-grade disinfectant. And that’s a disinfectant that has efficacy against these two types of bacteria. And it’s not really important that you remember what these two types of bacteria are exactly, it’s more important that you’re thinking about looking for a hospital-grade disinfectant, because that’s going to be a really good sign that it’s going to be effective against a wide range of bacteria that you might run into in your practice. So that’s definitely an important one to look out for. The product should also be virucidal, meaning that it’s been proven to be effective against viruses, it should be fungicidal, so proven to be effective against fungi, it should meet the OSHA blood-borne pathogen standard. So it should have that language right on the label that says it meets the standard for use against HIV, hepatitis B and C. And I put tuberculocidal with a question mark there because that’s really going to depend with the state guidelines, wherever you’re based. Some may require tuberculocidal product, but definitely not all will. So that one really depends from location to location, but that’s something to look into if it’s required for wherever you’re practicing.

So, a common misconception around disinfectants, in general, is that when you spray the disinfectant onto the surface, or you wipe it onto the surface, it’s going to kill pathogens instantly, and the surface is immediately disinfected. And that would be great if it was true, but the reality is that all disinfectants have what’s known as a contact time. And that is the length of time that a disinfectant needs to stay wet on the surface in order to work properly, in order to be effective. You know, there really is quite a range out there in the market of contact times that disinfectants have. You know, it’s pretty common for products to have longer contact times like 10 minutes, whereas, some solutions have contact times that are quite a bit more rapid, so as little as 1 minute to kill bacteria and viruses. And I’m going to show you a video to really illustrate why this matters, the fact that there’s this range out there, why contact time matters. So I’m just gonna play that quickly for you. So you can see product A, product B are both being applied using the same type of cleaning material. And product A has a one-minute contact time, and product B has a three-minute contact time. And what you can see is that product B is drying, you know, quite rapidly on the surface. And so you can imagine that it’s not really staying wet on there for three minutes. So we’re probably going to have to reapply product B multiple times in order to actually allow it to work properly against pathogens.

And so for that reason, we always recommend looking for a product with a fast contact time. And there’s a couple of reasons behind this. I mean, the first one is that it’s going to save time, it’s really gonna allow for that quick turnover between clients because you’re not, you know, you’re not necessarily having to wait for that 10 minutes before the next appointment. But it’s also going to make it that much easier to achieve compliance, to disinfect properly with just one application. So to apply the product once, you know, if it has a one-minute contact time, you likely won’t have to then reapply in order to actually allow it to work properly. So a fast contact time really is, you know, an important ticket to achieving compliance. So another kind of misconception or myth around disinfection is really around safety. So there’s this old belief that, you know, disinfectants, because their job is to kill pathogens on surfaces, that must mean that they’re just inherently toxic, they’re naturally toxic and they’re also potentially harmful to people. And that used to be true back in the day, but it definitely does not have to be true today, because there are solutions out there that are, you know, highly effective against pathogens without making that compromise, without trading off on safety. And so we always recommend when you’re looking for a product, looking for something that’s going to be non-irritating to the eyes and skin, at the use-solutions, and I’ll kind of explain that in a minute, that it’s going to be non-allergenic, non-sensitizing, and it’s not going to have any potentially carcinogenic ingredients. And this seems really obvious, but there are a number of products that are still used within the industry that are associated with these really poor occupational safety profiles. So this is really a key differentiator to look out for when you’re looking for a product. And in terms of where to find this information, the two main resources are going to be the product label itself, and the product’s safety data sheet.

So in terms of how to interpret a product’s safety data sheet, so SDSs, many of you may be familiar with these, but they are these sheets of paper with important safety information about the product. It’s required by OSHA for them to be provided by employers whenever dealing with potentially hazardous chemicals. And that’s really the main source of this important information in terms of preparing, using, storing, and even disposing a disinfectant safely. Particularly, we’re really gonna look at section two, because that’s the section that contains this key information on the hazards associated with the product. So that includes physical hazards, health hazards, and even potentially environmental hazards. Though I think environmental hazards are not…you may see this not as often compared to physical and health hazards, but we’ll look at a couple of examples to kind of illustrate that point. So in terms of what to actually look for on the label and on the SDS, we want to look for a product that’s not going to have any hazard pictograms. And so on the right, I have these examples of what hazard pictograms look like, that’s not going to have any hazard statements associated with it and that’s not going to require the use of personal protective equipment from a safety standpoint. Now, you may choose to wear personal protective equipment, because it’s a good practice from an infection prevention standpoint, you know, if you’re wearing gloves, that can help prevent the transmission of pathogens, but we want to look for product that’s not going to require PPE in order to use the product safely. And I just want to make the point that I am referring to the use solutions with these points. So if you’re dealing with a concentrate product that you’re diluting in order to use, you want to look at the information that’s relevant to the solution that you’re actually using.

You know, it’s still important to understand the concentrate information for handling the solution and preparing the solution. But with these points here, I’m really focusing on that solution that you’re actually going to be using for disinfection. So here are two examples of SDSs, and we’ll kind of look at the difference between the two. So on the top right is an example of a type of SDS that we want to be looking for. So we can see, if we look for hazard pictograms, we can see that there are no hazard pictograms associated with the product. And if we look at the hazard statements, you can see that it says none. So, you know, and it says it is not classified under any GHS hazard class. So that’s really the sign that this is the type of product that you want to be looking for. And then on the bottom left is an example of a product that does have some hazards associated with it that we can see. So we can see a couple of hazard pictograms, you know, one specific to flammability of the product, another one talking to eye irritation. And then we can see those hazard phrases associated with the product as well. So flammable liquid and vapor, as well as causes serious eye irritation. So this is just an example of if you’re reviewing SDSs, what to look for, and really kind of how to differentiate, to choose the safest product that you can.

So, you know, the disinfectant that you choose should be safe not only on you, your clients, as well as any team members that you work with, but it should also be gentle on the surfaces that you use as well. You know, your surfaces, and tools, and equipment, you know, they’re important investments, obviously, and you want to make sure that you’re doing everything you can to protect the integrity of these surfaces. And a really important part of that is using a disinfectant that’s been validated to be compatible with a wide range of commonly used materials that you’re using on a daily basis. So just in terms of what to look out for, so some, you know, products that are higher in alcohol, for instance, tend to have an effect in drying or weakening plastics. Whereas solutions based on chlorine, like you’re using a bleach-based solution, you might deal with some issues around metal compatibility. Others might leave behind, you know, certain sticky residues or films on the surface. But really, the point that I really want to make is that no disinfectant is compatible with every single surface. So you really want to ask the manufacturer of whatever product that you’re using, you know, what compatibility testing has been done with the product? And then, really, it comes down to choosing the one that is, you know, validated to be compatible with the surfaces that you care about most, and with a wider range of these surfaces that you’re using.

And so last but not least, I want to talk about ease of use of the product that you choose. So there’s a couple, you know, different factors that can help with this. One is to choose a product with a longer shelf life. And that reduces the need to constantly be changing over solutions and worrying about the expiry date of the product. Because we know that some solutions tend to break down, you know, quite quickly after opening. So we recommend looking for a product that’s going to have a longer shelf life, you know, for instance, a couple of years, and that really reduces the need to have to deal with that. And also choosing the right formats for your practice, and this depends on what works best for whatever your needs are. But, you know, premoistened wipes are convenient in the sense that they come pre-dispensed with the right amount of liquid. Also ready to use sprays are another, you know, convenient format that you can use to quickly disinfect the various surfaces. So the formats that you want are definitely something to think about when you’re building out your protocols.

So now that we’ve talked about choosing the ideal disinfectant for your practice, we’re going to switch gears a little bit, and in the last part, focus on how to apply the product for best results. And so, no matter what you’re doing to apply the product, whether you’re wiping it, whether you’re spraying the solution onto the surface, we’re really focusing on three important steps, regardless of what the application method is. So first, we want to make sure that we’re removing visible dirt and debris from the surface. And the reason for that is if there’s a lot of dirt on the surface, this can really act as a shield and actually block the disinfectant from being able to kill pathogens properly. So this can be as simple as just taking a dry cloth or brush and just making sure that any kind of visible dirt on the surface or debris is removed before the disinfection step, just to make sure that you’re actually going to be able to target these pathogens effectively. Again, an important step is to make sure that whatever the application method, that you’re covering the surface evenly, that there’s no spots that are being missed, so you’re either wiping evenly across the entire surface, or if you’re spraying, making sure that that surface is, you know, fully saturated with the disinfectant.

And then, of course, the third step is really to make sure that you’re waiting for whatever that contact time is. Making sure that the surface is not being wiped dry before the contact time, or that it’s not being allowed to evaporate before the contact time is reached. And then the next step really depends on the product that you’re using. For instance, some will recommend a rinse step after the contact time is reached, others will say, you know, just simply let the product air dry. So really refer to whatever label you’re using, but these steps have to be achieved no matter what product, no matter what application method that you’re using. And just to drive home that point about contact time, I’ll show you a quick clip of sort of what not to do in terms of… So you see that the disinfectant is being sprayed, and then immediately wiping the surface dry after that. So, you know, you probably see this done a lot, but that’s definitely not going to be an effective way to apply the product because we’re definitely not reaching the contact time. So just kind of want to wrap up with a few general protocol tips. You know, if you happen to be pouring your solution into secondary bottles within your workplace, we always recommend having the expiry date marked down on that, and just letting the solution be used up before it’s refilled just to make it easier to keep track of the shelf life of the product that you’re using and not end up using anything that’s expired. We always recommend avoiding mixing the disinfectant with other chemicals, you know, whether that’s added fragrances or particular colors that people might want to use, unless the label specifies that that can be done. Just because that can, you know, maybe dilute the solution, it could potentially inactivate the solution or hopefully not, but in the worst-case scenario is we could be dealing with potentially dangerous reactions. So we always recommend just not mixing anything, unless the label directly advises that you can.

We always recommend, of course, consulting labels for, you know, preparing and applying and storing the product. And logs can be a great way to help manage these protocols and really make sure that nothing gets missed in terms of surfaces that need to be disinfected throughout the facility. And we always think that training is really one of the best investments that you can make in terms of really understanding effective disinfection and building protocols that are going to protect, you know, your facility, your team, your clients from the spread of infection. So I just wanted to let you know that we do offer a couple of free resources, if you’re interested in learning a little bit more about some of these topics. So we have a customizable disinfection protocol tool builder available for free on our website. And you can customize it to your practice or your facility by entering in, you know, the surfaces and other information, and it will populate a protocol that can be printed and easily hung up anywhere or taken around with you. So we definitely encourage you to check that out. We also have an online certification program for infection prevention in massage practices. And that consists of three modules that really cover the topics that we’ve been talking about in a little bit more detail. So if you’re interested in anything that you heard, and you want to check it out in a little bit more detail, I would definitely encourage you to go and find our certificate program for massage. And with that, I really wanted to thank you again for tuning in today, and I’m happy to open it up to any questions that you might have.

Lara: Well, thank you, Matt, for a great presentation. We did have a few questions come in. But before we get started, I did want to draw everybody’s attention to the chat very quickly. I’ve put in the links to the resources that Matt has referenced. And we do have a special offer for $29.95. You can now purchase the Rejuvenate disinfection kit to help you elevate your disinfection. So with that being said, let’s dive right into the questions. So, Matt, this first question is, do you suggest soaking cups and stones in disinfectant or spraying and wiping?

Matt: That’s a great question. And the answer is, as long as you’re meeting the criteria, it really doesn’t matter what application method you use, or if you’re soaking the solution or if you’re spraying and wiping the solution, as long as the surface is being covered evenly and the contact time is being reached, you know, both of those methods should be effective from a disinfection standpoint. However, I would say that the potential downside to soaking is you are consuming a lot of product that way, especially if you’re changing out the solution on a regular basis. So spraying and wiping those is probably, you know, as effective as soaking from a disinfection standpoint, but it can help you end up using less product in the long run. So I think a common misconception is that soaking is required for those types of devices, but really, spraying and wiping is also perfectly acceptable as long as the liquid is evenly covering the surface, and you’re allowing that contact time to be reached.

Lara: And while we’re on that topic, we actually did get a great question about application. So do you have suggestions for how to actually apply the disinfectant? What would the benefit be of, say, a premoistened wipe versus spraying and wiping with a paper towel or a cloth?

Matt: Yeah, so that’s a great question. And I’ll try to answer it as specifically as I can, but with the kind of disclaimer that it really is going to depend on whatever product that you’re using. And the reason for that is that different chemistries might interact with the different cleaning substrates or different cleaning materials in different ways. So for example, you know, a certain type of disinfectant called a quat-based disinfectant tends to interact with cotton, in particular, and bind to the cleaning material. So if you’re using a cotton cloth to clean with a quat disinfectant, you might find that the chemistry can actually bind to the cloth, and not actually be available to kill pathogens. So it really is a question of asking your manufacturer, you know, have you validated any particular cleaning materials to use with your product? You know, for instance, maybe they say that microfiber is a great option. Pre-moistened wipes usually are…you know, obviously, they have been validated because they’re paired directly with the right amount of disinfectant. And so that’s a great way to go to kind of feel comfortable from a material perspective. And yeah, another thing that I would add about that is… Yeah, I would sum it up just by saying that, you know, definitely have that conversation about what materials have been validated. Oh, I remembered what I was gonna say, I lost my train of thought, but I was gonna say, you mentioned paper towel. And we haven’t done testing personally with paper towel, but our sense that we get is that it tends to be better at…more designed for absorbing liquid than it does for releasing liquid. So I would probably recommend avoiding paper towel for that reason, you’re probably not going to get that even distribution of liquid across the surface.

Lara: Makes sense. And our very last question, and this is always a popular one, but, could you just one more time recap, what is contact time and why it’s important?

Matt: Sure, yeah. So contact time is the time that a disinfectant needs to stay wet on a surface in order for it to be fully effective. So, you know, instead of just applying the disinfectant on the surface and expecting it to kill pathogens instantly, whatever product that you’re using will say somewhere on the label, that the product…that it needs to stay wet for a certain amount of time, and this could be anywhere from 1 minute all the way up to 10 minutes. And so, you know, that means making sure that it’s not being wiped dry before this time is reached and also making sure that it’s not being allowed to evaporate naturally before this time has been reached. And so, choosing a product with a rapid contact time can really help, you know, make protocols faster, but also help make sure that you’re disinfecting properly with just one single application of your product.

Lara: Well, that’s great. And it looks like we don’t have any more questions. Just double-checking the chat, just, you know, in case anything else comes in. So thank you to you, Matt, for a great presentation and thank you to everybody for joining us today. If you have any additional questions, please visit rejuvenatedisinfectants.com. There’s also some great links in the chat there, you can check out for additional resources. And you will be receiving a follow-up email with links to additional resources, so please keep an eye on your inboxes. So, thank you again for joining us, and please don’t hesitate to reach out with any questions.