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Every massage therapist has been trained never to work on an open lesion. We understand that bacteria from one client can be transferred to another so we practice sanitary hand washing between clients. However not all practitioners are taught that even minor lesions created by shaving, plucking, waxing, insect bites and pimples can cause risk for the client. These are not always visible lesions but according to the CDC (Centers for Disease Control) they are enough to place the client at risk. Nearly all women shave their legs and most men shave their face while many can have a pimple or an insect bite that is virtually invisible to the therapist. Dried and cracked heels, elbows and knees, chapped hands and lips and pealing sunburns are all open lesions. We seldom see a client who does not have at least one of these conditions present at the time of a treatment session.

According to the CDC hand washing techniques in the health care industry is being more strictly enforced due to the increase in serious skin infections. A variety of upgrades including harsher antibacterial agents are being used in hand soap to insure sanitation. Flesh eating bacteria cases are arriving in the US and crossing every social and economic boundary as society becomes more mobile. Even these minor skin lesions can leave a client susceptible to cross contamination for disease related germs and viruses such as HIV, MRSA and other staph infections. Some of these infections can lead to serious illness requiring surgery and hospitalization and even death. In no other health care profession is so much of the skin touched and exposed to contamination than in the massage profession.

The need for strict sanitation criteria for stones came to the attention of our industry after a serious outbreak of MRSA in the Greece spa industry was reported in early 2009. Current research with the CDC is underway by the Geothermal Therapy Association but until final results can be published the recommendations are as follows:

1) Water must be changed between each client and the heating unit wiped out with antibacterial disinfectant. (DO NOT BELIEVE THE OUT DATED RESEARCH SAYING 90% OF BACTERIA ARE KILLED AT TEMPS OF 120 AND ABOVE….THESE GUIDELINES DO NOT PROTECT AGAINST H1N1 FLU VIRUS, MRSA OR HIV. HOSPITALS USE BOILING TEMPERATURES OF 220 AND ABOVE FOR TWENTY MINUTES WHEN HEAT IS USED AS A DISINFECT)

2) A hospital grade antibacterial agent such as MCP must be active in the water at all times. (MOUTH WASH, ESSENCIAL OILS OR OTHER UNTESTED METHODS OR INGREDIENTS WILL NOT HOLD UP IN COURT IF A CLIENT IS INFECTED AND SUES FOR COMPANSATION) **

3) Each stone must be sprayed with isopropyl alcohol and dried prior to replacing in heating unit after each use. (THIS INEXPENSIVE AND QUICK PROCESS IS A VITAL PROTECTION MEASURE)

4) Stones should be scrubbed with a brush and antibacterial soap if they have any pours surfaces. (IT MAY ‘FEEL’ SMOOTH BUT MOST STONES HAVE SOME POROSITY WHICH COLLECT DEAD SKIN CELLS AND DELIVER THEM TO THE NEXT SURFACE THEY TOUCH)

5) All cold stones must be wiped with alcohol between uses. (DELICATE STONES CAN BE PROTECTED WHILE INSURING SANITATION SIMPLY BY USING ALCOHOL IN A SMALL SPRAY BOTTLE)

** Sorry, these are not very ‘natural’ or ‘green’ sanitation procedures. Sadly this is a serious threat to the Geothermal Therapy industry. Remember oil and water does not mix so a few drops sitting on the surface of the water in a heating unit serve only as aroma therapy. Mouth wash is safe if swallowed and remember an oral bacterium is not the same as those found on the skin. **

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Replies to This Discussion

Sanitation is imperatiave when working with hot stones. I have a huge supply...and rotate them out. I put used ones immediately in a plastic bag and take them home. Each set is put in my dishwasher on sanitize before it is used again. Yes i am hauling rocks to and from work. Better than taking some sort of bug and hauling it around. The caustic nature of dishwasher soap removes all oils (fragrance and stickiness) and heats them to a high temp. for an exteded period of time. Never had a problem.
Thank you Jenny for the sanitation and cleansing procedures! A great reminder anytime as our clients welfare should always be foremost in our practice! And thank you also to Mary Ellen for the tip on using your dishwasher, I did not think the temp on the dishwasher would get high enough?!?! I f I can figure out how to print this out, I am going to share this with my fellow therapists as a reminder....
How do you keep them from falling through the racks? I like the dishwasher idea immensely.

Mary Ellen Derwis-Balaz said:
Sanitation is imperatiave when working with hot stones. I have a huge supply...and rotate them out. I put used ones immediately in a plastic bag and take them home. Each set is put in my dishwasher on sanitize before it is used again. Yes i am hauling rocks to and from work. Better than taking some sort of bug and hauling it around. The caustic nature of dishwasher soap removes all oils (fragrance and stickiness) and heats them to a high temp. for an exteded period of time. Never had a problem.
Excellent! This sure got me back on track because I am very new to hot stone massage and no one has ever mentioned the proper way to make sure the stones are sanitized.
I have just received some new information from the CDC... they have approved the sanitation methods as outlined in my other letter...adding that any stone soaked in an alcohol bath for 10 minutes will not need scrubbing...??...ok...the sanitation criterion I quoted was set up by the Geothermal Therapy Association. I will soon post more information about the association as well, for a brief over view you can visit their web site at www.stonewalkersassociation.com
it will soon be moving to www.geothermaltherapy.com and will have a lot more information....
Jenny ray

Donna C. Agrinsonis, LMT said:
Excellent! This sure got me back on track because I am very new to hot stone massage and no one has ever mentioned the proper way to make sure the stones are sanitized.
Alcohol bath - as in full strength alcohol and not mixed with water right?

Jenny Ray said:
I have just received some new information from the CDC... they have approved the sanitation methods as outlined in my other letter...adding that any stone soaked in an alcohol bath for 10 minutes will not need scrubbing...??...ok...the sanitation criterion I quoted was set up by the Geothermal Therapy Association. I will soon post more information about the association as well, for a brief over view you can visit their web site at www.stonewalkersassociation.com
it will soon be moving to www.geothermaltherapy.com and will have a lot more information....
Jenny ray

Donna C. Agrinsonis, LMT said:
Excellent! This sure got me back on track because I am very new to hot stone massage and no one has ever mentioned the proper way to make sure the stones are sanitized.
yes pure alcohol (undiluted) if it is for the ten minute soak - this is CDC idea...not sure I like it, but hey, they should know...it is also acceptable to spray and wipe each stone (edges too don't forget) with alcohol before it is replaced in the heating unit...remember if you change water between clients and disinfect equipment this is enough, if you don't change water you should have the antibacterial agent MPC in the water...best case is to have enough stones that you never need to reheat during the treatment session..you can always use two heaters if needed I have an 18 quart Spa Pro that can handle about 80 stones and a smaller 8 quart (facial Spa Pro) for all small stones and specialty stones... and an ice chest for cold stones...all stones get the alcohol spray before they touch the next person...and enough time between clients to completely clean all items...

Donna C. Agrinsonis, LMT said:
Alcohol bath - as in full strength alcohol and not mixed with water right?

Jenny Ray said:
I have just received some new information from the CDC... they have approved the sanitation methods as outlined in my other letter...adding that any stone soaked in an alcohol bath for 10 minutes will not need scrubbing...??...ok...the sanitation criterion I quoted was set up by the Geothermal Therapy Association. I will soon post more information about the association as well, for a brief over view you can visit their web site at www.stonewalkersassociation.com
it will soon be moving to www.geothermaltherapy.com and will have a lot more information....
Jenny ray

Donna C. Agrinsonis, LMT said:
Excellent! This sure got me back on track because I am very new to hot stone massage and no one has ever mentioned the proper way to make sure the stones are sanitized.
Thank you for sharing this information. I learned to give hot stone massage by recieving them and was never aware of the method to sanitize everything except to wash them. I too have enough stones to use without reheating between clients. Where can the MCP be purchased?
Mono Chloro Phenol (M.C.P.) can be purchased from www.spaelegance.com about $40 a gal..mixes 2 oz/gal.
Monks disinfectant wipes (quick and easy way to clean stones and surfaces between clients....can be purchased here...about $5 per can...read the web page tells about killing MRSA and other such grunge...
http://www.apollosafety.com
and remember cheapest and quickest is alcohol...(if smell bothers you try Vodka, some is even higher proof than isopropyl alcohol which is usually 70%...and please don't sip pre-client!!)....ok ...just kidding...that is not recommended by CDC or any other sane person...
Connie McKim said:
Thank you for sharing this information. I learned to give hot stone massage by recieving them and was never aware of the method to sanitize everything except to wash them. I too have enough stones to use without reheating between clients. Where can the MCP be purchased?
These are good precautions but unfortunately massage rooms are rarely designed to be sanitary. Often being soothing and comforting is a higher priority. To be sanitary walls and items used to decorate must meet the standard of being smooth and impermeable. This allows effective wiping down with sanitizers. A good way to reduce bacteria is nightly misting of the room with a quaternary sanitizer. Most cleaning supply companies have these.

The quaternary sanitizer can be added to the water to sanitize your stones. You can also wipe them after each use with antibacterial wipes.

The main transfer source of bacteria is your hands. Follow proper hand washing procedures and if there is no sink in the room wipe with a antibacterial wipe or waterless sanitizer before touching the door knob.

http://www.research.cornell.edu/care/documents/SOPs/CARE713.pdf

You probably can not maintain a sanitary room in most massage therapy locations but you can drastically reduce exposure. Following SOPs such as that provided above and having them available for review and training will limit your liability.
To Mary Ellen:
You are not sanitizing your stones properly using the dishwasher! Oil on the stones creates a biofilm making bacterial growth more likely! You are actually hauling the bacteria, fungi, viruses, etc. back and forth on your stones and spreading them around your dishwasher! I'm not sure what the temperature has to be in order to completely clean them between clients but I don't think it's hot enough.These stones are porous so the inside nearly never dries completely! I'd like to direct you to Jenny Ray's CDC approved protocol for sanitization. How do you know you've "never had a problem" if every single client who has come in contact with your stones hasn't been tested for, say, hepatitis? Yes, it's convenient to wash them in the dishwasher but it is NOT SAFE! Check out Jenny Ray or call the CDC! You and your clients are at risk of contracting something dangerous or even deadly!!!!
Roberta Bleckner

Thank you for your guidelines Jenny.

 

Reading up on MRSA, I got to think. What about sheets and towels? The MRSA - and I assume other viruses and bacteria, can be transferred via clothing as well. This would mean that washing sheets at 30 degree Celsius (86F) as some of the nice massage sheets require, wouldn't be enough as such a low temperature doesn't kill all the bugs.

Even 60°C (140F) wouldn't be quite enough - which is the normal cotton sheet washing temperature.

Wouldn't this be just as big a risk as the stones considering that our clients lie on and under sheets and there is a lot of skin contact?

What are your thoughts (everyone)?

Cheers,
Pia

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