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Guidelines for MRSA?

Would appreciate input on guidelines for working with clients who have MRSA. I am both surprised and disappointed that this specific issue is not covered in any massage pathology textbook, and the only info I can find online consists of horror stories of MTs who were infected by patients who did not disclose their condition.

I personally have had a very negative experience with a client who did not disclose this condition to me, even after I questioned him about the reasons for his multiple sudden hospital stays due to a mysterious skin condition. At no point did I ever see him when this skin condition was active, and he told me he was working with a dermatologist who "couldn't figure it out". The last time he came to see me, he informed me (as I was undraping his lower leg) that he'd fallen and "slightly scraped" his shin. Imagine my shock when I saw that his entire anterior lower leg looked like raw meat. I refused to continue the session (which was already half over) and asked him to immediately see a doctor. I later found out through a mutual friend that he entered a hospital 2 days later and was being treated with IV antibiotics for MRSA. When I later confronted this client about his condition, he told me it was "not MRSA", but a type of antibiotic resistant dermal staph infection that was "not any big deal"; he'd had it for years. Antibiotic resistant staph requiring lengthy hospital stays IS MRSA and IS a big deal.I immediately fired him as a client.

I have now been approached by someone who has MRSA, has frequent severe dermal outbreaks, knows when he is "hot" and wants regular bodywork. I am very uncomfortable about the possibility of working with this person, even fully gloved. Like most MTs, I adhere to CDC guidelines for sanitization in massage therapy practice, but frankly, most of us don't work in an office environment that can be easily sanitized when severe infection is present (unlike medical offices, we many of us don't have tiled floors, coved corners and countertops, etc.). I have told him that I will not provide bodywork, but will work with him in my capacity as a registered aromatherapist, having received training in creating blends for MRSA. I have no issue in providing some topical remedies for him to use, provided I don't have to have physical contact with him.

Any advice or comments? I've been searching industry websites all day and have come up with nothing definitive; everything I've found concerns accidental exposure.

Replies to This Discussion

Permalink Reply by Carl W. Brown on January 23, 2011 at 7:52pm

The healthcare industry focuses an policies like avoiding gloveless contact with patients and even so some estimated place the number of carrier healthcare workers as high as 20%.

I would start with public education. When patients know that have infections and don’t disclose them you need to let them know that if they infect their therapist the therapist might not only get very sick my may no longer be able to practice their profession. It is akin to knowingly transmitting AIDS.

I also suggest that if you are seriously thinking of working with people with medical problems your will have a higher exposure. You may want to shift from Swedish based therapies to other modalities that work on fully clothed patients. Reducing direct skin contact and eliminating the use of oils will dramatically reduce your exposure. Yes it won’t have the clamor of a spa like experience but it can be just as relaxing and can be far more effective for treating physical problems. It give you more freedom in positioning clients, it give you more control of the force you apply to tissues, and if you are working on things deep in the body another layer is no big deal if it is knot ribbed sweaters or heavy jeans.

Besides if you are working on bedridden or wheelchair bound patients Swedish does not work very well anyway

Permalink Reply by Katharine Koeppen on January 23, 2011 at 8:33pm

Thanks, Carl, for a very thoughtful reply. Based on my prior experiences, I already give all clients a handout on contagious illness (outlining the possibility of infecting me and the rest of my client base), in addition to the mandatory health profile they must complete upon their first appointment. I advise all bodyworkers to do the same. Still, it is rather unbelievable to me how many people will still intentionally not disclose a contagious illness.

Carl W. Brown said:

The healthcare industry focuses an policies like avoiding gloveless contact with patients and even so some estimated place the number of carrier healthcare workers as high as 20%.

I would start with public education. When patients know that have infections and don’t disclose them you need to let them know that if they infect their therapist the therapist might not only get very sick my may no longer be able to practice their profession. It is akin to knowingly transmitting AIDS.

I also suggest that if you are seriously thinking of working with people with medical problems your will have a higher exposure. You may want to shift from Swedish based therapies to other modalities that work on fully clothed patients. Reducing direct skin contact and eliminating the use of oils will dramatically reduce your exposure. Yes it won’t have the clamor of a spa like experience but it can be just as relaxing and can be far more effective for treating physical problems. It give you more freedom in positioning clients, it give you more control of the force you apply to tissues, and if you are working on things deep in the body another layer is no big deal if it is knot ribbed sweaters or heavy jeans.

Besides if you are working on bedridden or wheelchair bound patients Swedish does not work very well anyway

Permalink Reply by Diedre Seeley on January 24, 2011 at 7:46am

I agree with Carl about working with the client fully clothed and you should wear gloves. Here's some info on sterlizing through diffusion of essential oils. Sometimes we have to tell clients that their issue is beyond our scope of practice and refer them to someone who can do energy (hands-off) healing.

Essential oil diffusion

An in vitro study on the inhibition of MRSA by essential oil diffusion found that 72 of 91 investigated essential oils exhibited zones of inhibition in soy agar plates streaked with MRSA (strain ATCC 700699). The most effective being lemongrass oil (Cymbopogon flexuosus), lemon myrtle oil (Backhousia citriodora), mountain savory oil (Satureja montana), cinnamon oil (Cinnamomum verum), and melissa oil (Melissa officinalis) essential oils. Of these, lemongrass essential oil was the most effective, completely inhibiting all MRSA colony growth.^[39]

Tea tree oil also kills all MRSA strains that have been tested.^[40]

Permalink Reply by Katharine Koeppen on January 24, 2011 at 3:20pm

Thanks for your input. Lemon, sweet marjoram and peppermint are also quite effective at inhibiting or destroying MRSA. Please note that tea tree in subclinical doses is now becoming ineffective against a number of bacteria, which is very upsetting news for members of the aromatherapy community.

I have decided that I will refer this client out for bodywork, probably to the fitness division of one of the local hospitals. I'll still be working with him on aromatherapy solutions.

Diedre Seeley said:

I agree with Carl about working with the client fully clothed and you should wear gloves. Here's some info on sterlizing through diffusion of essential oils. Sometimes we have to tell clients that their issue is beyond our scope of practice and refer them to someone who can do energy (hands-off) healing.
Essential oil diffusion

An in vitro study on the inhibition of MRSA by essential oil diffusion found that 72 of 91 investigated essential oils exhibited zones of inhibition in soy agar plates streaked with MRSA (strain ATCC 700699). The most effective being lemongrass oil (Cymbopogon flexuosus), lemon myrtle oil (Backhousia citriodora), mountain savory oil (Satureja montana), cinnamon oil (Cinnamomum verum), and melissa oil (Melissa officinalis) essential oils. Of these, lemongrass essential oil was the most effective, completely inhibiting all MRSA colony growth.^[39]

Tea tree oil also kills all MRSA strains that have been tested.^[40]