The six essential pillars of hygiene in a clinic and therapy setting

There is a huge void of any clear and direct hygiene standards for therapy professionals who have a duty of care to their customers such as the allied health, massage and beauty sectors.  

Purifas® has developed the following essential steps that constitute best practice for therapy professionals, based on all current research and evidence.

 

1. Clientele with symptoms of illness should be strongly advised not to attend therapy.

     It is well established1, 1a, 1b by virologists and medical experts that the infectious period after contraction of an infectious pathogen begins before the carrier becomes symptomatic (if at all).  Whilst the overlap may vary between diseases, incubation period is usually between 7-10 days, with a carrier becoming infectious usually within the latter 5 days.

    Whilst it is near impossible to monitor infection without symptoms, it should be made explicitly clear that a client with any significant symptoms should not attend for therapy, regardless of how mild they make think their condition is,  as they have the potential to be a carrier of an infectious pathogen. Extra caution may also be established by asking clients who have been exposed to people who are ill to also reconsider their attendance.

     

    You can communicate this to your clientele by displaying signs in high traffic areas of your clinic; including a hygiene requirement section on your website; promoting your policies on social media; and explicitly asking your clients either at the time of booking or confirming the appointment.

     

    2. Clientele and therapists should wash their hands before and after therapy.

       The primary focus of hygiene research has largely been on hand hygiene and its effectiveness in diminishing the transmission of disease via contact2, 3. Hand washing is accepted as essential especially in healthcare. However the issues is compliance by health care personnel and attendants. Studies show the compliance rate to be as low as 10%4, 5!

      Therapy professionals must observe frequent and stringent handwashing at three critical points:

      • Upon entry to the clinic
      • Prior to treatment
      • Immediately following contact with a client.

      Clientele should be given access to facilities to wash their hands upon entry to the clinic, and upon the completion of their treatment.

      Whilst thoroughly wash their hands, they must limit the use of reusable towels, which have been shown to harbour bacteria despite repeated washing6.

      Healthcare Associated Infections (HAIs) are a substantial contributor to the healthcare burden and preventable disease figures. It is therefore imperative that the heightened hygiene practices implemented to mitigate the COVID-19 viral pandemic remain in place and become the new standard.

       

      3. Within the therapy room, only apply single use, fit for purpose hygiene products to all shared surfaces and items.

        Single use protective materials are known to be more hygienic, quickly eliminating the trace of contact of the previous patient or potential infectious pathogens. In addition to being efficient and inexpensive, the risk of cross contamination of any bacteria/flora/microbes is dramatically reduced.

        Research6 has shown reusable materials – such as towels, pillow cases and bed linen, can harbour bacteria despite hospital grade washing. In particular, it was shown that Staph can survive up to three weeks in cotton towels – which are commonly used in therapy clinics and hospitals - despite regular laundering6. It was concluded that normal washing, or laundering of towels – whether done in house or externally, was not enough to remove all viable microorganisms from them6.

         

        4. Added protection of Purifas® FaceShield™ for the eyes, nose and mouth during prone (face down) therapy.

          The main points of entry and exit of a pathogen are through the nasomucosal openings7. Prone therapies use a shared face hole which can therefore significantly increase a client’s risk of cross-transmission via contact, droplet and potentially even airborne microbes shed from the nose, mouth and even eyes.

          The patent pending Purifas® FaceShield™ is the only fit for purpose product that completely covers the facehole and head rest. It doesn’t tear or move during treatment and is scientifically abd clinically proven to significantly reduce the transmission of bacteria. No other product can provide this level of protection and it is recommended for all prone therapy sessions.

           

          5. Sanitisation of all shared surfaces after each therapy session.

          All shared surfaces should be sanitised between each client to ensure the risk of cross transmission is minimised. To effectively sanitise a surface, research indicates it must first be cleaned with a detergent and then disinfected with an appropriate TGA approved antibacterial or sanitising agent8, 9. Remember to ensure that these agents are safe for use in a clinical setting.

           

          6. All high traffic areas and contact points should be cleaned regularly.

          High traffic contact points such as door handles, arm chairs, waiting room areas and the reception desk are cross transmission risks especially in facilities with high turnover of clients. All areas that customers come into contact with upon entry and exit of the clinic, such as bathroom areas should be cleaned and sanitised regularly. There is evidence to show a significant reduction in HAIs when a staff member is added with a dedicated role specifically for this task10. Depending on the size of your clinic, this may not be feasible. In this case, you should have these hygiene and safety tasks clearly assigned to the appropriate personnel, including clear outlines on what is needed to be done, and the frequency.

           

          Making these six steps standard practice in your clinic will help maintain a safe and hygienic environment for your clients and contribute to a reduction in community transmission of illness.

           

          REFERENCES

          1. SARTWELL, P. “The incubation period and the dynamics of infectious disease” American Journal of Epidemiology (1966) – Accessed online, 04/05/2020 http://www.columbia.edu/itc/hs/pubhealth/p8462/misc/sartwell.pdf
          2. Johnson, PDR, Martin,R, Burrell, LJ, et al. Efficacy of an alcohol/chlorhexidine hand hygiene program in a hospital with high rates of nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infection. Medical Journal of Australia (2005) 183:10 509-515
          3. Centers for Disease Control and Prevention. Guideline for Hand Hygiene in Health-Care Settings: Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. MMWR 2002;51(No. RR16). Available at: www.cdc.gov/mmwr/PDF/rr/rr5116.pdf. Accessed 5 May, 2020
          4. Grayson, ML, Russo, PL, Cruickshank M, et al. Outcomes from the first 2 years of Australian National Hand Hygiene Initiative. Medical Journal of Australia, 2011; 195(10): 615 – 620.
          5. Azim,S, McLaws,ML (2014) Doctor, do you have a moment? Medical Journal of Australia 2014; 200(9)
          6. Sifuentes, LY., Gerba, CP, Weart, I., Engelbrecht, K., Koenig, DW. Microbial contamination of hospital reusable cleaning towels. American Journal of Infection Control. 2013 Oct;41(10):912-5. doi: 10.1016/j.ajic.2013.01.015. Epub 2013 Mar 22.
          7. Alberts B, Johnson A, Lewis J, et al. Molecular Biology of the Cell. 4th edition. New York: Garland Science; 2002. Cell Biology of Infection.Available from: https://www.ncbi.nlm.nih.gov/books/NBK26833/
          8. Centre for Disease Control and Prevention - “Cleaning and Disinfecting your Home” Accessed 04 May 2020 from https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/disinfecting-your-home.html
          9. Hota B, Contamination, Disinfection and Cross-Colonizations: Are hospital surfaces reservoirs for nosocomial infection? Clinical Infectious Diseases 2004;39:1182–9
          10. Doll, M, Stevens, M, Bearman, G. Environmental Cleaning and Disinfection of Patient Areas; International Journal of Infectious Diseases, 2018; 67: 52-57

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