Infection Control And Complementary Therapies

IntroductionnComplementary therapies are now popular in mainstream America. Some involve direct contact, such as acupuncture, others may transmit organisms by indirect contact when touching a client. Droplet and airborne transmission may occur during transformational breathwork and other forceful breathing exercises if someone has the flu or TB. nnThe use of instruments in common in many complementary therapy sessions. Acupuncture, biofeedback, tuning forks, electrodes, crystals, colon hydrotherapy, lotions and essential oils are examples of equipment that may be touched by a practitioner or used directly on the skin of a client. And there are mats, blocks, wedges, ropes, balls, transformers, chairs, pillows, cushions and heated rooms that may become contaminated between classes and clients. However, hands are the most common mode of transmission of microorganisms from person to person. Many complementary therapies involve touch and well meaning therapists and teachers may not be aware of the importance of hand hygiene and environmental disinfection between clients and classes. This article will explain how microorganisms are transmitted and simple techniques complementary therapy practitioners can adopt to prevent the spread of microorganisms in their classes or office.nnBackgroundnComplementary and therapies have increased dramatically in the United States as non-traditional forms of healing and stress reduction. The National Institutes for Health established a branch called the national commission for the study of complementary and alternative medicine (NCCAM) in 1993. Scientific studies are ongoing to explore the efficacy of certain therapies and how these might be integrated into allopathic medical models. nnHowever, during the same time many new infectious diseases and resistant organisms emerged. In the early 1980’s there was an increase in bloodborne pathogens transmitted, such as human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV). Hospitals started to deal with multiple antibiotic resistant bacteria such as Methicillin-Resistant Staph Aureus (MRSA). In the early 1990’s increased cases of Tuberculosis appeared primarily in the HIV community and Vancomycin Resistant Enterococcus (VRE) in hospital patients. More recently there has been an increase in community-acquired methicillin resistant staph aureus (CA-MRSA) in the intravenous drug population, prisons, day care centers, sports teams, health clubs and rehabilitation facilities. Infection prevention and control is becoming increasingly important in the community and should be incorporated into complementary therapy practices to prevent disease transmission in settings that are conducive to the spread of microorganisms.nnSources for Microorganisms nMicroorganisms are resilient with an array of artillery that enhance their opportunities to survive. They use special enzymes to protect their cell wall; they have adherence properties to stick to surfaces, and mechanisms to survive intense environmental conditions, such as dryness and heat. Other organisms prefer liquid mediums and moist environments, such as growing in steam, wet surfaces and fluids. However, they all need a mode of transmission and portal of entry to penetrate the body and cause infection.nnModes of TransmissionnThere are five modes of transmission for microorganisms – direct, indirect, droplet, airborne and vector borne.n1. Direct transmission is one way certain viruses and bacteria enter the body. HIV, HBV and HCV are examples of viruses that are transmitted by direct transmission from blood or body fluid exposure, such as when injected with a contaminated needle. There is a case report of an acupuncture needle transmitting HIV from the sharing of needles between clients. Bloodborne pathogens have been documented to be spread by n· Contaminated tattoo needles n· Colon hydrotherapy equipment n n2. Indirect transmission is one of the most common modes of transmission, primarily by contaminated hands and equipment. A variety of microorganisms and viruses can be transmitted by indirect transmission. However, one in particular, MRSA, has been shown to contaminate cell phones, pagers, stethoscopes, blood pressure equipment, counters and surfaces in the healthcare environment. This organism is now causing outbreaks associated with contaminated locker rooms, tattoo businesses, health clubs, day care centers and other areas where close contact occurs and items get shared. Indirect transmission allows the microorganisms to travel from one source to another. Humans use transportation systems to move about, so do microorganisms. They hitch rides on hands, equipment, clothing, air currents and liquids to move around. There are many opportunities in the complementary therapy field conducive to indirect transmission.n· Hands during massage therapies and other touch therapies such as Reikin· Hands during personal training, private therapy and adjustmentsn· Shared equipment, such as yoga mats, yoga blocks, exercise balls, stationary equipment, pilates reformers, massage tables and chairs, meditation cushions and benches, yoga straps, hand weights and stones used for massagen· Essential oils, massage oil, hand lotions, liquid soapn· Heated yoga rooms incubating mildew and moldn· Bathrooms, especially with colon hydrotherapyn· Showers, locker rooms and steam rooms n· Herbal medication preparation areas and delivery equipmentnn3. Droplet transmission occurs with close contact with aerosols generated nduring speaking, coughing and sneezing. Examples of diseases transmitted through this route are influenza, German measles and bacterial meningitis. Close face-to-face contact is necessary for droplet transmission. n4. Airborne transmission occurs just as it implies – through the air and into the nrespiratory tract. A person with an airborne disease is infectious not only face to face but these organisms or viruses can stay suspended in a space for hours after they leave. Examples of disease transmitted by the airborne route are Tuberculosis, Chickenpox and Measles.nnInfection Prevention Measuresn1. Do not share any invasive devices or equipment that comes in contact with n blood. Examples are needles, syringes, multi-dose vials, vacutainer holders, n intravenous therapy tubing and other items used to administer intravenous n therapies.n2. Clean hands before touching a client with an alcohol based hand rub. n3. Wash hands after having prolonged contact with a client’s body, such as after a Reiki session, massage or foot reflexology.n4. Clean-shared equipment at the end of the day with an effective germicide that has activity against common pathogens, such as staphylococcus aureus. A weak solution of 1:10 bleach may be used or natural cleansers such as Tea Tree oil prepared germicides. n5. Have students purchase their own yoga mats, blocks, towels and straps and encourage them to wash them often, especially after heated yoga practice.n6. Clean environmental surfaces (tables, counters, chairs, face rests) at the end of the day with an effective germicide that has activity against common pathogens, such as staphylococcus aureus.n7. Wash linens/blankets often (at least monthly) when used on clothed clients.n8. Change sheets between each patient after a massage. n9. Place paper towels over pillows that the head and hair will contact during a session.n10. Place a tissue over an eye pillow between each client/student use.n11. Make sure prepared solutions, such as aromatherapy spray, energized water and spritzers are used within a short period (3-6 months) of time to prevent bacterial growth in the bottles. Clean the bottles by rinsing between refills.n12. Use individual bottles of hand soap for hand washing – never refill a container or top it off since this can cause bacterial growth in the bottom of the container.n13. Use only sterile individual use acupuncture needles.n14. Use only sterile individual use colon hydrotherapy tubing.n15. Do not share towels or other absorbing materials that are exposed to sweat and other body fluids. n16. If you provide yoga mats and blankets wash them at least monthly.nnPrevention Measures for Respiratory ConditionsnPolicies should be in place to advise clients to use good respiratory etiquette, such as coughing into clothing rather than into a hand. Encourage them to stay home if they feel ill, have a draining wound, diarrhea or rash. Advise clients and students to cancel an appointment or class if they develop a high fever and acute respiratory symptoms. If a client comes for an appointment and they are coughing, sneezing and using lots of tissues, it may be advisable to stop the session and ask the client to reschedule.nnEveryone can transmit microorganisms and must participate in infection prevention measures. The number one measure is the practice of good hand hygiene. Make alcohol based sanitizer available in the studio, center or class. Encourage everyone to fight the spread of infection.nnnResources:nnwww.cdc.govnnhttp://tahilla.typepad.com/mrsawatch/n