Denise Logsdon shares her personal tips to help massage therapists—and their clients—manage massage sessions in the era of COVID-19.

How must we help our clients feel safe in our care in this age of infection awareness?  Besides the obvious masks, are there other changes we need to make our treatment rooms viral-free? 

Do a Practice Run

There is no safety in clutter.  The massage therapy treatment room needs to be sparsely furnished so that anything a client or the therapist may have touched is disinfected before the next client arrives.  

Mentally walk through a new client appointment in your space to make a checklist for cleaning after each appointment.  Follow the checklist rigorously after rehearsing this scenario with a family member or business associate.  You may want to put sticky dots on touched surfaces to help you remember your path through the room.  

The client arrives and uses your exterior door handle.  If you shake hands here, your right hand is unable to touch anything else until you wash it, so a slight bow may be more appropriate.  

If you can, show the client immediately to a sink so they can wash their hands prior to the treatment.  Hand-washing may be replaced by 60% alcohol hand sanitizer that stays on your hands 20 seconds.

Show the client directly into your treatment room.  Ideally, your intake form online is to be done before the client arrives. If not, hand them a clipboard with one new client treatment form instead of a stack of the same forms.  When the form is complete, use the same pen (unless they used their own) to make your notes.  After completing your clarifying questions, take the clipboard and pen straight to a designated surface outside the treatment room where you will make post-treatment notes and then sanitize the surface and the clipboard.  Sanitize the pen with your hands in your pre-treatment hand wash.

Return to the treatment room.  Since the client did not touch your external treatment room door handle, your hands are still clean to open a cabinet and select the crème or oil you will need for this client.  If you are adding an essential oil, keeping that bottle out of the client’s hands is necessary unless you carry it out with you to wash with your post-treatment hand wash.  You cannot leave it out on the counter as the client may pick it up to read the label while you are out of the room. 

Before you contact the client, make any needed adjustments to music, temperature, and lighting.  Once you touch the client, contact with any switch will mean the switch plate will need sanitizing post-treatment.   

During the treatment, you should be wearing a face mask.  You may want to greet the client from a distance and pull the face mask up once they’ve seen your smile.  This means that it is protecting them as you do the intake interview.  You may prefer to put it on just before you begin the treatment if you can maintain 6’ of distance while you do the interview.  Either way, make sure it is on and properly adjusted prior to beginning the session.

When the session is finished, leave the room with all lubricant containers that were used and your face mask.  Go immediately to your hand washing station and wash the lubricant container as you wash your hands, without setting it on a counter unwashed.  Do not remove the mask until this client has left.  With your clean hands, sanitize your sink faucet and handles.  

Greet your client as they open the treatment room door, keeping them in the treatment room for the post-massage advice for a stretch.  Make note to yourself if they touch a door frame or anything else. 

As you accept payment, be aware that they have touched the card or check they are handing you, so whatever the card or check or cash touches will have to be cleaned.  You may prefer to put checks and cash immediately into a pouch that can be sanitized before you lay it down anywhere and wash your hands again.  This is an excellent time to be able to accept electronic payment such as Zelle or Venmo. 

Any appointment-reminder handed to a client needs to be created with clean hands.  Business cards should be handed individually to the client, or keep one at a time in the display. 

Whoever opens the door as they leave now has had hands contaminated by the payment.  The inside door knob(s) will need to be cleaned.  

Quickly type or write your client notes.  If you touch the clipboard, wash your hands again before moving from the area.  Grab you cleaning supplies with your clean hands.  Wash or spray off the clipboard and pen before returning it to your treatment room.   Get out your clean linens before touching the used ones.  Pull off the used linens without shaking them and put them directly into a hamper or washing machine. Use a sanitizing solution on the plastic sheet you have covering your table and table warmer. Sanitize every knob, switch and piece of furniture or decor that you or the client may have touched, including the hand-sanitizer pump.  Wash your hands and re-dress your table.  Do not handle the clean linens without washing your hands after touching the dirty ones.  Dressing the table after you sanitize décor and doorknobs will give the sanitizer 20 seconds on the vinyl sheet.  If you can change the vinyl sheet between clients you would be on the good side of an abundance of caution. 

Sanitize the surface and keyboard you used for client notes.

Consider scheduling for cleaning

What does this mean?  It may mean that you need more time between clients while you get this routine down. Like the restaurant industry which is facing restrictions on how closely they can space tables, you may find that you need 20-30 minutes of space between clients until you learn to keep everything clean while moving quickly.  You cannot scrimp on hand-washing time.  You cannot skip hand-washing after touching an unclean surface.

This also means less is more.  Less décor in your room means fewer things a client may touch.  Clients have been known to pick up knick-knacks or straighten a picture frame.  It’s time to remove all temptation.  Observe the exam rooms next time you have a doctor or veterinarian appointment to see how easy it is to sweep through and clean the area.  

Encourage clients to not bring in a purse or backpack, and if they do, carefully spray or wash the surface where it sat.  Wiping down your client seat is important, and if they used the restroom or a sink in your room, that needs thorough cleaning as well.

Group Practices

What if you work for a clinic or group practice? Look through the treatment rooms, lobby, restrooms and breakroom with a view towards simplifying the décor.  This can be a real time-saver for cleaning.  Receptionists need to be equipped with desk shields, hand sanitizer, and cleaning supplies for all the door handles leading to and from the lobby, exterior and interior.  No-touch trash receptacles and hand sanitizer should be available to clients in every room including reception.

Policies need to be set that absolutely require employees to stay home if they are sick.

You may still find some clients are leery about coming into contact with you after you have been in contact with 3-4 other clients in a day.  If you treat medically fragile clients, you could restrict your practice to these clients who have probably practiced social distancing rigorously.  You could add a statement to your intake form asking the client to verify their adherence to that policy.  You may find that your state will require you to be able to do a forehead temperature check.  

If a client or co-worker reports they have been diagnosed or are showing signs of the virus within two weeks of seeing you, you must prepare to quarantine yourself for fourteen days from the day you saw them.  You must notify all clients you saw withing fourteen days of the carrier client’s appointment.  States will be tracing the spread of the virus and asking all of us to keep note of our contacts, so your accurate client scheduling records could be very important to tracking.

The employee breakroom and supply area are potential hotbeds.  Minimize supplies, arrange them in such a way that a therapist does not have to move around supplies to get to a particular product.  Employees should wash their hands before and after entering these areas.  Phones in these areas should have a speaker function so no one has to put a phone to their head to speak to a receptionist.  Keyboards must be sanitized after each use to check schedules or make client notes.

Each therapist should clean their own cellphone as soon as they bring it into this area, or avoid setting it on any surface. Each therapist should bring as little as possible into this room.  Sanitize food containers and surfaces on which they were used.  Eliminate clutter.

All of this applies to doing house calls. Using sample lotion packets that are disposed of in the client home reduces a carrier.  If you put an unsanitized table case in your car, you will potentially carry the virus into the next home and leave some in your car for a few days.  You need to sanitize your keys between house calls.  

Of course, your mask will have to be changed for every client.  The CDC website shows how to make a mask out of a bandana, coffee filter and ponytail bands.1   You should prepare a mask for each session, and put the bandana and elastics in your laundry in a laundry bag after removing the coffee filter for disposal.

If you are choosing to wear an apron or scrub jacket, change to a new one for each client.  You may want to change clothes and shoes after each client, depending upon the vulnerability of the next client.  With a mobile business, your safest route would be to return home after each appointment for the clothing change while being careful to not bring the virus into your home.  

After using these precautions for a few weeks, they will become more habitual and less unfamiliar.  Routine awareness can help you prepare for safe practice when the next contagion arises.  Every practice is different.  Make it a regular “scavenger hunt” to find any potential carrier in your equipment and routines.  Your clients will respect you even more for the effort you make for their safety.

References:

1.     https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/diy-cloth-face-coverings.html.  Accessed 4/18/2020