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Massage in an Era of COVID-19

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Occasionally, I invite guest contributors to this blog. Given our current situation with the COVID-19 pandemic, I thought it would be beneficial to bring in Anne Williams to discuss the issue of massage in the time of COVID-19. She is the lead author of the newly released digital textbook Preventing Disease Transmission in a Massage Practice which she has made available for FREE to anyone in the massage profession. I’d highly recommend that you get your hands on it. We have used the book as the basis of a course here at erikdalton.om and you can get CE hours and a certificate of completion for a nominal fee here.  Watch this first training video above and register for the textbook to view the other three training videos and get access to other resources. The full set of safety training videos can be found in Chapter 8 of the book. ~ Erik Dalton

The release of Preventing Disease Transmission in a Massage Practice has given me the opportunity to connect with massage practitioners across the U.S. and in other English speaking countries like Canada, Ireland, the UK, Australia, and New Zealand. Many people have asked me questions about face masks. The truth is that flashy tiger-print face covering looks great but it will not give you enough protection in the close confines of a session room. So here, I’d like to talk about what is known about the spread of COVID-19 and how this relates to the type of face mask you might choose to wear when you give massage.

Respiratory Droplets

While information continues to emerge about the ways that COVID-19 spreads from person-to-person, we know that this highly contagious virus is conveyed from an infected person to an uninfected person through large and small respiratory droplets.

When someone sneezes, coughs, laughs, sings, talks or even breathes, they release respiratory droplets into the air around them. Depending on the force behind the release of droplets these partials can travel long distances. In fact, sneezes can disperse droplets that travel 25 feet! Some droplets are heavy and fall to surfaces or the ground. Others, called aerosols are so small that they  hang in the air for a period of time before they dissipate.

Previously uninfected people can inhale infected droplets, be splattered with a fine spray that lands on the mouth, nose, or eyes when they stand close to another, or touch an object contaminated with fallen droplets and then touch their mouth, nose, or eyes giving the virus entry into their body.

In general, facemasks ensure that our own respiratory droplets don’t disperse into the air or “mist” someone standing nearby. Some masks protect against the inhalation of large droplets, while others from the inhalation of both large and small droplets. All face coverings remind us not to touch our faces with potentially contaminated hands.

Types of Masks

There are lots of different styles and types of face masks, but for our purposes we’ll want to know about face coverings, surgical masks, and respirators.

Number 1 is an image of a face covering. It is made of cotton fabric and not particularly form fitting. This is a good choice when you are able to maintain six feet of distance between you and other people. It is not a good choice while giving massage to clients or for clients to use while receiving massage. It doesn’t offer you or the client enough protection from the dispersal of droplets.

Number 2 shows disposable surgical masks. I would have these types of masks on hand to give to clients who arrive at your practice in loose face coverings or cloth masks. These masks will give you and the client more protection from respiratory droplets. Have your client wear the mask off of your facility and dispose of it in a closed trashcan when they get home.

The mask shown below is an N95 filtering face piece (FFP) respirator mask. The N stands for “not resistant to oil” and the 95 stands for “tested to block 95% of the smallest airborne particles.” This is the type of mask that will give you the most protection from large and small respiratory droplets in the enclosed space of a massage session room.

The mask shown next is a KN95 made in China or Korea. These types of masks provide about 8% less protection than an N95 FFP but more protection than surgical masks. They also are easier to obtain because the N95 masks are in short supply because they are needed by front-line health care professionals in hospitals. 

This mask with a plastic vent on the outside is called an N95 FFP with an exhalation valve. This type of mask stays cooler on your face and makes it easier to exhale. However, the valve allows a small amount of unfiltered air to escape each time you exhale. This mask gives the wearer a high level of protection but provides less protection to others in the same environment. This type of mask is not recommended for use by massage therapists.  

Currently, the CDC recommends the use of goggles when people are in close proximity, as you are when you provide massage. These keep respiratory droplets out of your eyes, which are a point of entry for SARS-CoV-2, the virus that causes COVID-19. 

Reuse Your Respirator Mask

Currently, the CDC recommends the purchase of 5 N95 masks. Wear one mask for a shift at the massage clinic Remove it properly (discussed next) and place it directly into a paper sack. Seal up the paper sack and place the sack where air will circulate around it.

The next day, wear your second mask, and the next, your third mask and so forth. If SARS-CoV-2 is present on the mask it will die before you use the mask again. Continue to recycle your masks like this until they show signs of wear and no longer conform to your face.

How to Put On and Take Off the Mask Properly

  • Before you touch your facemask, wash your hands with soap and water for 20 seconds or use an alcohol-based hand sanitizer to decontaminate your hands.
  • Cover your nose and mouth with the mask and tighten the straps to ensure that there are no gaps around the edges of the mask.
  • If you are putting on a respirator mask, place both clean hands on the mask and inhale to suck the mask into your face. Tighten the nosepiece. Respirators don’t adhere to facial hair so either shave your facial hair or use a cone shaped surgical mask instead of a respirator if you have a beard.
  • Anytime you touch the surfaces of the facemask you contaminate your hands and must clean them with handwashing or an alcohol-based hand sanitizer.
  • Remove the mask from behind using the straps to release it. Avoid touching the surfaces of the mask.
  • Place a respirator mask directly into a paper sack and seal the sack. Dispose of disposable masks in a no-touch trashcan.
  • After removing a facemask, wash your hands with soap and water or decontaminate your hands with an alcohol-based hand sanitizer.

For more information on Personal Protective Equipment (PPE) register for the Preventing Disease Transmission eCourse here on the erikdalton.com site and watch Part 2 of the COVID-19 Safety Training. These materials were updated October 13, to reflect changes and updates in CDC and World Health Organization information and recommendations. 

Get CE Hours and a Certificate of Completion

Erik Dalton has agreed to provide a CE course based on the Preventing Disease Transmission in a Massage Practice book. The eight digital chapters that comprise this guide boast over 185 images, 20 activities, four training videos (the first one is posted above), and 8 quizzes on an interactive learning platform that ensures content is engaging, organized, and fun. Downloads provide checklists and client education materials. This guide is accessible on any device: desktop, laptop, tablet or mobile.

You’ll find this resource invaluable as you make the decision as to whether you will return to work or not. And if you have decided to reopen, the resources and guidelines will help ensure that you minimize the risk of transmission in your practice and that you and your clients stay as safe as possible. 

We are not planning on becoming approved continuing education providers. It involves a lot of administrative work that we just don’t have time for. However, Erik Dalton, has kindly offered to help therapists with CE and has had the content approved for 8 hours of CE with NCBTMB. He is hosting a final examination, which therapists can take for a nominal fee if they want to obtain CE hours for mastering the content in the digital textbook.

Anne Williams

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