Key Principles
Chain of Transmission
Every infection requires six links in a chain. Breaking any one link prevents transmission:
1.
Infectious agent — pathogen (bacteria, virus, fungus, parasite, prion).
2.
Reservoir — where the pathogen lives and multiplies (person, environment, equipment).
3.
Portal of exit — how the pathogen leaves the reservoir (respiratory secretions, blood, skin lesions).
4.
Mode of transmission — how the pathogen travels (contact, droplet, airborne, vehicle, vector).
5.
Portal of entry — how the pathogen enters the new host (broken skin, mucous membranes, respiratory tract).
6.
Susceptible host — a person without sufficient immunity or barriers.
Standard Precautions
Standard precautions apply to
every client, every session, regardless of known or suspected infection status. They include:
- Hand hygiene (see 4 Moments below).
- Use of personal protective equipment (PPE) when exposure to blood or body fluids is anticipated.
- Respiratory hygiene / cough etiquette.
- Safe handling of contaminated equipment and linens.
- Environmental cleaning and disinfection.
- Safe injection practices (not applicable to standard MT but relevant for acupuncture-authorized RMTs).
Hand Hygiene: The 4 Moments
The Public Health Ontario (PHO) 4 Moments for Hand Hygiene framework adapted for MT:
| Moment |
When |
Why |
| 1. Before initial client contact |
Before handshake, before beginning assessment or palpation |
Protect the client from organisms on your hands |
| 2. Before a clean/aseptic procedure |
Before applying lotion/oil from a communal container, before wound-adjacent work |
Prevent introducing organisms to vulnerable sites |
| 3. After body fluid exposure risk |
After contact with blood, mucous membranes, non-intact skin, or wound dressings |
Protect yourself and prevent cross-contamination |
| 4. After client contact |
After completing treatment, after removing gloves |
Protect yourself and the clinic environment |
- Alcohol-based hand rub (ABHR): Preferred when hands are not visibly soiled. Apply enough product to cover all surfaces; rub for at least 15 seconds until dry. Do not wipe off.
- Soap and water wash: Required when hands are visibly soiled, after contact with blood or body fluids, and after caring for clients with known C. difficile or norovirus. Wet hands, apply soap, lather all surfaces for at least 15 seconds, rinse, pat dry with disposable towel, use towel to turn off faucet.
- Nails: Short, clean, no artificial nails or nail enhancements. Organisms harbor under long or artificial nails.
Linen Management
- Use clean linens (sheets, pillowcases, face cradle covers, bolster covers) for every client.
- Soiled linens go directly into a designated laundry hamper — never on the floor or treatment table.
- Wash linens in hot water (at least 60 degrees C / 140 degrees F) with detergent. Commercial laundry services are acceptable.
- Linens contaminated with blood or body fluids: handle with gloves, wash separately, use bleach or an appropriate disinfectant additive.
- Store clean linens in a clean, enclosed area (not exposed to the treatment room environment).
Equipment Cleaning, Disinfection, and Sterilization
Three levels of reprocessing based on risk:
| Level |
Definition |
When Used |
Examples |
| Cleaning |
Physical removal of organic matter and contaminants |
All items after every use |
Treatment table surfaces, bolsters, oil bottles, goniometers |
| Low-level disinfection |
Kills most bacteria, some viruses and fungi |
Non-critical items (contact intact skin only) |
Treatment table, face cradle, hot packs, cold packs |
| High-level disinfection / sterilization |
Kills all organisms including spores |
Semi-critical / critical items (contact mucous membranes or non-intact skin) |
Acupuncture needles (single-use preferred), cupping devices that contact broken skin |
1. Remove all linens.
2. Clean visible soiling with soap and water.
3. Apply low-level disinfectant (quaternary ammonium compound or accelerated hydrogen peroxide) to all surfaces.
4. Allow appropriate contact time per manufacturer's instructions (typically 1-3 minutes).
5. Allow to air dry or wipe with a clean cloth after contact time.
Lubricant containers:
- Use pump-style dispensers (not open jars) to prevent cross-contamination.
- If using jars, dispense lubricant with a clean spatula or single-use applicator — never re-dip hands into the container.
- Clean exterior of containers regularly.
Personal Protective Equipment (PPE)
- Gloves: Wear when contact with blood, body fluids, non-intact skin, or mucous membranes is anticipated. Change between clients and between tasks with the same client if contamination occurs.
- Mask: Wear when the client has respiratory symptoms or during aerosol-generating situations. Consider routine masking based on current public health guidance.
- Eye protection: Wear if splashing of blood or body fluids is possible (rare in standard MT).
- Gown: Wear if clothing contamination is likely (rare in standard MT).
Bloodborne Pathogen Exposure Protocol
If you experience a needlestick (acupuncture), cut, or mucous membrane exposure to a client's blood or body fluids:
1.
Immediate first aid: Wash the wound with soap and water. Flush mucous membranes (eyes, mouth) with water. Do not squeeze the wound.
2.
Report: Notify the clinic manager or, if self-employed, document the incident immediately.
3.
Seek medical attention: Go to the nearest emergency department or occupational health clinic within 1-2 hours. Post-exposure prophylaxis (PEP) for HIV is time-sensitive.
4.
Document: Record the date, time, nature of exposure, actions taken, and follow-up plan in an incident report.
5.
Follow up: Complete recommended blood testing at baseline, 6 weeks, 3 months, and 6 months as directed by the treating physician.
Screening and Rescheduling
- Screen clients for signs and symptoms of contagious illness before every session.
- Reschedule clients presenting with fever, active respiratory infection, active skin infection in the treatment area, or other contagious conditions.
- RMTs should not treat clients when they themselves are symptomatic with a contagious illness.
