massage schools of queensland - amazon s3...massage schools of queensland australia po box 6782...

Massage Schools of Queensland Australia

Po Box 6782 Level 1, 36 Kortum Dr

GCMC Qld 9726 Burleigh Heads Qld 4220

Ph. 55766 366 F: 55766 398

E: [email protected] W: www.massageschools.com.au

Safety &

Hygiene

mailto:[email protected]

http://www.massageschools.com.au/

Massage Schools of Queensland

Version Control Document: V/WHS Student Notes 09814

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Table of Contents UNIT DESCRIPTION ................................................................................................................................................. 5

REQUIRED SKILLS AND KNOWLEDGE - HLTWHS300A ........................................................................................ 5

REQUIRED SKILLS AND KNOWLEDGE – HLTIN301C ............................................................................................ 7

METHOD OF DELIVERY: ...................................................................................................................................... 9

METHODS OF ASSESSMENT.............................................................................................................................. 10

SECTION 1 ............................................................................................................................................................. 11

What is Work Health and Safety?..................................................................................................................... 11

Role of the WHS Act, Regulation, Ministerial Notice and Code of Practice. ................................................ 11

Duty of care in the massage workplace ....................................................................................................... 13

AUSTRALIAN STANDARDS FOR WHS ............................................................................................................ 14

HAZARDS AND RISK MANAGEMENT ............................................................................................................. 15

WHS – For Employees ................................................................................................................................... 22

Communication in the Workplace ................................................................................................................ 23

Workplace Inspections ................................................................................................................................. 23

Emergency plans ........................................................................................................................................... 28

Safety Signs ................................................................................................................................................... 31

SECTION 2 ............................................................................................................................................................. 34

INFECTION CONTROL ........................................................................................................................................ 34

Principles of Infection Control ...................................................................................................................... 34

Disease & Microbiology ................................................................................................................................ 34

Contagious & Non Contagious Skin Disorders .............................................................................................. 35

Standard Precautions ................................................................................................................................... 37

Additional Precautions Implementation ...................................................................................................... 38




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Transmission-Based Precautions .................................................................................................................. 39

HAND WASHING ........................................................................................................................................... 39

Other hand hygiene considerations ............................................................................................................. 42

Personal Hygiene ......................................................................................................................................... 43

Personal protective equipment (PPE) .......................................................................................................... 43

Safe handling, use and disposal of sharp instruments ................................................................................. 44

Disinfection and sterilisation ........................................................................................................................ 45

Management of Waste ................................................................................................................................. 47

Management of Linen .................................................................................................................................. 50

Routine cleaning of facilities and surfaces ................................................................................................... 52

Spills management ....................................................................................................................................... 53

Preventing Cross-Infection between Clients ................................................................................................ 55

Hygiene standards to avoid contamination ................................................................................................. 58

GLOSSARY ......................................................................................................................................................... 59

REFERENCES & RECOMMENED READING ........................................................................................................ 63




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UNIT DESCRIPTION

HLTWHS300A: This unit specifies the workplace performance required by an employee to

contribute to WHS processes where there is responsibility for own work outputs and possibly limited

responsibility for the work output of others

HLTIN301C: This unit of competency describes the skills and knowledge required for workers

to comply with infection control policies and procedures. All procedures must be carried out in

accordance with current infection control guidelines, Australian and New Zealand Standards for

maintaining infection control and the policies and procedures of the organisation.

This unit acknowledges the importance of complying with an effective infection control strategy that

ensures the safety of the client (or end-user of health-related products/services), maintains personal

protection and prevents the transmission of infections from person to person.

All tasks must be carried out in accordance with State or Territory legislative requirements that affect

work practices of the organisation and/or worker

REQUIRED SKILLS AND KNOWLEDGE - HLTWHS300A

This describes the essential skills and knowledge and their level required for this unit.

Essential Knowledge:

The candidate must be able to demonstrate essential knowledge required to effectively do the task

outlined in elements and performance criteria of this unit, manage the task and manage contingencies in

the context of the identified work role

This includes knowledge of:



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Basic hazard identification procedures such as workplace inspections and review of workplace

data

Hierarchy of control and its application

Nature of common workplace hazards relevant to work role

Personal protective equipment (PPE) requirements including use, storage and maintenance

Principles of basic risk assessment

Relationship between WHS and sustainability in the workplace, including the contribution of

maintaining health and safety to environmental, economic, workforce and social sustainability

Roles and responsibilities of employees, supervisors and managers in the workplace

Roles and responsibilities of WHS representatives and WHS committees

Safety signs and their meanings, including signs for:

o dangerous goods class signs

o emergency equipment

o personal protective equipment

o specific hazards such as sharps, radiation

Sources of WHS information within the workplace and awareness of external sources of WHS

information

Standard emergency signals, alarms and required responses

The difference between hazard and risk

The legal rights and responsibilities of the workplace parties

Workplace specific information including:

hazards of the particular work environment

hazard identification procedures relevant to the hazards in their workplace

designated person(s) for raising WHS issues





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organisation and work procedures particularly those related to performance of own work,

specific hazards and risk control, reporting of hazards, incidents and injuries and WHS issue

resolution, consultation, use of PPE and emergency response

potential emergency situations, alarms and signals and required response

Essential Skills:

It is critical that the candidate demonstrate the ability to contribute to WHS processes in the work

context by:

addressing their own health and safety

addressing health and safety of others who may be affected by their actions

supporting members of the workgroup who may be less experienced in the workplace in regard

to WHS matters

taking initiative to address hazards and manage risks at a systemic level

REQUIRED SKILLS AND KNOWLEDGE – HLTIN301C

To demonstrate competence for this unit the worker must acquire the essential knowledge and skills

described:

Essential Knowledge:

The candidate must be able to demonstrate essential knowledge required to effectively do the task

outlined in elements and performance criteria of this unit, manage the task and manage contingencies in

the context of the identified work role

This includes knowledge of:

Additional precautions

Aspects of infectious diseases including:

o opportunistic organisms





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o pathogens

Basic microbiology including:

o bacteria and bacterial spores

o fungi

o viruses

Clean and sterile techniques

Disease transmission:

o paths of transmission including direct contact, aerosols and penetrating injuries

o risk of acquisition

o sources of infecting microorganisms including persons who are carriers, in the incubation

phase of the disease or those who are acutely ill

Effective hand hygiene:

o procedures for routine hand wash

o procedures for surgical hand wash

o when hands must be washed

Good personal hygiene practice including hand care

Identification and management of infectious risks in the workplace

Organisation requirements relating to immunisation, where applicable

Personal protective equipment:

o guidelines for glove use

o guidelines for wearing gowns and waterproof aprons

o guidelines for wearing masks as required

o guidelines for wearing protective glasses

Standard precautions

Susceptible hosts including persons who are immune suppressed, have chronic diseases such as

diabetes and the very young or very old





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Surface cleaning:

o cleaning procedures at the start and end of the day

o managing a blood or body fluid spill

o routine surface cleaning

Sharps handling and disposal techniques

The organisation's infection control policies and procedures

Essential Skills:

It is critical that the candidate demonstrate the ability to:

Consistently apply hand washing, personal hygiene and personal protection protocols

Consistently apply clean and sterile techniques

Consistently apply protocols to limit contamination

METHOD OF DELIVERY:

Each session is of 3 hours duration and is a combination of theory and practical hands on work. Session

hand outs are provided and students are advised that some note taking is recommended, and

assessments to be completed on or before due date.

Two-way sharing of information and experience is encouraged in all classes.

SESSION PLAN:

SESSION 1 Introduction to WHS

Introduction to Infection Control





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Assessment requirements for WHS & Infection Control

Class discussion

SESSION 2 Practical assessments for WHS & Infection Control

Clinical Procedures for MSQ

METHODS OF ASSESSMENT All units being assessed are competency based and your assessment will be defined as:

C – Competent or

NYC – Not Yet Competent

ASSESSMENTS

Please see attached Student assessment handout





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SECTION 1

What is Work Health and Safety?

Workplace Health and Safety (WHS) in Australia aims to prevent injury and disease to persons in the

workplace. Employers must comply with the State, Territory or Commonwealth WHS legislation which

applies to them.

Nationally uniform laws

Nationally uniform laws ensure all workers in Australia have the same standard of health and safety protection, regardless of the work they do or where they work. The laws replaced existing work health and safety legislation in all states, territories and the Commonwealth from 1 January 2012. Nationally uniform work health and safety laws means greater certainty for employers (particularly those operating across state borders) and, over time, reduced compliance costs for business. More consultation between employers, workers, and their representatives, along with clearer responsibilities will make workplaces safer for everyone.

Role of the WHS Act, Regulation, Ministerial Notice and Code of Practice.

In Queensland the current legislation is:

Work Health & Safety Act of 2011; Work Health and Safety

Regulation2011

In New South Wales the current legislation is:

Work Health and Safety Act 2011 ; Work Health and Safety Regulation 2011.

The Act places obligations on people who can affect the work health and safety of others or themselves

by what they do or fail to do in the workplace.

The Regulation provides a framework for managing these work health and safety obligations. It states

the way a person can discharge their work health and safety obligations.

http://www.legislation.nsw.gov.au/maintop/view/inforce/act+10+2011+cd+0+N

http://www.legislation.nsw.gov.au/maintop/view/inforce/subordleg+674+2011+cd+0+N





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A Ministerial Notices is released when the Minister identifies a risk for person or property and believes

that urgent action should be taken.

A Code of Practice does not specify everything that you should or should not do to meet your

obligations. However an employer or worker would fail to meet their obligations if they went against or

acted inconsistently with a code of practice or did not adopt a method as safe as, or safer than a code.

You must abide by the Act, Regulation and Ministerial Notice.

The web address for the latest WHS legislation for Queensland can be found at:

https://www.legislation.qld.gov.au/LEGISLTN/CURRENT/W/WorkHSA11.pdf

Workplace Health & Safety Legislation

Under the Workplace Health & Safety Act of 2011, the organisation / business has an obligation to

ensure the workplace health and safety of:

Management, staff;

Clients, visitors and contractors;

All other persons to the extent that they are not affected by the way we conduct our business.

The Act places the onus of workplace safety on all individuals concerned. Rather than a set of ‘rules’,

there is an accepted ‘Duty of Care’ undertaken by both employers and employees.

Basically this means that:

Employers have a duty of care to provide a safe working environment for employees

Employees have a duty of care to work safely in the workplace.

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Duty of care in the massage workplace

To provide a safe working environment for clients, duty of care pertains to the massage therapist’s

ethical and legal obligation to avoid acts or omissions that are likely to cause harm to their clients. It is

the appropriate and responsible application of professional knowledge and skill.

Many employees live under the premise that not only is their workplace compliant with the Workplace

Health and Safety (WH&S) legislation, but that they are not liable should the Act be breached.

In 2005 the Queensland State Government amended the WH&S Act to increase the obligations of those

in control of workplaces. General Managers and Line Managers can potentially be in the firing line as well

as Directors and Board members. There is reciprocal legislation across Australia.

The legislation is designed to prevent a person's death, injury or illness being caused by a workplace. The

fact is that it is impossible to eliminate risk from a workplace. But the workplace health and safety act

provides a framework around which businesses are required to put policies in place, that ensure the

workplace is free of risks to employees and those of others. Regardless of the legislation, it is critical to

build a safety culture at work.

Employees that hold managerial responsibility need to be aware that they are responsible for the

workplace environment they offer to people that work there. Individuals may be liable for a penalty of a

maximum of $75,000 for death or grievous bodily harm with a maximum of two years in imprisonment.

Businesses can ensure compliance through:

Train and educate staff diligently

Ensure detailed systems and procedures are in place

Adhere to all prescribed codes of practice or standards where relevant

Accept risk can never be fully eliminated

Focus on creating a safety culture and behaviour based compliance program

Have an incident response plan

Meeting Your Obligations under the Workplace Health & Safety Act 2011:

WH&S Officer will carry out regular risk assessments and put appropriate control measures in

place to minimise the risk of injury and illness to yourself and others.

Risk assessments will be carried out at regularly documented intervals.

Risk assessments will also be carried out whenever a potential risk or hazard is brought to the

attention of the nominated WH&S Officer / representative.





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Nominated Workplace Health & Safety Officer:

If the organisation employs more than 30 people, they must nominate a Workplace Health &

Safety Officer, who must be appropriately trained to the national standard.

If the organisation has less than 30 persons, a representative must be nominated and act

accordingly in line with the obligations of the Act. In a small business, this is generally the

business owner / operator.

AUSTRALIAN STANDARDS FOR WHS

Standards are developed and issued by regulatory bodies. Standards Australia set minimum levels of

quality or specifications for products, equipment and material used in the workplace for health and

safety.

Standards are not law unless they are incorporated into legislation. Some examples of standards are –

• AS/NZS 4804-2001 – Occupational Health and Safety Management Systems

• AS/NZS 1269.3:1998 – Occupational Noise Management

• AS 3745-2002 Emergency Control Organisation and Procedures for

Buildings, Structures and Workplaces.

Please note, that compliance to WHS standards does not mean compliance to

WHS legislation or codes.

So, to fit all this together, consider the hazard of excessive noise at the workplace.

Noise is a physical hazard; excessive noise at work causes noise induced hearing

loss. Hearing loss caused by noise cannot be replaced by a hearing aid or surgical

procedure. Having to turn the TV and radio up louder at the end of a day’s work is indication that

hearing loss is happening. Ringing in the ears is another common indication that excessive noise is doing

damage to the inner ear. WHS legislation is in place to prevent this.

As an example – the WHS Act states that the employer “is to eliminate or control hazards arising from

work” – noise is a hazard.

The Regulation states that “noise must not exceed an eight hour level equivalent of 85dB OR a peak of

more than 140 dB.

The Code of Practice “noise management and protection of hearing at work” (NWHSC 2009, 2004) gives

detailed information about how the limits set by the Regulation can be met.





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So, in summary, all employers must ensure that codes, regulations and acts are adhered to in their

entirety. With this in mind, many businesses employ WHS companies to manage and design WHS

strategies for their employers.

HAZARDS AND RISK MANAGEMENT

Hazard identification is a process of identifying sources of harm, and may be required:

before new forms of work and organisation of work are implemented

before changes are made to workplace, equipment, work processes or work arrangements

as part of planning major tasks or activities, such as equipment shutdowns

following an incident report

when new knowledge becomes available

at regular intervals during normal operations

prior to disposal of equipment, or materials

A hazard is:

a source or situation with the potential for harm in terms of human injury or ill-

health, damage to property, the environment, or a combination of these.

Specific hazards may include, but are not limited to:

Alarms

Bodily fluids

Burnout (compassion fatigue)

Chemicals

Computer use

Cytotoxic medicines and waste

Defusing violent behaviour

Egress from rooms





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Managing violent behaviour on outreach and home visits

Manual handling

Manual handling (boxes)

Moving parts of machinery

Noise

Rostering

Sharps

Trips falls etc

Underfoot hazards

Violence in the workplace

Work posture

Other workplace hazards may include:

Occupational violence

Stress

Fatigue

Bullying

Risk:

In relation to any hazard, means the probability and consequences of injury, illness or damage resulting

from exposure to a hazard.





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Residual risk is the risk which remains after controls have been implemented

Examples of risks requiring management in a direct client care work environment may include:

Worker fatigue or burnout requiring appropriate supervision and stress management

Injury or damage resulting from violent or aggressive behaviour, requiring strategies to defuse or

avoid behaviours of concern

Risks relating to working in client's homes, requiring appropriate worker education and

associated strategies

Fire in client's homes requiring workers to provide basic information on home fire safety

Examples of workplace hazards in a Massage Clinic Environment

Unstable massage table

OIL spills

Candles /Aromatherapy oils/Incense left unattended

Clutter around massage table

Electrical cables etc around floor

Therapist Burnout/Poor body mechanics





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Noise

Slippery floors

Overflowing waste bin

Electrical fan or faulty heaters-

Risk Management – Rick Control Measures

1. If it is not reasonably practicable for the duty holder to eliminate risks to health and safety then

they must implement risk control measures.

They must do so by doing 1 or more of the following:

2. Substitution (wholly or partly) the hazard with something that gives rise to lesser risk;

3. Isolating the hazard from any person exposed to it;

4. Implementing engineering controls

5. If the risk then remains, the duty holder must minimize the remaining risk, so far as is reasonably

practicable, by implementing administrative controls;

6. If the risk then remains, by ensuring the provision

and use of suitable personal protective equipment.

The duty holder must ensure the control measure is

implemented and maintained and reviewed where

required.

In assessing the risk: - consider the following:

Nature of the hazard and associated risks

Hazard severity and health effects

Duration / frequency of exposure to risk

Probability that an event may occur

Risk Control Measures:





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1. Elimination / substitution of cause of hazard. The hazard is to be eliminated altogether, or

substituted by something that poses lower / no risk. IE, replace a hazardous substance with one

less hazardous.

2. Engineering controls – make changes in the work environment or work process which places a

barrier, or interrupts the transmission path, between the person/s and the hazard. IE, guarding /

signage of dangerous machinery parts is an example.

3. Administrative controls – which prevent or minimise exposure to a hazard. IE, appropriate

instruction / advice to trainees / staff / other persons to ensure healthy & safe outcomes.

Examples:

instruction to clients in instance of slippery floor surfaces

instruction to relevant persons relating to the safe

handling of essential oils

instruction to relevant persons relating to First Aid /

Emergency procedures

instruction to relevant persons relating to Emergency

Evacuation procedures

instruction to relevant persons relating to Fire Fighting procedures

Personal protective equipment (PPE) – to be worn as a barrier between persons and the hazard.

Examples:

Chemical mask to be worn by staff members when dealing with bulk amounts of essential oils

In some instances, a combination of two or more of the above Risk Control Measures may be

appropriate.

Management of risk obligation for hazardous chemicals and asbestos

Hazardous chemicals

The Work Health and Safety Regulation specifically require the risk associate with the handling and

storage of hazardous chemicals in the conducted of a business or undertaking are controlled to ensure

work health and safety.





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Manufactures and suppliers must ensure hazardous chemicals are classified, appropriately stored and

safety data sheets are supplied.

A person conducting a business or undertaking must manage risks to health and safety associated with

using, handling, generating or storing hazardous chemicals at the workplace.

In managing risk the person must have regard to the following:

The hazardous properties of the hazardous chemicals;

Any potentially hazardous or physical reaction between the hazardous chemical and another

substance or mixture, including a substance that may be generated by the reaction;

The nature of the work to be carried out with the hazardous chemical;

Any structure, plant or system of work:

o That is used in the use, handling, generation or storage of the hazardous chemical; or

o That could interact with the hazardous chemical at the workplace.





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Safety Data Sheets

A safety data sheet for a hazardous chemical must:

Contain unit measures expressed in Australian legal units of

measurement;

State the date it was last reviewed;

State the name, and Australia address and business telephone

number of the manufacturer or the importer;

State an Australian business telephone number for information about the chemical can be

obtained in an emergency;

Be in English.

As well the following information about the hazardous chemical must be included:

Product identifier and chemical identifier;

Hazard identifier;

Composition and information on ingredients;

First aid measures;

Fire fighting measures;

Accidental release measures;

Handling and storage, including how the chemical may be safely used;

Exposure control and personal protection;

Physical and chemical properties;

Stability and reactivity;

Toxicological information;

Ecological information;

Disposal consideration;

Transport information;

Regulatory information;





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Any other relevant information.

WHS – For Employees

It is imperative that in any workplace, in any industry and organisation, each employee is proactive in

maintaining a clear, clean and tidy work area.

Prevention of accident, injury and illness in the workplace involves a commitment from management,

the unions and most importantly, employees. It is the responsibility of each employee to maintain the

equipment that they use and to notify any malfunction to a supervisor. It essentially has a snow-ball

effect, and continues to affect not just the person who forgot to notify the equipment malfunctions in

office hours.

Within a massage therapy practice, and with the concept of infection control embedded in our matrix, it

is almost common sense to ensure clean equipment and correct storage of equipment. This includes

disposal of soiled linen, or any other hazardous waste. Emptying bins is each therapist’s responsibility –

ensure that you are aware as overflowing bins are both a WHS hazard and risk, and an infection control

risk.

WHS is generally, in most health facilities, a major component of mandatory training to be attended

annually. Within this lecture/talk, the employees are updated on any changes to the WHS policies

directly affecting their work environment. These lectures also generally

entail ensuring clear exits and walkways, uncluttered massage table spaces,

and equipment storage.

Ongoing WHS training and education for staff at all levels is essential for

the prevention of accidents and the maintenance of a safe workplace. All

personnel within an organisation must be committed to an active

workplace health and safety program. Managers, union representatives

and employees must all participate in safety programs. So whilst some

staff will complain about it and do what they can to get out of it, it is a

responsibility for all staff to attend.

The following are not specific to health care or the provision of health care, but are the NSW WHS

guidelines -

Management must provide a safe work environment and provide and promote a health and

safety program.

Unions should support management on safety issues and have input into safety initiatives.

Employees must always work with a safe attitude and safe work practices and participate in

health and safety programs that are provided.





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There must be open communication and consultation between employees and management

regarding health and safety issues.

In most organisations there will be certain mandatory programs that must be undertaken at the

commencement of employment regarding health and safety. Certain programs may also have to be

attended annually. Records will be kept of such attendance.

In any case, WHS is a responsibility of all employees, not just employers

Communication in the Workplace

Analysis of things that go wrong with WHS consultation issues frequently reveals communication

breakdown to be a major cause of problems. It might be a body gesture, a written instruction, a diagram

or verbal message that is misunderstood.

Individuals may hear the words you say, but interpret your message incorrectly, or they might miss one

key work, which could in effect alter the meaning. And for the people who did not attend the verbal

information, the writing down by staff attending might also be altered unintentionally.

Some individuals may not pick up 70% of your verbal message. A lot depends on how focused they are

when they are listening, how well they hear what you are saying, or whether they are interested in what

you are saying. You may well have experienced this in every day working life!

WHS committee members may have to communicate verbally with people in situations where their

message is important for their own safety. Within the health care system, there are mechanisms in place

to ensure that information is disseminated and received by all. Some examples are:

Signed acknowledgement of safety recall on devices/equipment

Signed acknowledgement of changes to the hazard log

Ward communication books entailing broken equipment etc

In-service education provided to safely manage new equipment

Company issued documentation concerning safety issues

New guidelines issued by product manufacturers or pharmacological companies

Three simple ways for employers to consult with workers concerning their health, welfare and safety are

regular meetings, notice boards, suggestion boxes, and health & safety committee

Workplace Inspections





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Regular inspections of the workplace allow discussion with employees on health and safety issues to take

place. Consultation between management and employees can only enhance health and safety

performance.

Workplace inspections are planned; systematic appraisals of the workplace which can help identify

hazards, assess and control risks, ensure a safe and healthy working environment and assist in complying

with WHS legislation.

Inspections are generally carried out by management representatives and health and safety

representatives or members of the WHS committee. Employees can also be involved.

Inspections can take various forms and are usually classified according to the purpose

of the inspection, for example:

Routine hazard inspections of the workplace

Routine inspections of particular activities, processes or areas

Specific inspections arising from complaints by employees

Accident and incident investigations

Follow-up inspections after implementing measures to improve health and safety

The main reason for undertaking inspections is to identify the health and safety

hazards in the workplace. During inspections, health and safety issues can often

be identified and resolved before any harmful event takes place.

Inspections also help to identify whether measures are in place to ensure the

workplace complies with all relevant health and safety legislations. Regular

inspections of the workplace allow discussion with employees of health and safety

issues to take place. It is the employees who are most familiar with all aspects of the work, equipment

and processes within the workplace and they are an invaluable source of information. Consultation

between management and employees can only enhance health and safety performance.

Routine hazard inspections of workplace activities should occur regularly, but their frequency will

depend on the nature and circumstances of each workplace. Investigations to investigate specific

problems should be scheduled at a time when the problems are most clearly showing to enable to most

useful accurate information to be gathered.

When the areas for routine inspection have been established, simple questions or checklists which can

be systematically completed during inspections should be prepared. Checklists will help save time and





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help ensure a thorough inspection is carried out. They can form the basis of a comprehensive review of

workplace practices on a regular basis. Checklists will vary according to the workplace environment.

The types of hazards present will determine the areas covered in a checklist. Some of the areas to cover

include:

Manual handling hazards

Housekeeping – floors, work benches, ladders and walkways

Machinery – moving parts, waste disposal, noise levels

Working at height

Chemical hazards – fumes, gases, storage, labelling, handling, material safety data sheets, PPE

Fire safety – fire fighting equipment, access and exits, alarm systems, instructions for employees

First aid provisions

Because each workplace is different, it is important to develop checklists which match the actual design

and processes of the workplace. Tailoring inspection checklists to suit the workplace will ensure that all

existing and potential health and safety problems can be identified.

For Example – Massage Schools of Queensland WHS Policy & Procedures

Workplace Health and Safety Officer (WHS Officer) = Head of School - Rhona McKay

All WHS hazards, risks, possible injuries and injuries/accidents MUST be reported to WHS officer –

IMMEDIATELY

In the event that Rhona McKay is off-site – report to the following:

MSQ Student Clinic - Student practitioners should report WHS issues/concerns to clinic

supervisor

Sessions - Students should report WHS issues/concerns to their (Trainer/Assessor)

On campus - Students should report WHS issues/concerns to administration team i.e.

Please refer to MSQ Student Handbook for further information on MSQ WHS Policies and Procedures.

Risk/hazard Prevention

Infectious disease/condition Follow infection control procedures





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Examples:

HIV, Hepatitis

Respiratory infections – colds, flu

Skin infections – esp. hand and nails

Examples:

Wash hands

Appropriate cleansing & sterilization techniques

Manual Handling / Lifting risks

Example

Lifting portable massage table

Follow WHS procedures

Use appropriate manual handling / lifting procedures

Do education/training courses in manual handling/WHS

Repetitive strain injuries (RSI)

Examples:

Rotator cuff injury

Carpal tunnel syndrome

Follow WHS procedures

Take appropriate and regular breaks between clients and

limit number of massages performed daily/weekly

Utilise stretching and strengthening exercises for

muscle/joint areas used repetitively in massage work

Seek treatment from health professionals i.e. massage

therapist, occupational therapist, osteopath, chiropractor,

physiotherapist, etc

Back Injury Follow WHS procedures

Maintain correct body mechanics at all times

Use appropriate manual handling techniques



Utilise stretching and strengthening exercises for

muscle/joint areas used repetitively in massage work

Seek treatment from health professionals i.e. massage

therapist, occupational therapist, osteopath, chiropractor,

physiotherapist, etc

Trips/slips/falls Follow WHS procedures

Implement spill management procedures especially in

relation to oil spills

Have designated area for clients clothes/shoes away from





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massage table

Enough space in treatment room to transition around

massage table comfortably

Emotional/psychological stresses

Examples:

White coat syndrome – stress of seeing

clients and their view of you the therapist

Status stress – dealing with clients from

diverse cultural, religious and status

backgrounds

Know your professional limitations when dealing with

emotional/psychological/counselling issues with clients –

refer to appropriate health professional

Seek treatment from health professionals i.e. counsellor,

psychologist, psychiatrist, etc

Professional development education – cultural,

communication, counselling skills, etc

Personal development courses

Support network – friends, family and colleagues - other

massage therapists and health professionals

Motor vehicle accidents – mobile massage Leave enough time to get from appointment to

appointment

Mechanically sound, reliable and appropriate transport

vehicle

Employer/client pressure Follow WHS procedures

Do not overbook

Know the appropriate legislation that covers you

regarding WHS and industrial relations so that you are not

overused, overbooked and underpaid







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Emergency plans

A person conducting a business or undertaking must ensure that an emergency plan is prepared for the

workplace that provides:

1. Emergency procedure, including:

An effective response to an emergency;

Evacuation procedures;

Notification of emergency services at the earliest opportunity;

Medical treatment and assistance; and

Effective communication between the person authorized by the person conducting the business

or undertaking to coordinate the emergency response and all persons at the workplace.

2. Testing of the emergency procedures, including how often they should be tested;

3. Information, training and instruction to relevant workers in relation to implementing the

emergency procedure.

There are different types of emergency situations, including fire or explosion, dangerous chemical

release, medical emergency, natural disaster, bomb threats, violence or robbery.

In preparing and maintaining an emergency plan, the following must be taken into account:

The particular work being carries out at the workplace;

The specific hazards at the workplace;

The size and location of a workplace;

The number and composition of the workers and other people at a workplace.

Evacuation procedures should be displayed in a prominent place, for example on a notice board.

Workers must be instructed and trained in the procedures. The standard AS3745 Planning for

emergencies in facilities provides guidance.





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Example Organizational Procedures for the following hazardous situations:

Emergency Evacuation Procedures

EVACUATE ON SIREN

CALL 000 (mobile 112)

PROCEED TO DESIGNATED EVACUATION ASSEMBLY AREA

Fire Procedures

SOUND ALARM – ADVISE ALL PERSONS

USE FIRE EXTINGUISHER / BLANKET


EVACUATE THE PREMISES TO ASSEMBLY AREA

Client requiring medical assistance:

REPORT TO FRIST-AID OFFICER. OR ADMINISTER FIRST-AID


REPORT DETAILS ON INJURY REPORT FORM

It is important to write a report of any accident that may occur in a massage clinic environment, why…

Legal requirements;

as a reference if issue escalates;

insurance purposes & protection.

Information you should record on your accident / incident report form includes:

Date, time,

witness, names,

address of incident,

cause, injuries sustained,

phone calls made and what time,

first-aid administered and pulse.





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Fire extinguishers

Portable Fire Extinguishers can save lives and property by putting out or containing fires within the

capability of the extinguisher. However, they must be of the correct type for the particular fire, and they

must be used correctly.

Selection of Fire Extinguishers

There are a number of types of portable fire extinguishers available in Australia. Each type of

extinguisher may be rated for one or more classes of fire.

The classes of fire are:

Class A Ordinary Combustibles

Class B Flammable and combustible liquids

Class C Flammable gases

Class D Combustible metals

Class E Electrically energised equipment

Class F Cooking oils and fats

Portable fire extinguishers are distinguishable by their labels and their colouring.

The most common types of extinguishers are:

Water - solid red Suitable for Class A fires. Not considered effective for Class B and Class C fires, and dangerous if used for electrically energised equipment or cooking oils or fats.

Foam - red with blue band or label (previously solid blue). Suitable for Class A and Class B fires, with limited effectiveness for Class F fires. Not considered effective for Class C fires, and dangerous if used for electrically energised equipment.

Powder - red with a white band or label. These extinguishers are rated as either ABE or BE. ABE rated extinguishers are considered suitable for Class A, Class B, Class C and Class E fires. They are not considered effective for Class F fires. BE rated extinguishers are considered suitable for Class B, Class C and Class E fires, and may be used with limited effectiveness on Class F fires. They are considered effective for Class A fires.

Carbon Dioxide (CO2) - Red with a black band or label. Suitable for Class E fires, has limited effectiveness on Class A, Class B and Class F fires.

Vaporising Liquid - Red with Yellow band or label. Suitable for Class A and Class E fires, has limited effectiveness on Class B fires, not considered effective for Class F fires.





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Wet Chemical - Red with an Oatmeal band or label (previously oatmeal colour). Suitable on Class F fires and may be used on Class A fires. Not considered effective for Class B or Class C fires and dangerous if used on Class E fires.

Class D fires require special purpose extinguishers.

It is recommended that the extinguisher meet Australian Standards approval as per AS1841.6

An Extinguisher Guide is available at www.fpaa.com.au

Safety Signs

Safety signs communicate work health and safety messages and play an important part in

providing duty of care. Australian Standard AS1319 Part 1 Safety signs for the occupational

environment outlines the wording, design, format and colour of signs required under Work

Health and Safety Legislation.

http://www.google.com.au/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&docid=h4R0wROluc9YLM&tbnid=X2R6IEyek5X7TM:&ved=0CAUQjRw&url=http://www.firestop.net.au/fire-extinguishers.htm&ei=Aq-mU5qbPIGrkQXAk4GICg&bvm=bv.69411363,d.dGI&psig=AFQjCNEqVU8XWWP0UpEWfI0EDYXS-Ca_1Q&ust=1403519100430283

http://www.fpaa.com.au/





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There are 3 basic sign categories:

1. Regulatory –

Prohibited: red and black on white (forbids action); and

Mandatory: blue and black on white (required action).

2. Hazard – divided into sub categories

Warning: black on yellow (indicates potential

hazard)

Danger: red and black on white (indicates a

definite hazard)

3. Information – divided into sub categories

Emergency: white on green (indicates first

aid and emergency information)

Fire protection: white on red (fire fighting)

Other safety signs governed by Standards and

Regulation are:

Manual handling

Directional housekeeping

Quality assurance

Braille signs and Tactile comply with the Building Code of Australia and AS1428 Design for

access and mobility and Disability Discrimination Act.

Dangerous Goods (HAZCHEM) The Transport Storage and Handling Dangerous Goods

following -

AS ISO 16101 Transport packaging for dangerous goods

NOHSC National Code of practice NOHSC 1015

Relevant State Fire Authority & Environment Protection Authority Regulation

Safety signs should be legible enough to be read from whatever distance the affected person

should need to be instructed or warned before being in possible risk or harm.





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COMMON HAZARD WARNING SIGNS





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SECTION 2

INFECTION CONTROL

Overview

Principles of Infection Control

basic measures for infection control (standard and additional precautions);

identifying hazards and minimising risks;

identifying who is at risk and from what;

responsibilities of health care workers;

routine practices essential for effective infection control

Effective work practices and procedures.

design and maintenance of premises;

hand washing and personal hygiene;

use of personal protective equipment;

management of clinical and related wastes;

environmental cleaning and spills management;

management of incidents involving blood or body fluid exposure;

Disease & Microbiology

Pathogenic organisms cause many diseases. The key is to prevent pathogenic organisms from entering

the body. The actual procedures that are followed may vary from one health care facility to another, but

should all be based on sound microbiological principles.





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There are forms of animal or plant life too small to be seen without a microscope. You may have to use a

light microscope (illuminates ordinary light rays and can magnify up to 2000times) or an electron

microscope (which uses electrons instead of light rays – this is capable of magnification up to several

hundred times). Micro-organisms are found everywhere in their millions and may be present in air,

water, soil, dust, both in and on food, on every surface and in and on bodies of other organisms,

including humans.

Pathogenic means capable of producing disease whereas non – pathogenic means not capable of

producing disease in their normal environment. However, they can become pathogens if transferred to

a different environment.

Pathogens are organisms that are able to overcome the normal defences of body and invade tissues.

Their growth in the tissues, or their production of poisonous substances such as toxins, damages the

tissues and causes the manifestations of disease. The process of microbial invasion is called infection,

and a microbial disease is often called an infective disease.

They are classified according to size, structure and method of reproduction. Some of these include:

Bacteria are primitive cells that don’t have a nucleus and they produce disease by secreting toxic

substances therefore damaging human tissues, they then become parasites inside human cells and form

colonies in the body

Viruses invade cells and insert their own genetic code into the host cell and use the host cell’s nutrients

and organelles to produce more virus particles

Fungi are simple parasitic organisms that are similar to plants and they mostly live on the skin or mucous

membranes e.g., tinea, thrush

Parasites are sometimes called metazoan which are large multicellular organisms that are often worms

that feed off human tissue or cause other disease and many of these pathogens cause skin disease

Contagious & Non Contagious Skin Disorders

Non-Contagious Skin Disorders

Psoriasis -Psoriasis is a condition that cause big areas of red, raised skin, flaky dry skin, and scaled skin. It

cannot be contracted with skin to skin

Eczema -

Eczema is a skin condition caused by inflammation. It is a chronic condition for many people. It is most

common among infants, many of whom out grow it before school age.

Rosacea -





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Rosacea is a very common acne-like facial skin condition which has red or pink patches, broken blood

vessels, small red bumps, and pink eyes. It is found in people with very fair skin.

Contagious Skin Conditions

Impetigo - Found mostly in children, this highly contagious skin condition often happens after a recent

upper respiratory infection. Impetigo begins as itchy, red sores that blister, produce fluid, and eventually

become covered with a tight crust.

Tinea -

Ringworm (Tinea) is a common skin disorder. There are multiple forms of ringworm, which affect the skin

on the body (Tinea Corporis), the scalp (Tinea Capitis), the feet with athlete’s foot (Tinea Pedis), or groin

with jock itch (Tinea Cruris).

Tinea Versicolor - Tinea Versicolor is thought to be the most commonly occurring type of fungal skin

infection and can affect adults, although it’s most prevalent in adolescents.

Often found on oily parts of the body, like chest or back, it causes many small, flat spots on the skin. The

spots can be flaky or itchy. Many small spots may also blend together into larger patches.

Scabies - Scabies is an itchy skin condition caused by a tiny mite called Sarcoptes Scabiei. Blistery bumps

often appear. Scabies is often found between the fingers, in the armpits, around the waist, on the inside

of the wrist, on the inner elbow, on the knees, and on the buttocks, but can be in other locations.

Basically use extreme caution and avoid skin issues that have blisters, itchy or dry patches, open wounds,

or ring-like sores. The best self care advice…ask your client about questionable areas and avoid anything

that looks suspicious.





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Standard Precautions

Standard Precautions are work practices that are required for the basic level of infection control.

Standard Precautions help prevent the spread of infections in health care facilities and are used for the

treatment and care of ALL patients regardless of what is known of their infectious status. ALL body

substances of ALL people should ALWAYS be considered to be potential sources of infection.

Standard Precautions include:

good hygiene practices

frequent hand hygiene and hand-washing

the appropriate use of gloves

the use of other personal protective apparel, such as eye protection, masks, aprons, gowns and

overalls

the safe use and disposal of sharp instruments, such as needles

and syringes

the use of disposable equipment where applicable

correct cleaning, disinfection and sterilisation of non-disposable

equipment

correct collection, storage and disposal of waste

correct handling and reprocessing of linen

the appropriate use of cleaning agents

protocols for occupational exposures to blood and body substances

staff health programs.

The current Australian guidelines cover all pathogens that are likely to be present in any type of body

fluid or substance

These guidelines apply to:

Blood

All body fluids, secretions and excretions





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Non intact skin

Mucous membrane

These guidelines include specific recommendations for the use of all (PPE) personal protective

equipment contact with blood or body secretions is possible.

Standard precautions promote:

Hand washing

Use of gloves, masks, eye protection (PPE)

Use of gowns, when appropriate for client contact

Aseptic technique

Techniques to limit contamination

Surface cleaning and management of blood and body fluid spills

Safe handling of sharps

Safe disposal of sharps and other clinical waste

Appropriate reprocessing and storage of reusable instruments

Immunisation

Additional Precautions Implementation

Additional Precautions are used where Standard Precautions may be insufficient to prevent transmission

of infection. (Refer to Section A2 Table of Infectious Diseases). Additional Precautions are always used in

addition to Standard Precautions.

Additional Precautions are used for patients known or suspected to be infected or colonised with

epidemiologically important or highly transmissible pathogens.

The precautions implemented are specific to the situation and selected based on the mode of disease

transmission.

Airborne transmission (tuberculosis, measles, chicken pox)

Droplet transmission (mumps, rubella, influenza, pertussis)

Contact transmission (MRSA, Clostridium difficile)





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Any combination of these routes

Additional Precaution may also be implemented for:

immunocompromised patients (clients are treated in a separate clean environment)

patients with altered mental state and/or poor hygiene

gross disseminators of microorganisms (e.g. patients with large areas of colonised,

infected skin or large, open, purulent wounds).

Additional Precautions should be employed regardless of the nature of the procedure being undertaken

or whether the procedure itself carries an established risk.

Additional Precautions may include one or any combination of the following:

Allocation of a single room with ensuite facilities

Cohort (room sharing by persons with same disease) may be an alternative if single rooms are

not available

Special ventilation requirements (a negative pressure room)

Use of ‘STOP’ sign placed on the door of the patient’s room visible whether the door is open or

closed, directing all persons to consult nursing staff prior to entering

Antiseptic hand cleansers for routine hand washing

Transmission-Based Precautions

Transmission-Based Precautions are recommended for patients known, or suspected, to be infected by

pathogens spread by airborne, droplet or contact transmission, or any combination of these routes.

When applied, Transmission-Based Precautions do not replace Standard Precautions but are used in

addition to Standard Precautions.

HAND WASHING





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Seriously, hands should always be cleaned:

at the start and finish of shifts and breaks

before and after any direct client care or contact (ie before and after each massage)

after contact with blood or body substances

after handling soiled equipment, clothing or bed linen

after the removal of gloves

before contact with any immunosuppressed clients

before and after activities such as going to the toilet, eating, handling food or coughing or

sneezing.

In the health care setting there are three types of hand washes and these are referred to as:

social hand wash

clinical hand wash

surgical hand wash.





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Social hand wash

A social hand wash is a hand-washing technique recommended following social-type contact with clients,

after going to the toilet and after covering a cough or sneeze. A plain liquid soap is often used.

Clinical hand wash

A clinical hand wash is used before clinical procedures on clients, when a client is being managed in

isolation, or in outbreak situations. An anti-microbial soap, containing an antiseptic agent, is used.

Staff that have to perform clinical hand washes are usually shown the procedure and assessed during

training, orientation or in-service.

Surgical hand wash

A surgical hand wash is required before any invasive or surgical procedure requiring the use of sterile

gloves. An antimicrobial skin cleanser, usually containing chlorhexidine or detergent-based povidone-

iodine, is used.

Hand-washing principles

Although the type of skin cleanser used, the length of the hand wash and the

technique may vary on the type of hand wash being performed, the

following basic principles should be applied when washing hands:

1 All surfaces of the hands, including palms and back of the hands are

wet with warm water.

2 Apply skin soap or cleanser.

3 Lather the hands with the soap or skin cleanser.

4 Hands are vigorously rubbed together cleaning palms, fingers, between fingers, backs of hands,

thumbs, wrists and forearms up to the elbows to be washed.

5 Soap is rinsed off thoroughly.

6 Hands are pat-dried with a disposable towel or clean cloth.

7 Hands should be dried thoroughly to prevent chafing and chapping.

Hand rubs and gels





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Hand rubs and hand gels are very effective agents for helping increase the standard of hand hygiene and

may be used on hands that are not visibly soiled or where hand-washing facilities are not available.

Hands should be washed with soap or skin cleanser and water when visibly soiled.

Skin care

Intact skin is a natural defence against infection so massage therapists should cover all cuts and

abrasions with an occlusive dressing. Hands may become dry with constant hand-washing, so the use of

hand cream is recommended.

Other hand hygiene considerations

Jewellery or wristwatches should not be worn, because the areas beneath rings, stone settings, other

jewellery and wristwatches harbour microorganisms. It is also difficult to perform a thorough hand wash

while wearing them.

It is recommended that the fingernails be kept clean and short, and no broken skin on their hands. Any

broken skin should be covered appropriately with non-absorbent covering or the application of personal

protective equipment (PPE).

Artificial nails or extenders should not be worn when having contact with patients at high risk or when

surgical hand-washing is required, and is also not pleasant for the patient receiving a massage.





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Personal Hygiene

Personal hygiene is paramount to infection control. As a massage therapist, direct person to person

contact is a part of every regime. It is therefore essential that every aspect of personal hygiene to

attended to at the highest possible standard.

Personal cleanliness should be maintained at all times. Therapists should ensure their hair is clean and

tied back if long enough. This prevents intrusion in the therapy technique as well as decreasing

transmission of microbes.

Personal protective equipment (PPE)

Gloves, masks, face shields, protective eyewear, aprons and gowns are

personal protective equipment that should be worn while the health

care worker is performing any procedure where there is the likelihood

of splashing or splattering of blood or other body substances.

Gloves should be used when there is a risk of exposure to blood or body

fluids. They must be of high standard and meet Australian guidelines

for patient examination.

There is also a particular procedure for the correct removal of the gloves after clean up or contact with

the potential hazard. After contact with the bodily fluid or infected material the gloves themselves

become sources if infection and must be handled appropriately. It is necessary that the therapist does

not touch the outer surface of the contaminated gloves in order to remove them.

Therapists need to follow the correct procedure:

Grasp the outside of the cuff of one glove below the wrist

Pull the glove down over the hand, turning the glove inside out and continue to hold that glove

Insert the un-gloved fingers inside the cuff of the other glove

Pull the glove downwards and over the hand and first glove, turning the glove inside out

Drop the inverted gloves directly into a bin for disposal.

The basic principles of blood and body fluid management





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Spills should be cleared before the area is cleaned, as adding cleaning solutions (detergent) to the spill

increases the size of the spill to be dealt with

The generation of aerosols should be avoided, so prevent vigorous scrubbing when potentially infectious

fluid is present

Using personal protective equipment such as gloves, masks, and eye goggles

Carefully remove as much of the spill as possible with absorbent material, such as a paper towel, and

dispose of it in a plastic bag or container

Clean the area with warm water and detergent

If contact with bare skin is likely, disinfect the area with a diluted bleach solution with at least 1000ppm

available chlorine and allow to dry

Wash hands thoroughly after clean up

Safe handling, use and disposal of sharp instruments

The potential for the transmission of infections is greatest when needles, scalpels and other sharp

instruments or devices are used. Therefore wherever possible the use of sharps should be minimised.

The responsibility for the management and disposal of sharps is the person using the sharps!

Special care should be taken to prevent injuries during procedures, when cleaning reusable sharp

instruments and during the disposal of used sharps. Disposable sharps should be disposed of as soon as

practicable following use.

Sharps containers

Only commercially designed containers that meet the required Australian

Standards and produced for the sole purpose of disposing medical sharp

instruments must be used in health care settings. The colour coding of sharps

containers in Australia is yellow. They must be puncture-resistant, waterproof

and leak-proof. Sharps containers are produced in many different designs and

sizes. The container most suited for the department or facility where it is to be used should be chosen.

Sharps containers should be placed as close as is practicable to the point of use of the sharp instruments,

to limit the distance between use and disposal. Sharps containers should be placed so visitors,

particularly children, cannot access them.





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Sharps should never be forced into a sharps container, the container should never be overfilled and

when full the container should be securely sealed with a lid before disposal.

Disinfection and sterilisation

We have briefly looked at the main sources and routes of transmission of infection, and measures and

recommendations to prevent infection. Now let’s look at the processes of disinfecting and using

antiseptics, sterilisation including the management of sterile storage and supply, and the reuse of

medical devices.

In All health care facilities, the prevention or control of infection requires appropriate methods to

ensure:

destruction and control of microorganisms

elimination or control of the sources and/or routes of transmission of infection

protection of the human host from the serious effects of disease.

One way to achieve this is by using chemicals called disinfectants and antiseptics on objects, for example,

wiping a surface with a disinfectant. These act by damaging the structure or impairing the metabolism of

microorganisms . It can also be achieved by subjecting instruments and equipment to a process of

disinfection or sterilisation, for example, placing a surgical instrument into a steam steriliser for a

sterilising cycle.

There are some generalisations we can make about the effects of various methods used to sterilise or

disinfect.

Microorganisms differ in their response to the physical and/or chemical agents used to destroy

them or to inhibit their growth.

Destruction of microorganisms is a function of the:

o time that the microorganism is exposed to the agent

o number of microorganisms present

o nature of the agent used

o concentration of the agent used.





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The choice of agent used depends on the nature of the microorganism likely to be present and

the ability of the item being processed to withstand the agent used and the temperatures

required.

Disinfectants vs. Antiseptics

An antiseptic is a substance that inhibits the growth of bacteria. A disinfectant is a stronger agent, usually

a chemical substance that destroys infection-producing organisms.

Cleaning

Cleaning is the removal of foreign material from objects, such as soiling and organic material, and the

reduction in the number of microorganisms from a surface. Cleaning is normally done with water,

mechanical action and detergents.

Cleaning always precedes disinfection and sterilisation.

Instruments and equipment that come into contact with intact skin must be cleaned before they are

reused. Examples are bedpans, beds and stethoscopes.

Disinfection

Disinfection is a process that inactivates microorganisms, except spores, using either thermal (heat or

heat and water) or chemical means.

Instruments and equipment that come into contact with non-sterile tissue other than intact skin must be

disinfected before they are reused. Examples are respiratory therapy equipment, endoscopes and

specula.

Sterilisation

Sterilisation is the complete destruction of all microorganisms, including spores.

Instruments and equipment that enter tissue that would be sterile under normal circumstances, or the

vascular system, must be sterile before they are reused. Examples are surgical instruments, laryngoscope

blades, and biopsy forceps.

The surfaces that need disinfection and the pathogens that need to be eliminated determine the steps

required to prevent pathogen transmission. There are three generally recognized levels of infection

control: high- level, intermediate-level, and low-level.

High-level exposures include spills of bodily fluids.

Put on latex or other acceptable barrier gloves

Absorb the spill with disposable towels.





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Apply disinfectant to the area and let it sit for 20 minutes (use household bleach, about 2

tablespoons per litre of water

Absorb the disinfectant solution with disposable towels

Dispose of all articles with bodily fluids and used disinfectant including gloves, in plastic

bags, and seal bags

Wash hands

Allow the area to dry completely

Intermediate-level exposures include smooth, hard surfaces that come into contact with

mucous membranes or broken skin.

Apply enough disinfectant to wet the entire surface and let sit on the surface for about

10 minutes

Use 70% to 90% ethyl alcohol or isopropyl alcohol, also use bleach (same measurements

as before)


Wash hands

Low-level exposures include smooth, hard surfaces touched by intact skin.

Apply enough disinfectant to wet the entire surface and let sit on the surface for about

10 minutes

70% to 90% ethyl alcohol or isopropyl alcohol and also bleach (same measurement as

before)


Dispose of used towels in trash container

Management of Waste

There is the possibility for the healthcare associated waste to contain

potentially hazardous waste. There is a requirement for the generators of

waste to ensure that no-one who handles the waste during the disposal

process is placed at any risk of offence, exposure, injury or disease.





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With the application of the general principles of infection control including Standard and Transmission-

Based Precautions, hand-washing and appropriate use of PPE, there should be little risk of disease

transmission or injury from the disposal and handling of waste generated in Health Care Facilities (HCFs).

Every HCF has a responsibility to ensure that any waste is appropriately segregated and handled to

ensure the safety of all who may subsequently have contact with that waste.

As a result, waste management guidelines for health care facilities have been developed in most states

and territories and must be followed.

Depending on the nature of the health care facility, the following types of waste may be generated:

clinical

cytotoxic

pharmaceutical

chemical

radioactive

organic

liquid

general

recyclable products

Transportation and disposal of waste:

This will be determined by the required waste streams and the licensing requirements for that facility.

The requirements of facilities outside metropolitan centres will also be influenced by local government

requirements. Each state will determine licensing requirements for waste and this should be checked

prior to transport or disposal. This can be important if waste is to be disposed of over state borders,

where the transporter should be licensed in both or all states involved.

Operation of landfill or treatment facilities:

This will be considered when contracts are being developed to ensure that required standards are being

met for the last stage in the handling of waste that has been generated in your facility.

Waste management strategies to be considered should include staff safety when undertaking waste

management activities, reduction or minimisation and segregation of waste from all possible streams.





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Packaging from suppliers should be included as a consideration when selecting products, especially high-

volume products.

A successful waste management program will include the following elements:

planning and consultation

management support and commitment

staff involvement

clear objectives

resources to achieve the objectives

Storage facilities for waste should be secure and hygienic in order to protect the environment and staff.

The storage area should be easy to clean and water runoff should be considered, ensuring that

contamination of stormwater or groundwater is prohibited.

The frequency of waste collections needs to meet the needs of the facility. Waste should not be stored

for extended periods, especially when there is the possibility of high temperatures.

General Waste

General waste is waste that is not visually contaminated with blood and that does not contain bulk body

fluids. It does not have the potential to cause infection, injury or offence. General waste usually

comprises uncontaminated items such as wrappers, paper, packaging and some food scraps.

Clinical Waste

Clinical waste has the potential to cause sharps injury, infection or offence.

Clinical waste includes the following types of waste:

sharps

human tissue

bulk body fluids and blood

visibly blood-stained body fluids and visibly blood-stained disposal material and equipment

laboratory specimens and cultures, animal tissues, carcasses or other waste arising from

laboratory investigation.





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When clinical waste is appropriately handled and contained through good work practice and the use of

protective apparel, the risk of infection is minimised.

Clinical waste is usually removed from health care facilities by licensed medical waste contractors.

The following principles should always be followed when handling waste:

Gloves should be worn when handling waste bags.

Waste bags should not be overfilled (approximately two-thirds full).

Excess air should be excluded without compaction before closure, using a bag tie at the point of

segregation.

Bags should be held away from the body and (ideally) placed in a mobile garbage bin or trolley.

Waste should be stored in a secure place with restricted access.

The Australian Standard that refers to the cleaning, disinfecting and sterilising reusable medical and

surgical instruments and equipment, and maintenance of associated environments in heath care

facilities is AS/NZS 4187

Management of Linen

The risk of disease from soiled linen is negligible. However, all employees involved in the handling,

transport and processing of used linen soiled with blood, body substances, secretions and excretions

should carry out their tasks in a manner that prevents skin and mucous membrane exposure,

contamination of clothing and transfer of microorganisms to other patients and environments.

Laundry staff should wear appropriate protective apparel, including general-purpose gloves when

handling and sorting linen. Soiled linen should be handled as little as possible and with minimal agitation,

to prevent gross contamination of the air and linen handlers. Used linen should be put in bags at the

point of generation.

Linen soiled with blood or body substances should be bagged, transported and stored in leak-proof bags.

Staff should ensure sharps and other objects are not discarded into linen bags. Routine washing

procedures using hot water and detergents are adequate for decontamination of most laundry items

(Australian/New Zealand Standard, 2000).

Linen services





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With the application of the general principles of infection control including Standard and Transmission-

Based Precautions, hand-washing and appropriate use of personal protective equipment (PPE), there

should be little risk of disease transmission from soiled linen.

Commercial laundering processes provide linen that is hygienically clean and free from infection-causing

microbes that could cause illness to humans. Drying and ironing at high temperatures assist in

decontaminating linen in these situations. Clean linen in health care agencies must meet the Australian

Standard AS/NZS 4146 - 2000 Laundry practice. Using these specifications, laundries are able to ensure

that harmful viruses and pathogenic bacteria are killed. For example, the Hepatitis B micro-organism is

destroyed when exposed to temperatures of 90oC for two minutes.

A Massage Therapists decisions about linen services should include review and documentation of all

aspects of linen-handling regardless of whether the service is going to be provided by the facility or the

external provider. The Massage Therapist should consider the following aspects of the linen service:

Laundering practices

Staff handling issues

Clean and used/soiled linen storage

Clean and used/soiled linen transportation.

Clean and soiled/used linen must be transported and stored separately. Soiled/used linen should be

placed into linen bags as close to the point of generation as possible and should not be handled any

more than is necessary, with care being taken not to agitate or aerosolise any contamination or

microorganisms on the linen.

If the linen is heavily contaminated or at risk of leakage, it should be placed into a clear plastic

impervious bag that is securely closed, before being put into a linen bag. This will assist with protection

of employees and linen handlers. The linen bags should not be overfilled since this will create a problem

for safe closure and the potential for spillage of soiled linen during transit.

Used/soiled linen should not be rinsed or sorted in clinical or patient care areas.

All therapists must take care to ensure that no equipment, instrumentation waste or sharps are placed

into linen bags.

Laundering processes must meet the requirements of the relevant Standard, AS/NZS 4146. This relates

to sorting, wash times, water temperature, detergents, drying times and temperatures, as well as

storage and linen quality considerations. Manufacturer or supplier instructions should be consulted.

Issues relating to maintenance and monitoring of washing machines and dryers should also be

considered when reviewing or developing laundry policies and procedures.





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If a commercial laundry service is utilised by the therapist, under contractual arrangements that should

be in place all the aspects of linen handling and reprocessing should be met by the service provider and

this should be reviewed by the facility.

One major risk involved with Massage Therapists and drying of their towels is to ensure if the towels are

dried using a hot dryer that they are completely cool before folding and storage. There have been

numerous situations where clinics and dry cleaners have burnt down due to the high heat of oil build up

in the massage towels, and then folded when still at a high heat temperature. Also ensure that the

temperature whilst drying is on a medium heat.

Routine cleaning of facilities and surfaces

Standard Precautions should be implemented when cleaning surfaces and facilities in the clinic.

Toilets, sinks, washbasins, and surrounding areas should be cleaned regularly or as required.

Although environmental surfaces play a minor role in the transmission of infections, a regular cleaning

and maintenance schedule is necessary to maintain a safe environment.

Surfaces should be cleaned on a regular basis using only cleaning procedures, which minimize

dispersal of microorganisms into the air.

Routine surface cleaning should proceed as follows:

clean and dry massage table each session;

spills should be dealt with immediately;

use detergent and warm water for routine cleaning;

where surface disinfection is required, use in accordance with

manufacturers’ instructions;

clean and dry surfaces before and after applying disinfectants;

empty buckets after use, wash with detergent and warm water and store dry.

Skin disinfectants (antiseptics)

Skin disinfectants, or antiseptics, are substances used for dermal or mucous membrane application to kill

or prevent the growth of microorganisms.





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Chemical disinfectants are not recommended for routine cleaning, although chlorine releasing agents

(CRAs) are still recommended and are widely used in circumstances during which significant risk of

infection transfer may be identified e.g. treatment of spillage of contaminated exudates from infected

clients.

Disposable coverings, for example, plastic-backed single-use paper face hole liners, may be used to

reduce surface contamination. They are often a viable and economical alternative to surface disinfection

but should be changed with each use. When liners are changed, the underlying bench surface should be

cleaned as above, and disinfected if contaminated. Your massage oil container also needs regular

cleaning and disinfecting.

Spills management

The management of spills should be sufficiently flexible to cope with the circumstances in which the spill

occurs, and may depend on a number of factors, including:

the nature of the spill (e.g. sputum, vomit, faeces, urine, or blood);

the likely pathogens that may be involved in these different types of spills (e.g. Mycobacterium

tuberculosis in sputum);

the size of the spill e.g. spot, small or large spill;

the type of surface e.g. carpet or hard flooring;

the area involved i.e. whether the spill occurs in a contained area such as a microbiology;

whether or not there is a likelihood of bare skin contact with the soiled surface.

In areas such as waiting rooms, or clinic treatment areas, blood and body substance spills should be dealt

with immediately.

Where there is a possibility of bare skin contact with the surface, the area should be disinfected with a

suitable disinfectant. Small spots or drops of blood or body fluids can be removed immediately by

wiping the area with a damp cloth, tissue or paper towelling.

A disposable alcohol wipe can also be used.

Where large spills have occurred in a ‘wet’ area, such as a

bathroom or toilet area, the spill should be carefully hosed off

into the sewerage system and the area flushed with water and

detergent. After the area is cleaned and if there is a possibility of

bare skin contact with the surface, the area should be





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disinfected.

Standard cleaning equipment, including a mop and cleaning bucket plus cleaning agents should be

readily available for spills management and should be stored in an area known to all staff.

To facilitate management of spills in areas where cleaning materials may not be readily available, a

disposable ‘spills kit’ could be used, assembled as follows:

A large reusable plastic bucket with fitted lid, containing;

A 5 litre impervious container (treated cardboard or plastic) with fitted lid for waste material;

2 large (10 litre) zip seal plastic bags for waste material;

A disposable, sturdy cardboard scraper and pan (similar to a ‘pooper scooper’);

A large bottle of bleach;

Disposable rubber gloves suitable for cleaning;

Eye protection (disposable or re-usable);

A plastic apron;

A mask (for protection against inhalation of powder from the disinfectant granules, or aerosols

from high risk spills which may be generated during the cleaning process).

General waste

A large proportion of clinical and related wastes are no more dangerous than domestic waste. Waste

segregation at the source allows for supervised landfill as a viable alternative to incineration for the bulk

of clinical and related wastes generated.

Gloves and protective clothing should be worn when handling infectious waste bags and containers.

Spills Management

Blood or body fluids - clean immediately

Massage Oil – if in traffic area and risk of fall/slip - clean immediately

Massage Oil – in non-traffic area and no risk of fall/slip - clean immediately after massage before next

client





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MSQ Cleaning Products

Orange squirt - for surfaces i.e. massage tables, floors, benches, etc

Tea tree, eucalyptus and water mix - for client and student practitioners i.e. feet, hands, etc

Preventing Cross-Infection between Clients

Massage towels – changed after each client

Wash hands before and after Massage – ALWAYS

Where infection may be additional risk e.g. previous client has indicated that they have an infectious

disease – change towels, wipe down surfaces especially massage table, and wash hands

In extreme situation e.g. client has bleeding from wound – report to clinic supervisor/WHS officer

IMMEDIATELY, towels to be disposed of for immediate washing, and use protective clothing i.e. gloves.

Some infections that may cause concern in the clinic:

Common cold.

Sneezing, scratchy throat, runny nose—everyone knows the first signs of a cold,

probably the most common illness known. Although the common cold is usually

mild, with symptoms lasting 1 to 2 weeks, it is a leading cause of doctor visits and

missed days from school and work. Adults average about two to four colds a year,

although the range varies widely. Women, especially those aged 20 to 30 years,

have more colds than men, possibly because of their closer contact with children.

On average, people older than 60 have less than one cold a year.

More than 200 different viruses are known to cause the symptoms of the common cold. Some, such as

the rhinoviruses, seldom produce serious illnesses. Others produce mild infections in adults but can lead

to severe lower respiratory tract infections in young children.

Rhinoviruses (from the Greek rhino, meaning “nose”) cause an estimated 30 to 35 percent of all adult

colds, and are most active in early autumn, spring, and summer. Scientists have identified than 110

distinct rhinovirus types. These agents grow best at temperatures of about 91 degrees Fahrenheit, the

temperature inside the human nose.

You can get infected by cold viruses by either of these methods;





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Touching your skin or environmental surfaces, such as telephones and stair rails, that have cold

germs on them and then touching your eyes or nose

Inhaling drops of mucus full of cold germs from the air

Influenza

The term 'flu' is often misused to describe a range of mild respiratory bugs, but true influenza is a

potentially serious condition that can spread in epidemics and kill large numbers of people. Fortunately,

there are treatments as well as a vaccine.

The flu, or influenza, is caused by a highly infectious virus. It spreads through the air, multiplies in cells

lining the airways, and causes seasonal epidemics of respiratory infections which are sometimes life-

threatening.

Flu circles the globe every year. As it spreads, the virus is slowly changed by mistakes made when it

copies its genetic material. These changes make it very difficult for our immune systems to recognise the

infection for a second time, explaining why a previous bout of the flu does not prevent subsequent

infections.

The viral particles that cause flu are tiny, measuring about one ten-thousandth of a millimetre in

diameter. The virus consists of a core, containing the genetic material, surrounded by a coat studded

with proteins that help the virus to lock on to and invade its target cells. Once inside, the virus

effectively hijacks the infected cell, turning it into a flu factory. Each infected cell can produce thousands

of new viral particles.

With every cough, or sneeze, they spray out in their millions and loiter in the air until they are breathed

in by another susceptible victim.

Influenza can also be transmitted by saliva, nasal secretions, faeces and blood. Infections also occur

through contact with these body fluids or with contaminated surfaces. Flu viruses can remain infectious

for about one week at human body temperature, over 30 days at 32 °F and indefinitely at very low

temperatures. Most influenza strains can be inactivated easily by disinfectants and detergents.

Measles, also known as rubella

A disease caused by a virus It is spread through respiration (contact with fluids from an infected person's

nose and mouth, either directly or through air), and is highly contagious—Additional precautions should

be taken for all suspected cases.

Fungal Infections.





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Fungi, the organisms which cause fungal infections, are primitive members of the plant family and some

cause infections in humans.

Fungal infections occur more frequently in areas of the body where there is heat, friction, moisture, or

where folds of the skin rub together. Many of these infections occur on the skin (scalp, feet, groin areas

etc), but other areas such as the nails, vagina, mouth and gums can also be infected.

The term tinea is used to describe most fungal infections of the skin, nails and hair. These include

athlete's foot, ringworm, jock itch and onychomycosis (infection of the nails).

Certain types of tinea are found in parts of the body that are not exposed to air and light, such as

between the toes. On the skin, tinea produces reddish patches. There may be scales or pustules and the

areas involved may be itchy and tender.

Tinea infections are contagious and can be passed through direct contact or contact with such items as

shoes and shower or pool surfaces.

Additional precautions are tailored to the specific infectious agent concerned and may include measures

to prevent airborne, droplet or contact transmission.

Additional Precautions should be applied in a health care setting for patients known or suspected to be

infected or colonised with infectious agents that may not be contained with standard precautions alone

and that could transmit infection by the following means:

airborne transmission of respiratory secretions (e.g. chickenpox, measles);

droplet transmission of respiratory secretions (e.g. rubella, influenza);

contact with patients who may be disseminators of infectious agents of special concern (e.g.

faecal contamination from carriers of vancomycin resistant enterococci);





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Hygiene standards to avoid contamination

Consistently high hygiene standards should apply for all people involved in body work. Work areas and

equipment must be cleaned regularly, hands must be washed frequently, uniforms should be clean, and

hair should be tied back or covered.





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GLOSSARY

Term Meaning

Additional precautions

Where standard precautions may be insufficient to

prevent transmission of infection (e.g., airborne

transmission).

Asepsis

Means the absence of disease producing micro-organisms

Aseptic technique

is an effort to keep the client as free from exposure to

infection-causing pathogens as possible.

Arthropods

Insects

Bacteria

Unicellular organisms that do not require living tissue to

survive.

Colonisation

Refers to the presence and growth of a micro-organism on

the skin or mucous membrane without ant evidence of

infection.

cleaning The removal of all foreign material from objects and the

reduction in the number of microorganisms from a

surface. Cleaning is normally done with water, mechanical

action and detergents. Cleaning must always precede

disinfection and sterilisation.

clinical waste Waste generated by health care facilities that is visibly

contaminated with bulk blood or body substances. Also

includes microbiological and pathological waste and





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tissue.

contamination The introduction of microorganisms into sterile material or

living tissue, or the presence of an infectious agent on

skin, tissue, articles, solutions and substances.

Fungi

Large diverse group of organisms

detergent Chemical cleansing agent which may be in liquid, paste or

powdered form. Detergents may be neutral, alkaline or

acidic.

disease Any change from a state of health.

disinfectant A chemical for inactivating and destroying organisms.

Common disinfecting agents are formalin, alcohol, phenols

and quaternary compounds.

disinfection A process that eliminates many or all microorganisms

except bacterial spores, using heat and water or chemical

means.

general waste Waste generated by health care facilities that is not more

of a public health risk than domestic or household waste.

hygiene The principles and science of the preservation of health

and prevention of disease.

iatrogenic infection Infections that occur as a result of health care

interventions such as surgery, catheterisation, and

injection.

infection The growth of microorganisms in the body, causing

disease.

invasive procedure A procedure such as surgical entry into tissues, cavities or

organs, or repair of traumatic injuries.

Nosocomial infection

Is one that is acquired in a hospital or other health care

facility.

Parasites Derive nutrients from a host i.e. worms





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PPE

Personal Protection Equipment

Protozoa

Unicellular organisms with no cell wall, larger than

bacteria with visible organelles

reusable item An item designated or intended by the manufacturer as

suitable for reprocessing and reuse. It is not a device that

is designed or intended by the manufacturer for single use

only.

Sharps container

Is a container that is filled with used medical needles (and

other sharp medical instruments, such as an IV catheter)

Standard precautions

Precautions designed to reduce the risk of transmission of

microorganisms from both recognised and unrecognised

sources of infection in health care settings. Standard

Precautions are required for the basic level of infection

control for the treatment and care of ALL patients,

regardless of what is known of their infectious status.

Sterilisation

Involves the complete destruction or removal of all living

organisms from an object including spores





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Transmission-Based Precautions Transmission-Based Precautions are designed for patients

known or suspected to be infected with pathogens for

which additional precautions beyond Standard

Precautions are needed to interrupt transmission in health

care facilities. There are three types of Transmission-Based

Precautions:

• airborne precautions

• droplet precautions

• contact precautions.

A combination may be required for diseases that have

multiple routes of transmission. The use of Transmission-

Based Precautions should always be in addition to

Standard Precautions.

terminal cleaning Cleaning of a room or area after being vacated by a

patient.

Symbiosis

The biological term to describe two organisms living

together

Viruses

Very small intracellular parasites that require a living host

for replication

VRE

Vancomycin Resistant Enterococcus





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REFERENCES & RECOMMENED READING

http://cciwa.hradvance.com.au/WHS-summary.asp

http://safeworkaustralia.gov.au/AboutSafeWorkAustralia/WhatWeDo/NationalWHSStrategy/Pages/Prog

ress-National-WHS-Strategy-2002-2012.aspx

http://safeworkaustralia.gov.au/AboutSafeWorkAustralia/WhatWeDo/Publications/Pages/FS2010Health

AndCommunity.aspx fact SHEET

http://www.mindtools.com/smpage.html STRESS

http://www.health.qld.gov.au/ph/documents/cdb/32182.pdf infection control policies and procedures

http://www.health.qld.gov.au/chrisp/ic_guidelines/contents.asp guidelines

Tuchtan, C, Tuchtan, V, Stelfox D (2005) Foundations of Massage second edition. Elsevier

Salvo, S G (2007) Massage Therapy Principles and Practice, Third Edition. Saunders Elsevier

http://cciwa.hradvance.com.au/OHS-summary.asp

http://safeworkaustralia.gov.au/AboutSafeWorkAustralia/WhatWeDo/NationalOHSStrategy/Pages/Progress-National-OHS-Strategy-2002-2012.aspx

http://safeworkaustralia.gov.au/AboutSafeWorkAustralia/WhatWeDo/NationalOHSStrategy/Pages/Progress-National-OHS-Strategy-2002-2012.aspx

http://safeworkaustralia.gov.au/AboutSafeWorkAustralia/WhatWeDo/Publications/Pages/FS2010HealthAndCommunity.aspx

http://safeworkaustralia.gov.au/AboutSafeWorkAustralia/WhatWeDo/Publications/Pages/FS2010HealthAndCommunity.aspx

http://www.mindtools.com/smpage.html

http://www.health.qld.gov.au/ph/documents/cdb/32182.pdf

http://www.health.qld.gov.au/chrisp/ic_guidelines/contents.asp

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