CDC Disease Control and Prevention Written on Green Key of Metallic Keyboard. Finger pressing key.

COVID-19 made massage therapists very aware of the need for increased sanitation protocols.

With the lack of a gold standard for massage therapists, we can turn to entities like the CDC to learn how to create a therapy space that is safe and sanitary. While some practices remain closed, some massage businesses are open now.

The Centers for Disease Control and Prevention (CDC), Occupational Safety and Health Administration (OSHA) and the World Health Organization (WHO) are among many entities that offer resources massage therapists can utilize.

On May 14 the CDC issued new guidance on reopening businesses, including a decision tree to help business owners decide if they should reopen now or not.

In my last article, “3 New OSHA COVID-19 Workplace Guidelines that Massage Therapists Need to Understand,” I discussed new OSHA guidelines.

This updated article draws from the CDC’s “Reopening Guidance for Cleaning and Disinfecting Public Spaces, Workplaces, Businesses, Schools, and Homes.”

Previously this article focused on the CDC’s “Interim Guidance for Businesses and Employers Responding to Coronavirus Disease 2019 (COVID-19)” and other guides and recommendations that may be extrapolated to massage therapy practices.

The CDC’s Mission

COVID-19 brought the CDC to our attention as massage therapists because they are a good resource for information about proper environmental cleaning and disinfection, Personal Protective Equipment (PPE), and how to protect ourselves and our clients from infection and disease. They offer free courses on these subjects.

The Centers for Disease Control and Prevention (CDC) are the leading national public health institute of the U.S. Their mission is: “To protect America from health, safety and security threats, both foreign and in the U.S. Whether diseases start at home or abroad, are chronic or acute, curable or preventable, human error or deliberate attack, CDC fights disease and supports communities and citizens to do the same.

“CDC increases the health security of our nation. As the nation’s health protection agency, CDC saves lives and protects people from health threats. To accomplish our mission, CDC conducts critical science and provides health information that protects our nation against expensive and dangerous health threats, and responds when these arise.”

The focus here is on how to prepare the therapy room and other parts of your office according to CDC guidelines.

Employees & Clients

The CDC guides us to implement new procedures for our clients and employees.

1. Use an intake to help ensure that no one who enters your office has knowingly been in contact with someone who has COVID-19.

2. Place admittance signs at the front door explaining your policies and procedures.

3. Many states are requiring masks for both employees and clients to help slow the spread of COVID-19. While you must provide them for your employees, consider your policy for clients who do not have them. If they do not have a mask, will you provide it for free or charge them for it? If your client is unable to wear a mask, and your state has an order requiring it, your client would be considered contraindicated for massage until the order is lifted.

4. We are asked to take temperatures with a thermal or ear thermometer when a client and employee enters the office. As customary in our industry, we are to deny service or request the employee to remain at home if the temperature is above 99.9.

5. Consider having clients wait in their cars until the therapist is ready to work with them.

6. Request only the client being treated enter the office. If a minor or client needing help dressing, the person accompanying them also needs to be screened.

7. Have disinfecting gel, tissues and no touch trash cans throughout the office.

8. Encourage employees to visit the CDC websites on respiratory etiquette and hand washing and place reminder posters strategically throughout the office.

9. If you have items for sale, it is recommended you have a protocol in place before opening and train each employee on this protocol. Place signage requesting staff to help with selecting items. The staff should use gloves when touching items and ensure the gloves are changed between clients and disinfected if cash or other items high-touch items are touched. Ensure each item a client touches is cleaned.

10. Highly touchable items — magazines, brochures, rack cards, business cards, samples — must be removed and stored in a closed container, and the therapist should hand clients these items as needed or requested.

Cleaning, Disinfecting and Sanitizing

Cleaning disinfection and sanitizing are not all the same. These three processes are different from one another.

11. In the therapy room, we use oils and other oil-based products that create a film on surfaces. These items must be cleaned first and any soil removed before we are able to effectively disinfect or sanitize.

There are many Environmental Protection Agency (EPA)-approved cleaners and disinfectants that are useful in a therapy setting. (Access the EPA’s “List N: Disinfectants for Use Against SARS-CoV-2 here.) Each of these products has instructions and time limits for disinfecting.

Many massage suppliers and Amazon Business have cleaning and disinfecting supplies in stock. You are also able to use 1/5 cup of bleach to 1 gallon of water or 4 tsp. bleach to 1 quart of water.

12. As an employer you are to create a checklist for cleaning that is to be kept as a record of cleaning, disinfecting and sanitizing for your office.

13. Every surface that has been touched — such as bottles, knobs and light switches — needs to be first cleaned then disinfected. Other surfaces — such as floors, containers and chairs — may be disinfected with appropriate disinfectants.

14. Tools and other items used must first be cleaned then disinfected or sanitized according to both the tool’s instructions and the EPA-approved disinfection or sanitizing products’ instructions. Many therapists use sanitizing cabinets that have been approved for sanitizing items.

15. Restrooms must be cleaned and disinfected after use, and a schedule kept to indicate when they were last cleaned. (We’ve all seen publish restrooms’ cleaning schedules posted to the wall.) Areas to check off include the toilet seat, flush handle, doorknob and light switch.

16. High touch areas — doorknobs, light switches, counters, etc.— must be cleaned and disinfected frequently and on a schedule.

17. Requirements pertaining to laundry are not much different than what we usually do, except we are to wear gloves and possibly masks when touching soiled linens and contain the linens until they are washed.

The CDC’s purpose of the laundry portion of the standard is “to protect the worker from exposure to potentially infectious materials during collection, handling and sorting of contaminated textiles through the use of personal protective equipment, proper work practices, containment, labeling, hazard communication and ergonomics.”

Every single piece of linen that is used — including sheets, blankets, towels and any other washable, soft-surfaced item — must be washed each and every time it is used. It is recommended to separate the laundry in the treatment room then either place it in a closed container transport it to the area where it will be washed, or to place it directly in the wash. The CDC suggests not shaking the items and to clean out the storage container once empty. The CDC recommends using the hottest water allowed for your items, soap, and either bleach or an oxygen product to boost cleaning.

It is recommended to place a waterproof cover on your table. You can place this over a warmer or an egg crate. If you do this, you can clean and disinfect the cover after removing the linens.


• Read the CDC’s “Businesses and Workplaces: Plan, Prepare and Respond.”

• Read “3 New OSHA COVID-19 Workplace Guidelines that Massage Therapists Need to Understand.”

• Read the CDC’s “Reopening Guidance for Cleaning and Disinfection Public Spaces, Workplaces, Businesses, Schools, and Homes,” which includes sections on conducting daily health checks, improving a ventilation system and more.

• Read the CDC’s presentation, “Guidance for the Selection and Use of Personal Protective Equipment (PPE) in Healthcare Settings.”

A Clean, Safe Practice

Depending on your pre-closure practices, some of the suggestions in these two articles may seem daunting and overwhelming, even without COVID-19 coming into the equation.

However, with the dangers posed by COVID-19 to your clients, employees and yourself, it is essential that the massage therapists implement the highest standards of safety and sanitation. I hope the guidelines listed here help you, your clients and your staff stay safe and give you more confidence in your abilities to create a hygienic environment.

About the Author:

Andrea Fiorillo, LMT, owns Virginia Medical Massage in Chesapeake, Virginia. She has an amazing team of therapists working with her. In April 2020, she created a second company, LMT Solutions, to help other massage therapists understand and implement many of the new standards they are being requested to comply with. It is her passion to help each massage therapist be the best therapist they can be.