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OSHA has updated its regulations to include airborne pathogens. With this change, the way business owners, employers and massage therapists work will also need to change.

Before COVID-19, the Occupational Safety and Health Administration (OSHA)’s regulations on bloodborne pathogens impacted massage therapists only when someone had bled or vomited in the office. Now, OSHA regulations pertain to airborne pathogens as well.

OSHA has published a new handbook, “Guidance on Preparing Workplaces for COVID-19.” Download it here.

New Guidelines

Like many massage therapists, in April my practice suspended services for an unknown amount of time. During the shutdown I spent weeks asking medical professionals for advice, pouring over handbooks and worldwide regulations, and taking continuing education courses in multiple medical fields that pertain to sanitation guidelines.

My goal was to be able to practice safely, ethically and legally (and without fear). I have since developed a continuing education class for massage therapists, on OSHA and CDC guidelines relating to COVID-19, recently submitted to NCBTMB for CE credits.

Before COVID-19, my local health department, following OSHA guidelines, made me keep a book full of safety data sheets for my hazardous cleaners, install self-closing doors on my restrooms, and they didn’t allow throw rugs in the restrooms. Things are different now.

OSHA’s multiple handbooks contain many recommendations massage therapists need to follow. OSHA has more regulations and recommendations than can be touched on in one article, so this article will condense the main points for massage therapists and get the conversation started on new OSHA-based requirements for safe practice.


“Guidance on Preparing Workplaces for COVID-19”

Occupational Safety and Health Administration: Safety and Health Topics / COVID-19 Control and Prevention

Occupational Safety and Health Administration: Safety and Health Topics / COVID-19

3 Measures for Massage Therapists

OSHA separates businesses by their risk categories. Massage therapy is considered a Medium Exposure Risk job because we require frequent/close contact with people who may be infected, but who are not known or suspected to be infected with COVID-19, and because most of us are exposed to people who live in an area where COVID-19 is active.

In the midst of a COVID-19 outbreak, it is difficult to impossible to eliminate exposure. The most effective protection measures for us in order are: engineering controls, administrative controls and PPE. While there are pros and cons to each type of control, a combination of the three has been found to be necessary to protect from exposure to COVID-19.

1. Engineering controls isolate therapists from work-related hazards and would include:

  • Installing high-efficiency filters on your HVAC system and changing them frequently.
  • Improving or increasing the ventilation rate throughout your treatment area.
  • Improving air circulation, if you have a window, consider opening it frequently, if you do not have a window, placing a HEPA filter in the room is one consideration.
  • Plexiglass or another type of barrier at your reception desk.

2. Administrative controls are changes in work policies or procedures in order to minimize exposure. Some changes to consider are:

  • Create ways to ensure clients are able to stay six feet away from each other.
  • Stagger employee shifts so they are not in the same areas at the same time.
  • Implement online booking and payments.
  • Stagger appointments and asking clients to remain in their vehicles until you notify them you are available.
  • Keep clients in the treatment room to complete intakes and reschedule.
  • Begin using paperless forms of payment and health histories, to reduce face-to-face exposure.
  • As an employer, you need to provide your workers with education and training on COVID-19 risk factors and ensure they are aware of respiratory etiquette, proper hand-washing, and proper care and use of PPE.
  • Implement a strict cleaning schedule for common areas and restrooms.
  • You will also need to place respiratory etiquette and handwashing protocol posters throughout your workspace. These can be found on the WHO and CDC websites.
  • Training therapists how to use their own electronic equipment in the office, for intakes, footnotes and payments. Employees should have individual computers or digital pads, or this equipment should be sanitized between shifts.

3. Personal Protective Equipment (PPE) includes gloves, goggles, face shields, masks and gowns. While engineering and administrative controls are considered more effective in minimizing exposure for your office staff, massage therapists are at a higher risk of exposure due to the extent of time working in close proximity to another person.

The use of PPE depends largely on what your local government advises and if you feel that is not enough, then add to it. It is your responsibility to ensure you and your clients are comfortable, while at the same time not exposing yourself or your employees to an OSHA violation.

When local direction is not available, many massage therapists refer to the local recommendations for physical therapists and dermatologists.

Finding PPE was quite difficult in mid-April, but more recently most of the items can be found on Amazon Business or from other massage and medical suppliers. (Amazon Business frequently has more products available to business owners than the regular Amazon Prime membership does.)

N95 masks are probably the most difficult to find, but OSHA does not require them for health care workers unless they are in extended contact with a person who is known to have COVID-19. As a massage therapist, it is a contraindication to work with or on a person who is ill.

As an employer, you are required to:

  • Provide your workers with the proper PPE to keep them safe while massaging, cleaning and interacting with clients and other staff.
  • Ensure PPE fits properly. Each piece has directions on how to wear them and how they are to fit properly.
  • You must also ensure all employees know how to properly put on their PPE, how to do their jobs while wearing it, how to properly remove it, and how to dispose of it or store it according to your policies.

Second Nature

While all of this may seem overwhelming, my practice was allowed to open at the end of April to see clients who have a doctor’s referral. We have been implementing these changes and a few more for about two weeks. I am pleased to say all the steps my state requires have almost become second nature to my massage therapists.

Our clients are happy to learn we are implementing such strict protocols, and know we are doing all we can to keep them and others safe.

We also require our clients to wear masks in our clinic. We have had very few issues with clients breathing prone with the mask on. For the clients who get stuffy while face down even without a mask, we provide an essential oil on a tissue for them to sniff through the mask, and that has worked well for us. Overall, our clients are aware they are keeping us safe when they keep their mask on.

By using the above recommendations you will reduce your, your employees’ and your clients’ exposure to COVID-19. Download the CDC’s handbook, “Guidance on Preparing Workplaces for COVIC-19” for additional information.

This article has touched on some of the changes OSHA recommends. The next article will cover changes the CDC is recommending.

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.