It’s important to properly clean and disinfect massage cups between sessions.
As practitioners of a health care modality, massage therapists must conform to health regulations and standards of practice created by their regulatory body. As a profession, we need to come to one standard, and that must be the highest standard recommended.
1. As cups are medical devices, they must be reprocessed — cleaned and disinfected — accordingly. Where massage therapy is regulated in Canada and the U.S., such regulation generally falls under the auspices of the local health department. There are two classifications that cover cups; however, one covers them in all instances, while the other does not.
A semicritical medical device is defined as: “Medical equipment/device that comes in contact with nonintact skin or mucous membranes but ordinarily does not penetrate them … Reprocessing semicritical equipment/devices involves meticulous cleaning followed by, at a minimum, high-level disinfection.”(1) This is the category that covers a cup all the time. As a standard practice, the classification of cups should cover the cups at all times. One standard is the best standard.
2. The reprocessing effort begins with cleaning. Wash your cups thoroughly with soap and water. This may need to be done more than once, since lubricants that are used in manual therapy treatments are difficult to remove entirely on the first wash. The washed cup is rinsed and then put through the disinfection process.
3. For high-level disinfection, the cups need to be placed in a bath of one of the following chemicals: 2% glutaraldehyde; 6 to 7.5% hydrogen peroxide (the CDC in the U.S. recommends use of 7.5% hydrogen peroxide as opposed to the 6.0% recommended by Canadian regulatory bodies.); 0.2% peracetic acid; or 2 to 7% enhanced action formulation hydrogen peroxide and 0.55% ortho-phthalaldehyde (OPA).
Each of these chemicals has a specific contact time, or the time in which it must be in contact with the cups in order to reach high-level disinfection.(2) Pasteurization also achieves high-level disinfection.
4. I recommend hydrogen peroxide as the disinfection agent. This product is easy to get and relatively inexpensive, breaks down into water and oxygen, does not smell, and is easily disposed of in most places. It can be picked up locally in higher concentrations at hydroponics stores, some pool supply stores, and some pharmacies.
The bottle that you purchase will be good for two years from the date of manufacture. It can be disposed of in most municipal plumbing or into rural septic systems as long as it is diluted with running water as it is poured in. It is good as a disinfectant bath for multiple uses for 21 days from when it is diluted down from a higher concentration or is used the first time. Please note that higher concentrations are not necessarily better, as higher than 10% can cause the breakdown of some types of cups.
Cups are left in a bath of 7.5% hydrogen peroxide for 30 minutes to reach high-level disinfection. If cups are left for six hours, they are considered sterilized, which is the next highest level of disinfection. This is good for when the cups do inadvertently come into contact with blood or body fluids. If any of the other disinfectants are used, follow appropriate guidelines as to the contact time of that disinfectant.
5. It is important to remember that these disinfectants, no matter which, are meant to kill organic matter. Please respect them, and wear the recommended personal protective equipment to handle them appropriately. Gloves, goggles and sometimes a gown or apron are a good idea when working with disinfectant chemicals.
6. From the disinfection bath, the cups need to be rinsed, so the disinfectant agent is rinsed off, or neutralized. Cups are then left to dry. Once dry, the cups are safe to use on the next client without worry of cross- contamination.
About the Author:
Paul Kohlmeier, BPE, RMT, RAc., is a course creator and lead instructor with Cupping Canada and Cupping USA. He is a massage therapist, acupuncturist and self-proclaimed research geek, regularly participating in research conferences. He has been teaching and lecturing for over 15 years. His experience, along with a love of research led him to create Cupping Canada’s Evidence Informed Clinical Cupping course.
(1) Ontario Agency for Health Protection and Promotion (Public Health Ontario). Provincial Infectious Diseases Advisory Committee. Best practices for cleaning, disinfection and sterilization of medical equipment/devices. 3rd ed. Toronto, ON: Queen’s Printer for Ontario; May 2013: 5
(2) Ontario Agency for Health Protection and Promotion (Public Health Ontario). Provincial Infectious Diseases Advisory Committee. Best practices for cleaning, disinfection and sterilization of medical equipment/devices. 3rd ed. Toronto, ON: Queen’s Printer for Ontario; May 2013: 32