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How to Clean Gua Sha Tools

How to Clean Gua Sha Tools. Part 1

Gua sha is incredibly helpful to break down adhesions, reduce scar tissue and forcing fluid into stagnant tissue. It's quite simple and safe tool to add into the practice of a massage therapist or even an individual. It has very basic contraindications that you would likely assume.

But there are too much controversy about cleaning gua sha tools when you surf the net and even in the books. Let's make things clear.

Cleaning Gua Sha Tools the Right Way

We have to understand some basic terms before going deeper.

Disinfection

Thermal or chemical destruction of pathogenic and other types of microorganisms. Disinfection is less lethal than sterilization because it destroys most recognized pathogenic microorganisms but not necessarily all microbial forms (e.g., bacterial spores).

Sterilization

Validated process used to render a product free of all forms of viable microorganisms. In a sterilization process, the presence of microorganisms on any individual item can be expressed in terms of probability. Although this probability can be reduced to a very low number, it can never be reduced to zero.

High-level disinfectant

Agent capable of killing bacterial spores when used in sufficient concentration under suitable conditions. It therefore is expected to kill all other microorganisms.

Mycobacteria

Bacteria with a thick, waxy coat that makes them more resistant to chemical germicides than other types of vegetative bacteria.

Microorganisms

Animals or plants of microscopic size. As used in health care, generally refers to bacteria, fungi, viruses, and bacterial spores.

Spore

Relatively water-poor round or elliptical resting cell consisting of condensed cytoplasm and nucleus surrounded by an impervious cell wall or coat. Spores are relatively resistant to disinfectant and sterilant activity and drying conditions (specifically in the genera Bacillus and Clostridium).

Vegetative bacteria

Bacteria that are devoid of spores and usually can be readily inactivated by many types of germicides.

Regulatory Framework

There is no any federal or state regulations relating specifically to the handling or disinfecting/sterilization of gua sha tools and instruments.

However, there are standards and recommendations of the CDC (Centers of Disease Control and Prevention), OSHA (Occupational Safety and Health Administration), and FDA (Federal Drug Administration) which can provide a solid base for well grounded desicions.

Spaulding principles

In the late 20th century Earle H. Spaulding devised a classification scheme, simple and logical, which then has been adopted by all infection control professionals.

According to this scheme all patient care instruments and items are divided into 3 subcategories: critical, semi-critical and non-critical items. Proper categorization lets to effectively plan measures of disinfecting and sterilization with maximum efficiency and minimum risk of contamination and infection spreading.

Critical Items

The objects which pose a high risk of infection if they are contaminated with any microorganism.
Thus, items that enter sterile body tissue or the vascular system are critical.
These items must be sterile too because otherwise any microbial contamination could transmit disease. This category includes surgical instruments, urinary catheters, implants, etc.
Subject to sterilization

Semi-Critical Items

The objects which come in contact with nonintact skin or mucous membranes.

These objects and devices must be free from all microorganisms, but, small amount of bacterial spores are allowed.

The reason for that is because mucous membranes (those of the gastrointestinal tract and the lungs) generally are resistant to infection by common bacterial spores but vulnerable to other microorganisms, such as bacteria, mycobacteria, and viruses.

This category includes anesthesia and respiratory therapy equipment, some endoscopes, anorectal manometry catheters, laryngoscope blades, etc.
Subject to High-Level Disinfection (HLD), some items subject to Intermediate-Level Disinfection (ILD)

Non-Critical Items

These items are defined as those that come in contact with intact skin but not mucous membranes.

Intact skin serves as a barrier to most microorganisms. Thus, the sterility of objects contacting with intact skin is "not critical."
Subject to Low-Level Disinfection (LLD)

Sometime, when some critical items are heat-sensitive, indeed, there is a controversy about whether they should be sterilized or high-level disinfected.

A curious reader can be referred to the section “Concerns about Implementing the Spaulding Scheme” of this document.

The section Disinfection of HBV-, HCV-, HIV- or TB-Contaminated Devices of the above document reads:
The CDC recommendation for high-level disinfection of HBV-, HCV-, HIV- or TB-contaminated devices is appropriate because experiments have demonstrated the effectiveness of high-level disinfectants to inactivate these and other pathogens that might contaminate semi-critical devices.

Let’s conclude:

Sterilization ► Critical items
HLD ► Semi-critical items
ILD ► Some semi-critical items
LLD ► non-critical items

Arya Nielsen – Gua Sha in professional settings

Based on the above principles, the recommendations were given by Arya Nielsen et al. in Addendum: Safety Standards for Gua sha (press-stroking) and Ba guan (cupping).

Let’s sum up those recommendations.

She insists that gua sha tools are to be classified, depending on situation, as critical or semi-critical items, because potentially contaminated by blood, thus, subjected to sterilization or high level disinfection if they are to be re-used.

Arya Nielsen warns that Gua sha tools have been mistaken as non-critical instruments, thus, not requiring HLD because they don’t contact ‘intact’ skin.

However, the contact of the gua sha tool or instrument with skin involves enough repeated pressure to cause extravasation of “blood and fluids that may also seep or be let from the skin even if not immediately visible”.

A.Nielsen categorically insists:
“Gua sha and Ba guan tools are, we maintain, categorically critical (for wet-cupping) and semi-critical (for Gua sha and dry cupping) instruments that require sterilization or high level disinfection (HLD) espectively before re-use.”
It remains unclear whether gua sha instruments falls under critical or non-critical category but the overall message is quite clear.

Decontamination of Gua Sha tools according to A. Nielsen.

Step 1 Clean with Soap and Water

Gua sha tools should be cleaned of blood, proteinaceous material and lubricants before high-level disinfection or sterilization which can be done with soap and water.

If desired, the tools can be wiped with Super Sani-Cloth (optional).

The cleaning step is vital and can’t be omitted. Otherwise it can dramatically reduce the efficacy of the following HLD and sterilization. On this stage we remove adherent visible soil, protein substances, blood, microorganisms and other debris from the surfaces, serrations, crevices of instruments or tools by a manual or mechanical process that prepares the items for safe handling and/or further decontamination.

Step 2 Rinse and Dry

The cleaned gua sha instruments may then be rinsed of any soap or debris and dried before to immersion in the high-level disinfection/sterilization bath or autoclave (device that sterilizes instruments using steam under pressure).

Step 3 for High-Level Disinfection – Hydrogen Peroxide Immersion – 30 minutes

The FDA approved 7.5% hydrogen peroxide solution is recommended for HDL and sterilization because it does not require special ventilation and degrades to water and oxygen over time.

BEWARE. At this concentration, direct contact with the solution may cause eye irritation and bleaching of the skin. Gloving and eye protection is recommended.

30 minute immersion in 7.5% hydrogen peroxide solution is enough for HLD.

Or Step 4 for Sterilization – Hydrogen Peroxide Immersion – 6 Hrs

SPOROX II Sterilizing & Disinfecting Solution is a solution that is FDA-cleared for HLD at 30 min immersion at 20 ◦C (68 ◦F), and for sterilization at 6 hrs immersion at 20 ◦C (68 ◦F).

SPOROX II should be checked with test vials described in product instructions to ensure adequate concentration. Maximum reuse time for the solution is 21 days.
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