Approximately 300,000 British patients a year acquire a Healthcare-Associated Infection (HCAI) following care within the National Health Service (NHS).²

The risk of acquiring an infection during physio, osteo, chiro or other physical treatments in the allied health care sector is real. In fact, therapists registered with The Health & Care Professions Council (HCPC), not only have a duty of care, but must also adhere to The Health and Social Care Act 2008: Code of Practice on the prevention and control of infections.

To assist all healthcare providers, including the allied healthcare sector, in their infection control efforts, the NHS has developed a basic framework of precautions. These precautions are split into two categories, and seek to contribute to improvements in infection rates as well as reduce deaths associated with HCAI’s:

  • Standard Infection Control Precautions: The standard practice that should be incorporated with every therapy consultation.
  • Transmission Based Precautions: Additional and essential measures where patients may have a higher risk of infection. The NHS defines this as those who are “known or suspected to be colonised or infected with highly transmissible or epidemiologically important microorganism or are at increased risk of infection”³.

  • Standard Infection Control Precautions (SICPs)

    “Standard Infection Control Precautions (SICPs) are to be used by all staff, in all care settings, at all times, for all patients whether infection is known to be present or not, to ensure the safety of those being cared for, staff and visitors in the care environment”⁴.

    The SICP’s include important hygiene practices such as hand hygiene, the use of personal protective equipment (PPE), safe management of care equipment and care environment, and in cases where it is still used, the safe management of linen.

    Transmission Based Precautions (TBPs)

    In order to determine the additional measures that need to be taken, it is important to first understand the modes of transmission of pathogens. There are 3 modes of transmission – all of which have their own added precautions; droplet, contact and airborne.


    Droplet transmission occurs when an infected person coughs, sneezes or talks. These respiratory droplets can then infect a person if transmitted directly to a susceptible mucosal surface (eyes, nose or mouth) of another person. As with contact transmission, it can also be spread indirectly by contaminating a shared intermediary object or fomite. Again, the prone position elevates the infection risk during therapy. The droplets of a cough, sneeze or even spit whilst speaking or breathing land on the bed’s surface – particularly the interior aspect of the face hole and it’s surrounds. Staph may be carried in people’s noses and has been found on the internal aspect of the face hole during random swab testing on private clinics. This is even despite what some perceive or may appear to be “hygienic practice.” Agents such as saliva and other fluids act as vehicles which allow bacteria to travel from one area to another, meaning the risk of infection in the face hole is greatly intensified for the next customer. Particularly without proven protection or hygiene practice as they will be exposing their mucosal surfaces to the resultant bacteria.


    Contact is the most common mode of bacterial transmission. It involves transmission via touch which can be direct whereby infectious agents and microbes transfer directly through contact from one person to another. It can also be indirect, whereby infectious agents of microbes are transferred between people via an intermediate object (fomite) or person.

    Any client or patient receiving treatment on a massage table, has potential for contact transmission. Any part of the therapist or customer’s body that touches the bed may, and in most cases will, transfer bacteria whether it be harmful or non-harmful. This risk is heightened during prone therapy, as the eyes, nose and mouth, the express lanes for bacteria and viruses to be transmitted or acquired, comes into contact with the face hole – be it in or around it.

    Surfaces have been shown to carry bacterial agents for weeks, and serve as the intermediary object as described above, particularly in therapy settings and high traffic areas. With regards to the therapy bed, single use, fit for purpose barriers which cover the entire contact surface, and do not move or tear during treatment, should be standard practice. Decontaminating the bed is also a must before or after treatments.


    Airborne transmission can occur during breathing, talking, coughing or sneezing and by evaporation of larger droplets which can be dispersed over long distances by air currents and infect individuals by entering the small airways of the respiratory tract. This is the most difficult mode of transmission to manage. It is best managed by screening patients as much as possible prior to their appointment and encouraging people to reschedule if they are showing any signs of illness.

    Standard and Transmission Based Precautions and the Purifas™ FaceShield™

    Purifas® FaceShield™ is the only form of PPE that fully covers the face hole and is proven to provide bacterial filtration. It is an essential device for reducing the transmission and contact of infectious diseases within the healthcare, clinical and therapy setting and providing a safe environment for both workers and patients.

    These properties not only help decrease the transmission of the bacteria from the patient to the bed, but also provide a barrier that reduces the potential exposure of bacteria from the bed to the next customer.

    The 2-ply polypropylene composition of the FaceShield™ creates a hydrophobic barrier (that is, it repels water and water-like fluids) ensuring that infectious microbes travelling through an agent such as saliva will not penetrate the barrier. This will result in a reduction of transmitted bacteria through the droplet mode and will in turn reduce the next customer’s exposure to bacteria.

    The patent-pending internal skirt – the key feature of the FaceShield™ – is the only element of its kind to cover the entire inside of the face hole and the whole facial surface of the therapy bed, providing complete coverage and maximum protection for high quality therapy.

    Its main purpose is to reduce the exposure of infectious agents to a customer’s mucosal surfaces (eyes, nose or mouth) which are the most common points of entry for an infectious agent. Many of the current paper products do not have any bacterial filtration properties and only cover the top surface of the therapy bed, leaving the patient widely exposed to the infection risk of the face hole.

    At present, there is less diligence when it comes to therapy bed hygiene – both in healthcare facilities and in other therapy services due to the high patient turnover and perceived cleanliness of the current ‘paper’ sheets. Purifas® FaceShield™ provides easy hygiene compliance by staff and a reduction in the transmission of and exposure to infectious agents.

    Purifas® FaceShield™ should be set as standard clinical practice in all healthcare and therapy facilities for all prone therapy sessions. It not only assists with complying with The Health and Social Care Act 2008 and fulfilling a therapist’s duty of care, but as a physical and visual barrier, can also help ensure therapist compliance.

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    1. Public and International Health Directorate (2015) The Health and Social Care Act 2008 Code of Practice of the prevention and control of infections and related guidance. Accessed December 2020. Available from:

    2. National Institute for Health and Care Excellence (2014) Infection and Prevention Control. Available from:

    3. National Health Service. Infection Prevention and Control Assurance - Standard Operating Procedure 2 (IPC SOP 2) Transmission Based Precautions. Accessed December 2020. Available from:

    4. National Health Service (2019) Standard infection control precautions: national hand hygiene and personal protective equipment policy. Accessed December 2020. Available from: