"So baby please, open your eyes (wash your hands), and (don't) catch my disease.."

Infection control is a pretty hot topic in any healthcare setting and should be, in my opinion, a hot topic in any setting. If you don’t want to get sick, avoiding germs is key. Even more important is not *spreading* germs to other people- especially if you are coming in contact with anyone with compromised immune systems. So even if you’re feeling great, you may still be carrying disease from client to client. On your hands, your shoes, your gear. 

Immune systems are generally awesome if they are working- so that many of us don’t have to worry about eating a dropped food item off our kitchen floor, or sharing a plate of cake with a friend, or letting a plant get old and moldy in our entryway. These things aren’t recommended, but we often take for granted that we don’t have to worry about them too much. This blog is focusing on what to consider when you’re working with clients- and we typically don’t share cake with clients. 

In the chain of infection, we humans are the “reservoir”, the receptacle. Plants, animals, food, water, environments can also be the reservoir, upon which the causative agent lives. The length of time a reservoir acts as a carrier state can be short or long, depending on what the microorganism is. The microorganism, (which I’ll name “Germ. James Germ.”), finds a portal of exit from their reservoir (Sir Gerry Germsalot). This could be through the GI tract (vomit and poo, oh my!), the respiratory tract (sneezing, coughing, drooling), the genitourinary tract (urine, secretions), blood (an open wound, broken skin), or tissue (infected wounds). Mmmmm… pleasant topic, right? 

The reservoir chain of infection also includes a mode of transmission- there are just three of these: Direct Contact, Indirect Contact, and Airborne. Direct contact is when someone sneezes right into your face and you breathe it in. Gross. Indirect contact is when someone sneezes on a handkerchief or a toy, and then you pick up that item. Ewww. Airborne transmission has to do with droplets and dust- less common, but some infections can travel via spores in the air. The thing about indirect transmission is that the Agent Germ still needs a portal of entry- the same portals where AG left Sir Gerry Germsalot are the portals AG will enter the host. So if you just pick up a sneezed-on tissue, and throw it out, and then wash your hands (again, not recommended, just put some gloves on!), you’re less likely to be infected. But if you pick up a sneezed-on tissue, throw it out, and then wipe your eyes while laughing about how silly you were to not wear gloves- ah! You’ve just spread Agent James Germ into your own Portal, and congrats! You are now a reservoir. 

Again, many of us can wander around all week sitting next to people with the sniffles, hugging kids who just picked their noses, etc., without catching an infection. Where this chain of infection becomes problematic is when we introduce a *susceptible* host at the end- if it’s not a healthy person hosting pathogens, but someone with a compromised immune system, the danger is greater. Susceptible hosts include people who are very young or very old, people who are on immune suppression treatments (for cancer or a transplant), and people who have chronic immune deficiency. When we are working with susceptible hosts we must be extra careful to not only break the Germ Train, but to avoid the chain altogether. And this is where we come to STANDARD PRECAUTIONS

If I haven’t lost you yet, great! Welcome to the GermNerdsClub. If I lost you at the beginning, please start here because this is important. 

1 in 30 patients develop healthcare-associated infection because of exposure to pathogens, that often could have been avoided. That’s a CDC number (don’t shoot the messenger) and it’s improving rapidly because hospitals want people to get healthy and go home. 

Let’s start with some standard precautions you should take to protect your clients and your self. Are you wondering, why the heck is this on a music therapy blog? We’ll get to that!

  1. HAND HYGIENE: Oh! This is just my favorite. Everyone should be excited about hand hygiene. It is THE best. Here are the basics:

    1. Wash your hands before and after contact with bodily fluids

    2. Wash your hands before and after using equipment, especially shared equipment

    3. Wash your hands before and after eating

(there must be a Dr. Seuss book about hand hygiene? I do not like germs here or there, I do not like germs anywhere…)

  1. If you cough/sneeze, cough into your elbow. Not into your hand, not into the air, not into your friend’s face. Cough into your elbow, at the very least, or a tissue if you have one on hand. 

  2. Don’t touch your eyes, nose, or your mouth. If you do, see #1. 

  3. There is hand washing technique! Scrub for at least 30 seconds, all surfaces of your hands, under your nails, in between your fingers. 

  4. Alcohol rub is usually fine unless you’ve been working with some infectious substances- in which case you should go back to soap and water. 

  5. If you work in a setting with lots of James Germ around, leave shoes at your door and wash your clothes. 

  6. Here’s a fun cheer to practice: “Disease Can Wait, Vaccinate!” If the world health organization, a group of well-educated un-biased medical professionals from all over the earth, recommend specific vaccinations to prevent the spread of disease: listen to them. 

I think most anyone who works as a medical professional is familiar with these basic tenets of infection control. I’m not so sure that people who have healthy immune systems spend much time thinking about the pathogens on their sneakers, or question whether they’ve sanitized their hands before digging for spinach in their back teeth. And that’s fine. Part of what makes our immune systems strong is our interaction with common germs, dirt, pathogens (“mud, mud, I love mud”). BUT, if you’re looking to volunteer in a medical setting, or in homes of people with compromised immune systems, you don’t want to be Sir Gerry Germsalot. It’s super important to consider what you’re bringing - in addition to your good intentions, wonderful talents, and friendly demeanor. 

If you are a music therapist or a volunteer musician, a good rule of thumb is to follow the same protocol of the staff at any given facility. Any gear that used communally must have a hard, cleanable surface, and should really be cleaned in between every patient interaction. Now, in some settings you might adapt stricter rules to make things easier. For instance, at some day programs for seniors I’ll start and end each group by passing around hand sanitizer for each person to use. During the group, we interact and share instruments, and at the end of it I wipe down my musical instruments. But if you are visiting, say, a cancer center, you’d want to be much more careful. If patients can come out and join in a music group, they are likely not on specific precautions. If you are visiting patients’ rooms and working bedside, you’ll want to pay attention to specific precautions- and you may need to wear a mask, gloves, and/or a gown. Singing and playing guitar in a mask and gloves is a real adventure! It’s one of those things you don’t get to practice in music school, so you learn by doing. My advice is to size down on your gloves so that you can still play chords.

Unfortunately, the instruments that make the most beautiful sounds are usually the least infection-control-friendly. This is something I would love to see changed. Consider this blog a call to entrepreneurs, musicians, and luthiers: PLEASE create some therapy-friendly instruments! We need washable instruments. While you’re at it, we could also use some disability-friendly instruments. Something to consider! Developers could make a fortune off these things. And I won’t even take 10% for the idea- I’ll just take a few instruments for work ;). 

So your favorite acoustic guitar? Not super washable, unless you want to bleach the finish right off. That tambourine with the head? Sooooo porous. Some safer bets are plastic shakers, like egg shakers or maracas; Kala soprano ukuleles (they are waterproof, so they’re useful for hospital settings OR boat gigs!), and plastic paddle drums. Remo makes some great paddle drums but I have found that a few years of scrubbing them in between sessions has taken the color off. Another music therapist recommended the Hapi drum, which is a lovely tuned tongue drum, and I have a few Freenotes Wings, which are like mini vibraphones tuned to specific keys. Metal instruments are usually safer to disinfect, but heavier and more expensive. It’s frustrating, because there are so many considerations in choosing instruments for healthcare work- what age/population, what the goals are (are they pain relief? fine motor skills? relaxation?), what type of music you’re making… but when you add in infection control, the choices become more limited. Frankly I think it’s offensive to bring small plastic childrens instruments to a group for mature adults, and unsafe to bring fancy large instruments to work with young kids. There is a balance, so I try to keep a mixture of options in my cart so that I can meet each day with the right tools. 

If you have the budget and are working with ongoing groups, a nice option is to provide an instrument for each patient to keep. We did a group for adults with cancer a few years ago, and each person received a recorder to play. (it actually is possible to disinfect recorders and reuse them, but it’s kind of a pain and they’re relatively inexpensive and fun for people to take home). We also give out ukuleles to a lot of patients, and they are simple for people to begin learning songs. 

It is absolutely wonderful to want to share the joy of music far and wide- and people dealing with illnesses can benefit so much from enjoying it with you. Just be sure to follow the rules of infection control and general hygiene so that your music program will keep the respect it deserves from medical professionals! Spread joy, not germs.