Chiropractic treatment tables and infection control

  Are there infectious pathogens on chiropractic treatment tables? Here are two articles that examine this issue.

Evans MW, Jr., Breshears J, Campbell A, Husbands C, Rupert R. Assessment and risk reduction of infectious pathogens on chiropractic treatment tables. Chiropr Osteopat 2007; 15(1):8. [Open Access]

BACKGROUND: To investigate the presence of pathogenic microbes on chiropractic treatment tables in one outpatient teaching clinic. Additional aims were to test inexpensive disinfectants on tables that may kill microbes and suggest infection control measures for chiropractic offices, clinics and classrooms. The aim of the study was to assess the presence of pathogenic microbes on treatment tables in one outpatient teaching clinic and determine a simple behavioral model for infection control including table disinfection and accepted hand washing and sanitizing protocols.
METHODS: 10 treatment tables were selected and sampled for possible microbial flora on face and hand pieces. Samples were cultured on MacConkys agar and mannitol salt agar, labeled and incubated for up to 48 hours. Confirmatory testing of microbes to determine if drug resistant flora were present was performed. Among tables tested, 5 were selected to test disinfectants. One-half of the face piece and 1 hand piece were treated with two different wipes and then post-tested for microbes.
RESULTS: Pathogenic microbes were present on chiropractic treatment tables including methicillin-resistant Staph aureus. Simple disinfectants neutralized the pathogens. A rudimentary disinfection procedure and infection control measures are suggested based on the findings.
CONCLUSION: Pathogenic microbes may be present on chiropractic treatment tables and can be effectively killed with proper disinfecting. Hand washing/ sanitizing is an important measure in infection control as is table disinfecting. Rudimentary behavioral changes to improve chiropractic clinic infection control are needed. More comprehensive behavioral models are needed. All teaching clinics and private chiropractic offices should adopt infection control practices including routine table disinfecting and hand sanitizing. Effective measures can be put in place at minimal costs. Accrediting bodies of chiropractic institutions should mandate an infection control plan for member institutions immediately.

Two of the authors also published this article in JACA Online:

Evans MW, Breshears J. Attitudes and Behaviors of Chiropractic College Students on Hand Sanitizing and Treatment Table Disinfection: Results of Initial Survey and Focus Group. JACA Online 2007 May-June;44(4):13-23.

Bifero AE, Prakash J, Bergin J. The role of chiropractic adjusting tables as reservoirs for microbial diseases. Am J Infect Control April 2006; 34(3):155-157.

BACKGROUND: Our goal was to enumerate the microbial flora on the headrest, armrest, and thoracic portion of chiropractic adjusting tables to determine the presence of pathogenic microorganisms and identify the potential for nosocomial transmission.
METHODS: Defined portions of the headrest, armrest, and thoracoabdominal pieces from 9 chiropractic adjusting tables were randomly sampled using the ACT II culture transport system (Remel, Lenexa, KS). Samples were incubated using standard culture techniques for bacteriology and mycology that included 15 mL of heart infusion agar at 35 degrees C for 24 hours and 15 mL of Sabouraud dextrose agar at 30 degrees C up to 7 days.
RESULTS: Identification of microorganisms by biochemical analysis yielded a wide variety of gram-positive (G+) and gram-negative (G-) cocci and bacilli as well as standard fungi. Many were of the genus Staphylococcus. Methicillin-resistant S. aureus (MRSA) isolates were recovered from 2 separate tables.
CONCLUSION: This study supports a growing consensus that those outpatient facilities that do not adhere to strict infection control protocols may become ecological reservoirs of potentially harmful human pathogens.