With the majority of physiotherapy clinics left to their own devices when it comes to hygiene, one physiotherapist has investigated industry practices with surprising results.

Research undertaken by physiotherapist and founder of Purifas, Ibrahim Samaan, found physios were dropping the ball around environmental hygiene, specifically areas and devices shared between clients, such as the therapy bed.

“Given that almost every patient makes direct contact with these beds, the current practice in ensuring this bed is clean is very poor,” Mr Samaan says.

“Clients who are lying face down, with their face in the hole of the bed, will often leave saliva behind, both on and in the hole of the bed,” he says.

With therapists and business owners essentially setting their own standards, conditions vary, but generally, says Mr Samaan, there are a couple of approaches therapists take, including:

1. A terry towelling cover that is shared between clients.
2. Laying a new towel on the bed for each client.
3. Laying down a paper roll between clients – which does not cover the entire contact surface and moves during treatment.
4. Wiping the bed in between each client – which relies on the compliance of the practitioner as well as ensuring they follow the manufacturer’s process to disinfect.

To initially assess the hygiene practices of Australian physiotherapy clinics, Mr Samaan’s team randomly swapped the internal aspect of the face hole of five therapy beds across Sydney – testing for the presence of bacteria.

“We found that all five beds were contaminated with microbes (both harmful and non-harmful),” Mr Samaan explains.

The research showed one in five beds contained rhinovirus, two in five contained Staphylococcus aureus, and five out of five showed the presence of skin cells and skin flora.

Mr Samaan has always had a preoccupation with cleanliness. When he joined the workforce, his immediate observation was that the industry wasn’t up to scratch when it came to hygiene.

“In an industry that is dedicated to helping people, it only made sense to include hygiene as part of this service – to work on fixing one thing and risking another has never made sense to me,” he says.

As an employee though, it was very difficult to make changes, but after he established his own clinic, Mr Samaan took action to offer a more hygienic service to his clients.

“I was unable to use the existing products on the market and I immediately developed my own fit-for-purpose products for use in my clinic. It was the feedback from my clients that reinforced the demand in the market and provided motivation for the commercialisation of these prototypes.”

Product development led to research, research to understanding, which then led to more research and further product development, explains Mr Samaan.

“Following the results of other research conducted, we then funded a preliminary clinical trial performed by an independent microbiologist from Macquarie University. The primary purpose of this research was to determine the effectiveness of our products, however, the raw data that was collected showed some interesting findings.”

More than just interesting, some of Mr Samaan’s findings were quite shocking, including:

- On average 55,000 CFUs (active/live germ colonies) were present on the face hole of a therapy bed after treatment.
- Saliva was not only present on the therapy bed after every single treatment but was still present even after the therapy bed was wiped down – indicating that any saliva borne pathogen could also be present.
- Not a single swab of the therapy bed was found to be free from bacteria throughout the whole trial – with over 100 swabs taken.
- At least four out of the seven subjects were carriers of Staphylococcus aureus.

“There is no doubt that some of the data we collected in our independent preliminary research would be surprising to physiotherapists, as well as how prevalent harmful pathogens are and how difficult they are to remove.”

Although the coronavirus pandemic has helped improved hygiene awareness, many of the practices that were adopted by physiotherapists during the pandemic have now been dismissed, says Mr Samaan, with previous poorer practices returning.

“Ongoing training and education are the key to improving understanding and, in turn, improving hygiene practices in a clinic,” Mr Samaan says.

Mr Samaan believes cost is also a deterrent for some physiotherapists.

“There is definitely a need to review how hygiene is policed in the physiotherapy sector. This has always been the case and the flaws were exposed during the recent pandemic – with the entire essential healthcare system scrambling to improve hygiene practices. Given COVID-19 is only one of thousands of deadly pathogens, these practices should be standard,” he explains.

Since launching his physiotherapy hygiene product development company, Purifas, Mr Samaan and his team have worked closely with industry bodies and government policymakers, with a solid goal of improving physiotherapy hygiene standards.

“We now have 20 distributors selling in five countries. We also have thousands of therapists globally who have adopted the Purifas FaceShield as standard practice in their clinics, at a cost of less than 40 cents per patient,” he says.

This growth helped the business win the 2021 Asia-Pacific Gold Stevie Award for Most Innovative Startup of the Year — Business Product Industries.

“The clients’ response was also immediate — the softer feel, the reduction in noise, and an increased hygiene perception were constant themes in our market research. The clients have since been our biggest advocates – introducing our products to their therapists.”

Mr Samaan believes hygiene education should start at the earliest stage – university, to cement a hygiene focused mindset for future physiotherapists. 

“Each healthcare discipline, such as physiotherapy, should have their own set of standards specific to their treatments and practicing requirements. These should also be enforced and accredited by their national board. This will also ensure that any standards developed for a profession are known and implemented.”

“There is much more research that needs to happen in this sector and as data continues to be made available, there should be ongoing support and education for therapists.”