C.O.E. CONTINUING EDUCATION

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1 Continuing Page 1 of 19 Microbiology and Infection Control Introduction to Microbiology and Infection Control Microbiology is a big word to describe the study of such small organisms! Yet that s exactly the definition of microbiology, the study of small living organisms called microbes. A basic knowledge of microbiology is the best defense against the spread of potentially infectious organisms. By adhering to infection-control standards, you can prevent microbes, such as bacteria, from being transmitted from one client to another or to yourself and your colleagues via the use of contaminated (dirty) esthetic tools and implements. Estheticians should take infection control very seriously. Bacteria Bacteria, also called germs or microbes, are one-celled microorganisms. While thousands of different kinds of bacteria exist, they are generally classified into two types: 1. Pathogenic disease-producing bacteria 2. Nonpathogenic non-disease-producing bacteria Here is an easy way to remember these words. The Greek word pathos means suffering. Pathogenic bacteria causes disease = suffering. Nonpathogenic bacteria does not cause disease = non-suffering. There are more than 2,000 different kinds of bacteria and most are harmless, or even helpful! Nonpathogenic Bacteria Nonpathogenic bacteria are harmless and can at times be very beneficial. Approximately 70% of all bacteria are nonpathogenic, many of which live on the surface of the skin. Some nonpathogenic bacteria have medical applications. Other bacteria, like those found in certain dairy products (such as yogurt), have health-enhancing properties, and still others cause the decay of refuse or vegetation and thereby improve the fertility of soil. Saprophytes (SAP-ro-fights) are nonpathogenic bacteria that live on dead matter. Without this type of bacteria, the earth would literally be covered with dead matter! Pathogenic Bacteria Pathogenic bacteria live everywhere in your environment and even exist inside your body. Several different types of pathogenic bacteria are harmful because they cause infection and disease, and some produce toxins. These infectious bacteria can be easily spread in the skin care center through the use of contaminated implements or via dirty hands and fingernails. Continuing 1

2 Continuing Page 2 of 19 Only in the last 100 years have scientists discovered these microscopic (seen only with the aid of a microscope) bacteria and invented solutions for destroying many of them, thereby combating the spread of infection. Scientists found that bacteria have distinct shapes that aid in microscopic identification. The study of bacteria is called bacteriology. Bacteria are single cells with one of three basic shapes: circular, spiral or rod-shaped. Because of the importance of infection control to the esthetician, you need to be knowledgeable about all types of microscopic bacteria. However, in your practice as a skin care specialist, you will not be able to identify the bacteria in the skin care center or spa with a microscope. Therefore, your main responsibility is to prevent the spread of all bacteria by exercising proper hygiene and cleanliness. The following are more common pathogenic bacteria that you might encounter as a professional esthetician. Common Bacterial Types Cocci (KOK-sigh) are spherical or round-shaped bacterial cells, which appear singularly or in groups. To remember, think c = circle and cocci. There are three groups of cocci: Staphylococci (staf-i-lo-kok-sigh) are pus-forming bacterial cells that form grape-like bunches or clusters and are present in abscesses, pustules and boils. Continuing 2

3 Continuing Page 3 of 19 Streptococci (strep-to-kok-sigh) are also pus-forming bacterial cells, which form in long chains and can cause septicemia (sometimes called blood poisoning), strep throat, rheumatic fever and other serious infections. Diplococci (dip-lo-kok-sigh) are bacterial cells that grow in pairs and are the cause of certain infections, including pneumonia. To remember, think d = double and diplococci. Bacilli (ba-sil-eye) are the most common form of bacterial cells. Bacilli are bar or rod-shaped cells that can produce a variety of diseases including tetanus, bacterial influenza, typhoid fever, tuberculosis and diphtheria. To remember, think b = bar and bacilli. Spirilla (spi-ril-uh) are spiraled, coiled, corkscrew-shaped bacterial cells that cause highly contagious diseases such as syphilis and cholera. To remember, think s = spiral and spirilla. Keep in mind that this list is never complete. Through research, previously unknown pathogenic bacteria are discovered on an ongoing basis. Bacteria can cause infections by invading the body through a break in the skin or through any of the body s natural openings (nose, mouth, eyes, etc.). An infection occurs when an insufficient number of antibodies are produced by the body s immune (defense) system to fight harmful bacteria. Growth of Bacteria Bacteria thrive in dark, damp or dirty areas where a food source is available. All bacteria go through a growth cycle that consists of two stages: an active stage and an inactive stage. Active Stage During the active stage, also known as the vegetative stage, bacteria reproduce and grow rapidly. As the bacteria absorb food, each cell grows in size and when it is fully grown, it divides to create two cells. The process of cell division in bacteria is similar to the budding process in plants. Under favorable conditions, bacteria reproduce quickly, developing as many as 16 million offspring in 12 hours. Inactive Stage Bacteria are not always active; in unfavorable conditions, the cells die or become inactive. Some bacteria, such as anthrax and tetanus, also have a normal inactive or dormant stage. When the environment makes the bacteria s survival difficult, some bacteria enter this inactive, spore-forming stage, by creating spherical spores resistant to disinfectants, cold or heat. Spore formation and other means by which bacteria can resist disinfection are factors to be considered when practicing infectioncontrol procedures in the skin care center. Some bacteria can survive for a long time in extreme heat or cold. When conditions again become favorable for the bacteria s growth, the bacteria return to the active stage. Movement of Bacteria Continuing 3

4 Continuing Page 4 of 19 Because of their tiny size, bacteria can travel easily from place to place through air or water, from you to your client and vice versa. Bacilli and spirilla have the ability to move by themselves, using hair-like projections called flagella (flah-jel-ah) or cilia (SIL-ee-a). These projections move the cells using a wave-like motion. More than 1,500 of some types of bacteria will fit on the head of a pin. Viruses The word virus comes from the Latin word meaning poison. It is defined as a sub-microscopic infectious agent that replicates itself only within cells of living hosts (meaning it takes over the cell to live), and many are pathogenic. Viruses are much smaller than bacteria but cause more serious diseases, such as herpes, influenza and other respiratory and gastrointestinal infections, chickenpox, mumps, measles, smallpox, yellow fever, rabies, Acquired Immunodeficiency Syndrome (AIDS), hepatitis and polio. Viruses cannot live on their own. They need host cells in order to survive. Vaccination is usually recommended for professionals whose work may cause them to be exposed to HBV, such as dental hygienists. Check with your local health agency or doctor to determine whether you are a candidate for this inoculation. Since you will be exposed to openings in the skin during the extraction process of most facial procedures, you should consider being vaccinated against HBV as a preventative measure. Gloves and eye protection are essential during the extraction process to protect you from exposure to clients' blood or body fluids. Acquired Immunodeficiency Syndrome (AIDS), is a highly infectious disease caused by HIV (or a variant of HIV, called HIV-i), which interferes with the body s natural immune system and causes it to break down. Scientists have gained a great deal of knowledge about HIV, including information about its transmission and prevention. HIV is spread when blood or body fluids from an infected individual enter the body of an uninfected person and are absorbed into the bloodstream. The fluids from the infected person must contain sufficient amounts of the virus in order for the disease to be transmitted. Fluids known to contain sufficient amounts of HIV include blood, semen, vaginal fluids and breast milk. Infectious fluids can enter through sexual intercourse, childbirth, cuts, and sores or by sharing needles to name a few. Continuing 4

5 Continuing Page 5 of 19 External Parasites Pediculosis Capitis External parasites (PEAR-uh-sights) are organisms that grow and feed on other living organisms, which are referred to as hosts. They contribute nothing to their host and cause contagious diseases. Two such parasitic animals are head lice (pediculosis capitis) and itch mites (scabies). Clients that have a disease caused by a parasitic animal should not be treated and should be referred to a physician. Parasitic plants, or fungi, are molds and yeast that produce such contagious diseases as ringworm (tinea capitis), honeycomb ringworm (favus) and nail fungus. These can occur on natural nails or with clients wearing artificial nails, and can spread via improperly disinfected implements. An esthetician can spread infection to a noninfected area by using the same implements previously used in an infected area. Be aware of this fact when performing hand or foot treatments. Infection An infection occurs when disease-causing (pathogenic) bacteria or viruses enter the body and multiply to the point of interfering with the body s normal state. An infection is the growth of a parasitic organism within the body. These microorganisms are referred to as pathogens, and include viruses, bacteria, protozoa and fungi. An object that contains pathogens is considered contaminated. To prevent cross-contamination, all pathogens need to be removed from the object (decontaminated). Bloodborne pathogens such as HBV and HIV are transmitted through blood or body fluids and cause infectious diseases. Airborne pathogens can travel through the air and can be transmitted from one person to another through casual contact. Contagious infections or communicable diseases such as tuberculosis are caused by airborne pathogens. Common means of spreading infection in a skin care center include: Contact with open sores Continuing 5

6 Continuing Page 6 of 19 Contact with contaminated hands and implements (usually due to improper disinfection between clients) Exposure to coughing or sneezing Use of common drinking cups and towels Exposure to unsanitary conditions Use of facial beds that are not properly disinfected between clients INFECTIOUS VS. CONTAGIOUS You may be wondering what the difference is between an infectious disease and a contagious disease. An infectious disease is caused by pathogenic bacteria or viruses that enter the body and multiply to the point of interfering with the body s normal state. Infectious diseases can be transmitted from person to person through casual contact or through the exchange of bodily fluids. For instance, AIDS, Hepatitis B, Herpes, measles and mumps are infectious diseases. Contagious diseases cause infection and are communicable by casual contact. Not all infectious diseases are contagious because not all of them can be spread through casual contact. Some examples of diseases that are both infectious and/or contagious are listed below. Disease Infectious Contagious AIDS Chicken Pox X X Common Cold X X Hepatitis B X Herpes X X Influenza X X Legionnaire s Disease Lyme Disease Measles X X Tuberculosis X X X X X The first example is AIDS, which is communicable through body fluids and causes infection. However, it is not spread by casual contact and therefore, not considered contagious. When a disease spreads from one person to another via casual contact (by touch or through the air), it is referred to as contagious. Infectious diseases, on the other hand, are typically more difficult to transmit, and are often spread by blood-to-blood or body-fluid transmission. Continuing 6

7 Continuing Page 7 of 19 Tuberculosis Tuberculosis (too-bur-cu-lo-sis) is a contagious and potentially fatal infection caused by airborne bacteria that first affect the lungs. Early signs of tuberculosis are a smoker s cough, often accompanied by cold sweats during the night and shortness of breath. If left untreated, tuberculosis can spread from a lesion in the lung to the lymph nodes, and possibly other organs of the body. Tuberculosis most frequently affects elderly people, individuals with AIDS and those with low immune systems, but antibiotics can cure most cases of tuberculosis when caught in earlier stages. Preventative measures in the esthetic environment are necessary to avoid contamination and the spread of tuberculosis. Using germicidal disinfectants for equipment and implements is an effective preventative measure. Infections can also be prevented by good personal hygiene, public awareness and following infectioncontrol procedures in the skin care center. If you have a contagious or communicable disease, extra caution should be taken in order to prevent the spread of infection. Check with your area s regulating agency for specific guidelines on dealing with contagious diseases. There are two basic classes of infection: 1. A local infection (below) is present in a small, confined area often indicated by a pus-filled boil, pimple or inflammation. To remember, think local = little. 2. A general (or systemic) infection (below) occurs when the circulatory system carries bacteria and their toxins to all parts of the body. To remember, think general = giant. Continuing 7

8 Continuing Page 8 of 19 For this reason, the same infection-control procedures should be used with all clients. Using consistent infection-control procedures for all clients is called Universal Precautions. If your client has a contagious or an infectious disease, you may not be made aware of it! Practice Universal Precautions to protect yourself and your clients. For example, working on an HIV-positive client (with no open lesions) should be no different than working on any other client. Universal Precautions means using the same infection control practices with all clients. Immunity Immunity is the body s ability to destroy infectious agents that enter it. The immune system is a remarkable defense mechanism that fights infections in two basic ways: 1. Natural immunity is a partially inherited, natural resistance to disease. A healthy body produces white blood cells and antibodies to fight disease-causing agents. Also, the epidermis (outermost layer of skin) protects the body from microbes. If the skin is punctured, the cut must be treated to prevent microbes from infecting the skin. It is often said that the unbroken skin shields the body from disease. 2. Passive (acquired) immunity occurs through vaccinations, or the injection of antigens, which stimulate the body s immune response (i.e., innoculation for polio or flu). The body s dependence on its immune system inspires most people to protect themselves from coming in contact with potentially harmful bacteria and viruses. Healthy, unbroken skin is the first major defense the body has against infection. Now that you have read about the dangers of microbes, you are ready to learn how you can destroy them and prevent disease from spreading in the skin care center. Infection Control Principles As you know, microbes are everywhere, including in the air around you; so infection control requires diligence. Infection control is the term used to describe efforts to prevent the spread of disease and kill Continuing 8

9 Continuing Page 9 of 19 microbes. Prevention is practiced at three varying levels of control, which include sanitation at the lowest level, disinfection at the second level and sterilization at the third, and highest level. General practices used during infection-control procedures include hand washing and using personal protective equipment, such as gloves and safety glasses when needed. It also means properly disinfecting all skin care implements and surfaces to prevent cross-contamination (when bacteria are spread by contaminated equipment, surfaces, equipment or food). Gloves must be worn for waxing or extraction procedures when there is the possibility of exposure to blood or body fluids. You may also choose to wear gloves during the facial procedure. This may be required by law in some regions. Check with your regulating agency, but a general rule to follow is this: When in doubt, wear the gloves. There are different types of gloves available on the market, but the two most common types that you will encounter are latex or vinyl gloves. In general, latex gloves cost less than vinyl, but it is advisable to have both types available. Though both are effective some clients and estheticians may have an allergic reaction to latex. A latex allergy could produce reactions such as redness, swelling, itching, burning or hives. An esthetician should inquire about whether a client has this allergy during the Client Consultation. If you notice any unusual redness or reaction during the procedure, you should discard the gloves and wear another type. Infection Control General Terms Infection Control is the prevention of the spread of infectious agents to you and your clients. Sanitation, Disinfection and Sterilization comprise the three levels of infection control. Sanitation is the low-level destruction of surface bacteria. Disinfection eliminates bacteria, viruses and most organisms on inanimate non-porous surfaces. This procedure is recommended for all esthetic implements and surfaces. Sterilization eliminates all living organisms on non-porous surfaces, including bacterial spores that adhere to surgical instruments in medical treatment rooms. Antiseptics arrest or prevent the growth of microorganisms on the skin. Infection-control procedures include handwashing, using personal protective equipment, such as gloves and safety glasses when necessary, and properly disinfecting all skin care implements and surfaces to prevent cross-contamination. Universal Precautions, a set of guidelines established by the Center for Disease Control (CDC), means using the same infection control practices on all clients. Since we cannot identify clients with infectious diseases, it is safer to handle the blood spills and body fluids of all clients as potentially infectious. Continuing 9

10 Continuing Page 10 of 19 Exposure to blood and other body fluids presents a risk for skin care professionals. For the esthetician, exposure can occur during the extraction process of a facial, as well as during other services, such as waxing Hand washing removes microorganisms by lifting them from the surface of the skin. Hands should be washed between each service, before and after a lunch break, after using the bathroom, or any time they become contaminated. OSHA s Bloodborne Pathogen Standard should be followed for all tools and implements that come in contact with blood or body fluids. This type of high-level disinfection requires the use of an EPA-registered hospital-level (commonly referred to as hospital-grade) disinfectant that is labeled as effective against HIV-i and Hepatitis B or tuberculocidal (effective against mycobacterium). In relation to disinfectant products in the U.S., EPA Standards require efficacy labels on all disinfectants to inform the user about what organisms the product is effective against. Reading the label and following the directions ensures that the product will perform according to the efficacy claims on the label. Reading the manufacturer s directions plays a significant role in ensuring infection-control practices. You will notice that methods vary from product to product. For example, immersion times (length of time for soaking) in a disinfectant, storage practices and application methods differ for each product. Follow the directions. It cannot be emphasized enough that two steps are necessary for effective infection control, which include reading the label and following the directions. Understanding the importance of reading and following directions, and being familiar with the role of efficacy during infection control, prepares you for a closer look at the procedures used to implement these practices in the workplace. In today s salon or spa environment, infection control has become a major focus of attention. Client concerns about safety, along with new standards set by regulatory agencies, have resulted in heightened awareness of the procedures necessary to prevent cross contamination. The three levels of infection control are sanitation, disinfection and sterilization, which are used to protect you and the public you serve. Determining the appropriate level of decontamination (free of germs) and infection control depends on how a tool or implement is used. Continuing 10

11 Continuing Page 11 of 19 Sanitation Sanitation is the lowest level of infection control and serves as the foundation of your infection- control program. This first level of infection control is the physical removal of debris, which reduces the number of microbes present. Sanitation also removes organic matter, such as blood and skin particles, which may interfere with proper disinfection procedures. Infection-control practices for sanitation of the school, spa or skin care center require shared responsibilities from everyone on the team in order to provide and maintain a healthy environment. The goal of infection control is to eliminate the transfer of microorganisms. This goal can be accomplished in many ways, but it begins with cleanliness. Standards for infection control are developed by your area s regulating agency to protect the consumer. Sanitation practices that meet these established rules are carried out by you to keep the working areas, esthetic implements and all equipment clean. As the lowest level of infection control practiced in the skin care center, sanitation practices are performed on non-critical objects (objects that come into contact with intact skin). Sanitation begins the process of protecting you and your clients from the transmission of diseases. Following is an overview of steps to take to achieve the highest standards of sanitation. 1. Wash your hands with a liquid antibacterial soap and water immediately before and after each service. Liquid soap is recommended, since bar soaps can harbor and transmit microbes. 2. Disinfect all surfaces before and after each service. 3. Provide hot and cold running water at all times. 4. Provide clean restrooms, with well-stocked liquid soap, toilet tissue and paper towels. Never use restroom areas for storage of chemicals. 5. Provide disposable drinking cups. 6. Clean sinks and water fountains regularly. Continuing 11

12 Continuing Page 12 of Keep the skin care center free from insects and rodents. 8. Empty waste receptacles daily. 9. Wear clean, freshly laundered clothing. 10. Provide freshly laundered towels for each client. 11. Use a fresh, clean sheet to cover the treatment table, facial bed or chair before each service. 12. Launder all towels and linens on a regular basis. 13. Store soiled towels in a covered receptacle until laundered. 14. Avoid touching your face, mouth or eyes during services. 15. Wear protective gloves if you are performing; service that exposes you to a client s blood or body fluids, such as during extractions or waxing 16. Never allow pets or animals in service areas, except for Service Animals as identified in the Americans with Disabilities Act. 17. Provide a new loofah or sponge for each client during a body treatment, or for showering. Loofahs and sponges are porous and cannot be properly disinfected. 18. Dispense all semi-fluids and powders with a shaker, dispenser pump, spray-type container, spatula or disposable applicator. 19. Label all chemicals and keep them covered when not in use. 20. Use a fresh spatula or applicator stick for each client every time you dip in for more product. No double-dipping, which means using the same spatula or stick more than one time in any product. This can spread bacteria and contaminate the product. This precaution applies to waxes as well as other skin care products. 21. Mix skin care formulations in flexible mixing bowls that are manufactured with FDA- approved materials. Traditional rubber bowls contain contaminants and are not intended for use with products that touch the human body. 22. Dispose of sharp objects (razor blades, insulin needles, etc.) in a sealable, rigid (puncture-proof) container strong enough to protect you, the client and others from accidental puncture wounds. Sharps containers'" (puncture-resistant containers for biohazardous waste) exist for this purpose. 23. Discard disposable items, porous implements and sponges after each service. 24. Maintain a file of Material Safety Data Sheets for all products used in the skin care center or spa. Continuing 12

13 Continuing Page 13 of 19 Sharps containers are red, puncture-resistant containers labeled with the biohazard symbol and the words sharp waste or biohazard. Disinfection Disinfection is the second level of infection control and means using products (or methods) that kill or destroy bacteria and a broad spectrum of viruses. However, chemical disinfectants do not eliminate bacterial spores. This is the main difference between disinfection and sterilization. The 2001 OSHA Bloodborne Pathogens Standard requires the use of an EPA-registered disinfectant with an efficacy against HIV and HBV or tuberculocidal. This requirement applies to all implements that come into contact with blood or body fluids. Because disinfection products claim to kill or destroy bacteria, and most of these products are toxic, they are regulated by law through a governing agency such as the EPA (Environmental Protection Agency). Standards for disinfection apply to all non-porous surfaces, tools and implements in the esthetics room. For example, tweezers, extractors and probes, which can be exposed to blood during service in the skin care center, as well as all esthetic implements and surfaces, require pre-cleaning (sanitation) and disinfection after each use. These objects are considered semi-critical objects and require a high level of disinfection since they may come in contact with mucus membranes or skin that is broken (not intact). Instrument disinfection and pre-cleaning can be done by hand or with an ultrasonic cleaning machine, which uses high-frequency energy waves. While both methods are acceptable, ultrasonic cleaners have proven to be 16 times more effective than hand scrubbing with a brush. Ultrasonic cleaners also eliminate handling of sharp instruments that may be contaminated with blood. The use of an EPAregistered, broad-spectrum disinfectant effective against HIV-i and HBV, which is also tuberculocidal, is recommended to eliminate or minimize occupational exposure to bloodborne pathogens in the 2001 OSHA Bloodborne Pathogens Standard. DISINFECTION GUIDELINES 1. Discard or disinfect every implement that comes into contact with the client. 2. Remove all debris from non-disposable implements and pre-clean by washing the implements thoroughly with soap and water, by hand or with an ultrasonic cleaner. 3. Rinse thoroughly and pat implements dry prior to immersion to avoid dilution when immersed in disinfectant. 4. Completely submerge all non-porous skin care implements in a disinfectant that is EPA- registered, broad-spectrum and designated as effective against HIV and HBV or tuberculocidal. Continuing 13

14 Continuing Page 14 of 19 Follow manufacturer s instructions for submersion time and for dilution, if you are using a concentrated formula. 5. Change chemical solutions in disinfectant containers daily, or as recommended by the manufacturer. 6. Remove implements with forceps, tongs or gloved hands, or use a self-draining basket, which is usually included with the soak tray. Do not leave implements in solution for extended periods of time, or beyond manufacturer directions. 7. Follow the manufacturer s directions for disinfection. 8. Store implements that have been disinfected in a clean, dry, covered container or cabinet until needed. 9. Never use an implement or towel that has been dropped onto the floor. Even though your floor may be cleaned daily, always discard or prepare the item for disinfection, then continue services with clean, disinfected materials and implements. 10. If towels and body wraps are laundered in your facility, use an additive that disinfects and sanitizes wet linens. 11. Keep a first-aid kit on hand. 12. Refer to guidelines on blood spill procedures for cuts or broken skin exposures. 13. Dispose of any material that comes in contact with blood or body fluids, such as discharge from open sores, pimples and sebaceous glands, in a sealable plastic bag (or appropriate sharps container) and place inside a covered waste can liner for disposal. This process is called doublebagging. You may be required to label this bag with a red or orange marker to indicate that it contains hazardous waste. Check with your area s regulating agency for disposal guidelines. Precautions for Mixing Chemicals Since chemical disinfecting agents can be dangerous, remember to take the following precautions to prevent accidents and mistakes: 1. Tightly cover and label all disinfecting products and other chemicals for use in the skin care center. 2. Store in a cool, dry area. Air, light and heat can weaken chemicals. 3. Purchase chemicals in small quantities. Continuing 14

15 Continuing Page 15 of Do not inhale (or smell) chemical solutions. Avoid contact with skin or eyes. Wear protective gloves. Refer to MSDS for procedures if contact does occur with the skin or eyes. 5. Wash hands with soap and water after handling all chemicals. Avoid using bar soap that can harbor and transmit microbes. Use a liquid, antibacterial soap from a pump-type dispenser. 6. Try to avoid spilling. If you do spill, wipe up all spills at once. Refer to MSDS for proper handling. 7. Change chemical solutions in disinfectant containers daily, or as recommended by the manufacturer. 8. Always follow manufacturer s instructions. Proper Handwashing Procedure Handwashing is one of the most important sanitation actions you can take to prevent the transfer of microorganisms from one person to another. Washing hands with an antibacterial liquid soap removes microorganisms from the folds and grooves of the skin by lifting and rinsing them from the skin surface. In the skin care center, wash your hands before and after each service. At the end of the day, wash your hands again thoroughly to prevent carrying microorganisms outside of the skin care center. 1. Use a paper towel or tissue to turn the water on, if you have a paper towel or tissue dispenser (some facilities only offer hands-free air blowers). Dispense an additional 10 to 12" (25-30CIT1) and leave hanging in place from the dispenser for later use (#5). 2. Wet hands with warm water. 3. Apply soap and clean hands, nails and between fingers 4. Lather and scrub for approximately 15 seconds. Continuing 15

16 Continuing Page 16 of Rinse hands; then tear off paper towel and dry 6. Turn off water with paper towel or tissue not with your clean hands! If more paper is needed, use the paper in your hand on the dispenser handle. Helpful Hints If possible, use a paper towel or tissue to turn the doorknob to exit the restroom. Those who left before you may not have followed the procedure to the left. Contaminated is defined as not free from dirt, oil and/or microbes. Antibacterial soap can cause your hands to become dry and cracked, so keep some moisturizing hand creme or lotion handy. Single-use paper towels are most effective and do not carry the risk of cross-contamination posed by communal cloth towels. Avoid bar soap, since it is more likely to become contaminated with bacteria. Antibacterial soaps are more likely to kill resident microorganisms in deeper layers of the skin than plain soap or detergents. Be sure to rinse the soap off of your hands from just above the wrist down to the fingertips. Keeping your hands angled downward prevents soapy water from dripping down your arm to your elbow it also keeps your sleeves from getting wet! Ventilation A properly ventilated skin care center ensures that air does not have a stale, musty odor or the odor of various chemical solutions. Insufficient ventilation can transmit allergens and pathogens throughout the air in the skin care center. The average room temperature should be about 70 Fahrenheit (21 Celsius). The following guidelines provide an overview of various ventilation and sanitation practices for a healthy environment: Air conditioners regulate changes in the quality and quantity of air brought into the skin care center as they cool, dehumidify (remove moisture) and eliminate pollutants from the air. Remember to change air filters as needed. Forced-air furnaces heat the air and purify it by filtering out most dirt and debris. Remember to change air filters as needed, usually when dirt is visible. Continuing 16

17 Continuing Page 17 of 19 Exhaust fans help circulate the air but do not clean it. Position fans to draw air away from you and your client. Air should be mechanically supplied through vents and air returns and/or through opening windows and doors, or by using blower fans to direct air as desired. Whenever possible, direct exhaust air out of the building. Regulating Agencies In the United States, the Occupational Safety and Health Administration (OSHA) is the regulating agency under the Department of Labor that enforces safety and health standards in the workplace. OSHA standards require that employees be informed of the dangers of the materials used in the workplace and the exposure they might have to toxic substances and that all workplace conditions are sanitary. Material Safety Data Sheets (MSDS) and labeling of products are two important regulations that this agency has instituted to assist in safe operations. An MSDS (sample below) provides key information on a specific product regarding ingredients, associated hazards, combustion levels and storage requirements. Remember that, for your protection and safety, you have a right as an employee to know what is contained in any product being used. OS HA standards significantly impact the industry by helping to ensure general safety, especially in regard to mixing, storing, labeling and disposing of chemicals. Continuing 17

18 Continuing Page 18 of 19 An MSDS for every product used in the skin care center or spa must be kept in a file or a binder that is easily accessible to all skin care center personnel for reference and in the event of an emergency. The MSDS provide information on the product ingredients, including potential hazards. Such information may prove helpful if an allergic reaction or injury occurs related to the product s usage. MSDS must be supplied by the manufacturer with each shipment (or made available upon request) by the supplier or manufacturer of the product. This standard applies to disinfectants, soaps, lotions, crèmes, exfoliants, oils, and any other products used in the skin care center. Regulatory agencies outline very specific rules pertaining to thoroughly pre-cleaning non-porous instruments with soap and water before immersing in any disinfectant solution. The pre-cleaning (washing with soap and hot water) of instruments is the first step to proper disinfection. Always follow the manufacturer s directions, and always wear protective gloves and safety glasses when mixing disinfectants. Read the label on all disinfectant products to determine the specific organisms the product has been proven effective against. Broad-spectrum disinfectants, formerly known as hospital-level disinfectants, will state on the label that they are as follows: Germicidal, Fungicidal, Pseudomonacidal, and Virucidal. If the disinfectant is not proven effective against pseudomonas aeruginosa, or Pseudomonacidal, and if this does not appear on the label along with an EPA Registration Number, the disinfectant is not broad-spectrum. The disinfectant must also be effective against HIV and HBV or tuberculocidal. If it is effective against these organisms, it will always be stated on the label as shown below. In the United States, the Environmental Protection Agency (EPA) approves the efficacy of products used for infection control. The manufacturer must submit a product to the EPA for verification of effectiveness against the organisms listed on the label. Once verification has been established, the product receives an EPA registration number, along with approval of the efficacy claims on the label, stating what organisms the product is effective against. Disinfection Considerations Since the regulatory agency in each area determines efficacy standards, they may vary from place to place. Some areas may recommend disinfecting all tools and implements regardless of whether or not they have come in contact with blood or body fluids, while others recommend disinfecting only those that have come in contact with blood or body fluids. A broad-spectrum disinfectant with an efficacy label that reads effective against HIV and Human Hepatitis B Virus or tuberculocidal meets both of these requirements. Chemical disinfecting agents come in varied forms, including liquid, capsule and powder. When choosing one from your supplier, consider the following: Continuing 18

19 Continuing Page 19 of 19 Is it non-irritating to the skin? Is it in compliance with your area s regulating agency or health department? Is it economical? Is it easy to use? Is it an agent that works quickly? Is it safe for use with metal and plastic implements? Is the recommended storage container sufficient for usage? Read the directions carefully and follow recommended safety precautions! Always note and follow specific immersion times, and always cleanse implements before disinfecting. Remember that disinfection methods do not work instantly but require some time to destroy microbes. Procedures and timing will vary, based on the product used to disinfect. Read the label to determine the length of time required for implement and surface disinfection. Sanitation and disinfection practices are the methods most often utilized in the skin care center. The third level of infection control, sterilization, is used less frequently, but is far more effective. Moreover, it is sometimes imperative. However, it is more costly. Keeping Safety First! The safety, protection and welfare of the clients you serve are among the many reasons you are licensed as a professional. This chapter holds valuable information for you to utilize and practice. Remember that your own health and safety carry significance as well. Make sure you know the procedures necessary to maintain a clean, healthy, safe environment. Your clients will respect your efforts and trust your services. Microorganisms inhabit bodies at all times both yours and your clients. Practicing Universal Precautions protects everyone and eliminates the spread of infection. By adhering to strict guidelines for hygiene using the proper procedures, tools and solutions for sanitation, disinfection and sterilization you exhibit the utmost professionalism. You also demonstrate concern for your clients health and wellbeing, putting them at ease and making them feel secure and relaxed in your hands. This is the best peace of mind you can offer them. Protect your clients and yourself by practicing proper infectioncontrol procedures throughout your workplace. Your clients will appreciate your efforts to protect their health, but the true benefactor is you, today s professional esthetician. Continuing 19