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Beauty Salons are in the Eye of the Beholder ….. A Survey into the Environmental Health Standards Operating in Beauty Salons in Co. Donegal, March – April.

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Presentation on theme: "Beauty Salons are in the Eye of the Beholder ….. A Survey into the Environmental Health Standards Operating in Beauty Salons in Co. Donegal, March – April."— Presentation transcript:

1 Beauty Salons are in the Eye of the Beholder ….. A Survey into the Environmental Health Standards Operating in Beauty Salons in Co. Donegal, March – April 2009 Cora Murray, SEHO

2 This presentation…… Introduction Introduction Scope and Limitations Scope and Limitations Methodology Methodology Results Results Conclusions Conclusions Recommendations. Recommendations.

3 Introduction Summer 2009 - 130 beauty salons in Co. Donegal and 5 training colleges Summer 2009 - 130 beauty salons in Co. Donegal and 5 training colleges What do they offer?..... What do they offer?..... - skin treatments e.g. make-up application, microdermabrasion - hair removal e.g. by laser, electrolysis or waxing - teeth whitening - removal of body toxins e.g. by platinum detox - manicures, pedicures - massage - ear candling - ….. and more.

4 Regulatory Background USA, Australia, UK.. Douze points - USA: licensing and inspection of nail salons - Australia: registration and inspection by EHOs where skin penetration procedures occur - UK: h & s enforcement by EHOs Irelande … zero points! - currently no public health legislation governing the operation of businesses such as beauty salons in the Republic of Ireland.

5 So what are the risks? Hazzard Potential cause / source Skin and other infection Re-use of towels, tools, materials without proper cleaning and disinfection; Re-use of disposable tools, materials Hepatitis / HIV Re-use of crystals during medical microdermabrasion Inadequate disinfection of body-piercing tools Burning of skin / hair, ear damage Improper use of ear candles Burns and scarring Improper laser treatment Nail infection Manicures / pedicures / application of acrylic nails / poor cleaning / poor training Mouth and gum irritation / tooth damage Teeth whitening Allergic reaction / skin irritation Failure to carry out patch testing prior to application of e.g. dye, bleach Fungal infections of feet Recycling of water in or improper disinfection of foot spas

6 Case Incidence CountryDetails Source of Info USA 2002 An outbreak of infection from Mycobacterium fortuitum occurred as a result of clients receiving pedicures with whirlpool footbaths and / or shaving from failure to clean and disinfect the equipment used. The New England Journal of Medicine USA 2006 Fungal infection and nail bed damage at a nail salon Birmingham News newspaper The Netherlands 2006 MRSA transmission as a result of contact with an infected Beautician due to use of diluted alcohol used to disinfect skin after waxing and failure to wear gloves Emerging Infectious Diseases journal of the CDSC Ireland None found. Some anecdotal evidence.

7 Scope and Limitations Included in the survey …. Commercial beauty salons only Commercial beauty salons only Voluntary participation Voluntary participation Information as reported by salon operator as observation was not possible Information as reported by salon operator as observation was not possible No prior appointment (in 87% of cases) – time restrictions No prior appointment (in 87% of cases) – time restrictions Not Included in the survey … Services offered from private residences Services offered from private residences Sun-bed facilities, tattooing, ear piercing and hair dressing services Sun-bed facilities, tattooing, ear piercing and hair dressing services Holistic services e.g. reflexology, acupuncture etc. Holistic services e.g. reflexology, acupuncture etc. Workplace health and safety assessment Workplace health and safety assessment Efficacy of treatments offered. Efficacy of treatments offered.

8 Aim To determine compliance levels with the EC (Cosmetic Products) Regs., 2004 - 2006 among beauty salons in Co. Donegal and To determine compliance levels with the EC (Cosmetic Products) Regs., 2004 - 2006 among beauty salons in Co. Donegal and To determine the degree to which such salons protect public health in the delivery of their service by way of the hygiene precautions implemented and To determine the degree to which such salons protect public health in the delivery of their service by way of the hygiene precautions implemented and To make recommendations as to any improvements that could be made and To make recommendations as to any improvements that could be made and To instigate the formulation of national standards for health and hygiene within the commercial beauty salon industry in Ireland, working in partnership with relevant bodies such as the E.H.O.A., N.S.A.I., NABTET and / or IBPA To instigate the formulation of national standards for health and hygiene within the commercial beauty salon industry in Ireland, working in partnership with relevant bodies such as the E.H.O.A., N.S.A.I., NABTET and / or IBPA

9 Objectives To carry out a survey of approx. 25% (N = 30) of the salons operating within Co. Donegal during March – April 2009 To carry out a survey of approx. 25% (N = 30) of the salons operating within Co. Donegal during March – April 2009 To assess the standard of hygiene by taking environmental swabs & / or samples for microbiological analysis. To assess the standard of hygiene by taking environmental swabs & / or samples for microbiological analysis. To sample cosmetic products used in beauty salons for analysis under the EC (Cosmetic Products) Regs., 2004 - 2006 To sample cosmetic products used in beauty salons for analysis under the EC (Cosmetic Products) Regs., 2004 - 2006 To disseminate results of the survey. To disseminate results of the survey.

10 Survey Development Two members of EH staff Two members of EH staff Database of beauty salons generated Database of beauty salons generated Pilot survey Pilot survey Letter issued to salon owners Letter issued to salon owners Two-pronged approach i.e. Two-pronged approach i.e. 1. Assessment of compliance with Cosmetic Products Regs. including a labelling assessment and sampling of cosmetic products in a number of salons. 2. Assessment of hygiene standards a) observed by the E.H.O. and b) as reported by the person in charge and c) by microbiological analysis of environmental swabs & or samples.

11 Results Three sections: 1. Cosmetic Products Regs. 2. Microbiological analysis 3. Hygiene standards observed and practices reported.

12 European Communities (Cosmetic Products) Regulations, 2004 - 2006 Laboratory analysis Laboratory analysis (N = 10) - 100% compliance Labelling assessment (N = 25 salons) – 20% non-compliance re. EU name and address Labelling assessment (N = 25 salons) – 20% non-compliance re. EU name and address Sample of No. of Samples Tested for Eye lash and eye brow tint 1 P- phenylen ediamine Teeth whitening foam strips 1 Bleaching agent Lotions8 Lead and cadmium Total10-

13 Microbiological Analysis Parameters: Total Viable Count (TVC) at 30ºC. Total Viable Count (TVC) at 30ºC. Staphylococcus aureus Staphylococcus aureus Enterobacteriaceae (not tested for regarding foot spas) Enterobacteriaceae (not tested for regarding foot spas) Pseudomonas spp. (tested in swabs from foot spas only) Pseudomonas spp. (tested in swabs from foot spas only) N = 60 samples from 29 different salons ( including 6 control samples) ( including 6 control samples)

14 Types of Swabs Taken Swab of: No. of Swabs: Foot spa 14 Make-up brush, Eye shadow / Make-up, Lip & eye pencil Lipstick 14 Sinks / WHBs 6 Wax from wax pot 4 Toe separators / Manicure & Pedicure tools 4 Heads of facial machine / Interior of UV cabinet / Hot towel cabinet / Towels / Surface of trolley / Bowl / Plastic sheet for waxing / Hot stone in tank 15 Barbicide disinfectant 1 Vaseline1 Sun bed surface 1 Total60

15 Microbiological Standards There were no reference standards for microbiological levels within beauty salons There were no reference standards for microbiological levels within beauty salons Equipment used to pierce skin must be sterile Equipment used to pierce skin must be sterile The interpretation of the results based on a combination of factors including comparison with control samples and with results from other salons in the survey; experience within the Environmental Health Department and general research The interpretation of the results based on a combination of factors including comparison with control samples and with results from other salons in the survey; experience within the Environmental Health Department and general research 14% (N = 4) of the salons visited required a follow-up visit due to levels of contamination that were deemed unsatisfactory i.e. 14% (N = 4) of the salons visited required a follow-up visit due to levels of contamination that were deemed unsatisfactory i.e. 3 foot spas (1 higher TVC / 2 Pseud) 1 toe spacers (S aureus ).

16 Summary of Results Swab of No. taken Summary of Result (in cfu per area swabbed / per g or per ml) Foot spa 14 Pseudomonas spp. identified in two samples and in one other case where TVC levels were comparatively high, adequate cleaning procedures were not in place Make up and Make up applicators etc. 14 Generally very good e.g. max TVC 282; < 10 Staphylococcus aureus and < 10 Enterobacteriaceae Sinks/Wash hand basins 6 Generally very good e.g. max TVC 5,600; < 10 Staphylococcus aureus and < 10 Enterobacteriaceae Wax taken from wax pots 4 Generally very good e.g. max TVC 10; < 10 Staphylococcus aureus and < 10 Enterobacteriaceae Toe Separators & Manicure and Pedicure tools 4 Generally good. Low levels of S aureus present on x1 swab from toe separators –no disinfectant step applied. General Equipment / Surfaces 18 Generally very good. In the interior of a UV cabinet, a TVC level of 673cfu was found

17 Hygiene Standards Assessed - cleaning facilities - hand washing facilities - laundry storage - storage of equipment - services (sanitary accommodation, heating, lighting, ventilation) - policies (hand washing, gloves, skin test) - personal hygiene - waste disposal - equipment for sterilisation and disinfection - cleaning of implements / tools - practices (e.g. double dipping, wax, use of disposables etc) - after care leaflets - client record cards - training - laser and intense pulsed light treatment - medical clinic - general observations. observations.

18 Findings Cleaning Facilities Standard Required Standard Found Separate facilities for cleaning tools, equipment etc. should be provided in or within easy access to the treatment room(s) e.g. a sink with hot and cold water in a hallway from which the treatment room(s) are directly accessed. A sink in a toilet area is not suitable. 7% (N=2) grossly inadequate i.e. had only a whb with only cold water in a toilet area for cleaning of tools, equipment and hand washing. Higher prevalence (75%) noted during pilot survey

19 Findings (contd.) Hand Washing Facilities Standard Required Standard Found Provision of whb in toilet area and whb / sink in or adjacent to the treatment area(s). Hot and cold water, paper towels, soap 17% (N = 5) inadequate i.e. 2 salons only had whb in toilet area, others without hot water or soap

20 Findings (contd.) Services – Ventilation Standard Required Standard Found Mechanical extract or air conditioning in appropriate areas and / or a suitable means of natural ventilation. Mechanical extract in spray tanning areas ** Visual assessment 37% (N = 11) inadequate ventilation in treatment areas 20% ( N = 3) no mechanical extract ventilation in spray tanning areas 50% (N= 15) satisfactory means of ventilation in all areas of salon

21 Findings (contd.) Policies Findings (contd.) Policies Standard Required Standard Found - Hand washing before and after treating a client - Use of disposable gloves where there is or may be contact with mucous membranes (e.g. during intimate waxing) or blood or serum - Various sensitivity tests available with varying time intervals between test and treatment 27% (N = 8) reported washing hands only after treating a client - 87% ( N = 26) reported not using disposable gloves, as required for specific treatments (ref case in Holland) - Further research required in this area

22 Findings (contd.) Waste Disposal Standard Required Standard Found Double-bagging prior to disposal by landfill of contaminated waste including waste cotton wool, tissues or cloths with any blood spots or human tissue 100% (N = 12) contaminated waste not double bagged Use of a sharps box labelled as contaminated and for incineration for used needles 15 salons required a sharps box. 13 % ( N = 2) did not have one. 7 % ( N = 1) box inadequately labelled. Disposal of boxes of used needles by collection by permitted collectors. 13 % ( N = 2) needed to dispose of sharps box in past via Medical Practitioner. Knowledge on permitted disposal methods lacking.

23 Findings (contd.) Sterilising & Disinfection Standard Required Standard Found - Provision of sterilisation equipment e.g. glass-bead steriliser or an autoclave, for hard, reusable implements e.g. commodone extractors, metal scissors, tweezers, cuticle knives etc. used to cut or pierce the skin is considered essential - provision of an adequate supply of suitable chemical disinfectant - maintenance of UV bulb where UV cabinet is provided - 100% (N = 30) did not have sterilisation equipment - 100% (N = 30) has a supply of suitable chemical disinfectant - 73% ( N = 22) had a UV cabinet - of those, 50% ( N = 11) were unaware of when the bulb was last changed

24 Findings (contd.) Cleaning of Tools Standard Required Standard Found Thorough cleaning followed by suitable disinfection Inadequate cleaning procedures as reported re: 66% (N = 19) foot spas 63% ( N = 19) make-up brushes 17% ( N = 5) manicure / pedicure tools 6.6% ( N = 2) sponges

25 Findings (contd.) Practices Findings (contd.) Practices Standard Required Standard Found - Provision of suitable floor cover or disposable foot covers required where client is bare- footed - Double dipping to be avoided - Towels to be changed after every client - 10% (N = 3) reported inadequate procedures for protection for feet - 77% ( N = 23) reported double dipping during waxing and 7% ( N = 2) used same spatula for different areas of the body - 46 % ( N = 13) double dipping of make-up applicators - 3.3 % ( N = 1) couch roll placed on towel on a couch with same towel changed after fourth client

26 Findings (contd.) Laser and Intense Pulsed Light Treatments 23% (N=7) offered laser treatment 23% (N=7) offered laser treatment H & S regulation protects employees H & S regulation protects employees No regulation to protect clients safety No regulation to protect clients safety Medical Clinics 17% ( N = 5) offer medical clinic e.g. botox, injectables, anti-aging treatments 17% ( N = 5) offer medical clinic e.g. botox, injectables, anti-aging treatments Irish Medical Council

27 Findings (contd.) General Observation- Proprietors: - Would welcome guidance - Many were in favour of some form of regulation

28 Conclusions Cosmetic Product Regs. – good compliance Cosmetic Product Regs. – good compliance Microbiological Results – generally good Microbiological Results – generally good Hygiene Standards Observed and Practices Reported Hygiene Standards Observed and Practices Reported - cleaning facilities generally good but grossly inadequate in a small number - hand washing facilities generally good but inadequate in nearly 1/5 of salons - improvements in policy on hand-washing and glove use needed

29 Conclusions (contd.) Hygiene Standards Observed and Practices Reported (contd.): Hygiene Standards Observed and Practices Reported (contd.): - improvement needed in waste disposal - absence of sterilising equipment a concern - cleaning procedures inadequate for certain equipment / tools - practice of double-dipping commonplace - regulation not in place - practitioners open to regulation and guidance

30 Recommendations Further research within EH Further research within EH Training for EHOs Training for EHOs Guide to Good Practice in Beauty Salons is developed by the EH in conjunction with relevant stakeholders Guide to Good Practice in Beauty Salons is developed by the EH in conjunction with relevant stakeholders EH, in turn and in conjunction with relevant bodies, contribute to the training of Beauty Therapists by the development of a syllabus including Cosmetic Products Regs and P.H. Aspects EH, in turn and in conjunction with relevant bodies, contribute to the training of Beauty Therapists by the development of a syllabus including Cosmetic Products Regs and P.H. Aspects EH staff, in conjunction with relevant, interested bodies develop an award system for salons proving to be operating to a defined standard, such as the guide referred to. EH staff, in conjunction with relevant, interested bodies develop an award system for salons proving to be operating to a defined standard, such as the guide referred to.

31 Recommendations (contd.) That information is provided to the public in relation to standards to expect in a beauty salon That information is provided to the public in relation to standards to expect in a beauty salon That microbiological guideline standards applicable to beauty salons are developed by the E. H. service That microbiological guideline standards applicable to beauty salons are developed by the E. H. service That research is undertaken to determine the level of beauty salon acquired infection or injury That research is undertaken to determine the level of beauty salon acquired infection or injury Regulation of beauty salons is introduced e.g. by licensing and enforcement of standards on an ongoing basis through regular inspections carried out by EHOs and any other profession deemed necessary Regulation of beauty salons is introduced e.g. by licensing and enforcement of standards on an ongoing basis through regular inspections carried out by EHOs and any other profession deemed necessary Staged implementation of above recommendations. Staged implementation of above recommendations.

32 Acknowledgements Jenny Fortune, EHO, Letterkenny Jenny Fortune, EHO, Letterkenny Salon owners Salon owners Mary Ferry, Fás Course Tutor Mary Ferry, Fás Course Tutor Irish Beauty Professionals Association Irish Beauty Professionals Association Wendy Nixon in HABIA Wendy Nixon in HABIA Tina Garrity, CIEH Tina Garrity, CIEH Dr. Olive Smith, Irish Medicines Board Dr. Olive Smith, Irish Medicines Board Suzanne Tinney, Waste Awareness Officer, Donegal County Council Suzanne Tinney, Waste Awareness Officer, Donegal County Council Louise Cullen, Public Health Dept., Letterkenny Louise Cullen, Public Health Dept., Letterkenny

33 New Developments … Fish pedicure …. Fish pedicure ….

34 Thats it! Thank you for your attention. Contact details: Contact details: Cora Murray, Senior EHO, Cora Murray, Senior EHO, Co. Clinic, Co. Clinic,Letterkenny, Co. Donegal Tel. 074-9123759 Email: cora.murray@hse.ie cora.murray@hse.ie See EHOA Yearbook 2010


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