1. Chapter 5 Infection Control: Principles and Practices

2. “What progress, you ask, have I made
“What progress, you ask, have I made? I have begun to be a friend to myself.” – Hecato, Greek Philosopher

3. Objectives
Understand state laws and rules and the differences between them.
List the types and classifications of bacteria.
Define hepatitis and HIV and explain how they are transmitted.
Explain the differences between cleaning, disinfecting, and sterilizing.

4. Objectives (continued)
List the types of disinfectants and how they are used.
Discuss universal precautions.
List the responsibilities of a salon professional.
Describe how to safely clean and disinfect salon tools and equipment.
LEARNING MOTIVATION (WHY?)
Throughout your career in the field of cosmetology, you will come into direct contact with many clients. As a result, the principles and practices of infection control are of key importance in your daily practice. This subject has a direct bearing on your well-being and that of your clients. That is why it is so important for you to know the necessary steps to prevent the spread of disease. A basic understanding of how pathogens affect our daily lives is helpful in becoming competent in infection control procedures.
Contagious diseases, blood poisoning, and skin infections are caused by infectious bacteria transmitted from one individual to another often through the use of contaminated implements or dirty hands and fingernails.
As a professional cosmetologist, you will be exposed to a variety of germs or bacteria every day. You will be working directly with your clients’ skin, scalp, hair, and nails, all of which are ideal breeding grounds for bacteria. Your hands and the implements you use will be additional sources of passing pathogens. Thus, the applied practice of infection control is even more essential to your safety.
If you follow established guidelines and sound principles of infection control and safety, you should never encounter any problems with the spread of harmful pathogens. In fact, each state establishes detailed procedures for protection against the spread of disease. You will learn and practice these regulations throughout your course of study.
You must take care when using implements that could cut or pierce the skin. They must be cleaned and then disinfected before and after each use. Implements that cannot be properly cleaned and disinfected must be disposed of as directed.
Consider this: How would you feel if you were very ill and went to the doctor only to find the examination room dirty, with contaminated gauze, soiled cotton, and used gowns strewn about? What if you were then asked to recline on an examining table that the former patient had just vacated and the disposable covering had not been changed? You would not feel very confident that the doctor knew what he or she was doing or that you were going to be well taken care of, would you?
Your profession is one of constant touch and contact. Therefore, it is critical for you to develop proper infection control habits now, while you are in school. You will want to modify your behavior to ensure that good infection control practices are routine in your daily activities. This behavior will endear you to your clients and increase their confidence in your professional abilities and your concern for their safety.

5. OSHA Occupational Safety and Health Administration (OSHA)
Material Safety Data Sheets (MSDS)
Product content
Associated hazards
Combustion levels
Storage requirements
REGULATION: Many different state and federal agencies regulate the practice of cosmetology. Federal agencies set guidelines for manufacturing, the sale and use of equipment and chemical ingredients, and requirements for safety in the workplace. State agencies regulate licensing, enforcement, and your conduct in the salon.
OSHA: The Occupational Safety and Health Administration was created as part of the U.S. Department of Labor to enforce safety and health standards in the workplace. The Occupational Safety and Health Act of 1970 established the Hazard Communication Rule, which requires manufacturers to assess and communicate hazards associated with their products.
MSDS: Material Safety Data Sheets provide pertinent information. Have students look them over as you review the documents.
a) Product content
b) Associated hazards
c) Combustion levels
d) Storage requirements: OSHA standards are important to cosmetologists because of nature of chemicals used; mixing, storing, and disposal of chemicals; general safety, and our rights to know what we are working with.

6. Environmental Protection Agency
EPA registration number
Hospital disinfectants
Tuberculocidal disinfectants
Disinfectant myth
The EPA registers many different types of disinfectants. The two types that are used in salons are hospital and tuberculocidal.
Hospital disinfectants are effective for cleaning blood and body fluids. They can be used on any nonporous surface in the salon. Nonporous means that an item has no pores or openings and cannot absorb liquids. Hospital disinfectants control the spread of disease.
Tuberculocidal disinfectants are proven to kill the bacteria that cause tuberculosis, a disease transmitted through coughing or sneezing. These bacteria are capable of forming spores, so they are difficult to kill. Tuberculocidal disinfectants are one kind of hospital disinfectant. Some of these products can be harmful to salon tools and equipment, and they require special methods of disposal. Check the rules in your state to be sure that the product you choose complies with state requirements.
Disinfectant myth: The term hospital grade is not used by the EPA. The EPA does not grade disinfectants; a product is either approved by the EPA as a hospital disinfectant or it is not.

7. State Regulatory Agencies
Protect consumers’ health, safety, and welfare
Laws (statutes)
Rules (regulations)
STATE REGULATORY AGENCIES: Exist to protect consumers’ health, safety, and welfare. They include boards of cosmetology, commissions, and health departments.
Laws: Also called statutes, laws are written by the state legislature and determine the scope of practice (what you are allowed to do), and establish guidelines for agencies to make rules.
Rules: Also called regulations, rules are more specific than laws. They determine how the law will be applied. Rules establish specific standards of conduct and can be changed and updated frequently without the passing of a law through a legislature.

8. Principles of Infection
Careless actions can cause injury or the invasion of body tissues by disease-causing pathogens.
Prevention is key and it begins with you!

9. Potential Infectious Organisms
Bacteria
Fungi
Viruses
Parasites
Being a salon professional is fun and rewarding, but it is also a great responsibility. One careless action could cause injury or infection or the invasion of body tissues by pathogens, and you could lose your license or ruin the salon’s reputation. Fortunately, preventing the spread of infections is easy if you know what to do and you practice what you have learned at all times. Safety begins and ends with you.
The photo depicts an example of a sparkling clean salon that gives clients confidence in their safety and welfare.

10. Salon Disinfectants Bactericidal (destroy bacteria)
Fungicidal (destroy fungi)
Virucidal (destroy viruses)
There are four types of potentially infectious microorganisms that are important to cosmetology practitioners: bacteria, fungi, viruses, and parasites. An infectious disease is spread from one person to another, or from one infected body part to another.
Remember, cosmetologists are not allowed to diagnose, treat, or recommend treatments for disease or abnormal conditions; what you will learn in this chapter will teach you how to properly clean and disinfect the tools and equipment so they are safe to use on clients. These steps are designed to prevent infection or disease. Disinfectants used in salons must be bactericidal, capable of destroying bacteria; fungicidal, capable of destroying fungi; and virucidal, capable of destroying viruses. Be sure to mix and use these disinfectants according to the instructions on the labels so they are effective.

11. Bacteria Minute, one-celled microorganisms
Prominent in dust, dirt, refuse, and diseased tissue
Can exist almost anywhere
1,500 rod-shaped bacteria will fit on the head of a pin.

12. Types of Bacteria Nonpathogenic – helpful or harmless
Pathogenic – harmful and disease producing
BACTERIA TYPES
Nonpathogenic: Helpful or harmless bacteria that perform useful functions such as decomposing refuse and improving soil fertility. They help metabolize food, protect against microorganisms, and stimulate immune response.
Pathogenic: Harmful and disease producing when they invade plant or animal tissue.

13. Causes of Disease

14. Pathogenic Bacteria Classifications
Cocci – round shaped
Staphylococci (grow in clusters)
Streptococci (grow in curved lines)
Diplococci (grow in pairs)
Bacilli – rod shaped
Spirilla – spiral or corkscrew shaped
CLASSIFICATIONS OF PATHOGENIC BACTERIA
Cocci: Round-shaped bacteria that appear singly or in the following groups:
– Staphylococci: Pus-forming bacteria that grow in clusters like grapes; cause abscesses, pustules, and boils.
– Streptococci: Pus-forming bacteria arranged in curved lines resembling a string of beads; cause infections such as strep throat and blood poisoning.
– Diplococci: Spherical bacteria that grow in pairs and cause diseases such as pneumonia.
Bacilli: Short, rod-shaped bacteria. They are the most common and produce diseases such as tetanus, typhoid, tuberculosis, and diphtheria.
Spirilla: Spiral or corkscrew-shaped bacteria. They are divided into subgroups: Treponema pallidum, which causes syphilis (an STD); or Borrelia burgdorferi, which causes Lyme disease.

15. Movement of Bacteria Cocci – rarely show motility (self-movement)
Bacilli and Spirilla – use slender, hairlike extensions (flagella or cilia) for locomotion
MOVEMENT OF BACTERIA
Cocci: Rarely show motility (self-movement); transmitted in air, dust, or in the substance in which they settle.
Bacilli and Spirilla: Motile and use slender, hairlike extensions known as flagella or cilia for locomotion. A whiplike motion of these hairs moves the bacteria in liquid.

16. Growth and Reproduction
Active
Takes 20 to 60 minutes to reach full growth
Divides into two cells (binary fission)
Inactive or spore forming
Resistant to adverse conditions
GROWTH AND REPRODUCTION: The material needed to sustain the life of bacteria are the outer cell wall and internal protoplasm. Bacteria manufacture their own food, give off waste products, and grow and reproduce.
Active: Bacteria thrive in a warm, moist, dark, and dirty environment. It only takes about 20 to 60 minutes for bacteria to reach full growth. They then divide into two new cells through a method called binary fission. The new cells are called daughter cells.
Inactive or spore forming: Bacteria such as anthrax and tetanus bacilli form spherical spores with tough outer coverings that are resistant to adverse conditions. This allows the dormant bacteria to withstand long periods without food. The spores can be blown about and can come to rest on various surfaces within the salon. When favorable conditions are restored, the spores become active, or vegetative, and begin to grow and reproduce once again. Therefore, even bacteria in the inactive stage can ultimately be a threat for the spread of disease or infection in the salon.

17. Bacterial Infections Staphylococci Food poisoning Toxic shock syndrome
MRSA
Local infection
Systemic infection or disease
Contagious or communicable disease
BACTERIAL INFECTIONS: Infections occur when body tissues are invaded by disease- causing, or pathogenic, bacteria. The presence of pus is a sign of infection. Pus is a fluid product of inflammation and contains white blood cells and the debris of dead cells, tissue elements, and bacteria.
Staphylococci: Most common human bacteria; can be picked up from doorknobs, countertops, handshaking, or unclean implements.
– Responsible for food poisoning
– Responsible for toxic shock syndrome
– MRSA: Methicillin-resistant staphylococcus aureus.
Local infection: Infection that is confined to a single area such as a pimple, boil, or infected cut. Presence of pus is the sign of infection. Pus contains bacteria, waste matter, decayed tissue, body cells, and living and dead blood cells. Staphylococci is the most common pus-forming bacteria.
Systemic infection: When pathogenic bacteria and their toxins are carried to all parts of the body by way of the bloodstream, they create a systemic infection such as blood poisoning or syphilis.
Contagious or communicable diseases: Diseases that are spread from one person to another by direct or indirect contact such as coughing, sneezing, unclean hands, unclean implements, open sores, common drinking cups, common towels, and so on. Common contagious diseases preventing cosmetologists from working are tuberculosis, colds, ringworm, scabies, head lice, and virus infections.

18. Viruses Live by penetrating cells Resistant to antibiotics
Prevented by vaccination
Human papilloma virus (HPV)
A virus (plural: viruses) is a parasitic submicroscopic particle that infects and resides in the cells of a biological organism. A virus is capable of replication only through taking over the host cell’s reproductive function. Viruses are so small that they can only be seen under the most sophisticated and powerful microscopes. They cause common colds and other respiratory and gastrointestinal (digestive tract) infections. Other viruses that plague humans are measles, mumps, chicken pox, smallpox, rabies, yellow fever, hepatitis, polio, influenza, and HIV, which causes AIDS.
One difference between viruses and bacteria is that a virus can live and reproduce only by taking over other cells and becoming part of them, while bacteria can live and reproduce on their own. Also, bacterial infections can usually be treated with specific antibiotics, but viruses are not affected by antibiotics. In fact, viruses are hard to kill without harming the body’s own cells in the process. Vaccinations prevent viruses from growing in the body. There are many vaccines available for viruses, but not all viruses have vaccines. There is a vaccine available for hepatitis B, however, which you should strongly consider receiving. Health authorities recommend that service providers in industries with direct contact with the public—including cosmetologists, teachers, florists, and bank tellers—ask their doctor about getting vaccinated for hepatitis B.
An example of a common viral infection often seen in salons is the human papilloma virus (HPV), also known as plantar warts. This virus can infect the bottom of the foot and resembles small black dots, usually appearing in clustered groups. HPV is highly contagious, difficult to kill, and can be passed from pedicure client to pedicure client by dirty implements and foot baths. If the client shows signs of HPV infection, do not perform a pedicure service. Instead, refer the client to a physician.

19. Bloodborne Pathogens Hepatitis – inflammation of liver Hepatitis A
Hepatitis B (HBV)
Hepatitis C (HCV)
BLOODBORNE PATHOGENS: Disease-causing microorganisms that are carried through the body in the blood or body fluids, such as hepatitis and HIV, are called bloodborne pathogens.
Hepatitis: Disease marked by inflammation of the liver and caused by a bloodborne virus similar to HIV/AIDS in transmission. It is present in the body fluids of an infected individual.
Hepatitis A: [NOTE: Not all this information is contained in the current edition of the textbook.] Illness lasts about three weeks. Symptoms similar to flu; may cause yellowing of skin and eyes in adults. Spread through close contact; poor sanitation and personal hygiene: contaminated food, milk, water, and shellfish; infected food handlers; and sexual contact. A vaccine is available.
Hepatitis B (HBV): Can cause long-term hepatitis, cirrhosis, and/or liver cancer. There may be no symptoms or flulike symptoms. It is primarily transmitted through sexual contact or blood transfusions or when infected needles are shared. A vaccine is available. It is the most difficult to kill on the surface.
Hepatitis C (HCV): Progresses slowly and about one-third of those with the illness show no symptoms. When symptoms exist, they include fatigue and stomach pain. It is also transferable through parenteral contact and sexual activity with infected partners. No vaccine is available.

20. HIV/AIDS Passed through blood and body fluids
Unprotected sex, sharing of IV needles, accidents with needles, cuts and sores
Methods that do not transmit the disease:
Hand holding, hugging, kissing, sharing food or household items
Can be infected for many years without symptoms
HIV/AIDS: HIV (Human Immunodeficiency Virus) is the virus that causes AIDS (Acquired Immune Deficiency Syndrome). AIDS breaks down the body’s immune system.
Passed through blood and body fluids.
– unprotected sexual contact
– sharing of IV needles with infected drug users
– accidents with needles in health care facilities
– through cuts and sores: (though transmittal from sharp implements in the salon is not known to have ever occurred)
Methods that do not transmit the disease
– hand holding
– hugging
– kissing
– sharing food/household items, like telephones or toilet seats. There are no documented cases of the virus being transmitted by food handlers, insects, or casual contact.
Can be infected for many years without symptoms. A person may be infected and transmitting the disease without even knowing they have the disease.

21. Fungi
Microscopic plant parasites that include molds, mildews, and yeasts
Can be spread by contaminated implements or by not preparing nail plate before applying enhancements
More common on feet than hands

22. Fungi (continued) Tinea barbae (barber’s itch)
Tinea capitis (fungal infection of scalp)
Tinea pedis (ringworm fungus of the foot)
The most frequently encountered fungal infection resulting from hair services is tinea barbae, also known as barber’s itch. Tinea barbae is a superficial fungal infection that commonly affects the skin. It is primarily limited to the bearded areas of the face and neck or around the scalp. This infection occurs almost exclusively in older adolescent and adult males. A person with tinea barbae may have deep, inflamed or noninflamed patches of skin on the face or the nape of the neck.
Tinea barbae is similar to tinea capitis, a fungal infection of the scalp characterized by red papules, or spots, at the opening of hair follicles.
Hair stylists must clean and disinfect clipper blades to avoid spreading scalp and skin infections. The risk of spreading skin and scalp infections can be reduced by first removing all visible hair and debris from clippers. This can be done effectively and quickly by using compressed air. Then the nonelectrical parts can be cleaned and disinfected properly. Always refer to the manufacturer’s directions for proper cleaning and disinfecting methods and recommendations.

23. Parasites Grow, feed, and shelter on or in other living organisms
Must have host to survive
Found in food, plants, trees, water
Pediculosis capitis (head lice)
Scabies (caused by itch mite)
Parasites are organisms that grow, feed, and shelter on or in another organism (a host) while contributing nothing to the survival of that organism. They must have a host to survive. Parasites can live on or inside of humans and animals. They also can be found in food, on plants and trees, and in water. Humans can acquire internal parasites by eating fish or meat that has not been properly cooked. External parasites that affect humans on or in the skin include ticks, fleas, and mites.
Head lice are a type of parasite responsible for contagious diseases and conditions. One condition caused by an infestation of head lice is called pediculosis capitis. Scabies is also a contagious skin disease and is caused by the itch mite, which burrows under the skin. Contagious diseases and conditions caused by parasites should only be treated by a doctor.
Contaminated countertops, tools, and equipment should be thoroughly cleaned and then disinfected with an EPA-registered disinfectant for the time recommended by the manufacturer or with bleach solution for ten minutes.

24. How Pathogens Enter the Body
Break in skin
Mouth
Nose
Eyes or ears
Unprotected sex
HOW PATHOGENS ENTER THE BODY
Break in skin (cut, pimple, or scratch)
Mouth (breathing or swallowing air, water, or food)
Nose (air)
Eyes or ears (dirt)
Unprotected sex

25. How Body Fights Infection
Unbroken skin
Body secretions
White blood cells
Antitoxins
HOW BODY FIGHTS INFECTION
Unbroken skin
Body secretions such as perspiration and digestive juices
White blood cells
Antitoxins

26. Immunity Natural immunity – inborn ability
Acquired immunity – developed after overcoming disease or through inoculation
IMMUNITY: The ability of the body to fight off or resist infections and disease and to destroy bacteria that have entered the body.
Natural immunity: An inborn ability to resist certain diseases. It is partly inherited and partly developed through hygienic living and such factors as frequent exercise and a wholesome diet.
Acquired immunity: Developed after the body has overcome a disease or through inoculation. The disease or inoculation causes the blood cells to produce antibodies, which are proteins that fight disease germs. Acquired immunity may be temporary or permanent.

27. Principles of Prevention
Contamination (presence of potentially infectious materials)
Contaminate (make impure by contact)
Contaminant (substance that causes contamination)
PRINCIPLES OF PREVENTION
CONTAMINATION: The presence (or anticipated presence) of blood or other potentially infectious materials on an item’s surface or visible debris or residues such as dust, hair, and skin.
Contaminate: To make impure by contact; to taint or pollute.
Contaminant: Any substance that causes contamination.
ACTIVITY: Have students look around the classroom and identify all the surfaces, tools, doorknobs, fixtures, and so on that constitute routine sources of contamination. Then discuss preventive measures the student can take to reduce it. Ask for a volunteer to record the list on the board or flip chart.
IMPORTANT POINT: Don’t use the word sterilize incorrectly. You can only sterilize nonporous surfaces, such as metal implements – you cannot sterilize the skin or nails.

28. Principles of Prevention (continued)
Decontamination
Cleaning
Scrubbing with a brush
Using an ultrasonic unit
Using a solvent
Disinfection
Method 1: cleaning and then disinfecting with an EPA-registered disinfectant
Method 2: cleaning and then sterilizing
Proper decontamination can prevent the spread of disease caused by exposure to potentially infectious materials on an item’s surface. It also will prevent exposure to blood and visible debris or residue such as dust, hair, and skin.
Decontamination is the removal of blood or other potentially infectious materials on an item’s surface and the removal of visible debris or residue such as dust, hair, and skin. There are two methods of decontamination.
DECONTAMINATION: The act of removing pathogens and other substances from tools or surfaces.
Cleaning: A mechanical process (scrubbing) using soap and water or detergent and water to remove dirt, debris, and many disease-causing germs. Cleaning also removes invisible debris that interferes with disinfection. Cleaning is what cosmetologists are required to do before disinfecting.
Methods of cleaning include:
– scrubbing with a brush
– using an ultrasonic unit
– using a solvent (e.g., to clean metal bits from electric files)
DISINFECTION (disinfecting): A chemical process that uses specific products to destroy harmful organisms (except bacterial spores) on environmental surfaces. Disinfection is a higher level of decontamination than sanitation. Disinfecting is second only to sterilization, but it does not kill bacterial spores. NOT for use on human skin, hair, or nails.

29. Decontamination Method 1: Two Steps
Step 1: Cleaning methods
Washing with soap, water, and a scrub brush
Using an ultrasonic unit
Using a cleaning solvent
Step 2: Disinfection methods
EPA-registered disinfectants
– Avoid skin contact!
Decontamination Method 1 has two steps: Clean and then disinfect.
Remember that when you clean, you remove all visible dirt and debris from tools, implements, and equipment by washing with liquid soap and water and by using a clean and disinfected scrub brush to scrub any grooved or hinged portions of the item.
A surface is properly cleaned when the number of germs on the surface is greatly reduced. In turn, this reduces the risk of infection. A surface or item must be properly cleaned before it can be properly disinfected. Using a disinfectant without cleaning first is like using mouthwash without brushing your teeth—it just does not work properly!
Cleaned surfaces can still harbor small amounts of pathogens, but the presence of fewer pathogens means infections are less likely to be spread. The proper cleaning of the hands requires rubbing hands together and using liquid soap, running water, a nail brush, and a clean towel.
There are three ways to clean your tools or implements:
Washing with soap and water, then scrubbing with a clean and properly disinfected nail brush.
Using an ultrasonic unit.
Using a cleaning solvent (e.g., to remove metal bits from electric files).
The second step of Decontamination Method 1 is disinfection. Disinfection is the process that eliminates most, but not necessarily all, microorganisms on nonliving surfaces. This process is not effective against bacterial spores. In the salon setting, disinfection is extremely effective in controlling microorganisms on surfaces such as shears, nippers, and other multi-use tools and equipment. Any disinfectant used in the salon should carry an EPA-registration number; the label should clearly state the specific organisms the solution is effective in killing when used according to the label instructions.
Avoid skin contact, with your skin as well as the client’s. Do not put your fingers directly into any disinfecting solution. Disinfectants are pesticides and can be harmful if absorbed through the skin. If you mix a disinfectant in a container that is not labeled by the manufacturer, you must properly label the container with the contents and the date it was mixed. All concentrated disinfectants must be diluted exactly as instructed by the manufacturer on the container’s label.

30. Decontamination Method 2: Two Steps
Step 1: Cleaning
Step 2: Sterilizing using high-pressure steam autoclaves (steam penetrates the spore coats of spore-forming bacteria)
Dry heat (less effective and requires more time; not recommended in salons)
The second method of decontamination is cleaning and then sterilizing. The word sterilize is often used incorrectly. Sterilization is the process that completely destroys all microbial life, including spores.
The most effective methods of sterilization use high-pressure steam autoclaves. Simply exposing instruments to steam is not enough. To be effective against disease- causing pathogens, the steam must be pressurized in an autoclave so that the steam penetrates the spore coats of the spore-forming bacteria.
Most people without medical training do not understand how to properly use an autoclave. For example, dirty implements cannot be properly sterilized without first being properly cleaned. Autoclaves need regular maintenance and testing to ensure they are in good working order and performing properly. Color indicator strips on autoclave bags can provide false readings, so you should never rely solely on these indicators to ensure proper sterility. These strips are only an indication, not verification that the autoclave is working properly.
Dry heat forms of sterilization are less efficient and require longer times at higher temperatures. Dry heat sterilization is not recommended for use in salons.

31. Choosing a Disinfectant
Correct efficacy (effectiveness against bacteria)
Hospital-level disinfectant.
Pseudomonacidal, bactericidal, fungicidal, and virucidal
CHOOSING A DISINFECTANT: Disinfectants are chemicals. You must read and follow directions carefully; even safe products can be harmful if used incorrectly.
Correct efficacy: Efficacy is the effectiveness with which a disinfecting solution kills specific organisms when used according to label instructions. Labels must list the germs the product is proven to kill.
Hospital-Level Disinfectant. Must be pseudomonacidal, bactericidal, fungicidal, and virucidal.
An EPA-registered hospital liquid disinfectant or bleach solution for clean-up of blood or body fluid. When salon implements accidentally contact blood, body fluids, or unhealthy conditions, they should be cleaned and then completely immersed in an EPA-registered hospital disinfectant solution or 10 percent bleach solution. The National-Interstate Council of State Boards of Cosmetology (NIC) follows this standard for testing as well.

32. Benefits of Sterilizing
Most reliable means of infection control
Increased client confidence.
Not every tool or implement can be sterilized. Therefore, most state regulatory agencies do not require salons to sterilize tools and implements. However, Texas is one exception. The Texas Department of Licensing and Regulation requires sterilization of nonporous manicure and pedicure tools and implements before each service. Other states may follow. Check with your state regulatory agency to determine whether sterilization of tools and implements is required in your state.
The benefits of sterilization are twofold:
Sterilization is the most reliable means of infection control.
Sterilized tools and implements in sealed bags assure clients that you are using fresh instruments during the service. The bag should be opened just before the service to show clients that the tools and implements have been sterilized and that the salon cares about the safety of its clients.

33. Choosing a Disinfectant
Correct efficacy
Ideal disinfectant qualities
Bioburden effectiveness
Longer renewal time
Low cost
Nontoxic and nonirritating
Effectiveness strips
Readily available
To use a disinfectant properly, you must read and follow the manufacturer’s instructions. Mixing ratios (dilution) and contact time are very important. Not all disinfectants have the same concentration, so be sure to mix the correct proportions according to the instructions on the label. If the label does not have the word concentrate on it, the product is already mixed and must be used as it is, directly from the container. All EPA-registered disinfectants, even those sprayed on large surfaces, will specify a contact time in their directions for use. Contact time is the amount of time the surface must stay moist with disinfectant in order for the disinfectant to be effective.
Disinfectants must have efficacy claims on the label. Efficacy, when applied to disinfectant claims, means the effectiveness with which a disinfecting solution kills germs when used according to the label instructions.
Professionals have many disinfectants available to them and should choose the one best-suited for their specialty. The ideal disinfectant would:
Maintain efficacy in the presence of bioburden, the number of viable organisms in or on the object or surface, or organic material on a surface or object prior to decontamination or sterilization
Require renewal in a longer length of time than daily (a week or more)
Be inexpensive
Be nontoxic and nonirritating
Include strips for checking effectiveness
Be readily available from multiple manufacturers

34. Choosing a Disinfectant (continued)
Hospital-level disinfectant
EPA-approved
Environmentally friendly
Odorless
Noncorrosive
A hospital-level disinfectant should:
Be EPA approved
 Be environmentally friendly (can be disposed down the salon drain)
Have little or no odor
 Be noncorrosive
Salons pose a lower infection risk when compared to hospitals. Hospitals must meet much stricter infection control standards and often use disinfectants that are too dangerous for the salon environment.
It is still very important to clean and then disinfect all tools, implements, surfaces, and equipment correctly. When salon implements accidentally contact blood, body fluids, or unhealthy conditions, they should be properly cleaned and then completely immersed in an EPA-registered hospital disinfectant solution that shows effectiveness against HIV, hepatitis, and tuberculosis. Always wear gloves and follow the proper universal precautions protocol for cleaning up and then disinfecting after an exposure incident.

35. Proper Use of Disinfectants
Use on precleaned, nonporous surfaces.
Dilute according to directions.
Contact time per directions.
Spray on contact time per directions.
Spray can’t be used if immersion required.
Use only as directed.
Use only EPA-registered disinfectant in pedi-spa.
Clean all surfaces or implements prior to immersing in disinfectant.

36. Types of Disinfectants
Quats – nontoxic, odorless, fast-acting
Phenolics – powerful tuberculocidal disinfectants (high pH and can damage skin, eyes, plastic, and rubber)
TYPES OF DISINFECTANTS
Quaternary ammonium compounds, also known as quats, are disinfectants that are very effective when used properly in the salon. The most advanced type of these formulations are called multiple quats. Multiple quats contain sophisticated blends of quats that work together to dramatically increase the effectiveness of these disinfectants.
Quats solutions usually disinfect implements in ten minutes. These formulas may contain antirust ingredients, so leaving tools in the solution for prolonged periods can cause dulling or damage. They should be removed from the solution after the specified period, rinsed (if required), dried, and stored in a clean, covered container.
Phenolic disinfectants are powerful tuberculocidal disinfectants. They are a form of formaldehyde, have a very high pH, and can damage the skin and eyes. Phenolic disinfectants can be harmful to the environment if put down the drain. They have been used reliably over the years to disinfect salon tools; however, they do have drawbacks. Phenol can damage plastic and rubber and can cause certain metals to rust. Phenolic disinfectants should never be used to disinfect pedicure tubs or equipment. Extra care should be taken to avoid skin contact with phenolic disinfectants. Phenolics are known carcinogens.

37. Types of Disinfectants (continued)
Accelerated hydrogen peroxide (AHP) – long-lasting
Bleach (5.25 percent sodium hopochlorite)
The EPA has recently approved a new disinfectant for salon use that is available in the form of spray, immersion, and wipes.
ACCLERATED HYDROGEN PYROXIDE (AHP): This disinfectant is based on stabilized hydrogen peroxide. AHP disinfectant only needs to be changed every 14 days and is nontoxic to the skin and environment. There is an AHP formula that is available for disinfecting pedicure tubs.
Read the labels of all disinfectants closely. Choose the one that is most appropriate for its intended use and is the safest for you and your clients.
BLEACH: Household bleach, 5.25 percent sodium hypochlorite, is an effective disinfectant and has been used extensively as a disinfectant in the salon. Using too much bleach can damage some metals and plastics, so be sure to read the label for safe use. Bleach can be corrosive to metals and plastics and can cause skin irritation and eye damage.
To mix a bleach solution, always follow the manufacturer’s directions. Store this solution away from heat and light. A fresh bleach solution should be mixed every 24 hours or when the solution has been contaminated. After mixing the bleach solution, date the container to ensure that the solution is not saved from one day to the next. Bleach can be irritating to the lungs, so be careful about inhaling the fumes.
Not all household bleaches are effective as disinfectants. To be effective, the bleach must have an EPA-registration number, contain at least 5 percent sodium hypochlorite, and be diluted properly to a 10 percent solution—9 parts water to 1 part bleach.

38. Fumigants Formalin tablets (paraformaldehyde)
Glutaraldehyde (used to sterilize surgical instruments in hospitals – not safe for salon use)
FORMALIN TABLETS
Years ago, formalin tablets, or paraformaldehyde, were used as fumigants (a gaseous substance capable of destroying pathogenic bacteria) in dry-cabinet sanitizers. This was before EPA-registered disinfectants came on the market and before it was known that paraformaldehyde slowly releases low concentrations of formaldehyde gas. The release of this gas can cause eye, nose, and lung irritation or allergic inhalation sensitivity in individuals who repeatedly breathe the gas. Although the level of formaldehyde gas produced does not cause more serious health problems, these fumigants are no longer used in the salon.
GLUTARALDEHYDE
Glutaraldehyde is a powerful chemical used to sterilize surgical instruments in hospitals. It produces fumes that are irritating to the lungs, eyes, and skin. While other professions use glutaraldehyde, it is not safe for salon use.

39. Disinfectant Safety Keep Material Safety Data Sheets (MSDS) on hand.
Wear gloves and safety glasses.
Avoid skin and eye contact.
Add disinfectant to water, not water to disinfectant.
Use tongs, gloves, and draining basket.
Keep away from children.

40. Disinfectant Safety (continued)
Carefully measure products.
Measure and use per instructions.
Follow replacement instructions.
Never allow disinfectant to come in contact with your skin.
Never place in unmarked container.

41. Disinfect or Dispose Multi-use – reusable and can be cleaned
Single-use – disposable items used only once
Porous – constructed of absorbent material
Logbook
DISINFECT OR DISPOSE
Multi-use: Reusable and can be cleaned, disinfected, and used on more than one person. Examples include nippers, shears, combs, metal pushers, and some nail files and buffers.
Single-use: Disposable items that cannot be used more than once (either because they cannot be properly cleaned or cleaning damages them). Examples include orangewood sticks, cotton balls, gauze, tissues, paper towels, and some nail files and buffers.
Porous: Items made or constructed of an absorbent material. Some can be cleaned and disinfected. Examples include towels, chamois, and some nail files and buffers. NOTE: If a porous item contacts broken skin, blood, body fluid, or any unhealthy conditions, it must be discarded immediately. (When in doubt, toss it out!)
KEEP A LOGBOOK
Salons should always follow manufacturers’ recommended schedules for cleaning and disinfecting tools and implements, changing the water in and disinfecting foot spas and basins, scheduling regular service visits for equipment, and replacing parts when needed. It may be advisable to keep a logbook of all usage, cleaning, disinfecting, testing, and maintenance for salon personnel, regulatory inspections, and to show clients. Showing your logbook to clients provides them with peace of mind and confidence in your ability to protect them from infection and disease.

42. Disinfection Procedures
Towels and linens: Launder and store in closed container.
Electrical tools and equipment
Work surfaces: Wipe clean and then disinfect.
Foot spas and pedicure equipment
DISINFECTING FOOT SPAS AND PEDICURE EQUIPMENT
All equipment that holds water for pedicures– including whirlpool spas, pipeless units, foot baths, basins, tubs, sinks, and bowls– must be cleaned and disinfected after every pedicure. Inspectors may issue fines if there is no logbook. Most pedicure spas hold 5 gallons of water; check with the manufacturer so that you use the correct amount of disinfectant. Remember: 128 ounces = 1 gallon.

43. Disinfection Procedures (continued)
Detergents and soaps
Additives, powders, and tablets
Dispensary
DETERGENTS AND SOAPS
Using chelating surfactant soaps or detergents, which work to break down stubborn films, is very important for removing the residue from pedicure products such as scrubs, salts, and masques. The chelating agents in these detergents work in all types of water, are low-sudsing, and are specially formulated to work in areas with hard tap water, which reduces the effectiveness of cleaners and disinfectants. Check with your local distributor for pedicure cleaners that contain chelating detergents.
ADDITIVES, POWDERS, AND TABLETS
There is no additive, powder, or tablet that eliminates the need for you to clean and disinfect. You cannot replace proper cleaning and disinfection with a shortcut. These products cannot be used instead of EPA-registered liquid disinfectant solutions. Water sanitizers do not clean or disinfect equipment. They are designed for jacuzzis and hydrotherapy tubs where no oils, lotions, and so on are used, so they don't work well in a salon environment. Never rely solely on water sanitizers to protect your clients. Products that contain chloramine-T, for example, are not effective disinfectants for equipment and only treat the water. They have limited value in the salon.
DISPENSARY
The dispensary must be kept clean and orderly, with the contents of all containers clearly marked. Store products according to manufacturers’ instructions and away from heat. Keep MSDS for all products used in the salon.

44. Disinfection Procedures (continued)
Single-use supplies (wooden sticks, cotton, gauze, wipes, porous files, paper towels, etc.)
Proper hand washing (important action)
Antibacterial soap (can dry skin; use lotion)
SINGLE-USE SUPPLIES
All single-use supplies, such as wooden sticks, cotton, gauze, wipes, porous nail files and buffers, and paper towels should be thrown away after one use. Anything exposed to blood, including skin-care treatment debris, must be double-bagged and marked with a biohazard sticker, separated from other waste, and disposed of according to OSHA standards.
PROPER HAND WASHING
Washing your hands is one of the most important actions you can take to prevent spreading germs from one person to another. Hand washing removes dirt and germs from the folds and grooves of the skin and from under the free edge of the nail plate by lifting and rinsing germs and contaminants from the surface.
You should wash your hands thoroughly before and after each service. Follow the hand-washing procedure in this chapter.
ANTIBACTERIAL SOAP
Antimicrobial and antibacterial soaps can dry the skin, and medical studies suggest that they are no more effective than regular soaps or detergents. Therefore, it is recommended that you minimize the use of antimicrobial and antibacterial soaps. Repeated hand washing can also dry the skin, so using a moisturizing hand lotion after washing is a good practice. Be sure the hand lotion is in a pump container, not a jar.
Avoid using very hot water to wash your hands because this is another practice that can damage the skin. Remember: You must wash your hands thoroughly before and after each service, so do all you can to reduce any irritation that may occur.

45. Universal Precautions
Guidelines published by OSHA
Assumption that all human blood and body fluids are infectious
Asymptomatic – no symptoms or signs of infection

46. Exposure Incident Disinfection
Stop service and put on gloves.
Stop bleeding.
Clean injured area.
Apply antiseptic and/or liquid/spray styptic.
Bandage cut.
Clean and then disinfect workstation.
Discard contaminated objects.
Disinfect all tools in EPA-registered disinfectant.
Remove gloves and wash hands.
Refer to physician if needed.
EXPOSURE INCIDENT (formerly called blood spill) DISINFECTION: This procedure protects both the client and the professional.
1. Stop service and clean injured area.
2. Apply gloves for self-protection.
3. Apply antiseptic and/or liquid or spray styptic. Don’t contaminate container.
Bandage cut with an adhesive bandage.
Clean and then disinfect workstation as needed.
6. Discard contaminated objects. Dispose of all disposable contaminated objects such as wipes or cotton balls by double bagging. Use biohazard sticker. Deposit sharp disposables in a box.
7. Clean and then disinfect all tools contaminated with blood or body fluids by complete immersion in an EPA-registered disinfectant that kills HIV-1 and Hepatitis B or in a tuberculocidal disinfectant.
Remove gloves and wash hands with soap and warm water.
CAUTION: Hand washing is the single most effective measure for reducing the spread of infectious disease. Be aware that antibacterial soap may NOT kill more germs than regular soap and water and can be harmful because it leaves the skin vulnerable to skin problems such as eczema.

47. Professional Salon Image
Keep floors clean.
Control dust, hair, and debris.
Keep trash contained.
Clean fans, ventilation systems, and humidifiers weekly.
Keep all work areas well lit.
Clean and disinfect restroom surfaces.
Supply restrooms.

48. Professional Salon Image (continued)
No cooking or sleeping.
Store food separate from products.
Prohibit eating, drinking, and smoking.
Empty waste receptacles.
Mark containers.
Place tools properly.
No cooking or sleeping. Do not allow the salon to be used for cooking or living quarters.
Store food separate from products. Never place food in refrigerators used to store salon products.
Prohibit eating, drinking, and smoking. Do not allow in areas where services are performed or where product mixing occurs (i.e., back bar area).
Empty waste receptacles. Do so regularly throughout the day. A metal waste receptacle with a self-closing lid works best.
Mark containers. Make sure all containers are properly marked and stored.
Place tools properly. Never place any tools or implements in your mouth or pockets.

49. Professional Salon Image (continued)
Disinfect tools.
Properly store tools.
Don’t touch face or mouth.
Clean and then disinfect work surfaces after each client.
Use clean, disposable paper towels.
Wash hands before/after each client.
Use clean linens.
Use exhaust systems.
Disinfect tools. Properly clean and then disinfect all tools after each use.
Properly store tools. Store clean and disinfected tools in a clean container or sanitary manner. Clean drawers may be used for storage only if clean items are stored in it.
Don’t touch face or, mouth. Avoid touching your face, mouth, or eye areas during services.
Clean and then disinfect work surfaces after each client. This includes manicure tables, esthetic chairs and tables, workstations, and shampoo bowls.
Use clean, disposable paper towels and linens Keep soiled linens separate from clean linens. Use neck strips or towels to avoid skin contact with shampoo capes and cutting or chemical protection gowns.
Wash hands before/after each client.
Use exhaust systems. Replacing the air in the salon with fresh air at least four times every hour is recommended. This will ensure proper air-quality in the salon.

50. Professional Responsibility
Follow state/federal laws.
Keep licenses current.
Monitor state rule changes.
YOUR PROFESSIONAL RESPONSIBILITY
You have many responsibilities as a salon professional, but none is more important than protecting your clients’ health and safety. Never take shortcuts for cleaning and disinfecting. You cannot afford to skip steps or save money when it comes to safety.
It is your professional and legal responsibility to follow state and federal laws and rules.
Keep your license current and notify the licensing agency if you move or change your name.
Check your state’s Web site weekly for any changes or updates to rules and regulations.

51. Disinfection Procedures
Disinfecting nonelectrical tools and implements
Disinfection of whirlpool foot spas and air-jet basins
Pipeless foot spas
Nonwhirlpool foot basins or tubs
Proper hand washing
NOTE: Refer students to LP 5.0 for the specific procedures. Have them follow along while you present/demonstrate the correct procedures.

52. Summary and Review What is the primary purpose of regulatory agencies?
What is an MSDS? Where can it be obtained?
List four types of microorganisms pertinent to cosmetology.
What is a contagious disease?
SUMMARY AND REVIEW
Regulatory agencies and your local health board require that businesses serving the public follow certain infection control precautions. As you have learned, contagious diseases, skin infections, and blood poisoning are caused either by infectious bacteria being transmitted from one individual to another or by the use of unclean implements. The more you know and understand about bacteria, how they grow and reproduce, and how they are destroyed, the more success you will attain in the salon in protecting both yourself and your clients from unnecessary infections or disease. It is essential to practice universal precautions, which include using gloves, safety glasses, and disinfectants, and maintaining salon/school cleanliness. Don’t take shortcuts when it comes to cleaning and disinfection. Following proper procedures will earn your clients’ trust and will work to improve the public’s perception of cosmetology as a career.
1. What is the primary purpose of regulatory agencies?
Answer: Federal agencies regulate the practice of cosmetology by setting guidelines for the manufacturing, sale, and use of equipment and chemical ingredients, and for safety in the workplace. State agencies regulate licensing and enforcement; protect the health, safety, and welfare of the consumer; and guide your conduct when working in a salon.
2. What is an MSDS? Where can it be obtained?
Answer: An MSDS, or Material Safety Data Sheet, is required by law for all products sold. MSDSs include safety information about products compiled by the manufacturer, including hazardous ingredients, safe use and handling procedures, proper disposal guidelines, precautions to reduce the risk of accidental harm or overexposure, and so on. Federal law requires nail salons to obtain MSDSs from the product manufacturer or distributor, or to download them from the manufacturer’s or distributor’s Web site.
3. List the four types of microorganisms pertinent to cosmetology.
Answer: The four types of microorganisms important to the nail tech are: (1) bacteria, (2) viruses, (3) fungi, and (4) parasites.
4. What is a contagious disease?
Answer: A contagious disease is a disease that is transmittable by contact.

53. Summary and Review (continued)
Is HIV a risk in the salon? Why or why not?
What is the difference between cleaning, disinfecting, and sterilizing?
What is complete immersion?
List at least six safety tips to follow when using disinfectants.
5. Is HIV a risk in the salon? Why or why not?
Answer: HIV can be a risk in the salon if you accidentally cut a client who is HIV-positive and you continue to use the implement without cleaning or disinfecting it. You risk puncturing your own skin or cutting another client with a contaminated tool.
6. What is the difference between cleaning, disinfecting, and sterilizing?
Answer: Cleaning is a mechanical process (scrubbing) using soap and water or detergent and water to remove all visible dirt, debris, and many disease-causing germs. Cleaning also removes invisible debris that interferes with disinfection. Cleaning is what cosmetologists are required to do before disinfecting. Disinfecting is a chemical process that uses specific products to destroy harmful organisms (except bacterial spores) on environmental surfaces. Sterilizing is the process that completely destroys all microbial life, including spores.
7. What is complete immersion?
Answer: Complete immersion means there is enough liquid to cover all surfaces of the item being disinfected, including the handles, for at least 10 minutes.
8. List at least six safety tips to follow when using disinfectants.
Answer:
Always wear gloves and safety glasses.
Always add disinfectant to water. Never add water to disinfectant.
Always use tongs, gloves, or a draining basket when removing implements from disinfectants.
Always keep disinfectants out of reach of children.
Never pour quats, phenolics, formalin, or any other disinfectant over your skin. If you get disinfectants on your skin, wash your hands with soap and warm water and dry thoroughly.
Always carefully measure all disinfectant products according to label instructions.
Never place any disinfectant or other product in an unmarked container.
Always follow manufacturer’s instructions for mixing, using, and disposing of disinfectants.
Always change disinfectants every day or more often if the solution becomes visibly dirty or contaminated.

54. Summary and Review (continued)
How do you know if an item can be disinfected?
Can porous items be disinfected?
What are universal precautions?
What is an exposure incident?
9. How do you know if an item can be disinfected?
Answer: An item that can be disinfected is one that is called multi-use or reusable and can be cleaned, disinfected, and used on more than one person. These items must have a hard, nonporous surface. Examples are nippers, shears, pushers, and some nail files, bits, and buffers.
10. Can porous items be disinfected?
Answer: Porous means made or constructed of an absorbent material. Some porous items can be cleaned, disinfected, and used on more than one client. Examples of these are towels, chamois, and some nail files and buffers. If a porous item contacts broken skin, blood, body fluids, or unhealthy conditions, it must be discarded immediately.
11. What are universal precautions?
Answer: Universal precautions are guidelines published by OSHA that require the employer and the employee to assume that all human blood and body fluids are infectious for bloodborne pathogens. Precautions include hand washing, wearing gloves, and proper handling and disposal of sharp instruments and items that have been contaminated by blood or other body fluids. It is important that specific procedures are followed if blood or body fluid is present.
12. What is an exposure incident?
Answer: An exposure incident (previously called blood spill) is contact with nonintact skin, blood, body fluid, or other potentially infectious materials that results from the performance of an employee’s duties.

55. Summary and Review (continued)
Describe the procedure for handling an exposure incident in the salon.
List the steps for cleaning and disinfecting whirlpool foot spas and air-jet basins after each client.
13. Describe the procedure for handling an exposure incident in the salon.
Answer:
The steps for taking care of an exposure incident are:
1. Stop the service.
2. Wear gloves to protect yourself against contact with the client’s blood.
3. Clean the injured area with an antiseptic.
4. Bandage the cut with an adhesive bandage.
5. Clean your workstation, using an EPA-registered disinfectant designed for cleaning up blood spills.
6. Discard all disposable contaminated objects by double-bagging, place a biohazard sticker (red or orange) on the bag, and dispose of it in the regular trash can or in a container specifically designated for contaminated waste.
7. Before removing your gloves, make sure that all tools and implements that have come into contact with blood or other body fluids are thoroughly cleaned and completely immersed in an EPA-registered, tuberculocidal disinfectant solution or 10 percent bleach solution for 10 minutes.
8. Remove your disposable gloves and seal them in the double bag along with the other potentially contaminated items. Thoroughly wash your hands with soap and warm water before returning to the service.
9. Recommend that the client see a physician if any signs of redness, swelling, pain, or irritation develop.
14. List the steps for cleaning and disinfecting whirlpool foot spas and air-jet basins after each client.
1. Drain all water from the basin.
2. Scrub all visible residue from the inside walls of the basin with a cleaned and disinfected brush and liquid soap and water.
3. Rinse the basin with clean water.
4. Refill the basin with clean water and circulate the correct amount of the EPA-registered hospital disinfectant through the basin for ten minutes.
5. Drain, rinse, and wipe dry with a clean paper towel.

56. You have completed one unit of study toward course completion.
Congratulations!
You have completed one unit of study toward course completion.