Infection Control Principles & Practices Chapter 5 – 12’ It is your duty to ensure that your clients receive their services in the safest possible environment Why Study This? To be a knowledgeable, successful and responsible professional you are required to understand the types of infections you may encounter. Understanding the basics of cleaning and disinfecting and following state rules will ensure a long successful career. Understanding the chemistry of the cleaning and disinfecting products you use and how to use them will keep you, your clients, and the salon environment safe. Regulation Federal agencies set guidelines for – Manufacturing – Sale – Use of equipment – Chemical ingredients – Monitor Safety in the workplace – Place limits on types of services performed Occupational Safety and Health Administration (OSHA) Created b y the US Department of Labor – Occupational Safety and Health Administration - OSHA HOME PAGE Regulate and enforce safety and health standards in the workplace Occupational Safety and Health Act of 1970 Regulating employee exposure to toxic substances Informing about the dangers of materials used Hazard Communication Rule Requires chemical mfg. and importers assess the hazards associated with their products MSDS and product labeling are important results of this law Products in salons Standards address: – Handling – Mixing – Storing – disposing General safety in the workforce Your right to know the hazardous ingredients in the products you use Material Safety Data Sheet (MSDS) Federal law requires manufactures (mfg.) to provide Contains important information about chemicals – Hazardous ingredients – Safe use and handling procedures – Safety precautions to reduce the risk of harm and overexposure – Associated hazards – Combustion levels (flammability and data in case of fire) – Disposal guidelines – EPA fines – Medical information – Storage requirements etc. – Ingredients OSHA and state regulatory agencies require MSDSs be kept available State Inspectors can issue fines for not having MSDSs available Material Safety Data Sheet Not having an MSDS Poses a health risk to all exposed to hazardous materials Is a violation of federal regulations Take time to read all of the information to be certain that you are protecting yourself and your clients to the best of your ability Environmental Protection Agency (EPA) Two types of disinfectants used in salons 1. Hospital - products are safe for cleaning blood and body fluids 2. Tuberculocidal – proven to kill the bacteria that causes tuberculosis It is against FEDERAL LAW to use any disinfecting product contrary to its labeling If you do not follow the instructions for mixing, contact time and the type of surface the disinfecting product can be used on, you have broken a federal Law. State Regulatory Agencies Exist to protect the consumer’s health, safety, and welfare while receiving services Everyone working in a salon/spa must follow specific procedures Enforcement through inspections and investigations of consumer complaints Issue penalties against both the salon and the operator (designer/technician) – Warnings to fines – Probation – Suspension or revocation of licenses – Jail time Laws/Rules – What is the difference? Laws are written by legislature – Determine the scope of practice (what each license is allowed to do) – Establish guidelines for regulatory agencies to make rules Laws/statutes Rules/Regulations are written by the regulatory agency or board – Determines how the law will be applied Rules establish specific standards of conduct, can be changed and updated FYI Pp. 72 Principles of Infection One careless action could cause injury or infection (write in side notes) We are not seeking to treat any disease or conditions We are taking steps so that the tools and equipment we use are safe to use on clients Infection Control Methods used to eliminate or reduce the transmission of infectious organisms 4 types of potentially harmful organisms – Bacteria – Viruses - Fungi - Parasites Infectious disease –caused by pathogenic organisms that enter the body Clean – mechanical process using soap and water or detergent and water to remove all visible dirt, debris and germs from tools, implements and equipment Disinfection – destroys most harmful organisms on environmental surfaces Disinfectants Bactericidal – kills bacteria Virucidal – kills virus Fungicidal – kills fungus Dirty salon tools and equipment may spread infection from client to client. You have an OBLIGATION to provide safe services and prevent consumers from harm You may be found legally responsible for not correctly performing services! Bacteria Minute one-celled organisms Known as germs or microbes (write in) Can exist almost everywhere Can be only seen with aid of a microscope 1,500 rod-shaped will fit on the head of a pin (write in) Types of Bacteria Nonpathogenic – Helpful or harmless; not disease producing – Help metabolize food – Protect against infectious microorganisms – Stimulate immune response – Saprophytes – lives on dead matter Pathogenic – Harmful; disease producing – Parasites – require living matter for their growth Classifications of Pathogenic Bacteria Cocci – round shape, appear singly or alone – Staphylococci – pus-forming, grow in bunches/clusters (like grapes), cause boils, abscesses and pustules Streptococci – pus-forming, arranged in curved lines (like a string of beads), strep throat, blood poisoning Diplococci – grow in pairs , cause pneumonia Bacilli – short, rod-shaped, most common, cause tetanus and tuberculosis Spirilla – spiral, corkscrew shaped, cause Lyme disease Movement of Bacteria Motility – self movement Cocci – – transmitted in the air, in dust or within the substance in which they settle Bacilli and Spirilla – motile – – use slender hairlike extensions called flagella or cilia – Whip like motion propels bacteria through liquid Important Tables in Book Table 5-1 Definitions relating to causes of disease – pp. 75 Table 5-2 General terms relating to disease – pp. 78 Bacterial Growth and Reproduction Bacteria – Manufacture their own food from the surrounding environment – Give off waste – Grow and reproduce Protoplasm – outer cell wall containing liquid Active Stage Warm, dark, damp or dirty places where food is available Mitosis/Binary Fission – Bacteria reach largest size - divide into two (2) new cells – Daughter cells Unfavorable conditions they die or become inactive Mitosis: An Interactive Animation Mitosis Mitosis Inactive or Spore – Forming Stage Spherical spores with tough waxy outer coverings/shells Withstand periods of famine, dryness, and unsuitable temperatures Can be blown about and not harmed by disinfectants, heat or cold Spores are dangerous if they enter the body Pose little to no risk to clients in the salon Bacterial Infections Inflammation – the body reacts to injury, irritation, or infection Inflammation is characterized – Redness – Heat – Pain – swelling Infection – occurs when body tissues are invaded by pathogenic bacteria Pus – is a fluid product of inflammation and contains white blood cells, dead cells, and bacteria The presence of pus is a sign of infection Local Infection – is one confined to a particular part of the body and is indicated by a lesion containing pus General Infection – results when the bloodstream carries the bacteria or virus and their toxins to all parts of the body Staphylococci Among the most common human bacteria and carried by 1/3 of the population Picked up – – Doorknobs, countertops, other surfaces – Skin to skin contact – shaking hands, unclean implements Some Staph infections are now resistant to antibiotics – Symptoms – skin infections, pimples and boils Greatest need for proper infection control measures Methicillin-resistant staphylococcus aureus MRSA – Weakened immune system – Medical procedures Appears as skin infection that can be difficult to cure You owe it to yourself and your clients to clean and disinfect tools, implements and equipment Do not perform any service if signs of abrasions or infection! Contagious – communicable – a disease spread from one person to another by contact Spread most commonly by – Dirty hands – especially under fingernails or webs between fingers Chief Sources of contagion Unclean hands and implements Open sores, pus, mouth and nose discharges Shared drinking cups and towels Telephone receivers Uncovered coughing or sneezing and spitting in public Infected nails Viruses Parasitic submicroscopic particle that infects and resides in the cells of a biological organism. Capable of infecting almost all plants and animals, including bacteria Seen only with the most sophisticated and powerful microscopes Cause Common colds and other respiratory and gastrointestinal infections Measles, mumps, chicken pox, smallpox, rabies, yellow fever, hepatitis, polio, influenza, and HIV Differences Virus – can live and reproduce only by penetrating other cells and becoming part of them Bacteria – can live and reproduce on their own Antibiotics – Bacteria – treated – Viruses – not affected by Vaccination can prevent viruses from growing in the body Bloodborne Pathogens Disease causing bacteria that are transmitted through the body in the blood or body fluids Use great care to avoid damaging the client’s skin during any type of service Spread anytime skin is broken Hair cutting Shaving Nipping Clipping Facial treatments Waxing/tweezing Chemical burns Federal law - Cutting skin is allowed by qualified medical professionals Cutting hardened cuticle and removing callus are both considered medical procedures Hepatitis Blood borne pathogen that damages the liver Easier to contract than HIV Present in all body fluids of infected person Can live on a surface outside the body for a long time Vital all surfaces are thoroughly cleaned Be sure to clean hands after coughing or sneezing Types A, B, C Hepatitis B – most difficult to kill on a surface – check label of disinfectant Public workers should be vaccinated HIV/AIDS Human Immunodeficiency Virus Acquired Immune Deficiency Syndrome Breaks down the body’s immune system Person to person through blood and other body fluids Infected many years without symptoms Testing can tell if infected within 6 months of exposure Spread Needles – intravenous drug users Unprotected sexual contact Accidents with needles in the healthcare field Less likely to enter the bloodstream through cuts and sores Not Spread Holding hands Hugging Kissing Sharing food or household items Currently no documented cases of food handlers, insects, or casual contact or hair, skin, or nail services How Pathogens Enter the Body FYI page 81: Enter the body: – Break in the skin – Mouth – Nose – Eyes and ears – Unprotected sex Body Fights Infection Unbroken skin Body secretions White cells antitoxins Human Disease Carrier A person who is personally immune to a disease, yet can transmit germs to other people (write in on PP 81) Fungi Vegetable (plant) parasites – Molds – Mildews – Yeasts – Produce contagious diseases Ringworm Areas affected Tinea Barbae – barber’s itch – superficial fungal infection Mustache/beard Around neck or scalp – Usually older adolescents and adult men Tinea Capitis – fungal infection on the scalp Cleaning clippers of all visible hair Disinfecting properly reduces the risk of spreading skin and scalp infections Using compressed air to clean clipper blades – effective and saves time Nail Fungus Implements not properly disinfected Not properly preparing surface of the natural nail before enhancement products are applied Moisture trapped under nail enhancements Chronic and localized 1 or 2 fingers or toes Can be spread to other nails and clients if implements are not disinfected before and after each client FDA determined topical treatment applied directly to the affected area is NOT effective FDA prohibits sale of antifungal products for finger or toenails without a medical prescription Refer to a physician Parasites Vegetable or animal organisms that live on another living organism and draw their nourishment from that organism Animal Parasites Pediculosis Capitis – Head lice Scabies – Itch mite – burrows under the skin Both extremely contagious NEVER treated or work on in a salon!!! Refer to a physician Clean contaminated areas with pesticide or insecticide – mfg. directions Parasites Vegetable Animal Immunity The ability of the body to destroy any bacteria that have gained entrance and resist infection in general Natural immunity – Partly inherited – Partly developed through hygienic living Acquired immunity – The body develops after it overcomes a disease – Through inoculation (chicken Pox) Principles of Prevention Proper care must be taken to meet rigorous health standards Controlling infection and disease is a vitally important aspect of the salon industry You must ensure the safety of your clients Three main levels (write on page 82) – 1st – sterilization – 2nd – disinfection – 3rd - sanitation Only disinfection and sanitation are required in a salon Proper decontamination can prevent spread of disease caused by infectious material on a surface Prevent exposure to blood and visible debris or residue Decontamination Contaminants – substances that can cause contamination (write on PP 82) – Hair in a comb, makeup on a towel, nail dust on a file A salon can never be completely free from all contamination It is YOUR responsibility as a professional to be constantly looking for disease causing contaminants Decontamination The removal of blood or other potentially infectious materials on an item’s surface and the removal of visible debris or residue Disinfection Second level Kills most microorganisms on hard nonporous surfaces Decontamination Method 1 2 steps – Cleaning – Disinfecting Step 1:Cleaning: – Remove all visible dirt & debris – Wash with warm water & soap – Scrub with brush grooves and crevices Surface is cleaned when number of contaminates is greatly reduced A surface must be properly cleaned before it can be disinfected Properly clean and sanitize hands – Discussed later in chapter 3 ways to clean tools/implements Wash with soap and water – Scrub with brush Ultrasonic unit Cleaning solvent Step 2: Disinfection – Eliminates most microorganisms – Not effective against bacterial spores Disinfectant label must have: – EPA registration number – Specific organisms the solution is effective in killing – Use according to MFG directions!!!!!!!!!!!! Disinfectants are not for use on human skin, hair or nails! Never use as hand cleaners! Read carefully before using! Disinfectants can be dangerous if used improperly Must be approved by the Environmental Protection Agency (EPA) and each individual state All disinfectants clearly state on the label to avoid skin contact Do not put your fingers directly into any disinfectant solution These are pesticides All bottles must be labeled! Caution boxes on page 84 Decontamination Method 2 2 steps: – Cleaning – Sterilization Sterilization Highest level Completely destroys all microbial life on a surface Kills bacterial spores (inactive stage) – most resistant form of life Dentist and surgeons use Methods – – high-pressure steam – dry heat autoclave Less effective, require longer times at higher temperatures – chemicals Texas – manicurists Autoclaves Pressurized Steam penetrates spore coats of pathogens Require regular maintenance and testing Color strips on bags are indicators not verifiers CDC requires autoclaves to be tested weekly – Spore test – Send to contracted lab – Find on internet If intended temps are not reached – creates a breeding ground for pathogens (warm, moist, dark) Follow mfg. directions!!!!!!!!!!!!!!! – Cleaning – changing water – Service visits – Replacement parts – Required maintenance Keep a logbook Cannot sterilize the skin or nail plate without killing it If estheticians use needles and probes that lance the skin - they must also use sterilization processes Best to use disposable Only non porous surface can be sterilized Metal implements can be sterilized but wood cannot Sterilization in a salon is impractical and unnecessary Unless exposed to blood Choosing a Disinfectant Read the label! to use properly and safely Follow mfg. directions! Mixing precautions Exposure times What the disinfectant has been tested for Disinfectants Chemical agents used to destroy most – bacteria – Fungi – Some viruses and to disinfect implements and surfaces Does not kill bacterial spores Mixing chemicals stronger than recommended by the manufacturer counteracts their effectiveness The use of goggles and gloves is usually recommended Mixing ratios are & contact time are VERY important If concentrate is NOT on the label it is ready to use without mixing Contact time – amount of time the surface must stay moist with disinfectant to be effective Efficacy The ability to produce an effect Effectiveness with which solution will kill organisms To meet salon requirements – Bacteria – Fungi – viruses Ideal disinfectant See list page 85 “Did you Know” box - pp.. 85 Caution box - pp.. 85 When salon implements come into contact blood, body fluids or unhealthy conditions: – Cleansed – Completely immersed in an EPARegistered hospital disinfectant solution – Effective against HIV, hepatitis, tuberculosis – 10% bleach solution Always wear gloves Follow Universal Precautions Proper Use of Disinfectants Any item that is used on a client must be disinfected or discarded All implements must be thoroughly cleansed before soaking to avoid contaminating the disinfection solution “Did you Know” box – pp.. 86 Implements be completely submerged for proper disinfection Complete immersion – cover all surfaces of the item Disinfectant Tips: Pre-cleaned, hard, non-porous surfaces Wear gloves and safety glasses Dilute according to mfg. directions Immerse and soak according to the label Spray and leave on for required mfg. time on label If directions say to immerse – spraying will not work Change solution according to mfg. directions Circulate in whirlpool spas for required mfg. time Any other use than that on the label is a violation of Federal Law (write on page 86) NOTE: absorbent nail files must be thrown out if break client’s skin or make contact with unhealthy skin or nails – Ex: nail with a fungus – Ex. infected hangnail Types of Disinfectants QUATS – Quaternary Ammonium Compounds – Considered non-toxic, odorless and fastacting – Immerse implements for 10 minutes – Enough liquid to cover all surfaces of item – Contain anti-rust ingredients – Leaving tools in solution too long can cause damage – Remove, rinse, dried, stored in clean covered container – Metal implements should be oiled regularly – Effective for countertops and tables Phenols – Form of formaldehyde – Caustic poison – high pH – Can cause damage to skin and eyes, and some environments – Can be safe and effective if used according to instructions – Harmful to environment of put down drain – Disadvantage – most rubber and plastic materials may be softened or discolored – Metal implements can rust – Extra care to avoid skin contact – cause irritation – concentrated formulas can seriously burn the skin and burn the eyes – Some are poisonous if accidentally ingested – carcinogens Alcohol and Bleach – Ethanol (70%) and Isopropyl (99%) alcohol are used sometimes to disinfect metal implements – Alcohol is NOT an EPA registered disinfectant – therefore not permitted for use on implements in states where hospital level disinfectants are required – Disadvantages: Extremely flammable, evaporate quickly, slow-acting, less effective Corrode implements and cause sharp edges to become dull They discolor and damage the surface of floors and countertops Vapors can cause headaches and nausea when inhaled in high concentrations or after prolong exposure Bleach – Sodium Hypochlorite – Household bleach – Effective disinfectant – Some of the same disadvantages as alcohol – Not for use in most states – Effective additive for laundry Follow mfg. directions Store solution away from heat & light Mix every 24 hours Can irritating to lungs Do not inhale fumes Commercial cleansers – Lysol and pine-sol – Floors, bathrooms, sinks, waste cans – Not for use on salon implements – General household cleaners – Not for professional tools Fumigants – Caution box pp.. 87 Formalin tablets – before EPA Formaldehyde vapors cause cancer Allergic sensitivity for those who constantly breathe vapors Kills one fungus in 24 hours Vapors are poisonous Irritating to eyes, nose, throat, lungs Glutaraldehyde Dangerous chemical used to sterilize surgical instruments in hospitals Not safe for salon use Pseudomonacidal Formulated for hospitals and health care facilities Hospital disinfectant PP 86/87 – – Bactericidal – Fungicidal – Virucidal Tuberculocidal EPA registered effective against HIV or HPV Meet OSHA’s Bloodborne Pathogens Standards – Write on page 87 Ultrasonic cleansers use highfrequency sound waves to create powerful cleansing bubbles in the liquid (write pp. 86) – Reaches tiny crevices – Useful addition to your disinfection process, but not required – Saves time by eliminating cleaning by hand Disinfectant Safety Pesticides - poison Can be hazardous if used incorrectly Poisonous if ingested Can cause serious skin and eye damage USE CAUTION! Follow mfg. directions List on pp. 88 Wet disinfectant jars – solutions changed daily – wear gloves kept free from debris Purpose is to disinfect – not clean Covered but not airtight Follow mfg. directions Disinfect or Dispose Multi-use – Cleaned – Disinfected – Used more than once “Disinfectable” – Items that can be disinfected Multiuse: – Reusable – Cleaned & disinfected – Used on more than 1 person – Hard, nonporous surface Single-use: – Disposable – Cannot be used more than 1 time – Cannot properly be cleaned – Thrown out after each use Porous – Made or constructed of an absorbent material (has open pores or openings) Contact with broken skin, blood, body fluids, or any unhealthy conditions MUST BE DISCARDED!!!!!!!!!!!! Caution boxes pp. 89 Keep a logbook – Follow mfg. directions – State may not require – Clients peace of mind & confidence in you Disinfecting nonelectrical tools & equipment Multiuse tools & implements must be cleaned & disinfected before & after every service Mix according to mfg. directions! Remember to always add the disinfectant to the water Pp. 96 Disinfecting Implements Pre-clean 2. Rinse thoroughly and pat dry 3. gloves, goggles or safety glasses 4. Mix disinfectant according to mfg. directions 5. Use gloves or tongs, completely immerse implements or tools – soak for the required time 6. Remove from solution with tongs, basket, or gloves 7. Rinse thoroughly, and dry 8. Place disinfected implements in clean, dry, disinfected container (pictures PP 96) Disinfecting Electrical Tools/Equipment Contact points cannot be immersed in a wet solution Spray with EPA registered, hospitalgrade disinfectant for electrical equipment Follow mfg. directions Disinfecting Work Surfaces Before and after each client spray with hospital-grade disinfectant Any surface client’s skin came into contact Doorknobs, phones etc. - transferring germs Follow mfg. directions – Usually 10 minutes Disinfection Procedures Clean surface 2. Spray disinfectant 3. Let stand 10 minutes 4. Wipe dry (write on top/bottom of page 90 or 91) Disinfecting Linens, Capes and Towels Laundered and bleached according to label directions Completely dried All capes and linens that come into contact with clients must be laundered according to mfg. directions Use Sanex strips Store soiled linens in covered close container Use disposable towels as much as possible (bathrooms) Do not allow capes to touch client’s skin Wash after each client Disinfecting Pedicure Equipment & Foot Spas Read mfg. directions Write in page pp74 – follow state guidelines Improperly disinfected whirlpools can harbor bacteria Procedures on page 97 – Handout Caution boxes pp.. 91 Detergents and Soap Chelating surfactants Work to breakdown debris Important to remove residue from products – Scrubs, salts, and masques Work with all types of water Low-sudsing Specially formulated to work with hard water – Makes disinfectants less effective Ask distributor for hard water products Information Additives, Powders and Soaps You CANNOT replace proper cleaning and disinfection with a shortcut Must use EPA registered disinfectant Water sanitizers do not work for a salon environment Chloramine T – treat water & have limited value in salons http://hydra-chloramine-t.com/ http://www.fishdoc.co.uk/treatments/c hloramine-T.htm http://www.osha.gov/dts/chemicalsam pling/data/CH_226190.html Dispensary Must be kept clean and orderly All containers labeled Store according to mfg. directions MSDS (s) kept on every chemical in stock Handling Single-use or Disposable Supplies All single use thrown out after use Anything exposed to blood must be double-bagged Marked as bio-hazard Disposed of according to OSHA regulations – Separate from other waste Individual Client Packs Each item must be cleaned, disinfected, and dried Do not store disposable items Client’s own tools must cleaned and disinfected before and after using It is YOUR license at risk Washing the Hands Is one of the most important actions that can be taken to prevent the transfer of microorganisms from one person to another Before and after each client Removes germs from folds, grooves of skin, under nail free edge Caution box pp.. 92 Avoid touching – Bar soaps – towel dispenser – door handle/knob Use paper towel to open door Hand washing procedure pp.. 102 Antimicrobial & antibacterial – soaps can dry the skin – No more effective – Minimize use use moisturizers Very hot water can dry skin Hand Washing Procedures Wet your hands with warm water 2. Using liquid soap lather hands for 15 – 20 seconds 3. Rinse with warm water 4. Dry with paper towel - not cloth – (page 102) Waterless Hand Sanitizers Chemical germicides formulated for use on skin Regulated by the FDA Antibacterial soaps when overused can be harsh and drying and can eventually lead to eczema Alcohol-based no-rinse products are very drying to the skin Benzalkonium Chloride – less drying Cannot clean Not to be used as a disinfectant Caution boxes - page 92 Antiseptics Can kill, retard, or prevent growth of bacteria Not disinfectants Weaker than disinfectants Safe for human skin Classified as sanitizers – not for use on instruments and surfaces Sanitation Cleaning - removing all visible dirt and debris Third = lowest level of decontamination Cleaning A surface must be properly cleaned or it cannot be properly disinfected Do not underestimate importance of cleaning. Most powerful and important way to prevent spread of infection. Universal Precautions Set of guidelines and controls Center for Disease Control and Prevention Assume that ALL HUMAN BLOOD AND SPECIFIED HUMAN BODY FLUIDS ARE INFECTIOUS for HIV, HBV and other blood borne pathogens Asymptomatic Show no signs of symptoms or signs of infection May not even know they are infected Blood of all clients should be treated as if infected Precautions Hand washing Gloving Personal protective equipment Goggles Proper handling and disposal of sharp implements and items that have been contaminated by blood and other body fluids. Injury prevention Proper handling and disposal of needles and products that are contaminated by blood or other body fluids Exposure Incident: Contact with Blood or Body Fluid – Contact with nonintact (broken) skin, blood, body fluid, or other potentially infectious material – Caution Box pp.. 93 Blood Spill Disinfection 1. 2. 3. 4. 5. Stop, clean injury Gloves Apply antiseptic Cover injury Clean client and workstation 6. Discard all disposable objects 7. Remove gloves 8. Completely immerse all contaminated implements in an EPA registered, hospital-grade disinfectant that kills HIV and Hepatitis B “Did You Know” box pp.. 94 The Professional Image Overall health, safety and cleanliness should be an integral part of your normal routine and all those who work around you Pages 94 - 95 Your Professional Responsibility The most important responsibility you have is to protect your client’s health as well as you own Never take short cuts! To be an effective cosmetologist you must learn and follow ALL the rules to the letter of the law By doing so you, your peers and clients will maintain a sense of trust and respect for each other