Disinfection vs. Sterilization
There is a big difference between sanitizing and sterilizing. Use of a hospital grade, EPA-approved disinfectant is the most common sanitizing procedure used in the practice of professional skin care. In most cases, these are liquid solutions that serve as soaking/immersion disinfectant agents. Disinfection kills pathogenic organisms, but not pathogenic spores. Sterilization is the process of killing all the microorganisms present on the implement, as well as spores. The only real way to sterilize an implement is to use an autoclave. Autoclaves are not frequently used in the practice of aesthetics unless the practice is being performed in a medical facility where there may be invasive procedures taking place such as injections, surgery, or procedures that always expose live tissues or blood.
There is a common misconception in the aesthetic community that UV sanitizers are sterilizers. In fact, they are often wrongly labeled as sterilizers. UV sanitizers do a good job keeping already-sanitized materials and implements sanitized, but they do NOT sterilize, and they cannot take the place of autoclaves or disinfectant solutions like quaternary ammonia (quats).
Cleansing vs. Sanitizing
Cleaning and sanitizing are NOT the same thing! Dirty and used implements must be thoroughly washed and cleaned before they are placed in sanitizing disinfectant solution. Metal implements such as tweezers or comedone extractors should be thoroughly washed with a suitable detergent prior to immersion in disinfectant or autoclaving. It is advisable to wear gloves while washing such implements. Brushes should be soaked in a mild detergent bath in a tub, cleaned of all mask or product, and then thoroughly rinsed before immersion in sanitizing solution.
Aseptic procedure refers to the proper handling of disinfected and sterile equipment or implements. In the non-medical aesthetic practice, aseptic procedure is the type of material handling that should take place. Sterile procedure is the type of procedure followed by hospitals and surgical facilities, and is much more stringent.
Aseptic procedure involves the handling of sanitized materials with freshly sanitized or gloved hands, and avoiding the introduction or mixing of non-sanitized materials with the sanitized items.
Double Dipping: Cross-Contamination
Many of the sanitation errors we will be discussing involve cross-contamination, which is contaminating a sanitized or sterile surface by exposing that surface to something non-sanitized. This is mishandling or disinfected or sterilized equipment or supplies, and is therefore a violation of aseptic procedure.
Reusing the same spatula more than once to remove product is a no-no if it has touched a contaminated area such as your hand or the client's skin. The correct technique would be to remove product with a spatula and place the product in a disposable bowl or palette. You can re-dip your brush on the palette or the bowl, as long as both the brush and the bowl or palette will be used on only one client before being discarded or sanitized. Using the same eye makeup brush to apply a second coat of eye shadow is fine as long as you do not double dip in the eye shadow compact with the same brush. Again, the correct aseptic technique would be to scrape the eye shadow with a sanitized spatula, and place the scraping on a palette. Small paper plates make excellent disposable palettes.
Washing dirty laundry and using the same basket for dirty and sanitized linens.
This is a frequent boo-boo! Use different color baskets for linens and have them clearly marked as dirty and clean. Make sure your custodial help is well acquainted with aseptic technique, so that they aren't accidentally contaminating your fresh linens. Plastic baskets are easier to clean and properly sanitize than wicker or weave baskets. They should be sprayed regularly with disinfectant spray. Also, it is a good idea to wear gloves when working with soiled laundry.
Reusing the same spatula while waxing.
This is a very frequent blunder. This includes both using the same spatula over and over, with direct contact with the wax pot, on the same client, and/or not changing spatulas between clients. Both errors contaminate the wax for all future clients!
The only correct way to wax using the same spatula is to place some warm wax into a disposable cup. You can re-dip a spatula into this disposable cup as long as you are working on the same client. The spatula and cup should be disposed after each client. Junior size (children's) tongue depressors make excellent inexpensive, one-use, disposable spatulas for waxing.
There is really no way to completely sanitize a sink because of the drain. Sinks are notorious for their pathogen content. The only items that should have direct contact with a sink are items that are going to be disposed of immediately or sanitized properly before being reused.
Filling a sink with water to prepare implements, sponges, or pads is not an acceptable aseptic procedure. Preparing, wetting, or rinsing sponges must take place in a bowl that can be sanitized between clients or uses. Likewise, cotton pads should not be prepared in a sink without using a sanitized bowl. Bowls should be thoroughly washed and sanitized with a disinfectant any time they have had contact with a soiled or contaminated item such as a dirty facial sponge or used mask brush.
Other Sanitation Issues
Disposable gloves should always be worn when performing any service that might involve contact with body fluids. This would include extraction, waxing, tweezing, and any procedure that might expose small amounts of blood. Gloves should also always be worn after these services are performed, as blood or body fluids may continue to be present after the actual procedure is finished. If the client has any scrape on the skin, or likewise, if the aesthetician has a scrape or skin hand injury, gloves should be worn constantly. Gloves should be worn only once for one client only and then discarded.
The best choice for gloves is disposable nitrile gloves, also known as Neoprene®. These synthetic gloves are less likely to cause allergies than latex, and fit better than disposable vinyl gloves.
Brow Hair in the Bottom of the Tweezer Jar
Tweezers should be used on one client and then placed in a "dirty box" for later sanitizing. Too many facial rooms have only one set of tweezers, which are often not properly sanitized between clients. If you do have only one set, rinse them thoroughly after each use (to remove all hair!) and keep them constantly immersed in a jar containing sanitizing solution.
Glass high frequency electrodes often come in direct contact with clients' skin, and must be properly disinfected between uses. Metals can become corroded easily by some disinfectants, and therefore, the glass part of electrodes must be sanitized without exposing the metal portion of the electrode to the disinfectant. Allowing the glass part of the electrode to be immersed in a shallow bowl of sanitizer for 15 to 20 minutes sanitizes the part of the electrode touching the client without exposing the metal tips to the sanitizing solution. Again, it is a good idea to have more than one set of electrodes to work efficiently.
Most public health officials agree that the very best way to curb the spreading of infection is the conscientious effort to properly wash the hands on a frequent and regular basis. Aestheticians should always wash their hands, in front of the client, at the beginning of every treatment. Hands should be rewashed before touching any sanitized implement.
One of the best ways to practice aseptic procedure is to pre-measure products in small disposable paper cups before the beginning the client's treatment. This way you have a pre-measured amount of product and the paper cup can be thrown away after use. You can touch or re-touch the cup as long as you are working on the same client.
Likewise, it is a great idea to set up equipment before starting the treatment. Lay out tweezers, cotton swabs, tissue, cotton, electrodes, and other tools before starting the treatment. By laying out this "kit," you will not have to fumble around in the middle of treatment, trying to find tools. This procedure of organization also cuts down on the likelihood of cross-contamination. Coming in early before work to get organized also helps to prevent accidents or accidental contamination that can occur when therapists get in a hurry during the day.
Purchasing products with pumps or dispenser caps is another efficient way to a sanitary practice. The less a product is handled, the less the chance of cross-contamination. Even if products do come in jars, place smaller amounts of the product in small cups for easy use on one client as described previously.
Some Generally Good Ideas for Easy Aseptic Technique
- Use disposable items whenever possible. Inexpensive disposable lip brushes, cotton swabs, makeup sponges, and junior tongue depressors (for spatulas) are easy one-use implements. All sharp implements like lancets should be one-use only and disposed of in a sharps container.
- Include your sponges in the cost of a facial treatment, and give them to the client for home use when you are finished with their treatment.
- For reusable (non-disposable) implements, have more than one implement in each room. In other words, have six sets of tweezers in every room, four comedone extractors, etc. This way you always have a fresh sanitized implement. Place your used ones in a "used" container for sanitizing or sterilizing later, when you are not busy with clients.
- If you use high quality, non-disposable makeup brushes, have lots of them on hand. That way you can use each one once, and then place it in a "dirty box" for sanitizing later. If you need to reapply eye shadow a second time, you have a fresh brush. Have a pre-prepared kit for every service with plenty of sanitized brushes.
- Have clearly marked baskets or large bins for contaminated linens or implements.
- All trash containers should have lids. This is a state regulation in many states.
- Wash your hands frequently in front of your clients. This lets them know you care about cleanliness and their health. Use hand sanitizer as needed also.
- Post a poster or bulletin in a prominent place letting your clients know what your sanitation techniques are.
- Have a detailed written outline of sanitation and disinfectant procedures. This should be included in your employee manual. All employees, including non-licensed personnel such as reception staff should be trained in aseptic procedures, as they inevitably help out with laundry, keeping the dispensary clean, preparation of cotton pads, etc.
- Have daily checklists so that team members can initial that all procedures have been followed properly.
- Have regular sanitation inspections with a thorough checklist maintained by each therapist.
Check out Your Own Office!
Part of a sanitary practice is also image! Get out of the box, and pretend you are a client visiting your own salon or clinic. Enter through the front door. How does your lobby or reception area look? Are the shelves dusty? Do the testers look used with smears of product on the container or product crusted around the pump dispenser? Are there fresh and easily acceptable disposable brushes in the makeup area for clients to use while looking at makeup? Is there a team member nearby to make sure clients are properly trying testers, and not contaminating testers with fingers? All areas of the facility should be immaculately clean, especially client access areas!
Enter the treatment room. Are the counters clean or dusty? Lie down on the facial chair or table. Look around the room. Are the jars well-organized and clean? Are there dust bunnies under the carts? Is the ceiling stained or the air vents dirty? Is the equipment clean and new-looking? All of these examples can make a great or unfavorable impression on a client. By taking routine "tours" of your facility, you can stay ahead of the dirt, and project a great image!
Much of good sanitary practice is about being well-organized! Educate your team well and enforce sanitary rules. Make sure that you are also following regulations and laws established by your state board and OSHA. Having an established procedure for all sanitation and disinfection functions makes it much easier to always have a beautifully clean and sanitary facility.
Mark Lees, Ph.D., M.S. is an award-winning speaker and product developer, and has been actively practicing clinical skin care for over 20 years at his CIDESCO accredited Florida facility, which has won multiple consumer awards. His professional line of clinical products, specializing in acne, sensitive, and aging skin, is available throughout the United States at licensed skin care facilities. His professional awards are numerous and include American Salon Magazine Esthetician of the Year, the Les Nouvelles Esthetiques Crystal Award, and the Dermascope Legends Award. Dr. Lees has also been inducted into the National Cosmetology Association's Hall of Renown. Dr. Lees is author of the popular book, Skin Care: Beyond the Basics, now in its 3rd edition.