Aestheticians should also educate clients regarding proper hygiene, sanitation, and product usage and storage at home. Clients can unknowingly spread infection by touching their faces with unclean hands, picking at comedones or pustules, or contaminating products with improper use and storage. This can cause skin conditions to worsen and can also cause pathogenic bacteria, viruses, and fungi to enter the body and cause disease. This is unfortunate, but it is also a liability to the spa if the client has recently received aesthetic services or has purchased products. A client is more likely to immediately place blame on the spa rather than consider the cleanliness of his or her home environment. The best way to prevent contamination and spread of pathogens at home is through client education.

Prevention of Contamination Begins with Basic Personal Hygiene.
Aestheticians work directly on the human body, are in close contact with body fluids, and use instruments and equipment that may break the skin. These are risks to both the client and the aesthetician. While an aesthetician does not have control over a client's personal hygienic practices, he or she must follow proper hygiene practices to protect the client. Basic personal hygiene includes:

• Bathing the body and washing the hair regularly
• Keeping long hair pulled back and short hair properly groomed
• Regular flossing, brushing the teeth, and use of mouthwash for good oral hygiene
• Keeping fingernails natural and short with smooth edges – artificial nails are not recommended in this profession
• Keeping hands moisturized to prevent cracks in the cuticles or skin
• Following proper handwashing guidelines
• Wearing clean clothing
• Covering the mouth and nose when coughing or sneezing

Not enough can be said about the importance of following proper handwashing. The Centers for Disease Control and Prevention (CDC) recommends specific procedures for how and when to wash the hands. Hands should be washed with soap and warm water for at least 20 seconds. They should be thoroughly dried with an air dryer or disposable paper towel. If the faucet does not automatically shut off, it is recommended to use a paper towel to turn it off manually. It is also a good idea to use a paper towel on door handles and knobs when exiting the room.
The CDC also has resources available regarding how to choose appropriate hand soap or sanitizer, as well as a specific policy concerning the usage of gloves. It is recommended that aestheticians follow the guidelines and policies outlined by the CDC for health care workers.The Occupational Safety & Health Administration (OSHA) also has specific hand washing requirements for all workers following contact with blood or other potentially infectious materials. The CDC also has practical guidelines for handwashing at home, which the aesthetician can share with clients and encourage them to follow at home.

Proper Sanitation at the Spa
It is essential that spas are adequately outfitted with decontamination products and equipment such as Environmental Protection Agency (EPA)-approved hospital-strength disinfectants for nonporous implements, EPA-registered cleaning products for surfaces, and autoclaves to sterilize any non-disposable sharps used to break the skin or any other implement or autoclave-safe piece of equipment which has come into contact with blood or pus. It is important to read all Material Safety Data Sheets (MSDS) for correct usage and storage instructions for each substance.
All non-disposable linens, towels, client gowns, and headbands must be laundered after each use in hot water using bleach or another approved detergent. They should be stored in closed cabinets when not in use. Disposable items should be stored in closed, dry containers and only the amount needed for each treatment should be taken out at a time. These items should be disposed of in proper covered containers. Sharps should be disposed of in approved sharps containers and any other disposables that have come into contact with blood, pus, or other body fluids should be disposed of in an approved biohazard covered container.
Nonporous implements such as metal extractors, tweezers, diamond-bit microdermabrasion heads – in addition to other immersible items that might not be autoclave safe – must be pre-cleaned before immersing in disinfectant. Skipping this step contaminates the disinfectant itself, and thus spreads the microbes among all immersed implements. After use, implements should be scrubbed with soap and water, and then fully rinsed before immersing into the disinfectant for the time specified by the manufacturer.
Non-immersible tools and equipment such as steamers and electrotherapy machines should be cleaned regularly as indicated by the manufacturer. Non-disposable makeup brushes and tools should be disinfected between clients with an approved disinfectant spray, and then they should be washed with antibacterial soap and warm water at the end of the day. They should be laid flat to dry on a disinfected surface, and then stored in a closed container. It is important for clients to know how to properly care for their own makeup brushes and tools at home as well. Between clients and at the end of the work day, all items and supplies in the treatment room should be properly disinfected, disposed of, or put away.
Special care must be taken in wet rooms and showers. The combination of heat, water/steam, and procedures like exfoliation creates an ideal breeding ground for mold and other fungi, bacteria, and viruses. It is imperative that proper ventilation is used, that wet areas be dried and disinfected immediately, and that any wet linens or floor mats be removed and laundered or properly cleaned between clients.
Waxing is an especially touchy topic in terms of cleanliness. Too often, waxing machines are left uncovered when not in use, collars are not changed often enough, and waxing applicators are not disposed of frequently enough. The gold standard is to never double dip – this means a much lower risk, but increased costs. However, it is never worth risking injury, spread of disease, or other liabilities to save on costs. It is helpful to keep daily and weekly checklists in each room as well as master checklists for the entire spa to make sure proper protocols are followed.

Taking Care with Products
Incorrect storage, dispensing, and use of products in the spa as well as at home can cause them to become contaminated and spoil. All retail products should be inventoried upon arrival, with the expiration dates checked. The ones that expire soonest should be sold soonest, and the others should be stored in properly labeled closed containers or cabinets off of the ground in a cool, dry place.
It is important to understand that cosmetic manufacturers are not required by the Food & Drug Administration (FDA) to provide expiration dates on product labels. This is done on a voluntary basis and is not regulated. Most companies do choose to provide expiration dates, but it is important for both aestheticians and clients to know that the expiration date only refers to how long a product can remain unopened and sealed on a shelf. Once it is opened, it begins to deteriorate.
Liquid and cream products are the most likely to become contaminated due to their water content. It is most advisable to use products packaged in airtight pumps to prevent contamination. Jars, bottles, and tubes are exposed to air, light, and microorganisms every time they are opened. If it is necessary to use products in this type of packaging, disposable spatulas, cotton swabs, cotton pads, or other sterile disposables must be used to dispense product each time. This applies to use in the spa, as well as at home. All back bar products should be closed tightly when not in use, and should be stored in a closed cabinet, drawer, or container in a cool, dry place. Many clients store their products in their bathrooms at home, which can become warm and moist. It is important that they make sure the containers are kept closed in cabinets or drawers. Special care must be taken with any product used in the eye area. It is best to have separate products and tools for the eyes to prevent cross-contamination. It is also important that products and implements such as eyelash curlers not be used in the eye area in the case of irritation or infection. Special precautions must be taken for all cosmetics testers to ensure proper handling and sanitary use.Although most products come with expiration dates and all contain preservatives of some kind, it is best to use them quickly once opened. According to the American Academy of Dermatology, dry products like powders, dry clay masks, and eye shadows should be discarded after two years. Cream or liquid products should be replaced after six months to a year. Products that use wands like mascaras and lip glosses are the most likely to become contaminated and should be replaced every two to four months. In the spa, the tips of the wands should be cut off and disposable wands and applicators should be used.
It is important to be aware of any changes in the color, consistency, or smell of all products at home and in the spa. Any of these changes, in addition to the presence of mold, clearly indicate that the product has either become contaminated or has deteriorated and should be discarded regardless of the expiration date.
Preparation and prevention are paramount in having a safe and healthy spa environment for clients as well as for all spa professionals. It is the responsibility of all spa professionals to stay abreast of and comply with all state and federal regulations regarding sanitation practices. This not only ensures a clean and safe environment for clients, but it also helps to protect aestheticians. It is always worth the time and effort to follow protocols and prevent any mishaps.

Rachael Pontillo is an AADP board-certified Holistic Health Practitioner, licensed aesthetician, writer, and entrepreneur. In addition to working with clients in individual and group coaching programs, she also teaches holistic skin care, nutrition, and wellness classes in the Philadelphia area and has presented lectures at national conferences. She is the founder and author of the popular website and blog Holistically Haute™ at www.holisticallyhaute.com and is owner of the local skin care and wellness company Holistically Haute, LLC.