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Sanitation: Who is Responsible? pt 1

Sanitation is important, but there are often little things that can be overlooked when maintaining your facility. Unfortunately, there have been specific instances where the lack of sanitation has resulted in the spread of illness and disease. When proper sanitation measures are not followed, there can be fines issued to owners and licensees, which can lead to the closing of establishments. Many of you may think your facilities are clean, but what you cannot see is what needs to be combated. Basic biology and chemistry has taught us that the elements of our world consist of molecules, cells, bacteria, and viruses that cannot be seen.

What we can see, in some cases, are the effects. Aestheticians treat acneic clients, who are prone to cysts, pustules, and open and closed comedones. All of these skin blemishes can harbor bacterial infections that can spread to other clients and the aesthetician if proper sanitation measures are not upheld. It is the duty of the aesthetician, stylist, make-up artist, nail technician, permanent cosmetic artist, and facility owner to uphold proper sanitation requirements issued by the States Cosmetology Commission and Federal Government and to keep everyone involved in maintaining a safe and clean work environment to protect themselves, their clients, and patients.

Basic Cleanliness
Our industry is based on image. If a client’s general impression of your facility is negative, there is a good possibility that they will not return. Word of mouth is our best referral, or our worst enemy. Keeping the public area and procedural rooms in tip-top shape is important for the success of the business. General equipment in the facility must be in good repair; this includes toilets, sinks, walls, ceilings, and other free standing or stationary fixtures. According to the Cosmetology Commission, the floors of the procedure rooms should be non-porous surfaces. The non-porous flooring allows you to clean the flooring more efficiently, killing microorganisms that may be harbored in the flooring itself. Another simple maintenance procedure that is often overlooked is changing the air filters of the heating, ventilation, and air conditioning system on a regular basis. This maintenance of the air system will prevent the spread of dust and allergens. Installing an ultraviolet light to your air filtration system will help kill airborne bacteria, molds, and some viruses, which is especially important during the common cold and flu season. Your facility must have clean, potable water and have hot and cold water available throughout the entire facility. Any significant problems that may arise with the structure and equipment in or out of the building should be taken care of immediately to prevent further damage to the building or ultimately the people inside.
A simple way to keep your facility in a clean condition is to follow a housekeeping regimen with your staff. When everyone is involved in the cleaning process, it is easy to maintain a clean facility and detect any repairs that will need to be done. Daily checklist items are easy to follow and become part of a routine, these items include simple chores: cleaning countertops, phones, and other high use equipment; washing linens with added bleach; washing and/or soaking bowls, peel brushes, sponges, and other equipment in disinfectant solution; sweeping; and vacuuming. Once you establish daily cleaning it will become a mainstay, much like a nail technician applying nail polish or an aesthetician removing a mask, you wouldn’t forget to take the mask off, why forget to clean after your client? Weekly cleaning regimens will go into a more thorough cleaning of the bathrooms, kitchen, and floors with a disinfectant solution. Monthly regimens include changing air filters and light bulbs. Follow guidelines and create a routine to get yourselves into good cleaning practices.

In addition to structural maintenance and housekeeping, it is necessary to follow through with other regulations to keep the facility clean. The Cosmetology Commission does not allow you to sell food in your facility, but you can provide snacks and drinks to make your clientele more comfortable. Water and green tea are excellent detoxifying beverages after a good massage, but be sure that your pitchers are cleaned daily. Another sanitation precaution is the admittance of animals into your facility. No animals are allowed unless the animal provides a service to a handicapped individual and is registered as a working animal.

Federal Precautions to be Considered and Followed
We are not only bound by the regulations of the Cosmetology Commission, but federal regulation as well. Federal regulation of clean work environments and precautions is written and practiced by the Center for Disease Control (CDC), Occupational Safety and Health Administration (OSHA), and, in product safety and use, the Food and Drug Administration (FDA). Each one of these federal organizations works to protect the consumer and employees. The FDA protects us by regulating products for specific use. Topical products that are used on the skin surface must be used with care to protect from irritation or damage; these products include hair relaxers, hair dyes, and acids. Although some products may be labeled as natural, many topical products can cause damage to the body when ingested or introduced via the eyes, nose, and mouth.
It is OSHA’s regulation that maintains a safe work environment for any occupation. Federal regulation under OSHA maintains the privacy and protection of employees as individuals, and reports any injury or illness from the physical environment of the workplace. Stair railing must be supportive and have the capacity to hold weight, entrances and exits must be distinguishable from other doors, hallways must be clear from obstruction, floors must be clean, dry, and in good repair, and overall the work environment must be in good order. Specific items that are used daily need to be taken into consideration. For example: extension cords that are not hidden can pose a tripping hazard; and candles, although excellent for ambiance, can be a fire hazard.
OSHA also takes great measure to protect individuals from occupational exposure to human body fluids. Body fluids can be defined as blood, semen, vaginal secretions, saliva, and any other body fluid that cannot be distinguished. These fluids, when infected, are the cause of infectious diseases including HIV and Hepatitis B. Neither of these diseases are transmitted through casual contact; HIV is rarely transmitted by needle stick, but it is important to realize that individuals who suffer from HIV are prone to other infections including tuberculosis, shingles, herpes, yeast infections and/or skin rashes. Hepatitis B (HBV) is also a viral infection that can be transmitted through a needle stick and affects the liver of those who suffer from this infection. Caution must be taken when dealing with potentially infectious body fluids. Should any of these fluids come into contact with an open abrasion on the skin or under the skin through a needle stick, the disease can be spread. The easiest and best rule to follow is OSHA’s Universal Precautions rule; which states that you should treat any body fluid as though it is contaminated with a bloodborne illness. Wearing the required personal protective equipment is vital to protect yourself from contracting an illness. Personal protection includes the use of gloves and aprons or lab coats. Gloves are for single use only and must be discarded after each client. Should your glove be torn or punctured you should immediately replace it; most importantly, gloves are not a substitution for hand washing! Aprons and lab coats help to protect your body from exposure. These garments should be washed daily at the facility and not taken home where contamination can spread. Any sharp instrument that is used (i.e. Lancet) must be disposed of appropriately in a sharps container. Sharps containers must be easily accessible, colored red, and remain closed at all times. Also, they should not be penetrable. OSHA’s Bloodborne Pathogen Standard goes into great detail regarding the logistics of who is covered by the Standard, what precautions need to be taken, what protocol should be followed, and why employees who are covered under the Standard need to take the proper protection with any client/patient so as to prevent contamination of themselves, their families, and others. For further information on OSHA, please refer to their website at www.osha.gov.

Characteristics of Diseases
What is it that we’re protecting ourselves against? The unseen demons outnumber us by far, but we do have our defense, the skin. Our largest organ acts as our biggest defense line, but it is not invincible. Microorganisms can infect the skin or bypass the skin through cuts and natural openings. HIV and HBV were mentioned previously with OSHA. Other viral diseases that need to be taken into consideration are Hepatitis A (HAV), chicken pox, and Herpes Simplex 1 and 2. Bacterial infections cannot always be seen and, in some cases, are difficult to distinguish in skin conditions. These infections are not always on the skin, some, like tuberculosis (TB) can be spread via the air. Protect yourself and protect your clients from disease by getting vaccinated and taking the appropriate sanitation and disinfection measures.
HAV is contracted through fecal-oral transmission. There are antiviral medications that can be taken to cure HAV; once your body builds immunity against the virus, your chances of contracting it again are rare. How do you prevent HAV? Wash your hands with soap and water after using the restroom and before eating. This is the most essential thing to do. Unfortunately, those who do not wash their hands after using the restroom help spread the virus.
Herpes Simplex 1 (HSV-1) and Herpes Simplex 2 (HSV-2) cannot be cured, only suppressed through medications. The virus is transmitted by direct contact with a sore on the skin surface and there are generally no signs of Herpes unless the affected individual has an outbreak. HSV-1 usually affects those individuals from the waist up. HSV-2 is known as “genital herpes” and is generally found from the waist down; however, HSV-2 can be found in or around the mouth and facial area. Understanding the characteristic of Herpes is important because it is transmitted by direct contact. Failure to recognize the difference between a herpes outbreak, rash, or cold sore will result in the spread of the virus to yourself and your clients. Remember to take Universal Precautions when performing facials or waxing the face and bikini areas. More importantly, how do you perform on a client if you suspect he/she may have a herpes outbreak around the bikini area? You don’t! Simply tell the client that there’s a condition that you do not recognize, then tell them that they’ll need to see a dermatologist about it before you can perform any services. Do not diagnose any skin conditions that are out of your scope of practice and remember to maintain confidentiality. It is a simple act of professionalism to keep your clients information confidential.
Bacterial diseases on the skin surface appear as a rash or sore and are transmitted by direct contact. Treatment of bacterial diseases includes an antibiotic and/or topical antibacterial ointments. Syphilis is commonly a Sexually Transmitted Disease that can affect different areas of the body, including the bones and nervous system, and can go through phases that ultimately lead to death if left untreated. Sores on the skin that are characteristic to syphilis cannot always be seen and any contact made with a sore could leave you or your client with syphilis. Impetigo is a bacterial infection of the skin; its characteristics include blisters that burst on the skin surface leaving a sore that can lead to scarring. Folliculitis has an appearance similar to white heads, and can harbor a form of Staph infection that affects the Pilosebaceous unit. Clean-shaven or waxed areas are more prone to contract the bacteria and care must be taken with contaminated laundry so as not to spread the bacteria. Infected individuals must take care to not reuse towels and sheets so they can rid themselves of the bacteria.
These few examples are only the tip of the iceberg when it comes to the amount of diseases that can be contracted. Public establishments are required to maintain proper sanitation measures for protection of themselves and their patrons. Cosmetology facilities are required to increase their standards of sanitation because cosmetologists have direct contact with the public, touching hair, nails, and skin. This increases the risk of a nail technician, aesthetician, or hair stylist contracting an illness and spreading the disease to their clientele and ultimately their home. The last thing a working individual needs is to transport a disease that a client gave them and, worst of all, a bloodborne illness that will affect you the rest of your life. Remember to use Universal Precautions with each client that you treat this is the most simple and smartest precaution to follow.
Proper protection and cleaning will prevent the spread of disease at work and at home, but unfortunately even the cleanest facilities are at risk. For example, a case was brought to my attention from a permanent cosmetic artist. Their client had contracted a Staph infection after receiving permanent cosmetics and blamed the facility. As a result, testing was conducted at the permanent cosmetic facility and at the client’s place of business (a restaurant). Results concluded that the cosmetic facility did not carry Staph, but the restaurant did. Before conducting the permanent cosmetic procedure, the client was given a consent form that gave a detailed explanation of the precautions that need to be taken after the procedure, one of them being a warning that the affected area is an open wound and should not be touched. The permanent cosmetic facility maintained a clean, disinfected facility and gave their clientele informational consent forms, but were still accused of having an unsanitary facility. It is unfortunate that unclean facilities have affected the majority of us, but by maintaining clean practices and keeping ourselves educated we can provide a safe work environment for our employees and our clientele.
My goal is to keep you up-to-date on trends in the industry and remember that education is your key to success. Follow up with us in the July issue of DERMASCOPE to learn more about effective disinfectants, proper cleaning protocols, personal protection, and protecting your employees and clientele.

Tina Zillmann is a paramedical aesthetician, having a focus in acne care and light-peeling treatments. She is also the owner of the Skin Rejuvenation Clinique, Inc., a facility that services to pre- and post-operative patients. Zillmann also acts as a national educator for Advanced Rejuvenating Concepts™. Recently, she was the recipient of the Entrepreneur Spirit Award from the National Association of Women Business Owners.

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