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1 Frequently Asked Questions Requirements for license renewal Licenses Expire CE Hours Required March 31, How do I complete this course and receive my certificate of completion? As per state requirements this course contains a pre-program assignment that is to be completed online at before you can complete your final examination. Upon completion of the pre-program assignment you will be given access to the online final examination questions. A score of 75% or higher shall be considered a passing examination score. Follow the prompts and print your certificate immediately. This course can ONLY be completed online at. See page 26 for step by step directions. Cost Course Title CE Hours Price 4 CE Hour Update for Wisconsin Salon Professionals 4 $29.95 Are your courses Wisconsin board approved? Elite s course is approved by the Wisconsin Department of Regulation & Licensing. Are my credit hours reported to the Wisconsin board? No. The board performs random audits at which time proof of continuing education must be provided. Keep your certificate in a safe place. Is my information secure? Yes! Our website is secured by Thawte, we use SSL encryption, and we never share your information with third-parties. What if I still have questions? What are your business hours? No problem, we have several options for you to choose from! Online at you will see our robust FAQ section that answers many of your questions, simply click FAQ in the upper right hand corner or us at office@elitecme.com or call us toll free at , Monday - Friday 9:00 am - 6:00 pm, EST. Important information for licensees: Always check your state s board website to determine the number of hours required for renewal, and the amount that may be completed through home-study. Also, make sure that you notify the board of any changes of address. It is important that your most current address is on file. State of Wisconsin Department of Safety and Professional Services Mailing Address PO Box 8935 Madison, WI Regulation Contact Information Street Address 1400 East Washington Avenue, Room 112 Madison, WI Phone: (608) or (877) Website: Page i

2 Table of Contents CE for Wisconsin Salon Professionals CHAPTER 1: WISCONSIN LAWS AND RULES Page 1 All 4 Hrs ONLY $ (1 CE Hour) Mandatory CHAPTER 2: SAFETY, SANITATION AND INFECTION CONTROL Page 8 (3 CE Hours) Mandatory Course Completion Instructions Page 26 Pre-Program Assignment Questions Page 27 Final Examination Questions Page 28 Customer Information Page 30 What if I Still Have Questions? No problem, we have several options for you to choose from! Online at Cosmetology. EliteCME.com you will see our robust FAQ section that answers many of your questions, simply click FAQ in the upper right hand corner or us at office@ elitecme.com or call us toll free at , Monday - Friday 9:00 am - 6:00 pm, EST. Visit Cosmetology.EliteCME. com to view our entire course library and get your CE today! PLUS... Lowest Price Guaranteed Serving Professionals Since 1999 Elite Continuing Education 2016: All Rights Reserved. Materials may not be reproduced without the expressed written permission or consent of Elite Professional Education, LLC. The materials presented in this course are meant to provide the consumer with general information on the topics covered. The information provided was prepared by professionals with practical knowledge in the areas covered. It is not meant to provide medical, legal or professional advice. Elite Professional Education, LLC recommends that you consult a medical, legal or professional services expert licensed in your state. Elite Professional Education, LLC has made all reasonable efforts to ensure that all content provided in this course is accurate and up to date at the time of printing, but does not represent or warrant that it will apply to your situation or circumstances and assumes no liability from reliance on these materials. Page ii

3 Chapter 1 : Wisconsin Laws and Rules 1 CE Hour Author: JoAnn M. Stills Learning objectives Name the four (4) classifications of services under cosmetology that are performed and provided for compensation. Differentiate the services which a dermatologist may provide with the services a cosmetologist, aesthetician, and manicurist provide. Introduction There are many laws, rules, and regulations that govern the profession of cosmetology in Wisconsin. These laws, rules, and regulations come from actions of the Legislative and Executive Branches which pass laws that modify Wisconsin Statutes and the Rulemaking process which involves agencies such as the Department of Safety and Professional Services (DSPS) working together with professional boards to develop rules which will carry out requirements set out in Wisconsin Statutes. These rules, when they are developed and finalized, become part of the Wisconsin Administrative Code. The Wisconsin Department of Safety and Professional Services (DSPS) routinely reviews and updates, as needed, the Administrative Rules that relate to the professions, establishments and activities they regulate. Rulemaking involves a number of distinct and Identify the license and renewal requirements for cosmetologists, aestheticians, and manicurists. Explain the continuing education that is now required under Wisconsin law. important steps, such as a review of the existing rules affecting small businesses, comments on rulemaking projects (each rulemaking project has a legally prescribed process for submitting comments), and suggestions considered for modification. If you, as a licensee, think there are existing rules which need to be revised and considered for modification, you mail the suggestion(s) to DSPS. Annually, these rules are reviewed and amended and/or new rules enacted. This section will provide you with the statutory changes, updated through Currently, there is a list of active rulemaking projects which can be accessed through the DSPS website or via this link, Projects/. If you are interested in participating in in the rulemaking process, please visit this site. Barbering and Cosmetology Overview, Chapter 454 (Know the definitions that apply to your license) If you are unsure about the correct definition for the title that represents your license; here are the terms defined under Chapter 454 Barbering and Cosmetology: Definitions in this subchapter Aesthetician means a person who practices aesthetics. Aesthetics (also spelled esthetics) is a branch of philosophy dealing with the nature of beauty, art, and taste, and with the creation and appreciation of beauty. It is more scientifically defined as the study of sensory or sensory-emotional values, sometimes called judgments of sentiment and taste. More broadly, scholars in the field define aesthetics as critical reflection on art, culture and nature. Aesthetics is a sub discipline of axiology, a branch of philosophy, and is closely associated with the philosophy of art. Aesthetics studies new ways of seeing and of perceiving the world. ( en.wikipedia.org/wiki/aesthetics) Aesthetics means, for compensation, caring for or beautifying the skin of the human body, including but not limited to cleaning, applying cosmetics, oils, lotions, clay, creams, antiseptics, powders or tonics to or massaging, stimulating, wrapping or exercising the skin of the human body. Apprentice means a person who is learning the practice of barbering or cosmetology. Barbering means, for compensation, arranging, styling, dressing, shampooing, cleansing, curling, dyeing, tinting, coloring, bleaching, waving, cutting, shaving, trimming, relaxing, singeing, or performing similar work upon the hair of the head, neck, or face of any person by any means. Barbering does not include the removal of a person s hair at the root or the application of temporary or permanent eyelash extensions to the eyelashes of a person. Compensation means direct or indirect payment, including the expectation of payment whether or not actually received. Cosmetologist means a person who practices cosmetology. Cosmetology means, for compensation, performing one or more of the following: Barbering. Aesthetics. Manicuring. The removal of hair of any person at the root, except by use of an electric needle. Cosmetology manager means a person who practices cosmetology and who is responsible for managing the operation of an establishment. Electrologist means a person who practices electrology. Electrology means, for compensation, removing hair from the human body by use of an electric needle. An electrologist offers services with the use of an electrolysis machine. As opposed to the hair removal via waxing offered by an esthetician, hair removal via electrolysis is permanent. Usually estheticians will seek higher education beyond beauty school to learn electrolysis. Some state board beauty schools however teach electrolysis in basic courses. org/wiki/ Cosmetology Establishment means any place in which barbering, cosmetology, aesthetics, electrology, or manicuring is performed. Examining board, means the cosmetology examining board. Page 1

4 Inactive license means a license issued under s (2) to (6) that is classified as inactive by the examining board under s (8m). Manicuring, means, for compensation, cleansing, cutting, shaping, beautifying or massaging limited to the hands, feet or nails of the human body. Manicurist means a person who practices manicuring. A manicurist specializes in the art form and care of nails. This includes manicures, pedicures, acrylic nails, gel nails, nail wraps, fake nails, self-adhesive nail cove rings, etc. They are also knowledgeable in nail irregularities and diseases and may be able to identify such problems. They do not treat diseases and would Limitations and exceptions Can a cosmetologist diagnose, prescribe for, or treat diseases? Cosmetologist, aestheticians, barbers and manicurist are not dermatologist or physicians who diagnose and treat skin disease and disorders. It is very important that you are able to recognize different skin conditions in order to protect yourself and your client. However, coming in contact with skin every day should encourage you to be cautious when you find cases of severe skin disorders. What Wisconsin Law states: A license to practice cosmetology does not confer the right to diagnose, prescribe for, or treat diseases or conditions except as indicated in the definition of cosmetology, previously noted, or under the direction of a licensed and practicing physician. Cosmetology, aesthetics, electrology, and manicuring do not include any of the following: Services performed by a person licensed, certified or registered under the laws of this state as a physician, physician assistant, podiatrist, physical therapist, nurse or funeral director if those typically refer a client to a physician. Cosmetology Student means a person who is learning and not licensed to practice ba rbering, cosmetology, aesthetics, electrology, or manicuring at a school licensed under s (3) School Licenses or exempted under s (Schools regulated or approved by the technical college system board; Schools operated by the department of health services or the department of corrections) or a specialty school. Theoretical instruction means training through the study of principles and methods. Training hour, means at least 50 minutes but not more than 60 minutes of instruction. services are within the scope of the license, certificate or registration. Personal care services performed in correctional institutions, hospitals and licensed nursing homes under the supervision of a person responsible for inmate or patient care. Cosmetology, aesthetics, and manicuring do not include any of the following: Services performed by masseurs or masseuses. Service performed preparatory to a live public performance or appearance, whether in person or through broadcast media, including the Internet. A service performed in the course of the production of any digital, analog, or other recording of a moving or still image intended for public release or broadcast, including through the Internet. Aesthetics, if performed on the face to demonstrate a product, without compensation from a patron, other than the sale of the product. What is the difference between a dermatologist and an aesthetician? The purpose of this explanation is to emphasize or highlight the A dermatologist is trained to: Wisconsin legislation, stated above. Diagnose and treat all skin disorders, abnormalities and diseases. The greatest difference between a dermatologist and an aesthetician is Write prescriptions based on knowledge of skin care the schooling required for each profession. Basically, a dermatologist pharmaceuticals. is a doctor. This means that he or she completed four years of Perform surgery on skin abnormalities. undergraduate work, three years of medical school and one to two Detect and aid in the treatment of skin cancer. years of residency and internship at a medical facility. In most cases An aesthetician is trained in: this also means he or she received additional specialized training and Facials. education. Body wraps. In contrast, an aesthetician attends a trade school to learn the craft of Microdermabrasion. skin care and has passed the state board exam. Makeup application. Aromatherapy. In addition to the schooling differences, there is also a major difference Skin analysis. in the practices allowed. Practice The following criteria stipulate the Wisconsin Examining Board s statutes in the area of limitations relating to the practice for each licensee: Practices not prohibited What requirements must I meet to engage in cosmetology, aesthetics, electrology, and manicuring? Numerous cases have surfaced involving unlicensed practitioners. Fines can range into the thousands for this violation. Knowing the qualifications that allow you to engage in your field of practice is a very important aspect of upholding your professional image. The Wisconsin statutes below define the requirements for each license holder: No person may engage in cosmetology unless the person has received training in the areas of service provided and holds a Page 2 current cosmetologist license or cosmetology manager license issued by the examining board that is not an inactive license or temporary permit issued by the examining board or is an apprentice or a student in a cosmetology course of instruction. No person may engage in aesthetics unless the person has received training in the areas of service provided and holds a current aesthetician license, cosmetologist license, or cosmetology manager license issued by the examining board that is not an inactive license or temporary permit or training permit issued by the examining board or is an apprentice or a student in an aesthetics or cosmetology course of instruction. No person may engage in electrology unless the person holds a current electrologist license issued by the examining board that is not an inactive license or temporary permit or training

5 permit issued by the examining board or is a student in an electro logy course of instruction. No person may engage in manicuring unless the person has received training in the areas of service provided and holds a current manicurist license, cosmetologist license, or cosmetology manager license issued by the examining board that is not an inactive license or temporary permit or training permit issued by the examining board or is an apprentice or a student in a manicuring or cosmetology course of instruction. No license is required under this subchapter for the use of thread to remove hair from the eyebrow, upper lip, or other area of the face of a person. Prohibited use of titles What titles can I use to identify the professional license that I hold? No person may use the title cosmetologist or any other similar title unless the person holds a current cosmetologist license or cosmetology manager license issued by the examining board that is not an inactive license. No person may use the title aesthetician or any other similar title unless the person holds a current aesthetician license, Licensure Under this section all applications for licenses shall be filed with the examining board. Subsections are included for your reference. Please consult the Wisconsin state board s web page for a full recital of these rules and laws. All of the following conditions must be satisfied: Cosmetologist license. The examining board shall issue a cosmetologist license to any person who does all of the following: Pays the initial credential fee. Presents evidence satisfactory to the examining board that the applicant has not been convicted of a felony committed while engaged in the practice of barbering or cosmetology. Graduated from high school or has attained high school graduation equivalency as determined by the department of public instruction. Graduates from a course of instruction of at least 1,550 training hours in not less than 10 months in a school of cosmetology licensed, or accredited by an accrediting agency approved by the board, or has successfully completed an apprenticeship. Passes an examination conducted by the examining board to determine fitness to practice cosmetology. Cosmetology manager license: The examining board shall issue a cosmetology manager license to any person who does all of the following: Holds a cosmetologist license. Completes 4,000 hours of practice as a licensed cosmetologist under the supervision of a licensed cosmetology manager or completes 2,000 hours of practice as a licensed cosmetologist and 150 training hours of theoretical instruction in a school of cosmetology, licensed and accredited. Pays the appropriate fee. Passes an examination conducted by the examining board to determine fitness to practice as a cosmetology manager. Aesthetician license: The examining board shall issue an aesthetician license to any person who does all of the following: Pays the initial credential fee. Presents evidence satisfactory to the examining board that the applicant has not been convicted of a felony committed while engaged in the practice of barbering or cosmetology. Graduated from high school or has attained high school graduation equivalency as determined by the department of public instruction. Completes either of the following: A course of instruction in aesthetics of at least 450 training hours in not less than 11 weeks and not more cosmetologist license, or cosmetology manager license issued by the examining board that is not an inactive license. No person may use the title electrologist or any other similar title unless the person holds a current electrologist license issued by the examining board that is not an inactive license. No person may use the title manicurist or any other similar title unless the person holds a current manicurist license, cosmetologist license, or cosmetology manager license issued by the examining board that is not an inactive license. than 30 weeks, in a school of cosmetology or a school of aesthetics. At least 450 training hours in not less than 11 weeks and not more than 30 weeks under the supervision of a cosmetology instructor or aesthetics instructor certified or a licensed cosmetology manager, in a licensed establishment that is also licensed as a specialty school of aesthetics. Passes an examination conducted by the examining board to determine fitness to practice as an aesthetician. Electrologist license: The examining board shall issue an electrologist license to any person who does all of the following: Pays the initial credential fee. Presents evidence satisfactory to the examining board that the applicant has not been convicted of a felony committed while engaged in the practice of barbering or cosmetology. Graduated from high school or has attained high school graduation equivalency as determined by the department of public instruction. Completes either of the following: A course of instruction in electrology of at least 450 training hours in not less than 11 weeks and not more than 30 weeks, in a school of cosmetology, or a school of electrology. At least 450 training hours in not less than 11 weeks and not more than 30 weeks under the supervision of an electrology instructor or a licensed electrologist who is also a licensed cosmetology manager, in a licensed establishment that is also licensed as a specialty school of electrology. Passes an examination conducted by the examining board to determine fit ness to practice as an electrologist. Manicurist license: The examining board shall issue a manicurist license to any person who does all of the following: Pays the initial credential fee. Presents evidence satisfactory to the examining board that the applicant has not been convicted of a felony committed while engaged in the practice of barbering or cosmetology. Graduated from high school or has attained high school graduation equivalency as determined by the department of public instruction. Completes either of the following: A course of instruction in manicuring of at least 300 training hours in not less than 7 weeks and not more Page 3

6 than 20 weeks, in a school of cosmetology or a school of manicuring. At least 300 training hours of training in not less than 7 weeks and not more than 20 weeks under the supervision of a cosmetology instructor or manicuring instructor or a licensed cosmetology manager, in a licensed establishment that is also licensed as a specialty school of manicuring. Passes an examination conducted by the examining board to determine fitness to practice as a manicurist. Posting of license certificates The examining board furnishes a certificate to each licensee, certifying that the holder is licensed to practice cosmetology, aesthetics, electrology, or manicuring or is a licensed cosmetology manager. The licensee is required to post the certificate in a conspicuous place in the licensed establishment. A licensee who holds an inactive license may not post a certificate for that inactive license. When is the renewal date for my license and what is my renewal fee? Expiration and renewal The renewal dates and fees for each licensee are stipulated below: Barbering Manager Cosmetologist 03/31/odd year 03/31/odd year $82 $82 $107 $107 Profession/entity Renewal date Renewal fee With late Cosmetology fee Establishment 03/31/odd year $82 $107 Aesthetician 03/31/odd year $82 $107 Aesthetics 03/31/odd year $82 $107 Establishment Aesthetics 03/31/odd year $82 $107 Instructors Barber 03/31/odd year $82 $107 Barbering 03/31/odd year $82 $107 Establishment Barbering Instructor 03/31/odd year $82 $107 Cosmetology 03/31/odd year $82 $107 Instructor Cosmetology 03/31/odd year $82 $107 Manager Manicurist 03/31/odd year $82 $107 Manicuring 03/31/odd year $82 $107 Establishment Manicuring Instructor 03/31/odd year $82 $107 How can I place my license in an inactive status? Placing your license in inactive status Any person who has been issued a license may apply to the examining board to classify that license as inactive. Upon application under this paragraph, the examining board may classify a license as inactive if the examining board determines that the person who holds that license is in good standing with the examining board and intends to refrain from the practice that is authorized under the license during the period that the license is an inactive license. The examining board may remove the inactive classification of an inactive license if the person who holds that inactive license applies to the examining board to remove the inactive classification and the person meets any additional requirements of the examining board. A person may perform work that is included in the practice for which that person holds an inactive license if that work is minimal, as determined by the examining board by rule. How can I obtain a training permit or a temporary permit? Training permit You can obtain a training permit from the examining board, before beginning training, if you can present evidence that you have not been convicted of a felony while engaged in the practice of barbering or cosmetology, you have graduated from high school or have attained a high school graduation equivalency; if you are participating in a program approved by the examining board; or if you are at least 18 years old. What should I be prepared for when going before the examining board for an examination? Examinations The examining board shall conduct examinations for cosmetologist, cosmetology manager, aesthetician, electrologist, and manicurist licenses not less than 8 times annually, at times and places determined by the examining board. Examinations of applicants for licenses shall consist of written tests and practical demonstrations requiring applicants to demonstrate minimum competency in services and subjects substantially related to practice and public health and safety. A person is not eligible for examination for a license unless the person has completed the requirements for licensure except passing the examination. An applicant shall file an application for examination in the office of the examining board at least 3 weeks before the examination. If an applicant fails to file the application within the required time, the examining board may postpone the applicant s examination to the date of the next available regular examination. The examining board may require an applicant who fails to appear for or to complete an examination to reapply for examination. An applicant who fails an examination may request reexamination and shall pay a fee for reexamination. What guideline does the examining board use when issuing licenses to an establishment? Establishment licenses The examining board may endorse rules permitting the provision of personal care cosmetology, aesthetics, electrology, or manicuring services outside of licensed establishments by cosmetologists, aestheticians, electrologists, and manicurists, to persons who are unable to leave their homes because of illness or disability or who are in hospitals, nursing homes, correctional institutions, or other institutions. Page 4

7 No person may practice cosmetology, aesthetics, electrology, or manicuring in an establishment unless the establishment is licensed to provide that practice. The examining board shall issue the following establishment licenses: A [barbering] cosmetology establishment license that authorizes the practice of barbering, cosmetology, aesthetics, electrology, and manicuring in the licensed establishment. An aesthetics establishment license that authorizes the practice of aesthetics in the licensed establishment. An electrology establishment license that authorizes the practice of electro logy in the licensed establishment. A manicuring establishment license that authorizes the practice of manicuring in the licensed establishment. The examining board shall issue an establishment license to any person who pays the initial credential fee, determined by the department, and who satisfies the requirements established by the examining board by rule, including proof of ownership of the business. The new owner shall report any change of ownership to the examining board within 5 days after the change of ownership. The examining board shall, by rule, establish minimum standards concerning the maintenance, equipment, plans, and specifications for licensed establishments as they relate to the public health and safety. The examining board may not promulgate a rule requiring the use of a tuberculocidal disinfectant by a manager of or a barber or cosmetologist in an establishment licensed under this section. The examining board may not license an establishment under this section unless it meets the standards established by the examining board. A person proposing to open an establishment in a new location shall apply to the examining board for an inspection and approval of the establishment, submitting an exact description and floor plan of the proposed location of the establishment on a form provided by the department. A person who is not licensed by the examining board may own or operate an establishment, but may not practice barbering, cosmetology, aesthetics, electro logy, or manicuring. A person who owns a cosmetology establishment shall employ at least one person as a manager who holds a cosmetology manager license and manages the establishment on a full-time basis. The cosmetology manager shall ensure that the establishment operates in compliance with this subchapter and rules promulgated by the examining board. Commercial businesses and practices other than barbering or cosmetology may be operated within a licensed establishment, except that a business or practice, which poses a sanitation or health hazard, may not be conducted within a licensed establishment. The examining board shall furnish a certificate to the owner of a licensed establishment, certifying that the examining board licenses the establishment. The owner shall post the certificate in a conspicuous place in the establishment. The department determines the renewal date for licenses, and the renewal fee for such licenses. What rules are used by the examining board to govern the approval of apprenticeship? Apprenticeship All apprentices shall be employed under an apprentice contract and shall be governed by the apprenticeship rules of the department of workforce development, and the rules of the examining board. Apprentices shall receive at least 3,712 hours of practical training and at least 288 training hours of theoretical instruction in a school of cosmetology in order to complete the apprenticeship program and be eligible to take the examination for a cosmetologist license. Apprentices shall receive training for a total of at least 32 hours per week. The training shall be completed in not less than 2 years and not more than 4 years. No apprentice under this section may practice cosmetology except under the supervision of a licensed cosmetology manager, whose cosmetology license is not an inactive license, or under the supervision of a licensed cosmetologist, whose cosmetology license is not an inactive license, and to whom supervisory authority has been delegated by a licensed cosmetology manager. A licensed cosmetology manager may only delegate supervisory authority to a licensed cosmetologist who has completed at least 2,000 hours of practice as a licensed cosmetologist. Apprentices shall be trained in all branches of practical work and in all subjects required in schools of barbering or cosmetology as prescribed by the examining board by rule. A person who has successfully completed the requirements may not continue to practice as an apprentice but may apply for a temporary permit. What are my continuing education requirements? Continuing education The examining board may impose continuing education requirements on a person who holds a license that is not an inactive license either: As a part of the disciplinary process to ensure competency; or By rule, if necessary to preserve the public health, safety or welfare. Cosmetology practitioners must renew their license by March 31 of every odd year to keep t heir license current. The continuing education (CE) required for renewal must be completed during the 2-year period, referred to as a biennium, before the renewal deadline. The biennium for cosmetology practitioner licenses is from 4/1/ every odd year to 3/31/ every odd year. Continuing education requirements for delegated medical procedures Continuing education (CE) is required for licensees providing the following delegated medical procedures for each renewal period: Laser hair removal At least 6 hours in programs specific to laser hair removal. Microdermabrasion At least 6 hours in programs specific to microdermabrasion. Chemical exfoliation At least 6 hours in programs specific to chemical exfoliation. See Wis. Admin. Code. ch. BC for more details on the continuing education requirements if you perform these delegated medical procedures. March 2017 renewal Beginning in 2015, cosmetology licensees had to complete 4 hours of approved continuing education in order to renew their active license. For the March 2017 license renewal, license holders must also complete 4 hours of approved continuing education in order to renew their active license (1 hour in laws and 3 hours in safety, sanitation an infection control). The CE must be completed during the time period from 4/1/2015 to 3/31/2017. Page 5

8 NOTE: If you were issued your license for the first time on or after 4/1/2015, you are not required to complete any continuing education for the 3/31/2017 license renewal. I m from another state; what are the requirements that I must follow to be issued a license in Wisconsin? Licensees of other jurisdictions Upon application and payment of the fee, the examining board may issue a license to practice cosmetology, aesthetics, electrology, or manicuring or to practice as a cosmetology manager to an applicant who is licensed in another state or territory of the United States or in another country to perform services that are substantially the same as those performed by licensees in this state and to whom either of the following applies: Inspections The department shall appoint inspectors under the classified service to inspect licensed establishments. Disclosure of temporary permit status A person practicing under a temporary permit shall, before performing a service that he or she is authorized to perform by the temporary permit, inform the person who is receiving the service that he or she Disciplinary proceedings and actions The examining board may make investigations or conduct hearings to determine whether a person has violated this subchapter or any rule promulgated under this subchapter. The examining board may revoke, limit, suspend, or refuse to issue or renew, in accordance with the severity of the violation, a license or permit issued under this subchapter or reprimand the holder of a license or permit issued under this subchapter if it finds that the holder or applicant has done any of the following: Made a material misstatement in an application for license or permit or renewal, or in an application to classify a license as an inactive license. Failed to correct or take substantial steps approved by the examining board to correct a violation of any sanitary or other rule of the examining board within the time limit stated by the examining board in a notification of violation. Engaged in conduct in the practice of barbering, cosmetology, aesthetics, electrology, or manicuring that evidences a lack of knowledge or ability to apply professional principles or skills. Penalties Any person who violates this subchapter or any rule promulgated under this subchapter shall be fined not less than $100 nor more than In conclusion The administrative code in Wisconsin is updated monthly on the Wisconsin State Legislature website at gov/code/admin_code. Here you may subscribe to receive notifications of administrative code changes and Administrative Register notices. Within the table of contents is the Cosmetology Examining Board (Cos) and if you click on this tab, it will provide you with the necessary legislative updates. It is recommended to remain up-to-date on legislative changes as they primarily impact you as a licensee, and/or the establishment you own The applicant has at least 4,000 hours of experience in licensed practice, has never been disciplined by the licensing authority of another jurisdiction and is not a party to a proceeding before the licensing agency in which it is alleged that the applicant was negligent in the licensed practice or violated the law relating to the licensed practice. The applicant meets the requirements established in a reciprocal agreement between the examining board and the licensing authority in the state where the applicant is licensed. The examining board may enter into reciprocal agreements with officials of other states for licensing cosmetologists, aestheticians, electrologists, manicurists, and cosmetology managers and grant licenses to persons licensed in other states according to the terms of such an agreement. An inspector may enter and inspect any licensed establishment at any time during business hours. is practicing under a temporary permit and that he or she has satisfied all requirements except passage of an examination for a license for the applicable occupation. Been convicted of a felony committed while engaged in the practice of barbering, cosmetology, aesthetics, electrology, or manicuring. Continued practice while knowingly having an infectious, contagious or communicable disease. Advertised in a manner, which is false, deceptive or misleading. Advertised, practiced or attempted to practice under another s name or another s trade name. Been addicted to alcohol or other drugs to an extent related to the individual s ability to adequately undertake the job-related responsibilities of that individual s licensure. Violated this subchapter or any rule promulgated under this subchapter. Violated subchapter II or any rule promulgated under subchapter. II. The examining board may, in addition to or in lieu of a reprimand or revocation, limitation, suspension or denial of a license or permit, assess against a person who has done any of the things under sub. (2) (a) to (i), a forfeiture of not more than $1,000 for each separate offense. Each day of continued violation constitutes a separate offense. $5,000 or in prisoned for not less than 10 days nor more than 90 days or both. or where you are employed. There are violations a licensee needs to be aware of and penalties for these violations which can drastically affect the cosmetology professional s license. The Cosmetology Examining Board can revoke, suspend, or deny a license to an applicant based upon these statutes, therefore it is necessary to understand what you are liable for, what services may be performed, how to acquire and maintain a professional license, and what penalties do violations incur. Page 6

9 References Wisconsin State Legislature (2015). Wisconsin administrative code, Chapter Cos Cosmetology Examining Board. Retrieved October 14, 2015 from code/cos Wisconsin Department of Safety and Professional Services (2015). Wisconsin statutes, barbering and cosmetology schools and instructors, Chapter SPS Retrieved on October 14, 2015 at Manicuring-and-Electrology-Administrative-Rules-and-Statutes/ Page 7

10 Chapter 2 : Sanitation, Sterilization and Infection Control 3 CE Hours Author: JoAnn M. Stills Learning objectives Describe recent events that require your knowledge of sanitation techniques. Explain the difference between pathogenic and nonpathogenic bacteria. Contrast disinfectants and antiseptics. Explain the significance of these differences. Describe the steps necessary to properly sanitize your hands, as well as how to disinfect, handle, and store tools appropriately. Introduction Why must I complete sanitation continuing education? Quite simply, salon professionals need to be aware that antibioticresistant organisms can kill and that the frequency of these types of infections is increasing. Due to the sheer nature of people touching people in the salon atmosphere, these killer organisms can easily occur within a facility - particularly if practitioners are not informed and are not following proper procedures. The following information emphasizes how important sanitation is in the salon. Professional responsibility Salon professionals have a responsibility to their states and to their profession. They must learn how to use appropriate precautionary measures and sanitization procedures to protect themselves, the staff Microorganisms and infectious agents Microorganisms are tiny living particles (organisms) with many different characteristics. They live in the air, water and earth; microorganisms are found everywhere on the planet. Some microorganisms are associated with infection or disease - others are harmless, or even helpful. There are three major categorizes of microorganisms encountered every day: bacteria, viruses and parasites. Bacteria Bacteria are tiny, one-celled plant microorganisms that can be seen only with a microscope. Bacteria are the most plentiful organisms on the earth and are found virtually everywhere around us. They exist in dust, dirt and decay, on our skin, in body tissues, in the air we breathe as well as in the water we drink. Bacteria produce slimy fluids - or waxy coatings - that moisten them and help them survive in inhospitable environments. Fimbriae (hair-like tendrils that anchor the bacteria to an object) make bacteria sticky. This requires the use of pressure when scrubbing in order to to break the hold of these tenacious fibers. Bacteria exist in one of two modes: an active, vegetative mode, and an inactive, spore-forming mode. In the active stage, bacteria grow and multiply at an astonishing speed. Bacteria reproduce millions of copies within hours through binary fission a process in which one bacteria splits in two. Bacteria are only able to reproduce when the environment meets their specific needs in temperature and rates of moisture: they require a warm, damp, usually dark, and often dirty environment that provides a supply of food adequate to sustain the bacteria, and provide fuel for reproduction. If conditions are not favorable for reproduction, the Page 8 List infection control responsibilities within the cosmetology profession. List infection control responsibilities according to universal sanitation precautions. Contrast sanitation and sterilization. Explain the significance of these differences. and clients, to reduce the incidence of bacterial, viral, and fungal infections, as well as to prevent the spread of diseases. Individuals, instruments and workstations must be kept as clean as possible. No precautionary measures discussed in this chapter should be neglected. The remainder of this chapter will review: The biology of pathogens as well as how they function, reproduce and infect. Universal sanitation and sterilization precautions. The difference between decontamination, sanitation, sterilization and disinfection. How to effectively disinfect tools and surfaces in your environment, and how to best sanitize hands. bacteria will move into a spore-forming stage. They will then produce spores with tough outer surfaces that are almost impervious to wind, heat, cold, harsh cleaners or disinfectants. These characteristics help spores survive for long periods between reproductive phases. Although there are hundreds of different kinds of bacteria, they are primarily sorted into one of two types pathogenic and nonpathogenic - according to the danger they pose to us. Potentially harmful bacteria are called pathogenic; harmless or beneficial bacteria are called nonpathogenic. Seventy percent of bacteria are nonpathogenic. These harmless organisms saprophytes - do not produce disease. Instead, they carry out necessary functions, such as decomposing dead matter. Nonpathogenic bacteria also exist in the human digestive tract as well as in the mouth and the intestines, where they facilitate digestion by breaking down food. A much smaller minority (about 30 percent) of organisms are pathogenic organisms - called microbes or germs. These are harmful and produce disease when they invade animal or plant life. Pathogenic bacteria commonly exist in the salon environment. Bacterial infection occurs when a body is exposed to (and is unable to fight off) bacterial invasion. General infections typically begin as local infections. They may start as a boil or pimple and are accompanied by pus (a combination of bacteria, decayed tissue, waste and blood cells) often associated with infection. Bacterial toxins from local infections can spread to different parts of the body through the bloodstream, increasing the likelihood of general infection.

11 Pathogenic bacteria are distinguished by their characteristic shapes. Bacilli, the most common bacteria, are rod-shaped and cause diseases such as influenza, tetanus and diphtheria. Spirilla are spiral-shaped bacteria. Cocci are round bacteria that produce pus. Cocci rarely Methicillin-resistant Staphylococcus aureus (MRSA) Methicillin-resistant Staphylococcus aureus (MRSA) is caused by bacteria known as staphylococcal aureus. Staph aureus is a common bacteria found on skin and in mucous membranes. A strain of Staph aureus has become resistant to antibiotics in the penicillin family, including methicillin. MRSA can either colonize or infect. In colonization, MRSA can live on the skin or mucous membranes without signs of infection. With infection, the bacteria have entered the body and have begun to multiply - causing damage to the organ or body tissue involved. How is MRSA spread? Anyone can get MRSA on his or her body from contact with an infected wound or by sharing personal items, such as towels or razors. Risk can be increased in places that involve crowding, skin-to-skin contact, and shared equipment or supplies. Athletes, daycare and school students, military personnel in barracks, and those who recently received inpatient medical care are at a higher risk of contracting MRSA. MRSA is spread by direct contact with affected areas; it is normally not spread through casual contact. Good hand washing techniques and the use of gloves when in contact with mucous membranes will avoid transferring the bacteria from one person to another. How common are staph and MRSA infections? Staph bacteria are one of the most common causes of skin infection in the United States. They are a common cause of pneumonia, surgical wound infections and bloodstream infections. The majority of MRSA infections occur among patients in hospitals or in other health care settings. CDC studies show that about one in three people carry staph in their nose - usually without any illness. Two in 100 people carry MRSA. There are no current data showing the total number of people who get MRSA skin infections; however, they are becoming more common in the community setting. MRSA often causes skin infections; it can also cause pneumonia and other health issues. If left untreated, MRSA infections can become severe and cause sepsis - a life-threatening reaction to a severe infection in the body. Sepsis is the body s response to an infection and can lead to tissue damage, organ failure, and even death. It is difficult to predict, diagnose and treat. Patients who develop sepsis have an increased risk of complications and death and face higher healthcare costs and lengthened treatment plans. The CDC is working to increase sepsis awareness and improve treatment options among the public, healthcare providers, and healthcare facilities (CDC, 2016 b). What does a staph or MRSA infection look like? Staph bacteria, including MRSA, can cause skin infections that may look like a pimple or boil. It can be red, swollen, and painful and contain pus or other drainage. Infections that are more serious may cause pneumonia, bloodstream infections or surgical wound infections. Are certain people at increased risk for community-associated staph or MRSA infections? Factors that have been associated with the spread of MRSA skin infections include close skin-to-skin contact, openings in the skin - such as cuts or abrasions - contaminated items and surfaces, crowded living conditions and poor hygiene. How can I prevent staph or MRSA skin infections? Practice good hygiene. Keep hands clean by washing thoroughly with soap and water or using an alcohol-based hand sanitizer. move on their own; rather, they are transported through the air in dust particles or other substances. Bacilli and spirilla are both capable of self-movement (motility), using hair-like projections (flagella or cilia) to propel themselves. Keep cuts and scrapes clean and covered with bandages until healed. Avoid contact with other people s wounds or bandages. Avoid sharing personal items, such as towels or razors. Practice good disinfection techniques. What are MRSA symptoms? According to the CDC (2016), people with MRSA skin infections may first believe that they have a spider bite. Unless a spider has actually been seen, however, the irritation is likely not a spider bite; most staph skin infections appear as a bump or infected area on the skin that might be: Red. Swollen. Painful. Warm to the touch. Full of pus or other drainage. Accompanied by a fever. Elevated white blood cell count. What should I do if I see these symptoms? If anyone observes or experiences these signs and symptoms, cover the area with a bandage, wash hands, and contact a doctor. It is especially important to contact a doctor if signs and symptoms of an MRSA skin infection are accompanied with a fever (CDC, 2016 b). What should I do if I think I have a skin infection? It is impossible tell just by looking at the skin if it is a staph infection (including MRSA). Contact a doctor if an infection is suspected. Finding infections early and obtaining appropriate care makes it less likely that the infection will become more severe. Do not try to treat the infection by picking at - or popping - the sore. Cover possible infections with clean, dry bandages after seen by a doctor, nurse, or other health care provider (CDC, 2016 b). If I have a staph or MRSA skin infection, what can I do to prevent others from being infected? Prevent spreading staph or MRSA skin infections to others by following these steps: Cover the wound. Keep wounds that are draining or contain pus covered with clean, dry bandages. Follow your health care provider s instructions about proper care of the wound. Pus from infected wounds can contain staph and MRSA, so keep the infection covered this will prevent the spread to others. Bandages or tape can be discarded with the regular trash. Clean hands. Everyone in close contact should wash their hands frequently with soap and warm water, or use an alcohol-based hand sanitizer - especially after changing a bandage or touching the infected wound. Do not share personal items. Avoid sharing personal items such as towels, washcloths, razors, clothing or uniforms that may have had contact with the infected wound or bandage. Wash sheets, towels and clothes that become soiled with water and laundry detergent. Drying clothes in a hot dryer (instead of airdrying) will also help kill the bacteria on clothing. Wash clothes according to manufacturer s instructions on the label. Wash hands after touching dirty clothes. Talk to the doctor. Inform health care providers about any potential contact with staph or MRSA skin infection. Page 9

12 What is the prognosis of MRSA infection? According to the U.S. National Institutes of Health, the outcome (prognosis) of MRSA infection varies according to the severity of the infection - as well as the health of the person who has the infection. People with good general health who have a mild infection which is promptly treated recover in almost every case. Mild skin infections (and even some moderate infections - boils, small abscesses) can have an excellent prognosis - if treated early and effectively. Other more serious or extensive MRSA infections can have a range of outcomes: from good to poor. MRSA pneumonia and sepsis (blood poisoning) have high death rates; the calculated death rate of invasive MRSA is about 20 percent. Data are sparse on the on the recurrence of MRSA infections. The recurrence rate of MRSA infection in mild cases is thought to be very Clostridium difficile (C. diff) Facts (CDC, 2016a) Clostridium difficile (or C. difficile, C. diff) colitis is a common infection of the colon that is typically associated with the use of antibiotics. It is, therefore, also called antibiotic-associated colitis. Another common name for this condition is pseudo membranous colitis. Clostridium is a family of bacteria containing several members. Some of the other well-known bacteria in this group include Clostridium botulinum and Clostridium tetani, which are the causes of botulism and tetanus, respectively. There are typically two forms of Clostridium difficile: the first is the inactive or non-infectious form, called the spore; the second is the active and infectious form. The spore form can survive in the environment for a long time; the active form cannot. Clostridium difficile colonize the intestinal tract by the oral route (mouth). This disease typically follows the disruption of the balance of normal colonic bacteria (flora), due to the use of antibiotics. Although C. diff spores may reside in the active form in the colon of some individuals (carrier state), they can also be ingested in this form (fecal-oral transmission). After being shed in the stool, C. diff may be found residing in many places - especially in hospitals, nursing homes, and other health care facilities. Cosmetology services are classified under health care by the CDC, due to the close contact with clients (CDC, 2016 a). The common locations of C. diff - that relate to cosmetology - include: Furniture. Bathroom floors. Telephones. Fingernails. Floors. Waste containers. Jewelry (rings). Toilet seats. Viruses Viruses are infectious biological entities that are very small much smaller than bacteria and cause disease by entering a healthy cell, maturing and then reproducing. Unlike bacteria, viruses do not survive for any length of time without the protection of a living cell. Viruses are dangerous because their replication inside the cell eventually causes the death of that cell. They are parasites: viruses absorb cell s nutrients and destroying the cell in the process. The cell is then used to breed hundreds, thousands, - even millions - of new mature infectious viruses that lead to infect other cells. Viruses cause diseases like hepatitis, influenza, and measles. They are the source of colds, chicken pox, cold sores, genital herpes, mononucleosis, hepatitis and HIV/ AIDS. low; however some investigators report that patients may be carriers for up to 30 months, so it is possible for a carrier to have a contagious period for this length of time. One group of investigators reports a 21 percent recurrence rate in HIV patients up to nine months after the initial diagnosis. Other investigators report a recurrence rate of 41 percent in individuals with MRSA skin infections. Most investigators agree that strict hygiene helps reduce the risk of recurrent infections. Complications of MRSA (as mentioned above) can be serious and include sepsis, pneumonia, organ damage, tissue loss and scarring due to necessary surgery. Additionally, a serious complication of antibiotic treatment is intestinal infection by the aerobic organism Clostridium difficile. Other objects and equipment commonly used by cosmetology and hair care professionals. During the last ten years, C. difficile infections have become more frequent, severe, and resistant to standard therapy. This is linked to the emergence of new strains of C. difficile and the continued increase in the use of antibiotics. Large outbreaks of C. difficile infections have been observed throughout North America and Europe. Not only is the incidence of these infections increasing in the hospital setting, but they are also occurring in the community setting called community acquired infections (CDC, 2016 a). What causes Clostridium difficile (C. diff)? C. diff spores are present within the colon in the inactive form. There are numerous bacteria that typically reside in the colon which makes up its normal flora. These bacteria prevent the activation of the C. diff spores into the active bacterial form. When antibiotics are administered for the treatment of an infection, they may kill some of the normal colonic bacteria. This process disrupts the normal balance of gut bacteria and allows Clostridium difficile to become activated and infectious. When C. diff becomes activated, it produces two different toxins. These toxins may cause inflammation of the inner lining of the colon, resulting in pooling of white blood cells in the colon. If the inflammation is severe, it can result in the destruction of the normal cells that line the inside of the colon. The inflammatory process may result in diarrhea, abdominal pain, fever, and other signs of infection. It is important to note that not all antibiotics cause C. difficile colitis; not everyone receiving antibiotics will develop this infection - diarrhea may occur during antibiotic use for other reasons. Not all antibiotic-associated diarrhea means that the individual has C. difficile colitis - diarrhea is often listed as a side effect of antibiotics. Viruses are a particular concern in salons because of their potential severity, as well as the way they spread. Viruses occupy the surfaces of objects salon professional are in contact with every day: door handles, coffee mugs, money and scissors. Viruses can be inhaled on tiny dust particles or they can travel on a tiny amount of saliva expelled in a cough. Viral infections can be transmitted from one person to another through casual contact, or through contact with what he or she touched. Both hand-to-surface and hand-to-hand contacts are highly effective methods for transferring virus particles from one individual to another. Viruses are hardy organisms. They can live for up to 48 hours on the surfaces of toys, coffeemakers, doorknobs, computer keyboards and other hard surfaces in a salon. It can take up to a week for the symptoms of a virus to occur. Page 10

13 Plant parasites Plant parasites, such as fungus or mold, mildew and yeasts, are multicellular organisms. They are as prevalent as bacteria, and they consume both living and dead tissues to survive. Fungi usually prefer a damp environment; however, they can also survive in warm, dry climates. They reproduce and spread a number of different ways and can invade the human body easily - requiring no break in the skin. Ringworm and athlete s foot are two common contagious diseases that are spread by fungi. Another is favus, which affects the scalp. Cosmetologists should not serve any individual with signs of a fungal infection. If you have a fungal infection, do not work and seek treatment immediately. If you believe that client has ringworm (identified by a ring-shaped, circular pattern on the skin, or athlete s foot), do not provide service to the individual - he or she is highly contagious. Tell the individual to consult a physician for treatment. Precautions with plant parasites Fungal infections can be stubborn. Although many fungal infections affect the skin, they can cause severe respiratory infections, too. More common versions of fungal infections are those caused by yeast: nail fungus, athletes foot, jock itch and ringworm. Both over-the-counter and prescription treatments are available for relief from the unpleasant, itchy symptoms of many yeast infections. Plant parasites, like fungus and mold, are contagious: significant risk is posed to clients receiving nail services. Fungi can spread, not only from one nail to another, but also from a client to a technician (or vice versa), given improper sanitation techniques at a salon. Nail fungus Animal parasites Animal parasites may be single-cell (protozoans) - like amoebas or malaria - or multicell - like mites or lice. Protozoans consume both plant and animal tissue and are found in blood and body fluids, water and food. Multicell animals, such as lice and mites, can hide in the hair and burrow under the skin. Be aware of the signs of scabies - identified by bite marks on a client; Rocky Mountain spotted fever, or typhus, caused by rickettsia; and animal parasites carried by fleas, lice and ticks that are even smaller than bacteria. Modes of cpmtamination Diseases are communicable or contagious when they move from one individual to another. Working with the public means encountering potentially dangerous pathogens and opportunistic organisms every day. Always assume that your clients, co-workers and environments are carrying illnesses. Use proper infection control procedures every day. Even though humans have some level of immunity against infections, the levels of protection vary with age, health and a range of other factors. Skin is our first line of defense: if there are no cuts or scrapes, our skin is an excellent protection against pathogens. In the vast majority of cases, bacteria, fungi and viruses enter the body through the portals of the nose, mouth, and breaks in the skin - and to a lesser extent, the eyes and ears. Once inside the body, the pathogen reproduces rapidly, overwhelming the immune system, resulting in disease. Transmission may occur through direct or indirect contact. Indirectly inhaling contaminated droplets in the air (airborne transmission) - or touching a contaminated surface and then touching one s nose, eyes or a mucous membrane - are easy ways to transmit germs. Avoid touching your face during the day and always wash your hands between clients. Yeast, scabies, lice and many other skin infections do not require an open sore or mucosal surface to infect. Athlete s foot contaminates through indirect transmission. When an infected individual walks appears as a discoloration of the nail plate (on either the fingernails or toenails). This discoloration initially appears white, but grows darker over time. Clients with nail fungus should be referred to a physician for treatment. Molds and mildews do not infect fingernails; they rarely, if ever, appear under the nail. Greenish bacterial infections are sometimes mistakenly attributed to mold: they may appear yellowish or yellow-green initially, and can continue to stain the nail plate long after an infection has subsided. Nails can harbor dangerous bacteria that thrive on the oils and moisture of the nailbed. The bacteria can easily exist between an improperly prepared or unsanitized nail plate, and an applied enhancement. Although clients with nail fungus or other infections should not receive nail services, they can be assisted in removing an artificial nail from the infected natural nail. If you are asked to expose the natural nail, follow these precautionary steps: Wear gloves during the removal of artificial nails. Follow the manufacturer s instructions for removal. Discard any implements, including orangewood sticks, items with porous surfaces, and any abrasives used. Disinfect all implements and work surfaces. Refer the client to a physician for treatment once the natural nail is exposed. For any individual with a visible communicable disease (like pediculosis [head lice], open sores or marks suggesting scabies), it is recommended that a statement signed by a physician is provided indicating that the disease or condition is not infectious, contagious or in a communicable stage. The same is true if the cosmetologist has symptoms or indications of a visible disease, lice, or open sores; he or she should not practice cosmetology until obtaining a statement signed by a physician stating that the disease or condition is not infectious, contagious or in a communicable stage. barefoot on a wet bathroom floor, for example, this person leaves behind spores that will stick to the foot of anyone else walking barefoot on that floor. These spores will infect that other individual - even if he or she has no cuts or openings on the feet. Fungi, like athlete s foot, will survive for some time on a damp or wet floor. Spa shower stalls and soaking baths that retain small amounts of water must be thoroughly cleaned and disinfected with the appropriate disinfectant. The primary modes of travel for common contagions are: Unclean hands. Unclean implements. Open sores. Pus. Mouth and nose discharge. Shared cups or towels. Coughing or sneezing. Spitting. Pathogenic bacteria can also enter the body through: A break in the skin, including pimples, scratches or cuts. The nose and the mouth during breathing. The mouth during eating and drinking. Humans are excellent sources of contamination. We are constantly leaving organic particles behind us wherever we go - mixtures of Page 11

14 dead skin cells with viral, bacterial and fungal particles and other microorganisms that consume our skin cells - or simply use us to travel to an appropriate host. Every time you touch something, you deposit some of this organic matter on another surface. Simple actions, such as touching a client s hair, brushing some of your hair out of your eyes with your hand or touching a spray bottle, can move microorganisms from one item to another, from you to your client, or from your client to you. Individuals who are susceptible to infection due to a compromised immune system - or through some failure in their ability to resist invasion - are also the targets of opportunistic microorganisms. Opportunistic organisms are a contrast to pathogens in that they do not cause initial illness; rather, they will infect an individual once pathogenic organisms have already weakened an immune system. Opportunistic organisms cling to the skin and the hair; they exist in the bodies of healthy people. Microbes also contaminate ventilation systems. To discourage their growth, vents, filters, humidifiers and dehumidifiers should be cleaned and maintained regularly. Investigate any mildew or musty odors, which are often good indications of microbe growth. Germs in a ventilation system will easily spread throughout a salon - settling on people, surfaces and implements - whenever the fan turns on. Germs not only float through the air, continuously settling on salon surfaces, such as sinks and countertops: they can also hitchhike on human skin, hair and clothing, and contaminate anything with which they come into contact. The problem of antibiotic resistance Viruses cause: All colds and flu. Most coughs. Most sore throats. Antibiotics cannot kill viruses; this is a common misconception. Many of us demand antibiotics from our doctors when we have severe colds, but antibiotics can actually cause more harm than good. Drug-resistant bacteria Bacteria are killed each time an antibiotic is taken. Sometimes bacteria may be resistant, or may become resistant. Drug-resistant bacteria do not respond to antibiotic treatments and continue to cause infection. When an antibiotic is taken unnecessarily or improperly, the chances are increased for developing drug-resistant bacteria; therefore, it is important to take antibiotics only when necessary. Because of these resistant bacteria, some diseases that have historically been relatively easy to treat are now becoming nearly impossible to treat. What do you need to know about antibiotics? Remember that antibiotics don t work against colds and flu. Unnecessary antibiotics can be harmful. Talk to your health care provider about antibiotics. Find out about the differences between viruses and bacteria and when antibiotics should and shouldn t be used. If you are prescribed an antibiotic, take it exactly as prescribed. Antibiotic resistance is particularly dangerous for children, but it can occur in adults as well. Taking antibiotics appropriately and getting immunized will help prevent the necessity of prescribing increasingly dangerous and more costly medications. If antibiotics are used appropriately, drug resistance can be avoided. Take all medications exactly as prescribed and do not expect to take antibiotics for every sickness. The troubling result The triumph of antibiotics over disease-causing bacteria is one of modern medicine s greatest success stories. Since these drugs first Pathogenic and opportunistic microorganisms are able to thrive in a salon s warm, moist places - like the drain of the shampoo sink, the footbaths, taps, and the hot- and cold-water handles. Implements such as scissors, files, brushes or nippers can be major sources of contamination. These items often contain organic matter, which provide an optimum growth environment for pathogenic and opportunistic microorganisms. Some of the most dangerous areas in a salon are where contaminated manicuring tools or equipment are kept, including the manicure table and the trashcans that dirty implements are deposited into. Microbes can also exist on seemingly unlikely products, like bars of soap. Because germs and other microorganisms have been shown to thrive on bar soap, many salons prefer to use liquid soap that can be dispensed from a container. In addition, soaking solutions, lotions and creams that are initially uncontaminated may lose the preservatives that prevent opportunistic microbes or opportunistic microbes from growing in them. Changes in color, texture, appearance or odor can be signs of contamination. Fighting infection may be as simple as staying home when sick. Just as contagious clients should be avoided, employees should not go to work if they have infections, such as a bad cold or the flu. Cover your mouth and nose to control pathogens escaping through sneezes and coughs. Avoid accidentally inflicting wounds if your client s skin is dry or fragile; tears and breaks can occur easily - even when filing nails. Use abrasive instruments with care and a gentle touch, especially around the nail bed. Bacteria cause: Most ear infections. Some sinus infections. Urinary tract infections. Antibiotics do kill specific bacteria. became widely used in the World War II era, they have saved countless lives and blunted serious complications of many feared diseases and infections. After more than 50 years of widespread use, however, many antibiotics don t pack the same punch as they once did. Some bacteria have developed ways to outwit the effects of antibiotics over time. Widespread use of antibiotics is thought to have spurred evolutionary changes in bacteria that allow them to survive these powerful drugs. While antibiotic resistance benefits the microbes, it presents humans with two big problems: it makes it more difficult to purge infections from the body, and it heightens the risk of acquiring infections in a hospital. Diseases such as tuberculosis, gonorrhea, malaria and childhood ear infections are now more difficult to treat than they were decades ago. Drug resistance is an especially difficult problem for hospitals: they harbor critically ill patients who are more vulnerable to infections than the general population and therefore require more antibiotics. Heavy use of antibiotics in these patients hastens the mutations in bacteria that bring about drug resistance. Unfortunately, this worsens the problem by producing bacteria with a greater ability to survive even our strongest antibiotics. These increasingly stronger drug-resistant bacteria continue to prey on vulnerable patients. To help curb this problem, the Centers for Disease Control and Prevention (CDC) provides hospitals with prevention strategies and educational materials to reduce antimicrobial resistance in health care settings. Page 12

15 According to CDC statistics: Nearly 2 million patients in the United States contract an infection in a hospital each year. Of those patients, about 90,000 die as a result of their infections an increase from 13,300 patient deaths in More than 70 percent of the bacteria that cause hospital-acquired infections are resistant to at least one of the drugs most commonly used to treat them. Persons infected with drug-resistant organisms are more likely to have longer hospital stays. They also may require treatment with second- or third-choice drugs that may be less effective, more toxic and more expensive. Antimicrobial resistance is driving up health care costs, increasing the severity of disease, and increasing the death rates from certain infections. A key factor in the development of antibiotic resistance is the ability of infectious organisms to adapt quickly to new environmental conditions. Bacteria are single-celled creatures that, compared with higher life forms, have a smaller number of genes. Therefore, even a single random gene mutation can greatly affect their ability to cause disease. And because most microbes reproduce by dividing every few hours, bacteria can evolve rapidly. A mutation that helps a microbe survive exposure to an antibiotic drug will quickly become dominant throughout the microbial population. Microbes also often acquire genes (including those that code for resistance) from each other. The advantage that microbes gain from their innate adaptability is augmented by the widespread - and sometimes inappropriate - use of antibiotics. A physician wishing to placate an insistent patient ill with a cold or other viral condition sometimes inappropriately prescribes antibiotics. When a patient does not finish taking a prescription for antibiotics, the drug-resistant microbes that are not killed within the first days of treatment can proliferate. Hospitals also provide fertile environments for drug-resistant germs: close contact among sick patients and extensive use of antibiotics force bacteria to develop resistance. Another controversial practice that some believe promotes drug resistance is adding antibiotics to agricultural feed. A growing problem For all of these reasons, antibiotic resistance has been a problem for nearly as long as we ve been using them. Not long after the introduction of penicillin, a bacterium known as Staphylococcus aureus began developing penicillin-resistant strains. Antibacterial agents What is an antibacterial? How are antibacterials classified? In its broadest definition, an antibacterial is an agent that interferes with the growth and reproduction of bacteria. Antibiotics and antibacterials both attack bacteria, but these terms have evolved over the years to signify two separate descriptions. Antibacterials are now most commonly described as agents used to disinfect surfaces and eliminate potentially harmful bacteria. Unlike antibiotics, they are not used as medicines for humans or animals; instead, they are found in products such as soaps, detergents, health and skincare products and household cleaners. What are some common antibacterials? Antibacterials can be divided into two groups, according to their speed of action and residue production. The first group contains those that act rapidly to destroy bacteria, but quickly disappear (by evaporation or breakdown). These leave no active residue behind and are referred to as non-residue-producing. Examples of non-residue-producing are the alcohol, chlorine, peroxide and aldehyde antibacterials. The second group consists mostly of newer compounds that leave longacting residues on disinfected surfaces. These have a prolonged action and are referred to as residue producing. Common examples Today, antibiotic-resistant strains of Staphylococcus aureus bacteria, as well as various enterococci bacteria that colonize the intestines are common, and pose a global health problem in hospitals. More and more hospital-acquired infections are resistant to the most powerful antibiotics available: methicillin and vancomycin. These drugs are reserved to treat only the most intractable infections in order to slow development of resistance to them. There are several signs that the problem is increasing: In 2003, epidemiologists reported in The New England Journal of Medicine that 5-10 percent of patients admitted to hospitals acquire an infection during their stay. The risk for a hospitalacquired infection has risen steadily in recent decades. Strains of S. aureus resistant to methicillin are endemic in hospitals and are increasing in non-hospital settings - such as locker rooms. According to the CDC, outbreaks of methicillin-resistant S. aureus infections have been reported among high school football players and wrestlers in California, Indiana, and Pennsylvania since The first S. aureus infections resistant to vancomycin emerged in the United States in 2002 and presented physicians and patients with a serious problem. In July 2002, the CDC reported that a Michigan patient with diabetes, vascular disease and chronic kidney failure had developed the first S. aureus infection completely resistant to vancomycin. A similar case was reported in Pennsylvania in September Increasing reliance on vancomycin has led to the emergence of vancomycin-resistant enterococci infections. Prior to 1989, no U.S. hospital had reported any vancomycin resistant enterococci; however, over the next decade, such microbes have become common in U.S. hospitals, according to CDC. A 2003 study in The New England Journal of Medicine found that the incidence of blood and tissue infections (sepsis) almost tripled from 1979 to Other federal agencies are involved in combating the problem of drugresistant microbes. See the links below for more information. Centers for Disease Control and Prevention Food and Drug Administration National Library of Medicine Medline Database Public Health Action Plan to Combat Antimicrobial Resistance of this group are triclosan, triclocarban and benzalkonium chloride antibacterials. How common are antibacterials in consumer products? All products that claim to kill bacteria or viruses have some kind of antibacterial agent. Alcohols, chlorine and peroxides have been used for many decades in health care and cleaning products. Within the past two decades, the residue-producing antibacterials once used almost exclusively in health care institutions have been added to increasing numbers of household products - particularly soaps and cleaning agents. A recent survey reported that 76 percent of liquid soaps from 10 states contained triclosan; approximately 30 percent of bar soaps contained triclocarban. Many cleaning compounds contain quaternary ammonium compounds. Because these compounds have very long chemical names, they often are not easily recognized as antibacterial agents on packaging labels. More recently, triclosan has been bonded into the surface of many different everyday products that humans come into contact, such as plastic kitchen tools, cutting boards, highchairs, toys, bedding and other fabrics. Page 13

16 Is the use of antibacterial agents regulated in the U.S.? Whether an antibacterial agent is regulated depends upon its intended use and its effectiveness. The U.S. Food and Drug Administration (FDA) regulate antibacterial soaps and antibacterial substances that will either be used on the body or in processed food. This includes food wrappers, and agents added to water that is involved with food processing. If a substance is not intended for use on, or in, the body it is registered by the U.S. Environmental Protection Agency (EPA) under the Federal Insecticide, Fungicide and Rodenticide Act. Substances are registered either as public health or as non-public health antimicrobial agents. What is the difference between bacteriostats, sanitizers, disinfectants and sterilizers? The EPA classifies public health antimicrobials as bacteriostats, sanitizers, disinfectants and sterilizers -based on how effective they are in destroying microorganisms. Bacteriostats inhibit bacterial growth in inanimate environments. Sanitizers are substances that kill a certain percentage of test microorganisms in a given time span. Disinfectants destroy - or irreversibly inactivate - all test microorganisms, but not necessarily their spores. Sterilizers destroy all forms of bacteria, fungi and other microorganisms - as well as their spores. Disinfectants can be further categorized as broad- or limited-spectrum agents. A broad-spectrum disinfectant destroys both gram-negative and gram-positive bacteria. A limited-spectrum disinfectant must clearly specify the specific microorganisms against which it works. How beneficial are antibacterials? Antibacterials are definitely effective in killing bacteria; however, there is considerable controversy surrounding their health benefits. The non-residue-producing agents have been used for many years and continue to be effective agents for controlling disease organisms in a wide variety of health care and domestic settings. When used under strict guidelines of application, the residueproducing agents have proven effective at controlling bacterial and fungal infection in clinical settings such as hospitals, nursing homes, neonatal nurseries and other health care facilities where there may be a high risk of infection. A certain few consumer products have demonstrated effectiveness for specific conditions: antibacterial toothpaste helps control periodontal (gum) disease; antibacterial deodorants suppress odor-causing bacteria; and antidandruff shampoos help control dandruff. There is, however, no evidence to date that supports claims that antibacterials provide additional health benefits when used by the general consumer. Are antibacterial agents safe? When used as directed for external surfaces, antibacterial agents are considered to be relatively non-toxic. Some may cause skin and eye irritation; all have the potential for doing harm if not stored or used properly. Evaluations of risk are based on single agents and do not consider the effects of multiple uses or multiple compounds. Recently, triclosan has been reported in surface waters, sewage treatment plants, the bile of fish and breast milk. The significance of these findings is presently unknown. Do antibacterials create resistant bacteria? Because of their rapid killing effect, the non-residue-producing antibacterial agents are not believed to create resistant bacteria. Resistance results from long-term use at low-level concentrations - a condition that occurs when consumers use residue-producing agents such as triclosan and triclocarban. Until recently, it was accepted Addressing the problem Salon professionals have a responsibility to control exposure to pathogens by decontaminating their environments and their tools by using universal precautions - or standards used in health care and other environments. that these agents did not affect a specific process in bacteria. For this reason, it was unlikely that resistant bacteria could emerge; however, recent laboratory evidence indicates that triclosan inhibits a specific step in the formation of bacterial lipids involved in the cell wall structure. Additional experiments found that some bacteria can combat triclosan and other biocides with export systems that could also pump out antibiotics. It was demonstrated that these triclosanresistant mutants were also resistant to several antibiotics - specifically chloramphenicol, ampicillin, tetracycline and ciprofloxacin. Resistance to antibacterials has been found where these agents are used continuously (hospital and food industries); this modest increase in resistance has not yet created a clinical problem at the present time. Can the widespread use of antibacterial agents lead to bacteria that are more resistant? Many scientists feel that this is a potential danger; others argue that the laboratory conditions used in the research studies do not represent the real world. So far, studies of antibacterial use in home products such as soap, deodorant and toothpaste have not shown any detectable development of resistance. These products have only been in use for a relatively short time and studies of their effects are still extremely limited. Are there other concerns about the use of antibacterial agents? Yes. Experts believe that the use of these agents creates a false sense of security that may cause individuals to become lax in their hygiene habits. Antibacterial use should not be considered an alternative to normal hygiene habits, except where or when normal hygiene practices are impossible. Remember that most bacteria are harmless and in many cases, beneficial. Very few bacteria actually cause disease. Antibacterials are not discriminating and an all-out general attack on bacteria is unjustified. Constant use of disinfecting agents tends to disrupt the normal bacteria that act as barriers against invading pathogens. This may cause shifts in bacterial populations and create a space for disease-causing bacteria to enter and establish infection. In addition, some scientists have gathered evidence showing that overly hygienic homes during early childhood may be linked to the appearance of allergies later in life. In this hygiene hypothesis, allergies develop because the childhood immune system fails to mature properly due to lack of contact with immune-stimulating bacteria. This hypothesis remains controversial and requires further research for validation. When are antibacterials useful? While there is no evidence that the routine use of antibacterials present health benefits, they are useful where the level of sanitation is critical and where additional precautions are needed to prevent spread of disease. They are important in hospitals, day care centers, salons, health care facilities and other environments with high concentrations of infectious bacteria. In the home environment, they may be needed for the care of sick individuals with specific infections- or for those whose immune systems have been weakened by chronic disease, chemotherapy or transplants. Under these circumstances, antibacterials should be used according to protocol - preferably under the guidance of a health care professional. Please visit the following link to learn more about antibiotics: Remember that pathogens can collect any time an object or surface is exposed to air. Doorknobs, handles, telephones, money, cabinets, and cash registers are all are surfaces that are regularly touched by co-workers and clients that may harbor harmful pathogens. All must Page 14

17 be decontaminated to some degree; cleaning is only the first step of the process. The following sections review the meaning of sanitation, sterilization, and disinfection: terms that are commonly used interchangeably, but have very different meanings and require different procedures. Wisconsin Department of Department of Safety and Professional Services (DSPS) Administrative rules and statutes There are many laws, rules, and regulations covering the various professions and services for which the Department of Safety and Professional Service (DSPS) has responsibility. These laws, rules, and regulations come from actions of the Legislative and Executive Branches which pass laws that modify Wisconsin Statutes and the Rulemaking process which involves agencies - such as DSPS - working together with professional boards to develop rules which will carry out requirements set out in Wisconsin Statutes. These rules, when they are developed and finalized, become part of the Wisconsin Administrative Code (DSPS, 2016). Each state has a department, licensing and examining board that regulates all areas of cosmetology practice. It is important that all practitioners study the laws and standards in their area of expertise and check the state website frequently for updates. The following information was obtained from the Wisconsin DSPS relating to sanitation in Cosmetology, Aesthetics, Manicuring, and Electrology Rules and procedures Cos 4.01 Equipment and sanitation. 1. All areas of an establishment and the equipment, tools and implements used by licensees for services in an establishment shall be maintained in a clean, sanitary and safe condition. 2. Licensees shall wash their hands thoroughly with soap and running water prior to serving each patron and following removal of gloves. Waterless hand washing agents with alcohol as an active ingredient with a concentration of at least 60 percent are an acceptable substitute for washing hands that are not visibly soiled with soap and running water. 3. All tools, implements and items that come in direct contact with a client shall be cleaned and disinfected or disposed of after use on each client. (g) All non-disposable, disinfectable manicure tools and implements shall be cleaned and disinfected with a disinfectant as defined in s. Cos 1.01 (6), after use on each client. (r) All items designed to be disposed of after a single use including orangewood sticks, cotton, gauze, neck strips, nail wipes, tissues, sponges, paper towels, wooden applicators and spatulas, emery boards, buffer blocks, pumice stones, sanding bands or sleeves, and disposable nail bits shall be disposed of after each use. 4. All liquids, creams, powders and semi solid substances shall be dispensed from a container in a manner which will prevent contamination of the unused portion of the substance. 5. Shampoo bowls and basins shall be drained after each use and kept in a sanitary and safe condition. 6. Clean towels shall be used for each patron. A neck strip or towel shall be placed around the neck of the patron to prevent contact with the cape. The head rest of any operating chair shall be covered with fresh linen or paper for each patron. 7. All other equipment and instruments shall be clean to sight and touch. 8. Licensees using lancets for the lateral piercing of raised whiteheads shall utilize only pre-sterilized, single use, disposable lancets. Cos 4.02 Disinfection. 1. Unless sterilized, disinfecting is required prior to reuse on another patron of any personal care instruments, including scissors, razors, clipper blades and tweezers, excluding tweezers used in electrolysis. 2. Disinfection for scissors, razors, clipper blades and tweezers shall consist of cleaning with soap and water to remove all organic material, wiping with or soaking in a disinfectant as defined in s. Cos 1.01, and air drying. 3. Disinfection for combs, lifts, brushes, rollers and any other contact equipment shall consist of cleaning with soap and water to remove all organic material, treating with a disinfectant as defined in s. Cos 1.01, and air drying. 4. Clean and disinfected contact equipment shall be placed in one or more covered containers. One or more separate containers shall be provided for the immediate storage of soiled contact equipment until cleaned and disinfected. 5. Disinfectant used for decontamination shall be changed daily and shall be kept in a covered container. 6. Laundry shall be disinfected by washing with a solution containing a germicidal compound. Cos 4.03 Sterilization. 1. Sterilization in ss. Cos 4.07, 4.09 and 4.10 shall be accomplished by use of a dry heat or steam sterilizer cleared for marketing by the food and drug administration, used according to manufacturer s instructions. If steam sterilization, moist heat, is utilized, heat exposure shall be at a mini- mum of 121 C., 250 F., for at least 30 minutes. If dry heat sterilization is utilized, heat exposure shall be at a minimum of 171 C., 340 F., for at least 60 minutes. 2. Sterilizers shall be maintained in working order. Equipment shall be checked in compliance with manufacturer s recommendations at least monthly to ensure that it is reaching required temperatures. Cos 4.04 Supplies. 1. All establishments shall supply each licensee with at least one of the antiseptics listed in s. Cos All licensees working in a licensed establishment shall be supplied with bandages and disposable gloves. Cos 4.05 Procedure for exposure to blood. 1. When any patron or licensee is exposed to blood by scissors cut, razor cut, needle stick, laceration or other exposure to broken skin or a mucous membrane, the licensee shall stop, thoroughly wash the exposed area or wound on the patron s or the licensee s body with soap and water, and disinfect the exposed area or wound with a topical antiseptic such as iodine, 70percent isopropyl alcohol, or 6 percent stabilized hydrogen peroxide or equivalent. In the case of mucous membrane exposure, the licensee shall wash or rinse the affected area with plenty of water. 2. A licensed establishment shall post a written protocol describing the procedure for unintentional occupational exposure to bodily fluids described in sub. (1). The protocol shall be posted in a place conspicuous to licensees. Cos 4.06 Precautionary procedures. 1. A licensee shall cover any abrasions, oozing or open lesions or wounds on his or her hands or forearms prior to patron contact. If a licensee has oozing or open lesions or weeping dermatitis on his or her hands or forearms that cannot be effectively covered, the licensee shall refrain from direct patron contact until the condition has been resolved. 2. A licensee shall use disposable protective gloves when dealing with patrons with oozing or open lesions or weeping dermatitis. These gloves shall be changed between patrons and disposed of after use. Gloves shall be removed upon completion of patron services, and hands washed after glove removal. Page 15

18 Note: It is recommended that licensees use protective gloves in handling caustic chemicals such as permanent waving solution and neutralizer or hair straightening preparations. The handling of these substances without protection can cause skin damage that may provide a route for infection to be transmitted to the licensee. 3. Licensees shall carefully bag and dispose of paper products contaminated with blood and thoroughly cleanse and disinfect linens contaminated with blood in accordance with s. Cos 4.02 (6). Cos 4.07 Ear piercing. Ear piercing may be performed by non licensees, but licensees performing ear piercing shall do all of the following: 1. Wear disposable protective gloves. These gloves shall be changed between patrons and disposed of after each use. Hands shall be washed after removal of gloves. 2. Thoroughly wash the skin area to be pierced with soap and water or a waterless washing agent with alcohol as an active ingredient. 3. Apply an antiseptic to the skin surface of the area to be pierced and allow the antiseptic to air dry. Note: Iodine and Betadyne are acceptable antiseptics. 4. Sterilize earrings, needles, or any other piercing instruments prior to insertion. Pre-sterilized earrings may be utilized. 5. Prior to each use all other surfaces that come into contact with the skin of the patron shall be disinfected. Cos 4.08 Waxing. 1. Electrologists performing waxing shall have completed training in depilation by waxing in a school of electrology or a school of cosmetology consisting of not less than 8 training hours in all of the following areas: a. Hygiene and sterilization. b. Treatments with hard hot wax. c. Treatments with liquid strip wax. d. Hair removal from legs and arms, bikini and underarm hair. e. Removal of facial hair. f. Eyebrow shaping. g. Post depilation treatments. Sanitation Sanitation is the lowest level of decontamination. Sanitation will reduce germs on a surface, but will not kill all organisms. Sanitation provides a minimum level of cleanliness, protecting public health by preventing the spread of some, but not all, bacteria and fungi; instruments that are sanitized are not sterile. Countertops and workstations should also be sanitized, wiped down with soap and water. This process should not be confused with - and does not replace - disinfection. Disinfectant requires an appropriate disinfectant. Remember that soap and water will kill most of the bacteria on the hands, workstation or chair, but will not kill all the bacteria or fungal spores. The term sanitation is most often used in reference to cleaning the hands. Hand washing is absolutely essential to controlling bacteria and is the most effective way to prevent the spread of infectious agents from one person to another. Hands cannot be sterilized because it is Wash your hands Hand washing is a simple thing, and it s the best way to prevent infection and illness. Page Manicurists performing waxing shall have completed training in depilation by waxing in a school of cosmetology or a school of manicuring consisting of not less than 8 training hours in all of the following areas: a. Hygiene and sterilization. b. Treatments with hard hot wax. c. Treatments with liquid strip wax. d. Hair removal from the foot, lower leg, hand and forearm. e. Post depilation treatments. 3. Licensees performing depilation by waxing shall do all of the following: a. Apply a topical antiseptic to the skin surface of the area to be waxed and allow the antiseptic to air dry. b. Dispose of spatulas after each use. c. Dispose of wax and strips after each use. Cos 4.09 Electrolysis. Licensees performing electrolysis shall: 1. Use sterilized needles, lancets and tweezers for each patron, in accordance with s. Cos Wear disposable protective gloves when working on a patron. These gloves shall be changed between patrons and disposed of following use. Hands shall be washed after removal of gloves. 3. Thoroughly wash the skin area to be treated with soap and water. Apply an antiseptic to the skin surface of the patron and allow the antiseptic to air dry prior to commencing electrolysis. 4. Dispose of needles and lancets in a puncture resistant container specifically designed for disposal. Full sharps containers shall be disposed of appropriately. Cos 4.10 Manicuring. 1. Prior to use, all reusable manicure instruments shall be disinfected. 2. Disinfectant used for decontamination shall be changed daily and shall be kept in a covered container. 3. Sterilization shall be accomplished in accordance with s. Cos Manicure instruments that cannot be cleaned and disinfected or sterilized shall be disposed of following each use. 5. Massaging by manicurists is limited to the hand, including the forearm and elbow, and the foot, including the lower leg and knee. impossible to remove all microorganisms from the surface of the skin. Water and soap, in fact, are not sterile; they can introduce new bacteria and infectious agents. Both resident and transient organisms populate the hands. Resident organisms are a normal part of the skin s environment: their natural habitat. They grow and multiply in an oxygen environment and rarely cause infection, or harm the host. These organisms cannot be removed easily by hand washing. Sanitation minimizes exposure to transient organisms such as E. coli, salmonella that can cause dangerous infections in humans. In contrast to resident organisms, transient organisms cannot live long on the surface of our skin. They function poorly in an oxygen environment and survive less than 24 hours. These organisms can be removed easily through the process of hand washing, using friction, soap and water. Clean hands prevent infections at home, school and at work. Hand hygiene practices are key prevention tools in healthcare settings, in daycare facilities, schools, public institutions as well as for the safety of our food. In health care settings, hand washing can prevent potentially fatal infections from spreading from patient to patient and from patient to health care worker. The basic rule in the hospital is to cleanse hands before and after contact with each patient by either washing hands or using an alcohol-based hand rub.

19 At home, hand washing can prevent infection and illness from spreading from family member to family member and sometimes throughout a community. In the home, the basic rule is to wash hands before preparing food and after handling uncooked meat and poultry; before eating; after changing diapers; after coughing, sneezing, or blowing one s nose into a tissue; and after using the bathroom. Wash your hands: The right way. When washing hands with soap and water: Wet your hands with clean running water and apply soap. Use warm water if it is available. Rub hands together to create lather. Scrub all surfaces. Continue rubbing hands for seconds. Need a timer? Imagine singing Happy Birthday twice. Rinse hands well under running water. Dry your hands using a paper towel or air dryer. If possible, use your paper towel to turn off the faucet. Always use soap and water, especially if your hands are visibly dirty. If soap and clean water are not available, use an alcoholbased hand rub to clean your hands. Alcohol-based hand rubs significantly reduce the number of germs on skin and are fastacting. Hand washing: The beginning of infection control Ignaz Semmelweis, an Austrian-Hungarian physician, first demonstrated that hand hygiene can prevent the spread of disease over 150 years ago. Dr. Semmelweis worked in a hospital in Vienna whose maternity patients were dying at such an alarming rate that they begged to be sent home. Most of those dying had been treated by student physicians who had worked on corpses during an anatomy class, before beginning their rounds in the maternity ward. Because the students did not wash their hands effectively between touching the dead and the living, pathogenic bacteria from the corpses were transmitted to the mothers. The result was a death rate five times higher for mothers who delivered in one clinic of the hospital than for mothers who delivered at another clinic that was not attended by the student physicians. In an experiment considered quaint at best by his colleagues, Dr. Semmelweis insisted that his students wash their hands before treating the mothers. The deaths on the maternity ward fell fivefold. When using an alcohol-based hand sanitizer: Apply product to the palm of one hand. Rub hands together. Rub the product over all surfaces of hands and fingers until hands are dry. ( html) Unquestioned today as the most important tool in the health care worker s arsenal for preventing infection, hand washing was not readily accepted in Dr. Semmelweis s era. Indeed, his pleas to make hand washing a routine practice throughout the hospital were largely met with derision. Another 50 years would pass before the importance of hand washing as a preventive measure would be widely accepted by the medical profession. Sanitation is now a standard and thousands of lives have been saved because of Dr. Semmelweis s discovery. Cleaning agents for hands Cleaning agents assist in the process of removing substances from surfaces. Soaps and detergents are two common cleaning agents that are often confused with one another; they are, however, composed of very different ingredients and possess different cleaning properties. Soaps are the product of a chemical reaction, formed by vegetable oil reacting with lye, for example. Chemicals are added to achieve a desirable smell or consistency to the soap - such as glycerine (to make it milder). While soap does not kill microorganisms, soap and water will help remove them from surfaces. Detergents are manufactured for the express purpose of cleaning specific substances off specific items; they are created using chemicals that can be very harsh to skin. In contrast to detergents that do not leave a residue or require rinsing, soaps leave a coating or residue on the body - typically one designed to make skin smoother or more attractive. Soaps also remove less fat from the skin than detergents, which can have a drying quality and may strip the skin of oils. Be sure to use the appropriate cleaning agent for the job. Different cleaning and disinfecting agents have many different properties. Always read the ingredients, instructions and recommendations for use on the item s label. Page 17

20 Sterilization and disinfection Sterile means free from all germs; sterilization is the most effective level of decontamination and involves the removal of all bacterial life from a surface. This is the level of decontamination required for tools and surfaces in hospital surgeries. Hospitals use steam autoclaves to heat instruments to a very high temperature. Many salons are investing in autoclaves to reinsure clients that their safety is the number one priority. Disinfection is the process of killing specific microorganisms, bacteria or germs using physical or chemical processes. Disinfectants are chemical agents that destroy organisms on contaminated instruments or surfaces and can be dangerous. They must be used with caution. Disinfectants are used to destroy bacteria on equipment and implements, but they should not be used on the skin. In a salon atmosphere, disinfectants must be able to kill viruses, fungus and dangerous bacteria. Disinfectants Controlling bacteria in a salon requires some degree of effort, vigilance and good sense. In choosing a disinfectant, always look for the EPA registration number (awarded by the Environmental Protection Agency) to ensure you are using an approved disinfectant. This number indicates a level of safety for specific kinds of disinfection. To be registered by the EPA, it must be effective in killing bacteria, including Staphylococcus, aureus, salmonella and pseudomonas. Cosmetology salons must use not only EPA-approved disinfectants, but also those with an EPA rating of hospital-level (tuberculocidal) quality. These disinfectants are especially effective for salon use and are capable of killing viruses, dangerous bacteria and fungus. Disinfectants can be hazardous if prepared incorrectly. Consult the manufacturer s material safety data sheets (MSDS) for information on preparing the solution; check the listing of chemicals in the disinfectant and how they can pose safety hazards, if any. Be certain to follow manufacturers instructions and all written directions for the preparation and use of a specific disinfectant. Remember to follow all directions when using this type of disinfectant or any other disinfectant. To ensure safety, use an appropriate ratio of concentration in the solution, and clean only approved items, according to label instructions. Wear gloves and safety glasses, as indicated when mixing and using solutions. Do not confuse disinfectants (which destroy harmful microorganisms), with antiseptics (products designed to slow the growth of microorganisms). Antiseptics do not kill microorganisms and should not be confused with disinfectants or used for salon disinfection. Household disinfectants are commonly used to clean offices and homes. They may be used to clean floors, doorknobs, walls as directed on the container label; they should not be used in place of a hospitalgrade salon disinfectant, which is required to sterilize instruments. Bleach can be used as an effective disinfectant, but it is not a cleaning agent and should only be applied to clean surfaces. Bleach must be used with caution because it can release toxic fumes when mixed with certain substances. Bleach is far too harsh for day-to-day disinfection and will damage instruments. It may be used for washing towels and other salon laundry. What are efficacy tests? The tests used to measure the effectiveness of disinfectants on various pathogenic (disease-causing) organisms are called efficacy tests. The EPA must pre-approve all efficacy test methods used to measure the effectiveness of disinfectants against specific microorganisms. The most common efficacy test prescribed by the EPA is the Association of Official Analytical Chemist (AOAC) test. Currently, for a disinfectant cleaner to be registered by the EPA as hospital strength, it must be effective at its recommended dilution in killing target pathogens in the Page 18 presence of 400 ppm hard water and 5 percent organic serum, and it must kill 100 percent of the target test organisms. It is a good idea for you to require the manufacturer or distributor of a disinfectant or disinfectant-cleaner to provide efficacy data to you before you select it for use in your salon. What factors affect how well a disinfectant works? There are six main factors: 1. Concentration This is dilution rate. Proper dilution is very important. Read label for complete dilution directions. 2. Contact time For most all disinfectants, such as bleach, contact time is not very critical. 3. PH Certain disinfectants work best under acidic conditions, and others work best under alkaline conditions. 4. Temperature Certain disinfectants work best in cold water (bleach). Most work best in warm water. 5. Soil load Disinfectants do not know the difference between soil and bacteria. That is why heavy soil should be removed before disinfecting. See explanation above for more details. 6. Organism type Not all disinfectants work on all types of organisms. When in doubt, read the product label for a complete list. How can you calculate active parts per million (ppm) of the disinfectant you are using? To calculate active ppm, you ll need three things: the active ingredient list from the disinfectant label, the dilution rate of the product, and a calculator. The following is an example of how this would be done using a neutral germicidal cleaner: Step 1: Add together active ingredient percentages from the label: For example, 5.07 percent percent = 8.45 percent total active ingredients. Step 2: Multiply by 10,000: 8.45 X 10,000 = 84,500. Step 3: Divide the result of Step 2 by the dilution rate (128 in this example): 84,500 / 128 = 660 ppm. Parts per million (ppm) is a ratio figure that represents the amount of one substance that is in one million parts of another substance. Selected EPA-registered disinfectants The following lists of antimicrobial products registered by the US Environmental Protection Agency Office (EPA, 2016) are effective against common pathogens, as indicated in the list titles. EPAregistered antimicrobial products may not make efficacy claims against these pathogens unless the agency has reviewed data to support the claim and has approved the claim on the label. Use of the listed EPAregistered products consistent with the product labeling complies with the Occupational Safety and Health Administration s requirements for Occupational Exposure to Bloodborne Pathogens (29 CFR 1910) as well as proper management of any waste when disposed. The list below contains only a few examples of the active ingredients included on the EPA list. They are included since no specific products will be endorsed in this course. A complete list of the specific product brands are included on the EPA website listed in the reference section. List A: EPA s registered antimicrobial products as sterilizers Hydrogen peroxide 70.0%. Ethaneperoxoic acid 4.5%; Hydrogen peroxide 22.0%. Tetraacetylethylenediamine 61.6%. Caprylic acid 3.3%; Hydrogen peroxide 6.9% ; Ethaneperoxoic acid 4.4%. Sodium chlorite 1.52%. Ethaneperoxoic acid 0.05%; Hydrogen peroxide 3.13% ; Caprylic acid 0.099%. 1-Octanaminium, N, N-dimethyl-N- octyl-, chloride 0.06%. Alkyl* dimethyl benzyl ammonium chloride. Decanaminium, N, N-dimethyl-N- octyl-, chloride 0.12%.

21 Ethylene oxide 100.0%. FMC CORPORATION. Sodium hypochlorite 12.5%. Chlorine dioxide) 2.0%. List E: EPA s registered antimicrobial products effective against mycobacterium tuberculosis, human HIV-1 and hepatitis B virus Hydrogen peroxide 0.8%; Peroxyacetic acid 0.06%. 1-Octanaminium, N, N-dimethyl-N-octyl-, chloride 1-Decanaminium, N-decyl-N, N-dimethyl-, chloride % 1-Decanaminium, N, N-dimethyl-N-octyl-chloride %. Ethanol 58.0% Alkyl*dimethyl benzyl ammonium saccharinate 0.1%. Ethanol 58.0% Alkyl* dimethyl benzyl ammonium saccharinate 0.1%. Alkyl dimethyl ethylbenzyl ammonium chloride. Alkyl dimethyl benzyl ammonium chloride. Isopropanol 17.2%; Diisobutylphenoxyethyl dimethyl benzyl ammonium chloride 0.28%. Ethyl alcohol %;Phenylphenol %. Sodium hypochlorite 2.4%. Isopropyl alcohol 63.25% Alkyl* dimethyl ethylbenzyl ammonium chloride 0.12%. List H. EPA s Registered products effective against methicillin resistant staphylococcus aureus (MRSA) and vancomycin resistant enterococcus faecalis or faecium (VRE) NOTE: * Products with MRSA claim only; ** Products with VRE claim only. **Product: Octanoid Acid. Didecyl dimethyl ammonium chloride. Alkyl* dimethyl benzyl ammonium chloride. Hydrogen peroxide. *Product: Alkyl* dimethyl benzyl ammonium chloride 3.0%. Didecyl dimethyl ammonium chloride 0.768%. Octyl decyl dimethyl ammonium chloride 1.536%. Triethylene Glycol 5.40%, Alkyl* dimethyl benzyl ammonium saccharinate. Peroxyacetic acid 15.2%; Hydrogen peroxide 11.2%. Sodium chlorite 20.8%; Sodium dichloroisocyanurate dihydrate 7.0%. Other things you can do Cleaning salon computers and reception areas Almost all modern salons now work with computers and computer appointment books. These computer appointment books are generally at the reception desk and are also found in break areas so that salon workers can view their schedules. Few people think about the germ havens these areas have become. Experts say the computer keyboard, phone, and desk areas of salons are major germ areas that must be sanitized. Believe it or not, you could put your fingers on a toilet seat and collect fewer germs than the average desk or keyboard. Charles Gerba, a microbiologist at the University of Arizona, counted bacteria on several surfaces. He found the office toilet seat had an average of 49 germs per square inch. When he looked at keyboards, he found 3,295 bacteria per square inch, 60 times higher than the toilet seat. Even worse were tops of desks at 21,000 bacteria per square inch and telephones at 25,000 per square inch. People are constantly coughing and sneezing on them. Germs from unwashed hands can remain alive for days. In other words, shared computer keyboards, a phone or a desk, in the salon leads to sharing germs among the staff. List F: EPA s registered antimicrobial products effective against hepatitis C virus 1:100 dilution of a hypochlorite solution ( ppm free chlorine). Peracetic acid. Formaldehyde. Glutaraldehyde. Chlorine-containing compounds (e.g., sodium hypochlorite). List K: EPA s registered antimicrobial products effective against clostridium difficile spores Hydrogen peroxide. Hypochlorite. Glutaraldehyde. Formaldehyde. Iodine and Iodophors. Peroxygens. Ethyleneoxide. Sterilization methods The following two methods could be used in a cosmetology setting to sterilize tools and completely or eliminate all bacteria, virus, parasites, fungus and all other possible contaminants. Steam autoclave An autoclave is a high-pressure device used to allow the application of moist heat above the normal-atmosphere boiling point of water. The steam autoclave is the process of sterilization using heated steam under pressure to kill vegetative microorganisms and directly exposed spores. Common temperature and pressure for being effective is 121 C (250 F) at 15 psi (pounds per square inch) over pressure for 15 minutes. Special cases may require a variation of the steam temperature and pressure used. Dry heat Ovens operating at C for periods of 2-4 hours are efficient for sterilizing glassware or other non-porous heat conductive materials. This method is unsatisfactory for organic and inorganic materials that can act as insulation and is also unsuitable for heat labile materials. Incineration is a very effective means of final sterilization and disposal. To combat the problem, assign cleaning duties to staff. First, remove the screws on the underside of the keyboard and separate the two parts. Brush the debris away and then wipe with a sanitizing cloth. Once the keyboard is back together, spray the entire keyboard with a disinfectant spray like Lysol. Do this lightly so as not to ruin the electronics. Sanitation wipes commonly found in drug stores can be used. Staff should clean phones daily with a disinfectant spray - more often when someone is known to be sick or feels sick. Also, remember to daily disinfect each workstation. Stylists forget to perform this important step, yet they routinely place combs, scissors and other items on top of the workstation. Disease and infestation Salons and schools should not knowingly permit a person afflicted with an infection (or a parasitic infestation capable of being transmitted to a patron) to serve patrons or train in the establishment or school. In addition, salons and schools should not knowingly require or permit a licensee or student to work with a person who appears to have an infection or a parasitic infestation capable of being transmitted to the licensee or a student. Page 19

22 Infections or parasitic infestations capable of being transmitted between licensee or student and patron include the following: Cold, influenza or other respiratory illness accompanied by a fever, until 24 hours after resolution of the fever. Streptococcal pharyngitis ( strep throat ), until 24 hours after treatment has been initiated, and 24 hours after resolution of symptoms. Purulent conjunctivitis ( pink eye ), until examined by a physician and approved for return to work. Pertussis ( whooping cough ), until five days of antibiotic therapy has been completed. Varicella ( chicken pox ), until the sixth day after onset of rash or sooner if all lesions have dried and crusted. Mumps, until nine days after onset of parotid gland swelling. Tuberculosis, until a physician or local health department authority states that the individual is noninfectious. Impetigo (bacterial skin infection), until 24 hours after treatment has begun. Pediculosis (head lice), until the morning after first treatment. Scabies, until after treatment has been completed. No person working or training in an establishment or school should massage any person upon a surface of the skin or scalp where such skin is inflamed, broken (e.g., abraded, cut) or where a skin infection or eruption is present. Occupational Health and Safety Administration (OSHA) OSHA s Bloodborne Pathogens standard (29 CFR ) - as for employers to identify, evaluate, and implement safer medical amended pursuant to the Needlestick Safety and Prevention Act of devices such as needleless systems and sharps with engineered prescribes safeguards to protect workers against the health sharps protections. The Act also mandated additional requirements hazards caused by bloodborne pathogens. These safeguards apply for maintaining a sharps injury log and for the involvement of to cosmetology because there is the possibility of cuts or nicks by non-managerial healthcare workers in identifying, evaluating and sharp objects, such as razors or scissors to practitioners or clients. In choosing effective engineering and work practice controls. These addition, certain services such as waxing or tweezing may cause the are workers who are responsible for direct patient care and be barrier of the skin against infection to be compromised. The entire potentially exposed to injuries from contaminated sharps. standard should be reviewed on the OSHA website. Do the Bloodborne Pathogens standard and the Needlestick Safety and Prevention Act apply to me? However, a few highlights pertinent to cosmetology are included as OSHA s Bloodborne Pathogens standard, including its 2001 follows (OSHA, 2016b): revisions, applies to all employers who have an employee(s) with What is the Bloodborne Pathogens standard? OSHA s an occupational exposure (i.e., reasonably anticipated skin, eye, Bloodborne Pathogens standard (29 CFR ) as amended mucous membrane, or parenteral contact with blood or other pursuant to the Needlestick Safety and Prevention Act of 2000, potentially infectious materials (OPIM) that may result from the prescribes safeguards to protect workers against the health hazards performance of the employee s duties). These employers must caused by bloodborne pathogens. Its requirements address items implement the requirements set forth in the standard. Some of such as exposure control plans, universal precautions, engineering the new and clarified provisions in the standard apply only to and work practice controls, personal protective equipment, healthcare settings. Other provisions, however, particularly the housekeeping, laboratories, hepatitis B vaccination, post-exposure requirements to update the Exposure Control Plan and to keep a follow-up, hazard communication and training, and recordkeeping. sharps injury log, apply to non-healthcare as well as healthcare The standard places requirements on employers whose workers settings. can be reasonably anticipated to contact blood or other potentially What does OSHA currently accept as appropriate infectious materials (OPIM), such as unfixed human tissues and disinfectants to prevent the spread of HIV and HBV? certain body fluids. OSHA s position is that EPA-registered tuberculocidal What is the Needlestick Safety and Prevention Act? The disinfectants, diluted bleach solutions and EPA-registered Needlestick Safety and Prevention Act (the Act) (Pub. L ) disinfectants that are labeled as effective against both HIV and was signed into law on November 6, Because occupational HBV as well as Sterilants/High-Level Disinfectants cleared by the exposure to bloodborne pathogens from accidental sharps injuries FDA, meet the requirement in the standard and are appropriate in healthcare and other occupational settings continues to be a disinfectants to clean contaminated surfaces, provided that such serious problem, Congress required modification of OSHA s surfaces have not become contaminated with agent(s) or volumes Bloodborne Pathogens standard (29 CFR ) to set forth of or concentrations of agent(s) for which higher level disinfection in greater detail (and make more specific) OSHA s requirement is recommended. OSHA health Hazard Alert for hair salons The following excerpt from the OSHA Hazard Alert was directed toward hair salon owners and workers and is contained in full on the OSHA website (OSHA, 2016a): Recent reports from Federal OSHA, Oregon OSHA, and California OSHA should alert salon owners and stylists to look closely at the hair smoothing products they are using to see if they contain methylene glycol, formalin, methylene oxide, paraform, formic aldehyde, methanal, oxomethane, oxymethylene, or CAS Number All of these are names for or treated as formaldehyde under OSHA s Formaldehyde standard. There are also chemicals, such as timonacic acid (also called thiazolidinecarboxylic acid), that can release formaldehyde under certain conditions, such as those present during the hair smoothing treatment process. Products that contain these chemicals can expose workers to formaldehyde. Employers who use, manufacture, import, or distribute the products must follow OSHA s formaldehyde Page 20 standard. The Food and Drug Administration (FDA) has issued a warning letter to the importer and distributor of Brazilian Blowout Acai Professional Smoothing Solution (GIB LLC dba Brazilian Blowout) identifying this product as adulterated and misbranded because it contains methylene glycol, which can release formaldehyde during the normal conditions of use, and because the label makes misleading statements ( Formaldehyde Free or No Formaldehyde ). These products are known to have serious health risks for workers and clients, as well as described by OSHA as follows (OSHA, 2016 a): Formaldehyde is a colorless, strong-smelling gas that presents a health hazard if workers are exposed. A worker can easily be exposed to formaldehyde when they breathe it into the lungs, if it gets into eyes, or if it is contained in a product that comes in contact with skin. They can be exposed accidentally if they touch

23 their face, eat food, or drink after using a product containing formaldehyde without first washing their hands. It can irritate the eyes and nose, and cause coughing and wheezing. Formaldehyde is a sensitizer, which means that it can cause allergic reactions of the skin, eyes, and lungs such as asthma-like breathing problems and skin rashes and itching. When formaldehyde is in a product that gets sprayed into the eyes, it can damage the eyes and cause blindness. It is also a cancer hazard. Formaldehyde is a health hazard, whether in a product or in the air. OSHA s Formaldehyde standard 29 CFR covers employers who use formaldehyde, and products that contain or release formaldehyde. OSHA has also published a Formaldehyde Fact Sheet. What can I do to reduce exposure to formaldehyde when using formaldehyde releasing hair smoothing/straightening products? Employers, stylists, and other salon workers should read the product information and MSDSs for the products they buy and use, so that they know what chemicals are in them and how to use them safely in the workplace. The best way to control exposure to formaldehyde is to use products that do not list formaldehyde, formalin, methylene glycol, or any of the other names for formaldehyde listed above on the label or in the MSDS. Beauty care companies are now making and selling products that they claim do not contain formaldehyde in the solution. Choosing one of these products might eliminate the risk of formaldehyde exposure. Note that just because a product doesn t list formaldehyde, formalin, or methylene glycol does not mean that it does not contain any other hazardous ingredients. If salon owners decide to use products that contain or release formaldehyde, then they must follow the requirements in OSHA s Formaldehyde standard. The standard requires that employers test the air to find out the level of formaldehyde present in the air when the product is being used. If the test shows that formaldehyde is present at levels above OSHA s limits (0.75 parts of formaldehyde per million parts (or ppm) of air during an 8-hour work shift or 2 ppm during any 15-minute period), then the employer must: Install air ventilation systems in the areas where these products are mixed and used to help keep formaldehyde levels below OSHA s limit and perform regular maintenance to make sure the systems work correctly; When possible, require workers to use lower heat settings on blowdryers and flat irons used during the process; Give workers respirators, if needed; train them to use the respirator properly; meet the other requirements in OSHA s Respiratory protection standard, 29 CFR ; Ensure workers understand the information on a product s label and MSDS; Post signs at entryways to any area where formaldehyde is above OSHA s limit to tell workers of the danger and stating that only authorized personnel may enter; Tell workers about the health effects of formaldehyde, how to use the product safely, and what personal protective equipment to wear while using the product; and Train workers how to safely clean up spills and properly throw products out. In addition, where the tests show that formaldehyde is present in the air at a level of 0.5 ppm during an 8-hour work shift or 2 ppm during any 15-minute period, then the employer must: Get workers the right medical attention (e.g., doctor exams); and Test the air periodically to make sure that formaldehyde levels are below OSHA s limits. Whether or not air tests show formaldehyde levels above OSHA s limits, employers must follow certain parts of the standard if a product contains formaldehyde: Give employees appropriate gloves and other personal protective equipment (e.g., face shield, chemical splash goggles, chemicalresistant aprons) and train them on how to use this equipment while mixing and applying the products; Explain to workers how to read and understand the information on a product s label and MSDS; Make sure the workplace has eye and skin washing equipment if products that contain formaldehyde could be splashed onto the workers skin or into their eyes; Train workers how to safely clean up spills and properly throw products out; and Get workers the right medical attention (e.g., doctor exams) if they develop signs and symptoms of an exposure to formaldehyde or are exposed to large amounts of formaldehyde during an emergency (e.g., a large spill). Employers must also keep records of the air tests they perform, any medical attention needed by their employees, and respirator fit testing. OSHA Health Hazards warnings for nail salons OSHA released the following Health Hazard warning for nail salon workers that could also affect clients. Across the country, advocate organizations and local governments are working together to help prevent chemical exposures and protect worker health by developing programs that encourage the use of less toxic products and safer practices in nail salons. In California, several counties and cities are implementing Healthy Nail Salon Recognition Programs that recognize salons that use less toxic polishes and other nail salon products, improve ventilation, and participate in trainings that focus on best practices for a healthier workplace. Visit cahealthynailsalons.org to find out more about these innovative programs (OHSA, 2016c). OSHA product warnings for nail salons Products used in nail salons may contain chemicals that can affect worker health. Using these products can expose nail salon workers to chemicals. Workers may breathe in the harmful vapors, dusts, or mists; get the product on their skin or in their eyes; or swallow the product if it is accidentally transferred onto food or cigarettes (OHSA, 2016c). Working in a nail salon exposes workers to many different chemicals each day. These exposures can add up, especially when many products are being used at the same time, the products are used day after day, or are used when there is poor ventilation in the salon. When this happens, workers can get sick. Many nail salon workers also work long hours; this adds to the amount of time they may be exposed to chemicals. These types of exposures may make workers sick immediately, or cause effects over time. Chemical exposures can be controlled. The information below will help you find out what chemicals are in your salon s products and what steps you can take to reduce exposures and protect workers health. You can find more specific information about the chemicals in your workplace from the safety data sheets (SDS) that manufacturers are required to provide for potentially hazardous salon products. Hazardous chemicals found in nail salon products Products used in nail salons can contain many chemicals that can have serious health effects. Some potentially hazardous chemicals, the types of products they can be found in, and how they can affect a worker include (OSHA, 2016c): Acetone (nail polish remover): headaches; dizziness; and irritated eyes, skin, and throat. Acetonitrile (fingernail glue remover): irritated nose and throat; breathing problems; nausea; vomiting; weakness; and exhaustion. Butyl acetate (nail polish, nail polish remover): headaches and irritated eyes, skin, nose, mouth, and throat. Dibutyl phthalate (DBP), (nail polish): nausea and irritated eyes, skin, nose, mouth, and throat. Long-term exposures to high concentrations may cause other serious effects. Page 21

24 Ethyl acetate (nail polish, nail polish remover, fingernail glue): irritated eyes, stomach, skin, nose, mouth, and throat; high levels can cause fainting. Ethyl methacrylate (EMA), (artificial nail liquid): asthma; irritated eyes, skin, nose, and mouth; difficulty concentrating. Exposures while pregnant may affect your child. Formaldehyde (nail polish, nail hardener): difficulty breathing, including coughing, asthma-like attacks, and wheezing; allergic reactions; irritated eyes, skin, and throat. Formaldehyde can cause cancer. Isopropyl acetate (nail polish, nail polish remover): sleepiness, and irritated eyes, nose, and throat. Methacrylic acid (nail primer): skin burns and irritated eyes, skin, nose, mouth, and throat. At higher concentrations, this chemical can cause difficulty breathing. Methyl methacrylate (MMA), (artificial nail products, though banned for use in many states): asthma; irritated eyes, skin, nose, and mouth; difficulty concentrating; loss of smell. Quaternary ammonium compounds (disinfectants): irritated skin and nose and may cause asthma. Toluene, formaldehyde, and dibutyl phthalate are sometimes referred to in the industry as the toxic trio. Toluene (nail polish, fingernail glue): dry or cracked skin; headaches, dizziness, and numbness; irritated eyes, nose, throat, and lungs; damage to liver and kidneys; and harm to unborn children during pregnancy. For a broader list of potentially dangerous chemicals that may be found in nail salons, read EPA s Protecting the Health of Nail Salon Workers (OSHA, 2016c). Workers need to report any health problems they think are from the products they use in the workplace to their employer and doctor. Employers must follow up on the reports of health problems made by workers. Steps to prevent exposures and protect worker health In a study run by the California Department of Toxic Substances Control, a limited number of nail salon products claiming to be free of one or more of the toxic trio tested positive for the chemicals of which they claimed to be free of. Employers and workers can take steps to protect their health when working with products that contain potentially hazardous chemicals as follows (OSHA, 2016c): Choose safer products and read about the products being used Whenever possible, use products with the least hazardous chemicals in them. 3-free: Some products now claim to be made without the toxic trio (toluene, formaldehyde, and dibutyl phthalate). These products are called 3-free products. Acid free: Some primers claim to be made without chemicals like methacrylic acid. These are labeled acid free. For any product used in your salon, be aware of the health effects it may cause and how to prevent overexposure. Always read product labels and SDSs and follow manufacturers instructions when using all nail salon products, including those labeled as free of hazardous chemicals. SDSs may not contain all of the information needed to for adequate protection. For example the manufacturer may state, wear impervious gloves without specifying the type of glove material needed. Ventilate the room to remove chemicals in the air Ventilation is the best way to lower the level of chemicals in a salon. NIOSH laboratory tests (PDF) indicate that exhaust ventilation systems may reduce worker chemical exposure in nail salons by at least 50percent. These steps really help improve worker health (OSHA, 2016c): Let in fresh air, when possible, by opening doors and windows. If the salon has a ceiling vent, it should be turned on and working. Always keep the nail salon s exhaust system on. If the salon does not have an exhaust system, always keep the heating, ventilation, and air conditioning (HVAC) system on during work hours. The HVAC thermostat fan switch should always be in the on position (not auto ) so that it runs even when the heat or air conditioner is off. The salon owner should have a HVAC contractor clean the HVAC system and replace the filters at least once a year. Install exhaust fans wherever possible. Place fans near open doors or windows. Fans should pull air in one end of the salon and push it out of the other end. If the salon has ventilated tables, make sure they are turned on. Also, change the charcoal filters at least once a month and clean out the catch basin at least once a week. Consider using portable ventilation machines to remove dust and chemicals directly from the work area. Use safe work practices to avoid regular and accidental exposures Label chemicals moved from large bottles to smaller bottles with the information from the manufacturer s label. Close bottles tightly when they are not being used so the product does not spill or get into the air. Use metal trash cans with tight, self-closing lids to keep the nail products soaked on cotton balls and other trash from evaporating and getting into the salon s air. Put cotton balls and other soaked materials into the trash cans immediately. If there are no metal trash cans with self-closing lids, put cotton balls and soaked materials in a sealed bag before putting them in the trash can and keep the trash covered. Empty trash cans often and remove them from the work area to the outside garbage at the end of each day. Use only the amount of product needed to perform the service. When possible, do not keep extra product at workstations. Follow instructions for safely disposing used chemicals. DO NOT pour them down the sink or toilet, throw them on the ground, into outside drains, or pour them onto cotton balls. Some chemicals have specific disposal requirements. For example, used liquid acetone must be saved in a fire department-approved metal container and disposed of as hazardous waste. Wash hands before eating, drinking, applying cosmetics, and smoking. Keep food and drink covered at all times. Do not store or eat food in work areas. Keep products off of the skin and out of the eyes. Wear long-sleeved shirts to protect arms, and pants or skirts that are at least knee-length to protect your lap from acrylic nail and other dusts. Wash hands before and after working on clients, before eating, drinking, applying cosmetics, or smoking, and after handling or transferring products. Wear goggles and the appropriate type of disposable gloves when handling and transferring products. For example, nitrile gloves protect against many chemicals used in nail salon products; latex or vinyl gloves are appropriate when handling acetone. Replace gloves immediately if there are cuts, tears, or holes in them. Cover and protect cuts or cracks on the skin. Damaged skin can increase chemical absorption and exposure. Page 22

25 Do not continue to use a product if there are visible signs of skin irritation immediately after exposure to the product, or from previous exposure to the product. Note that if hands display signs of irritation, examine the gloves closely to make sure they are intact and properly protecting the skin. Determine if respiratory protection is needed Do not use surgical masks. These types of masks - even when stuffed with tissues - do not protect workers from breathing in gases, vapors, or particulates. Respirators protect against breathing in hazardous gases and vapors (such as formaldehyde) and particulates (such as dusts, germs, and viruses). Employers must evaluate worker exposure to dust and/or chemical vapors, determine if the levels in the work place are a risk to workers, and decide if respirators are required to protect workers. Small employers can get help with this process from OSHA s free On-site Consultation Program. Other groups that can help include an employer s private insurance carrier, professional associations, and private industrial hygiene consulting firms. Most work in a nail salon will not require respiratory protection; good ventilation and good work practices should keep exposure to gases, vapors, and particulates to a minimum. However, when respiratory protection is required, employers must implement a respiratory protection program that meets the requirements in OSHA s Respiratory Protection Standard, 29 CFR (OSHA, 2011). This program must include proper respirator selection, fit testing, medical Health issues related to waxing services Unsanitary waxing procedures often occur because practitioners and clients may falsely believe that the temperature of the hot wax kills bacteria - so precautions and safety standards can be overlooked. These include double dipping into wax, waxing without gloves, not storing non disposable equipment like tweezers in an antibacterial autoclave, or reusing wax. These unsanitary practices can lead to dangerous infections for the client and professional due to exposure to bacteria, blood, bodily fluids, open follicles and skin that may be abraded - no matter how small the area. There are two kinds of waxing: facial and body. Both must be properly disinfected prior to waxing. The skin s surface may have sweat, bacteria, and oil that can enter the body through the open follicle after waxing, leading to infection. It is important to remember that waxing is considered to be an invasive procedure. The area being waxed must be disinfected with alcohol before and after the procedure. The next sanitary procedure that must be followed is the elimination of double dipping in the wax. This can be eliminated by preparing a small amount of wax needed for that client in a separate bowl. The applicator must only touch the wax for that client, in the individual bowl, and then that wax and applicator must be disposed properly. In order to kill bacteria, the wax would have to be heated at 100 degrees Celsius, 212 Fahrenheit, for 30 minutes or longer. The wax would have to be cooled before application and the lower temperature would allow for the transmission of bacteria among clients if double dipping occurred or wax was reused. The open follicle becomes an infection transmission route and can result in serious health consequences. This occurred in New Jersey in 2009 when two women received unsanitary Brazilian waxes which led to hospitalizations for severe infections. These cases caused the state to consider banning the practice of this service and lead to the requirement in additional training on sanitation practices for waxing services. In some situations a client may not be a good candidate for waxing services as follows (Sarfati, 2016): Do not wax over a previously waxed area. evaluations, and training. Workers may also decide that they want to wear a respirator while transferring chemicals or buffing and filing nails, in which case the employer may also have responsibilities under OSHA s Respiratory Protection standard. Types of respirators that may be used in nail salons The OSHA Health Warning for Nail Salons includes the following guidelines on respiration protection (OSHA, 2016c). Filtering facepiece respirators (often called N95s or dust masks): Only use N95s that are NIOSH-approved. N95s protect workers from particulates, such as dust, viruses, and other germs, and are helpful when buffing or filing nails or using acrylic power. They do not protect workers from vapors or gases, such as hazardous chemicals. Employers who allow their employees to wear this type of respirator voluntarily must give their employees Appendix D of the OSHA Respiratory Protection Standard. This appendix has certain requirements that include training and medical evaluation. Half-facepiece elastomeric respirators with cartridges: These respirators can protect workers from hazardous gases and vapors (such as formaldehyde) when performing tasks such as moving chemicals from large bottles to smaller bottles and cleaning up large spills. Using this type of mask requires that the employer implement a respiratory protection program under OSHA s Respiratory Protection Standard, 29 CFR This standard has certain requirements that include training and fit testing. In addition, employers must evaluate the appropriate cartridge for the job, provide the cartridge to workers, and inform workers of how and when to change cartridges. Do not wax over an area that has had a Botox injection for at least 72 hours. Do not wax if the client has protruding varicose veins, diabetes, phlebitis, or any skin irritation. Do not wax if a client is having any dermabrasion services. The Department of Professional and Occupational Regulation, Board for Barbers and Cosmetology Perimeter Center in Virginia, provides the following guidelines for sanitary waxing procedures (DPOR, 2014). General safety precautions Electrical cords shall be placed to prevent entanglement by the client or license. The salon area shall be sufficiently ventilated to exhaust hazardous or objectionable airborne chemicals, and to allow the free flow of air. Equipment sanitation 1. Waxing tables shall be cleaned and sanitized after each use and any other objects that touch the client shall be cleaned and sanitized after each use or disposed of. 2. The top of work stands or back bars shall be kept clean. 3. The work area shall be free of clutter, trash, and any other items that may cause a hazard. 4. Heat producing appliances and equipment shall be placed so as to prevent any accidental injury to the client or licensee. Articles, tools and products 1. The temperature of waxing products shall be in accordance with the manufacturer s specifications and shall be tested prior to application to ensure client safety. 2. Any multi-use article, tool or product that cannot be cleansed or sanitized is prohibited from use. 3. Soiled implements must be removed from the tops of work stations immediately after use. 4. Clean spatulas, other clean tools, or clean disposable gloves shall be used to remove bulk substances from containers. Page 23

26 5. A clean spatula shall be used to remove wax, creams or ointments from jars. Sterile cotton shall be used to apply creams, lotions and powders. Cosmetic containers shall be recovered after each use. 6. All sharp tools, implements, and heat-producing appliances shall be safely stored. 7. Pre-sanitized tools and implements, linens and equipment shall be stored for use in a sanitary enclosed cabinet or covered receptacle. 8. Soiled towels, linens and implements shall be deposited in a container made of cleanable materials and separate from those that are clean or pre-sanitized. 9. No substance other than a sterile styptic powder or sterile liquid astringent approved for homeostasis and applied with a sterile single-use applicator shall be used to check bleeding. 10. Any disposable material making contact with blood or other body fluid shall be disposed of in a sealed plastic bag and removed from the shop, salon, school or facility in accordance with the guidelines of the Department of Health. Chemical storage and emergency information 1. Salons, schools and facilities shall have in the immediate working area a binder with all Material Safety Data Sheets (MSDS) provided by manufacturers for any chemical products used. 2. Salons, schools and facilities shall have an OSHA approved blood spill clean-up kit in the work area. 3. Flammable chemicals shall be stored in a non-flammable storage cabinet or a properly ventilated room; and Conclusion The cosmetology industry is booming. Factors that could harm the industry are insufficient sanitation and infection controls for client health and safety, or perceptions by our clients that their health may be at risk. Salon professionals must make safe sanitation techniques the foundation of their daily routines and encourage their co-workers to do the same - for the health and well-being of practitioners and clients. 4. Chemicals that could interact in a hazardous manner (oxidizers, catalysts and solvents) shall be separated in storage. Client health guidelines: 1. All waxing services must be performed in a prescribed manner to avoid burns or bruising to the client s skin. 2. All employees providing client services shall cleanse their hands with an antibacterial product prior to providing services to each client. 3. No salon, school or facility providing waxing services shall have on the premises waxing products containing hazardous substances that have been banned by the U.S. Food and Drug Administration (FDA) for use in waxing products. 4. No product shall be used in a manner that is disapproved of by the FDA; and 5. All regulated services must be performed in a facility that is in compliance with all applicable building and zoning codes. In addition to guidelines in this section, all practitioners should adhere to regulations and guidelines established by the state of license and OSHA. To maintain a safe and healthy environment for clients and staff, salon, school and facility personnel should follow sanitation and sterilization practices at all times. All staff should conduct self-inspections of their area and site on a daily basis following the guidelines in this course. Sanitation and disinfection techniques to control infection have a direct impact on the health and welfare of clients and the careers of salon professionals. The importance of maintaining proper sanitation procedures cannot be overstated; it can literally be a matter of life or death. Following proper sanitation guidelines will greatly reduce the potential risks to the professional, clients and co-workers - as well as ensure the highest quality of service. References Centers for Disease Control and Prevention. (2016 a). Clostridium difficile Infection. Retrieved June 7, 2016 from Centers for Disease Control and Prevention. (2016 b). National Center for Emerging and Zoonotic Infectious Diseases (NCEZID). Division of Healthcare Quality Promotion (DHQP): Methicillinresistant Staphylococcus aureus (MRSA). Retrieved June 8, 2016 from community/index.html. Department of Professional and Occupational Regulation: Board for Barbers and Cosmetology Perimeter Center. (2014). Waxing Regulations. Retrieved June 8, 2016 from regulations/waxing-regulations.html. Environmental Protection Agency. (2016). Selected EPA-registered Disinfectants. Retrieved June 7, 2016 from Occupational Safety & Health Administration. (2011). Respiratory Protection Standard. Retrieved June 9, 2016 from table=standards&p_id=127 Occupational Safety & Health Administration. (2016a). Hazard Alert: Hair Smoothing Products That Could Release Formaldehyde. Retrieved June 9, 2016 from formaldehyde/hazard_alert.html Occupational Safety & Health Administration. (2016b). Quick Reference Guide to the Bloodborne Pathogens Standard. Retrieved June 8, 2016 from bloodbornepathogens/bloodborne_quickref.htm Occupational Safety & Health Administration. (2016c). Safety and Health Topics Health Hazards in Nail Salons. Retrieved June 8, 2016 from Sarfati, L. (2016). The Importance of Sanitary Waxing Practice. Dermascope. Retrieved June 8, 2016 from practices Wisconsin Department of Safety and Professional Services (2016). Administrative Rules and Statutes. Retrieved June 9, 2016 from Page 24

27 NOTES Page 25

28 Course Completion Instructions CE for Wisconsin Salon Professionals Steps to complete your online Elite continuing education course: 99 Review the course materials and complete the pre-program assignment in the book. 99 Answer the final examination questions in the book. 99 Proceed to Cosmetology.Elitecme.com. 99 Select your state and course. 99 Create a user login and password. 99 Submit the pre-program assignment answers online. You must complete this before you receive the button to proceed to the online final examination. 99 Submit your online final examination answers and payment to Elite. 99 Receive and print your certificate of completion immediately. Chapter Cos 11 CONTINUING EDUCATION Cos Continuing education requirements for license renewal. 5(c) Distance education, including completion of interactive short courses or tutorials, delivery of educational programs and courses on CD ROM or the internet or correspondence courses. Distance education courses shall meet the following criteria: 1. The course or program is offered by a provider approved under s. Cos and the program meets the requirements of s. Cos The course or program requires assignments that are completed or prepared by the licensee and submitted to the provider for correction, grading, or both. 3. The course or program includes a written examination designed to ensure that the licensee actively participated in the presentation of the material and derived a measurable benefit from participation. A score of 75 percent or higher shall be considered a passing examination score. 4. The course or program contains a reasonable procedure for verifying the enrollees identities. 5. The course or program contains a minimum of 50 minutes of actual instruction for each credit hour offered. For purposes of calculating actual instruction time, the time spent for testing and assessment purposes shall not be included. 6. All corrected or graded lessons and examinations are maintained by the provider for no less than 5 years and submitted to the board or its designee upon request for auditing purposes. Page 26

29 wisconsin Salon Professionals Pre-Program Assignment Questions Select True or False for questions 1-20 and mark your answers online at. 1. Cosmetology salons and schools should not knowingly require or permit a licensee or student to work upon a person with an infection or parasitic infestation capable of being transmitted to the licensee or student. 2. It is not necessary to clean the reception area including the electronics because no clients are exposed to this. 3. The toilet seat contains a greater ratio of bacteria than the telephone. 4. The tests used to measure the effectiveness of disinfectants on various pathogenic (disease-causing) organisms are called efficacy tests. 5. There are 5 main factors that affect how well a disinfectant works. 6. Bleach is an effective disinfectant and can be used exclusively to clean most areas in the salon and school. 7. The EPA registration number (awarded by the Environmental Protection Agency) ensures that you are using an approved disinfectant. 8. Disinfectants can be hazardous if prepared incorrectly. Consult the manufacturer s material safety sheets (MMSS) for information on preparing the solution. 9. In a salon atmosphere, disinfectants must be able to kill viruses, fungus and dangerous bacteria. This means that they should be used liberally on the skin. 10. In order to thoroughly wash the hands, the soap should be in contact with the skin for seconds or 2X the reciting of the Happy Birthday song. 13. Antibacterial agents are considered a good alternative to normal hygiene; but are considered toxic. 14. Many people demand antibiotics from the doctor when they have a severe cold, but antibiotics in this situation can actually do more harm than good. 15. There are three factors that have contributed to the rise of Methicillin-resistant Staph aureas (MRSA): 1. Overuse of antibiotics. 2. Close skin-to-skin contact with others. 3. Contaminated items and surfaces. 16. Cosmetologists, aestheticians, barbers and manicurists are not dermatologists or physicians who diagnose and treat skin disease and disorders. 17. In order to receive an electrologist license, one of the prerequisites are that the candidate must: Pay the initial credential fee and present satisfactory evidence to the examining board that the applicant has not been convicted of any type of felony. Pass an examination conducted by the examining board to determine fitness to practice. 18. A prescribed apprenticeship program is an approved alternative to the completion of the course in a school. 19. Starting with the March 2015 renewal, cosmetology licensees must complete 8 hours of approved continuing education in order to renew their active license. 20. Regarding Inspections, an inspector may enter and inspect any licensed establishment at any time, during normal business hours. 11. Soap and water will kill most of the bacteria on the hands, workstation or chair, but will not kill all the bacteria or fungal spores. 12. Sanitation, sterilization, and disinfection are terms that are commonly used interchangeably, but have very different meanings and require different procedures. Page 27

30 WISCONSIN SALON PROFESSIONALS Final Examination Questions Select the best answer for questions 1-20 and mark your answers online at. 1. Cosmetology means, for compensation, performing the following: Barbering, Aesthetics, and the removal of hair of any person at the root, except by use of an electric needle. What is the other profession under cosmetology which is missing from the list? a. Esthetics. b. Salon manager. c. Manicuring. d. Apprentice. 2. The greatest difference between an aesthetician and a dermatologist? a. Dermatologists do not analyze the skin. b. An aesthetician performs surgery on skin abnormalities. c. A cosmetologist uses different methods to aid in the healing treatments. d. The schooling required, basically a dermatologist is a doctor. 3. The examining board may permit the provision of personal care cosmetology, aesthetics, electrology, or manicuring services outside of licensed establishments by cosmetologists, aestheticians, electrologists, and manicurists, to persons who are. a. Afraid of closed in spaces. b. In school. c. Who are unable to pay. d. Unable to leave their homes. 4. The continuing education requirements for those licenses that perform delegated medical procedures, such laser hair removal, microdermabrasion, and chemical exfoliation. How many additional CE hours (in that specific field) are needed if a licensee performs one of these procedures? a. Ten. b. Four. c. Six. d. Two. 5. The examining board may revoke, limit, suspend, or refuse to issue or renew a license or permit or may reprimand the holder of a license if it finds that the holder or applicant has a. Continued to practice while knowingly having an infectious, communicable disease. b. Listed their age incorrectly on the renewal or initial application by mistake. c. Advertised in a truthful manner to the public. d. The licensee has been alleged to be negligent in practice in the licensed state. 6. Why do cosmetologists need to complete sanitation continuing education? a. Killer organisms can occur in the salon if we are not informed and following proper procedures. b. MRSA is on the rise. c. We will increase our business. d. Nonpathogenic bacteria are dangerous. 7. Bacterial cells that may be harmful to the body are called: a. Saprophytes. b. Pathogenic. c. Nonpathogenic. d. Fimbri. 8. Nonpathogenic bacteria that live on dead matter are known as: a. Cocci. b. Streptococci. c. Staphylococci. d. Saprophytes. 9. Pathogenic bacteria are responsible for all of the following EXCEPT: a. Causing disease. b. Producing toxins. c. Benefiting the environment. d. Produce pus. 10. Pus-forming bacterial cells that form in long chains and cause blood poisoning are called: a. Diplococci. b. Spirilla. c. Streptococci. d. Staphylococci. 11. Rod-shaped bacterial cells are known as : a. Cocci. b. Bacilli. c. Spirilla. d. Staphylococci. 12. What bacteria, when viewed through a microscope, would appear to be coiled, corkscrew-shaped bacterial cells? a. Spirilla. b. Flagella. c. Saprophytes. d. Staphylococci. 13. The client has been diagnosed with MRSA. Which type of bacteria is the cause of this disease? a. Spirilla. b. Streptococci. c. Staphylococci. d. Saprophytes. 14. The common cold, hepatitis and measles are examples of: a. Beneficial diseases. b. Communicable diseases. c. Saprophytes. d. Nonpathogenic diseases. 15. Which of the following is NOT a source through which bacteria or viruses enter the body? a. Mouth. b. Broken skin. c. Healthy skin. d. Eyes. 16. Nail fungus is a type of: a. Plant parasite. b. Pathogenic bacteria. c. Nonpathogenic bacteria. d. Mildew. Page 28

31 17. Plants or animals that live on or obtain nutrients from another organism are known as: a. Bacteria. b. Internal parasites. c. External parasites. d. Spores. 18. Infection control is divided into the following categories: a. Bacteriology, ecology, and first aid. b. Sanitation, disinfection and sterilization. c. Contamination, immunity and inoculation. d. Decontamination, antiseptics and concentration. 19. Key information on a specific product regarding ingredients, associated hazards, combustion levels and storage requirements is provided by: a. OSHA. b. MSDS. c. The efficacy label. d. EPA. 20. Which of the following steps should a cosmetologist perform immediately prior to a service? a. Rinse hands in cold water. b. Dry hands with a communal cloth towel. c. Wash hands with warm water and antimicrobial, liquid soap. d. Spray hands with a disinfectant. CWI04E17 Page 29

32 2017 Continuing Education Course for Wisconsin Salon Professionals Customer Information All 4 Hrs ONLY $ License Renewal Information Once you have received your certificate of completion you can renew your license online at UserLogin.aspx. In order to avoid late fees, your CE and license renewal must be completed before March 31. What if I Still Have Questions? No problem, we have several options for you to choose from! Online at Cosmetology. EliteCME.com you will see our robust FAQ section that answers many of your questions, simply click FAQ in the upper right hand corner or us at office@ elitecme.com or call us toll free at , Monday - Friday 9:00 am - 6:00 pm, EST. Board Contact Information: Mailing Address State of Wisconsin Department of Safety and Professional Services PO Box 8935 Madison, WI Street Address 1400 East Washington Avenue Madison, WI Phone: (608) or (877) Website: Elite Continuing Education Page 30

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