Pedicuring (6 hours) Pedicuring and Health and Sanitation. Presented by ContinuingCosmetology.com

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1 Pedicuring (6 hours) Pedicuring and Health and Sanitation Presented by ContinuingCosmetology.com

2 Pedicuring ( hours) TABLE OF CONTENTS page P ( ) 2 Sanitation ( 21 1

3 Pre-service Preparations for Pedicuring Outline Pre-service Sanitation Multi-use Tools Immersible Implements Hand Sanitation Storage Surfaces and Equipment Single-use Items Pre-service Station Set Up Learning objectives: After completing this lesson you will be able to: Identify steps for washing tools and implements with soap and water Describe proper rinsing and drying Explain sanitation by immersion Describe proper hand washing Identify steps for handling sanitized implements Describe storage of sanitized items Identify surface disinfecting procedures of pedicuring station and service areas Describe refilling single-use items 2

4 Introduction The purpose of this study module is to review the principles and practices of the preservice preparations for pedicuring. Precautions: It is required that all salon professionals read product labeling and instructional materials as well as state mandated sanitation regulations regarding products and equipment. To remain safe in the workplace, all federal and state laws must be followed. Never take for granted that you already know the proper use and procedures of any product. Manufacturers, from time-to-time, adjust application instructions of sanitizing chemicals as well as pedicuring products. Strengths, times of exposure, removal procedures and ingredient lists can change, so be diligent and consistent when reviewing labels, document enclosures, and manufacturers MSDS prior to use. Infection control depends on the proper use of sanitizing products. Any misuse of a sanitizing product can result in lessened effectiveness or injury. Preparation We are taught to be prepared. It is a motto commonly used. In the personal beauty-care industry, it is impossible to be a salon professional without possessing high-level preparedness skills. Your level of preparedness speaks volumes of the quality of work you produce. It is also evidence of your respect for the patron and for the profession. With that said, let's review how to professionally prepare for the pedicuring service. The first consideration in pedicuring preparedness is the availability of sanitized implements and equipment. Without the availability of properly sanitized equipment, services can not be performed. Having products in clean containers, and having sufficient amounts of sanitized towels, linens and other service instruments is not only a necessity but is a mandatory requirement. A well prepared salon professional will be able to perform more services throughout her day if all steps of pre-service, pedicuring procedures and post-service procedures are followed and more completed services means more revenue. At the end of the day, your level of preparedness can directly reflect in your total income. 3

5 Pre-service Sanitation One of the first things to do pre-service, is to sanitize. The following procedures are standard for pedicuring implements and multi-used tools. Washing Implements A) SOAP AND WATER: It is imperative that implements are thoroughly washed before the disinfection process. Image 1: Wash Implements The washing process removes any seen or unseen residue that may exist on pedicuring tools. To wash a multi-use pedicuring implement, use warm or cool running water and soap. You must use a sanitized scrub-brush to brush grooves and hinges of the implement. Rinsing Implements B) WATER: It is equally imperative that implements are thoroughly rinsed after the soap and water scrubbing. Rinsing under running water is a necessity for removing all traces of residual soap. Image 2: Rinse Implements Residual soap on pedicuring implements can deactivate the disinfectant agent during the disinfecting process. Use warm running water. Drying Implements C) CLEAN OR DISPOSABLE TOWEL: It is imperative that implements be thoroughly dried using a clean or disposable towel. Drying pedicuring implements is a necessity before the sanitizing process. Do not place wet pedicuring implements into disinfectant solution until they are completely dry as water can dilute the disinfectant thus reducing it's effectiveness. Image 3: Dry Implements 4

6 Disinfecting Implements D) IMMERSION: When using an EPA-registered disinfectant, you are required to read the instructions for use. It generally has an immersion time of 10 minutes for full effectiveness. Read labels and follow manufacturer's instructions for mixing and time exposure. Be sure that you use an EPA-registered disinfectant solution that is designed specifically for the type of material in which your pedicuring instruments are made. The manufacturer is responsible for supplying information as to protective wear, containers and tools that are best suited for storage, handling, use and mixing of their products. Use the recommended type of container that allows the instrument to be completely immersed. Generally a hard plastic re-useable container is the designated type of material that is safe with using a sanitizing agent. Follow your state regulations regarding this aspect of sanitation. Hand Washing E) LIQUID SOAP: There are no other pre-service sanitation procedures more common sense oriented than the procedure of washing your hands. Image 4: Hand Washing As a salon professional, washing your hands should be a well established routine at any level. Use a liquid soap, rinse and dry with a clean single-use or disposable towel. Refer to State Sanitation Regulations to be in compliance. Removing Implements from the Disinfectant Solution F) TONGS AND GLOVES: Great care is to be taken by the salon professional when removing the sanitized implements from the disinfectant solution. Wear gloves if you are going to remove the implement by hand. Wearing protective goggles is a good idea to prevent any inadvertent splashes to come in contact with your eyes. If you prefer, you can use tongs to remove the instruments and to hold under running water until rinsed. Upon removal of the instrument from the solution, hold under water and rinse thoroughly. Dry with a clean or disposable towel to prevent the implement from rusting. Storing Sanitized Implements G) CLEAN CONTAINER:Follow your State Regulations for storage of sanitized implements. It is universally accepted to store sanitized implements in a clean covered container. Some States allow storage in clean cabinets. We will visit NC State requirements later in this study. 5

7 Manicurist's Table and Patron Surfaces H) SANITIZE: Sanitize the manicurist's table by wiping it with a sanitizing liquid. Also, wipe all surfaces in the patron area that will come in contact with the patron's skin. Image 5: Sanitize Surfaces again and allow to air dry. Spray the surface with a sanitizing solution that is designed for sanitizing large surface areas and let it stand for 10 minutes or per manufacturer's directions. Dry the surface with a clean towel then spray the area Refill Disposable Items I) SINGLE-USE ITEMS: Re-fill the containers on the manicurist's table - where you keep single-use items that will be used during the service: such as cotton balls. Hand Sanitizer Products J) ADDITIONAL HAND CLEANSING: Make available at your station a container of alcohol-based hand sanitizing gel. It can be used in addition to hand washing and is to be offered to the client as well. Pre-service Station Set Up Your station should be set up to meet the needs of your body type. If you are short you can find ways to customize your area so things are within easy reach as to reduce the risk of strain while performing the service. Your set up should include a manicurist's stool or chair that is comfortable for customary service time periods. Your station of course includes the client's chair and footrest. All furniture, tables and footrests should be situated to accommodate patrons comfortably. Towels Arrange a clean towel onto the client's footrest and one onto the floor in front of her chair. She will need clean towels in every area that she may place her feet during the pedicuring service. One towel will usually suffice for the floor area in front of the client's chair and one towel is to be placed on the footrest - which will be used to dry her feet. 6

8 Add Pedicuring Items In addition to standard single-use manicuring items, stock the manicurist's table with the following: lotions, creams, oils liquid soap pedicure slippers toe separators foot files nail clippers Water Basin A water basin is to be prepared and placed at your station. Prepare the water basin with warm water and the appropriate amount of liquid soap. Image 6: Water Basin Client Consultation Determining whether a pedicuring service is right for a client is the main idea behind the consultation. You might spot issues that the client herself is unaware of. Check her feet for any signs of inflammation, wounds or problems. Performing services when there is infection present is prohibited. Do not perform services when there is injury or broken skin. 7

9 The Pedicure Service Outline Service Procedures: Skin Care of the Feet Service Procedures: Toenail Care Pedicuring Procedures of the Toenail Pedicuring Procedures of the Skin of the Feet Final Procedures Post-pedicure Practices Learning objectives: After completing this lesson you will be able to: Identify practices of client preparation Describe procedures for soaking the feet Describe procedures for drying the feet Identify procedures for removing nail polish Define practices for cuticle removers and callus softeners Identify procedures and safe use of the curette Explain practices of toenail trimming Describe procedures in removing cuticle tissue Identify the use of the rasp Explain exfoliation Describe smoothing procedures for calluses Identify rinsing procedures Describe the use of masques and hot waxes Describe post-service client follow-up and sanitation 8

10 Introduction The purpose of this study module is to review procedures for pedicuring. Your spa or salon may offer different types of pedicuring packages that provide optional add-on services in addition to standard services, however we will review what is universally accepted as standard procedures for a full service pedicure. Full Service Pedicuring Procedures The full service pedicure should take approximately 15 minutes per foot to perform. The following information represents standard professional procedures of a full service pedicure. The Pedicure Ask your patron to remove his shoes and hosiery and to roll or fold his pant legs up to the knees. SOAKING A) Proper temperature of water is the first consideration of the soaking process. To ensure the safety and comfort of your client, water temperature must not exceed 104 F. Image 7: Soaking Fill the foot basin with warm water. Use a sanitized thermometer to monitor water temperature. Add soap /soaking product into the warm water Have the client to place his feet into the foot basin Soak the feet for 5 minutes, allowing the skin to soften and cleanse NAIL CARE B) Nail Care: Have the client to remove one foot from the basin, and place it onto the towel-covered footrest 9

11 DRY:Using the clean towel of the footrest, thoroughly dry the foot: make sure that all areas of the foot and between the toes are towel-dried Image 8: Dry Foot REMOVE POLISH:Begin with nail care by removing any existing nail polish from the toenails APPLY PRODUCTS:Apply cuticle remover and callus softeners as needed, and allow product to remain on those areas while performing the following steps Image 9: Cuticle Remover CLEAN NAIL AREA:CURETTE: Use the curette tool to gently nudge the soft tissue away from the nail plate in order to prepare the nail for trimming: remove any debris that may be resting in that area by using the spoon edge of the curette: the rounded side should face the tissue and the scoop side should face the nail TRIM TOENAILS:NAIL CLIPPERS AND THE FREE EDGE: Only trim the free edge. Use multiple small cuts beginning on one side working your way to the other side. This technique avoids flattening the nail which could injure the nail bed. When the toenail flattens it can cause the flesh to tear at the strained areas, so small multiple cuts are required to avoid injury. Another safety technique is to slightly tilt Image 10: Trim Toenails the top of the clippers back toward the nail plate when clipping. This helps keeping the clippers a safe distance from the soft tissues of the hyponychium under the free edge. Always, trim the toenails straight across. Be careful not to leave sharp edges on the corners of the trimmed nail as this can cause injury to the skin of the toes. RASP:Using your nail rasp, locate and remove any rough edges or hooks that were created while trimming. Removing hooks and sharp edges will prevent injury thus aid in preventing infections. 10

12 TRIM TAGS OF DEAD SKIN:NIPPERS:Use nippers to trim any tags of dead skin surrounding the nail area. Do not trim away any living tissue. REPEAT PROCEDURES WITH THE CURETTE: Upon completion of trimming and rasping the toenails go back over each toenail using the curette to gently find and remove any more debris that might have appeared during the trimming process. Re-check the sidewalls of the nail plate for any residual debris and for any rough edges that need additional attention with the rasp. CUTICLE: Using the curette remove cuticle tissue from the nail plate. Do not break the seal of the eponychium by pushing it back from the toenails but keep it in tact. FILE:Smooth and shape the free edge of the toenails with an abrasive file. Replace the client's foot back into the water basin and remove the second foot from the water and prepare it for nail care procedures NAIL CARE C) Repeat nail care steps to the second foot. SKIN CARE D) Skin care procedures focus on the skin of the foot and is performed after all nail care procedures are performed. During nail care, a callus softener was applied and has now softened calluses. The skin has been softened by soaking and is ready for the smoothing process. EXFOLIATION: To smooth the skin, apply an exfoliation product to the foot. Scrub the dry areas and focus on heels and calluses. Image 11: Exfoliation CALLUSES: Additional smoothing of calluses: using an abrasive foot paddle, smooth calluses using a gentle filing motion. Calluses are to be smoothed not removed. Take care to not overly file calluses and do not attempt to thin them. They occur because of the body's protective reaction to a repetitive irritation to the skin such as rubbing or pressure and should remain in tact and only smoothed for the purpose of better foot comfort. 11

13 RINSE D) Place the foot back into the foot bath and rinse the products from the feet. The salon professional can use a brush and gently brush the feet and toenails to remove any residue of products. Clean the areas between the toes. MASQUE or PARAFFIN E) At this point in the process, a masque or hot paraffin wax add-on service can be performed. Apply the masque or hot paraffin wax product according to manufacturer's directions. To enhance the hot wax service, apply oils or creams just before the hot wax is applied. The hot wax will aid in the penetration of the oil into the skin thus enhancing the quality of the skin care process. After applying hot wax, place the client's foot into a plastic bag and cover with a cloth pedicuring booty or cloth towel. Repeat this process for the other foot. Remove paraffin according to manufacturer's directions. POLISH F) This is also optional as to the customer's preference. When performing the nail polish application, use toe separators or cotton between toes in order to keep toes from touching one another while the polish is wet. Remove all residual hot wax from the toenails before polishing. For a professional finish you must apply the following 4 coats: a base coat, 2 color coats and a top coat. Post-service Procedures APPOINTMENT SETTING:Upon completion or your fabulously executed pedicuring service, it is a perfect time to book a future appointment with your client. She is relaxed and well cared for and sees the value of giving herself this manner of care. It is a perfect time to book her next appointment. SHAKE IT UP: Each pedicuring experience can be blissfully different in that the salon professional can get creative with add-on services and change it up with each appointment. Keeping the pedicuring experience fresh with new approaches and products maintains interest from the client and lets her know you have taken a personal interest in serving her. EDUCATING YOUR CLIENT: Another way to show the client that you are giving her high consideration in all areas is to give her information about caring for her feet at home. Give her information about products and procedures that are easy to apply by herself. Tell her about the health benefits of consistent self-care. If your client has calluses, give her tips to reduce the likelihood of this condition. 12

14 RETAIL: All clients need products and there are an abundance of product lines available for foot care. Most salons and spas have picked up on the marketing idea that the product can sell itself if used on the patron during the service. The patron then has direct experience with those individual products and immediately know it's results on their skin and /or nails. When using an exfoliating scrub during the pedicuring procedure, mention the wonderful aromatic scent that it has and point out how smooth it made her skin. Image 12: Retail She may want to have that product available to her for home use. Another example of good retail marketing is: if your client mentions that she is preparing for a special event - later when she is gathering her retail purchase items, ask her if she would like to get some nail polish to match her outfit that she will be wearing for that special occasion. Get creative and meet her needs. POST-SERVICE SANITATION:With no exceptions, all salon professionals must sanitize pedicuring basins, client areas, and pedicuring implements after the service is complete. All sanitation procedures that were performed in pre-service procedures must be repeated for post-service sanitation. As in the pre-service sanitation procedures: Clean by soap /water, brushing and rinsing for all foot basins, pedicuring implements, manicuring tables and equipment surfaces that touch the client's skin. Sanitize with EPA-registered disinfectant solutions per label instructions. RESTOCK:Refill single-use items of the manicurist's table and restore it to a useable status. 13

15 Selected Pedicuring Supplies Outline Selected Pedicuring Supplies Learning objectives: After completing this lesson you will be able to: Identify types of nail files and the purposes of each Describe foot files and their purpose Define features of nail clippers Describe nail nippers and proper use Define the curette and describe it's use Explain toes separators Describe pedicuring stations Identify types of manicurist's stools Describe water baths 14

16 Introduction In this study module we will continue studying important aspects of the pedicuring service. We will review detailed information about pedicuring equipment, supplies, tools and products. Precautions As always, remember to read labels and packaging directions and instructions for all equipment, supplies, tools and products before use. Learning how to store and care for these items will give them longer lasting life and keep your salon a safe environment. Pedicuring Supplies Description and Purpose nail file Origin: Definition:a small board of metal or cardboard, usually elongated and thin, used for smoothing, or shaping the nails Nail files come in levels of abrasiveness called grits. There are coarse-grit, medium-grit and fine-grit files. Coarse-grit files have fewer but larger - abrasive particles and are the most abrasive. Coarse-grit files contain less than 180 particles per centimeter.they remove larger amounts of nail in a single action than the other grit levels. Image 13: Nail Files Coarse-grit files are not for nail surfaces but for the free-edge. A coarsegrit file would create unseemly scratches on the nail surface if used for filing that area of the nail. It is also best not to use coarse-grit files on thin or average nails but to reserve them for use only on very thick nails. Medium-grit files have particles per centimeter which are smaller in size than coarse-grit particles. They are often the most widely used file for shaping nails. They serve excellently for shaping and refining thin to average nails. Fine-grit files have more than 240 particles per centimeter and are the smallest in size in comparison to the coarse-grit and medium-grit files. They are the best file type to use for buffing, polishing and removing small scratches from the nail surface. 15

17 foot file /paddle Definition: Foot files are sanding files that are larger than nail files and are for smoothing skin and callouses of the foot, and for reducing dry skin. They are sometimes designed in the shape of a paddle. Foot files come in both multi-use and single-use styles. Image 14: Paddle Foot File Image 15: Foot File If multi-use, they must be cleaned and disinfected after each patron and if they are single-use they must be disposed of after each patron. Foot files also come in a hybrid of multi-use / singleuse. They have abrasive pads or filing surfaces that are single-use / disposable and the handle is multi-use / disinfect-able. nail clippers Origin: Definition:a small mechanical device for clipping the nails. Toenail clippers are specifically designed for trimming the toenails and are larger than fingernail clippers. The blades come in different shapes. Most often the nail professional uses the type where the blade is straight across but some use the type that is slightly curved in a concave style. The blade area is called the jaws. The higher-end professional toenail clipper will have it's jaws meet as a fine point at the blades edge whereas lower-end clippers will meet more Image 16: Clippers bluntly at the blades edge. Blunter jaws can cause less effectiveness and precision. 16

18 nail nippers Definition:a small mechanical device for trimming tags of dead skin from the surrounding area of the nail There are many styles of manicurist's nippers on the market. It is ideal to select tools that fit your hand size. Being comfortable with your tools makes for a higher quality service. Like all professional tools, it is best to choose nail nippers that are high quality and have a fine well-meeting blade edge. Image 17: Nippers Using sharp nippers can help prevent pulling or tearing of the skin. Another way to prevent injury, hold the nippers very still while trimming away dead skin. Movement during use, other than squeezing the tool, can result in grabbing, ripping or tearing the skin. curette Origin: Pronounced: [kyoo-ret] Definition:a small, hand-held, scoop-shaped instrument used for removing debris from around nail folds and cuticle area of the nails This implement was first designed as a surgical instrument used for removing dead tissue of the human body from the walls of various body cavities. It was later implemented into practice for manicuring the nails. Image 18: Curette The recommended curette for pedicuring is the doublesided style. It's size is approximately 1.5 millimeters in diameter on one end and 2.5 millimeters in diameter on the other end. It is shaped similar to an ice cream scooper but can vary slightly in lengths and shapes. Unlike the nail nipper or nail clipper, the curette should not be sharp. In fact, it should be quite dull with no sharp edges. 17

19 It is not designed to cut into the nail, nail folds or cuticle but to remove debris which requires no cutting only gentle scrapping. The gentle scrapping of the surrounding area of the nail plate should not include any digging of the nail fold areas. If you find that the debris is snugly adhering to tissue, do not use the curette to force it loose. Doing this could result in injury to the patron. toe separators Definition: a form made of foam rubber or other material, that is specifically shaped to fit beneath and between the toes in order to keep the toes separated enough that they will not touch each other in order to independently apply products to each toenail A great alternative to foam separators are standard cotton balls. Image 19: Toe Separators Pedicuring stations Pedicuring stations include the client's chair, a platform or floor area for the water basin, and a footrest. The pedicuring station may be an all-in-one style or each item may be separate and portable. The client should sit higher than the pedicurist so the foot will be easily placed on a footrest positioned at a comfortable working level for the pedicurist. Equipment can be cost effective and still provide comfort, high quality and usability. Client comfort is a high consideration when choosing pedicuring stations. Her chair Image 20: Pedicuring Station and footrest should be situated for her relaxation as well. 18

20 Manicurist's chairs and stools Manicurist's chair Manicurist's chairs and stools come in various shapes, sizes and designs. Some chairs have adjustable backs and /or lumbar supports. Stools customarily have no back. Image 21: Manicurist's Chair Your manicurist's chair or stool should ideally be vertically adjustable in that it is easily lowered or raised to fit your needs. Manicurist's stool The saddle stool is often used in salons because it rolls on casters, the seat swivels, and it has quick and easy height adjustment. The pedicurist should be able to perform all procedures in a relaxed position using comfortable movements. Image 22: Manicurist's Stool There are many choices in pedicurist stools, client chairs and stations, portable foot baths, supply carts and manicurist tables. 19

21 Water baths Water baths are basins used for pedicuring. They hold warm water and soaking liquid for cleansing and softening the skin of the feet. Portable water baths / basins are available in many different sizes, shapes and styles. Some have features such as motorized whirlpools. One desirable feature of a portable footbath is it's ease of filling and emptying. Many portable footbaths are Image 23 Water Basin customized units that have a Image 24: Water Basin distinctive area for each foot. 20

22 Sanitation ( ) Outline Sanitation, Disinfection, and Sterilization EPA Universal Sanitation Hand-washing MRSA (Methicillin-Resistant Staphylococcus Aureus) Learning objectives: After completing this lesson you will be able to: explain the 3 levels of sanitation identify sanitation procedures describe the frequency of each type of sanitation procedure describe sanitary product usage identify methods of cleaning identify methods of storing cleaned implements describe procedures for blood contaminated items explain important elements of EPA standards regarding disinfectants list the types of diseases that hand-washing can prevent describe effective hand-washing techniques compare alcohol gels to hand-washing describe pathogen transmission define and explain the types of dermatitis associated with hand-washing describe facts about MRSA that were discovered through scientific research Introduction The purpose of this study is to review the principles, practices and theories of sanitation, disinfection and sterilization to include State rules and the United States Environmental Protection Agency (EPA). 21

23 Read the following information WHAT IS SANITATION? Sanitation is the first level of the sanitation process. Under this level soap and water are used to clean and remove dirt and debris. Then the next level of the sanitation process is ready! IMPORTANT DISINFECTION Disinfection is the second level of the sanitation process. This process must be used for all items that come in contact with a client. This means that all tools/implements that touch a client s skin, hair, nails, etc must be sanitized before being disinfected. Under this level, disinfectants kill most bacteria and must be performed after each client. Disinfectant products will have the word disinfectant on the cover of the bottle or can. Some products are even registered with the EPA stating how effective the product is at killing bacteria. After items that come in contact with clients are sanitized then disinfected, the next step may be required, but only when blood or body fluid is involved. STERILIZATION Sterilization is the final stage of the sanitation process and is only required when tools or implements come in contact with blood or bodily fluids. This process kills all bacteria and sterilizes the tools or implements. Many nail equipment and aesthetic equipment may fall under the category, but when there is the smallest blood spill or bodily fluids are exposed from the skin sterilization is a must! For sterilization product information, you may visit your local beauty supply store. All Salon Professionals must be thoroughly familiar with the purposes and procedures for each of the above types of sanitation. 22

24 On a personal level, each Salon Professional must hold themselves accountable for implementing these regulations for each and every service they perform. The safety of you and your patron depends on State and Federal health and safety regulations set forth by these entities. Read the following information regarding Universal Sanitation regulations from the United States Environmental Protection Agency (EPA). Proper Cleaning and Disinfection Everything in the salon has either a hard or soft surface. Any surface coming into direct contact with a client s skin is considered contaminated. All contaminated surfaces must be thoroughly and properly: 1) cleaned and then 2) disinfected. To be considered properly clean, a surface must first be thoroughly scrubbed free of all visible signs of debris or residue. Proper cleaning is the total removal of all visible residue from every surface of tables, tools and equipment, followed by a complete and thorough rinsing with clean water. Proper cleaning must be performed before continuing with the disinfection step. Proper disinfection is the destruction of potentially harmful or infection-causing microorganisms (pathogens) on a pre-cleaned surface. Disposable (single-use) items Items that the manufacturer designs to be disposed of after one use are called disposable or single-use. These items must be properly disposed of after one use on a single client. Reusing these items is considered an unsanitary, improper and unprofessional practice. Some examples of disposable items are: cotton balls, gauze pads, wooden implements, disposable towels, toe separators, tissues, and wooden sticks. Items damaged during the cleaning and disinfecting process are considered single-use and must be discarded after every client. Proper Product Application Some types of products can become contaminated if improperly used. Some examples are: creams, lotions, scrubs, paraffin wax, masks, and oils. These products must always be used in a sanitary manner that prevents contamination. For example, paraffin and nail oils should not be applied with a brush (or spatula) that has touched the skin. These practices may introduce bacteria into the product and cause contamination that can render products unsafe for use. 23

25 To avoid product contamination always: (a) Dispose of used or remaining product between clients. (b) Use single-use disposable implements to remove products from containers for application or remove product with a clean and disinfected spatula and put product to be used into a disposable or disinfect-able service cup. (c) Use an applicator bottle or dropper to apply the product. Proper Disinfection of Multi-use Tools and Equipment Some items are designed to be used more than once and are considered to be multi-use. Multi-use items are sometimes referred to as disinfect-able, which means that the implement can be properly cleaned and disinfected while retaining its usefulness and quality. Multi-use items are designed for use on more than one client, but require proper cleaning and disinfection between each use. Examples of multi-use items include cloth towels, and manicure bowls. Hard and nonabsorbent items constructed of hard materials that do not absorb liquid, like metal, glass, fiberglass or plastic should be cleaned and disinfected as described below. Individual Client Packs Tools/instruments kept in individual packs must be properly cleaned and disinfected after each use. State rules require all tools and equipment to be disinfected before being reused, even if used by the same client! Improperly cleaned and disinfected implements may grow infection/disease-causing organisms before the client returns for their next visit, thereby increasing the risk of infection. Never use air-tight bags or containers for storage as these can promote bacterial growth. Methods of Proper Cleaning Proper cleaning requires liquid soap/detergent, water and the use of a clean and disinfected scrub brush to remove all visible debris and residue. All items should be scrubbed with a clean and disinfected scrub brush under running water. Cleaning is not disinfection; disinfection is an entirely separate step. Different items are cleaned in different ways. This often depends on what the item is made of and how it was used. NOTE: the cleaning step must be properly performed before an item can be disinfected. All items must be thoroughly rinsed and dried with clean cloth or paper towels prior to putting them into a disinfectant. Methods of Proper Disinfecting After proper cleaning, all reusable implements and tools must be disinfected by complete immersion in an appropriate disinfecting solution. The item must be completely immersed so that all surfaces, including handles, are soaked for the time required on the disinfectant manufacturer s label. 24

26 In general, U.S. Environmental Protection Agency (EPA) registered disinfectants require 10 minute immersion. Remove items after the required time, using clean and disinfected tongs or gloves to avoid skin contact with the disinfectant solution. If required by the instruction label, rinse thoroughly in running water. Allow items to air dry completely by placing them on top of a clean towel and covering them with another clean towel. Methods for Proper Storage All properly cleaned, disinfected and dried implements must be stored in a sanitary manner. Appropriate Disinfectants How do you know if a disinfectant product is suitable for professional salon use? Standards and requirements vary from country to country, but in the United States, the EPA registered Hospital disinfectants with bactericidal, fungicidal and virucidal claims on the label are best for use in salons. Disinfectant products are designed to destroy disease-causing microorganisms (pathogens) on non-living surfaces, such as those described in this document. They are not appropriate for use on living skin and contact with skin should be avoided. Appropriate salon disinfectants include the following: (a) EPA-registered Hospital disinfectants with bactericidal, fungicidal and virucidal claims on the label. (b) 10% bleach solution (1 part bleach to 9 parts water) Contact with Blood, Body Fluid or Unhealthy Conditions If blood or body fluid comes in contact with any salon surface, the nail professional should put on a pair of clean protective, disposable gloves and use an EPA-registered Hospital liquid disinfectant or a 10% bleach solution to clean up all visible blood or body fluid. Disposable items, must be immediately double-bagged and discarded after use, as described at the end of this section. Any non-porous instrument or implement that comes in contact with an unhealthy condition of the nail or skin, blood or body fluid, must be immediately and properly cleaned, then disinfected using an EPA-registered Hospital disinfectant as directed or a 10% bleach solution. Any porous/absorbent instrument that comes in contact with an unhealthy condition of the nail or skin, blood or body fluid must be immediately double-bagged and discarded in a closed trash container or bio-hazard box. 25

27 Some EPA disinfectants are registered for hospital use, but may not say Hospital on their label. In these cases, the product label MUST claim effectiveness against Salmonella choleraesuis, Staphylococcus aureus, and Pseudomonas aeruginosa. Additional Information about Disinfectants and Cleaners 1) Disinfectants must be mixed, used, stored and disposed of according to manufacturer s label instructions (proper mixing ratio is of the utmost importance to be an effective disinfectant). Some are ready to use and do not require mixing. 2) U.S. Federal Law prohibits the use of EPA-registered disinfectants in a manner that is contrary to its label. 3) Disinfectants must be prepared fresh every day (including spray bottles). Further, they must be replaced immediately if the solution becomes visibly contaminated. Disinfectant solutions will lose their strength upon standing and become ineffective within 24 hours. Use a logbook to record when fresh disinfectant is made. 4) Disinfectants are ineffective if implement/tools are not properly cleaned prior to use. 5) Just spraying disinfectants on tools and equipment is inadequate. 6) Disinfectants can damage or rust some metal tools if improperly used. 7) All disinfectant containers must be properly labeled. Disinfectant solutions prepared in the salon must list on the container: the contents and percentage solution (concentration), and use a logbook to record the date and time of mixing. Check the label for the product s expiration date. 8) All brushes used for cleaning purposes must be properly cleaned and disinfected between each use. 9) Ultra-violet light cabinets are not suitable replacements for liquid disinfectant solutions. 10) Read all warning labels and precisely follow manufacturer s instructions. These guidelines are believed to be highly effective and are designed to help avoid unforeseen pitfalls, problems and complications. These guidelines are not a replacement for local government standards, rules or regulations. Always consult federal, state and local laws and regulations, which may vary somewhat from these recommendations. 26

28 Disinfectants used should indicate on the label that they're approved for hospital use. A disinfectant label should clearly show its uses and that it is EPA-approved. Study the following information. Merriam-Webster's Medical Dictionary defines Disinfectants and Antiseptics as: Antiseptic: a substance that inhibits the growth and reproduction of disease-causing microorganisms. For practical purposes, antiseptics are routinely thought of as topical agents, for application to skin and mucous membranes. Their uses include cleansing of skin and wound surfaces after injury, preparation of skin surfaces prior to injections or surgical procedures, and routine disinfection of the oral cavity as part of a program oral hygiene. Disinfectant: Any chemical agent used chiefly on inanimate objects to destroy or inhibit the growth of harmful organisms. Hand Washing Hand washing, when done correctly, is the single most effective way to prevent the spread of communicable diseases. Good hand washing technique is easy to learn and can significantly reduce the spread of infectious diseases among both children and adults. What types of disease can good hand washing prevent? Diseases spread through fecal-oral transmission. Infections which may be transmitted through this route include salmonellosis, shigellosis, hepatitis A, giardiasis, enterovirus, amebiasis, and campylobacteriosis. Because these diseases are spread through the ingestion of even the tiniest particles of fecal material, hand washing after using the toilet cannot be over-emphasized. Diseases spread through indirect contact with respiratory secretions. Microorganisms which may be transmitted through this route include influenza, Streptococcus, respiratory syncytial virus (RSV) and the common cold. Because these diseases may be spread indirectly by hands contaminated by respiratory discharges of infected people, illness may be avoided by washing hands after coughing or sneezing and after shaking hands with an individual who has been coughing and sneezing. Diseases may also be spread when hands are contaminated with urine, saliva or other moist body substances. Microorganisms which may be transmitted by one or more of these body substances include cytomegalovirus, typhoid, staphylococcal organisms, and Epstein-barr virus. These germs may be transmitted from person to person or indirectly by contamination of food or inanimate objects such as toys. 27

29 What is good hand washing technique? By rubbing your hands vigorously with soapy water, you pull the dirt and the oily soils free from your skin. The soap lather suspends both the dirt and germs trapped inside and are then quickly washed away. Follow these four steps to keeping hands clean: Wet your hands with warm running water. Add soap, then rub your hands together, making a soapy lather. Do this away from the running water for at least 15 seconds, being careful not to wash the lather away. Wash the front and back of your hands, as well as between your fingers and under your nails. Rinse your hands well under warm running water. Let the water run back into the sink, not down to your elbows. Dry hands thoroughly with a clean towel. Then turn off the water with a clean paper towel and dispose in a proper receptacle. May I use the over-the-counter alcohol gels for washing my hands instead of using soap and water? These products, which can be found wherever soap is sold, are very effective at killing germs on the hands as long as your hands are not visibly dirty. They should be used when soap and water are not readily available. To use correctly, apply about a teaspoonful of the alcohol gel on the palm of one hand. Then rub all over both hands, making sure you rub the front, back, and fingernail areas of both hands. Let the alcohol dry, which should take about 30 seconds.if your hands look dirty but you have no other way to wash your hands, use the gel but wash with soap and water as soon as you can. Transmission of Pathogens on Hands Transmission of pathogens from one person to another happens when: Organisms present on the patron's skin transfers to the hands of the Salon Professional Hand washing or hand antisepsis by the Salon Professional are inadequate or omitted entirely, or the agent used for hand hygiene is inappropriate. The contaminated hands of the Salon Professional comes in direct contact with another person, or with an inanimate object that will come into direct contact with a person Pathogens can be transported from one person to another. The number of organisms present on the skin varies. Persons with diabetes, patients undergoing dialysis for chronic renal failure, and those with chronic dermatitis are more likely to have colonized organisms. We shed microorganisms daily from normal skin onto nightgowns, bed linen, bedside furniture, and other objects in our environment. 28

30 Scientific Study of Hand Washing Investigators use different methods to study hand washing, antiseptic hand wash, and hand antisepsis protocols. Differences among the various studies include: whether hands are purposely contaminated with bacteria before use of test agents, the method used to contaminate fingers or hands, the volume of hand-hygiene product applied to the hands, the time the product is in contact with the skin, the method used to recover bacteria from the skin after the test solution has been used, and the method of expressing the effectiveness of the product Despite these differences, the majority of studies can be placed into one of two major categories: 1. studies focusing on products to remove transient flora and 2. studies involving products that are used to remove resident flora from the hands The majority of studies of products for removing transient flora from the hands involve artificial contamination of the volunteer's skin with a defined test organism before the volunteer uses a plain soap, an antimicrobial soap, or a waterless antiseptic agent. In the United States, antiseptic hand wash products are regulated by FDA's Division of Over-the-Counter Drug Products (OTC). Products are evaluated by using a standardized method. Tests are performed in accordance with use directions for the test material. Plain (Non-Antimicrobial) Soap Soaps are detergent-based products that contain esterified fatty acids and sodium or potassium hydroxide. Their cleaning activity can be attributed to their detergent properties, which result in removal of dirt, soil, and various organic substances from the hands. Plain soaps have minimal, if any, antimicrobial activity. However, hand washing with plain soap can remove loosely adherent transient flora. Alcohol-based Hand Cleansers The majority of alcohol-based hand antiseptics contain either isopropanol, ethanol, n- propanol, or a combination of two of these products. The majority of studies of alcohols have evaluated individual alcohols in varying concentrations. 29

31 Alcohols, when used in concentrations present in alcohol-based hand rubs, also have activity against several viruses. For example, 70% isopropanol and 70% ethanol are more effective than medicated soap or nonmedicated soap in reducing viruses on fingers. Products containing 60% ethanol were also found to reduce the presence of viruses. Other viruses such as hepatitis A and the polio virus may require 70%--80% alcohol to be reliably inactivated. However, both 70% ethanol and a 62% ethanol foam product with emollients reduced hepatitis A virus on whole hands or fingertips more than nonmedicated soap. However, depending on the alcohol concentration, the amount of time that hands are exposed to the alcohol, and viral variant, alcohol may not be effective against hepatitis A and other viruses. Alcohol can prevent the transfer some pathogens. Alcohol-based products are more effective for standard hand washing than soap or antimicrobial soaps. The effectiveness of alcohol-based hand-hygiene products is affected by several factors, including: the type of alcohol used concentration of alcohol contact time volume of alcohol used and whether the hands are wet when the alcohol is applied Frequent use of alcohol-based formulations for hand antisepsis can cause drying of the skin unless emollients, humectants, or other skin-conditioning agents are added to the formulations. The drying effect of alcohol can be reduced or eliminated by adding 1%-- 3% glycerol or other skin-conditioning agents. Moreover, in several recent prospective trials, alcohol-based rinses or gels containing emollients caused substantially less skin irritation and dryness than the soaps or antimicrobial detergents tested. These studies, which were conducted in clinical settings, used various subjective and objective methods for assessing skin irritation and dryness. Further studies are warranted to establish whether products with different formulations yield similar results. Alcohols are flammable. As a result, alcohol-based hand rubs should be stored away from high temperatures or flames in accordance with National Fire Protection Agency recommendations. 30

32 Irritant Contact Dermatitis Resulting from Hand-Hygiene Measures Frequency of Irritant Contact Dermatitis Frequent and repeated use of hand-hygiene products, particularly soaps and other detergents, is a primary cause of chronic irritant contact dermatitis. This is of great concern to all Salon Professionals. The potential of detergents to cause skin irritation can vary considerably. Irritation associated with antimicrobial soaps may be caused by the antimicrobial agent or by other ingredients of the formulation. Affected persons often complain of a feeling of dryness or burning; skin that feels rough or even scaling. Detergents can damage the skin. Irritant contact dermatitis is more commonly reported with iodophors. Other antiseptic agents that can cause irritant contact dermatitis (in order of decreasing frequency) include chlorhexidine, triclosan, and alcohol-based products. Skin that is damaged by repeated exposure to detergents may be more susceptible to irritation by alcohol-based preparations. Allergic Contact Dermatitis Associated with Hand-Hygiene Products Allergic reactions to products applied to the skin may present as delayed type reactions or less commonly as immediate reactions. The most common causes of contact allergies are fragrances and preservatives; emulsifiers are less common causes. Liquid soaps, hand lotions or creams, and may contain ingredients that cause contact allergies. Allergic contact dermatitis associated with alcohol-based hand rubs is uncommon. Allergic reactions to alcohol-based products may represent true allergy to alcohol, allergy to an impurity or aldehyde metabolite, or allergy to another constituent of the product. Proposed Methods for Reducing Adverse Effects of Agents Potential strategies for minimizing hand-hygiene--related irritant contact dermatitis include reducing the frequency of exposure to irritating agents (particularly detergents), replacing products with high irritation potential with preparations that cause less damage to the skin, and increasing education on hand care. Hand lotions and creams often contain humectants and various fats and oils that can increase skin hydration and replace altered or depleted skin lipids that contribute to the barrier function of normal skin. 31

33 MRSA Methicillin-Resistant Staphylococcus Aureus In health news reports, awareness of one particular type of invasive staph infection has come to the forefront. It is called MRSA. It is also known as the flesh eating disease. The results of having this disease is often bodily disfigurement. Bodily damage occurs in varying degrees of severity. An outbreak of USA300 strain MRSA: methicillin-resistant Staphylococcus aureus occurred in a Cosmetologist and 2 of her customers. Eight other persons, who were either infected or colonized, were linked to this outbreak, including a family member, a household contact, and partners of customers. The CA-MRSA USA300 strain is known to cause outbreaks among population groups, such as: native Americans, prison inmates, military personnel, men who have sex with men, and competitive sports participants, and accounts for 97% of MRSA isolates obtained in emergency departments across the United States from patients with soft tissue infections. CA-MRSA is associated with invasive infections. The USA300 strain, which is also found in Europe was first isolated in the Netherlands in Overall prevalence of MRSA in the Netherlands is low (2%). In 2006, 3.8% of all MRSA isolates sent to the National Institute for Public Health were identified as the USA300 strain. We report an outbreak of the USA300 strain related to a Beauty Salon in the Netherlands, in a: Cosmetologist A family member A household contact and Customers and their partners. 32

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