With the decision of a few state boards to require salons to use tuberculocidal disinfectants, manufacturers and industry associations debate whether they are really necessary for use in salons.
Whether or not a salon disinfectant must be tuberculocidal (able to kill the tuberculosis germ) is a question that is being debated in the salon industry — most heatedly by the manufacturers of the products themselves. Sanitation rules recently adopted by the Texas Cosmetology Commission (TCC) require a tuberculocidal disinfectant to be used on tabletops, shampoo bowls, and implements between clients. Implements must go through a dry sanitation process as well and be stored in covered containers or in an ultraviolet light cabinet. But many industry experts say that not only is the tuberculocidal ability unnecessary in the salon environment, but that requiring it has created a false sense of the danger that tuberculosis (TB) really poses to salon workers.
The TCC s action has stirred up a long simmering issue and prompted the Nail Manufacturers Council to create a liaison committee with the National Interstate Council of State Cosmetology Boards (NIC) to address the issue of national sanitation standards.
Although there was much discussion of TB, hepatitis, and HIV when the commission took its action, most everyone involved in the new regulations now say TB is not the issue.
“Tuberculosis is hard to kill, so if a product will kill TB, it will kill everything,” says Dr. Robert Powitz, a public health expert and independent consultant hired by Robert Reed, president of Hikari. TB is an airborne disease that can’t be transmitted by objects, he says, adding that there are no known cases of anyone contracting TB, hepatitis, or HIV in a salon.
Richard Rosenberg, vice president of Isabel Cristina Beauty Care Products, which makes a tuberculocidal disinfectant, says he’s responsible for “shaking up” the state cosmetology boards that are wrestling with the disinfection issue Rosenberg says that OSHA requires a tuberculocidal disinfectant to clear any spill of blood (which he interprets to include a nicked finger). Powitz disagrees, saying OSHA recommends a tuberculocidal disinfectant but does not require one.
“There’s no such thing as zero risk, but the risk of getting these diseases in a salon is very low. We need to study how many times is a client nicked, how many times the nail tech nicks herself, and how many times they both get nicked at the same time — because that’s what would have to happen to transmit a blood-borne disease in the salon,” Powitz says.
Rosenberg believes there’s a chance of getting AIDS from a salon but says his main issue is all the other infectious diseases such as staph infections. He points out that it is almost impossible to track a disease like hepatitis to its origin, noting that there could be cases of infectious disease transmission in salons that will never be discovered.
Other industry professionals agree that cuts and nicks happen, but they argue that requiring a tuberculocidal disinfectant for every sanitation need is overkill.
“More is not always better,” says Doug Schoon, an industry chemist and executive director of Chemical Awareness Training Service. “Disinfectants kill living organisms. To be more effective, they have to be more toxic,” says Schoon, who believes phenol, an active ingredient in many tuberculocidal products, is dangerous to use. Many hospitals no longer use phenols, Schoon says, adding that they are considered toxic waste and can’t simply be dumped down the drain.
Schoon is concerned about the corrosive nature of tuberculocidal disinfectants and the harm they could do if spilled on skin. A nail technician can easily splash disinfectant into her eyes when reaching into solutions for her implements.
“We don’t need to go to this level and make products more dangerous for nail techs to use,” Schoon says. He favors a quaternary ammonium solution as a safer yet effective disinfectant.
If there are major health problems lurking in salons, everyone would know about them by now because the sanitation level as a whole is not very high, he savs, estimating that less than 10% of all nail technicians follow proper procedures. It is an odd and discomfiting argument: that the adherence to sanitation rules is so bad now that if ever there was going to be a problem, it would have already happened.
“We need a rational solution. We can’t ask nail techs to take a flame thrower to their implements. We have to measure the safety risks against the benefits. If someone wants to use phenol, let them, but don’t require it. We need basic sanitation improvements instead,” says Schoon.
Dal La Magna, president of Tweezerman Corp , says he welcomes competition in the sanitation market because the more products that are available, the greater the chances of more nail technicians being informed about the importance of sanitation. Tweezerman markets a product for implement disinfection that is not tuberculocidal; La Magna says he would like to see industry standards established that all salons can meet without threatening the environment or posing health risks to those who use them.
Sue Sansom, who heads the NIC’s liaison committee for infection control and who is executive director for the Arizona State Board, says the group plans to propose national standards at its meeting in Boston on August 19-23, but she couldn’t say what those standards would be at this point.
The Nail Manufacturers Council (NMC), which is now working with the NIC, doesn’t have a position on the issue at this time, says NMC safety and standards committee chairman Charles Knight. The group is made up of manufacturers who make tuberculocidal products as well as those who don’t.
“We don’t want to prescribe what should be used. Salon owners and nail techs have to make the decision on a case-by-case basis. But national standards do make some sense,” Knight says.
More than anything else, Knight is worried about the fear factor that the tuberculocidal issue raises. If people are afraid to go to a salon, “then we’re all out of business,” he says.
Nail technicians, manufacturers, and the state boards need to start looking at the big picture instead of just their part of the issue, according to Diana Crosthwait, president of Salon Partners. Her company offers two disinfectants, a tuberculocidal one and a hospital-level concentrate that is not tuberculocidal.
No one product will solve every disinfection problem, she believes. She thinks a tuberculocidal product should be used when there’s a blood spill, but she is concerned about the repetitive use on a daily basis of chemicals that may not be necessary.
“I think a tuberculocidal product should be kept in a first aid kit to be used when it’s needed. We need to think about what’s practical. If we could just get people to wash their hands — that’s the number one way to fight infection — between clients, we’d be making a lot of progress in sanitation,” she says.
By Lynn O’Dell
Editor’s note: A letter that appeared in the May issue on salon disinfection elicited several responses from salon disinfectant manufacturers. The letter that appeared is reprinted here, as well as others concerning tuberculocidal disinfectants.
Many state cosmetology boards are requiring that the disinfectants professionals use in the salons be tuberculocidal. We challenge this requirement as unnecessary. The only disinfectants that we find truly proven to be tuberculocidal contain phenol (Claims that quaternary ammonium compounds are tuberculocidal must be challenged. They have not been proven tuberculocidal).
Disinfectants containing phenol are not biodegradable; they require special handling for disposal. They are very harsh on the skin and, ironically, because phenolics have very low detergent action, they can actually be less effective at destroying those germs that are a real threat to the safety of salon professionals and their clients.
While we are prepared to introduce a disinfectant for use in salons that is tuberculocidal, we hesitate because it contains phenol. We believe that the tuberculocidal requirement is superfluous and actually detrimental to the intentions of various state boards — effective disinfection of salons combined with convenience and ease of use.
The medical section of the National Tuberculosis Association reads: “...available evidence suggests that tubercule bacilli lodged on foamites, linen, furniture, books, and floors do not constitute a significant hazard.” The reason, of course, is that tuberculosis is an airborne disease. Hard-surface disinfection will do little to prevent its spread. In fact, federal standards do not require proven tuberculocidal activity before registering a hospital-grade disinfectant.
Many of the quaternary-based disinfectants available for use in salons today are hospital-grade and are as effective in every way as a phenol-based disinfectant except that they are not tuberculocidal; yet there are several critical advantages that the quaternary disinfectants enjoy over the phenol-based one.
There is evidence indicating that superior detergency produces superior disinfection First, detergents are needed to break down soils, thereby encapsulating bacteria and enabling the disinfectant to reach the cell wall. Second, detergents remove soil from hard surfaces and also physically remove bacteria Quaternary formulations generally provide better detergency than their phenolic counterparts. Phenolics are known for their poor cleaning ability and they often leave soil on the surface that organisms can thrive in.
Phenolics are also much more irritating than quats and can severely burn or cause depigmentation of the skin, as well as damage floor surfaces if not used properly.
Phenol in phenolics is not biodegradable and remains in our soil and water systems. They cannot be poured down the drain with good environmental conscience. In fact, in some states it may be against the law to pour them down the drain.
I urge everyone who reads this letter to petition their state board or other regulator not to impose the tuberculocidal requirement on the disinfectants used in salons for disinfecting tools and working surfaces. Dal La Magna President Tweezerman Corporation Glen Cove, N.Y.
We at Isabel Cristina Beauty Care Products are very interested in the letter, “Should Salon Disinfectants Be Tuberculocidal?” The research and development department of Isabel Cristina is especially concerned that the information given by Dal La Magna, president of Tweezerman Corporation, with all due respect, needs some clarification.
First and most important, all disinfectants which are registered by the Environmental Protection Agency (EPA) are strictly regulated, thoroughly tested, and must have correct disposal procedures listed right on the product container. Additionally, this means if the label states “dispose in a toilet” served by a sanitary sewer, it means that the product by law can be poured down the drain.
This also means that if a disinfectant containing quaternary ingredients is EPA-registered as tuberculocidal, it has been proven to kill tuberculosis as long as the user follows the label directions.
Hospital-grade is a lower level of disinfection which has been proven to kill staphylococcus, salmonella, and pseudomonas. Microbiologists agree that if a disinfectant is tuberculocidal and hospital-grade, it will kill many more germs than just hospital-grade disinfection, when used according to manufacturer’s directions.
In fact, the Federal Occupational Safety and Health Administration (OSHA) regulations for blood-borne pathogen standard CPL 2-2-44C states that in any job where a worker is exposed to blood and body fluids; the minimum when disinfecting objects with blood must be done with a tuberculocidal and hospital-grade disinfectant that is EPA-registered. This is the reason that the state boards are adopting the higher levels of disinfection such as tuberculocidal. It’s to protect people from difficult-to-kill germs and not necessarily to prevent the spread of tuberculosis in the salon. There are germs which are more difficult to kill than the low level hospital-grade germs. These are killed at the tuberculocidal level.
The second area of misunderstanding is about phenol and its chemically related great grandchildren, phenolics. Phenols and phenolics represent hundreds of Richard Rosenberg chemical combinations used commonly in foods, food processing, food packaging, cosmetics, and antiseptics. and are widely used in all areas of industry. Blanket statements such as “not biodegradable,” “very harsh on skin,” “low detergency action,” and “depigmentation” are not always true and unfair to such a helpful and accepted group of chemicals. Phenols and phenolics are in products like Lysol brand disinfectant, Chloraseptic throat spray (regular and for children), thymol and PCMX, which is in hand sanitizers used in our very own industry. Phenolics as raw material have been shown to be less toxic than that of the quaternary- based chemicals. Phenolics used for disinfectants have been combined with excellent detergents and surfactants to be sure that they will effectively break down soils and remove and kill germs. In fact, there are many phenolic products available with a 5% serum claim, which means that the disinfectant provides superior results in the presence of dirt. These disinfectants even have a tuberculocidal claim, the toughest vegetative organism to kill with a disinfectant, which further shows that phenolics work overtime.
Isabel Cristina’s Lets Touch and Let’s Dance products are tuberculocidal and hospital-grade and offer the highest level of salon disinfection. They are EPA-registered to be safely disposed of down the drain. In their use solutions they are, according to the Federal Hazardous Substance Act, non-toxic and non-corrosive to skin and eyes, have been thoroughly tested, and do not cause depigmentation of the skin. In fact, in their concentrated form, they are even less toxic than many commonly found household chemicals. Let’s Touch and Let’s Dance serve as two examples of effective, safe, friendly disinfectants. The state board’s concern is for the health and safety of the public and the workers. Many of them feel that tuberculocidal disinfection represents the safest and most effective level. They are, in fact, correct.
Richard Rosenberg President Isabel Cristina Beauty Care Products Teaneck, N.J.
Recent controversy over the necessity for a tuberculocidal disinfectant in the salon environment has prompted us to contact experts in infection control who are affiliated with OSHA, the Centers for Disease Control, the Tuberculosis Control Unit of the Department of Health, and the EPA. These professionals all agree that the enforcement of a tuberculocidal disinfectant is “overkill” in a salon or barber shop.
Furthermore, it is dangerous to impose such a regulation because this may lull the salon professionals and the general public into a false sense of security by having them believe that the use of a tuberculocidal product will protect them against TB transmission. It will not, for these reasons:
1. Tuberculosis in the United States today is spread almost exclusively by airborne transmission of the residues of tiny droplets produced by infectious individuals during the course of coughing, laughing, speaking, etc. 2. TB is an airborne pathogen, and using a tuberculocidal surface disinfectant is not a consideration as a preventive measure. 3. Equipment used on patients with TB is unlikely to be involved in the transmission of the organisms. 4. Organisms such as M. Tuberculosis generally require inhalation by the host for infection to occur. 5. In the medical environment, ventilation and the use of ultraviolet irradiation are used for air control in areas occupied by known or suspected producers of the infectious airborne particles. 6. The recent increase in TB cases is primarily among the homeless and prison inmates, who do not go to salons for haircuts and manicures.
If TB transmission were a valid concern in the salon, all salon professionals would have to wear masks and all salons would have to be equipped with proper ventilation and ultraviolet lighting throughout the salon. It is worth noting that the total number of AIDS cases far outnumbers TB cases. HIV-1 is transmitted by exposure to blood/body fluids, which can occur in a salon via an opening in the scalp, cuts with cuticle nippers, clippers, and razors, as well as during waxing and facial procedures Use of a hospital- level disinfectant with an HIV-1 claim appears far more practical and highly protective of the general public than a TB claim.
It is in the best interest of the beauty industry to provide professional services in a clean, safe environment. Many state cosmetology boards are upgrading to hospital-level disinfection requirements. These are reasonable guidelines that are practical for salon owners and operators to follow for the safety and well-being of themselves and their clients.
Gerri Cevetillo Group Manager Ultronics Mahwah, N.Y.
As I read the letter to the editor from Dal La Magna in the May issue, I realized that infection control in the beauty industry remains a major concern.
State boards of cosmetology are now in the process of reviewing their sanitation regulations to make sure they comply with OSHAs federal blood-borne pathogen regulations as related to blood spills.
In addition, state boards are concerned that salons and cosmetology schools provide clean and safe conditions for the public they service.
Although OSHAs blood spill regulations do not specifically reference salons, the regulations do cover any establishment that may have a blood spill, which could include salons that provide nail services (where nipping a clients finger results in a “blood spill”).
The question regarding sanitation seems to center around how much disinfection is too much. Until greater clarity is made by OSHA to deal specifically with salons, we have no other guidelines that will give us the assurance that we have done the right thing should a blood spill occur in the salon. Therefore, it is important that each technician understand OSHAs federal regulations as well as their state boards rules and regulations.
The issue of tuberculosis (the disease) and a product that is EPA-registered as tuberculocidal is not the same issue A tuberculocidal disinfectant provides assurance that OSHAs regulations for a blood spill are met OSHA’s concern is that HBV (hepatitis B virus) may be present in blood that is spilled The tuberculocidal disinfectant ensures that the HBV microorganism is killed, The confusion is in the thinking that one can safeguard the salon from TB by using an EPA- registered tuberculocidal product.
I recall the story about three blind men trying to describe what part of an elephant they were touching Each man proceeded to touch one part of the elephant and express what his touch was telling him. Each person was convinced that they were right in describing what they had touched. When comparing this story to stories on disinfection products and requirements, we can see that each person is “touching” only one part of the disinfection issue.
The challenge to state boards, manufacturers, and nail technicians is to see the big picture, not just a part of the issue. The welfare and safety of the clients and workers are very high stakes. It is most important to understand that there is no one product or procedure that works for every salon disinfection concern.
There are many germicidal active ingredients that can eliminate pathogenic microorganisms. Some are not appropriate for the salon environment because they are too expensive, too caustic, too damaging to combs, etc. However, to say that only phenol-based products are proven to be tuberculocidal is inaccurate. The EPA has registered many other chemicals and products with TB claims, including glutaraldehydes, iodophors, and quat/alcohol formulations. These products are used in hospitals and other establishments where the use of an EPA-registered, hospital- level disinfectant is specified.
One must look at the total formulation when making responsible product comparisons. The “new,” state-of-the-art formulations (dual quats and alcohol) are tuberculocidal as registered by the EPA, and they provide safe, effective, and easy-to-use products for the beauty industry.
Diana Crosthwait President Salon Partners Aseptic Products Ft. Worth, Texas