How Do State Boards Determine Sanitation Regulations?

The NMC’s safety and standards commission and the Nevada State Board of  Cosmetology respond to this and other sanitation questions.

In the march 1994 issue of NAILS, we did an extensive story on sanitation (“Salon Sanitation: for the Health of Your Business”), which included responses to your questions on sanitation issues from a panel of experts. In the article, we invited you to write us with additional questions, which you did. We again asked the members of the Nail Manufacturers Council’s (NMC) committee on safety and standards, as well as Mary Manna, the executive secretary of the Nevada State Board of Cosmetology, to respond. Here’s what they had to say:

Q How do state boards determine what methods of sanitation are effective?

A Mary Manna, executive secretary, Nevada State Board of Cosmetology: My experience is strictly with the State of Nevada, so I will answer your question in relation to what has been done in Nevada.

We are in constant communication with our state and local health divisions, and of our sanitation and sterilization requirements must be approved by the State of Nevada Health Board prior to being enforced by us.

In response to concern over new viruses and diseases, our Board formed a committee in May 1988 to research updated sanitation and sterilization procedures and to draft new regulations. Some of the research was done by committee member and Nevada State Board chief investigator Ju Lee Rollins. We also utilized the expertise of agencies such as the Centers for Disease Control, the Department of Occupational Health & Safety (OSHA), the state governments of Nevada, Oregon, and Washington: and the California and Oregon state boards. Other sources of information included the cosmetology division licensing codes for all states, and other agencies, commissions; and industry associations. We also relied on the cooperation of manufacturers, who often supply us with excellent information that we pass on to our state health division.

After four years of research and revisions, our new sanitation regulations went into effect May 15, 1992. Currently in Nevada, our regulations specify very clearly how the Board expects licensees to maintain all their instruments and tools in a sterile condition. The Board has a strict policy that products must be used according to the manufacturer’s directions.

Q What are state boards doing to educate licensees on state sanitation regulations?

A Manna: Again speaking for Nevada, sanitation and sterilization procedures are part of the required school curriculum. Our inspection staff conducts routine monthly inspections of the schools, and one area they check is the students’ sanitation and sterilization procedures. The inspectors are available to answer any questions the students may have and they occasionally present sanitation and sterilization classes in the schools.

All Nevada licensees are required to pass a State Law Exam, which includes questions on sanitation and sterilization. The inspection staff is available upon request to conduct classes in salons. It is our policy that if an infraction is found, we explain the problem and offer a solution to the licensee.

In January 1993, the Nevada Board of Cosmetology conducted a seminar for all licensees that offered an extensive generic program on sanitation and sterilization. The program was very well received, and some of our licensees have requested that we make it an annual event.

Q What is the most up-to-date, effective method of sanitation available?

A Gerri Cevetillo, group manager, Ultronics, Mahwah, N.J.; member of the NMC safety and standards committee: Today’s standard for protection against a broad spectrum of viruses and bacteria is hospital-level disinfection. The EPA requires that a hospital disinfectant be proven effective against these organisms: salmonella cholerasuis, staphylococcus aureus, and pseudomonas aeruginosa. The EPA also advises that, if a product is tested and proven effective against the AIDS virus, the label must state: “Kills HIV-1 on pre-cleaned environmental surfaces/objects previously soiled with blood/body fluids.”

Learn to read product labels. Also, note that your implements must be completely submerged in order to be properly disinfected. Additionally, all salon surfaces should be sprayed with a hospital disinfectant according to the manufacturer’s instructions; this includes footbaths, manicure stations, sinks, etc.

Diane Crosthwait, president, Salon Partners, Ft. Worth, Texas; member of the NMC safety and standards committee: First and foremost, there is no one magic or best solution. Sanitation and proper disinfection require a combination of procedures that are safe and practical. First, ask yourself what you are trying to accomplish. Environmental sanitation in general can mean that the walls, floors, mirrors, etc. have been cleaned and are free of debris. Daily salon sanitation is a must.

The hands are the most important factor in cross-contamination. Therefore, washing your hands between clients is the best line of defends in infection control. As a technician, your hands are vital to your business; guarding your intact skin from abrasion should be your daily goal. The use of hand lotions throughout the day is most important. There are many new products, as well as the “tried and true” team of soap and water, that can clean your hands quickly and effectively.

Your tools, implements, and surfaces must be disinfected, not just sanitized, between each service. Your objective is to kill pathogenic microorganisms that can affect your clients and your well-being.

Robert Reed, president, Hikari Products, Gardena, Calif.; member of the NMC safety and standards committee: Most experts agree that the use of a hospital-level disinfectant that is EPA-registered as staphylocidal, pseudomonicidal, and virucidal eliminates the risk of cross-contamination (infection) in the salon. Most, but not all, disinfectants that carry these label claims are hospital-level disinfectants, meaning they provide protection beyond the potential dangers that exist in a salon.

Q My clients have expressed concern about what methods of sanitation I use. How do I explain to them the sanitation methods I use and why, without them thinking that having their nails done puts them at risk of getting sick?

A Cevetillo: If a client asks what disinfectant products you are using, explain that you have upgraded to hospital-level disinfection for her protection. Disinfect your implements in front of your client and explain that disinfection eliminates the risk of cross-contamination. Should a client express concern about the AIDS virus, show her the label on the disinfectant container, which should state that the product you are using is proven effective against HIV-1. Also, take advantage of the marketing tools provided free by the disinfectant manufacturers. Window decals and display cards assure your clients that you are concerned about their safety and well-being.

Reed: You can bet that a client witnessing tool and surface disinfection procedures will have questions about why the procedures are necessary. Comforting the client is your goal, so it is critical to use correct and calming terms. We suggest telling clients, “This is how we disinfect our tools (surfaces) for your safety.” When preparing your hands (or theirs), we suggest saying, “This is how we prepare our (or your) hands for your safety.”

To prepare yourself for serious questions about the sanitation procedures you use in your salon, take advantage of manufacturer workshops that are designed to prepare you as a professional to answer clients’ questions with proven, accurate, and powerful terminology. Remember a correct response lessens fear; an incorrect response could mean the loss of a client.

Doug Schoon, a chemist and executive director of Chemical Awareness Training Services, Newport Beach, Calif.: There is a 0% chance that a client will get a life-threatening disease from your services. A client’s risk for contracting other diseases---a cold, the flu, or an infection in a cut---is the same as it is in any other public area. So explain to clients that you follow recommended sanitation procedures to prevent the spread of common germs.

Many nail technicians think they disinfect to prevent life-threatening illnesses; if the client thinks that, then you’ve got a problem. Know for yourself that practicing salon sanitation is like washing your hands after you go to the bathroom: If you don’t, you won’t die, but it is healthier to do so.

Q If a client is bleeding and I am doing artificial nails, what do I need to do to keep my product from becoming contaminated?

A Crosthwait: Contamination of your nail products should always be a concern, whether it is blood or some other substance that can make your product impure. When blood has touched your tools or product the biggest concern is the safety and welfare of your clients and yourself. As a nail technician, you need the best education and procedures to combat the risk of bloodborne pathogens such as the HIV (AIDS) virus and HBV. But there are also real, everyday risks from staphylococci, influenza, herpes, pseudomonas, and other major disease-causing microorganisms. Choosing an EPA-registered, hospital-level disinfectant will give you protection against pathogenic microorganisms found in the salon. This choice affords you a selection of products that are safe, economical, and practical for salon use.

The first line of defense in the prevention of cross-contamination is education; the second is preparation; and the third is having a written salon procedure on how to handle a particular situation such as the one described

If you accidentally cut or draw blood in some manner, your first action should be to ascertain that the client is OK and assure her that you will stop the bleeding (i.e., by applying a bandage). Any tools, implements, towels, or products that came in contact with blood or body fluids should be rinsed to remove the blood, then sprayed with a hospital-level, EPA-registered solution that is also tuberculocidal. (At present, a tuberculocidal solution is required by OSHA’s rules for handling a blood spill). Let the items stand in the solution for ten minutes, then pre-clean them, disinfect them with the proper solution, and dry and store them according to your state board rules.

Schoon: Although there’s always a risk of disease transmission with blood contact between two people, it’s unlikely to happen. It’s rare that both the technician and the client would have open wounds, and it’s unlikely that a client would cut herself at the same time the technician was cut. The chance that blood would intermingle and cause infection is extremely low.

If a client is bleeding, the first thing to do is stop the bleeding by having the client hold a cotton ball to the wound until the bleeding stops. Then have her put the cotton ball in a plastic bag and throw the bag in the trash. If you cut a client’s cuticle with a file, give the client the file to take home or throw it away.

You don’t have to worry about contaminating your product because the liquids are self-disinfecting. Nail products do not support microbial life so you don’t have to worry about microbes from blood getting into your liquids.

Richard Rosenberg, vice president, Isabel Cristina Beauty Care Products, Teaneck, N.J.,; member of the NMC safety and standards committee: If a client is cut during a service, stop the service and have the client apply liquid styptic or an antiseptic on the wound, then apply pressure on the wound with a pad. Stop the flow of blood before continuing the service. All products that get blood in them or on them should be thrown away if they cannot be disinfected with a tuberculocidal hospital-grade disinfectant. Some state boards do not allow work on clients with infections or open wounds. Always check local and state regulations for exact procedures.