When Is “Clean” Clean Enough?

Your clients have seen it on the news – technicians using nippers on client after client without disinfecting them, or salons using slapdash disinfection if they disinfect at all. Clients fear a cut will send them home with hepatitis B, herpes, or AIDS. And they’re asking what you’re doing to prevent the spread of infection.

Client concern is only one reason to take a long, hard look at the issue of salon disinfection. There are many ways to clean the items you use every day in the salon, but exactly what is meant by “clean” is sometimes hard to understand. There are three levels of cleaning we’ll discuss here: sterilization, disinfection, and sanitization. Knowing when each is required, and what products achieve each level, will help keep you and your clients safe.

Basic Infection Control

According to Geraldine Dettman, Ph.D., president of Viro Research International in El Toro, Calif., a nail salon’s basic infection control program should include employee education, skin cleansing, surface and instrument disinfection, and protective barriers such as gloves where necessary.

Instrument disinfection is especially important in the nail salon, as implements coming into contact with skin can transport germs and bacteria from client to client, or from client to technician. While it is rare that implements cut the skin and draw blood, precautions should be taken to prevent the transmission of blood-borne diseases like AIDS and hepatitis B as well.

Some states require high-level disinfection for cleaning manicuring implements. Most technicians know that there are different levels of cleanliness; however, the terms applied to the different levels are often misused and can be confusing.

What It Is, What You Need

According to Richard Rosenberg, president of RBR Productions in Teaneck, N.J., “Sterilization is 100% destruction of all forms of microbiological life, including bacterial spores.” A bacterial spore is similar to a seed, says Dettman. Spores are produced by microorganisms when conditions are not favorable for growth. The hardy spore will lie dormant, like a seed, until its environment changes and it can grow.

Sterilization is usually accomplished by the use of intense moist heat under pressure (steam autoclaving),” says Rosenberg, “but it can also be accomplished through other vehicles such as the use of ethylene oxide (gas), formaldehyde, glutaraldehyde, and, in some cases, dry heat.”

The process of sterilization is required for instruments that will enter a body cavity. Because manicuring implements are not intended to enter body cavities, they don’t require sterilization, but very conscientious salons may want to sterilize for their own – and their clients’ – peace of mind.

Disinfection, says Rosenberg, “is the 100% destruction of all forms of microbiological life, except for bacterial spores, by any physical or chemical means. Disinfection is usually accomplished by using chemicals formulated to kill the vegetative, or growing, form of the organism.” A disinfectant will not necessarily kill bacterial spores.

There are various levels of disinfection based on what microorganisms a disinfectant destroys. Low-level disinfection is achieved with ordinary household disinfectants, says Rosenberg. It does not eliminate more resistant strains of bacteria.

Hospital-grade disinfection will kill more resistant strains. Hospital-grade tuberculocidal disinfection will destroy a wider range of bacteria, including the tubercle bacillus. This is the level of disinfection recommended for manicuring implements by Rosenberg and by Gerri Cevetillo, group manager of Ultronics in New York City. “If you have a hospital-level disinfectant that has a tuberculocidal claim on the label, it will kill all the other bacteria technicians have to be concerned about in the manicure area,” says Cevetillo. “In Florida, California, and Minnesota, state boards have recently upgraded legislation for disinfection to require a tuberculocidal claim on the product.” Experts recommend that the disinfectant be effective against a broad range of viruses as well.

“The process of sanitizing is cleaning, wiping something down with soap and water,” says Dettman. However, sanitizing is only a reduction, not elimination, of microorganisms. “Sanitization is, candidly, a term which all of the professionals in the field of microbiology would like to dispose of because [sanitizing alone] is the least effective method of providing protection from biological contamination from person to person,” says Rosenberg. While sanitizing an implement is not an adequate cleaning process to prevent the spread of disease, it is still necessary to sanitize, or clean, instruments before disinfecting them.

How to Disinfect

Whatever method of disinfection your state board requires, there are a few steps you should follow to maintain the highest level of implement cleanliness at all times.

Wash the implement, using a detergent designed for implements or a disinfectant that has cleaning ability. Says Rosenberg, “About 50 years ago, Dr. Earl Spaulding of Temple University in Philadelphia made a statement that still holds true today: ‘You can clean without disinfecting, but you cannot disinfect without cleaning.” This is essential, especially in nail care.”

Dirt, skin flakes, or blood on an instrument can inhibit a disinfectant’s ability to kill bacteria. “If you put dirty instruments in a chemical solution, for example, the solution loses its effectiveness,” says Dettman, “The chemicals bind with bacteria to kill them. If there’s dirty present, the chemicals will bind to the dirt, and soon the disinfectant is ineffective.”

Just as you rinse dishes before putting them in the dishwasher, you clean implements to help the disinfectant work better. Be sure to rinse thoroughly to remove any soap, which also can hinder a disinfectant. (An ultrasonic cleaner is also a good way to clean implements before disinfection.)

Disinfect the implement. If chemical disinfection is used, the implements need to be rinsed and dried after disinfection.

Store disinfected implements properly. An airtight container helps keep implements free from contamination.

Glass Bead, UV Light Systems’

A variety of methods can be used to disinfect implements. These methods include the auto-clave, the glass bead system, the UV light system, the ultrasonic cleaner with disinfectant and chemical disinfection.

An autoclave unit uses pressure and heat to sterilize instruments. It is used mainly in the dental and medical fields. While the autoclave is a good method of sterilization, experts say that is costly for the nail salon and that it provides more protection than is needed. “The autoclave takes a considerable amount of time to work and can be dangerous to operate due to the heat and pressure involved,” says Rosenberg.

The glass bead system uses heat to kill microorganisms. “The heating unit has a will filled with glass beads,” says Jerry Mennicken, president of Mehaz International in Thousand Oaks, Calif. “This unit will heat to 450 degree Fahrenheit, and that’s what kills the bacteria.” To use a glass bead system, the technician dips the implement into the well and leaves it there for the specified period of time.

A UV light system uses UV light to destroy bacteria. Implements are placed on wire racks inside a unit, which floods the implements with UV light.

There are some disadvantages to using these methods of disinfection. “The glass bead sterilizer will kill everything on the tip of the implement, but not in the crevices or on the handle,” explains Cevetillo, “and a UV light sterilizer will kill bacteria only on the surfaces of the implement it touches. The light can’t get into crevices. Wherever there’s a shadow, bacteria can continue to live and grow.”

Some state boards do not approve of glass bead systems for salon disinfection. According to information provided by the California State Board or Cosmetology, the glass bead system was originally designed to decontaminate dental instruments during the course of treatment on a single patient. The U.S Food and Drug Administration (FDA) found that the device sometimes fails to sterilize dental instruments adequately, but no data has been submitted to evaluate its use in the beauty industry. The California board does not plan to include glass bead devices in its regulations until more data is available regarding their use in cosmetology.

The California board states that while glass bead devices may be effective in decontaminating instruments during a single client’s treatment, the unit can’t be used to disinfect or sterilize instruments between different clients.

UV systems are also not approved by the California board because FDS experts on disinfection and sterilization agree that UV light systems are not capable of completely sterilizing implements due to shading and the light’s lack of penetration on some portions of the instruments.

Chemical Disinfection

Most nail technicians use chemical disinfection because it’s simple and relatively inexpensive. “There is a host of chemical disinfectants,” says Dettman, “including glutaraldehyde formulations, quats, formaldehyde, chlorine compounds, iodophors, phenolic compounds, and alcohol.” She points out that certain chemicals have preferred uses. In addition, different solutions within the same category or products can achieve different levels of disinfection depending on their content and use.

“When using a chemical disinfectant, follow manufacturer’s instructions on how much to dilute the solution, how long to soak the implement, and when to change it,” says Dettman. “Remember that chemical disinfectants are strong – that’s why they kill organisms. You don’t want to expose skin to these chemicals.”

“Glutaraldehydes are high-level disinfectants that can be used on instruments, but shouldn’t be used on surfaces,” says Dettman. “Disinfection can be achieved in 10 to 30 minutes, depending on the formulation. You can sterilize instruments with longer soaking times, about 6 to 10 hours.”

Experts warn technicians to use glutaraldehydes with care, because of their toxicity. “Glutaraldehydes pose a serious health risk,” says Rosenberg. “If a technician inhales this highly toxic substance, it could cause respiratory distress.”

“Glutaraldehydes have caused irritation to the nose, skin, and eyes,” says Dettman. However, she says that there are mixtures of glutaraldehydes and phenolic compounds that are not as irritating. These products should always be used according to manufacturers’ instructions.

Quaternary Ammonium Compounds, or quats, are broad spectrum disinfectants. “There are many types and combinations of quats,” explains Dettman. “Some are in spray form, some are in liquid form, and some have to be diluted before use. Different solutions can be used to decontaminate surfaces and disinfect instruments in nail salons. They are not for sterilizing, because they won’t kill spores.” Some state boards do not allow the use of quats to disinfect implements.

“Because formaldehyde is carcinogenic, it’s being used less and less in all applications,” says Dettman. “I’d recommend against its use in the nail salon because of its toxicity.” While disinfectant formulations containing formaldehyde are not recommended, polish and other nail treatments containing formaldehyde that is molecularly bonded with another chemical are considered safe by the FDA.

Chlorine compounds, such as sodium hypochlorite and chlorine dioxide, are good disinfectants, says Dettman, but they can corrode implements. “Currently, there are no formulations on the market for nail salons,” she says.

Iodophors are disinfecting solutions containing iodine and detergents. The iodine in the solution kills microorganisms by acting as a cell poison. “Some solutions are adequate for [disinfecting] implements and hard surfaces in the nail salon,” says Dettman. “However, they are easily inactivated by organic debris, hard water, and heat. Most commercial preparations do not stain, have a broad spectrum of disinfection activity, and are effective when applied for 10 to 30 minutes.” She urges technicians who use iodophors to follow manufacturers’ instructions carefully, especially when diluting solutions. Too much or too little water can weaken their effect.

“Phenolic Compounds are good bactericides and tuberculocides, but weak spore killers,” says Dettman. There are phenolic compounds designed especially for the disinfection of nail implements, add Cevetillo and Rosenberg.

“Synergistic buffered phenols are now in use and are effective broad spectrum, hospital-grade tuberculocidal disinfectants,” says Rosenberg. “These are designed to be environmentally safe, non-toxic and non-corrosive.” Synergistic buffered formulas are chemical compounds developed to destroy a broad range of bacteria and to work for a long time.

Other phenolic compounds may be used for surface disinfection. Because certain types of phenolic compounds can be corrosive, experts recommend that you disinfect tools with compounds designed specifically for implement disinfection.

Alcohol can kill vegetative form of bacteria, according to Dettman. “Alcohol by itself is far from ideal as an instrument or surface disinfectant because it doesn’t clean surfaces. In a gel form it is an excellent skin antimicrobial,” says Dettman. When using alcohol to disinfect surfaces, always clean the surface first.

Which chemical disinfectant should you use? For implements, experts recommend a hospital-grade disinfectant with a tuberculocidal claim that is EPA-registered. Check with your state board and do some product research to find the most appropriate disinfection products for your salon.

Are You Doing All You Can?

Now that you’ve been introduced to the various forms of disinfection, it’s time to look at your current disinfection program. Is it meeting your state’s – and your clients’ – minimum requirements? Are you doing everything you can to eliminate bacteria in the salon?

The consequences of improper disinfection procedures are grave. It is the responsibility of the professional nail technician to follow her state’s rules of disinfection. Her own safety, her clients’ safety, and the reputation of her salon are at stake.

Universal Precautions

If you’re worried about the spread of disease, you may wish to take Universal Precautions in your salon. Universal Precautions entails treating all blood and body fluids as contaminated (whether they are or not). Appropriate nail salon precautions are as follows:

• Wash hands before each client, creating foam and friction for at least 10 seconds, using soap and water. You may use and soap and either hot or cold water.
• Cover all wounds with gauze or a bandage
• Use disposal materials, such as paper towels, sponges, cotton balls, and tongue depressors (to scoop lotion from a container) whenever possible. Dispose of these materials in a leak-proof, closable, and securable bag.
• Clean surfaces with a detergent and then wipe with a surface disinfectant after each client. Allow the surface to dry.
• Clean and disinfect instruments after each use.
• Wear gloves if handling soiled laundry. Wash linens in 160 degree Fahrenheit water.

What, When, and How to Disinfect

Item	Recommended Disinfection Level	Disinfection Procedure
tables and surfaces	clean/sanitize and disinfect	Use detergent to clean and household disinfectant to disinfect.
instruments	high-level disinfection	Follow state board regulations, or use EPA-registered disinfectant with a tuberculocidal, virucidal, and fungicidal claim
towels and linens	clean/sanitize	Wash in hot water, use bleach for whitening (no data is available on the effectiveness of bleach in disinfecting linens)
hands (yours and clients)	clean/sanitize	Use antimicrobial scrubs, foams, and g els (wash hands before applying gel).