Wisconsin Law (1 hour)

Transcription

1 Approved by the Wisconsin Department of Safety and Professional Services and the Wisconsin Cosmetology Examining Board Wisconsin Law (1 hour) Laws Governing the Barbering and Cosmetology Professions and Establishments Provided by ContinuingCosmetology.com

2 TABLE OF CONTENTS page TOPIC 1: Rules related to Responsibilities and Duties (30 minutes) 2 TOPIC 2: Rules related to Professional Licensing (30 minutes) 14 1

3 TOPIC 1: Rules related to Responsibilities and Duties (30 minutes) Outline Responsibilities of the Aesthetician Services offered by Establishments Volunteer Services Rules regarding Nursing Homes and Assisted Living Centers Student Regulations Apprenticeship Rules Continuing Education License Titles available to the Aesthetician Aesthetic duties allowed to Barbers and Cosmetologists Straight Razor Shaving Lash Extensions Manicurist Services Learning objectives: After completing this lesson you will be able to: Describe the scope of practice for body wrapping Define the legalities of fish pedicures Identify the legalities of serving liquor to clients Identify rules for off-site volunteer services for establishments List the conditions of licensure for Nursing Homes List the rules for Assisted Living Centers Describe how a Cosmetology graduate can work in a salon Identify CE requirements Define laws regarding cutting calluses Introduction It is the State Board's duty to protect the public and therefore they must enforce specific rules regarding the State laws of Barbering and Cosmetology. Some services are allowed and some prohibited. All rules are designed for the safety and health of the salon professional as well as the client. In this study we will review select facts regarding licensees, students, apprentices, beauty establishments and other public facilities. This review will focus on the more common questions regarding responsibilities and duties. 2

4 Is a licensed Aesthetician allowed to perform body wraps? Yes, these procedures are within the: scope of practice for an Aesthetician as defined in Wisc. Stat (1) & (2). EXCERPT Definitions (1) Aesthetician means a person who practices aesthetics. (2) Aesthetics means, for compensation, caring for or beautifying the skin of the human body, including but not limited to cleaning, applying cosmetics, oils, lotions, clay, creams, antiseptics, powders or tonics to or massaging, stimulating, wrapping or exercising the skin of the human body. Is a licensed establishment allowed to offer fish pedicures? The Wisconsin Statutes and the Wisconsin Administrative Code do not specifically prohibit fish pedicures. However, licensees should review the: sanitation requirements set forth in bc 4.02, Wisc admin code and the animal prohibitions set forth in bc 3.01(10), Wisc admin code EXCERPT BC 4.02 Disinfection. (1) Unless sterilized, disinfection is required prior to reuse on another patron of any personal care instruments, including scissors, razors, clipper blades and tweezers, excluding tweezers used in electrolysis. (2) Disinfection for scissors, razors, clipper blades and tweezers shall consist of cleaning with soap and water to remove all organic material, wiping with or soaking in a disinfectant as defined in s. BC 1.01, and air drying. (3) Disinfection for combs, lifts, brushes, rollers and any other contact equipment shall consist of cleaning with soap and water to remove all organic material, spraying with a tuberculocidal disinfectant as defined in s. BC 1.01, and air drying. (4) Clean and disinfected contact equipment shall be placed in one or more covered containers. One or more separate containers shall be provided for the immediate storage of soiled contact equipment until cleaned and disinfected. (5) Disinfectant used for decontamination shall be changed daily and shall be kept in a covered container. (6) Laundry shall be disinfected by washing with a solution containing a germicidal compound. BC 3.01 Establishment requirements (10) Pets shall not be kept in an establishment during business hours. 3

5 Is a salon allowed to offer their clients liquor during their appointment? The Wisconsin statutes and the Wisconsin administrative code do not specifically prevent a barber or cosmetology establishment from serving liquor to clients or allowing clients to bring in their own liquor. However, state or local liquor laws may impose restrictions on such activities. Furthermore, the department prohibits employees of the establishment from drinking while on the job and the manager of the establishment has the responsibility of assuring that no intoxicated client becomes a safety risk to employees of the establishment or to other clients. bc 2.03(4), Wisc admin code. EXCERPT BC 2.03 Practice standards (4) Licensees may neither consume alcohol nor take controlled substances during practice, unless prescribed by a physician. Is a licensed establishment with licensed barbers/cosmetologists allowed to offer volunteer services off-site for a charity event? Except as allowed by: Wisc. Admin. Code s. Bc all cosmetology services performed for compensation must be provided in a licensed establishment. If the service is not being performed for compensation (direct or indirect), then the establishment rules do not apply. EXCERPT BC Services outside of a licensed establishment. (1) Licensees shall not provide personal care services outside of a licensed establishment except for persons who are unable to leave their homes because of illness or disability or for persons who are in hospitals, nursing homes, correctional institutions or other institutions. Licensees may provide any personal care service for inmates or patients regardless of whether it is done in a designated area or in the personal room of an inmate, patient or infirm person within an institution or private home. (2) Licensees shall comply with all practice standards set forth in s. BC 2.03 (Practice Standards) in providing services outside of a licensed establishment. What are the rules and regulations for operating an establishment in a nursing home? Nursing homes are not required to obtain establishment licenses upon fulfillment of the following three conditions the residents of the nursing home are unable to visit an off-site salon. the salon only services the residents of the home. the salon employs licensed barbers or cosmetologists. Any establishment requires a manager if it is open for 30 or more hours per week. An establishment only needs one manager. This also applies to an establishment within a nursing home. 4

6 What are the rules and regulations for operating an establishment in an assisted living center? A living center does not directly employ the practitioners who offer services to nursing home residents. Therefore, each licensed practitioner must apply for an individual establishment license. Each licensed practitioner becomes an owner of the booth space. Any licensed establishment requires a manager if it is open for 30 or more hours per week. A licensed establishment only needs one manager. Is a Cosmetology student or a Cosmetology graduate allowed to work in a salon? A cosmetology school graduate may work in a licensed establishment under a temporary permit, granted by the department. Wisc. Stat (10). ESCERPT Licensure (10) TEMPORARY PERMIT. (a) The examining board may issue a temporary permit to practice as a cosmetologist without examination if the applicant meets all of the requirements of sub.(2) for licensure except passage of an examination and if the applicant is scheduled to take the examination for licensure. (b) The examining board may issue a temporary permit to practice as an aesthetician without examination if the applicant meets all of the requirements of sub. (4) for licensure except passage of an examination and if the applicant is scheduled to take the examination for licensure. (c) The examining board may issue a temporary permit to practice as an electrologist without examination if the applicant meets all of the requirements of sub. (5) for licensure except passage of an examination and if the applicant is scheduled to take the examination for licensure. (d) The examining board may issue a temporary permit to practice as a manicurist without examination if the applicant meets all of the requirements of sub. (6) for licensure except passage of an examination and if the applicant is scheduled to take the examination for licensure. (e) A temporary permit issued under this subsection is valid for not more than 6 months and may not be renewed. The fee for a temporary permit issued under this subsection is specified in s (6). What are the requirements for an apprenticeship? Apprenticeship requirements may be found in ch bc 6, Wisc admin code and Wis. Stat

7 Questions about apprenticeships may also be directed to the apprenticeship program in the department of workforce development. EXCERPT Apprenticeship. (1) All apprentices shall be employed under an apprentice contract under s and shall be governed by s , the apprenticeship rules of the department of workforce development, and the rules of the examining board. (2) Apprentices shall receive at least 3,712 hours of practical training and at least 288 training hours of theoretical instruction in a school of cosmetology in order to complete the apprenticeship program and be eligible to take the examination for a cosmetologist license. Apprentices shall receive training for a total of at least 32 hours per week. The training shall be completed in not less than 2 years and not more than 4 years. (3) (a) No apprentice under this section may practice cosmetology except under the supervision of a licensed cosmetology manager, whose cosmetology license is not an inactive license, or under the supervision of a licensed cosmetologist, whose cosmetology license is not an inactive license, and to whom supervisory authority has been delegated by a licensed cosmetology manager. A licensed cosmetology manager may only delegate supervisory authority to a licensed cosmetologist who has completed at least 2,000 hours of practice as a licensed cosmetologist. (b) Apprentices shall be trained in all branches of practical work and in all subjects required to be taught in schools of barbering or cosmetology as prescribed by the examining board by rule. (4) A person who has successfully completed the requirements of sub. (2) may not continue to practice as an apprentice but may apply for a temporary permit under s (10) (a). How many continuing education credits are required for Apprentices? There are no continuing education requirements for apprentices. Can a licensed Cosmetology instructor provide instruction or supervise students without an instructor certificate? The answer depends on the type of activity. A licensee may not provide practical instruction without an instructor s license. If the instruction is academic or theoretical, a licensee may supervise students, but general supervision, such as an off-site supervision with a record review, is not allowed. The Wisc. Stat (13) has the definition of practical instruction. The Wisc Stat (17) has the definition of theoretical instruction. The Wisc Stat has more information on persons providing practical instruction in specialty schools. Cosmetology profession includes Aestheticians, Electrologists and Manicurists 6

8 EXCERPT Definitions. (13) Practical instruction means training through action or direct contact with a patron or model other than a mannequin (17) Theoretical instruction means training through the study of principles and methods Persons providing practical instruction in specialty schools. (1) No person may provide practical instruction in a specialty school of aesthetics unless the person holds a current cosmetology manager license issued by the cosmetology examining board or a current cosmetology instructor or aesthetics instructor certificate issued by the department. (2) No person may provide practical instruction in a specialty school of electrology unless the person holds a current electrologist license and a current cosmetology manager license issued by the cosmetology examining board or an electrology instructor certificate issued by the department. (3) No person may provide practical instruction in a specialty school of manicuring unless the person holds a current cosmetology manager license issued by the cosmetology examining board or a current cosmetology instructor or manicuring instructor certificate issued by the department. How many continuing education credits are required for Cosmetology Instructors? There are no continuing education credits for cosmetology instructors. How many continuing education credits are required for licensees? Four (4) credits are required. Note, new licensees in their first license cycle are exempt from CE. Three (3) hours must be topics of Safety, Sanitation, and Infection Control and One (1) hour must be in topics regarding Wisconsin Laws that govern licensees and Establishments in the field of Barbering and Cosmetology. May a licensee use the title Medical Aesthetician or Paramedical Specialist (or anything similar)? Wis. Stat (2)(f) and bc 2.05(1) prohibit a licensee from false or misleading advertising. Medical or para-medical implies a special level of expertise that the Aesthetician has acquired through education and licensing, despite the fact that no such level exists. When an Aesthetician or Barber/Cosmetologist is acting under a physician s delegation, he or she is not acting under his or her own license, but as a medical employee under a physician s delegation. The use of a medical term in a licensee s title is misleading, and therefore, prohibited. 7

9 EXCERPT Disciplinary proceedings and actions (2) Subject to the rules promulgated under s (1) and this subchapter, the examining board may revoke, limit, suspend, or refuse to issue or renew, in accordance with the severity of the violation, a license or permit issued under this subchapter or reprimand the holder of a license or permit issued under this subchapter if it finds that the holder or applicant has done any of the following: (f) Advertised in a manner which is false, deceptive or misleading. BC 2.05 Advertising. (1) Advertising by licensees shall be truthful and accurate and may not mislead the public Are Aestheticians allowed to perform all of the same duties as a Barber or Cosmetologist? No. An Aesthetician may only care for or beautify the human skin. Aestheticians are not licensed to care for human hair. Wis. Stat (2) EXCERPT Definitions (2) Aesthetics means, for compensation, caring for or beautifying the skin of the human body, including but not limited to cleaning, applying cosmetics, oils, lotions, clay, creams, antiseptics, powders or tonics to or massaging, stimulating, wrapping or exercising the skin of the human body. Is a Barber/Cosmetologist allowed to perform all of the same duties as an Aesthetician (skin care)? In Wisconsin, a person holding a Cosmetology licensee can provide all the same services as an Aesthetician. Wisc. Stat. s (2) for a complete definition of barbering and Wis. Stat. s (7m) for the practice of cosmetology. EXCERPT Definitions (2) Barbering means, for compensation, arranging, styling, dressing, shampooing, cleansing, curling, dyeing, tinting, coloring, bleaching, waving, cutting, shaving, trimming, relaxing, singeing, or performing similar work upon the hair of the head, neck, or face of any person by any means. Barbering does not include the removal of a person s hair at the root or the application of temporary or permanent eyelash extensions to the eyelashes of a person Definitions. (7m) Cosmetology means, for compensation, performing one or more of the following: (a) Barbering. (b) Aesthetics. (c) Manicuring. (d) The removal of hair of any person at the root, except by use of an electric needle. 8

10 May a licensee do a straight edge razor shave in Wisconsin? The Wisconsin Statutes and the Wisconsin Administrative Code do not specifically prohibit the use of straight edge razors. However, because the strop or whetstone used to sharpen the razor cannot be cleaned as required by sanitation standards, they are for all purposes banned. bc 4.02 and 4.03 EXCERPT BC 4.02 Disinfection. (1) Unless sterilized, disinfection is required prior to reuse on another patron of any personal care instruments, including scissors, razors, clipper blades and tweezers, excluding tweezers used in electrolysis. (2) Disinfection for scissors, razors, clipper blades and tweezers shall consist of cleaning with soap and water to remove all organic material, wiping with or soaking in a disinfectant as defined in s. BC 1.01, and air drying. (3) Disinfection for combs, lifts, brushes, rollers and any other contact equipment shall consist of cleaning with soap and water to remove all organic material, spraying with a tuberculocidal disinfectant as defined in s. BC 1.01, and air drying. (4) Clean and disinfected contact equipment shall be placed in one or more covered containers. One or more separate containers shall be provided for the immediate storage of soiled contact equipment until cleaned and disinfected. (5) Disinfectant used for decontamination shall be changed daily and shall be kept in a covered container. (6) Laundry shall be disinfected by washing with a solution containing a germicidal compound. BC 4.03 Sterilization. (1) Sterilization in ss. BC 4.07, 4.09 and 4.10 shall be accomplished by use of a dry heat or steam sterilizer cleared for marketing by the food and drug administration, used according to manufacturer s instructions. If steam sterilization, moist heat, is utilized, heat exposure shall be at a minimum of 121 C., 250 F., for at least 30 minutes. If dry heat sterilization is utilized, heat exposure shall be at a minimum of 171 C., 340 F., for at least 60 minutes. (2) Sterilizers shall be maintained in working order. Equipment shall be checked in compliance with manufacturer s recommendations at least monthly to ensure that it is reaching required temperatures. 9

11 Who can perform eyelash extensions? That service is not regulated by the Department of Safety and Professional Services or the Cosmetology Examining Board. When may a licensee perform laser hair removal, chemical peels, or microdermabrasion? The use of a laser is a medical act. A licensee may only perform laser hair removal with six hours of training, and under a physician s supervision. bc 2.025(2)(a). EXCERPT BC Delegated medical procedures (2) Delegated medical procedures include the following: (a) Laser hair removal services. Prior to providing any laserhair removal procedures, a licensee shall complete advanced training in the use of laser devices in a training program of not less than 6 hours. If the training program is provided in a setting other than a licensed school of cosmetology or barbering, the program shall incorporate all of the following: 1. The training shall be conducted by a trainer who has been a practicing aesthetician, a barbering or cosmetology instructor, an aesthetics instructor, or a barbering or cosmetology manager for a minimum of one year, and who has completed a course in laser training provided by a licensed school of cosmetology or barbering, or provided by a licensed school of aesthetics. A licensed physician may also provide the training. 2. Trainees receive hands on training which includes actual use of the laser device under the supervision and guidance of the trainer. 3. The training is documented by a certificate of completion which sets forth the length of the training and the type of device and which is signed by the trainer and includes the trainer s license number. 4. The licensee posts in a conspicuous location in the immediate area where the procedure is carried out the certificate of completion of the training required in subd Licensees providing laser hair removal procedures shall complete each biennium at least 6 continuing education credit hours acceptable to the board in laser hair removal. This coursework shall be in addition to any other continuing education requirements required by the board for license renewal. Licensees shall maintain records of continuing education hours for at least 5 years from the date the coursework is completed. Certain chemical skin peels, or chemical exfoliations, are exempt from a physician s delegation. A licensee does not need a physician for the application of commercially available exfoliation products in accordance with the manufacturer s instructions. These commercially available products must meet the criteria in bc 2.025(2)(c)(1) and (2) 10

12 EXCERPT BC Delegated medical procedures (2) Delegated medical procedures include the following: (c) Chemical exfoliation, except for application of commercially available exfoliation products utilized in accordance with the manufacturers instructions, limited to the following: 1. Alpha hydroxyl acids of 30% or less, with a ph of not less than Salicylic acids of 20% or less, with a ph of not less than 3.0. Microdermabrasion is within the scope of practice only when the practitioner meets all of the requirements in bc 2.025(2r). BC Delegated medical procedures (2r) A licensee may utilize microdermabrasion devices in his or her practice without medical supervision if all of the following conditions are met: (a) The device shall be of an aesthetic grade and not labeledas a prescription device by the United States Food and Drug Administration. Only FDA approved Class I machines may be used pursuant to this subsection. (b) The device utilizes a closed loop negative pressure system that incorporates a tissue retention device. (c) The normal and customary use of the device results in the removal of only the surface epidermal cells of the skin. (d) Eye protection is provided to the client and protective gloves are worn by the operator. (e) Microdermabrasion services are not provided within 48 hours before or after a chemical exfoliation. (f) The licensee has performed a pretreatment assessment on the client and reviewed the results with the client. (g) The client has given written consent prior to the administration of the services. The consent shall contain all of the following: 1. A statement setting forth in general terms the nature and purpose of the procedure or procedures, together with the known risks associated with the procedure or procedures, if reasonably determinable. 2. A statement that acknowledges that the disclosure of that information has been made and that all questions asked about the procedure or procedures have been answered in a satisfactory manner. 3. The signature of the client for whom the procedure is to be performed, or if the client for any reason lacks legal capacity to consent, is signed by a person who has legal authority to consent on behalf of that client. (h) The licensee has completed advanced training in the use of microdermabrasion devices in a training program of not less than 6 hours. If the training program is provided in a setting other than a licensed school of cosmetology or barbering, the program shall incorporate all of the following: 11

13 1. The training shall be conducted by a microdermabrasion trainer who has been a practicing aesthetician, a barbering or cosmetology instructor, an aesthetics instructor, or a barbering or cosmetology manager for a minimum of one year, and who has completed a 40 hour course in microdermabrasion training provided by a licensed school of cosmetology or barbering, or provided by a licensed school of aesthetics. A licensed physician may also provide the training. 2. Trainees receive hands on training which includes actual use of the microdermabrasion device under the supervision and guidance of the trainer. 3. The training is documented by a certificate of completion which sets forth the length of the training and the type of device and which is signed by the trainer and includes the trainer s license number. (i) The licensee posts in a conspicuous location in the immediate area where the procedure is carried out the certificate of completion of the training required in par. (h). (j) The licensee shall complete at least 6 continuing education credit hours acceptable to the board in microdermabrasion each biennium. This coursework shall be in addition to any other continuing education requirements required by the board for license renewal. Licensees shall maintain records of continuing education hours for at least 5 years from the date the coursework is completed. At all other times, microdermabrasion is a delegated medical act. The person providing the service must be licensed and the facility in which the service is offered muse hold an establishment license. Is a certified nursing assistant allowed to wash and cut patients hair? Yes. Personal care services performed in a hospital or licensed nursing home under the supervision of a person responsible for patient care is not regulated by the board. Is a licensed practitioner allowed to offer services outside of an establishment at an adult day care? No. The only exception for practicing outside of an establishment is for clients who are unable to leave their homes. Because adult day care facilities only provide day-time services, they do not qualify for this exception. bc BC Services outside of a licensed establishment. (1) Licensees shall not provide personal care services outside of a licensed establishment except for persons who are unable to leave their homes because of illness or disability or for persons who are in hospitals, nursing homes, correctional institutions or other institutions. Licensees may provide any personal care service for inmates or patients regardless of whether it is done in a designated area or in the personal room of an inmate, patient or infirm person within an institution or private home. (2) Licensees shall comply with all practice standards set forth in s. BC 2.03 in providing services outside of a licensed establishment. 12

14 Is a Manicurist allowed to cut calluses? Yes. Wis. Admin. Code bc 1.01(3r) states: cutting, as used at s (13), stats., means exclusively the cutting of human nails, cuticles and calluses, and does not refer to any other invasive procedure May a licensed nail technician who is working on premises where Aestheticians are present perform a facial? No, a manicurist is limited to procedures within their scope of practice and facials are outside that scope. Is there a minimum age limit for clients who want to have acrylic nails applied? Good judgment and common sense dictate that certain individuals are too young or may be put at risk by unnecessary treatments. However there are no definitive age limits for acrylic nails as there are for tattoos and piercing. Are nail tech students allowed to do nails if they do not charge for the service? Yes, manicuring is defined as the cleansing, cutting, shaping, beautifying or massaging of the hands, feet or nails of the human body for compensation. Services provided without charge are not restricted. All rules of the Wisconsin Statues and Administrative Code are important. All rules are relevant to licensees and establishments in one way or another. Rules assist the licensed professional understand the Beauty and Personal Care Service Industry. Let's turn our attention to the next topic where we find additional information on the subject of rules and regulations. Topic Summary All rules of the Wisconsin Statues and Administrative Code are important and relevant to licensees and establishments in one way or another. Rules assist the licensed professional to understand the Beauty and Personal Care Service Industry. We can now describe the practice of body wrapping, the legalities of fish pedicures, the legalities of serving liquor to clients, the rules for off-site volunteer services for establishments and Nursing Homes and Assisted Living Centers. We can now define how a Cosmetology graduate can work in a salon. We also can list and describe continuing education credit hours required to renew a state issued license. And lastly, we can clearly identify laws that govern the practice of cutting calluses. Now let's turn our attention to the next topic where we find additional information on the subject of rules and regulations. 13

15 TOPIC 2: Rules related to Professional Licensing (30 minutes ) Outline Aestheticians Aesthetics Establishments Cosmetology Apprentices Cosmetology Establishments Cosmetology Managers Cosmetology Practitioners Electrologists Electrologist Establishments Manicurists Manicurist Establishments Learning objectives: After completing this lesson you will be able to: Describe education requirements to obtain a license Identify training requirements to obtain a license Describe the licensing exam Define endorsements Identify how to obtain a temporary license Define how to obtain and inactive license Describe a reinstatement Identify how to obtain an Apprentice Permit Describe how to obtain a Practitioner Credential Introduction Wisconsin Board of Barbering and Cosmetology implements rules and regulations for licensees. They enforce certain rules and regulations that allow for orderly licensing of all professions in the fields of Barbering and Cosmetology. We will begin our study by reviewing rules that govern specific fields of license. We will review licensing rules of the professional Aesthetician and Aesthetician Establishments, We will then review all of the categories of license regarding Cosmetologists and Cosmetology Establishments. There are 3 types of licenses for Cosmetologists: Apprentice, Practitioner, and Manager. We will also review the rules for Electrologists, Electrology Establishments, Manicurists and Manicuring Establishments. Although similar in regulations, there are some differences when obtaining a license, renewing, reinstating, or placing your license in an inactive status. 14

16 Aesthetician Read the following excerpt from Chapter 454 of the Wisconsin Statutes and Administrative Code EXCERPT Licensure (4) AESTHETICIAN LICENSE. The examining board shall issue an aesthetician license to any person who does all of the following: (a) Satisfies the conditions in sub. (1). (b) Completes either of the following: 1. A course of instruction in aesthetics of at least 450 training hours in not less than 11 weeks and not more than 30 weeks, in a school of cosmetology or a school of aesthetics licensed under s (3) (ar) or (b) or exempted under s At least 450 training hours in not less than 11 weeks and not more than 30 weeks under the supervision of a cosmetology instructor or aesthetics instructor certified under s (3) (am) or (b) or a licensed cosmetology manager, in a licensed establishment that is also licensed as a specialty school of aesthetics under s (4) (a). (c) Passes an examination conducted by the examining board to determine fitness to practice as an aesthetician. To clarify this rule, let's review the major aspects. To obtain an Aesthetician license by examination you must first Complete ONE of the following education requirements: Graduate from high school Attain high school graduation equivalency participate in a program approved by the department Be at least 18 years of age and meet the ability to benefit rule under 20 USC 1091 Complete ONE of the following training requirements: A course of instruction in aesthetics of at least 450 training hours in no less than 11 weeks and no more than 30 weeks in a school of cosmetology or a school of aesthetics licensed by the Department. At least 450 hours of training in no less than 11 weeks and no more than 30 weeks under the supervision of an aesthetics instructor or a cosmetology instructor licensed by the Department. Pass the examination Aesthetician applicants who have completed all training may be issued a temporary permit to practice for up to 6 months. 15

17 To obtain an Aesthetician license by endorsement you must have Completed at least 4,000 hours of licensed practice. If you are licensed as an Aesthetician in another state the examining board may issue a license to practice Barbering or Cosmetology, Aesthetics, Electrology or Manicuring or to practice as a Cosmetology Manager to an applicant who is licensed in another state or territory of the United States or in another country to perform services which are substantially the same as those performed by licensees in this state and to who either of the following applies: The applicant has at least 4,000 hours of experience in licensed practice, has never been disciplined by the licensing authority of another jurisdiction and is not a party to a proceeding before the licensing agency in which it is alleged that the applicant was negligent in the licensed practice or violated the law relating to the licensed practice Any applicant who does not meet the above licensing and experience requirements must graduate from a cosmetology school licensed in Wisconsin. Wisconsin Statutes do not allow for exemptions from the above requirements. Required Information To Be Submitted Application for License (Form #1681). The posted license fee. Verification of Employment (Form #1682) to verify 4,000 hours of licensed practice, must be completed in its entirety by the manager/owner of the licensed establishment. Any alterations will void this form. Verification of Self-Employment (Form #2168) should only be completed if you owned a cosmetology establishment; not if you were employed by another establishment. This form should be submitted with your application. Certification (Form #373) to be completed by each state in which you have been issued a license. You must hold a current license in at least one state. The certification form must be sent by the state directly to our office If you are licensed in another country, you must submit acceptable documentation that you have met the legal requirements for practice in that country. Sources of acceptable documentation include - but are not limited to a notarized copy of your license from the government office responsible for licensure, or a notarized statement from an embassy official for the country where you are licensed describing the requirements for practice and attesting that you meet those requirements. 16

18 If you are submitting documents in a language other than English, it is your responsibility to include translations into English for all documents submitted. You must submit both the document in the language of its country of origin and the translation. Documents cannot be translated by the applicant or by family members. Translators must provide a signed statement including contact information, attesting to their qualifications, and attesting to the accuracy of the translation. #1683 To obtain a temporary Aesthetician license: Rules to obtain a temporary license are the same as to obtain a license by examination. To obtain an Inactive Aesthetician license: Fill out Form #R454 Renewal Addendum and submit it to the department. To reinstate an Aesthetician license: A person whose license has been expired for more than 5 years is required to pass the current licensing examination (written and practical) to demonstrate minimum competency in services and subjects substantially related to practice and public health and safety. To request an approval letter to take the examination, you must call or send an to the Department with the following information: your name (prior names if your name has changed), your license number and your current address. You will be required to submit the reinstatement fee to the Department of Safety & Professional Services after passing the examination. To renew an Aesthetician license you must Pay the renewal fee and Complete continuing education courses. You may renew On-line or use a Paper Renewal Form Inactive Status If you do not intend to practice and want your license to be placed on Inactive Status per Wis. Stats (8m) & (6), you cannot renew online. You must use a paper renewal form use form R454 Aesthetics Establishment All establishments where aesthetics is practiced must be licensed either as an Aesthetics establishment or a Cosmetology establishment, and must have an Aesthetician or a Cosmetology manager or practitioner to provide services. 17

19 obtain a license before opening a new business, relocating an existing business, or a changing the ownership of the business. To obtain a new license an Aesthetics Establishment must submit a completed Application a Compliance Inspection Report a floor plan of the establishment a $75.00 credentialing fee To reinstate an Aesthetics Establishment license that has been expired more than 5 years, you must submit a completed Application. a Compliance Inspection Report a floor plan of the establishment a $ reinstatement fee Cosmetology Apprentice To Obtain a Cosmetology Apprentice Permit you must Complete Form the apprenticeship contract provided by the Department of Workforce Development (DWD) and obtain an apprentice permit. Fee is $10 for the initial permit. To Obtain A Cosmetology Practitioner Credential you must Complete 288 training hours of instruction in theory at an approved school of barbering or cosmetology and Complete 3,712 hours of practical training. Training must be at least 32 hours per week and be completed in not less than 2 or more than 4 years. Contact Pearson VUE for application materials to verify education and training and to register for the examination. Pass both the written and practical examinations. A credential to practice will be mailed after verification of passing both the written and practical examinations is received. Cosmetology Establishment All establishments where cosmetology is practiced must be licensed as a Cosmetology Establishment and have a Cosmetology Manager. Establishments obtain a license before opening a new business, relocating an existing business, or a changing the ownership of the business. 18

20 To obtain a new Cosmetology Establishment license you must submit a completed Application a Compliance Inspection Report a floor plan of the establishment a $75.00 credentialing fee To reinstate a Cosmetology Establishment license that has been expired more than 5 years, you must submit a completed Application a Compliance Inspection Report a floor plan of the establishment a $ reinstatement fee Cosmetology Manager Read the following excerpt: Chapter 454 of the Wisconsin Statutes and Administrative Code EXCERPT Licensure (3) COSMETOLOGY MANAGER LICENSE. The examining board shall issue a cosmetology manager license to any person who does all of the following: (a) Holds a cosmetologist license. (b) Completes 4,000 hours of practice as a licensed cosmetologist under the supervision of a licensed cosmetology manager or completes 2,000 hours of practice as a licensed cosmetologist and 150 training hours of theoretical instruction in a school of cosmetology licensed under s (3) (ar) or exempted under s (c) Pays the fee under s (1). (d) Passes an examination conducted by the examining board to determine fitness to practice as a cosmetology manager. To clarify this rule, let's review important aspects. License By Examination To obtain a Wisconsin Cosmetology Manager license: obtain a Wisconsin Cosmetologist license complete the training and/or experience: Option A: 4,000 hours of practice as a licensed cosmetologist under the supervision of a licensed Cosmetology Manager OR Option B: 150 training hours of theoretical instruction in a school of cosmetology licensed by the Department and 2,000 hours of practice as a licensed cosmetologist. take and pass the exam given by Pearson VUE 19

21 Cosmetology Manager License By Endorsement If you are currently licensed in another state and have completed at least 4,000 hours of licensed practice, you may apply for a license by endorsement. Reinstatement of Cosmetology Manager License A person whose license has been expired for more than 5 years is required to pass the current licensing examination (written and practical) to demonstrate minimum competency in services and subjects substantially related to practice and public health and safety. submit the reinstatement fee to the Department of Safety & Professional Services after passing the examination. Cosmetology Practitioner To obtain a Cosmetology Practitioner license by examination: Complete ONE of the following education requirements: Graduate from high school Attain high school graduation equivalency participate in a program approved by the department Be at least 18 years of age and meet the ability to benefit rule under 20 USC 1091 Complete ONE of the following training requirements: Graduate from a course of instruction of at least 1,800 training hours in no less than 10 months in a school of cosmetology licensed by the Department Successfully complete an apprenticeship of at least 3,712 hours of practical training at at least 288 training hours of theoretical instruction in a school of cosmetology Pass the examination Applicants who have completed all training may be issued a temporary permit to practice for up to 6 months. To obtain a Cosmetology Practitioner license by endorsement If you are currently licensed in another state and have completed at least 4,000 hours of licensed practice, you may apply for a license by endorsement. To obtain an Inactive Cosmetology Practitioner license: Fill out Form #R454 Renewal Addendum and submit it to the department. To reinstate a Cosmetology Practitioner license: A person whose license has been expired for more than 5 years is required to pass the current licensing examination (written and practical) to demonstrate minimum competency in services and subjects substantially related to practice and public health and safety. 20

22 submit the reinstatement fee to the Department of Safety & Professional Services after passing the examination. Electrologist Read the following excerpt: Chapter 454 of the Wisconsin Statutes and Administrative Code EXCERPT Licensure (5) ELECTROLOGIST LICENSE. The examining board shall issue an electrologist license to any person who does all of the following: (a) Satisfies the conditions in sub. (1). (b) Completes either of the following: 1. A course of instruction in electrology of at least 450 training hours in not less than 11 weeks and not more than 30 weeks, in a school of cosmetology, or a school of electrology licensed under s (3) (ar) or (c) or exempted under s At least 450 training hours in not less than 11 weeks and not more than 30 weeks under the supervision of an electrology instructor certified under s (3) (c), or a licensed electrologist who is also a licensed cosmetology manager, in a licensed establishment that is also licensed as a specialty school of electrology under s (4) (b). (c) Passes an examination conducted by the examining board to determine fitness to practice as an electrologist. To obtain an Electrologist license by examination: Complete ONE of the following education requirements: Graduate from high school Attain high school graduation equivalency participate in a program approved by the department Be at least 18 years of age and meet the ability to benefit rule under 20 USC 1091 Complete ONE of the following training requirements: A course of instruction in Electrology of at least 450 training hours in no less than 11 weeks and no more than 30 weeks in a school of cosmetology or a school of Electrology licensed by the Department. At least 450 hours of training in no less than 11 weeks and no more than 30 weeks under the supervision of an Electrology instructor licensed by the Department. Pass the examination Applicants who have completed all training may be issued a temporary permit to practice for up to 6 months. 21

23 To obtain an Electrologist license by endorsement: If you are currently licensed in another state and have completed at least 4,000 hours of licensed practice, you may apply for a license by endorsement. To obtain an Inactive Electrologist license: Fill out Form #R454 Renewal Addendum and submit it to the department. To reinstate an Electrologist license: A person whose license has been expired for more than 5 years is required to pass the current licensing examination (written and practical) to demonstrate minimum competency in services and subjects substantially related to practice and public health and safety. submit the reinstatement fee to the Department of Safety & Professional Services after passing the examination. Electrology Establishment All establishments where Electrology is practiced must be licensed either as an Electrology establishment or a Cosmetology establishment, and must have an Electrologist or a Cosmetology manager or practitioner to provide services. obtain a license before opening a new business, relocating an existing business, or a changing the ownership of the business. To obtain a new Electrology establishment license you must submit a completed Application a Compliance Inspection Report a floor plan of the establishment a $75.00 credentialing fee To reinstate an Electrology establishment license that has been expired more than 5 years you must submit a completed Application a Compliance Inspection Report a floor plan of the establishment $ reinstatement fee Manicurist Read the following excerpt: Chapter 454 of the Wisconsin Statutes and Administrative Code EXCERPT Licensure (6) MANICURIST LICENSE. The examining board shall issue a manicurist license to any person who does all of the following: (a) Satisfies the conditions in sub. (1). (b) Completes either of the following: 22

24 1. A course of instruction in manicuring of at least 300 training hours in not less than 7 weeks and not more than 20 weeks, in a school of cosmetology or a school of manicuring licensed under s (3) (ar) or (d) or exempted under s At least 300 training hours of training in not less than 7 weeks and not more than 20 weeks under the supervision of a cosmetology instructor or manicuring instructor certified under s (3) (am) or (d) or a licensed cosmetology manager, in a licensed establishment that is also licensed as a specialty school of manicuring under s (4) (c). (c) Passes an examination conducted by the examining board to determine fitness to practice as a manicurist. To obtain a Manicurist license by examination you must Complete ONE of the following education requirements: Graduate from high school Attain high school graduation equivalency participate in a program approved by the department Be at least 18 years of age and meet the ability to benefit rule under 20 USC 1091 Complete ONE of the following training requirements: A course of instruction in manicuring of at least 300 training hours in no less than 7 weeks and no more than 20 weeks in a school of Cosmetology or a school of manicuring licensed by the Department. At least 300 hours of training in no less than 7 weeks and no more than 20 weeks under the supervision of a manicuring instructor or a cosmetology instructor licensed by the Department. Pass the examination Applicants who have completed all training may be issued a temporary permit to practice for up to 6 months. To apply for a temporary permit and schedule an appointment to take the exam, contact the Department's contracted vendor, Pearson VUE, To obtain a Manicurist license by endorsement: If you are currently licensed in another state and have completed at least 4,000 hours of licensed practice, you may apply for a license by endorsement. To reinstate a Manicurist license: A person whose license has been expired for more than 5 years is required to pass the current licensing examination (written and practical) to demonstrate minimum competency in services and subjects substantially related to practice and public health and safety. submit the reinstatement fee to the Department of Safety & Professional Services after passing the examination. 23

25 Manicuring Establishment All establishments where manicuring is practiced must be licensed either as a manicuring establishment or a Cosmetology establishment, and must have a manicurist or a Csmetology manager or practitioner to provide services. obtain a license before opening a new business, relocating an existing business, or a changing the ownership of the business. To obtain a new Manicuring Establishment license you must submit a completed application a Compliance Inspection Report a floor plan of the establishment a $75.00 credentialing fee To reinstate a Manicuring Establishment license that has been expired more than 5 years you must submit a completed Application a Compliance Inspection Report a floor plan of the establishment a $ reinstatement fee Course Summary We have now reviewed key elements of important rules that regulate licensees and establishments, such as: services offered by establishments, volunteer services, nursing home and assisted living centers, as well as Cosmetology students and apprentices. We have also learned about continuing education rules and prohibited practices. All laws and rules must be followed to be in good standing regarding licensing. Whether you are a Cosmetologist, Aesthetician, Manicurist, Electrologist, or hold an Establishment license, it is recommended to know all laws created by the state of Wisconsin because laws do effect each licensee as well as the extended public. Your place of employment must also consistently be in compliance with all rules and regulations set forth by the Board. Please continue to regularly research updated information for yourself and remember to check with the State Board from time to time for any changes in laws governing the practices of Barbering & Cosmetology and Professional Establishments. Credits: ContinuingCosmetology.com copyright c 2013 Publisher PO Box , Orlando, FL Wisconsin Department of Safety and Professional Services 1400 E. Washington Avenue Madison, WI Cosmetology Examining Board 24

26 Approved by the Wisconsin Department of Safety and Professional Services and the Wisconsin Cosmetology Examining Board Safety, Sanitation, and Infection Control (3 hours) Provided by ContinuingCosmetology.com

27 TABLE OF CONTENTS page TOPIC 1: Safety (1 hour) 2 TOPIC 2: Sanitation (1 hour) 15 TOPIC 3: Infection Control (1 hour) 29 1

28 TOPIC 1: Safety (1 hour) Outline New OSHA (Occupational Safety and Health Administration) Regulations United Nations Globally Harmonized System of Classification and Labeling of Chemicals (GHS) New HAZCOM (Hazard Communication Standard) New SDS (Safety Data Sheets) Learning objectives: After completing this lesson you will be able to: Describe the new United Nation's GHS Identify important elements of the new Hazard Communication Standard (HAZCOM) Explain the new way that SDS (formerly known as MSDS) must be developed Define and identify the newest inclusions of Safety Data Sheets (SDS) Explain the new way that chemicals must be labeled Introduction The purpose of this study is to review new regulations of the United States Department of Labor's Occupational Safety and Health Administration. These newly adopted regulations are in cooperation and compliance with the United Nations global standards. Our United States Federal Department of Labor's Occupational, Safety and Health Association has adopted new hazardous chemical labeling requirements as a part of its recent revision of the Hazard Communication Standard, 29 CFR (HCS), bringing it into alignment with the United Nations Globally Harmonized System of Classification and Labeling of Chemicals (GHS). These changes will help ensure improved quality and consistency in the classification and labeling of all chemicals, and will also enhance worker comprehension. As a result, workers will have better information available on the safe handling and use of hazardous chemicals, thereby allowing them to avoid injuries and illnesses related to exposures to hazardous chemicals. The revised HCS changes the existing Hazard Communication Standard (HCS/HazCom 19941) from a performance-based standard to one that has more structured requirements for the labeling of chemicals. The revised standard requires that information about chemical hazards be conveyed on labels using quick visual notations to alert the user, providing immediate recognition of the hazards. Labels must also provide instructions on how to handle the chemical so that chemical users are informed about how to protect themselves. The label provides information to the workers on the specific hazardous chemical. While labels provide important information for anyone who handles, uses, stores, and transports hazardous chemicals, they are limited by design in the amount of information they can provide. 2

29 SDS Safety Data Sheets (SDSs), FORMERLY KNOWN AS Material Safety Data Sheets (MSDS) which must accompany hazardous chemicals, are the more complete resource for details regarding hazardous chemicals. The revised standard also requires the use of a 16-section safety data sheet format, which provides detailed information regarding the chemical. Section 1, Identification includes product identifier; manufacturer or distributor name, address, phone number; emergency phone number; recommended use; restrictions on use. Section 2, Hazard(s) identification includes all hazards regarding the chemical; required label elements. Section 3, Composition/information on ingredients includes information on chemical ingredients; trade secret claims. Section 4, First-aid measures includes important symptoms/ effects, acute, delayed; required treatment. Section 5, Fire-fighting measures lists suitable extinguishing techniques, equipment; chemical hazards from fire. Section 6, Accidental release measures lists emergency procedures; protective equipment; proper methods of containment and cleanup. Section 7, Handling and storage lists precautions for safe handling and storage, including incompatibilities. Section 8, Exposure controls/personal protection lists OSHA's Permissible Exposure Limits (PELs); Threshold Limit Values (TLVs); appropriate engineering controls; personal protective equipment (PPE). Section 9, Physical and chemical properties lists the chemical's characteristics. Section 10, Stability and reactivity lists chemical stability and possibility of hazardous reactions. Section 11, Toxicological information includes routes of exposure; related symptoms, acute and chronic effects; numerical measures of toxicity. Section 12, Ecological information* Section 13, Disposal considerations* Section 14, Transport information* Section 15, Regulatory information* Section 16, Other information, includes the date of preparation or last revision. *Note: Since other Agencies regulate this information, OSHA will not be enforcing Sections 12 through 15(29 CFR (g)(2)). Employers must ensure that SDSs are readily accessible to employees. 3

30 Changing over from the old system to the new system has created quite a stir in the Industrialized world. Every level will be affected by the changes. The following is an example of the cumulative effects of transitioning to the new Globally Harmonized System (GHS): This news-clip is from an article released by an MSDS Online Library/ Provider. New Look Helps Visualize Transition to Global Harmonization CHICAGO (January 8, 2013) MSDSonline, the leading provider of cloud-based solutions for managing hazardous chemicals, today announced it has made a modification to its logo. The update reflects recent changes OSHA has made to safety data sheets the documents used to provide critical information to users of hazardous chemicals. For decades, OSHA called such documents material safety data sheets and they are commonly known as MSDSs. Now, as part of its adoption of the Global Harmonization System (GHS), OSHA is dropping the word material and is simply calling them safety data sheets or SDSs. MSDSonline is responding to this transition by de-emphasizing the M in its logo and putting greater visual focus on the SDSonline portion of its name. The logo update is purposely timed to dovetail an important OSHA GHS implementation deadline. December 1, 2013 is the date, employers with workers exposed to hazardous chemicals were required to train their employees on OSHA s new chemical label and safety data sheet formats. The new formats and name change are part of larger changes OSHA recently made to its Hazard Communication Standard (HazCom) which covers hazardous chemicals in over 5 million workplaces. When OSHA aligned its HazCom Standard with GHS, the United Nation s model hazard communication system, it started a chain of events that have had far reaching consequences for chemical manufacturers, distributors and employers, said Glenn Trout, president and CEO of MSDSonline. Chemical manufactures have to reclassify all of their chemicals and then they have to re-author all of their MSDSs into the new GHS required SDS format. A mistake many employers are making is to think all of those changes to MSDSs have already been made for sure some have, but most have not, as chemical manufactures have until June 1, 2015 to make the changes. Dan Ciancio, VP of marketing at MSDSonline added, This is an important and complex transition that the workplace safety industry is going through. MSDSonline is so named because we specialize in helping customers manage safety information through our cloud-based hazard communication compliance solutions. During the next few years our customers are going to have to manage a mix of both current MSDSs and newly formatted GHS styled SDSs. Ciancio continued, We ve made this update to our logo to one, signal to our customers that they can continue to count on us for both their MSDS and SDS needs through this transitional phase; and two, to reflect the leadership MSDSonline will continue to provide on OSHA s GHS adoption by educating the marketplace and providing one-of-a-kind compliance solutions. Information OSHA s HazCom Standard and GHS adoption, including free webinars and other training materials, is available on MSDSonline s website at and on its blog, About MSDSonline Founded in 1996 and based in Chicago, MSDSonline is a leading provider of cloud-based EH&S compliance solutions, offering products and services for managing safety data sheets, reporting workplace incidents, training employees and administering other critical EH&S information. The company s mission is to provide sustainable solutions that help customers improve employee safety, streamline compliance recordkeeping and reduce potential exposures to workplace hazards and risks. 4

31 Labeling All hazardous chemicals shipped after June 1, 2015, must be labeled with specified elements including pictograms, signal words and hazard and precautionary statements. However, manufacturers, importers, and distributors may start using the new labeling system in the revised HCS before the June 1, 2015 effective date if they so choose. Until the June 1, 2015 effective date, manufacturers, importers and distributors may maintain compliance with the requirements of HazCom 1994 or the revised standard. Distributors may continue to ship containers labeled by manufacturers or importers (but not by the distributor themselves) in compliance with the HazCom 1994 until December 1, This document is designed to inform chemical receivers, chemical purchasers, and trainers about the label requirements. It explains the new labeling elements, identifies what goes on a label, and describes what pictograms are and how to use them. Label Requirements Labels, as defined in the HCS, are an appropriate group of written, printed or graphic informational elements concerning a hazardous chemical that are affixed to, printed on, or attached to the immediate container of a hazardous chemical, or to the outside packaging. The HCS requires chemical manufacturers, importers, or distributors to ensure that each container of hazardous chemicals leaving the workplace is labeled, tagged or marked with the following information: product identifier; signal word; hazard statement(s); precautionary statement(s); and pictogram(s); and name, address and telephone number of the chemical manufacturer, importer, or other responsible party. Labels for a hazardous chemical must contain: Name, Address and Telephone Number Product Identifier Signal Word Hazard Statement(s) Precautionary Statement(s) Pictogram(s) To develop labels under the revised HCS, manufacturers, importers and distributors must first identify and classify the chemical hazard(s). Once this information has been identified and gathered, then a label may be created. Label Elements The HCS now requires the following elements on labels of hazardous chemicals: Name, Address and Telephone Number of the chemical manufacturer, importer or other responsible party. 5

32 Product Identifier is how the hazardous chemical is identified. This can be (but is not limited to) the chemical name, code number or batch number. The manufacturer, importer or distributor can decide the appropriate product identifier. The same product identifier must be both on the label and in section 1 of the SDS. Signal Words are used to indicate the relative level of severity of the hazard and alert the reader to a potential hazard on the label. There are only two words used as signal words, Danger and Warning. Within a specific hazard class, Danger is used for the more severe hazards and Warning is used for the less severe hazards. There will only be one signal word on the label no matter how many hazards a chemical may have. If one of the hazards warrants a Danger signal word and another warrants the signal word Warning, then only Danger should appear on the label. Hazard Statements describe the nature of the hazard(s) of a chemical, including, where appropriate, the degree of hazard. For example: Causes damage to kidneys through prolonged or repeated exposure when absorbed through the skin. All of the applicable hazard statements must appear on the label. Hazard statements may be combined where appropriate to reduce redundancies and improve readability. The hazard statements are specific to the hazard classification categories, and chemical users should always see the same statement for the same hazards no matter what the chemical is or who produces it. Precautionary Statements describe recommended measures that should be taken to minimize or prevent adverse effects resulting from exposure to the hazardous chemical or improper storage or handling. There are four types of precautionary statements: prevention (to minimize exposure); response (in case of accidental spillage or exposure emergency response, and first-aid); storage; and disposal. For example, a chemical presenting a specific target organ toxicity (repeated exposure) hazard would include the following on the label: Do not breathe dust/fume/gas/mist/vapors/spray. Get medical advice/attention if you feel unwell. Dispose of contents/container in accordance with local/regional/ national and international regulations. A forward slash (/) designates that the classifier can choose one of the precautionary statements. In the example above, the label could state, Do not breathe vapors or spray. Get medical attention if you feel unwell. Dispose of contents in accordance with local/regional/national/international regulations. See Examples 1 and 2A of this document as an example. In most cases, the precautionary statements are independent. However, OSHA does allow flexibility for applying precautionary statements to the label, such as combining statements, using an order of precedence or eliminating an inappropriate statement. Precautionary statements may be combined on the label to save on space and improve readability. For example, Keep away from heat, spark and open flames, Store in a wellventilated place, and Keep cool may be combined to read: Keep away from heat, sparks and open flames and store in a cool, well-ventilated place. 6

33 Where a chemical is classified for a number of hazards and the precautionary statements are similar, the most stringent statements must be included on the label. In this case, the chemical manufacturer, importer, or distributor may impose an order of precedence where phrases concerning response require rapid action to ensure the health and safety of the exposed person. In the self-reactive hazard category Types C, D, E or F, three of the four precautionary statements for prevention are: Keep away from heat/sparks/open flame/hot surfaces. - No Smoking. ; Keep/Store away from clothing/ / combustible materials ; Keep only in original container. These three precautionary statements could be combined to read: Keep in original container and away from heat, open flames, combustible materials and hot surfaces. - No Smoking. Finally, a manufacturer or importer may eliminate a precautionary statement if it can demonstrate that the statement is inappropriate. Supplementary Information. The label producer may provide additional instructions or information that it deems helpful. It may also list any hazards not otherwise classified under this portion of the label. This section must also identify the percentage of ingredient(s) of unknown acute toxicity when it is present in a concentration of 1% (and the classification is not based on testing the mixture as a whole). If an employer decides to include additional information regarding the chemical that is above and beyond what the standard requires, it may list this information under what is considered supplementary information. There is also no required format for how a workplace label must look and no particular format an employer has to use; however, it cannot contradict or detract from the required information. An example of an item that may be considered supplementary is the personal protective equipment (PPE) pictogram indicating what workers handling the chemical may need to wear to protect themselves. For example, the Hazardous Materials Identification System (HMIS) pictogram of a person wearing goggles may be listed. Other supplementary information may include directions of use, expiration date, or fill date, all of which may provide additional information specific to the process in which the chemical is used. Pictograms are graphic symbols used to communicate specific information about the hazards of a chemical. On hazardous chemicals being shipped or transported from a manufacturer, importer or distributor, the required pictograms consist of a red square frame set at a point with a black hazard symbol on a white background, sufficiently wide to be clearly visible. A square red frame set at a point without a hazard symbol is not a pictogram and is not permitted on the label. The pictograms OSHA has adopted improve worker safety and health, conform with the GHS, and are used worldwide. While the GHS uses a total of nine pictograms, OSHA will only enforce the use of eight. The environmental pictogram is not mandatory but may be used to provide additional information. 7

34 Workers may see the ninth symbol on a label because label preparers may choose to add the environment pictogram as supplementary information. Figure 1 shows the symbol for each pictogram, the written name for each pictogram, and the hazards associated with each of the pictograms. Most of the symbols are already used for transportation and many chemical users may be familiar with them. Figure 1: Pictograms and Hazards It is important to note that the OSHA pictograms do not replace the diamond-shaped labels that the U.S. Department of Transportation (DOT) requires for the transport of chemicals, including chemical drums, chemical totes, tanks or other containers. Those labels must be on the external part of a shipped container and must meet the DOT requirements set forth in 49 CFR 172, Subpart E. 8

35 However, DOT does not view the HCS pictogram as a conflict and for some international trade both pictograms may need to be present on the label. The agency will allow both DOT and HCS pictograms for the same hazard on a label. While the DOT diamond label is required for all hazardous chemicals on the outside shipping containers, chemicals in smaller containers inside the larger shipped container do not require the DOT diamond but do require the OSHA pictograms. Labels must be legible, in English, and prominently displayed. Other languages may be displayed in addition to English. Chemical manufacturers, importers, and distributors who become newly aware of any significant information regarding the hazards of a chemical must revise the label within six months. Employer Responsibilities Employers are responsible for maintaining the labels on the containers, including, but not limited to, tanks, totes, and drums. This means that labels must be maintained on chemicals in a manner which continues to be legible and the pertinent information (such as the hazards and directions for use) does not get defaced (i.e., fade, get washed off) or removed in any way. The employer is not responsible for updating labels on shipped containers, even if the shipped containers are labeled under HazCom The employer must relabel items if the labels are removed or defaced. However, if the employer is aware of newly-identified hazards that are not disclosed on the label, the employer must ensure that the workers are aware of the hazards as discussed below under workplace labels. Workplace Labels OSHA has not changed the general requirements for workplace labeling. Employers have the option to create their label from the chemical manufacturer or, the own workplace labels. They can either provide all of the required information that is on the product identifier and words, pictures, symbols or a combination thereof, which in combination with other information immediately available to employees, provide specific information regarding the hazards of the chemicals. If an employer has an in-plant or workplace system of labeling that meets the requirements of HazCom 1994, the employer may continue to use this system in the workplace as long as this system, in conjunction with other information immediately available to the employees, provides the employees with the information on all of the health and physical hazards of the hazardous chemical. This workplace labeling system may include signs, placards, process sheets, batch tickets, operating procedures, or other such written materials to identify hazardous chemicals. Any of these labeling methods or a combination thereof may be used instead of a label from the manufacturer, importer or distributer as long as the employees have immediate access to all of the information about the hazards of the chemical. Workplace labels must be in English. Other languages may be added to the label if applicable. 9

36 Employers may use additional instructional symbols that are not included in OSHA s HCS pictograms on the workplace labels. An example of an instructional pictogram is a person with goggles, denoting that goggles must be worn while handling the given chemical. Including both types of pictograms on workplace labels is acceptable. The same is true if the employer wants to list environmental pictograms or PPE pictograms from the HMIS to identify protective measures for those handling the chemical. Employers may continue to use rating systems such as National Fire Protection Association (NFPA) diamonds or HMIS requirements for workplace labels as long as they are consistent with the requirements of the Hazard Communication Standard and the employees have immediate access to the specific hazard information as discussed above. An employer using NFPA or HMIS labeling must, through training, ensure that its employees are fully aware of the hazards of the chemicals used. If an employer transfers hazardous chemicals from a labeled container to a portable container that is only intended for immediate use by the employee who performs the transfer, no labels are required for the portable container. Sample Labels The following examples demonstrate how a manufacturer or importer may display the appropriate information on the label. As mentioned above, once the manufacturer determines the classification of the chemical (class and category of each hazard) using Appendices A and B, it would determine the required pictograms, signal words, hazard statements, and precautionary statements. The final step is to put the information on the label. The examples below show what a sample label might look like under the revised HCS requirements. The examples break the labeling out into steps to show the order of information gathering and how label creation occurs. Step 1 is performing classification; step 2 is gathering full label information; and step 3 is creating the label. These examples are for informational purposes only and are not meant to represent the only labels manufacturers, importers and distributors may create for these hazards. Example 1: This example demonstrates a simple label. The Substance: HS85 Batch Number: 85L6543 Step 1: Perform Classification Class: Acute Oral Toxicity; Category 4 Step 2: Gather Labeling Information Pictograms: 10

37 Precautionary Statements: Prevention: Wash hands and face thoroughly after handling. Do not eat, drink or smoke when using this product. Response: If swallowed: Call a doctor if you feel unwell.2 Rinse mouth Storage: None specified Disposal: Dispose of contents/container in accordance with local/regional/national/international regulations.3 Step 3: Create the Label Putting together the above information on HS85, a label might list the following information: Example 1: HS85 Label HS85 Batch number: 85L6543 Warning Harmful if swallowed Wash hands and face thoroughly after handling. Do not eat, drink or smoke when using this product. Dispose of contents/container in accordance with local, state and federal regulations. First aid: If swallowed: Call a doctor if you feel unwell. Rinse mouth. GHS Example Company, 123 Global Circle, Anyville, NY 130XX Telephone (888) Example 2: This example demonstrates a more complex label. Example 2 is for a substance that is a severe physical and health hazard. For shipping packages of chemicals that will be transported in the United States (i.e., drums, totes, tanks, etc.), the U.S. DOT requires a DOT label(s) on the outside container(s) for hazardous chemicals. Two versions of this label are presented below to demonstrate the difference between an OSHA label with pictograms from the HCS and a DOT label required for transport of a shipping container. 11

38 The Substance: OXI252 (disodiumflammy) CAS number: xx Step 1: Perform Classification Class: Oxidizing Solid, Category 1 Class: Skin Corrosive, Category 1A Step 2: Gather Labeling Information Pictograms: Signal Word: DANGER Hazard Statements: May cause fire or explosion; strong oxidizer Causes severe skin burns and eye damage Precautionary Statements: Prevention: Keep away from heat. Keep away from clothing and other combustible materials. Take any precaution to avoid mixing with combustibles. Wear protective neoprene gloves, safety goggles and face shield with chin guard. Wear fire/flame resistant clothing. Do not breathe dust or mists. Wash arms, hands and face thoroughly after handling. Response: IF ON SKIN (or hair): Take off immediately all contaminated clothing. Rinse skin with water. IF ON CLOTHING: Rinse immediately contaminated clothing and skin with plenty of water before removing clothes. Wash contaminated clothing before reuse. IF IN EYES: Rinse cautiously with water for several minutes. Remove contact lenses, if present and easy to do. Continue rinsing. IF INHALED: Remove person to fresh air and keep comfortable for breathing. IF SWALLOWED: Rinse mouth. Do NOT induce vomiting. Immediately call poison center.4 12

39 Specific Treatment: Treat with doctor-prescribed burn cream.5 In case of fire: Use water spray. In case of major fire and large quantities: Evacuate area. Fight fire remotely due to the risk of explosion. Storage: Store locked up. Disposal: Dispose of contents/container in accordance with local/regional/national/international regulations.³ Step 3: Create the Label Putting together the above information on OXI252, a label might list the following information: Example 2A: OXI252 Label inner package label with OSHA pictograms OXI252 (disodiumflammy) CAS #: xx Danger May cause fire or explosion; strong oxidizer Causes severe skin burns and eye damage Keep away from heat. Keep away from clothing and other combustible materials. Take any precaution to avoid mixing with combustibles. Wear protective neoprene gloves, safety goggles and face shield with chin guard. Wear fire/flame resistant clothing. Do not breathe dust or mists. Wash arms, hands and face thoroughly after handling. Store locked up. Dispose of contents and container in accordance with local, state and federal regulations. First aid: IF ON SKIN (or hair) or clothing6: Rinse immediately contaminated clothing and skin with plenty of water before removing clothes. Wash contaminated clothing before reuse. IF IN EYES: Rinse cautiously with water for several minutes. Remove contact lenses, if present and easy to do. Continue rinsing. IF INHALED: Remove person to fresh air and keep comfortable for breathing. IF SWALLOWED: Rinse mouth. Do NOT induce vomiting. Immediately call poison center. Specific Treatment: Treat with doctor-prescribed burn cream. Fire: In case of fire: Use water spray. In case of major fire and large quantities: Evacuate area. Fight fire remotely due to the risk of explosion. Great Chemical Company, 55 Main Street, Anywhere, CT 064XX Telephone (888)

40 Example 2B: OXI252 Label meeting DOT requirements for shipping OXI252 (disodiumflammy) CAS #: xx Danger May cause fire or explosion; strong oxidizer Causes severe skin burns and eye damage Keep away from heat. Keep away from clothing and other combustible materials. Take any precaution to avoid mixing with combustibles. Wear protective neoprene gloves, safety goggles and face shield with chin guard. Wear fire/flame resistant clothing. Do not breathe dust or mists. Wash arms, hands and face thoroughly after handling. Store locked up. Dispose of contents and container in accordance with local, state and federal regulations. First aid: IF ON SKIN (or hair) or clothing: Rinse immediately contaminated clothing and skin with plenty of water before removing clothes. Wash contaminated clothing before reuse. IF IN EYES: Rinse cautiously with water for several minutes. Remove contact lenses, if present and easy to do. Continue rinsing. IF INHALED: Remove person to fresh air and keep comfortable for breathing. Immediately call a doctor. IF SWALLOWED: Rinse mouth. Do NOT induce vomiting. Immediately call poison center. Specific Treatment: Treat with doctor-prescribed burn cream. Fire: In case of fire: Use water spray. In case of major fire and large quantities: Evacuate area. Fight fire remotely due to the risk of explosion. Great Chemical Company, 55 Main Street, Anywhere, CT 064XX Telephone (888) Topic Summary We can now better understand the impact of the United Nations regulations on the United States Occupational Safety and Health Administration. We have reviewed the basic elements of the new Globally Harmonized System (GHS) and should be able to describe and explain the elements it entails. We have also studied the updated Hazard Communication Standard (HAZCOM) and can now list the changes that will effect businesses and companies. We have reviewed the newest inclusions of the new Safety Data Sheets (SDS) and can now list the 16 elements that are required on those documents. And lastly we have learned about changes that effect the way in which chemicals must be labeled 14

41 TOPIC 2: Sanitation (1 hour) Outline Proper Cleaning and Disinfection Proper Product Application Proper Disinfection of Multi-use Tools and Equipment Methods of Proper Cleaning Methods of Proper Disinfecting Methods for Proper Storage Disinfectants and Antiseptics Hand Washing MRSA Learning objectives: After completing this lesson you will be able to: Explain how to properly clean and disinfect Explain how to avoid product contamination always Identify single-use disposable implements Describe multi-use items Identify individual client packs and explain their purpose Describe immersible implements List appropriate salon disinfectants List proper clean up of blood List diseases that good hand washing can prevent Describe good hand washing technique Identify over-the-counter alcohol-based hand cleansers and their purpose Explain how pathogens on hands can be transmitted List causes of irritant contact dermatitis Define MRSA Explain how MRSA can be spread Introduction The purpose of this study is to review the principles, practices and methods of cleaning and disinfecting items, tools and equipment. We will review hand-hygiene, and avoiding communicable diseases. 15

42 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. 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. 16

43 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. 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. 17

44 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. 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. 18

45 Growing Concerns Example: The following article proves the increasing of public concern regarding the severity of the problem of improper sanitation practices. Clip from a New York Times Article When a Salon Is Unsanitary, a Bad Nail Job Is a Customer's Least Worry By LAUREL NAVERSEN GERAGHTY NO matter how intense, a medicure, or any pedicure or manicure, should leave your nails looking gorgeous, not grotesque. But a number of nail infections that can be picked up at salons can lead to unsightly or even life-threatening results, doctors say. The issue of nail salon sanitation became national news when the "American Idol" judge Paula Abdul had her thumbnail removed in 2004 after contracting an infection she said she got from a manicure. Forty percent of women say they get pedicures at least occasionally, according to the market research firm Mintel International Group, yet little is known about how often infections from nail salons occur. "I hear about them sporadically," said Dr. Kevin L. Winthrop, an infectious disease epidemiologist in Portland, Ore. "They're definitely out there." Many conditions that can be transmitted are not reported, said Dr. Katie Rodan, a dermatologist in Oakland, Calif. And infections cannot always be easily traced to a salon because the symptoms usually do not appear until later, doctors say. Customers can potentially pick up athlete's foot, warts or yeast infections, or even, possibly, H.I.V., hepatitis C, or staph infections if salons do not disinfect equipment properly, Dr. Rodan said. New York requires salons to use emery boards and bar soap only once. Salons in some states, including New York, Virginia, New Jersey, Oregon and Massachusetts, must also clean tools and equipment using hospital-grade disinfectant after each customer, though not all such disinfectants kill bacteria, yeast or the hepatitis C virus, Dr. Rodan said. Dr. Winthrop was with the Centers for Disease Control and Prevention in 2000 when he investigated a mycobacteria outbreak that left more than 100 women in northern California with boils on their legs that took months to heal. He traced the bacteria to the whirlpool footbaths in a single salon. California, Texas and Arizona now require salons to clean the suction screens within whirlpool footbaths, where bacteria may accumulate. To reduce the risk of infection, dermatologists recommend that customers take their own tools to the salon. Most drugstores and beauty supply stores carry kits. Dermatologists suggest making sure that the salon and the technician are licensed by the state. It also helps to seek out the rare salon that uses an autoclave, a device that sterilizes tools with steam and heat. Dr. Winthrop recommends that women avoid shaving their legs for 24 hours before a pedicure because nicks can make the skin more vulnerable to infection. Those who provide their own tools need to make sure the technician uses them, as Dr. Rodan discovered after her toe was cut during a pedicure at a San Francisco salon. "You were using my instruments, right?" she recalled asking the woman working on her feet, but the woman said she had forgotten to do so. At that point, Dr. Rodan left the salon. 19

46 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 overemphasized. 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. 20

47 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: 1) Wet your hands with warm running water. 2) 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. 3) Rinse your hands well under warm running water. Let the water run back into the sink, not down to your elbows. 4) 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. Scientific Study of Hand Washing Investigators use different methods to study hand washing, antiseptic hand wash, and hand antisepsis protocols. 21

48 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 Overthe-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. 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. 22

49 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. 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. 23

50 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. 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. 24

51 The Study of MRSA In September 2005, a medical microbiologist from the regional medical microbiology laboratory reported to the municipal health department a recurring MRSA infection in a Cosmetologist. From December 2004 onwards, the woman had recurrent infections on the: legs, buttocks, and groin resulting in treatment to include incision and drainage of lesions. When an abscess developed in the genital area in July 2005, MRSA was cultured from a wound swab. In December 2005, the Cosmetologist was declared MRSA-free after antimicrobial treatment. Swabs were taken 3 times in 1-week intervals from: nose, throat, perineum, and wound and used for enrichment culture of MRSA. In March 2006, the woman was tested again for MRSA colonization; test results showed that she had been reinfected or that therapy had failed. The Cosmetologist had eczema. Because of the "hands on" nature of her work, she was advised to temporarily stop providing services to customers.the municipal health department conducted a risk assessment of the woman's household contacts and the Beauty Salon. The Netherlands does not require that MRSA infections be reported. Therefore, the municipal health department depends upon the consent and full cooperation of index patients and contacts for further investigation of outbreaks. Consequently, in this instance, household contacts for screening were identified but had not presented themselves for screening. Contacts who had complaints sought treatment at the emergency department, where the observant infection control practitioner and microbiologists related them to the MRSA outbreak. Nurses obtained specimens by swabbing each patient's nose, throat, and wounds. A case was defined as a patient who had a culture-confirmed MRSA infection during the outbreak period July 2005 December 2006 and a direct epidemiologic link to the index patient. In April 2006, a salon customer was hospitalized with an abscess of the breast caused by MRSA; in July 2006, another customer who had had boils since February 2006 was found to be MRSA positive. Both customers had been given wax treatments by the Cosmetologist during the period in which she had an infected hair follicle in her armpit. Swabs taken from this site showed that the beautician was infected with the same MRSA strain as before. Concern arose about the risk for infection to customers through: instruments, materials (wax), or contact with other employees. 25

52 The index patient and the other 6 employees of the salon regularly provided services to each another. A nurse and a member of the municipal health department visited the salon in June 2006 to check on hygiene protocols and to advise on preventive measures to reduce risk for further transmission. All working procedures and protocols were investigated, and the salon was advised to clean and disinfect instruments and procedure rooms. More specifically, the health department observed a total waxing procedure performed by the staff. Ten swabs were taken from: used wax, wax implements, and the treatment room. All 6 employees were screened and informed about MRSA and the current situation. Arrangements were also made to test 22 regular customers who had received wax treatments by the index patient in the previous 2 months. In the following weeks, these customers were screened at the municipal health office and informed about MRSA. Of the 22 regular customers, 21 completed a questionnaire and 19 were actually screened for MRSA by culturing samples from nose and throats. All employees and the 19 selected regular customers were negative for MRSA colonization. All environmental swabs were also negative for MRSA. It was noted that the 70% alcohol used to disinfect the skin after waxing was diluted with water because customers had complained about the stinging effect of the alcohol on treated skin. Furthermore, it became apparent that after performing waxing treatments the Cosmetologist would touch the waxed skin of customers with ungloved hands to check for remaining hairs. She did not wash her hands after removing the gloves.during the outbreak investigation, more background information became available from those who were MRSA colonized or infected and who could be indirectly linked to the beautician or her customers. During the week that the first infected customer was identified (in April 2006), another customer was hospitalized with an abscess in the groin. Unfortunately, no culture was taken from this patient. The partner of the second infected customer was also infected with MRSA that was related to an abscess on his leg. By the end of 2006, a MRSA-positive couple was identified as a contact of the second infected customer. In August 2006 another couple was reported to be MRSA positive; both had abscesses on the thighs. Because no further epidemiologic data could be obtained, whether the couple's infection was linked to the beauty salon is not clear. A total of 45 persons who had been in direct or indirect contact with the beautician were screened for MRSA: 3 family members 3 roommates 11 other persons (including secondary contacts) 6 beauty salon employees and 22 customers (including regular customers) 26

53 Fifteen persons had skin infections and 10 of them were colonized with MRSA Cosmetologist family member roommate ex-partner of the roommate customers and partners of customers Although skin infections never developed in the Cosmetologist's family members, tests did show MRSA colonization in one of them. The beautician's boyfriend, a native of the United States, had already lived for 2 years in the Netherlands. Although he had skin lesions, no MRSA was found. The girlfriend of a sport mate who regularly exercised with the partner of a customer was colonized with MRSA at the end of She had immigrated recently from the United States to the Netherlands, but her first screening test results were negative. The mean age of the patients was 29 years (range years). Eleven people were found to be MRSA positive. Of these 11: 3 persons with a direct link to the beauty salon (the Cosmetologist and 2 customers) 6 with an indirect link (family member, roommate, ex-partner of roommate, partner of a customer, sport mate of partner of a customer and his partner), and a couple from whom no epidemiological data could be obtained were infected with the same MRSA strain as the Cosmetologist. All MRSA isolates were identical and identified as the well-known CA-MRSA USA300 strain. All MRSA isolates had identical susceptibility patterns: resistant to oxacillin (and thus to all β- lactam antimicrobial drugs) and erythromycin, and susceptible to rifampicin, ciprofloxacin, gentamicin, clindamycin, vancomycin, teicoplanin, tetracycline, cotrimoxazole, mupirocin, and fusidic acid. Conclusions Outbreaks of CA-MRSA strains have been reported with increased frequency. Several reports involved outbreaks among: competitive sports participants military personnel men who have sex with men prisoners native Americans and drug users 27

54 Skin treatments in a beauty salon likely led to MRSA transmission as a result of contact with an infected Cosmetologist.Unless outbreaks occur in a defined group, MRSA remains undetected in the general population because reporting is not mandatory. Although the prevalence of MRSA in the Netherlands is low, local microbiologic laboratories should report outbreaks, when detected, to the local municipal health department for further investigation. More research is necessary to better understand the risk factors involved in these outbreaks. Topic Summary We have now reviewed ways to properly clean and disinfect salon equipment and implements. We can now describe proper techniques for effective product use. We are now able to list types of disposable (single-use) items and muli-use items. We can now properly identify individual client packs and explain their purpose. We now know the types of immersible implements. This study has also included extensive facts regarding appropriate salon disinfectants. This study has also reminded us of the proper clean up of blood. We can now list diseases that good hand can prevent as well as best hand washing technique. We can now properly identify over-the-counter alcohol-based hand cleansers and their purpose as well as explain how pathogens on hands can be transmitted. We are made aware and can list the causes of irritant contact dermatitis. And lastly we can effectively describe MRSA and can explain how MRSA can be spread With this abundance of knowledge we can now positively affect our health and others'. 28

55 TOPIC 3: Infection Control (1 hour) Outline Blood-borne Diseases Human Immunodeficiency Virus How HIV is spread Attitudes and behavior towards HIV and AIDS Infection control Communicable Diseases Hepatitis Learning objectives After completing this lesson you will be able to: define HIV and AIDS identify the stages of transmission describe clinical latency explain how you know that you have been infected with HIV describe home testing kits identify antiretroviral therapy identify the most common ways that HIV is transmitted describe people groups and their risks define methods of prevention and the challenges of preventing infection describe types of discrimination define hepatitis and the types of viral hepatits Introduction In this lesson we focus on communicable diseases. We will cover Federal and State information regarding disease and related data. To learn more about any disease that might be a concern, contact the Center for Disease Control. They have information on every communicable disease in the Unites States and abroad. All personal service care workers should be well-versed in the knowledge of communicable diseases in order to recognize symptoms and dangers in their environment. Defining HIV HIV stands for human immunodeficiency virus. It is the virus that can lead to acquired immunodeficiency syndrome, or AIDS. Unlike some other viruses, the human body cannot get rid of HIV. That means that once you have HIV, you have it for life. No safe and effective cure currently exists, but scientists are working hard to find one, and remain hopeful. Meanwhile, with proper medical care, HIV can be controlled. Treatment for HIV is often called anti-retro-viral therapy or ART. It can dramatically prolong the lives of many people infected with HIV and lower their chance of infecting others. 29

56 Before the introduction of ART in the mid-1990s, people with HIV could progress to AIDS in just a few years. Today, someone diagnosed with HIV and treated before the disease is far advanced can have a nearly normal life expectancy. HIV affects specific cells of the immune system, called CD4 cells, or T cells. Over time, HIV can destroy so many of these cells that the body can t fight off infections and disease. When this happens, HIV infection leads to AIDS. The Origin of HIV Scientists identified a type of chimpanzee in West Africa as the source of HIV infection in humans. They believe that the chimpanzee version of the immunodeficiency virus (called simian immunodeficiency virus, or SIV) most likely was transmitted to humans and mutated into HIV when humans hunted these chimpanzees for meat and came into contact with their infected blood. Studies show that HIV may have jumped from apes to humans as far back as the late 1800s. Over decades, the virus slowly spread across Africa and later into other parts of the world. We know that the virus has existed in the United States since at least the mid- to late 1970s. HIV disease has a well-documented progression. Untreated, HIV is almost always fatal because it eventually overwhelms the immune system resulting in acquired immunodeficiency syndrome (AIDS). HIV treatment helps people at all stages of the disease, and treatment can slow or prevent progression from one stage to the next. The Transmission of the HIV Virus A person can transmit HIV to others during any of these stages: Acute infection: Within 2 to 4 weeks after infection with HIV, you may feel sick with flu-like symptoms. This is called acute retro-viral syndrome (ARS) or primary HIV infection, and it s the body s natural response to the HIV infection. (Not everyone develops ARS, however and some people may have no symptoms.) During this period of infection, large amounts of HIV are being produced in your body. The virus uses important immune system cells called CD4 cells to make copies of itself and destroys these cells in the process. Because of this, the CD4 count can fall quickly. Your ability to spread HIV is highest during this stage because the amount of virus in the blood is very high. Eventually, your immune response will begin to bring the amount of virus in your body back down to a stable level. At this point, your CD4 count will then begin to increase, but it may not return to pre-infection levels. Clinical latency (inactivity or dormancy) This period is sometimes called asymptomatic HIV infection or chronic HIV infection. During this phase, HIV is still active, but reproduces at very low levels. You may not have any symptoms or get sick during this time. People who are on anti-retro-viral therapy (ART) may live with clinical latency for several decades. For people who are not on ART, this period can last up to a decade, but some may progress through this phase faster. It is important to remember that you are still able to transmit HIV to others during this phase even if you are treated with ART, although ART greatly reduces the risk. 30

57 Toward the middle and end of this period, your viral load begins to rise and your CD4 cell count begins to drop. As this happens, you may begin to have symptoms of HIV infection as your immune system becomes too weak to protect you. AIDS (acquired immunodeficiency syndrome) This is the stage of infection that occurs when your immune system is badly damaged and you become vulnerable to infections and infection-related cancers called opportunistic illnesses. When the number of your CD4 cells falls below 200 cells per cubic millimeter of blood (200 cells/mm3), you are considered to have progressed to AIDS. (Normal CD4 counts are between 500 and 1,600 cells/mm3.) You can also be diagnosed with AIDS if you develop one or more opportunistic illnesses, regardless of your CD4 count. Without treatment, people who are diagnosed with AIDS typically survive about 3 years. Once someone has a dangerous opportunistic illness, life expectancy without treatment falls to about 1 year. People with AIDS need medical treatment to prevent death. Infection Control Knowing that You are Infected The only way to know if you are infected with HIV is to be tested. You cannot rely on symptoms to know whether you have HIV. Many people who are infected with HIV do not have any symptoms at all for 10 years or more. Some people who are infected with HIV report having flu-like symptoms (often described as the worst flu ever ) 2 to 4 weeks after exposure. Symptoms can include: Fever Enlarged lymph nodes Sore throat Rash These symptoms can last anywhere from a few days to several weeks. During this time, HIV infection may not show up on an HIV test, but people who have it are highly infectious and can spread the infection to others. However, you should not assume you have HIV if you have any of these symptoms. Each of these symptoms can be caused by other illnesses. Again, the only way to determine whether you are infected is to be tested for HIV infection. Clinical Management Home Testing Kits Two types of home testing kits are available in most drugstores or pharmacies: one involves pricking your finger for a blood sample, sending the sample to a laboratory, then phoning in for results. 31

58 The other involves getting a swab of fluid from your mouth, using the kit to test it, and reading the results in 20 minutes. Confidential counseling and referrals for treatment are available with both kinds of home tests. If you test positive for HIV, you should see your doctor as soon as possible to begin treatment. Testing Sites For information on where to find an HIV testing site, Visit National HIV and STD Testing Resources and enter your ZIP code. Text your ZIP code to KNOWIT (566948), and you will receive a text back with a testing site near you. Call 800-CDC-INFO ( ) to ask for free testing sites in your area. These resources are confidential. You can also ask your health care provider to give you an HIV test. Prevention of HIV/AIDS For most people, the answer is no. Most reports of a cure involve HIV-infected people who needed treatment for a cancer that would have killed them otherwise. But these treatments are very risky, even life-threatening, and are used only when the HIV-infected people would have died without them. Anti-retro-viral therapy (ART), however, can dramatically prolong the lives of many people infected with HIV and lower their chance of infecting others. It is important that people get tested for HIV and know that they are infected early so that medical care and treatment have the greatest effect. The most common ways HIV is transmitted in the United States is through anal or vaginal sex or sharing drug injection equipment with a person infected with HIV. The following steps can reduce your risk: Know your HIV status. Everyone between the ages of 13 and 64 should be tested for HIV at least once. If you are at increased risk for HIV, you should be tested for HIV at least once a year. If you have HIV, you can get medical care, treatment, and supportive services to help you stay healthy and reduce your ability to transmit the virus to others. If you are pregnant and find that you have HIV, treatments are available to reduce the chance that your baby will have HIV. Abstain from sexual activity or be in a long-term mutually monogamous relationship with an uninfected partner. Limit your number of sex partners. The fewer partners you have, the less likely you are to encounter someone who is infected with HIV or another STD. Correct and consistent condom use. Latex condoms are highly effective at preventing transmission of HIV and some other sexually transmitted diseases. Natural or 32

59 lambskin condoms do not provide sufficient protection against HIV infection. Get tested and treated for STDs and insist that your partners do too. Male circumcision has also been shown to reduce the risk of HIV transmission from women to men during vaginal sex. Do not inject drugs. If you inject drugs, you should get counseling and treatment to stop or reduce your drug use. If you cannot stop injecting drugs, use clean needles and works when injecting. Obtain medical treatment immediately if you think you were exposed to HIV. Sometimes, HIV medications can prevent infection if they are started quickly. This is called post-exposure prophylaxis. Participate in risk reduction programs. Programs exist to help people make healthy decisions, such as negotiating condom use or discussing HIV status. Your health department can refer you to programs in your area. Racial and Ethnic Groups In the United States, HIV is spread mainly by having unprotected anal or vaginal sex or by sharing drug-use equipment with an infected person. Although these risk factors are the same for everyone, some racial/ethnic groups are more affected than others, given their percentage of the population. This is because some population groups have higher rates of HIV in their communities, thus raising the risk of new infections with each sexual or drug use encounter. Additionally, a range of social, economic, and demographic factors such as stigma, discrimination, income, education, and geographic region affect their risk for HIV. In the United States, HIV is spread mainly by having unprotected anal or vaginal sex or by sharing drug-use equipment with an infected person. Although these risk factors are the same for everyone, some gender groups are far more affected than others. Gay, bisexual, and other men who have sex with men, for example, account for the majority of new infections despite making up only 2% of the population. HIV among women Women account for one in four people living with HIV in the United States; African American women and Latinas are disproportionately affected at all stages of HIV infection. HIV among Gay and Bisexual Men Gay and bisexual men are more severely affected by HIV than any other group in the United States. Among all gay and bisexual men, blacks/african Americans bear the greatest disproportionate burden of HIV. From 2008 to 2010, HIV infections among young black/african American gay and bisexual men increased 20%. 33

60 Gay, bisexual, and other men who have sex with men (MSM) a represent approximately 2% of the US population, yet are the population most severely affected by HIV. In 2010, MSM accounted for 63% of all new HIV infections, and MSM with a history of injection drug use (MSM-IDU) accounted for an additional 3% of new infections. That same year, young MSM (aged years) accounted for 72% of new HIV infections among all persons aged 13 to 24, and 30% of new infections among all MSM. At the end of 2010, an estimated 489,121 (56%) persons living with an HIV diagnosis in the United States HIV Infections In 2010, MSM accounted for 63% of estimated new HIV infections in the United States and 78% of infections among all newly infected men. Compared with other transmission groups, MSM accounted for the largest numbers of new HIV infections in Among all MSM, white MSM accounted for 11,400 (38%) estimated new HIV infections in The largest number of new infections among white MSM (3,300; 29%) occurred in those aged 25 to 34. Among all MSM, black/african American MSM accounted for 10,600 (36%) estimated new HIV infections in From 2008 to 2010, new HIV infections increased 22% among young (aged 13-24) MSM and 12% among MSM overall an increase largely due to a 20% increase among young black/african American MSM. Among all MSM, Hispanic/Latino MSM accounted for 6,700 (22%) estimated new HIV infections in The largest number of new infections among Hispanic/Latino MSM (3,300; 39%) occurred in those aged 25 to 34. HIV and AIDS Diagnoses and Deaths In 2011, in the United States, MSM accounted for 79% of 38,825 estimated HIV diagnoses among all males aged 13 years and older and 62% of 49,273 estimated diagnoses among all persons receiving an HIV diagnosis that year. At the end of 2010, of the estimated 872,990 persons living with an HIV diagnosis, 440,408 (50%) were MSM. Forty-seven percent of MSM living with an HIV diagnosis were white, 31% were black/african American, and 19% were Hispanic/Latino. In 2011, MSM accounted for 52% of estimated AIDS diagnoses among all adults and adolescents in the United States. Of the estimated 16,694 AIDS diagnoses among MSM, 39% were in blacks/african Americans; 34% were in whites; and 23% were in Hispanics/Latinos. By the end of 2010, an estimated 302,148 MSM with an AIDS diagnosis had died in the United States since the beginning of the epidemic, representing 48% of all deaths of persons with an AIDS diagnosis. Prevention Challenges As a group, gay, bisexual, and other MSM have an increased chance of being exposed to HIV because of the large number of MSM living with HIV. Results of HIV testing conducted in 21 cities as part of the National HIV Behavioral Surveillance System indicated that 19% of MSM tested in 2008 were HIV-positive and that 34

61 HIV prevalence increased with increasing age and decreased with increasing education and income. Men aged 40 years and older had higher rates of HIV infection than men aged 18 to 39. Further, many gay and bisexual men with HIV do not know they have HIV, especially MSM of color and young MSM. Of MSM who tested positive for HIV in 2008, 44% did not know they were infected. Among those infected, young MSM (aged 18 to 29 years; 63%) and racial/ethnic minority MSM (54%) were more likely to be unaware they had HIV. Persons who don't know they have HIV don't get medical care and can unknowingly infect others. The Centers for Disease Control and Prevention (CDC) recommends that all MSM get tested for HIV at least once a year. Sexually active MSM might benefit from HIV testing every 3 to 6 months. Sexual risk behaviors account for most HIV infections in MSM. Unprotected receptive anal sex is the sexual behavior that carries the highest risk for HIV acquisition. For sexually active MSM, the most effective ways to prevent HIV and many other sexually transmitted infections (STIs) are to avoid anal sex, or for MSM who do have anal sex, to always use condoms. MSM are at increased risk for syphilis, gonorrhea, and chlamydia, and CDC recommends that all sexually active MSM be tested annually for these STIs. Alcohol and illegal drug use increases risk for HIV and other STIs. Using substances such as alcohol and methamphetamines can impair judgment and increase risky sexual behavior. Prevention Strategies To prevent transmission of HIV to health care workers in the workplace, CDC offers the following recommendations. Health care workers should assume that the blood and other body fluids from all patients are potentially infectious. They should therefore follow infection control precautions at all times. These precautions include Routinely using barriers (such as gloves and/or goggles) when anticipating contact with blood or body fluids. Immediately washing hands and other skin surfaces after contact with blood or body fluids. Carefully handling and disposing of sharp instruments during and after use. Safety devices have been developed to help prevent needle-stick injuries. If used properly, these types of devices may reduce the risk of exposure to HIV. Many per-cutaneous injuries, such as needle-sticks and cuts, are related to the disposal of sharp-ended medical devices. All used syringes or other sharp instruments should be routinely placed in sharps containers for proper disposal to prevent accidental injuries and risk of HIV transmission. Although the most important strategy for reducing the risk of occupational HIV transmission is to prevent occupational exposures, plans for post-exposure management of health care personnel should be in place. CDC issued guidelines in 2005 for the management of health care worker exposures to HIV and recommendations for post-exposure prophylaxis (PEP): 35

62 These guidelines outline considerations in determining whether health care workers should receive PEP and in choosing the type of PEP regimen. For most HIV exposures that warrant PEP, a basic 4-week, two-drug (there are several options) regimen is recommended, starting as soon as possible after exposure. For HIV exposures that pose an increased risk of transmission (based on the infection status of the source and the type of exposure), a three-drug regimen may be recommended. Special circumstances, such as a delayed exposure report, unknown source person, pregnancy in the exposed person, resistance of the source virus to anti-retro-viral agents, and toxicity of PEP regimens, are also discussed in the guidelines. Occupational exposures should be considered urgent medical concerns, and PEP should be started within 72 hours the sooner the better; every hour counts. Living With HIV Today, an estimated 1.1 million people are living with HIV in the United States. Thanks to better treatments, people with HIV are now living longer and with a better quality of life than ever before. If you are living with HIV, it s important to make choices that keep you healthy and protect others. Staying Healthy It s very important for you to take your HIV medicines exactly as directed. Not taking medications correctly may lower the level of immune system defenders called CD4 cells and cause the level of virus in your blood (viral load) to go up. The medicines then become less effective when taken. Some people report not feeling well as a reason for stopping their medication or not taking it as prescribed. Tell your doctor if your medicines are making you sick. He or she may be able to help you deal with side effects so you can feel better. Don t just stop taking your medicines, because your health depends on it. Tell your partner Be sure that your partner or partners know that you have HIV. Then they will know it s important to use condoms for all sexual activity and to be tested often for HIV. Health departments offer Partner Services to help you tell your partners about their exposure. Partner Services provides many free services to people with HIV or other STDs and their partners. Through Partner Services, health department staff help find sex or drug-injection partners to let them know of their risk of being exposed to HIV or another sexually transmitted disease (STD) and provide them with testing, counseling, and referrals for other services. Partner Services will not reveal your name unless you want to work with them to tell your partners. Don t take risks HIV is spread through body fluids such as blood, semen (cum), vaginal fluids, and breast milk. In the United States, HIV is most commonly passed from one person to another through unprotected anal or vaginal sex and through sharing needles or other drug equipment. In addition, a mother can pass HIV to her baby during pregnancy, during labor, through breastfeeding, or if by pre-chewing her baby s food. Viral load can range from undetectable levels of 40 to 75 copies per milliliter of blood to millions of copies. The higher your viral load, the greater the risk of spreading HIV to others. 36

63 Protect your partners by keeping yourself healthy. Take all of your medicines and get tested and treated for other STDs. If you have HIV plus another STD or hepatitis, you are 3 to 5 times more likely to spread HIV than if you only have HIV. Your viral load goes up and your CD4 count goes down when you have an STD. Although having a low viral load greatly decreases your chance of spreading HIV, some risk remains, even when your viral load is lower than 3,500 copies per milliliter. You can avoid spreading the virus to others by making sure they do not come into contact with your body fluids. Abstinence (not having sex) is the best way to prevent the spread of HIV infection and some other STDs. If abstinence is not possible, use condoms whenever you have sex vaginal, anal, or oral. Do not share drug equipment. Blood can get into needles, syringes, and other equipment. If the blood has HIV in it, the infection can be spread to the next user. Do not share items that may have your blood on them, such as razors or toothbrushes. Attitudes toward HIV and AIDS Homophobia, stigma, and discrimination can put MSM at risk for multiple physical and mental health problems and affect whether MSM seek and are able to obtain high-quality health services. Negative attitudes about homosexuality can lead to rejection by friends and family, discriminatory acts, and bullying and violence. These dynamics may make it difficult for some MSM to be open about same-sex behaviors with others, which can increase stress, limit social support, and negatively affect health. The Center for Disease Control Guided by the National HIV/AIDS Strategy for the United States, CDC and its partners are pursuing a high-impact prevention approach to reducing new HIV infections by using combinations of scientifically proven, cost-effective, and scalable interventions directed to the most vulnerable populations in the geographic areas where HIV prevalence is highest. CDC is using this new approach to fund state and local health departments and communitybased organizations to support HIV prevention services for MSM, including innovative behavioral health interventions. Through the Diffusion of Effective Behavioral Interventions (DEBI) project, CDC supports such programs as CDC supports such programs as Mpowerment, and d-up: Defend Yourself! for MSM. Through its Act Against AIDS campaigns (and other collaborative activities, CDC aims to provide MSM with effective and culturally appropriate messages about HIV prevention. The Testing Makes Us Stronger campaign encourages black gay and bisexual men aged 18 to 44 to get tested for HIV. 37

64 To expand HIV prevention services for young gay and bisexual men of color, transgender youth of color, and their partners, CDC recently awarded $55 million over 5 years to 34 communitybased organizations (CBOs) with strong links to these populations. This funding will be used to provide HIV testing to more than 90,000 young gay and bisexual men and transgender youth of color, with a goal of identifying more than 3,500 previously unrecognized HIV infections and linking those who are HIV-infected to care and prevention services. CBOs will also carry out proven behavioral change HIV prevention programs. Occupational HIV Transmission and Prevention Among Health Care Workers Occupational transmission of HIV to health care workers is extremely rare. CDC recommends proper use of safety devices and barriers to prevent exposure to HIV in the health care setting. For workers who are exposed, CDC has developed recommendations to minimize the risk of developing HIV. Fewer than 60 cases of occupational transmission of HIV to health care workers have occurred in the United States. The proper use of gloves and goggles, along with safety devices to prevent injuries from sharp medical devices, can help minimize the risk of exposure to HIV in the course of caring for patients with HIV. When workers are exposed, the Centers for Disease Control and Prevention (CDC) recommends immediate treatment with a short course of anti-retro-viral drugs to prevent infection. As of 2010, 57 documented transmissions and 143 possible transmissions had been reported in the United States. No confirmed cases of occupational HIV transmission to health care workers have been reported since Under-reporting of cases to CDC is possible, however, because case reporting is voluntary. Health care workers who are exposed to HIV-infected blood at work have a 0.3% risk of becoming infected. In other words, 3 of every 1,000 such injuries, if untreated, will result in infection. At the end of 2009, an estimated 1,148,200 persons aged 13 and older were living with HIV infection in the United States, including 207,600 (18.1%) persons whose infections had not been diagnosed (1). CDC estimates that approximately 50,000 people are infected with HIV each year (2). 38

65 Hepatitis Hepatitis is the inflammation of the liver and also refers to a group of viral infections that affect the liver. The most common types are Hepatitis A, Hepatitis B, and Hepatitis C. Viral hepatitis Viral hepatitis is the leading cause of liver cancer and the most common reason for liver transplantation. An estimated 4.4 million Americans are living with chronic hepatitis; most do not know they are infected. Hepatitis A Hepatitis A caused by infection with the Hepatitis A virus (HAV), has an incubation period of approximately 28 days (range: days). HAV replicates in the liver and is shed in high concentrations in feces from 2 weeks before to 1 week after the onset of clinical illness. HAV infection produces a self-limited disease that does not result in chronic infection or chronic liver disease. However, 10% 15% of patients might experience a relapse of symptoms during the 6 months after acute illness. Acute liver failure from Hepatitis A is rare (overall case-fatality rate: 0.5%). The risk for symptomatic infection is directly related to age, with >80% of adults having symptoms compatible with acute viral hepatitis and the majority of children having either asymptomatic or unrecognized infection. Antibody produced in response to HAV infection persists for life and confers protection against reinfection. HAV infection is primarily transmitted by the fecal-oral route, by either person-to-person contact or consumption of contaminated food or water. Although viremia occurs early in infection and can persist for several weeks after onset of symptoms, blood-borne transmission of HAV is uncommon. HAV occasionally might be detected in saliva in experimentally infected animals, but transmission by saliva has not been demonstrated. In the United States, nearly half of all reported Hepatitis A cases have no specific risk factor identified. Among adults with identified risk factors, the majority of cases are among men who have sex with other men, persons who use illegal drugs, and international travelers. Because transmission of HAV during sexual activity probably occurs because of fecal-oral contact, measures typically used to prevent the transmission of other STDs (e.g., use of condoms) do not prevent HAV transmission. In addition, efforts to promote good personal hygiene have not been successful in interrupting outbreaks of Hepatitis A. Vaccination is the most effective means of preventing HAV transmission among persons at risk for infection. Hepatitis A vaccination is recommended for all children at age 1 year, for persons who are at increased risk for infection, for persons who are at increased risk for complications from Hepatitis A, and for any person wishing to obtain immunity. 39

66 Hepatitis B Hepatitis B is caused by infection with the Hepatitis B virus (HBV). The incubation period from the time of exposure to onset of symptoms is 6 weeks to 6 months. HBV is found in highest concentrations in blood and in lower concentrations in other body fluids (e.g., semen, vaginal secretions, and wound exudates). HBV infection can be self-limited or chronic. In adults, only approximately half of newly acquired HBV infections are symptomatic, and approximately 1% of reported cases result in acute liver failure and death. Risk for chronic infection is inversely related to age at infection: approximately 90% of infected infants and 30% of infected children aged <5 years become chronically infected, compared with 2% 6% of adults. Among persons with chronic HBV infection, the risk for premature death from cirrhosis or hepatocellular carcinoma is 15% 25%. HBV is efficiently transmitted by percutaneous or mucous membrane exposure to infectious blood or body fluids that contain blood. The primary risk factors that have been associated with infection are unprotected sex with an infected partner, birth to an infected mother, unprotected sex with more than one partner, men who have sex with other men (MSM), history of other STDs, and illegal injection drug use. CDC s national strategy to eliminate transmission of HBV infection includes Prevention of perinatal infection through routine screening of all pregnant women for HBsAg and immunoprophylaxis of infants born to HBsAg-positive mothers and infants born to mothers with unknown HBsAg status Routine infant vaccination Vaccination of previously non-vaccinated children and adolescents through age 18 years Vaccination of previously non-vaccinated adults at increased risk for infection High vaccination coverage rates, with subsequent declines in acute Hepatitis B incidence, have been achieved among infants and adolescents. In contrast, vaccination coverage among the majority of high-risk adult groups (e.g., persons with more than one sex partner in the previous 6 months, MSM, and injection drug users) have remained low, and the majority of new infections occur in these high-risk groups. STD clinics and other settings that provide services targeted to high-risk adults are ideal sites in which to provide Hepatitis B vaccination to adults at risk for HBV infection. All non-vaccinated adults seeking services in these settings should be assumed to be at risk for Hepatitis B and should receive Hepatitis B vaccination 40

67 The following News-clip is from an Article from the Ivanhoe Newswire. This Example proves the growing concern for public health regarding the need for Hepatitis B Infection Control. Reported January 5, 2012 Nail Salon Nightmare: Hepatitis B From Mani-Pedis SAN DIEGO (Ivanhoe Newswire) --An estimated 4.4 million Americans are living with chronic hepatitis and most don t know it. Now a new study shows customers in nail salons could be putting themselves at risk for the deadly disease. We ll show you what to watch out for. From polishing to cleaning, Nancye Swanson does her own nails these days. Six months ago, she almost died from something she picked up at a salon. It felt like the flu, Nancye Swanson, a hepatitis B patient told Ivanhoe. Her skin looked yellow, doctors told her that was a clear sign of hepatitis B a serious liver infection. It happened while she was getting a pedicure. A lot of these places use sharp instruments and they could be re-using those, Robert Gish, M.D., a clinical professor at UC San Diego told Ivanhoe. Dr. Robert Gish is writing a health policy for the Vietnamese government on the spread of hepatitis B. That s because every person born in the Asian Pacific region are at a high risk of already having it. That includes the thousands of people working in salons across the U.S and they may not even know they are a carrier. 95 percent of people with hepatitis B have no symptoms. That s the problem, Dr. Gish said. While there is no cure a pill once a day will control it. That s what Nancye did. I cannot believe I was that close to death, Nancy explained. Here are some ways you can protect yourself at the salon. First, make sure your salon s license is clearly posted. Scissors and clippers should be disinfected after each use and only disposable files should be used. The same goes for the pedicure bath and all suction screens in the tubs. That s where deadly bacteria gets trapped. Also, look for labels on products. If you don t see one, they could be diluted. Also, always-take your own polish. It s not just nail salons to watch out for. Dr. Gish says anyplace where you can get tattoos, ear piercing, body piercing, and even dental offices can put you at risk. 41

68 Hepatitis C Hepatitis C virus (HCV) infection is the most common chronic blood-borne infection in the United States; approximately 3.2 million persons are chronically infected. Although HCV is not efficiently transmitted sexually, persons at risk for infection through injection drug use might seek care in STD treatment facilities, HIV counseling and testing facilities, correctional facilities, drug treatment facilities, and other public health settings where STD and HIV prevention and control services are available. Sixty to 70% of persons newly infected with HCV typically are usually asymptomatic or have a mild clinical illness. HCV RNA can be detected in blood within 1 3 weeks after exposure. The average time from exposure to antibody to HCV (anti-hcv) seroconversion is 8 9 weeks, and anti-hcv can be detected in >97% of persons by 6 months after exposure. Chronic HCV infection develops in 70% 85% of HCV-infected persons; 60% 70% of chronically infected persons have evidence of active liver disease. The majority of infected persons might not be aware of their infection because they are not clinically ill. However, infected persons serve as a source of transmission to others and are at risk for chronic liver disease or other HCV-related chronic diseases decades after infection. HCV is most efficiently transmitted through large or repeated percutaneous exposure to infected blood (e.g., through transfusion of blood from non-screened donors or through use of injecting drugs). Although much less frequent, occupational, perinatal, and sexual exposures also can result in transmission of HCV. The role of sexual activity in the transmission of HCV has been controversial. Case-control studies have reported an association between acquiring HCV infection and exposure to a sex contact with HCV infection or exposure to multiple sex partners. Surveillance data also indicate that 15% 20% of persons reported with acute HCV infection have a history of sexual exposure in the absence of other risk factors. Case reports of acute HCV infection among HIV-positive MSM who deny injecting-drug use have indicated that this occurrence is frequently associated with other STDs (e.g., syphilis). In contrast, a low prevalence (1.5% on average) of HCV infection has been demonstrated in studies of long-term spouses of patients with chronic HCV infection who had no other risk factors for infection. Multiple published studies have demonstrated that the prevalence of HCV infection among MSM who have not reported a history of injecting-drug use is no higher than that of heterosexuals. Because sexual transmission of other bloodborne viruses, such as HIV, is more efficient among homosexual men than in heterosexual men and women, the reason that HCV infection rates are not substantially higher among MSM is unclear. Overall, these findings indicate that sexual transmission of HCV is possible but inefficient. 42

69 Hepatitis D Hepatitis D, also known as "delta hepatitis," is a serious liver disease caused by infection with the Hepatitis D virus (HDV), which is an RNA virus structurally unrelated to the Hepatitis A, B, or C viruses. Hepatitis D, which can be acute or chronic, is uncommon in the United States. HDV is an incomplete virus that requires the helper function of HBV to replicate and only occurs among people who are infected with the Hepatitis B virus (HBV). HDV is transmitted through percutaneous or mucosal contact with infectious blood and can be acquired either as a coinfection with HBV or as superinfection in persons with HBV infection. There is no vaccine for Hepatitis D, but it can be prevented in persons who are not already HBV-infected by Hepatitis B vaccination. Hepatitis E Hepatitis E is a serious liver disease caused by the Hepatitis E virus (HEV) that usually results in an acute infection. It does not lead to a chronic infection. While rare in the United States, Hepatitis E is common in many parts of the world. Transmission: Ingestion of fecal matter, even in microscopic amounts; outbreaks are usually associated with contaminated water supply in countries with poor sanitation. Vaccination: There is currently no FDA-approved vaccine for Hepatitis E. Course Summary The purpose of this lesson was to review principles, practices and theories of safety, sanitation, and infection control. We learned about HIV infection and communicable diseases. By having this information, you can now be alert to health concerns for yourself, the salon environment, and for your clients. Knowing the impact of communicable diseases such as hepatitis helps give a well-rounded concept of how this impacts public health. It is important that the salon professional know the realities of communicable diseases and how it may affect them personally and professionally. Safe practices is the best prevention toward the spread of infectious diseases. When using professional sanitation applications an employee will be an irreplaceable asset to the establishment in which she is employed and even more valuable to the client. Knowing and applying the principles of health and safety into all procedures is a requirement for giving professional services. By observing State and Federal regulations you can keep the salon environment safe for all. Be diligent in keeping current with Material Safety Data Sheets and OSHA regulations. Safety First gives you the best chance of preventing injury and controls infection to you, to others and to the salon environment. 43

70 Credits: ContinuingCosmetology.com copyright 2013 Publisher PO Box , Orlando, FL Wisconsin Department of Safety and Professional Services 1400 E. Washington Avenue Madison, WI Cosmetology Examining Board Milady's Standard Cosmetology copyright 2008 Thomson Delmar Learning 5 Maxwell Drive, Clifton Park, NY * U.S Department of Labor / Occupational Safety and Health Administration 200 Constitution Ave., NW, Washington, DC * OSHA (6742) TTY: * U.S Environmental Protection Agency * Ariel Rios Building 1200 Pennsylvania Avenue, N.W. Washington, DC * (202) * TTY (202) U.S Food and Drug Administration: * New Hampshire Ave Silver Spring, MD * INFO-FDA ( ) Dictionary.com: Dictionary.com Unabridged: Based on the Random House Dictionary, Random House, Inc World English Dictionary: Collins English Dictionary - Complete & Unabridged 10th Edition 2009 William Collins Sons & Co. Ltd. 1979, 1986 HarperCollins Publishers 1998, 2000, 2003, 2005, 2006, 2007, 2009 American Psychological Association:Dictionary.com Unabridged. Chicago Manual Style:Dictionary.com Unabridged. Random House, Inc. Modern Language Association:Dictionary.com Unabridged. Random House, Inc. Random House, Inc.: BibTeX Bibliography Style {Dictionary.com 2011, title = {Dictionary.com Unabridged} The American Heritage Stedman's Medical Dictionary Copyright 2002, 2001, 1995 by Houghton Mifflin Company. Published by Houghton Mifflin Company. Merriam-Webster's Medical Dictionary, 2007 Merriam-Webster, Inc. Online Etymology Dictionary, 2010 Douglas Harper Ivanhoe.com 2012 ARTICLE: News-Clip Nail Salon Nightmare: Hepatitis B From Mani-Pedis MSDS Online 2013 ARTICLE News-Clip New Look Helps Visualize Transition to Global Harmonization New York Times 2013 ARTICLE News-Clip: When a Salon Is Unsanitary, a Bad Nail Job Is a Customer's Least Worry 44