Information
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Proprietor
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Business name & address
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Proprietor email:
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Council Health Registration No.
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Conducted on
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Prepared by
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Location
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Personnel
GENERAL PREMISES PHOTOS
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Add media
HEALTH GUIDELINES FOR PERSONAL CARE & BODY ART INDUSTRIES
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Does the business have a copy of the Health Guidelines for Personal Care and Body Art Industries?<br>
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The principle purpose of the Health Guidelines for Personal Care and Body Art Industries is to assist those involved in the personal care and body art industry to comply with the Public Health and Wellbeing Act 2008 and the Public Health and Wellbeing Regulations 2009 by providing information on: how infection can be associated with the procedures employed in the industry, and precautions to protect clients and employees. The guidelines are designed around a risk management approach to the transmission of infection from client to client, client to operator, and operator to client. Risk management involves an analysis (identification) of potential hazards, the controls (policies/procedures) required to minimise the hazard, and the corrective action to be taken if the control (action) does not achieve its aim of preventing or minimising the transmission of infection. The guidelines also provide information on general matters that may be useful to the industry in performing its practices, and on infection prevention and control in general. Some personal care and body art body industry practices are not specifically covered by the Public Health and Wellbeing Act 2008, but these guidelines include information on general infection prevention and control to assist these practices. These guidelines are not intended to replace industry-specific guidelines for personal care and body art body premises. Proprietors or occupiers and operators should also consult with their professional organisations and other organisations relevant to aspects of their business. These guidelines should be used as a guide to best practice and as a reference tool for people associated with the industry, including environmental health officers. A copy of the Health Guidelines for Personal Care and Body Art Industries can be downloaded from the link below - https://www2.health.vic.gov.au/public-health/infectious-diseases/personal-care-body-art-industries
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The principle purpose of the Health Guidelines for Personal Care and Body Art Industries is to assist those involved in the personal care and body art industry to comply with the Public Health and Wellbeing Act 2008 and the Public Health and Wellbeing Regulations 2009 by providing information on: how infection can be associated with the procedures employed in the industry, and precautions to protect clients and employees. The guidelines are designed around a risk management approach to the transmission of infection from client to client, client to operator, and operator to client. Risk management involves an analysis (identification) of potential hazards, the controls (policies/procedures) required to minimise the hazard, and the corrective action to be taken if the control (action) does not achieve its aim of preventing or minimising the transmission of infection. The guidelines also provide information on general matters that may be useful to the industry in performing its practices, and on infection prevention and control in general. Some personal care and body art body industry practices are not specifically covered by the Public Health and Wellbeing Act 2008, but these guidelines include information on general infection prevention and control to assist these practices. These guidelines are not intended to replace industry-specific guidelines for personal care and body art body premises. Proprietors or occupiers and operators should also consult with their professional organisations and other organisations relevant to aspects of their business. These guidelines should be used as a guide to best practice and as a reference tool for people associated with the industry, including environmental health officers. A copy of the Health Guidelines for Personal Care and Body Art Industries can be downloaded from the link below - https://www2.health.vic.gov.au/public-health/infectious-diseases/personal-care-body-art-industries
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1. PREMISES - STRUCTURAL
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Design & Construction
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Equipment, furniture, fittings, floors and walls should be purpose built or purchased specifically for the task to be performed. They should be durable, safe and suitable for cleaning and maintenance, and constructed of sealed, nonporous material. There should be adequate lighting and ventilation throughout the premises. Particular attention should be paid to those areas that are frequently damp, such as above, behind and under wash basins. The area of client procedure rooms/cubicles should be no less than 2.5 metres square. The premises should be planned to provide separate function-specific client and cleaning/sterilising areas. The cleaning area should be designed to ensure movement of instruments/equipment in a one-way direction from dirty to clean to sterile areas (figure 1). It should also have sufficient bench space for good working practices.
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Hand wash basins
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A hand basin with hot and cold running water supplied through a single outlet, liquid soap and paper towels should be installed in the procedure room/cubicle. An appropriate splashback should be provided behind plumbing fixtures. In addition to a hand basin in the procedure room/cubicle there should be a hand basin in the cleaning area. Where skin penetration procedures are performed, the hand basin should be hands free (for example, foot operated, electronically controlled or knee operated). Elbow-operated taps are not desirable. In establishments where hairdressing only takes place, a hair washing basin with hot and cold running water supplied through a single outlet can also be used for washing hands.
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Equipment sinks
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Separate sinks with hot and cold running water supplied through a single outlet (hot water not less than 70°C) should be located in the cleaning area for instrument and equipment washing.
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General Plumbing and Electrical safety
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Plumbing must conform with the requirements of the Plumbing Industry Commission (Victoria) and Standards Australia. These include: • Australian Standard/New Zealand Standard (AS/NZS) 3500.1:2003 Plumbing and drainage – Water services • AS/NZS 3500.2:2003 Plumbing and drainage – Sanitary plumbing and drainage • AS/NZS 3500.4:2003 Plumbing and drainage – Heated water services. Hot water installations should have sufficient capacity for the business being undertaken. Premises may include other plumbing fixtures beside the handbasin, such as that used for general cleaning. All electrical equipment must meet prescribed electrical standards.
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2. GENERAL REQUIREMENTS
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Linen eg use, storage, cleaning etc.
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Paper towel, paper strips or clean linen are recommended and must be changed between clients. Soiled linen, towels and protective clothing should be placed in a washable, leak-proof receptacle, and laundered using hot water (70–80ºC) and detergent. All clean linen, towels and clothing must be stored in a clean environment to reduce contamination
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Handling & Disposal of Sharps.
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Sharps are considered clinical waste. Sharps used for skin penetration, such as needles, must be handled carefully during procedures to avoid needle stick injuries and the possible transmission of blood-borne diseases. Sharps containers must comply with • AS 4031:1992 Nonreusable containers for the collection of sharp medical items used in health care areas, • AS 4031:1992/Amdt 1 Nonreusable containers for the collection of sharp items used in health areas and • AS/NZS 4261:1994 Reusable containers for the collection of sharp items used in human and animal medical applications. Suitable sharps containers are rigid-walled, puncture-proof containers with tightfitting lids that prevent sharp objects, such as razor blades that may be contaminated with blood, from injuring another person. These containers can vary in size up from 1 litre containers. Disposal of sharps containers need occur only when the container is full, but before it is overflowing. Ask your local government environmental health officer if you require further advice. Immediately after use, the operator should: • recap sharps • place single-use sharps into a sharps container that meets Australian standards • place multiple-use reusable sharp instruments into the container at the end of their useful life • not force items into the container, so as to prevent injury. Sharps containers should be placed a minimum of 1 metre above floor level, out of the reach of children. When the container is full, seal and dispose of it in accordance with Environmental Protection Authority requirements.
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Disposal of General & Liquid Waste.
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All bins used for waste must be lined with a plastic bag that can be sealed for disposal. All general waste, such as papers and powdered pigments, should be placed into a plastic bag-lined washable bin with a close-fitting lid marked ‘general waste’. General waste can be disposed via normal refuse collections. Bins should be regularly emptied and washed. All liquid waste may be disposed of via the sewer, provided the local water authority has given prior permission. Plumbing must meet regulations. All liquid waste must be diluted well during disposal, via the running of four times the amount of cold water through the system at the same time.
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Dispensing (creams, ointments etc)
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To avoid contamination, the operator must ensure any make-up, fluid, cream, ointment or similar substance is removed from its original container/tube (including self-dispensing pumps) using a clean disposable applicator. Leftover creams, ointments and similar substances must not be returned to the original container and must not be used on any other client. Applicators used for dispensing must not be re-dipped into the original container and must be discarded after each client. Single-use applicators are recommended. 2.5.1 Pumps/spray bottles/nozzles Pump outlets, bottles and nozzles are a potential source of contamination, particularly due to the build-up of contents around the outlet. Nozzles should be cleaned frequently and dried before being replaced. Wash bottles and nozzles in warm water and detergent, rinse them under hot running water, and dry them using a lint-free cloth, before refilling the bottle or replacing the pump/spray nozzle. Pump/spray bottles should never be topped up. Drop-in cassette dispensers are more convenient and economical (see part A, section 3.4.2).
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Animals on premises (excl. guide dogs).
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Animals, other than guide dogs for the hearing- or sight-impaired client, should not be permitted in procedure areas. Having animals in premises should be discouraged.
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Records (procedures, incidents etc)
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For all premises covered by these guidelines, it is important to keep accurate records of every procedure carried out on each client. All businesses should also record every incident relevant to occupational health regulations. Accurate and detailed records are valuable if there is any infection or possibility of a blood-borne virus transmission. In the case of a blood-borne virus, for example, these records can be cross-checked for the probability for or against a reported infection resulting from a specific procedure or incident (see part E, appendix 3 for examples of records). Operators should also ensure that they comply with the relevant legislation regarding the collection, storage, use and disclosure of personal and/or health information. For body art/colonic irrigation industry requirements please see specific sections.
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3. OCCUPATIONAL HEALTH & SAFETY
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Health & Safety in Workplace (training, immunisation, smoking etc)
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Employers are responsible for providing a safe work environment to minimise risks to the health of employees, clients and other persons entering the premises. This effort involves providing: • adequate staff training, including training in hygiene and infection control • properly maintained facilities and equipment, including personal protective equipment • a suitably designed and clean workplace to minimise potential hazards, such as the safe storage of equipment and chemicals, sharps and other clinical and related waste. 3.1.1 Immunisation No vaccine is available for the prevention of hepatitis C and HIV/AIDS. There is, however, a safe and effective vaccine for the prevention of hepatitis B. Immunisation is recommended for all operators involved in skin penetration procedures and for staff involved in cleaning instruments/equipment. A primary immunisation course in hepatitis B consists of three injections over six months. Hepatitis A immunisation is recommended for personnel working in colonic irrigation premises. Immunisation can be arranged through a general practitioner or the local government. 3.1.2 Smoking Operators should not smoke during client procedures because the operator risks transferring bacteria from their mouth and nose onto their fingers and then to the client, as well as providing a passive smoking hazard.
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Emergency situations (first aid, burns, bleeding, exposure to infection etc)
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3.2 Emergency situations It is essential for premises to have contact numbers for local and emergency services at hand. 3.2.1 First aid WorkCoverVictoria can provide information on first aid kits. Each workplace should conduct a risk assessment (see part C) to determine likely workplace hazards and develop a first aid kit accordingly. The contents of the kit will depend on factors such as the number of employees, the nature of any hazards and the location of the workplace. In most workplaces, a basic first aid kit would include the following items. • Basic first aid notes • Sterile eye pads • Eye bath • Individually wrapped sterile adhesive dressings • Disposable gloves • Scissors • Triangular bandages • Sterile coverings for serious wounds • Normal saline • Adhesive tape • Crepe bandage • Safety pins • Different-sized sterile, unmedicated wound dressings • Addresses and telephone numbers of emergency services • Names and contact details of workplace first aid officers 3.2.2 Training/education in first aid It is strongly recommended that proprietors/operators of personal care and body art premises complete a first aid course. The course should cover basic first aid, including cardiopulmonary resuscitation (CPR) and the management of burns and eye injuries/hazards such as splashes. Infection control/prevention and sterilisation training is also strongly recommended as a way of reinforcing the principles and practices in these guidelines. Contact an environmental health officer from local government or the Department of Human Services for further information. 3.2.3 Burns Burns are a type of soft-tissue injury that can occur when the body is exposed to certain chemicals, electricity or extreme heat or cold. The severity of the burn depends on the temperature of the object or gas causing the burn, the length of exposure to the source, the location of the burn, the extent of the burn, the victim’s age and the victim’s medical condition. The people most at risk of severe burns are those aged over 60 years and those aged under 5 years, because their skin is thinner. Burns are classified by the source (such as heat, cold, chemicals, electricity or radiation) and depth. Most burns caused by flames or hot oil require medical attention. What to do for burn care • Cool burns by flushing with cool water. • Remove rings and jewellery. • Cover the burn with a dry sterile dressing. • Take steps to minimise shock. • Seek medical attention. What NOT to do for burn care • Apply ice directly to burns. • Touch burns with anything except sterile or clean dressings. Do not pull clothes over any burned area. • Remove pieces of cloth that stick to a burned area. • Try to clean a full thickness burn. • Break blisters. • Use any kind of oil or ointment on severe burns. • Use cotton wool or other fluffy material on burns. Treat scalds by removing any nonadherent clothing because it traps the heat. Cool the scalded area with water for up to 20 minutes and treat as a burn. With chemical burns, the strength of the chemical and the length of the contact will determine the severity of the burn. The chemical will continue to burn as long as it is on the skin, so the chemical must be removed from the body as quickly as possible. Burns to the eyes from a chemical must be flushed with water (preferably sterile saline) until ambulance personnel arrive. Ensure water flushes underneath the eyelids. 3.2.4 Bleeding When bleeding occurs either during a personal care and body art procedure or accidentally, the operator should: • put on single-use gloves if not already wearing them • prevent the bleeding by applying pressure to the wound until it stops, using a dry sterile single-use dressing • apply an additional dressing, bandage very firmly if bleeding continues, and call for medical assistance • handle both the dressing and the contaminated implement carefully to avoid coming into contact with blood or body fluids/substances from the client or the instrument • place contaminated dressings or swabs in a plastic bag before disposing of them in the clinical and related waste bin • thoroughly wash hands with soap and hot water after treating wounds or handling contaminated dressings, then pat dry • discard single-use instruments into the appropriate clinical and related waste container • place contaminated reusable instruments in the appropriately marked container, and clean and sterilise them according to the procedures outlined in part A, section 5 • document the incident and all actions taken in an incident record book (see part E, appendix 3). 3.2.5 Occupational exposure to blood and/or body fluids/substances The following details expand on the procedures described in part A, section 3.2.4. Intact skin If blood and/or body fluids/substances come into contact with intact skin, then wash the area thoroughly with liquid soap and warm water, then pat dry. Nonintact skin If blood and/or body fluids/substances comes into contact with skin that is chapped, cut or abraded, or has dermatitis, or if accidental penetration (for example, a sharps injury) occurs, then the operator should: • flush with warm, running water, then wash with liquid soap and warm water • thoroughly pat dry • cover with a waterproof dressing • apply firm pressure to control bleeding if required. Mucous membranes (eyes/mouth) If blood and/or body fluids/substances come into contact with mucous membrane, then the operator should: • for eyes, rinse gently with eyes open, using copious amounts of warm tap water or saline • for the mouth, spit out the blood or body fluid, then rinse the mouth thoroughly and repeatedly with warm water. Follow-up action Report the incident to the proprietor/manager immediately and ensure appropriate follow-up with a general practitioner. Document the following: • the name of the exposed individual • the date and time of exposure • how the incident occurred • a description of the injury and treatment provided • the name of the individual who is the source of the blood or body fluid (if known). A general practitioner should evaluate all exposures as soon as possible for both the source individual and the person exposed. This examination may include serological testing for evidence of hepatitis B, hepatitis C and HIV antibodies, after appropriate pre-test counselling and informed consent.
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Hand Care (broken skin, hand washing etc)
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3.3.1 Broken skin Small areas of broken or infected skin on exposed parts of the operator’s body should be covered with a waterproof dressing that completely covers the affected area. If a cut or abrasion is on the hands, then single-use gloves should be worn during all procedures. 3.3.2 Hand-washing techniques The spread of infection from hands has been recognised. Washing hands is the single most important factor in preventing infection (after cleaning and sterilising equipment) and cannot be overstated. Unbroken skin is the best defence because it provides the perfect barrier against infection. The purpose of washing hands is to reduce any microorganisms that may be present. Unless the fingernails are visibly dirty, a nailbrush should not be used because it may cause breaks in the skin during vigorous brushing. Obvious dirt under the nails must be removed. Good hand-washing facilities are essential and should be located within the treatment area. Hands-free taps are required for premises carrying out high-risk procedures (for example, skin penetration). Liquid soap dispensers using single-use cassettes are recommended, because they do not permit a topping-up process and they minimise the risk of contamination. When to wash hands • Before and after contact with each client • After contact with blood or body fluids • After using a tissue or handkerchief • After smoking • After going to the toilet • Before and after eating • After answering the phone or touching any potentially contaminated objects, and before returning to a client How to wash hands (see figure 2) • First, wet hands with warm running water, use liquid soap (one pump measure is sufficient), then rub hands vigorously for a minimum of 15 seconds. • Wash hands all over, including: – backs of hands – wrists – between fingers – under fingernails. • Rinse hands well. • Pat dry hands thoroughly using a paper towel. What to use for hand washing For an ordinary and hygienic hand wash, applying plain liquid soap is sufficient. For all skin penetration practices, a procedural hand wash is required. This procedural hand wash should last for 3 minutes, working through each of the steps in figure 2. The wrists and the lower part of the lower arm (just above the wrist) should be included as part of this hand wash. Operators should use one of the following antimicrobial soap solutions: • aqueous 2% chlorhexidine-based solution • aqueous 4% chlorhexidine-based solution • aqueous povidone-iodine. People with an allergy to the chlorhexidine or povidone-iodine solutions should use a triclosan 2% solution. 3.3.3 Use of protective hand creams and lotions Hand creams and lotions should be applied regularly during the day to provide protection and help prevent chapped and cracked skin.
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Personal Protective Equipment (gloves, clothing, masks etc)
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3.4.1 Gloves The use of sterile single-use gloves is encouraged when skin penetration procedures are being performed and the operator’s hands are likely to be contaminated with blood or body fluids/substances or come into contact with mucous membranes or nonintact skin. Sterile gloves should also be worn when sterile equipment is being used (see part A, section 4.1). Sterile gloves should comply with AS/NZ 4179:1997 Single-use sterile surgical rubber gloves – Specification. They should remain in the manufacturer’s carton until required, and they should not be opened until immediately before the procedure. The use of nonsterile single-use gloves is the minimum requirement if sterile gloves are not provided on site. Wearing gloves must not replace hand washing because gloves may have defects that are not immediately obvious, or they may become damaged during use. Single-use gloves (sterile and nonsterile) should be carefully removed to avoid contamination of hands or other surfaces. They must not be washed or reused. Single-use gloves should be: • removed when leaving the client for any reason, and/or • removed if they become torn, and • changed after each client, and • disposed of in the clinical and related waste receptacle, and • used before the expiry date. Some operators may develop an allergy or sensitivity to latex gloves. This reaction is likely to be due to contact with latex proteins that might not have been adequately removed during the manufacturing process. In the presence of sweat or moisture, these proteins may become absorbed into the lubricant powder used in the latex gloves. Operators who develop sensitivities or allergies to latex can use powder-free latex gloves or alternatives to latex, such as neoprene. 3.4.2 Clothing The operator should wear clean washable garments or coveralls that enable them to thoroughly wash their hands when attending to clients. Personal protective equipment protects the clothing and skin from contamination with blood or body fluids and substances. Watches, wrist and finger jewellery, including wedding rings, should not be worn when attending to clients these items provide a source of infection. Hand jewellery should not be worn during skin penetration procedures because it may tear the gloves. 3.4.3 Masks Operators should wear masks when there is a possibility of splashing or splattering of blood or other body substances. The type of mask best suited to a particular situation depends on the nature of the activity. There are two main types of mask used in skin penetration procedures and cleaning. 1. Surgical masks reduce the risk to operators from splashing and spraying of body fluids/substances. They are generally loose fitting without a tight air seal, and they are not efficient in preventing the wearer from inhaling air-borne particles. See AS/NZS 4381–2002 Single-use face masks for use in health care. 2.Particulate filter personal respiratory protection devices are close fitting and capable of filtering up to 95 per cent of air-borne particles. They should be worn when using lasers. See AS/NZS 1715:1994, Selection, use and maintenance of respiratory protective devices, and AS/NZS 1716:2003 Respiratory protective devices. Masks should: • be fitted and worn according to the manufacturer’s instructions • not be touched by hands while being worn • cover both mouth and nose while being worn • be removed as soon as practicable after they become moist or visibly soiled • be removed by touching the strings and loops only • not be worn loosely around the neck, but be removed and discarded immediately after use. 3.4.4 Eye protection Eyes should be protected from splashing created during cleaning procedures, although the practices used by the operator should ensure these events are kept to a minimum. Various types of eye protection are available, including goggles, face masks, visors and full-face shields, which have either reusable or single-use guards. 3.4.5 Aprons Waterproof aprons should be worn when attending to clients during colonic irrigation procedures and also when undertaking cleaning procedures. 3.4.6 Footwear Footwear should cover the foot, to protect against accidental injury from dropped items of equipment.
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Use & Storage of Chemicals
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Many chemical products used in personal care and body art procedures have the potential to harm the health of the operator and client if they are not labelled, handled and stored with care. To protect the operator and the client, consider the following practices. • Ensure premises are well ventilated. • Only use drop-on or brush-on products. • Try to avoid aerosol products. • Wear gloves when decanting or mixing products such as chemicals (including readymade inks and powdered pigments) because they should not come into contact with the skin of the client or operator. • Label all solutions decanted from bulk containers, and date them with the day of decanting and a use-by date if applicable. • Do not eat, drink or smoke in areas where chemicals are stored or used, because food and drink may absorb emitted vapours that can be flammable. (A specific staff room should be set aside for breaks and the consumption of food.) • After handling chemicals, wash hands before consuming food or drink, because chemical residues on the hands will contaminate food and will be ingested. • Label all chemical containers, secure their lids and store them in a cool area away from gas appliances. • Secure chemicals to prevent unauthorised access. • Remember that cotton wool and similar articles soaked with chemicals will be present in waste, so fumes will be dispersed into the room if not adequately contained. Remove waste regularly from the immediate client area to a larger, covered bin. Proprietors and operators should request (from manufacturers/suppliers of chemicals) material safety data sheets relating to the safe handling, storage and first aid requirements for chemical products. All personal care and body art proprietors/operators should refer to these sheets for advice and keep copies on the premises at the point of use. Glutaraldehyde (sold under various names) is an instrument-grade disinfectant that is not suitable for the personal care and body art industry. There are major occupational health and safety requirements for the use of this product, such as the required use of personal protective equipment and elaborate air removal systems. Contact the Victorian WorkCover Authority and the Department of Human Services for additional information (see part A, section 5.3).
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4. PROCEDURES
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Are low risk hairdressing/beauty procedures conducted?
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Preparation of Client Procedure Areas
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4.1.1 Preparation of client procedure areas To provide a safe working environment, the operator should: • ensure the work area is clean and tidy • ensure all required items are within reach, and remove items not required from the immediate area • ensure work surfaces including procedure chair, couch etc, are cleaned with warm water and detergent, then rinsed and dried • place leak- and puncture-proof washable containers (only used for these purposes) with a firm-fitting lid labelled ‘dirty instruments for cleaning and sterilisation’ in the work area for the collection of used instruments. 4.1.2 Client preparation The client should be provided with privacy, depending on the type of procedure being undertaken. A clean gown and drapes that cover the privacy of the client should be provided. Each client should also be provided with additional equipment where necessary (such as goggles for solaria procedures), along with a full explanation before any procedure commences.
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Is Hairdressing conducted?
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Risk Management (infections, blood-borne viruses, head lice, burns etc)
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3.2.1 Infection Infections that can be spread in hairdressing premises include skin infections on the scalp, face and neck such as impetigo (also known as school sores) and fungal infections such as tinea capitis and ringworm. These infections can spread when instruments and equipment used on clients are not cleaned between client sessions or are not handled or used in a hygienic manner, and when structural facilities such as furnishings and fittings are not kept clean and in good repair. 3.2.2 Blood-borne viruses A risk of the transmission of a serious disease such as hepatitis B and C and HIV can occur when using razors, scissors or clippers, which can abrade the skin and/or cut accidentally. Contaminated instruments can transfer infection directly to the blood of another individual (for example, the operator or next client) if that individual has open cuts, sores or broken skin. 3.2.3 Other risks Burns Burns can occur during hairdressing procedures involving hot rollers, tongs and crimpers. They can also occur when hair is being washed with water that is too hot or when stationary or hand-held dryers are improperly used. Operators should be familiar with first aid procedures for burns (see part A, section 3.2.3). Pediculosis or head lice People get head lice from direct hair-to-hair contact with someone who has head lice. Head lice do not transmit any infectious diseases and there is no evidence to suggest that the environment is of significant concern in their transmission. They are fragile insects, easily killed by water temperatures greater than 60°C. No disinfection or fumigation of the salon is required. See www.health.vic.gov.au/headlice.
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Use & Disposal of Razors & Blades?
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All razors and blades are considered to be contaminated with blood, body fluids or substances after use. Routine cleaning of razor blades is not adequate to minimise the risk of transmission of blood-borne diseases. The safest and most efficient way of preventing the spread of these diseases is to use single-use items. Single use (disposable) razors If the razor is a single-use type, then it must not be used again on another client and must be disposed of into a suitable sharps container immediately after use. Single use (disposable) blades Where a safety-type razor is used, remove the blade from the razor body, taking care not to cut yourself. Dispose of the blade as above. The blade holder must be cleaned and disinfected between clients. If contaminated, it must be sterilised or disposed of. Do not use the body of the razor again until these measures have been taken. Electric razors Electric razor blades are considered contaminated with blood, body fluids or substances after use in the same way that other razors and blades are contaminated. The blades, mesh and the blade mechanism housing are difficult to clean and will not withstand the sterilisation process. This difficulty is due to their design and the materials from which they are made. Debris from shaving, such as blood, hair and skin cells, have been found in the body and motor of electric razors. Electric razors are therefore not recommended for use on clients and should not be loaned to clients. Razor haircutting Razors should be used so the operator can see the blade at all times. Blades may scrape the skin and become contaminated. Razor blades used for hair cutting should be changed after each client, and the blade should be disposed of into a sharps container. The handle should be washed and dried after the blade has been removed; if contaminated, it also requires sterilisation. See part A, sections 5 and 6 and section 2.4.1.
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Clippers
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Clippers should be used in such a way that the operator can see the tip of the clippers at all times. Clippers, including those with plastic attachments, should be dismantled after each use and thoroughly cleaned before being used on another client. If contamination occurs, then the clipper blades must be dismantled, cleaned and sterilised. Plastic attachments must be disposed of into a sharps container.
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Ultraviolet (UV) Cabinets
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These cabinets do not sterilise instruments and other articles placed in them because the UV radiation does not penetrate to all surfaces. Some viruses are not particularly susceptible to UV radiation, and UV cabinets are not suitable storage receptacles because the UV rays damage combs and brushes, and compromise sterile packaging. See part A, section 6.2 and 6.3.
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Cleaning of Hairdressing equipment
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The use of disinfectants requires operators to apply these solutions in strict accordance with the manufacturer’s directions. Due to the problems experienced, the use of disinfecting solutions is not recommended. Any item that accidentally penetrates or abrades the skin must be considered and dealt with as a high-risk category item. These items include, but are not limited to, scissors, combs, clippers, hair pins/clips and razors used for hair cutting. Any item dropped on the floor must be cleaned and dried, or discarded as per the table. Table 9: Cleaning requirements for hairdressing equipment (low risk) Equipment /Reason/risk /When /How /Additional information Scissors, Clippers • Potential for infection or infestation • After each client • Use lint-free cloth to remove hair. Wash in warm water and detergent. Rinse in hot running water. Dry with lint-free cloth. • Scissors become high risk if they penetrate or abrade the skin. Note: Plastic clipper attachments will not withstand the sterilisation process. Haircutting razors • Potential for infection or infestation • After each client • Sterilise or dispose of if blood is drawn. • See above note on safety razors. • Dispose of blades into sharps container. Combs, Hair brushes, Hairnets, Neck brushes, Ear caps, Hair pins/clips • Potential for infection or infestation • After each client and when dropped on the floor • Use lint-free cloth to remove hair. Wash in warm water and detergent. Rinse in hot running water. Dry with lint-free cloth. • Note: Brushes and plastic items will not withstand the sterilisation process. Dispose of any piece of equipment that pierces the client’s skin into a sharps container. Rollers (Regular, Hot, Hot tongs, Crimpers) • Potential for infection or infestation • After each client and when dropped on the floor • Use lint-free cloth to remove hair. Wash in warm water and detergent. Rinse in hot running water. Dry with lint-free cloth. • Note: Store in covered containers. For a risk of burns, see part A, section 3.2. Bottles (Shampoo Conditioner), Shaving bowls • Potential for contamination • When empty • Wash in warm water and detergent. Rinse in hot running water. Dry thoroughly with lint-free cloth before refilling. • Never top up. Dye mixing bowls • Potential for contamination • When empty • Wash in warm water and detergent. Rinse in hot running water. Dry with lint-free cloth. • Prevent residual dyes from being mixed into new preparations. Capes/wraps • Potential for infection if previous client has neck skin lesions or infection unless a clean towel or paper tape is used around neck. • After each client • Wash in warm water and detergent. Rinse in hot running water. Dry according to type of material. • Note: Launder—see part A, section 2.3.5. Use a clean towel or paper tape around neck. Equipment trolley • Prevention of dust and hairs from accumulating or contaminating clean equipment. • Weekly • Use lint-free cloth to remove hair. Wash with warm water and detergent. Dry thoroughly with lint-free cloth before refilling. • Note: Ensure items such as rollers are in closed containers. Cover when not in use.
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Mobile Hairdressing
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Mobile hairdressers must register their principle place of business (for example, their residence) with local government. They should comply with these guidelines, thus maintaining the cleanliness of equipment and personal hygiene standards. For example, the use of impervious and easily cleanable containers with lids for transporting equipment. If additional procedures are undertaken, such as hair removal using wax, then the operators should follow the relevant sections of these guidelines.
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Is Waxing conducted?
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Pre-waxing Procedures/Precautions
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Prior to waxing, the area of skin being waxed should be cleaned using a skin cleanser. This will reduce the levels of skin bacteria and the possibility of skin infection. It will also remove dirt and oils from the skin providing better wax adhesion. Wax must not be applied to broken skin or over an area where blood has been drawn. If blood is drawn during a procedure, the operator should follow the procedures outlined in 3.2.4 and 3.2.5 (Part A) to manage the bleeding. Wax is supplied in several forms; glucose (water soluble), strip (soft) wax, and hot (hard) wax. Concerns have been raised that there is a risk of passing microorganisms from one client to the next if waxing is not performed properly. Even though the risk is believed to be low, steps can be taken to reduce the risk further. It is also important that beauty therapists can demonstrate their practices are safe, so that should a client develop an infection, the beauty therapist can demonstrate that they have taken adequate precautions. Beauty therapists are therefore encouraged to employ a risk management approach to their procedures.
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Glucose (water soluble) wax (not recommended)
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This type of wax is more liable to permit the growth of potentially harmful microorganisms. Its use is not recommended.
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Strip (soft) wax
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Strip wax is available in two forms; water based or oil based. Only oil based strip wax should be used on clients. Strip wax should not be reused. Used wax should be discarded into a plastic bag that is then sealed and placed in the general waste bin.
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Hot (hard) wax
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Hot wax is commonly re-used several times before being discarded. If being re-used the wax should be heated to a temperature of 125° C (allows pouring consistency) and strained free of hairs and skin debris. Heating to this temperature would also destroy any harmful microorganisms. Straining should be performed using a fine mesh strainer (not a common kitchen strainer) and gauze. The gauze should be discarded into a plastic bag that is then sealed and placed in the general waste bin. The mesh strainer should be cleaned and disinfected. Hot wax used to remove hair from the face, underarm and pelvic area should not be re-used.
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Roll on Applicators
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Roll on applicators that can be dismantled and thoroughly cleaned are recommended. Applicators that cannot be dismantled should not be used because they contact the client’s skin and cannot be cleaned and disinfected adequately between clients. In between clients re-usable applicators should be: • initially cleaned using a wax solvent to remove all traces of wax • thoroughly cleaned using the method in Part A, 5.2 • dried, reassembled and stored appropriately. Wax cartridges with their roll on applicators attached should be placed in an enclosed heating unit capable of heating the wax cartridge and roller head to a temperature level of 70-80° C for a minimum of 15 minutes.
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Risk Management (single-use pots, no re-dipping applicators, heating wax etc)
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Using a risk management approach to waxing the Department of Human Services recommends either of the following two methods, which remove the possibility of cross contamination between clients altogether: • the use of single use pots for each client; the wax pot should be thoroughly cleaned after use. • avoidance of re-dipping applicators if wax pots are used on more than one client. Single-use wooden spatulas are recommended because these can be thrown away after use. However, if neither of these methods is practical, it is essential that temperature control be employed, as a means of controlling any possible risk. All types of wax (both strip and hot wax) should be kept undisturbed at a minimum temperature level of 70–80ºC for a minimum of 15 minutes between clients. (Viruses such as HIV would be expected to be inactivated at this temperature.) - For strip waxing, this should be monitored and recorded before the first client and at least one other time during the day. - For hot waxing, monitoring should occur between clients, or at least twice during an 8-hour day. - For both strip and hot wax, monitoring should also occur after pots have been refilled or replaced with a new pot. - The temperature and time of holding should be recorded and available for inspection for a reasonable period (at least one year). If wax and instruments are contaminated with blood or body fluids/substances, then the wax must be immediately discarded into the clinical and related waste container. The risk of spreading infection from one client to another through wax has been raised as an issue. The concern is that pots of wax could be contaminated with skin or blood borne viruses from one client, especially if bleeding has occurred, and then spread to the next client if the same equipment is used. There is insufficient evidence to clearly demonstrate the extent of this risk, but it would appear that the risk is low. However, operators should ensure that their processes for waxing clients and management of equipment minimises the potential for cross contamination. Operators should also maintain documentation (see part E appendices) of their processes.
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Client Advice
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Skin may be more susceptible to irritation or infection for up to 48 hours after a waxing procedure, so clients should be advised that they should not: • swim or have a spa bath • wear tight clothing such as jeans, tights and leotards, because these may cause excessive perspiration • sunbathe or have a solarium treatment • use a deodorant on the waxed area.
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Are Lasers used?
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Operators appropriately trained & correct use.
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Department of Human Services recommends that personal care and body art premises operating lasers follow the standards on the safe use of lasers in health care (AS/NZS 4173:1994) and laser safety (AS/NZS 2211.1:2004). Lasers used in personal care and body art premises are usually self-contained units with limited equipment requiring cleaning and sterilisation.
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Cleaning & Sterilisation eg end pieces
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Although the end through which the laser beam is released should not come into contact with the client, it will become contaminated during use, via the dispersal of contaminated tissue. The end pieces of the laser arm should be cleaned and sterilised after each client use and then stored in a dry place.
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Are Alternative forms of Hair Removal used? eg plucking, sugaring, threading
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Correct procedures, cleaning etc used.
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Other methods of hair removal are available, but limited information is available on both these techniques and their infection risk. The following are three examples. 1. Plucking involves using tweezers or another instrument to ‘pluck’ the hairs one by one from the area. It is best suited to small areas such as eyebrows. Plucking is more likely to cause bleeding due to the nature of the hair removal. Instruments must be cleaned and disinfected after each client (see part A, sections 5 and 6). If contaminated with blood or body fluids they should be cleaned and sterilised. 2. Sugaring involves heating a sugar-based paste, spreading it onto skin and then removing it using the hands to ‘roll’ it against the hairs to remove them. Sugar-based pastes must not be used in personal care and body art premises because they provides a perfect medium for the growth of potentially harmful microorganisms. 3. Threading involves pulling hairs from the follicles using a thread that is moved quickly over the skin, catching the hairs and causing their dislodgement from the follicle. Threads must be used only once and then discarded.
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Are Manicure, Pedicure & Nail Treatments conducted?
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Pre-manicure/pedicure Procedures
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The hands and feet of clients should be cleaned and dried before a manicure or pedicure. Any instrument or part of an instrument used on a client should be cleaned with detergent and warm water, dried and thermally disinfected before being used on another client. If an instrument penetrates the skin, then it requires cleaning and sterilisation. Single-use instruments are recommended and should be discarded after each client use. Bowls used to soak the hands or feet of clients should be cleaned and dried between each client use (see part A, section 5).
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Risk Management eg nail infections
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1.3.2 Fungal (onychomycoses) and bacterial nail infections Infections can be spread between the client and operator, and from client to client, if the instruments used have not been thoroughly cleaned and sterilised or disinfected between clients. Good hygiene and sensible precautions will reduce the transmission of nail infections. Fungal infections can cause tinea or ringworm, affecting hair, skin and nails. Paronychia (infection of the nail folds) can be caused by Candida albicans (a form of yeast infection) and the bacteria Staphylococcus aureus and Streptococcus pyogenes (group A streptococci). If the bacterium produces a cellulitis (a spreading infection), then it can cause severe damage and become serious very quickly. Fungi more commonly infect toenails than fingernails; less than 10 per cent of nail infections involve fingernails. In the attachment of acrylic nails and similar products to normal nails, care should be taken to avoid the formation of spaces between the two, which could provide the perfect environment for microorganisms to grow. It is important that an operator does not work on nails that are abnormal in appearance or have any evidence of infection (redness, pus, tenderness or swelling). The operator should not disguise nails affected by an infection, and should advise the client to consult a medical practitioner.
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Chemical exposure/fumes
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To protect the operator and the client against undesirable chemical exposure: • ensure premises are well ventilated • only use drop-on or brush-on products rather than aerosol products • keep lids on all containers to reduce vapour escaping into the air, because cotton wool and similar articles soaked with chemicals will disperse fumes into the room (see part A, section 3.5).
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Suitable instruments used (single-use where possible)
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The following instruments should be used: • single-use chamois buffers and emery boards (one for each client as they can not be effectively cleaned) • reusable cuticle sticks and cutters, which should be cleaned and dried between clients (single - use cuticle sticks are recommended). • nail brushes, which should be cleaned and dried between clients • burrs used for buffing, which should be cleaned and dried between clients (single - use burrs are recommended). • single-use nail files (reusable nail files should be cleaned and dried between clients). Disinfection (thermal/chemical - 70% alcohol) may be carried out following cleaning.
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Cleaning of instruments
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Table 6: Beauty therapy equipment – cleaning, disinfection and disposal schedule Equipment /Reason /When /How /Additional information High Risk Tweezers, Probes • Potential for skin infections or for blood borne virus transmission • After each client • Wash in warm water & detergent. Rinse in hot running water. Dry with lint free cloth. Sterilise if contaminated. • Note: Use a lint free cloth for all stages of the cleaning process. Store appropriately. Intermediate risk Nail clippers/scissors, Cuticle sticks, Nail burrs, Nail files • Potential for infection. • After each client • Wash in warm water & detergent. Rinse in hot running water. Dry with lint free cloth. Dispose of or sterilise if contaminated • Note: Become high risk if they penetrate or abrade the skin. Plastic equipment may not withstand the sterilisation process. Use single use where possible. Low risk Eyelash curlers, Nail brushes, Nail buffers, Emery boards • Potential for infection. • After each client • Wash in warm water & detergent. Rinse in hot running water. Dry with lint free cloth. Dispose of or sterilise if contaminated. • Note: May be disinfected in addition to cleaning. Become high risk if they penetrate or abrade the skin. Plastic equipment may not withstand the sterilisation process. Some buffers (and handles) may be washable (for example,chamois) – see the manufacturer’s instructions on cleaning and drying these items. Other buffers should be single use and disposed of after each client. Emery boards should be single use and disposed of after each client as they cannot be washed and dried effectively. Hand bowls • Potential for contamination. • After each client • Wash in warm water &. detergent. Rinse in hot running water. Dry with lint free cloth. Foot baths • Potential for contamination. • After each client • Wash in warm water & detergent. Rinse in hot running water. Dry with lint free cloth. Use chlorine-based disinfectant (bleach) to disinfect, rinse in hot water and dry with lint free cloth. • Note: Cleaning may not be sufficient to remove some fungal microorganisms therefore disinfection after each client is essential particularly if the foot bath is of the ‘spa’ type. Refer to part A, section 5.3. Single use Applicators • Potential for infection. • After each use. • Dispose of into a clinical or related waste container. • Note: Use once only. Bottles/sprays/ pump dispensers: (Liquid soap, Water, Lotions, Creams, Gels) • Potential for contamination. • When empty. • Wash in warm water & detergent. Rinse in hot running water. Dry thoroughly with lint free cloth before refilling. • Note: These should never be ‘topped up’. Manufacturer’s containers should be discarded when empty. Nail varnish brushes • Potential for contamination. • After each client • Remove varnish using an appropriate solvent. Wash in warm water & detergent. Rinse in hot running water. Dry with lint free cloth. • Note: Use single use brushes or varnish pots. Client couch/chair • Potential for contamination • After each client • Wash with warm water & detergent. Dry thoroughly with lint free cloth. Equipment trolley • Prevents dust accumulating and contaminating clean equipment • Weekly • Use damp cloth to remove dust. Wash with warm water & detergent. Dry thoroughly with cloth before refilling. • Note: Ensure items are in closed containers. Cover when not in use. Use a lint free cloth for cleaning.
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Are Facials conducted?
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Clients face cleaned pre-treatment
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The client’s face should be cleaned before any massage of facial tissue or the application of lotions, creams, moisturisers or make-up (see part A, section 2.5)
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Applicators (single-use, reusable)
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Applicators should be either single-use or cleaned & dried after each client. Ultraviolet light cabinets are not suitable as drying cabinets for brushes or other similar equipment.
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Are Other Beauty procedures conducted? Eg mud baths, skin exfoliation, body polishing, brush cleaning, eyelash perking & tinting, eyebrow tinting, bleaching of facial hair.
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Correct procedures conducted?
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There are many other beauty treatments available to clients, such as mud baths, skin exfoliation, body polishing, brush cleaning, eyelash perming and tinting, eyebrow tinting and bleaching of facial hair. Each proprietor and operator should assess the risk of infection associated with each procedure, using the information provided on low-, intermediate- and high-risk procedures (see table 1, part A, section 5.1 and part C).
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Are Physical Therapies conducted?
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Is Massage conducted?
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Infection Risks (awareness, training etc)
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In performing various massage therapies, the operator needs to assess all possible infection risks and to consult their professional organisation. See the following sections for appropriate procedures to reduce the potential for the transmission of infection: • hands—see part A, section 3.3 • surfaces—see part A, section 4.2.2 • linen—see part A, section 2.3.5 • oils/creams—see part A, section 2.5.
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Is Solaria conducted (illegal)?
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It is illegal to operate commercial solarium units in Victoria as of 1 January 2015. Historic It is recommended that an operator does not allow an individual under the age of 18 years to use a sun-tanning unit without parental or guardian consent. Any individual under the age of 15 years is strictly not permitted.
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Saunas
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Infection Risks (awareness, training etc)
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The main infection risk relates to the surfaces of the sauna. Operators should ensure surfaces are kept clean. Only nonabrasive cleaners should be used (see part A, section 4.2.2). Clients should be encouraged to use a clean towel for sitting or lying on while using the sauna. If the operator provides towels, they should be handled accordingly once used (see part A, section 2.3.5).
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Flotation Tanks
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Infection Risks (awareness, training etc)
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The main infection risk for floatation tanks is the salt water that is reused between clients. Operators should ensure both internal and external surfaces are kept clean, using nonabrasive cleaners to remove scum and to prevent corrosion caused by splashing of the highly concentrated salt water (see part A, section 4.2.2). Regular maintenance should include checking the filters. When applying oils or creams to protect the skin from the concentrated salt water, appropriate dispensing procedures should be used (see part A, section 2.5).
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Spas & Pools
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Health (Infectious Diseases Regs)
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Pools and spas are required to comply with the Health (Infectious Diseases) Regulations 2001, part 7 (public spa pools and public swimming pools).
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Gymnasium equipment
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Infection Risks (awareness, training etc)
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Daily cleaning of the gymnasium environment and its equipment is important to prevent the spread of infection and provide a safe environment for users and staff. Additional cleaning is required immediately when and where any person has sweated profusely. Bacteria such as Staphylococcus aureus (golden staph) can cause conjunctivitis and skin infections when transferred from inadequately cleaned equipment and reusable towels. The spread of infection is assisted by the reuse of a single towel for cleaning and by the use of the gymnasium user’s own towel to wipe down equipment. Supplied reusable towels should be used only once and placed in a receptacle for laundering (see part A, section 2.3.5). The following cleaning equipment should be readily available for gymnasium users or staff: • a solution of warm water and detergent in a pour bottle • paper towels for cleaning and drying equipment There should be a receptacle for the disposal of used paper towels. Facilities should be available for users and staff to wash their hands after cleaning or wiping down equipment (see part A, sections 2.3.1).
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Alternative Therapies (naturopathy, aromatherapy, homeopathy, ear candling etc)
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Infection Risks (awareness, training etc)
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There is an abundance of alternative therapies, including naturopathy, aromatherapy, homeopathy and ear candling. It is important for the operator to consider all possible infection risks and, if possible, consult their professional organisation. If those therapies consites of procedures that penetrate the skin then premises must be registered and guidelines for skin penetration (part B, section2) should be followed. See the following sections for appropriate procedures to reduce the potential for infection transmission: • hands—see part A, section 3.3 • surfaces—see part A, section 4.2.2 • linen—see part A, section 2.3.5 • oils/creams—see part A, section 2.5. The Health Act 1958 and the Health (Infectious Diseases) Regulations 2001 are designed to protect public health. To comply with public health legislation, it is good practice for proprietors to establish a risk-based approach to their operation by identifying potential hazards and ways in which these hazards can be controlled. This system is already well established in the food industry and can be adapted to suit other industries.
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5. GENERAL CLEANING
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Cleaning up after a Procedure/Incident
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4.2.1 Cleaning up after a procedure After completing any procedure, carry out the following steps. 1. Place all contaminated single-use sharp instruments into a sharps container immediately after a skin-penetration procedure has been performed. 2.Place all reusable skin penetration instruments, or other reusable instruments contaminated with blood, into the container labelled ‘dirty instruments for cleaning and sterilisation.’ 3.Place all reusable instruments from low- and medium-risk procedures into a container labelled ‘dirty instruments for cleaning.’ 4.Place the containers in the area set aside for cleaning. 5.Do not store instruments or needles in chemical disinfectant either before or after cleaning, sterilisation or thermal disinfection. 6.Dispose of all used single-use items (such as applicators, paper toweling and protective coverings from surfaces) into the clinical and related waste bin. 7. Place used linen into a washable leak-proof receptacle with a close-fitting lid labelled ‘dirty linen’ and launder (see part A, section 2.3.5). 8.Remove and dispose of gloves in the clinical and related waste bin, then wash hands and thoroughly pat dry (see part A, section 3.3.2). Care should be taken when handling sharp instruments to avoid potential sharps injuries. 4.2.2 Routine cleaning of work surfaces General-purpose utility gloves should be worn for general cleaning procedures. Utility gloves may be reused but should be washed in detergent after use and stored in a dry place, or replaced if torn, cracked, peeling or showing signs of deterioration. Proprietors should use gloves robust enough to stand general cleaning and not tear. Vinyl gloves should not be used, because they are more likely to develop large holes and are prone to tearing. Following client treatment, all work surfaces used, for example, procedure couches/chairs, solariums, benches and tables, should be washed with warm water and detergent, rinsed and dried using a clean lint-free single-use cloth. Additionally, at the end of each working day, wash all visibly soiled surfaces with warm water and detergent. Rinse and dry using a clean lint-free single-use cloth (see part E, appendix 3). 4.2.3 Cleaning standards for change/shower rooms and toilets Cleaning requires surfaces to be free from smudges, smears, body fats and mineral deposits. Surfaces include plumbing fixtures, tiles and other polished surfaces. Sanitary disposal units should be regularly emptied. 4.2.4 Clean-up procedures following blood or body fluid spills Surfaces contaminated with blood or body fluid should be cleaned in accordance with the following procedures. 1. Handle all soiled dressings and contaminated instruments carefully, wearing singleuse gloves, apron, protective eyewear. 2.Dispose of contaminated single-use instruments into a sharps container, then clean and sterilise reusable instruments according to part A, sections 5 and 6. 3.Soak up blood using paper towels. 4.Wash affected areas with warm water and detergent. 5.Rinse and dry affected areas using paper towels. 6.Dispose of all used paper towels by placing them in the clinical and related waste bin. 7. After treating wounds, handling contaminated dressings or cleaning up blood, remove gloves and dispose of them in the clinical and related waste bin. 8.Wash hands and thoroughly pat them dry. For major spills: • follow procedures 1–4 from the above list • mix a fresh solution of 1:4 diluted bleach—for 1:4 dilution, add 1 cup (250 millilitres) of bleach to 3 cups (750 millilitres) of warm water • wipe over the area using paper towels • rinse the area thoroughly and dry well, because bleach is corrosive • follow procedures 5–8 from the above list. For an excellent reference on the cleaning, disinfection and sterilisation of used items, see AS/NZS 4815:2001 Office-based, health-care facilities not involved in complex patient procedures and processes – Cleaning, disinfecting and sterilising reusable medical and surgical instruments and equipment, and maintenance of the associated environment. It provides clear instructions for all steps in the processing of reusable items.
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Manual Cleaning of Reusable Instruments
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• Do not leave instruments soaking for longer than one hour. (Instruments that cannot be immersed should be cleaned immediately). • Protect the tips of sharp reusable items from damage during cleaning and clean carefully to avoid a sharps injury to the operator. 5.2.2 Cleaning process • Rinse under warm running water to remove organic material. Do not use either very hot or very cold water because this will fix the soil to the item, making it more difficult to clean. • Fill the sink with warm water and liquid detergent (preferably low-foaming, nonabrasive, noncorrosive, biodegradable, free-rinsing, nontoxic detergent of a mild alkaline formulation). Common household detergents should not be used because they have high-foaming properties and their residue is difficult to rinse off. • Follow the manufacturer’s instructions for detergent use. (Material safety data sheets contain information on the formulation, use and suitability of particular items.) • Ensure all staff are familiar with each chemical used in cleaning items. • Use cleaning products containing enzymes, which break down proteins in organic matter, only if suitable for the item. (They are not recommended for routine use.) • Use products containing enzymatic matter according to standard precautions, and wear nitrile-type gloves. • Note that cannulated (hollow or lumened) items such as stainless steel receiving tubes used in body piercing are a particular challenge to clean. (Immersion in an ultrasonic cleaner may assist in the manual cleaning by removing or loosening soils.) • Note that reusable tubing is also a challenge to cleaning and has the potential to generate infectious aerosols. Use single-use tubing instead. For most personal care and body art industries, manual cleaning will be the best method. Manual cleaning is used when items require care in their handling and are not suited to mechanical cleaning methods (for example, an ultrasonic cleaner). Ultrasonic cleaners may be used for some parts of the manual process (depending on the fragility of the item).
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Ultrasonic Cleaners (process, monitoring, testing, maintenance)
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Ultrasonic cleaner method Ultrasonic cleaners work by producing high-frequency, high-energy sound waves that cause organic material to dislodge and drop to the bottom of the tank. Use only a manufacturer-recommended detergent because others may limit the effectiveness of the ultrasonic cleaner. Cannulated items may require additional manual cleaning, because these items are not always successfully cleaned in an ultrasonic cleaner. Cannulated items should be brushed thoroughly and rinsed before being carefully placed into the ultrasonic tank, to ensure air is not trapped within the lumen. They should be brushed again on removal (using a clean brush) to remove loosened debris. Ultrasonic cleaners do not sterilise or disinfect instruments, but they provide a safe and effective means of cleaning most reusable instruments before sterilisation. It is important that the cleaner is tested (via an aluminium foil test) each day to ensure the correct operation of the ultrasonic transducer. Do not submerge fingers or body parts into the fluid of an operating ultrasonic tank because the energy will damage joint tissues and result in long-term arthritic conditions. A notice should be attached to each ultrasonic cleaner, stating ‘while operating the ultrasonic cleaner, do not submerge fingers or other body parts into the fluid’. Keep the ultrasonic cleaner lid on during the operation to reduce the emission of high-frequency sounds to a safe level, because they may damage hearing (and also to contain aerosols emitted from the surface of the cleaning fluid, which can pollute the surrounding atmosphere and be a source of air-borne organisms). Table 2 summarises the steps. Table 2: Summary of steps in manual and ultrasonic cleaning Manual cleaning 1. Put on personal protective equipment, including heavy-duty household gloves. 2. Separate items according to the method of cleaning. 3. Rinse items in warm running water to remove soil. 4. Dismantle or fully open items to ensure all parts are present. 5. Immerse items (a few at a time) in the sink with warm water and detergent. 6. Scrub items using a soft nylon-bristle brush. 7. Keep each item low in the sink (below the surface) to prevent splashing and the formation of aerosols. 8. Rinse items in warm to hot running water. 9. Dry items with a lint-free cloth 10.Inspect the item for cleanliness and completeness 11. Do not reassemble the items before thermal disinfection or sterilisation. Ultrasonic cleaning Follow steps 1–4 for manual cleaning 5. Operate the machine to degas the solution. 6. Immerse items in the ultrasonic cleaner (which is filled with warm water and detergent). 7. Keep the lid on during the operation to prevent aerosols and splashing. 8. Rinse items in warm-to-hot running water. 9. Dry items with a lint-free cloth 10.Inspect the item for cleanliness and completeness. Items that cannot be fully immersed should be wiped over using a lint-free cloth dampened in warm water and detergent, then rinsed and dried. A 70% ethanol alcohol solution should then be used to chemically disinfect the item. Monitoring of ultrasonic cleaners Ultrasonic cleaners should be cleaned daily. The base plate, gaskets, water strainers and filters must be checked and cleaned, and a daily performance test is essential to check the transducer function. Ultrasonic transducer performance test (aluminium foil test) This test is designed to test the transducer function of the ultrasonic cleaner. • Cut a strip of aluminium foil that is approximately the width of the tank and twice its depth. • Fill the ultrasonic cleaner tank, add detergent and degas the tank (see the manufacturer’s instructions). • Lower the foil vertically into the tank until it almost touches the bottom of the tank. (Do not immerse hands.) • Operate the ultrasonic cleaner for 10 seconds (without the lid). • Remove the foil and inspect it for an even distribution of perforations and pitting. If pitting or perforations are uneven, then the ultrasonic cleaner should be checked for faults or serviced. • An uneven distribution of perforations and pitting of the aluminium foil indicate that the ultrasonic cleaner is not functioning at maximum efficiency and should not be used until it has been serviced. Figure 3: Aluminium foil test—wire frames for supporting sheets of aluminium foil Maintenance of ultrasonic cleaners Ultrasonic cleaners should be operated and maintained according to the manufacturer’s instructions. Ultrasonic cleaners must comply with AS 2773.1:1998 Ultrasonic cleaners for health care facilities, Part 1: Nonportable and with AS 2773.2–1999 Ultrasonic cleaners for health care facilities, Part 2: Benchtop. All cleaning equipment should be nonabrasive, and washed and dried after use.
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Disinfection (chemical, thermal)
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5.3 Disinfection 5.3.1 General Instruments used on intact skin may be washed and stored in a dry place, but instruments that penetrate the skin must undergo cleaning and sterilisation. The use of disinfectants does not replace the need for good cleaning practices, and all items/equipment/surfaces must be thoroughly cleaned before disinfection. Disinfectants should be used only when equipment or the environment is contaminated with blood or other body substances however, items that can be, must be sterilised after cleaning. Detergent solution is sufficient for cleaning off perspiration, for example. Disinfectants can become easily contaminated and are a potential source of infection. Solutions should be labelled appropriately (with the name, date and dilution strength). Do not mix detergent or disinfectant solutions because they may react with each other and, in doing so, reduce their effectiveness or cause harm. Some disinfectants, such as those producing chlorine, must be freshly prepared. Only disinfectants specified in the Australian Register of Therapeutic Goods (ARTG) should be used by operators for disinfection. This disinfectant should only be used for the approved purpose. 5.3.2 Storage of chemicals See part A, section 3.5. 5.3.3 Use of bleach (sodium hypochlorite) • All references to ‘bleach’ (sodium hypochlorite) throughout the guidelines relate to household-grade bleach products with a concentration of 40,000 parts per million (ppm) of available chlorine (ppm avCl) or 4% avCl. • To dilute bleach for a 1:4 dilution, add 1 cup of bleach (250 millilitres) to 3 cups of warm water (750 millilitres). • Prepare bleach solution as required, or prepare daily (label bottle) as its effectiveness deteriorates rapidly. • To prevent deterioration, store bulk bleach containers in dark cool areas (and strictly adhere to use-by dates on bleach products). • Wear gloves when handling bleach, because it can cause skin irritation. • If splashing occurs, rinse the affected area immediately, following the instructions contained in part A, section 3.2.5. • Rinse bleach solution from all surfaces, because bleach is corrosive. • Dry surfaces. It is not necessary to routinely use bleach or other disinfectants. 5.3.4 Disinfection processes Chemical disinfection should be used only for items for which sterilisation and thermal disinfection are not suitable—for example, items unable to be immersed in water (thermal) or unable to withstand high-pressure gradients (sterilisation). Items that can be fully immersed but are unable to withstand high-pressure gradients may be disinfected in a suitable chemical disinfectant solution if necessary. Thermal disinfection is recommended for items that can be immersed but are not required to be sterile at the time of use. Due to the misuse and overuse of chemical disinfectants, many microorganisms have become, or are becoming, resistant to them. For this reason, the routine use of disinfectants is not recommended. Items of equipment should be immersed in a chemical disinfectant solution only for the time specified by the manufacturer. They should be removed and rinsed with distilled water before being dried and stored. Chemical disinfectant solutions should be discarded immediately after use (see part A, section 2.4.4). The container should have a close-fitting lid. Spray bottles are not a suitable method of disinfecting equipment because the aerosols produced do not come into contact with all parts of the equipment. Proprietors/operators who choose to use chemical disinfectants as part of their practices should consider each chemical and its use carefully, and follow the manufacturer’s instructions. (Table 1 in part A, section 5.1 provides a guide for when a disinfection process [thermal or chemical] can be used.) Thermal disinfection Thermal disinfection uses heat and water (moist heat) at temperatures that destroy most organisms. It is the most cost-effective and efficient method of disinfection. It is only suitable for items that can be fully immersed in water at high temperatures. All items must be fully immersed for the entire time once the water boils. Additional items must not be added during this boiling stage. Table 3: Time/temperature ratios for thermal disinfection Surface temperature (°C) Minimum disinfection time (minutes) 90 1 80 10 75 30 70 100 Thoroughly clean and dry items before the thermal disinfection process (see part A, section 5.2.2). Chemical disinfection • All items that can be fully immersed in water may be disinfected in a chemical disinfectant solution. • All items should be cleaned and dried before chemical disinfection (see part A, section 5.2.2). • Fully immerse items for the time specified by the item/equipment and chemical manufacturer, then rinse them with distilled water and dry with a lint-free cloth. • Wipe over nonimmersible items with a 70% alcohol solution, then dry them using a lint-free cloth. It is essential to dry items fully after cleaning (before either wiping or immersing the item in a chemical disinfectant) because any moisture will dilute the solution, making it ineffective. Wiping instruments with disinfectants before use does not sterilise them. Instruments must not be stored in disinfectants before or after cleaning or sterilising. Suitable equipment disinfectants Suitable disinfectants are those with the following strengths: • 70% w/w ethyl alcohol • 80% v/v ethyl alcohol • 60% v/v isopropyl alcohol. Observe the use-by dates on all disinfectants, including those on decanted containers.
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