Cosmetology Exam

Infection control opens the Scientific Concepts domain, which supplies 35 percent of the scored items on the national theory examination. The topic covers how diseases are caused and transmitted; the differences among cleaning (sanitation), disinfection, and sterilization; the prevention of cross-contamination through correct handling of single-use and multi-use items; the blood exposure procedure and its order; and the requirements that the Occupational Safety and Health Administration (OSHA) and the Environmental Protection Agency (EPA) place on a salon.

A microorganism is any organism of microscopic size. A pathogen is a microorganism that causes disease, and salon infection control is aimed at four kinds: bacteria, viruses, fungi, and parasites. Bacteria are one-celled microorganisms with both plant and animal characteristics. Most are nonpathogenic: harmless or beneficial organisms that aid digestion, protect the skin, and decompose waste. A minority are pathogenic (harmful) and cause disease or infection when they invade the body. Because no one can tell by sight which organisms are present, every tool and surface is treated as if it carried pathogens.

Cocci rarely move on their own; they are carried in air, in dust, or within the substance in which they settle. Bacilli and spirilla are motile and propel themselves with slender, hairlike extensions called flagella. In the active stage, bacteria grow and reproduce in warm, dark, damp, or dirty places, each cell dividing into two new cells by binary fission. When conditions turn unfavorable, certain bacteria, such as the anthrax and tetanus bacilli, form spores with a tough outer coating. Spores withstand heat, dryness, and disinfectants, which is the reason disinfection is not the same as sterilization.

Staphylococci are among the most common bacteria affecting humans and are carried by about a third of the population. In salons they spread through skin-to-skin contact, unclean implements, and contaminated surfaces. Methicillin-resistant Staphylococcus aureus (MRSA) is a staph strain that resists many antibiotics. It typically begins as a skin infection resembling pimples or boils, is difficult to cure, and can become systemic. An area with a visible, open, or inflamed lesion is not serviced, and the client is referred to a physician.

A virus is a submicroscopic particle that can reproduce only by taking over a living host cell. Viruses cause the common cold, influenza, measles, hepatitis, and warts. Antibiotics act on bacteria and have no effect on viruses, although some viral diseases are prevented by vaccination. Bloodborne pathogens are disease-causing organisms carried in blood or body fluids, chiefly the hepatitis B virus, the hepatitis C virus, and the human immunodeficiency virus. They enter through broken skin, including cuts too small to see, which is why a nick from shears or nippers is handled as an exposure incident.

Fungi are organisms that include molds, mildews, and yeasts. Mildew grows on damp walls, fabrics, and surfaces; it does not cause human infection in the salon, but it signals a moisture problem. Pathogenic fungi produce the contagious conditions named tinea (ringworm): tinea capitis on the scalp, tinea barbae (barber’s itch) in the beard area, and tinea pedis (athlete’s foot) on the feet. Fungi also infect the nail unit. They spread through contaminated implements, clippers, towels, and foot basins.

Parasites are organisms that live in or on a host and draw nourishment from it. The two external parasites met most often in the salon are the head louse, which causes pediculosis capitis, and the itch mite, which burrows under the skin and causes scabies. Both conditions are highly contagious. A client with a contagious fungal or parasitic condition is not serviced; the client is referred to a physician, and every item and surface the client touched is cleaned and disinfected. Signs and symptoms of these disorders are covered in detail in Chapter 3.

Transmission is the process by which pathogens move between individuals and objects. A contagious disease, also called a communicable disease, spreads from one person to another; the common cold, ringworm, conjunctivitis (pinkeye), and viral infections are examples. An infectious disease is caused by pathogens that enter the body, whether or not it passes to another person. Pathogens enter through broken or inflamed skin, the mouth, the nose, the eyes, and the ears. Intact skin is the body’s first line of defense, so any break in the skin of the client or the cosmetologist raises the risk of infection.

An infection is the invasion of body tissue by pathogens. Inflammation is the body’s response to injury, irritation, or infection, and it shows four signs: redness, heat, pain, and swelling. Pus, a fluid containing white blood cells, bacteria, and dead cells, is a sign of bacterial infection. Immunity is the ability of the body to destroy pathogens and resist infection, and it is either natural or acquired. A cosmetologist does not diagnose or treat disease; the duty is to recognize the signs, decline or modify the service, and refer the client to a physician.

Decontamination is the removal of blood, body fluids, and pathogens from the surface of an item. It is carried out at three levels of increasing strength: cleaning, disinfection, and sterilization. The first level is cleaning, which exam questions may also call sanitation: a mechanical process that uses soap or detergent, water, and scrubbing to remove visible dirt, debris, and many pathogens. Sanitizing, strictly defined, is a chemical process that reduces the number of pathogens on an already clean surface to a level considered safe. Neither cleaning nor sanitizing destroys all pathogens.

Cleaning always comes first. Hair, skin cells, product residue, and blood shield organisms from a disinfectant and can inactivate the chemical itself, so a dirty implement placed in disinfectant is not disinfected. Proper cleaning removes most of the microbial load before any chemical is applied. A cleaned item is rinsed and dried before immersion, because water left on the tool dilutes the solution. Disinfectants are formulated for nonporous surfaces only and are never used on skin, hair, or nails.

Sterilization is the only level that destroys bacterial spores. In salons it is achieved with an autoclave, which uses steam under pressure; implements are cleaned first and sealed in pouches, and the unit is verified with periodic spore tests as the manufacturer directs. Most state boards require disinfection, not sterilization, for salon implements, although some require sterilization for certain metal implements. Ultraviolet cabinets and glass bead units neither disinfect nor sterilize; a UV cabinet is acceptable only as clean storage for items that have already been disinfected.

A disinfectant is a chemical product that destroys most bacteria, fungi, and viruses, but not spores, on nonporous surfaces. Salon disinfectants must be registered with the EPA and carry an EPA registration number on the label. An EPA-registered hospital disinfectant is effective for cleaning blood and body fluids from nonporous surfaces and is bactericidal (destroys bacteria), virucidal (destroys viruses), and fungicidal (destroys fungi). Tuberculocidal disinfectants also destroy the bacterium that causes tuberculosis; some states require them, or a product labeled effective against HIV and HBV, for items contaminated with blood.

Efficacy is the ability of a product to produce the effect claimed on its label, and it depends on correct use. Contact time is the period a surface must remain visibly moist with disinfectant, or an item completely immersed, for the product to destroy the listed organisms. Ten minutes is the usual value for quats, but the manufacturer’s label and state rules govern. Complete immersion means enough solution to cover every surface of the item, including handles and hinges. Using a disinfectant in a manner contrary to its label is a violation of federal law.

Concentrates are measured, never estimated: a solution that is too weak fails to disinfect, and one that is too strong damages tools and irritates skin. The disinfectant is added to the water, not the water to the disinfectant, to limit foaming that would give a false fill level. Solution is replaced every day, or sooner when it becomes cloudy or contaminated with debris, unless the label specifies otherwise. Gloves and safety glasses are worn while mixing, and implements are removed with tongs, a draining basket, or gloved hands.

Cross-contamination is the transfer of pathogens from a contaminated person, object, or surface to a clean one. It occurs when an implement is used on a second client without disinfection, when a clean item is set on a soiled surface or stored with used items, when a dropped tool is picked up and used, when fingers are dipped into a product container, and when hands are not washed between clients. Prevention rests on classifying every item correctly and then handling it according to its class.

Clean and soiled items are never mixed. Disinfected implements are kept in a clean, covered container; used implements go into a separate, labeled, covered container until they are cleaned. A freshly laundered towel and a fresh neck strip are used for each client so that the cape never touches the skin of the neck. Soiled linens are placed in a closed hamper away from clean linens. An implement dropped on the floor is treated as contaminated and is cleaned and disinfected before it is used again.

• Remove creams and pomades from jars with a clean or single-use spatula, never with the fingers.
• Choose pumps and squeeze bottles over open jars where possible.
• Never dip a spatula or applicator that has touched the client back into the product.
• Discard unused dispensed product; never return it to the original container.
• Store products as the manufacturer directs, away from heat and light; discard expired products.

Hand washing is the single most effective act of infection control. Hands are washed with soap and warm running water before and after each client, after using the restroom, after eating, after touching a contaminated surface, and after removing gloves; the exposed portions of the arms are included before a service. Plain liquid soap and friction are sufficient; bar soap is avoided because it can harbor bacteria.

Personal hygiene supports infection control and a professional image. Daily bathing, deodorant, oral hygiene, and clean clothing are expected; hair is secured away from the face, and closed-toe shoes protect the feet from dropped implements and spills. Nails are kept clean and at a moderate length, chipped polish is removed because it can harbor bacteria, and jewelry that traps debris or interferes with gloves is left off. Cuts and abrasions on the hands are covered with a bandage and gloves. A cosmetologist who has a contagious illness does not work on clients.

Standard Precautions are guidelines published by the Centers for Disease Control and Prevention (CDC) that require the employer and employee to assume that all human blood and body fluids are potentially infectious. Because many infected people are asymptomatic (showing no signs of infection), the same protective measures (hand washing, gloves, safe handling of sharps, and disinfection) are used with every client. The older term Universal Precautions expressed the same principle for blood. An exposure incident is contact with broken skin, blood, body fluid, or other potentially infectious material that occurs during the performance of work duties.

The steps below follow the blood exposure procedure published by the National-Interstate Council of State Boards of Cosmetology for an injury to the client. The service stops first, gloves go on before the wound or any contaminated item is touched, and the hands are washed after the gloves come off.

State rules add detail to this sequence and govern in practice. Many states require blood-contaminated disposables to be double-bagged or placed in a container marked with the biohazard symbol. Bleeding is controlled by having the client apply pressure with clean cotton or gauze. Styptic, where permitted, is a liquid or powder on a single-use applicator, never a shared pencil. Contaminated blades go into a sharps container. Implements that contacted blood are cleaned and then fully immersed in an EPA-registered disinfectant effective against HIV and HBV, or in a tuberculocidal product.

Federal agencies set guidelines for the manufacture, sale, and use of equipment and chemicals and for workplace safety; state agencies regulate licensing, enforcement, and conduct in the salon. OSHA, part of the U.S. Department of Labor, sets and enforces standards that protect employees. The EPA registers every disinfectant sold in the United States and approves its label claims. State regulatory agencies, including the state board of cosmetology and the health department, issue licenses, write infection control rules, inspect salons, investigate complaints, and discipline licensees through fines, suspension, or revocation.

The Hazard Communication Standard, sometimes called the right-to-know law, requires that employees be informed about the hazardous chemicals they handle, including disinfectants, permanent wave solutions, haircolor and lighteners, and nail product solvents. Manufacturers must evaluate the hazards of their products and supply a Safety Data Sheet (SDS), formerly the Material Safety Data Sheet, for each one. The employer keeps a current SDS for every hazardous product, makes the sheets readily accessible during every shift, keeps containers labeled, and trains employees to read labels and SDSs, to handle products safely, and to respond to an exposure or spill.

A manufacturer’s label under the standard shows the product identifier, a signal word, hazard statements, pictograms, precautionary statements, and the supplier’s name, address, and telephone number. The signal word Danger marks the more severe hazards and Warning the less severe. The original label stays intact on the original container. When a product is transferred to a secondary container, such as a spray bottle of disinfectant, that container is labeled with the product identity and its hazards. On the SDS, Section 4 gives first aid and Section 8 names the protective equipment required.

The Bloodborne Pathogens Standard applies wherever employees can reasonably be expected to contact blood. It calls for a written exposure control plan, protective equipment, puncture-resistant sharps containers, employee training, and an offer of the hepatitis B vaccination at no cost to every employee with occupational exposure to blood. Personal protective equipment (PPE) such as gloves, safety glasses, aprons, and masks is selected by the employer after a hazard assessment and, with limited exceptions, is supplied at no cost to the employee. Gloves are single-use: they are changed between clients and whenever torn, and the hands are washed after removal.

Safety glasses or goggles are worn whenever a chemical could splash, as when mixing disinfectant or lightener. Ventilation is the primary control for vapors and dust; a dust mask does not filter chemical vapors. OSHA’s General Duty Clause requires every employer to keep the workplace free of recognized hazards likely to cause death or serious physical harm, even where no specific standard exists. Every employer must report a work-related fatality within 8 hours and an inpatient hospitalization, amputation, or loss of an eye within 24 hours. OSHA may inspect a workplace and issue citations.

Workstations, chairs, and counters are cleaned and disinfected between clients; shampoo bowls are cleaned after each use, and drains are kept clear of hair. Hair is swept up after every haircut and placed in a closed waste container, and floors are mopped with disinfectant at closing. Restrooms are cleaned daily and stocked with liquid soap and disposable towels. Waste containers are kept covered and emptied before they overflow. Adequate ventilation removes chemical vapors that irritate the respiratory tract.

Musculoskeletal injury is the remaining workplace hazard. No specific OSHA ergonomics standard exists, so repetitive-motion and posture hazards fall under the General Duty Clause. Risk is reduced by adjusting the height of the hydraulic chair, keeping the wrists in a neutral position, distributing weight evenly on both feet, using anti-fatigue mats and ergonomically designed tools, and changing position and stretching through the day. Tool-specific ergonomics are covered in Chapter 7.