AEA Infection Prevention Standards
Infection prevention standards for the practice of electrology
Safety standards adopted by the American Electrology Association
Infection Prevention Committee
Lori G. Goldenberg, CPE
871 Ethan Allen Hwy Ste 101
Ridgefield, CT 06877-2811
The American Electrology Association's Infection Prevention Standards for the Practice of Electrology were chosen primarily for their acknowledged importance to infection prevention. Some standards are based on well-documented epidemiologic studies, while others are based on a reasonable theoretical rationale. Advanced research studies and theoretical rationale are continually revealing pertinent information relevant to these standards; therefore, revisions and additions will be made as necessary. The Standards are consistent with Standard Precautions for infection prevention as recommended by the Centers for Disease Control and Prevention (CDC). Standard Precautions synthesize the major features of Universal (Blood and Body Fluid) Precautions (designed to reduce the risk of transmission of blood-borne pathogens) and Body Substance Isolation (designed to reduce the risk of transmission of pathogens from moist body substances). Standard Precautions apply to (1) blood; (2) all body fluids, secretions, and excretions, regardless of whether they contain visible blood; (3) non-intact skin; and (4) mucous membranes. Standard Precautions are designed to reduce the risk of transmission of both recognized and unrecognized sources of infection. The Standards have been developed for use by electrologists and electrology instructors and emphasize the need 1) to consider all clients as potentially infectious 2) to adhere to infection prevention precautions for minimizing the risk of exposure to blood or body fluids of all clients, and 3) to reduce the risk of transmission of infection and disease from client to client, practitioner to client, and client to practitioner. Voluntary compliance with these standards in the absence of state regulations is encouraged. Adherence to the Standards will assist electrologists and electrology instructors to develop appropriate infection prevention practices, to develop a practical aseptic conscience, and to promote awareness for sanitary measures. State boards regulating the practice of electrology are encouraged to consider adoption of the Standards, and professional associations should promote members' voluntary compliance with the Standards. Both state boards and professional associations are encouraged to present continuing education seminars, lectures, and literature reviews to assist practitioners and instructors in developing a knowledge base on infection prevention and client safety, thereby protecting the public and the practitioner.
OBJECTIVES FOR PREVENTION MEASURES AND STANDARDS OF PRACTICE
The American Electrology Association's Infection Prevention Standards will assist and encourage the practitioner to:
- Develop a knowledge base of infection prevention and client safety.
- Develop a practical aseptic conscience.
- Maintain a state of cleanliness to minimize the transmission of microorganisms.
- Demonstrate expert skills in cleaning and sterilizing reusable instruments and disposal of used needles.
- Make sound professional judgments and decisions.
- Provide high quality client care.
- Participate in continuing education.
- Foster ongoing quality improvement of client care.
DEFINITION OF TERMS
For the purpose of these Standards, the following definitions are used:
alcohol-based hand rub
The alcohol-containing preparation designed for application to the hands for reducing the number of viable microorganisms on the hands. In the United States, such preparations usually contain 60%-95% ethanol or isopropanol. Formulations include foams, gels and liquid rinses. These products do not remove soil, but can be used for hand-antisepsis.
A germicide used on skin or living tissue to inhibit or destroy microorganisms. Antiseptic products are not appropriate in any instance for use in cleaning or disinfecting inanimate objects. Antiseptics are regulated by the Food and Drug Administration (FDA).
A set of specific practices used before, during and after a procedure to protect against the spread of pathogenic microorganisms. Examples of aseptic technique are appropriately timed handwashing, decontamination of inanimate surfaces and instruments, appropriate use of personal protective clothing or barriers, proper containment and disposal of waste, and consistent instrument manipulations which minimize cross contamination and reduce the electrologist's risk of exposure to pathogens.
autoclave (steam sterilizer)
A device used for sterilization by application of saturated steam under pressure and heat. Autoclaves are regulated by the FDA.
A commercially prepared device with a known population of highly resistant bacterial spores used to test the method of sterilization being monitored. The biological indicator (BI) is used to demonstrate that conditions necessary to achieve sterilization were met during the cycle being monitored. Biological indicators are regulated by the FDA.
A commercially prepared device used to monitor all or part of the physical conditions of a heat sterilization process by means of a characteristic color change, usually chemically treated paper strips. A chemical indicator does not indicate that sterilization has been achieved, and most indicate only that the temperature needed has been attained. Other types of chemical indicator are capable of "integrating" time at a particular temperature before color change. Chemical indicators are regulated by the FDA.
The removal of visible soil (e.g., organic and inorganic material) from objects and surfaces and is accomplished manually or mechanically using water with detergents or enzymatic products. Thorough cleaning is an absolute must prior to disinfection and sterilization procedures.
A condition of being soiled, stained, touched, or otherwise exposed to harmful agents, making an object potentially unsafe for use as intended or without barrier techniques. An example is entry of infectious or toxic materials into a previously clean or sterile environment.
To advise against or indicate the possible danger of a drug or treatment.
The instruments or objects that come in direct contact with the bloodstream or other normally sterile areas of the body. Critical items must be either pre-sterilized, single use, and disposable or subjected to sterilization before use.
Use of physical or chemical means to remove, inactivate, or destroy pathogens on a surface or item so that they are no longer capable of transmitting infectious particles and the surface or item is rendered safe for handling, use, or disposal.
A chemical agent used on hard inanimate surfaces and objects to destroy or irreversibly inactivate infectious fungi and bacteria but not necessarily their spores. Chemical disinfectants are classified as "high-level," "intermediate-level," and "low-level" according to their comparative levels of potency and intended uses, but not as a final step in reprocessing of instruments.
A process that eliminates many or all pathogenic micro-organisms, except bacterial spores, on inanimate objects.
The disinfection process that inactivates some, but not necessarily all, bacterial spores. High-level disinfection is the minimum treatment recommended by the CDC in guidelines for the reprocessing of semi-critical instruments or devices. Examples of high-level disinfectants include glutaraldehyde, chlorine dioxide-, hydrogen peroxide, orthophthalaldehyde-, and peracetic acid-based formulations. These are commercially available germicides that have been cleared by the FDA as sterilants/disinfectants (all but one product to date) or simply as "high-level disinfectants."
A disinfection process capableof killing M. tuberculosis var. bovis, but not bacterial spores. When using a process that kills M. tuberculosis var. bovis, you will also inactivate organisms with a lesser degree of intrinsic resistance, such as most vegetative bacteria and fungi as well as viruses such as hepatitis B virus (HBV) and HIV. Examples of intermediate-level disinfectants include alcohols (70 to 90% ethanol or isopropanol), chlorine compounds (free chlorine, i.e., hypochlorus acids derived from sodium or calcium hypochlorite), and certain phenolic or iodophor preparations, depending on formulation. Intermediate-level disinfectants are regulated by EPA.
A process capable of inactivating most bacteria, some viruses and fungi but not bacterial spores or Mycobacterium tuberculosis var. bovis. Examples of low-level disinfectants are quaternary ammonium compounds and certain iodophors or phenolics. Like intermediate-level products, low-level disinfectants are regulated by EPA and are appropriate for disinfecting environmental or medical equipment (non-instrument) surfaces.
dry heat sterilizer
A forced air oven-type device specifically designed to sterilize items by exposure to high temperatures for designated exposure periods. Dry heat sterilizers are regulated by the FDA.
Destruction of living tissue in the hair follicle, by means of an electric current applied with a solid needle-shaped electrode. Techniques utilizing various applications of electrolysis, thermolysis,and blended currents provide permanent hair removal. The procedure of electrology is also known as electrolysis and electroepilation.
Surfaces in the treatment room, which may contribute to crosscontamination by hands of the electrologist, or by contact with instruments that will subsequently come into contact with clients. These surfaces should be properly maintained to minimize their potential role in disease transmission. A low-level disinfectant is used to clean environmental surfaces.
The solution that helps break down organic soils and fats, and suspends particles during cleaning. An enzyme detergent is used as a soaking solution for critical, semi-critical, and noncritical instruments and as the detergent used in the ultrasonic device. Temperature and dilution affect the efficacy of enzyme detergents.
Insulated plastic covered cords used to complete current circuit between the epilator and the epilator needle or the indifferent electrode. Epilator cords are non-critical items. Either imtermediate-level or low-level disinfectants can be used to clean the cords.
The instrument or "tweezer" used in electrology treatments to extract the hair from the follicle. Forceps used in electrology may come in contact with blood, serum or other material and should be sterile when used. They should be treated as critical items.
Coverings for the hands made of various materials, which provide a protective barrier against infections and toxic substances. There are three types of gloves that can be used by electrologists:
- examination gloves are non-sterile, medical grade, disposable patient examination gloves, made of natural rubber latex or synthetic material, are worn during electrology treatments and during cleaning procedures to provide a barrier to prevent exposure to potentially infectious materials and other contaminants. Medical grade gloves are regulated by the FDA.
- food-handler gloves may be worn as a protective disposable barrier over exam gloves during treatment interruption to prevent contamination from touching objects such as drawer and doorknobs, phone receivers, computer keyboards, or pens and charts. These gloves are discarded after each use.
- cleaning and other non-medical gloves are general purpose, heavy-duty, reusable, puncture resistant utility gloves (e.g., rubber household) that may be used for housekeeping chores such as instrument cleaning and decontamination procedures that involve potential contact with blood. These gloves are washed and dried between each use and should be labeled for use by one individual. They should be discarded when showing evidence of deterioration. Utility gloves are not promoted for medical use; therefore, are not regulated by the FDA.
The general term that applies to:
- Handwashing - The decontamination process for the removal of soil and transient microorganisms from the hands by a vigorous rubbing together of all surfaces of lathered hands for at least 15 seconds, followed by rinsing under a stream of water.
- Antiseptic handwash - Washing hands with water and soap or other detergents containing an antiseptic agent.
- Antiseptic hand rub - Applying an antiseptic hand rub product, (e.g. alcohol-based hand rub) to all surfaces of the hands to reduce the number of microorganisms present.
A chemical germicide with label claims for effectiveness against Salmonella choleraesuis, Staphylococcus aureus and Pseudomonas aeruginosa. Hospital disinfectants may be classified as either intermediate-level or low-level in their spectrum of activity as indicated by label claims. These classes of germicides are regulated by EPA and are appropriate for environmental or medical device surfaces but not as a final step in reprocessing of medical instruments.
The stainless steel bar held by the client during electrology treatments to complete current circuit with galvanic/electrolysis modality or with the use of a timer delay switch in automatic delivery epilators. Indifferent electrodes are non-critical items.
Tools or devices designed to perform a specific function, such as grasping, holding, or retracting.
Healthy skin in which the natural protective barrier has no breaks, scrapes cuts, abnormal openings, infection or signs of trauma that allow pathogens to enter.
A systemic or local allergic response to various latex proteins to which the individual has been sensitized.
Monitoring devices built into a sterilizer, such as indicating thermometers, recording thermometers, pressure gauges and automatic controls, which are used to assist in identifying and preventing malfunctions and operational errors and for recordkeeping purposes.
The solid wire filament or electrode inserted into the hair follicle for application of current during electrology procedures. Needles used in electrology are not intended to be critical items, but may come in contact with blood, serum or other material; therefore they should be purchased as pre-sterilized and disposable for one-time use. Needles should be treated as critical items.
Instruments or environmental surfaces that will come in contact only with intact skin. If properly cleaned and maintained, these surfaces carry relatively little risk of transmitting infection directly or indirectly to clients.
Areas of the skin that have been opened by cuts, abrasions, dermatitis, acne or other causes which would allow bloodborne pathogens to enter the body.
Materials used to contain instruments for sterilization, such as woven or non-woven wraps, paper or film pouches or rigid container systems.
A microorganism or substance capable of producing a disease.
Rollers and phoresis applicators made of stainless steel are used to apply current to skin before or after an electrology treatment. This item is considered semi-critical and should be sterilized or exposed to high-level disinfectant.
A detergent-based cleanser without antimicrobial additives used for the primary purpose of physical removal of dirt and transient microorganisms. Soap is used in handwashing to suspend microorganisms and allows them to be rinsed off.
protective disposable barriers
A disposable, moisture-resistant covering, which reduces the potential for contaminating environmental or medical device surfaces that may be difficult or inconvenient to clean and disinfect routinely, e.g., tables and pillows, or hard-to-clean surfaces such as light handles and epilator surfaces.
The activity of cleaning, disinfecting or sterilizing a contaminated instrument to make it safe for its intended use.
Instruments that may come in contact with mucous membranes and non-intact skin, but do not ordinarily penetrate body surfaces. Semi-critical items require sterilization.
A specially manufactured and labeled, leak-proof, rigid, puncture resistant, durable plastic container into which needles are placed after use and designed to be disposed of as an item of regulated medical waste.
sterility assurance file
The record containing the sterilizer maintenance and use log and culture report from each biological indicator.
The process which destroys all forms of microbial life. The recommended methods of sterilization of instruments and items used in the practice of electrology are the dry heat sterilizer or the autoclave. These methods are standardized and can be routinely monitored for effectiveness.
tips for epilator needle
The plastic cap holding the base of the needle in place and covering the pin device on the needle cord. Tips for epilator needle holder are considered non-critical items, but may come in contact with blood, therefore the first steps of reprocessing includes soaking and cleaning. Heat sensitive tips are white and after initial cleaning are exposed to an intermediate-level disinfectant before reuse. Heat stable tips are black and can be cleaned, packaged, and sterilized with the forceps before reuse.
The operatory where electrology treatments are performed.
The processing unit using ultrasonic waves transmitted through the cleaning solution in a mechanical process known as cavitation. The sound waves produce tiny air bubbles on instrument surfaces, which scrub tightly adhering or embedded particles from solid surfaces. Ultrasonic cleaning is particularly effective in removing soil deposits from hard-to-reach areas.
Overview of Standards of Practice
Electrology is a procedure using a needle done through a hair follicle in the skin, therefore, standards have been developed for client safety. Electrology procedures do not routinely penetrate to sterile tissue although there are occasions where the needle may become contaminated with blood, serum or other material. For this reason, all needles used in electrology procedures should be single-use, pre-sterilized, and disposable. Other procedures, such as removing ingrown hair, result in blood contamination of instruments and can, therefore, contaminate related surfaces. All reusable instruments, including forceps, are sterilized using a standard method that can be routinely monitored for effectiveness (e.g., dry heat sterilizer or autoclave). The intended use of other items used during treatment will dictate whether or not sterilization is needed, or if disinfection is needed, which level of disinfection is appropriate. A thorough cleaning of instruments and other surfaces must precede either sterilization or disinfection procedures. Instruments that do not encounter blood or sterile tissue during use do not routinely require sterilization. During treatment of each client and during reprocessing of instruments gloves are worn. A proper hygienic environment should be maintained and infection prevention procedures followed to minimize the risk of transmission of infectious diseases between the practitioner and the client. An overview of standards based on these issues and principles are described as follows.
Prevention Methods and Standards of Practice
- Section 1: Hand Hygiene and Use of Gloves
- Section 2: Decontaminating Electrology Instruments and Other Related Items
- Section 3: Environmental Control and Housekeeping
- Section 4: Client Considerations
- Section 5: Hepatitis B Virus (HBV) Vaccination and Hepatitis C Information
- Section 6: Procedures for Potential Exposures to Hepatitis, HIV, and Other Blood-borne Pathogens
- Section 7: Standard Precautions as Recommended by the Centers for Disease Control and Prevention
Hand Hygiene and Use of Gloves
Prevention Measures for Hand Hygiene
Hand Hygiene is considered one of the most important procedures for preventing the transmission of infection. Hand transfer can be a significant mode of transmission of bacteria and viruses from person to person, from person to surface or vice versa.
Handwashing uses plain or non-antimicrobial soaps, which are detergent-based cleansers that have no bactericidal activity. Washing with plain soap will accomplish a physical removal of soil and microorganisms by mechanical action. The cleaning activity of plain (non-antimicrobial) soap can be attributed to its detergent properties, which result in the removal of dirt, soil, and various organic substances from the hands. Handwashing with plain soap can remove loosely adherent transient flora. Wash hands with warm water, not hot water, because repeated exposure to hot water may increase the risk of dermatitis. Residual moisture on hands after handwashing has been found to play an important role in the transfer of bacteria and viruses, so a longer duration of hand drying will result in fewer bacteria transferring to other surfaces. Handwashing products can become contaminated and support the growth of microorganisms, so adding soap to a partially empty soap dispenser can lead to bacterial contamination of soap; therefore, liquid products are to be stored in closed containers and dispensed from either disposable containers or containers that are washed and dried thoroughly before refilling.
Hand antisepsis uses antimicrobial soaps or alcohol-based hand rubs, containing ingredients, which will kill or inhibit microorganisms on the skin.
According to the CDC Guideline for Hand Hygiene in Health-Care Settings alcohol-based products are more effective for standard hand hygiene by health-care-workers (HCW) than soaps. The antimicrobial activity of alcohols can be attributed to their ability to denature proteins. Alcohol solutions containing 60% to 95% alcohol are most effective, and higher concentrations are less potent. The ideal volume of product to apply to the hands is not known and may vary for different formulations. However, if hands feel dry after rubbing hands together for 10-15 seconds, an insufficient volume of product likely was applied. Alcohols are not appropriate for use when hands are visibly dirty or contaminated with body fluids or visible blood products. After 5 to 10 uses of alcohol-based products, handwashing with soap and water is needed to remove a build-up of emollients. Since alcohols are flammable, it is important to rub hands together after application of alcohol-based products until all the alcohol has evaporated. Use containers that will minimize evaporation.
When selecting products for hand hygiene, solicit information from manufacturers regarding any known interactions between products used to clean hands and the types of gloves used. In addition, follow the manufacturer's recommendations regarding the volume of product to use for both hand soaps and alcohol-based hand rubs.
Standards of Practice for Hand Hygiene
Hand Hygiene is considered one of the most important procedures for preventing the transmission of infection.
- Hands are cleansed by washing with plain liquid soap and water or degermed by hand antisepsis with alcohol-based hand rubs (if hands are not visibly soiled):
- Before and after treatment of each client.
- Before donning gloves and immediately after gloves are removed.
- Hands are washed thoroughly with soap and water:
- When visibly soiled; and
- Immediately if bare-handed contact with blood, body fluids, secretions, excretions, non-intact skin, mucous membranes or contaminated equipment occurs.
- Handwashing technique with plain soap and water includes:
- Wetting hands with running water and applying liquid soap in the amount recommended by the manufacturer;
- Vigorously rubbing hands together for 15 to 30 seconds, covering all surfaces of hands, especially between fingers and fingernail areas;
- Rinsing hands thoroughly under a stream of water;
- Drying hands thoroughly with a clean disposable paper towel;
- Turning faucets off with the paper towel; and
- Disposing of the paper towel in the appropriate covered receptacle located in the treatment room.
- Hand antisepsis, achieved by using alcohol-based antiseptic hand rubs includes:
- Applying the product label recommended amount of alcohol gel or rinse to the palm of one hand;
- Vigorously rubbing hands together, covering all surfaces of hands, especially between fingers and fingernail areas;
- Continue rubbing hands together for 15 to 25 seconds until the alcohol dries.
- Hands are cleansed by washing with plain liquid soap and water or degermed by hand antisepsis with alcohol-based hand rubs (if hands are not visibly soiled):
- Use of Gloves
- Gloves are worn during hand-contaminating activities:
- A fresh pair of non-sterile, medical grade, latex, nitrile or vinyl disposable examination gloves are worn during the treatment of each client or when contact with blood or other potentially infectious materials, mucous membranes, and non-intact skin could occur.
- Exam or utility gloves are worn during the procedures of soaking, cleaning, rinsing, drying and packaging of forceps and other contaminated instruments.
- Decontaminate hands in accordance with the above Hand Hygiene Standards before putting on gloves and immediately after gloves are removed.
- When a treatment session is interrupted:
- Use a protective disposable barrier; or
- Remove and discard gloves; and
- Decontaminate hands before touching items or surfaces (i.e., telephone, computer, door knobs); then
- Decontaminate hands before re-gloving with a fresh pair of gloves before resuming treatment.
- Torn or perforated gloves are removed immediately; hands are decontaminated then re-gloved with fresh gloves.
- After each treatment gloves are removed and disposed of in the appropriate receptacle located in the treatment room and hands are immediately decontaminated.
- Gloves are worn during hand-contaminating activities:
Prevention Measures for Use of Gloves
Electrology is a practice which uses a needle procedure through the skin, which can result in direct contact with blood, and nonintact skin; therefore, the electrologist wears a fresh pair of medical grade disposable examination gloves during each client encounter. The CDC has recommended that HCW's wear gloves to 1) reduce the risk of personnel acquiring infections from clients 2) prevent health-care worker flora from being transmitted to clients and 3) reduce transient contamination of the hands of personnel by flora that can be transmitted from one client to another. The Occupational Safety and Health Administration (OSHA) mandate that gloves be worn during all client-care activities that may involve exposure to blood or body fluids.
Gloves are worn in addition to and not as a substitute for hand hygiene practices. When gloves are worn, hand hygiene practices are also recommended because gloves do not provide complete protection against hand contamination. The consistent wearing of gloves will decrease the risk of potential exposure. OSHA prohibits washing or decontaminating disposable (single use) exam gloves for reuse. In addition, the use of petroleum-based hand lotions or creams may adversely affect the integrity of latex gloves. The consistent wearing of gloves will decrease the risk of potential exposure. Wearing gloves will also protect the client from potential exposure to the microbial flora of the electrologist, including bloodborne organisms should there be cuts, scrapes, or micro-lesions on the electrologist's hands. Torn or perforated gloves should be removed immediately and hands washed after gloves are removed because pathogens can gain access to the electrologist's hands via small defects in gloves or by contamination of the hands during glove removal. Determine electrologist and client allergies before wearing latex gloves. Several factors have been linked with latex sensitization, including the presence of allergic conditions (e.g., asthma, eczema, hay fever), allergy to cosmetic powders or foods, and frequency or duration of glove use/exposure. The FDA has approved several powdered and powder-free latex gloves with reduced protein contents, as well as synthetic gloves that can be made available for those electrologists who are latex-sensitive.
Standards of Practice for Use of Gloves
Decontaminating Electrology Instruments and Other Related Items
Prevention Measures for Use and Disposal of Needles
Do not overfill the sharps container. When the sharps container is 75% full, seal it securely and follow state and local health regulations for disposal.
Standards of Practice for Needles
- Needles are:
- Single-use, pre-sterilized, and disposable.
- Stored in a manner that will maintain sterile condition of contents, away from wetness or humidity extremes.
- Not recapped, bent, or otherwise manipulated by hand prior to disposal to avoid accidental puncture injury.
- Placed in a puncture resistant sharps container:
- Immediately after use.
- When opened and found damaged.
- When contaminated before use.
- When not used before pre-printed expiration date.
- Needles are:
- Treatment Related Items
- Indifferent electrodes, cords for epilator and eye shields are:
- Cleaned, dried and subjected to intermediate-level disinfection before initial use and after each treatment.
- Replaced when showing signs of wear and tear.
- Ultrasonic cleaning units and all other containers and their removable parts used during soaking and cleaning procedures are:
- Cleaned and dried daily.
- Used and maintained according to manufacturer's instructions.
- Environmental surfaces directly related to treatment are cleaned and subjected to intermediate-level or low-level disinfection daily and whenever visibly contaminated.
- Forceps, phoresis applicators/rollers and tips are:
- Processed before initial use and after use on the client to make safe for use during the next client encounter.
- After a 24-hour period when packaging is opened and instruments are unused.
- When contaminated before use, (e.g., dropped or placed on surface not protected by barrier).
- Processing protocols for forceps, phoresis rollers and tips. Instruments and items are:
- Accumulated in a covered holding container by submersion in a solution of a protein-dissolving enzyme detergent and water, following manufacturer's instructions for dilution, rinsed and drained.
- Instruments and items are then placed in the basket of a covered ultrasonic cleaning unit containing a fresh solution, of a protein-dissolving enzyme detergent, following manufacturer's instructions for dilution and ultrasonic running times.
- Basket is removed from ultrasonic unit, rinsed under running water, drained and items are air dried on a clean, disposable, absorbent, non-shedding cloth in an area protected from exposure to contaminants.
- Forceps, phoresis rollers and heat-stable tips are packaged individually or in small multiples as required for one client encounter. Packaging for the sterilization process includes woven or non-woven wraps, paper or film pouches, or rigid container systems.
- Packaged instruments and items are placed in an autoclave or dry heat sterilizer with chemical indicator, loading and running the sterilizer according to manufacturer's instructions. If dry heat sterilizers are used, heat-sensitive tips are subjected to an intermediate-level disinfectant, rinsed and dried.
- After processing, instruments and items are stored in a clean, dry, covered container, drawer or closed cabinet, which prevents the contents from coming into contact with dust, moisture, unnecessary touching and soil.
- Indifferent electrodes, cords for epilator and eye shields are:
- Methods of sterilization:
- Dry heat. The following time-temperature relation ships are recommended:
- 340°F (170°C) for 1 hour.
- 320°F (160°C) for 2 hours.
- Autoclave (steam under pressure). The following time-temperature relationship is recommended:
- 15-20 minutes at 250°F (121°C) and 15 psi (pounds per square inch) for packaged instruments and items.
- Follow the sterilizer manufacturer's instructions for the unit you have if times and temperatures differ from those given.
- Dry heat. The following time-temperature relation ships are recommended:
- Use of sterilizers:
- The temperature and exposure time for using dry heat sterilizers and autoclaves relates only to the time of exposure after attainment of the specific temperature and does not include a penetration or heat-up lag time. Exposure time does not include drying and cool down time.
- Sterilizers should have visible physical indicators (e.g., thermometers, timers). Visually check sterilizer gauges during the cycle.
- Sterilizers should be loaded, operated and maintained according to manufacturer's instructions. The interior of these devices should be cleaned according to the manufacturer's instructions.
- Use sterilizers that are regulated by the FDA.
- Chemical (i.e., color change) indicators should be used on each package, and optionally, placed inside packages containing multiple instruments. Chemical indicators should be visible on the outside of each package sterilized and indicates that instruments/items have been exposed to a sterilization process, but it does not guarantee sterility.
- Biological indicators should be used no less than once a month (per sterilizer) according to manufacturer's instructions to ensure proper mechanical function of the sterilizer. Lab reports should be filed in a permanent Sterility Assurance file.
- Packaging for sterilization:
- When choosing package material, consider size, shape and number of instruments to be sterilized.
- The package material should be able to withstand the physical conditions of the selected sterilization process.
- There should be enough space between items in packaging for sterilization of all surfaces to occur.
- Follow manufacturer's recommendations for spacing of packaged items in the sterilizer.
- After sterilization, the package material should:
- Provide a barrier to microorganisms;
- Repel all liquids;
- Protect sterilized item during normal handling; and
- Provide for aseptic removal of contents.
- Methods of sterilization:
Prevention Measures for Cleaning
Cleaning is the basic first step for all decontamination because it physically removes debris and reduces the number of microorganisms present. Cleaning is the removal of organic material or soil from objects and is normally done by using detergent and water. Generally, cleaning is designed to remove rather than kill microorganisms. Immediate decontamination of instruments after use is an important step in providing protection to the electrologist and to help prevent the transmission of pathogens.
Technology has provided cleaning products and devices that are especially appropriate for the cleaning of instruments used in electrology. Enzyme detergents and ultrasonic cleaning units are examples of appropriate devices used to clean electrology instruments and items. The use of an ultrasonic cleaning unit will reduce the electrologist's risk for exposure to puncture injuries that can occur during the scrubbing of instruments. A meticulous physical cleaning is always done before disinfection or sterilization.
Prevention Measures for Disinfecting
Chemical disinfectants are regulated either by the Food and Drug Administration (FDA) for medical instrument uses or the Environmental Protection Agency (EPA) for environmental surface uses. Intended uses and directions for use are found both on the labels of the products and/or in package inserts. Material Safety and Data Sheets (MSDS) for each product are available from the manufacturer.
Disinfectant products are divided into two major types: hospital and general use. Hospital type disinfectants are the most critical to infection prevention and are used on medical and dental instruments, floors, walls, bed linens, toilet seats, and other surfaces. General disinfectants are the major source of products used in households, swimming pools, and water purifiers.
Non-critical equipment and environmental surfaces are cleaned and then treated with either intermediate-level, or lowlevel disinfectants. Intermediate-level kills mycobacteria, most viruses, and bacteria with a chemical germicide registered as a "tuberculocide" by the EPA. Low-level disinfection kills some viruses and bacteria with a chemical germicide registered as a hospital disinfectant by the EPA.
Standards of Practice for Decontaminating Electrology Instruments and Other Related Items
Coordinate necessary sterilized instruments and supplies needed for each treatment in a manner whereby adherence to aseptic technique is maintained with minimal modes and sources of contamination. Wear gloves when handling soiled instruments. Caution should be taken to avoid puncture injuries from instruments.
Prevention Measures for Sterilizing
Instruments that can penetrate soft tissue during electrology procedures are the needle and forceps. To assure the highest level of client safety, needles should be pre-sterilized, and disposable. Forceps should be thoroughly cleaned and sterilized before initial use and after use on each client to reduce the risk of transmission of infection and disease. While tips are considered non-critical items, they may come in contact with blood during a treatment. For this reason, they should be processed in the same manner as forceps. All tips tolerate autoclave sterilization; if dry heat sterilization is used, electrologists are encouraged to use heat-stable tips.
Do Not Use:
The glass bead sterilizer should not be used in the practice of electrology since it is no longer cleared to market by the FDA. The FDA Panel has stated that the glass bead sterilizer presents "a potential unreasonable risk of illness or injury to the patient because the device may fail to sterilize dental instruments adequately."
Some high-level disinfectants, including glutaraldehyde-based germicides, are not recommended as an applicable method of sterilization of instruments and items, based on their toxicity level, instability, and impracticality. Sterilization with liquid chemical germicides is not capable of being biologically monitored. If an electrology device is heat-stable, the proper method of reprocessing is by using a heat-based method such as a steam autoclave or dry air oven.
Carbon rollers for phoresis are porous and cannot be sterilized or disinfected; therefore, they should not be used.
Household bleach is not labeled for disinfecting instruments.
Standards of Practice for Sterilization
Environmental Control and Housekeeping
Prevention Measures for Environmental Control and Housekeeping
Hospital-grade disinfectants registered with the EPA should be used for environmental surface cleaning. Product labels give the EPA registration number and should give adequate safety and precautionary information. Manufacturer's instructions on the use of the product should be followed. Information on specific manufacturer label claims and the classification of disinfectants can be obtained by writing the Anti-Microbial Division, EPA 751OC, Office of Pesticides Programs, 401 M Street SW, Washington, DC 20460. http://www.epa.gov/. Environmental surfaces are "non-critical" and may be divided into at least two major subdivisions according to decreasing risk of disease transmission: (1) medical equipment surfaces such as frequently touched epilator surfaces, magnifying lamps, epilator carts, and (2) housekeeping surfaces such as floors, walls, door knobs, tabletops, and window sills. Adequate levels of safety for surfaces of electrology equipment (non-critical surfaces) may be achieved by simple washing or scrubbing with detergent and warm water or, depending on the equipment surface and the nature and degree of contamination, cleaning followed by an application of an intermediate to low-level chemical germicide. Follow manufacturer's instructions for application and exposure times of disinfectant products. Cleaning schedules and methods vary according to the type of surface to be cleaned and the amount and type of soil present. Countertops should be of smooth, nonporous material and should be cleaned daily, taking special care in the areas where the procedures of cleaning and sterilizing instruments and items takes place. Items on countertops should be maintained in a sanitary manner. Sinks and toilet facilities should be cleaned daily. Non-critical equipment, environmental surfaces, doorknobs, telephones, and treatment tables in the treatment room should be cleaned and disinfected on a regular basis. Floors and carpets should be vacuumed and cleaned regularly. Walls, blinds and curtains should be cleaned when visibly soiled.
Standards of Practice for Environmental Control
A proper hygienic environment should be the goal of the electrologist and electrology instructor. A variety of microorganisms are normal contaminants of environmental surfaces; therefore, routine cleaning and removal of soil are recommended. Most microorganisms found on environmental surfaces are non-pathogens, but conscientious sanitation and disinfection techniques control cross-infection.
- Environmental Control
- Each treatment room:
- Is kept clean, well lighted, and well ventilated.
- Contains a sink with hot and cold running water.
- Contains disposable paper towels and an appropriate handwashing product adjacent to the sink.
- Contains covered storage for supplies.
- Contains a puncture resistant sharps container labeled as a biohazard.
- Contains covered trash containers.
- Has availability to toilet facilities with sink, liquid hand soap and disposable paper towels.
- Treatment table surfaces are:
- Made of materials that can be washed with detergents and treated with disinfectants.
- Covered with fresh disposable paper drapes or barrier before each client treatment in the following manner:
- Headrests are covered with fresh disposable paper drapes or barrier before each client treatment.
- When body areas are treated and bare skin may come in contact with the treatment table surface, the surface must be covered with an appropriate sized fresh disposable paper drape or barrier.
- Containers for dispensing products, such as liquid soap, alcohol hand-rubs, and treatment supplies are disposable or if reusable they are cleaned and dried before being filled with fresh product.
- When using creams, lotions, ointments and antiseptics during treatment:
- Follow aseptic techniques for dispensing products.
- Follow manufacturer's recommendations for use.
- Dispose of product and container when contaminated or expiration date is reached.
- Environmental surfaces that are touched during treatment, such as epilator needle holder, cords, epilator cart, magnification lamps, lighting devices and epilator controls are:
- Covered with a fresh protective disposable barrier before each treatment of a client; or
- Decontaminated after each treatment of a client, following manufacturer's instructions for use of product.
- Each treatment room:
- Disposable items such as cotton, paper drapes and protective barriers are
- Stored in covered containers, closed cabinets or drawers before use; and
- Discarded into a covered trash container lined with a plastic bag, securely fastened when ready for disposal, and disposed daily into the regular trash, unless otherwise specified by state and local health regulations
- Reusable items such as sheets, pillowcases and towels, used to cover treatment table or as a client drape are:
- Stored in covered containers, closed cabinets or drawers before use.
- Placed in a covered container, labeled as "soiled laundry" after use, and
- Laundered with detergent and water temperatures that will ensure adequate cleaning and thermal disinfection, and
- Dried completely in a gas or electric clothes dryer, at high temperatures.
Standards of Practice for Housekeeping
- An intermediate-level or low-level hospital-grade disinfectant registered with the Environmental Protection Agency (EPA) is used for cleaning non-critical environmental surfaces.
- All other environmental surfaces in the treatment room are kept in a state of visible cleanliness by:
- Cleaning with water and detergent, and
- Using a hospital-grade disinfectant/detergent designed for general housekeeping purposes as indicated on the product label.
Prevention Measures for Client Considerations
The general health status of the client may be a predisposing factor in susceptibility to infection and normal healing. Professional interpretations require careful observation and good judgment.
The client's skin should be examined for signs of infection or rashes prior to each treatment. Treatment should be delayed if actual or potential signs or symptoms of infection are present. The practitioner should refer the client to an appropriate physician when evaluation of health history or skin examination indicates.
Cleansing the skin with soap and water prior to treatment serves to physically remove dirt and contaminating microorganisms. Wiping with an antiseptic will help to inhibit or destroy microorganisms. An FDA regulated antiseptic should be chosen that does not cause irritation to the skin surface.
- Client Considerations
- Standard Precautions should be consistently used for all clients.
- During the initial consultation:
- An appropriate health history should be obtained from each client.
- Each client should be informed of the:
- Possible causes of hair growth.
- Physical and medical conditions, which may influence the outcome of electrolysis treatments.
- Possible side effects of treatments.
- Recommended post-treatment care.
- The client's health status and any contraindications to treatment should be evaluated upon each client visit. Contraindication to treatments may include any of the following:
- Signs of skin infection or trauma.
- Hair growth in moles.
- Immunosuppression disorders.
- Medical implants such as pacemakers, defibrillators, or artificial joints.
- Electrolysis treatment should be postponed when the electrologist or client suspects any contraindication is present. Referring the client to a physician is appropriate when suspected contraindications are observed.
- Pre and Post Treatment of Skin Site
- Before treatment, the skin site should be cleansed with a skin-cleansing product followed by an antiseptic skin preparation. Skin should be dry before proceeding with electrolysis treatments.
- After treatment, the skin site should be wiped with an antiseptic product or an astringent followed by a skin protectant product.
- Clients should be instructed on appropriate post-treatment care to promote healing of the treated skin site.
Prevention Measures for Pre and Post-Treatment of Skin Site
Skin cleansing products are used to remove make-up and other debris from the skin prior to electrolysis. Soap and water or an alternative skin-cleansing product is appropriate for pre-treatment skin cleansing.
Antiseptics are antimicrobial products, regulated by the FDA, and applied to the skin to reduce the possibility of infection. They slow or stop the growth of germs and help prevent infections in minor cuts, scrapes and burns. Antiseptics can irritate the skin; therefore they should be used sparingly. Some commonly used antiseptics are isopropyl alcohol (60-70%), hydrogen peroxide, benzalkonium chloride, essential oil of thyme and wintergreen, and witch hazel with 14% alcohol.
While astringents are not effective antiseptics, they are appropriate to use in post treatment.
Skin protectant products are over-the-counter products regulated by the FDA that temporarily protect injured skin or mucous membrane surfaces from harmful or annoying stimuli and may help provide relief to such surfaces. Many skin protectant products provide a cooling relief to the irritated skin site. This is done by temporarily protecting the injured skin and mucous membrane surfaces from harmful or annoying stimuli and helping provide discomfort relief to such surfaces. Skin protectant products will be labeled with the following statement: "Use helps protect minor cuts and burns."
Standards of Practice for Pre and Post Treatment of Skin Site
Hepatitis B Vaccination and Hepatitis C Information
Prevention Measures for Hepatitis B
The CDC states that health care workers may be at risk for hepatitis B virus (HBV) exposure if their tasks involve contact with blood or blood-contaminated body fluids; therefore, such workers should be vaccinated.
Risks among health care professionals vary during the training and working career, but are often highest during the professional training period.
For this reason, the student's vaccination for HBV should be completed before electrology training begins.
In 1986 the FDA approved a new recombinant hepatitis B vaccine. It consists of highly purified hepatitis B surface antigen (part of the virus) that is produced by cells of bakers' yeast. The vaccine is a result of a genetic recombinant technique and contains no human source materials; therefore, there is no risk of acquiring a disease from the vaccine.
Practitioners should contact their personal physician for appropriate immunization against hepatitis B.
Prevention Measures for Hepatitis C
The exposure method for hepatitis C is the same as hepatitis B, however there is no vaccination for HCV. The CDC has proposed expanded testing guidelines for hepatitis C because more than 75 percent of American adults with hepatitis C are baby boomers. Deaths from hepatitis C are on the rise, and as those with HCV age, they are likely to develop serious, life-threatening complications, unless those infections are diagnosed and treated.
Standard of Practice for Hepatitis B Virus (HBV) Vaccination
The Centers for Disease Control and Prevention (CDC) reports that HBV infection is a major infectious occupational hazard for health care workers. The risk of acquiring HBV infection from occupational exposures is dependent on the frequency of a needle through the skin and permucosal exposures to blood or blood products.
Practitioners and electrology students should be immunized against hepatitis B virus (HBV).
Procedures for Potential Exposures to Hepatitis, HIV, and Other Blood-borne Pathogens Prevention Measures for Potential Exposures
Careful clinical skills should be practiced and Standard Precautions followed to prevent puncture injury or mucous membrane exposure to blood. Proper management of exposures is necessary including first-aid measures, medical follow-up including collection and testing of blood of source person and exposed person, necessary prophylaxis and written documentation. In the event of exposure to blood and body fluids containing visible blood, the steps recommended in Section 6 should be followed.
Standard of Practice for Potential Exposures to Hepatitis, HIV, and Other Blood-borne Pathogens
Health care workers who have needle punctures through the skin or mucous membrane exposure to blood and other body fluids are at risk for infection, including HBV, HCV and HIV infection. The CDC concludes in a continuing study that, while HIV infection is a real risk to health care workers, the risk is low and can be minimized by taking appropriate precautions. Identified risk factors for HIV and HCV transmission are almost identical to those for HBV transmission. Despite the similarities in modes of transmission, the risk of HBV infection in health care settings far exceeds that for HIV or HCV infection.
The following steps should be taken when a puncture injury has occurred:
- Remove and discard gloves.
- Wash exposed surface with running water and soap. If wound is bleeding, allow to bleed. After thoroughly cleaning the wound, apply an antiseptic product.
- Immediate contact is made to practitioner's personal physician for appropriate consultation, and for necessary post-exposure strategies.
- Documentation of the exposure is made including:
- Date and time of exposure;
- Details of the procedure being performed, including where and how the exposure occurred;
- Details of the exposure, including the type and amount of fluid or material and the severity of the exposure (e.g., for a needle puncture through the skin and depth of injury; for a skin or mucous membrane exposure, the estimated volume of material and the condition of the skin);
- Details of the exposure source (e.g., whether the source material contained HBV, HCV, or HIV);
- Details about the exposed person (e.g., hepatitis B vaccination and vaccine-response status); and
- Details about counseling, post-exposure management and follow-up, date, route of exposure, circumstance under which exposure occurred, name of source client, HIV and/or hepatitis status of source client, status of practitioner's testing, follow-up testing and any necessary post-exposure prophylaxis.
Standard Precautions as Recommended by the Centers for Disease Control and Prevention (CDC) Prevention Measures
These precautions should be performed universally for all clients. Standard Precautions are intended to prevent parenteral, mucous membrane, and non-intact skin exposures of health-care workers to blood-borne pathogens. In addition, immunization with HBV vaccine is recommended as an important adjunct to Standard Precautions for health-care workers who have accidental exposures to blood.
Standard of Practice for Precautions During Electrology Procedures
The following Standard Precautions are appropriate for the care of all clients during electrology treatments:
- Wash hands or use hand antisepsis BEFORE and AFTER each client contact.
- Wear gloves when touching blood, body fluids, secretions, excretions, contaminated items, mucous membranes and non-intact skin.
- Take care to prevent puncture injuries when using instruments during and after procedures; when cleaning instruments; and when disposing of used needles.
- Use adequate procedures for routine care, cleaning, and disinfection of environmental surfaces, and other frequently touched surfaces.
- Follow appropriate sterile procedures with instruments used in the treatment of electrolysis
- Clean skin pre-and post-treatment with appropriate products to prevent infection.
Electrology procedures do not generate splashes or sprays of blood and body fluids; however, electrologists may choose to utilize the following:
- Wearing mask and eye protection or a face shield to protect mucous membranes of the eyes, nose and mouth during procedures and client care activities that are likely to generate splashes or sprays of blood and body fluids.
- Wearing gown to protect skin and prevent soiling of clothing during procedures that are likely to generate splashes or sprays of blood and body fluids. Remove soiled gown as promptly as possible and wash hands.
AORN, Inc. Journal "Recommended Practices for environmental cleaning in the surgical practice setting." February 1998. 3 November 2005. http://www.findarticles.com/p/articles/mi_m0FSL/is_n2_v67/ ai_20651299/print
AORN, Inc. Journal "Recommended practices for high-level disinfection," In Sandards, Recommended Practices, and Guidelines (Denver: AORN, Inc. March 1999) 3 November 2005. http://www.findarticles.com/p/ articles/mi_m0FSL/is_2_81/ai_n13470567/print
AORN, Inc. Journal "Recommended Practices for Selection and Use of Packaging Systems." Standards, Recommended Practices & Guidelines. December 2000. 3 November 2005. http://www.findarticles.com/p/ articles/mi_m0FSL/is_6_72/ai_68534733/print
AORN, Inc. Journal "Recommended practices for skin preparation of patients." January 2002. 3 November 2005. http://www.findarticles.com/p/articles/mi_m0FSL/is_1_75/ai_83664586/print
AORN, Inc. Journal "Recommended practices for sterilization in perioperative practice settings," in Standards, Recommended Practices, and Guidelines (Denver: AORN, Inc, 2003) 363. 3 November 2005. http://www.findarticles.com/p/articles/mi_m0FSL/is_2_70/ai_55525534/ print
CDC, DHQP Issues in Healthcare Settings. Sterilization or Disinfection of Medical Devices: General Principles 3 November 2005. http:// www.cdc.gov/ncidod/hip/sterile/sterilgp.htm
CDC. Guidelines for Environmental Infection Control in Health-Care Facilities: Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC). MMWR 2003;52(No.RR-10);1-42 3 November 2005. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5210a1.htm
CDC. Guideline for Hand Hygiene in Health-Care Settings: Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. MMWR 2002;51(No. RR-16):[3-34]. 3 November 2005. http://www.cdc.gov/mmwr/PDF/rr/rr5116.pdf
CDC. Garner JS, Hospital Infection Control Practices Advisory Commitee. Guideline for isolation precautions in hospitals. Infect Control Hosp Epidemiol 1996;17:53-80, and Am J Infect Control 1996;24:24-52. 3 November 2005. http://www.cdc.gov/ncidod/hip/ISOLAT/ISOLAT.HTM
CDC. Guidelines for Infection Control in Dental Health-Care Settings - 2003. MMWR 2003 (No. RR-17): [1-34] 3 November 2005. http:// www.cdc.gov/mmwr/preview/mmwrhtml/rr5217a1.htm
CDC. Guideline for infection control in health care personnel, 1998. Published simultaneously in AJIC: American Journal of Infection Control (1998;26:289-354) and Infection Control and Hospital Epidemiology (1998;19:407-63) 3 November 2005. http://www.apic.org/AM/ T e m p l a t e R e d i r e c t . c f m ? t e m p l a t e = / C M / ContentDisplay.cfm&ContentID=1146
CDC. National Institute for Occupational Safety and Health Glutaraldehyde Occupational Hazards in Hospitals Publication No. 2001-115 May 2001. 3 November 2005. http://www.cdc.gov/niosh/2001-115.html
CDC. Updated U.S. Public Health Service guidelines for the management of occupational exposures to HIV and recommendations for Postexposure Prophylaxis. MMWR 2005;54(No. RR-9) 3 November 2005. http://www.cdc.gov/mmwr/PDF/rr/rr5409.pdf
Favero, M.S. and Walter Bond. Chemical disinfection of medical and surgical materials, Chapter 43. In: S.S. Block (editor) Disinfection, Sterilization and Preservation. 5th ed. Philadelphia: Lippincott Williams & Wilkins. 2000.
Jones RD, Jampani H, Mulberry G, Rizer RL. Moisturizing alcohol hand gels for surgical hand preparation. AORN J 2000;71:584-99.
Korniewicz DM, Laughon BE, Butz A, Larson E. Integrity of vinyl and latex procedures gloves. Nurs Res 1989;38:144-6.
Larson, EL, APIC Guidelines Committee. APIC guideline for handwashing and hand antisepsis in health care settings. Am J Infect Control 1995;23:251-69
Rutala WA, APIC Guidelines Committee. APIC guideline for selection and use of disinfectants. Am J Infect Control 1996; Volume 24, No. 4:313- 42.
Taber's Cyclopedic Medical Dictionary (1997). Philadelphia, PA: F.A. Davis company, Edition 18.
U.S. Department of Labor, Occupational Safety & Health Administration. Bloodborne Pathogens Standards 29 CFR - 1910.1030. 3 November 2005.http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table= STANDARDS&p_id=10051
U.S. Department of Labor, Occupational Safety & Health Administration. Safety and Health Topics bloodborne Pathogens and Needlestick Prevention 3 November 2005. http://www.osha.gov/SLTC/ bloodbornepathogens/index.html
Hand Hygiene Section reviewed by: Elaine Larson, RN, PhD, FAAN, CIC Professor of Pharmaceutical and Therapeutic Research; Editor, American Journal of Infection Control, Columbia University School of Nursing, 630 W. 168th St., New York, NY 10032, 212-305-0723, FAX: 212- 305-0722.