Heather Bouyear

Discussing Guideline 2: Infection Control

Welcome to the second part of my series on the Consumer’s Guide to the Nail Industry. In this post I will discuss what actions nail salons are required to take to reduce your risk of infection, salon vs. hospital disinfection, what you can do to protect yourself, and some red flags for which to watch out.

Nail salons use various methods to reduce or eliminate cross contamination. Some to these methods are: using single-use items and disposing of them after the service, laundering all towels and fabrics between each use; cleaning and disinfecting tools and implements between each use; cleaning and disinfecting work surfaces or surfaces in contact with the client after each service; and cleaning common areas regularly. The aim is to prevent cross-contamination with the surfaces that touch you and maintain an overall clean environment that supports the methods they employ.

In a nail salon, the items that touch you are only intended to touch your healthy, unbroken skin and nails, therefore cleaning and disinfecting are sufficient in most states. In a hospital, the items that touch you may be intended to touch sterile tissue inside your body and must be sterilized. So, hospital infection control is on another level than that of salons. That being said, most salons are required to use disinfectant that is EPA registered with demonstrated bactericidal, virucidal and fungicidal properties.

Some Brief Education

There are two Decontamination methods, the first is cleaning and then disinfecting, the second is cleaning and then sterilizing. Refer to your state regulatory agency to learn which method your state requires. Most states including Oregon and Washington require the first method. Texas and a couple other states require the second one in salons.

These definitions are for illustration purposes; they come from the Milady textbook and not any regulatory agency. Check your agency for their definitions.

Cleaning is defined as a mechanical process (scrubbing) using soap and water or detergent and water to remove all visible debris and many disease-causing organisms.

Sanitizing is a chemical process for reducing the number of disease-causing germs on cleaned surfaces to a safe level.

Disinfection is a chemical process that uses specific products to destroy harmful organisms (except bacterial spores) on environmental surfaces.

Sterilization is the process that destroys all microbial life including spores.

People often think cleaning and sanitizing to be the same thing. With these definitions, they can occur at the same time, but one is the mechanical process and the other is the chemical one. It really depends on your Regulatory Agency’s definition.

What’s Your Part?

Check that your nail service provider’s license is current and in his/her name. This lets you know he/she has received education on infection control and has proven they know how to perform the steps. If you want to ask about their infection control process, feel free.

Hand washing reduces the amount of germs on your hands. Hands can be sanitized with spray or cleaned at the sink, but remember it only reduces the germs, is not possible to disinfect living tissue and we shouldn’t be applying disinfectants to living tissue as they are classified as pesticides. Your nail tech should direct you to wash your hands before every service and he/she should also do the same. Some states permit hand sanitizer in pumps or sprays.

Know how to cough or sneeze to contain the spread of germs. Never cough into your hand and then give that hand to your manicurist. In addition to exposing your tech to your germs, you now need to sanitize your hands and wetting your nail during a service may reduce adhesion of product. Instead, try to collect the germs by coughing or sneezing into your sleeve above the elbow if possible. Ask for a mask if this is too difficult. If the use of a tissue is necessary, your hands will need to be sanitized which may compromise your service. If you need constant access to tissues or have a fever, it’s a good indicator that you should re-schedule. If you or your service provider is sick, then rescheduling your appointment is in line with infection control procedures under state law.

State laws allow nail techs to work on intact skin and nails that appear healthy and normal. If you have circumstances that don’t quite meet the criteria such as broken skin, a rash, or suspect a bacterial or fungal infection, your nail tech should refer you for medical evaluation before providing services. The only real way to know if you have fungus or bacteria is to visit a doctor that can diagnose, treat and prescribe. Sometimes, doctor visits are a necessary part of caring for your nails. I will discuss this further in my post on why doctor referrals are a good thing.

Nail tech licenses do not permit diagnosing, performing treatment via services, or prescribing products for these medical issues. Nail techs follow state laws by declining services and asking you to seek medical evaluation for service advice, or medical clearance. It may seem extremely minor to you and very inconvenient, but it is still the duty of the nail tech to decline service and request you to get a medical evaluation when they deem it necessary according to their education, licensing and experience. The tech may have policy in place that includes a form for your doctor. This process protects you from services you should not receive and it protects other patrons from potential cross contamination.

When licensed nail techs insist on medical evals and clients follow through ensuring they are healthy enough to receive services or become healthy enough to receive services, we all participate in positive change for the nail industry and make a vital impact in preventing the spread of infections.

Real World Application of this Info

Application number one: Let’s go back to those definitions above for a moment, and see what actions you can take to protect yourself.

If a state’s regulatory agency requires the first disinfection method consisting of cleaning and disinfection and we know that disinfection cannot kill bacterial spores, what should you do to prepare for services?

First, do not seek services if you have broken skin, rash or an open wound on your arms, legs, hands, feet, fingers, or toes as they can be portals for germs. I know sometimes we feel everything will be fine and it’s not a big deal because it’s always been fine in the past, but it just takes that one time to regret a decision like that. There are some very nasty infections out there, protect yourself.

Second, do not remove hair from your legs for a minimum of 24 hours prior to a pedicure. The reason is that shaving creates micro-cuts in the skin and waxing separates hairs from their blood supply at the root resulting in tiny open wounds inside each hair’s follicle. These openings can become a gateway for a pathogen to enter your body.

Application number two: This time, let’s think about how you can use this knowledge to protect yourself from the nail tech’s actions. New Files vs. Re-Using Files

This issue polarizes nail techs, but ultimately it’s the consumer’s choice and you choose by speaking up or remaining silent. I’m not going to avoid my personal bias on this topic, but I’ll try to be as fair as I can.

Single use implements are items that cannot be disinfected and should be thrown away after the service. Some of these are cotton, cosmetic sponges, eye shadow applicator, sanding bands, toe-separators, orange wood sticks, wooden applicators, nail wipes, pedicure liners, lip applicators, eyelash separators, foam flip-flops, emery boards, nail files, and buffers.

Nail files and buffers are allowed to be re-used in some states, if the file manufacturer specifies they can be disinfected. If that file or buffer is exposed to open skin or a blood exposure (it cuts you) then it is required to be thrown away. To be considered disinfectable, the manufacturer must print the word “Disinfectable” onto the file or buffer. Printing “washable” is not sufficient.

Spraying droplets onto a surface such as a file cannot fully cover every part of that file’s surface area, it cannot penetrate the entire porous area, nor can it remain in wet contact for the full dwell time recommended by the disinfectant’s manufacturer. So, it isn’t entirely disinfected. Consumers deserve to know this fact so they can make informed choices.

What about fully immersing the files and buffers in disinfectant? It’s going to cover the surface area and remain wet long enough and should be disinfected. So, it’s a good idea to ask:

•             If they re-use files
•             If those files are printed with the word disinfectable
•             If they spray or immerse their files in disinfectant

PERSONAL BIAS: I personally want to use a new file every time because the grit is not worn down, I don’t have to worry about disinfection methods, it saves time, and if any cut should occur, the file was new and never exposed to another person.

It’s up to the you to inquire about nail files or ask for a brand new file and buffer if that is important to you.

Red Flags to Walk Away

• The floor has an unreasonable build-up or has a lot of nail clippings. Build-up of debris on the floor can be an indicator of poor cleaning habits. Look around and trust your gut.
• The workspace you are seated at has a dirty service towel or there are clippings or debris on the table from another client.
• The tech begins to push your cuticles or remove lifted pieces of product with his/her own fingernail. This is not a permitted practice.
• Your hand is placed in a soaking bowl containing cold, murky water. This is a sign that they may use this bowl of used water on everyone, which is not permitted.
• The disinfectant should be transparent and have a slight color of blue, pink, purple or whatever color the manufacturer chooses to dye it. It should not have any debris floating.
• The manicurist begins to use a sanding band or drill bit that has debris from a prior client.
• You ask for a new file and they pull another used one.
• An obviously dirty implement is about to be used on you: skin or debris on it. It must be cleaned removing all visible debris and disinfected. Don’t fall for just brushing it off or placing it in a UV sanitizer. Only cleaned and disinfected items can go into a UV sanitizer. It keeps clean items clean, but cannot render dirty items clean or disinfected.
• Their hands are dirty or they have an open wound that is not covered by a glove.
• They cough or sneeze in their hand and do not get up to wash or use sanitizer before resuming your service.
• They cut you and keep working. If you are cut, they must stop the service and follow state agency guidelines.
• The pedicurist does not disinfect the pedicure bowl according to state agency regulations after cleaning between each client.
• In pedicures, the use of cutting tools such as cheese-grater like foot files and callus removing razors are usually prohibited due to the high incidence of injury and infection risk associated with their use. The use of pumice is also prohibited due to its inability to be cleaned and disinfected.

For additional information consult the regulatory agency in your area. If you feel a salon or service provider is not following good habits, you can speak to them directly about the concern and they should clear it up. If that isn’t working, please report them to your state board regulatory agency so they can follow up and work to correct the behavior.

When people ask me what I do, and learn I’m a nail tech, they often ask me questions about the nail industry and I am concerned that some of the basic knowledge I take for granted is not commonly understood.

I created a list of basic guidelines I would personally follow or keep in mind if I were a consumer in the nail industry. I hope you find something useful. Some of these will be the topic of a more in-depth subsequent post, so check them out to see what the guideline conveys.

The Guidelines

1. Every individual nail tech must post their own, current license to perform services even if their employer carries the business license and shop license, so lookup the license and verify it is active.
2. Infection Control is regulated, spend a moment to recognize signs that this may be lacking.
3. A doctor referral is a good thing, really.
4. There is a distinct difference between beautification services and medical procedures.
5. Ask questions. Communication is a necessity.
6. Trust your gut.
7. Be a smart consumer and watch out for deceptive practices.
8. Report incidents and concerns to the correct agency or agencies when warranted.

This list may evolve, but it’s a good starting place.

Discussing Guideline 1

This covers areas whose governing bodies choose to regulate nail services.

Regulation is intended to provide a minimum level of safety to the public. Operator’s licenses are issued by the regulatory agency to individuals who have met the requirements for education, training, and exams usually by graduating from a nail course at a cosmetology school and then passing state board exams. This is the basic license each and every nail tech needs. It is separate from an individual’s independent contractor or freelance licenses, a shop’s facility license or a state, county and local business license. I’m primarily talking about the permission to perform nail services.

Locate your tech’s license posted in the salon. It should be in his/her name with a matching photo. Verification of licenses by name and number can be done on the regulatory agency’s website rather quickly on your smart phone or tablet. Please verify the license number goes to that name. I will touch more on this topic when I post on watching out for deceptive practices and be sure to view the list of red flags below.

Operator licenses in the nail industry can be for nails or cosmetology. While cosmetology licenses include nail services, check with your regulating agency to see if your state includes artificial enhancements in the nail tech or cosmetology category. Some states have a separate operator title that authorizes artificial enhancements.

Check with your local regulating agency if you want to learn more about licensing requirements or to learn what is permitted in your area. To locate your state’s regulating agency, perform an online search using the phrase “cosmetology regulation” and your State.

Red Flags to walk away:

• Only one operator license is posted and workers claim they all work under that person’s license
• When verifying a license online, the license number comes back to a different person’s name
• You notice two or more posted licenses have the same number
• Your service provider does not have a posted license and you cannot verify one online
• After looking up the operator license online, you discover it isn’t active anymore
• Lack of posted facility or business licenses or they are expired/no longer active
• Verifying licenses appears to cause chaos

Why is licensing important?

Learning anatomy, chemistry, infection control, state laws and rules, receiving instruction and mentored practice from school has tremendous value. Licensing allows us to be insured. Registering who we are, what we can do and where we work, as well as paying our license fees to help fund a regulatory agency, is in the public interest for consumer safety and professional accountability.

Additionally, when you make the effort to verify you only receive services from licensed nail professionals, you are ensuring that you are not unknowingly participating in human trafficking. Not every unlicensed person is a victim of human trafficking, but those that are victims are not able to tell you.