This document discusses sterilization, disinfection and safety practices in medical spas. It defines sterilization as destroying all microbes, while disinfection eliminates many but not all. It recommends single-use, disposable items and sterilizing reusable items between clients. Methods of sterilization discussed include dry heat, chemicals, ethylene oxide gas and autoclaves. Safe practices like handwashing and proper sharps disposal are also covered. Finally, Texas state regulations regarding approved disinfectants and their use are presented.

1. Sterilization, Disinfection and
Safety in the Medical Spa
In this module you will learn:
 The difference between sterilization and disinfection.
 Different methods of sterilization
 The Blood borne Pathogens Act (OSHA)
 Identify safe practices in the spa or clinic

2. Lesson Objectives
This course is designed as a 1-hour internet-based
course which focuses on – sanitation, cleanliness, and the
safety of the salon and/or spa setting. In greater detail,
this proposed course focuses on (1) the definition of
sanitation and the various levels of decontamination; as
well as the discussion of pathogens, micro-organisms,
and disease-causing elements; and (2) regulations
regarding material safety data, the Environmental
Protection Agency, the Occupational Safety & Health
Administration; and Texas Board of Cosmetology.

3. Course Goals
• To educate course participants about the various forms of
decontamination and sanitation, and to encourage participants to
implement sanitation procedures at all times.
• To discuss in greater detail pathogens, germs, and disease-causing
organisms.
• To inform course participants regarding safety measures in the salon
or spa setting, and to encourage a proactive approach to safety
measures.
• To discuss laws and regulations that may be enforced by State
Boards of Cosmetology; as well as Federal Agencies and
Administrations (such as OSHA and EPA).
• To provide a checklist that may assist beauty professionals in regard
to using “best practices” regarding safety and sanitation.
• To serve as a refresher regarding sanitation basic principles, and to
remind course participants to keep up with current laws and
legislation (regarding salon sanitation and safety).

4. In the spa or clinical setting, strict sterilization and disinfection
technique is important not only for the clients, but for the
practitioners own protection.
Every client should be treated as though they might have some viral
or bacterial infection. Most items used in the clinical setting
therefore should be one time use and disposable including: 4x4’s,
gloves, razors, tongue blades etc.

5. Disinfection vs. Sterilization
There is a distinct difference between disinfection and
sterilization.
Sterilization is the destruction of all forms of microbial life by heat,
chemical sterilant, or gas.
Disinfection is the process that eliminates many disease producing
micro-organisms on inanimate objects, with the exception of bacterial
spores.

6. If using equipment that can be reused such as metal
implements or laser tips or guides, and laser eye wear.
These need to be sterilized between each client. Also
beds, tables, counter tops, and anything that is used by
the practitioner during the day needs to be wiped down
with sterilization wipes. These wipes are sold at medical
supplies and /or beauty supply.
Each state has different rules for sanitation techniques in
the spa. Check with your state governing agency for more
information. Other recommendations and guidelines can
be found under OSHA (Occupational and Health
Association) and CDC (Centers for Disease Control)

7. Methods of Sterilization and Disinfection
Dry Heat: Dry heat is a method of sterilizing objects in a temperature range of
320 to 338 degrees. This is commonly used due to low initial cost of equipment.
The cleaning cycle takes about 1-2 hours. This method is not recommended for
soft items.
Liquid sterilants/disinfectants: These are substances that are regulated by the
Environmental Protection agency and the Food and Drug Administration, that kill
or retard the growth of a variety of bacterial spores, fungi, mycobacterium,
tuberculosis, and viruses.
** All products in the office have to have a MSDS sheet
(Material Safety Data Sheet) this describes how to use
product, safety precautions, if harmful to humans and what to
do in case of contact with substance.

8. Methods of Sterilization and Disinfection - continued
Ethylene oxide gas: These are gas sterilizers that use low temperature (100-
300 degrees F), low humidity (40-60%), 8- 10 pounds per square inch, but
take anywhere from 2 to 6 hours to reach high level sterilization.
Autoclave: Saturated steam is another method for sterilizing objects with
moist heat. Am autoclave is a strong, airtight metal vessel with varying
chamber sizes. The temperature goes as high as 250-273degrees F. Cycle
times are from 9- 20 minutes. This is popular in many places as the cycle time
is fast, which is important in a fast paced, busy spa.
Autoclave

9. Safe Practices in the Spa Environment
All spas and clinics need to enforce protocols for safe sanitation
practices within the clinic environment. This is for protection of the
client, protection for the practitioner, as well as preventing
transmission of occupational transmission of disease.
These practices need to be enforced in the clinic and include:
• No eating or drinking, smoking, applying cosmetics or handling of contact
lenses in the work area.
• Employees must wash their hands in between patients, after using bathroom,
after eating, and after taking off protective gloves.
• Employees must wear protective gloves when working with a client and
performing a procedure.
• Equipment which might have become contaminated needs to be wiped down
and decontaminated with a solution that kills bacteria spores as well as other
pathogens.
• Clean all areas thoroughly before putting a laser on a client’s skin.
• A sharps container needs to be in the treatment room for disposal of all sharp
objects including: needles, razors, lancets and anything that can penetrate the
skin that comes in contact with bodily fluids.

10. State of Texas Rules:
83.100. Health and Safety Definitions. (New section effective March 1, 2006, 31
TexReg 1280; amended effective August 1, 2006, 31 TexReg 5952; amended
effective January 1, 2008, 32 TexReg 9970; amended effective February 17,
2012, 37 TexReg 681; amended effective July 1, 2014, 39 TexReg 4650)
The following words and terms, when used in this chapter, shall have the following
meanings, unless the context clearly indicates otherwise.
(1) Chlorine bleach solutions--A chemical used to destroy bacteria and to disinfect
implements and non-porous surfaces; solution should be mixed fresh at least once
per day. As used in this chapter, chlorine bleach solutions fall into three categories
based on concentration and exposure time:
(A) Low level disinfection (100 - 200 ppm)--Add two teaspoons
household (5.25%) bleach to one gallon water. Soak 10 minutes
minimum.
(B) High level disinfection (1,000 ppm)--Add one-third (1/3) cup
household (5.25%) bleach to one gallon water. Soak 20 minutes
minimum.
(C) Blood and body fluid cleanup and disinfection (5,000 ppm)—
Add one and three-quarters (1 3/4) cups household (5.25%)
bleach to one gallon water. Also referred to as a 10% bleach solution.

11. State of Texas Rules - continued
(2) Clean or cleansing--Washing with liquid soap and water, detergent,
antiseptics, or other adequate methods to remove all visible debris or residue.
Cleansing is not disinfection.
(3) Disinfect or disinfection--The use of chemicals to destroy pathogens on
implements and other hard, non-porous surfaces to render an item safe for
handling, use, and disposal.
(4) Disinfectant--In this chapter, one of the following department-approved
chemicals:
(A) an EPA-registered bactericidal, fungicidal, and virucidal
disinfectant used in accordance with the manufacturer’s
instructions; or
(B) a chlorine bleach solution used in accordance with this
chapter.
(5) EPA-registered bactericidal, fungicidal, and virucidal disinfectant--When used
according to manufacturer’s instructions, a chemical that is a low-level
disinfectant used to destroy bacteria and to disinfect implements and non-porous
surfaces.

12. State of Texas Rules - continued
(6) Multi-use items--Items constructed of hard materials with smooth
surfaces such as metal, glass, or plastic typically for use on more than one
client. The term includes but is not limited to such items as clippers,
scissors, combs, nippers, tweezers, and some nails files.
(7) Single-use items--Porous items made or constructed of cloth, wood, or
other absorbent materials having rough surfaces usually intended for single
use including but not limited to such items as tissues, orangewood sticks,
cotton balls, thread, surgical tape, extension pads, some buffer blocks, and
gauze.
(8) Sterilize or sterilization--To eliminate all forms of bacteria or other
microorganisms by use of an autoclave or dry heat sterilizer.
(9) Sanitize or sanitization--To reduce the number of microorganisms to a
safe level by use of an ultraviolet sanitizer.

13. State of Texas Rules - continued
83.101. Health and Safety Standards--Department-Approved Disinfectants.
(New section effective March 1, 2006, 31 TexReg 1280; amended effective
August 1, 2006, 31 TexReg 5952; amended effective July 1, 2014, 39 TexReg
4650)
(a) EPA-registered bactericidal, fungicidal, and virucidal disinfectants shall be
used as follows:
(1) Implements and surfaces shall first be thoroughly cleaned of
all visible debris prior to disinfection. EPA-registered bactericidal,
fungicidal, and virucidal disinfectants become inactivated and
ineffective when visibly contaminated with debris, hair, dirt and
particulates.
(2) Some disinfectants may be sprayed on the instruments, tools,
or equipment to be disinfected.
(3) Disinfectants in which implements are to be immersed shall be
prepared fresh daily or more often if solution becomes diluted or
soiled. 5) These chemicals are harsh and may affect the long term
use of scissors and other sharp objects. Therefore, the department
recommends leaving items in solution in accordance with the
manufacturers’ recommendation for effective disinfection.

14. State of Texas Rules - continued
(b) Chlorine bleach solutions shall be used as follows:
(1) Chlorine bleach at the appropriate concentration is an
effective disinfectant for all purposes in a salon.
(2) Chlorine bleach solutions shall be mixed daily.
(3) Chlorine bleach shall be kept in a closed covered container
and not exposed to sunlight.
(4) Chlorine bleach may affect the long-term use of scissors and
other sharp objects so the department does not recommend
leaving items in bleach solution beyond 2 minutes for effective
disinfection, (5 minutes if disinfecting for blood contamination).
(5) Chlorine bleach vapors might react with vapors from other
chemicals. Therefore chlorine bleach shall not be placed or
stored near other chemicals used in salons (i.e. acrylic
monomers, alcohol, or other disinfecting products) or near
flame.
(6) Used or soiled chlorine bleach solution shall be properly
disposed of each day.

15. State of Texas Rules - continued
83.102. Health and Safety Standards--General Requirements. (New section
effective March 1, 2006, 31 TexReg 1280; amended effective August 1, 2006, 31
TexReg 5952; amended effective February 17, 2012, 37 TexReg 681)
(a) All cosmetology establishments and licensees shall utilize clean and disinfected
equipment, tools, implements, and supplies in accordance with this chapter, and shall
employ good hygiene habits while providing cosmetology services.
(b) A licensee may not perform services on a client if the licensee has reason to
believe the client has a contagious condition such as head lice, nits, ringworm,
conjunctivitis; or inflamed, infected, broken, raised or swollen skin or nail tissue; or an
open wound or sore in the area to be serviced
(c) Multi-use equipment, implements, tools or materials not addressed in this chapter
shall be cleaned and disinfected before use on each client. Except as otherwise
provided in this chapter, chairs and dryers do not need to be disinfected prior to use
for each client.

16. State of Texas Rules - continued
(d) Single-use equipment, implements, tools or porous items not addressed in this
rule shall be discarded after use on a single client.
(e) Electrical equipment that cannot be immersed in liquid shall be wiped clean and
disinfected prior to each use on a client.
(f) All clean and disinfected implements and materials when not in use shall be
stored in a clean, dry, debris free environment including but not limited to drawers,
cases, tool belts, rolling trays, or hung from hooks.
They must be stored separate from soiled implements and materials.
(g) Ultraviolet electrical sanitizers are permissible for use as a dry storage container.
(h) Non-cosmetology related supplies must be stored in separate drawers or
locations.
(i) All trash containers must be emptied daily and kept clean by washing or using
plastic liners.

17. State of Texas Rules - continued
(j) Hand washing facilities, including hot and cold running water must be
provided for employees.
(k) Clean towels shall be used on each client. Towels must be washed in
hot water and chlorine bleach.
(l) Soiled towels shall be removed after use on each client and deposited in
a suitable receptacle.
(m) Each cosmetology establishment shall keep all products used in the
conduct of their business properly labeled in compliance with OSHA
requirements. (n) Hair cutting and shampoo capes shall be kept clean.

18. State of Texas Rules - continued
83.104. Health and Safety Standards--Esthetician Services. (New section
effective March 1, 2006, 31 TexReg 1280; amended
effective August 1, 2006, 31 TexReg 5952; amended effective February 17,
2012, 37 TexReg 681)
(a) Cosmetologists and estheticians shall wash their hands with soap and water,
or use a liquid hand sanitizer, prior to performing any services on a client.
Gloves shall be worn during any type of extraction.
(b) Equipment, implements, tools and materials shall be properly cleaned and
disinfected after servicing each client in accordance to this rule.
(c) Facial chairs and beds, including headrest for each, shall be cleaned and
disinfected after providing service to each client. The chair shall be made of or
covered in a material that can be disinfected.
(d) After each client, multiple use implements such as metal tweezers and
comedone extractors shall be cleaned and disinfected.

19. State of Texas Rules - continued
(e) The following implements are single-use items and shall be discarded in a trash
receptacle after use: cotton pads, cotton balls, gauze, wooden applicators,
disposable gloves, tissues, thread, disposable wipes, lancets, fabric strips and other
items used for a similar purpose as one or more of the items listed above.
(f) The following items that are used during services shall be replaced with clean
items for each client: disposable and terry cloth towels, hair caps, headbands,
brushes, gowns, makeup brushes, spatulas that contact skin or products from multi-
use containers, sponges and other items used for a similar purpose as one or more
of the items listed above.
(g) Items subject to possible cross contamination such as creams, cosmetics,
astringents, lotions, removers, waxes, moisturizers, masks, oils and other
preparations shall be used in a manner so as not to contaminate the remaining
product. Applicators shall not be re-dipped in product. Permitted procedures to
avoid cross contamination are:
(1) Disposing of the remaining product before beginning services on each
client; or
(2) Using a single-use disposable implement to apply product and
disposing of such implement after use; or
(3) Using an applicator bottle to apply the product.

20. State of Texas Rules - continued
83.111. Health and Safety Standards--Blood and Body Fluids. (New section
effective March 1, 2006, 31 TexReg 1280)
(a) Blood can carry many pathogens. For this reason licensees should never touch a
client’s open sore or wound. Powdered alum, styptic powder, or a cyanoacrylate (e.g.
liquid-type bandage) may be used to contract the skin to stop minor bleeding, and
should be applied to the open area with a disposable cotton tipped instrument that is
immediately discarded after application.
(b) In the case of blood or body fluid contact on any surface area such as a table,
chair, or the floor, an EPA registered hospital grade disinfectant, a tuberculocidal
disinfectant, or a 10% bleach solution (one-and-three quarters (1 ¾) cups of
household (5.25%) bleach to one gallon of water) shall be used per manufacturer’s
instructions immediately to clean up all visible blood or body fluids.
(c) If any non-porous instrument is contacted with blood or body fluid, it shall be
immediately cleaned and disinfected using an EPA-registered hospital grade
disinfectant, a tuberculocidal disinfectant in accordance with the manufacturer’s
instructions, or totally immersed in a 10% bleach solution (one-and-three quarters (1
¾) cups of household (5.25%) bleach to one gallon of water) for 5 minutes.
(d) If any porous instrument contacts blood or body fluid, it shall be immediately

21. (c) If any non-porous instrument is contacted with blood or body fluid, it shall
be immediately cleaned and disinfected using an EPA-registered hospital
grade disinfectant, a tuberculocidal disinfectant in accordance with the
manufacturer’s instructions, or totally immersed in a 10% bleach solution
(one-and-three quarters (1 ¾) cups of household (5.25%) bleach to one
gallon of water) for 5 minutes.
(d) If any porous instrument contacts blood or body fluid, it shall be
immediately double-bagged and discarded in a closed trash container or
biohazard box.
State of Texas Rules - continued

22. Personal Protective Equipment: (PPE)
Personal protective equipment must be worn when exposure to a bloodborne
pathogen is a possibility. An employer is required to provide and ensure that an
employee uses appropriate personal protective equipment when there is a risk of
occupational exposure.
“Appropriate PPE means that the equipment does not permit blood or other
potentially infectious materials to pass through or reach the employees work
clothes, street clothes, undergarments, hands eyes or other mucous
membranes”
PPE includes gloves, facemasks, fluid resistant gowns, and eye protection. All
PPE must be removed upon completion of a procedure and before leaving the
work area.
***Note: Be aware of allergies to Latex when
picking gloves. Latex is rubber derived from
petroleum. Latex also breaks down when
exposed to creams and oils.
Vinyl gloves would be the better choice, so you
have none of the issues described.

23. OSHA (Occupational Safety and Health Act) Blood Borne Pathogens:
OSHA was created within the U.S. Department of labor to encourage employers to
implement safer work and health practices in an effort to reduce on the job hazards.
The ACT also requires development and implementation of training programs to
ensure the safety of every man or woman in the workplace.
OSHA formed the blood borne pathogen act in 1992 to protect mainly against risk of
exposure to the Hepatitis B Virus. It involved Hepatitis B Vaccinations offered to
employees who are at greater risk of exposure to the disease.
This is definitely would include healthcare workers.
This included universal precautions. This is the name for the Center for Disease
Control’s recommended policy for workers regarding blood and body fluids. The
general rule is to wear gloves at all times for protection.
HIV and HBV and other infectious diseases are spread by direct contact through skin
or mucous membranes. Pre existing lesions on hands or from injuries incurred at the
workplace, at home or from dermatitis may provide a route of entry.
The Act requires all employers to assure that the workplace is maintained in a clean
and sanitary condition. The employer must provide methods of decontamination.

24. Safety in the Work Environment
Besides pathogens OSHA has other safety requirements. These requirements must
be met. I an OSHA inspector comes in and sees that a business is not in
compliance they can be fined and ordered to stop treatments until compliance is
met.
Safety precautions in the work place Include:
• Keep flammable materials at a distance from machines(lasers etc.)
• Repair frayed plugs and cords
• If using lasers, warning signs must be on doors of treatment rooms with class 4
laser on the sign
• Eye protection and gloves must be worn with all procedures.
• Know where emergency shutoff buttons are
• Take keys out of lasers when not in use.
• No liquids on top of equipment.
• Clean and sanitize all surfaces at the end of the day.
• Fire extinguishers must be nearby treatment room in case of fire.
• It is a good idea to unplug equipment at the end of the day. In case of storms
and power surges.
• Have ice packs available for burns

25. Safety - continued
If an eye injury occurs, quick action can prevent a permanent disability.
For this reason:
• Emergency eyewashes should be placed in all hazardous areas
• First-aid instructions should be posted close to potential danger spots
• Employees must know where the closest eyewash station is and how
to get there with restricted vision

26. Safety - continued
***According to the American National Standard for Safe Use of Lasers in Health
Care (ANSI Z136.3), the employer must provide a safety program that includes
employee training for class 3B and class 4 lasers and laser systems.
The following are 10 steps that can help you develop a medical laser safety program
that complies with the laser safety standard. This list is not intended to be
comprehensive.
1. Appoint a Laser Safety Officer (LSO) and define roles and responsibilities of the
LSO per the ANSI Z136.3 standard for the Safe Use of Lasers in Health Care.
2. Train the LSO. According to the ANSI Z136.3 standard, the employer shall provide
training on the potential hazards and controls of medical laser systems.
3. Write the laser safety policy statement and develop the details of the Laser Safety
Program.
4. Take an inventory of all class 3B and class 4 lasers.

27. 5. Identify which lasers are current on their Preventive Maintenance (PM) and which
lasers are compliant with the Food and Drug Administration’s Center for Devices and
Radiological Health (CDRH) federal requirements. If the lasers are not compliant with
the CDRH, contact the manufacturer.
6. Perform a laser hazard assessment of each operating room. Follow the ANSI Z136.3
for Safe Use of Lasers in Health Care standard and the Association of Peri Operative
Registered Nurse’s (AORN) recommended practices.
7. Evaluate, document and control non-beam hazards such as laser generated air
contaminants due to laser plume.(resurfacing lasers must be accompanied by a smoke
extractor)
8. Write standard operating procedures and maintenance procedures for all laser
systems. Implement control measures for the control of beam and non-beam hazards.
9. Authorize laser personnel and implement training commensurate to the degree of
hazard.
10. Audit the program to make sure the laser safety program is effective and the
controls and standard operating procedures for the hazards are working to keep people
safe.