Guidelines for Personal Service Settings

The Ontario Ministry of Health has released a protocol specific to Personal Services Settings (PSSs) under the Infection Control Program of the Mandatory Health Programs and Services Guidelines. This protocol applies to any facility or person offering services where there is a risk of exposure to blood or bodily fluid, such as, but not limited to: hairdressing, barber shops, ear piercing, body piercing, scarification, branding, implants, tattoo studios, micro pigmentation, laser hair removal, electrolysis, acupuncture and various aesthetic services. This protocol has been developed to minimize the risk of contracting blood-borne infections for both Personal Service Workers (PSWs) and clients during the delivery of personal services. Exposure to blood or body fluids can lead to infection with blood-borne pathogens including Hepatitis B, Hepatitis C, human immunodeficiency virus (HIV) and other human retro viruses and skin infections. It is important to recognize that blood and body fluids do not have to be visible on the item/instrument or needle to result in infection and that microscopic cuts to the skin are not visible to the eye. Carriers of some diseases show no signs or symptoms, and some viruses can remain active outside of the body (on surfaces and instruments) for up to a week or longer. For obvious safety reasons, PSWs need to consider all clients as being potentially infected with blood-borne pathogens.

The following requirements comprise general minimum recommendations for all personal service facilities and equipment. Establishments or operators who offer personal services are subject to a minimum of one annual routine inspection. Further requirements specific to each area of practice are available from the North Bay & District Health Unit, Infectious Diseases Program, 474-1400.

General Minimum Requirements for
Equipment, Instruments and Supplies

1. Work surfaces including counter tops, trays, or other surfaces used by the PSW to place instruments and supplies upon during a personal service, shall have a smooth and impervious finish (easy to clean), and shall be cleaned and disinfected with an appropriate level disinfectant after each client.

Surfaces where instruments are placed during service as well as contact surfaces such as lamps and magnifiers can be sprayed and wiped with an environmental disinfectant between clients.
Soft plastic pouches, leather holsters or cases lined with textured materials should not be used to store items in because they cannot be adequately cleaned and disinfected (contaminated area).
If a towel is used to place instruments on during service, it must be replaced with a clean towel after every client.

2. The work areas shall be well lit to facilitate cleaning and prevention of injuries.

3. A permanently installed sink with potable hot and cold running water under pressure must be provide for cleaning of the establishment, equipment/instruments and hand washing, for all personal service settings. Dispensable soap and single-use disposable hand towels on a dispenser must be provided for hand washing. PSWs must wash hands between servicing clients and as necessary during servicing a client.

If using single use cloth towels, a laundry receptacle must be directly accessible to prevent re-using of towels.
High and medium risk establishments (invasive or potentially invasive services) must have sinks accessible in the work area. Low risk establishments (see page 3) must have conveniently located sinks. A public washroom sink is not acceptable.
The sink must be of an adequate size to accommodate the largest instrument/equipment to be cleaned.
An (>60%) alcohol based hand gel (with lotion added) can be used for hand hygiene in situations were sinks are not readily accessible (e.g. manicure and hair stylists stations, etc.). If hands are visibly soiled, washing with soap and water is a must prior to using any hand sanitizer.

4. The equipment and instruments used shall be of durable construction, maintained in good repair, and kept in a clean and sanitary condition (discard instruments which are cracked, chipped, rusted or corroded).

5. When a protective cover is used around a client’s neck, a sanitary neck strip or clean towel shall be used to keep the protective cover from coming in contact with the client’s neck.

6. Immediately after each use, every sheet and towel that contacts the client’s skin shall be deposited in a conveniently located receptacle (reserved for that purpose) and laundered prior to re-use. Disposable, single use, paper products must be discarded in an accessible covered trash bin (preferably foot controlled).

7. Clean linens, instruments, and supplies shall be stored in a manner that protects them from contamination.

8. When only a portion of a cosmetic preparation or other substance (e.g., cream, lotion , powder, lubricating jelly, ink, make-up, nail gel or powder, paraffin or depilatory wax, etc.) is used on a client, the portion to be used must be removed from the container in such a way that the remaining portion is not contaminated (no double-dipping). Use a clean disposable wooden blade every time or a separate container for each client (applies to wax rollers as well). “Hand dipping in hair gels, barrier creams, etc. is not permitted. All liner pencils require sharpening between clients. Clean and disinfect sharpeners as semi critical items after every use.

9. All equipment, instruments and supplies intended for single service use and those which cannot be cleaned and disinfected or sterilized adequately, shall be disposable (wooden items, disposable make-up applicators, paper and plastic coverings, cling film, “loofah” sponges, nail drill sanding tips, streaking caps, plastic needle tubes, etc.). These items must not be used on more than one person and must be discarded after each use or each client, depending on the use. Items, such as emery boards, buffers, and wooden cuticle pushers can be sold or given to the client for their personal use (when returning).

10. All re-usable equipment, instruments and supplies, which are, or may become contaminated, must be thoroughly cleaned and disinfected or sterilized after each use or as specified according to the classification as shown in Table A (critical, semi-critical, non-critical). Disinfection of instruments requires contact time (spray and wipe is not sufficient). Disinfection or sterilization cannot be achieved unless the instrument is cleaned first, with soap and a brush under running water, or an ultra-sonic cleaner (with lid on), to remove any dried organic matter. Non-critical items are to be cleaned daily or more frequently, as often as necessary to maintain them in a clean condition. If flesh is nipped, non-critical items become semi-critical (page 2).

Critical Items

Items that penetrate skin (are invasive by nature), mucous membranes, or contact broken skin (e.g., all needles, needle bars, probes, scalpels, single use, disposable razors, forceps/tweezers used for electrolysis- if removing in-grown hairs, parts of the piercing gun which contact the ear, etc.) require thorough cleaning followed by sterilization (destruction of all forms of microbial life).
The only acceptable methods of sterilization are an autoclave (which uses heat and steam under pressure) or a dry heat sterilizer. Glass bead and ultra-violet light units are not an acceptable form of sterilization.
Some equipment cannot be adequately cleaned (e.g., needles, razor blades, needle bars, etc.), and must be supplied sterile and discarded immediately after use in an approved “sharps” container. Lancets or needles must never be re-capped to lower risk of a needle stick injury to the worker (place directly in sharps container).
Styptic pencils must not be used (powder form is acceptable).
Piercing guns with disposable cartridges (or disposable parts which contact the ear) supplied sterile are exempt from sterilization. After piercing, all disposable parts are discarded and the gun must be thoroughly cleaned and disinfected (follow procedures detailed in ear piercing pamphlet).

Semi-Critical Items

Items that may potentially break skin (invasive by accident), that come into contact with mucous membranes or objects that are used to handle sterile items (e.g., instruments used for manicures and pedicures, piercing guns, cradle/handle of razors, forceps to handle items, tweezers, cosmetic applicators, foot and finger bowls, parts of laser equipment which contact the skin, sharpeners used for lip and eye liner pencils, re-usable items for waxing (e.g. metal spatula), crochet hooks used for highlights, scissors and clippers that have nipped flesh, etc.).
These items require thorough cleaning followed by sterilization (preferable).
At a minimum, thorough cleaning followed by intermediate level disinfection.
Items which inadvertently contact body fluids require thorough cleaning with soap and a brush under running water, followed by full immersion in a recognized disinfectant (for example: 70% to 90% isopropyl or ethyl alcohol, or 6% hydrogen peroxide, or 1% bleach dilution) for a least 10 minutes. The item is then allowed to air dry and then stored in a manner that protects it from contamination from other items (a clean covered container). “Barbicide” is not effective against viruses such as Hepatitis and should not be used to disinfect semi-critical items.

Non-Critical Items

Items that may come in direct contact but do not penetrate intact skin, or those that do not ordinarily touch the client (e.g., work surfaces, client chairs, equipment trays, brushes, combs, tanning beds, counter tops, light handles, scissors and clippers which do not nip flesh etc.).
Clippers used with a guard to prevent direct skin contact are considered non-critical and clippers used directly on the skin are considered semi-critical (if the skin is irritated or bleeding).
Only clean combs and brushes may be used on clients. If using “Barbicide” at your station clean the item after removing from the solution or clean the item before fully immersing it in fresh “Barbicide”.

Establishments may be further classified according to the service they provide. Establishments that offer a service, which penetrates skin, are high risk. Establishments in which direct contact with non-intact skin and exposure to blood and bodily fluids is possible are medium risk. Establishments in which contact with intact skin and exposure to blood and bodily fluids is accidental are low risk. It is important to recognize that when accidents involving blood and bodily fluids occur in low and medium risk establishments, the health risk increases, and appropriate action must be taken immediately.

High Risk Establishments

Includes tattooing, micro-pigmentation, body piercing, ear piercing, scarification, branding, etc. (i.e., skin penetration is part of the service).

All owners of personal service establishments shall keep client records for skin invasive procedures for a minimum of one year. The records should include: date of procedure, client name, address, and telephone number; procedure carried out; PSW and any relevant comments.
Verbal and written care instructions for piercing must be provided for the client.
Critical items (which penetrate skin) must be purchased sterile, or sterilized, and disposed of in an approved sharps container, immediately after single use. Objects such as needle bars are also single use, disposable items.
All owners of personal service establishments must keep receipts from approved biomedical waste disposal companies verifying disposal of sharps (needles, blades, etc.). Keep with logbook.
Single-use, disposable items (which are supplied sterile or sterilized) are recommended as they provide the highest assurance of sterility.
Re-usable items, which cannot be adequately sterilized or disinfected, must be covered with disposable covers, cling film, or bags (inks, spray bottle, clip or epilator chord, tattoo machine, etc.).
Before any invasive procedure is performed on a client, the skin must be cleaned with a recognized skin antiseptic, such as 70% isopropyl alcohol or 10% povidone iodine (Betadyne).
If items are re-useable, they require sterilization by autoclave or dry heat sterilizer between uses.
If a “chemi-clave”, or other form of chemical autoclave is used, proper ventilation to the exterior of the establishment is required.
Autoclaves or dry heat sterilizers must be regularly serviced and monitored as follows:

• Items in every load must be packaged to maintain sterility. Every load requires temperature sensitive tape either separate or incorporated on the packaging, which indicates by colour change that an adequate temperature has been reached.

• The autoclave or dry heat sterilizer must be challenged a minimum of once a month with a commercially available preparation of heat resistant spores (Bacillus stearothermophilus or Bacillus subtilis for dry heat sterilizers). Confirmed lab results must be kept in the logbook. Spore tests must be packaged when testing.

• A log of the monitoring information for each load should be maintained including: date, item(s), temperature, and/or pressure, cycle length and spore test results. Keep logbook on premises.

Medium Risk Establishments

Includes a procedure, which involves close skin contact. This can be found in establishments offering shaving of any part of the body (barbers, hair salons, and aesthetics), waxing, paraffin treatments, manicures, pedicures, extractions, tweezing, etc. Instruments may penetrate skin, or contact non-intact skin or mucous membranes. Sterilization of instruments used in medium risk establishments is always recommended, but cleaning and appropriate disinfection is accepted.
Some items used in these premises can be considered critical. Needles used for extractions or removing ingrown hairs, or blades used for body, face, and feet must be supplied sterile, single-use, and disposed of in an approved “sharps” container. Single-use, disposable items are strongly encouraged because they offer the highest assurance of sterility and many establishments in this category do not have the ability to sterilize instruments.
Good organization of the work area and clear separation of clean disinfected instruments from used ones is critical in these establishments. Place dirty instruments in a designated tub filled with freshly made soapy water or detergent immediately after service. Soaking them to loosen any dried organic matter will make cleaning and disinfecting of the instrument more efficient.

Low Risk Establishments

Includes tanning salons and hair salons (without aesthetic services) where razors are not used on the skin and any contact between instruments and the client occurs on intact skin.
In these premises, skin contact with potentially invasive instruments is not expected to occur.
If flesh is nipped from potentially invasive instruments including scissors and clippers, the instruments must be treated as semi-critical items (see page 2).

Some Points to Remember

This hand out covers the minimum general guidelines for Personal Services Settings required by the Ministry of Health. Under the Health Protection and Promotion Act, each health unit must ensure that the guidelines are in place, and the recommendations contained in it are followed.
Specific requirements for ear piercing are attached.
Specific after care information following a piercing procedure is attached.
Ear piercing guns must only be used to pierce the lobe of the ear.
Immediately after use, all re-usable invasive and potentially invasive (corn removers, cuticle pushers, nail files, credo-blade handles, nippers, closing clamps, needle tubes, etc.) must be placed in a puncture resistant container labeled “dirty instruments for sterilizing” (or disinfecting). This container must be filled with soapy water or detergent to prevent debris from drying on the surface of the instrument. Pre-soaking will facilitate cleaning and disinfection or sterilization. Ensure items are properly dried prior to ‘bagging’ for sterilization (spraying with alcohol is useful).
Materials used for cleaning equipment, such as nylon brushes and pads, should be disinfected after each cleaning session by soaking in a freshly prepared 1:99 household bleach solution (Appendix 1) or other approved disinfectant. When not in use they should be stored dry.
Workstations, drawers, and areas where items and instruments to be used on clients are kept must be well organized and clean to prevent cross-contamination from dirty items to clean items (e.g. do not throw clippers in drawer of clean items after using on client).
Hand washing is the most effective method of disease prevention and is required between clients and as necessary (breaks in treatment, after using the washroom, etc.).
If used, impervious, single-use gloves must be changed between clients and between breaks in treatment of the same client. A latex alternative is strongly suggested for staff and clients who have a latex allergy.
Establishments that require strong chemicals as part of the service (e.g. manicure and pedicure establishments, etc.) must have adequate ventilation.
All records, log books, biomedical waste disposal receipts and spore test results must be kept on premises for verification by the Public Health Department.
If an accidental exposure to blood or body fluid occurs put on gloves and wash the exposed area immediately. If the area is bleeding, allow it to bleed freely. After cleaning the wound, apply a skin antiseptic and cover with a sterile dressing. The person should contact their family doctor for assessment of the need to receive appropriate post exposure prophylaxis.
Surfaces that have become contaminated with blood or bodily fluids should be cleaned with soap and water and appropriately disinfected (e.g. 10% bleach for 5 minutes). Gloves and cloths used to wipe up blood spills should be placed in a plastic bag, and tied before being put in the garbage.
The PSW must ensure any part of the body to be treated is clean and free of any cuts, wounds, rash (nail) mould, fungus or visible skin disease prior to commencing service.

Developed by Christian Lapensée, City of Ottawa Public Health. Reproduced with permission by the North Bay Parry Sound District Health Unit, 681 Commercial Street, North Bay, ON P1B 4E7 (705) 474-1400.

Revised: 06/12/2008 bot="Timestamp" endspan i-checksum="12544"