Current through Vol. 41, No. 13, March 15, 2024
(a)
Purpose. These standards
have been developed for electrology students, licensed practicing
electrologists, and approved electrology instructors in Oklahoma. These
standards emphasize the need to consider all patient/clients as potentially
infectious, minimize the risk of exposure to blood or body fluids, reduce the
risk of transmitting infection or disease from patient/client to
patient/client, practitioner to patient/client, and patient/client to
practitioner.
(b)
Description. Electrology is a superficially invasive procedure,
which does not generate splashes or sprays of blood and body fluids. It is NOT
necessary to wear masks, eye protection, a face shield, or gowns while
practicing electrolysis. Electrolysis needles can become contaminated with
blood, serum, or other material because of the insertion of the needles into
the hair follicle and skin. All needles must be either single-use,
pre-sterilized, disposable needles OR be properly sterilized in an autoclave or
dry heat sterilizer according to the standards that follow. Any critical
instrument re-used between patient/clients must be sterilized and monitored,
for effectiveness, according to these standards. Each instrument or piece of
equipment must be properly disposed of, disinfected, or sterilized depending on
its use and contamination. Cleaning of surfaces, instruments, and equipment
must precede appropriate disinfection or sterilization. During the treatment, a
new pair of non-sterile, medical grade, disposable exam gloves must be worn by
the electrologist to reduce the risk of transmitting disease or infection
between the practitioner and the patient/client.
(c)
Blood-borne pathogens.
(1) The three blood-borne pathogens of great
concern to healthcare workers who could be at risk to blood and body fluids
containing visible blood are Hepatitis B virus (HBV), Hepatitis C virus (HCV),
and HIV/AIDS.
(2) HIV/AIDS is a
threat to healthcare workers, but not as much as Hepatitis B.
(3) Practitioners and electrology students
should be vaccinated against HBV.
(4) Risks among health care professionals
vary during the training and working career, but are often highest during the
training period. For this reason, vaccination should begin before starting
training and be completed during training. If the student refuses to be
vaccinated, they must sign a waiver before beginning training.
(5) The immunization regimen consists of
three doses of vaccine. The first dose is provided initially, followed at one
month and six months.
(6) Students
and non-immunized practicing electrologists should contact their personal
physician or the City/County Health Department for appropriate immunization
against hepatitis B.
(d)
Standards for hand washing. Hand washing is one of the most
important procedures for preventing the transmission of infections. Hand
washing accomplishes a physical removal of microorganisms and a chemical
inactivation of residual microorganisms on the surface of the skin. Fingers are
thought to be the most important part of the hand in terms of the transfer and
spread of pathogenic micro flora. Hand washing products can become contaminated
or support the growth of microorganisms. Liquid products should be stored in
closed containers and dispensed from either disposable containers or containers
that are washed and dried thoroughly before refilling.
(1) A sink with hot and cold running water is
located in each treatment room
(2)
Hands are cleansed with use of plain liquid soap and water or degermed by hand
sanitizers using 60% - 70 % alcohol-based hand rubs (if hands are not visibly
soiled):
(A) Before and after treatment of
each patient/client
(B) Before
donning gloves and immediately after gloves are removed
(3) Hands are thoroughly washed with liquid
soap and water:
(A) When visibly
soiled
(B) Immediately if
accidental bare-handed contact with blood, body fluids, secretions, excretions,
non-intact skin, mucous membranes or contaminated equipment occurs.
(4) Hand washing technique with
liquid soap and water includes:
(A) Use of
plain soap and water
(B) A vigorous
rubbing together of all surfaces of lathered hands, especially between fingers
and fingernail areas, for 15 to 30seconds
(C) A thorough rinsing under a stream of
water
(D) Hands are dried
thoroughly with a clean disposable paper towel
(E) Faucets are turned off with the paper
towel
(F) Paper towel is disposed
of in the appropriate covered receptacle in the treatment room.
(5) Hand washing technique using
60% to 70% alcohol-based antiseptic hand rubs includes:
(A) Apply product label-recommended amount of
alcohol gel or rinse to the palm of one hand
(B) Vigorously rub hands together covering
all surfaces of hands, especially between fingers and fingernail areas, between
15 to 25 seconds until the alcohol dries.
(e)
Standards for use of gloves.
(1) Each patient/client must be treated with
fresh unused gloves. Determine patient/client allergies before wearing latex
gloves. Several conditions have been connected to latex sensitivity, including
such allergic reactions as asthma, eczema, hay fever, allergies to cosmetic
powders or foods, and frequency or duration of glove use/exposure. Non-sterile
gloves are appropriate for electrology procedures and should be worn when hands
are likely to become contaminated with potentially infective material such as
blood, all body fluids, secretions, excretions, non-intact skin, and mucous
membranes.
(2) The consistent
wearing of gloves will decrease the risk of potential exposure. Wearing gloves
will also protect the patient/client from potential exposure to the microbial
flora of the electrologist, including blood-borne organisms should there be
cuts, scrapes, or micro-lesions on the electrologist's hands. When gloves are
worn, hand washing is recommended after removal because gloves may become
perforated during use and bacteria can multiply rapidly on gloved hands. Gloves
that are torn or knowingly perforated during a treatment should be removed
immediately and hands washed before donning fresh gloves.
(3) Wearing latex powder-free, reduced
protein content gloves will reduce the risk of a latex allergy. When wearing
latex gloves, do not use oil-based hand creams or lotions, which causes glove
deterioration, unless they have been shown to reduce latex-related problems and
maintain glove barrier protection. If the electrologist or patient/client is
allergic to latex, there are other non-latex glove materials available such as
vinyl.
(4) Washing gloves while
treating the same patient/client is not recommended. This can cause "wicking",
the enhanced penetration of liquids through microscopic holes in the gloves.
Deterioration of the glove material can also occur with the use of disinfecting
agents or oils. Wearing gloves will not guarantee protection as gloves may have
micro tears.
(5) Use a fresh pair
of non-sterile, medical grade, disposable exam gloves during the treatment of
each patient/client. Gloves are disposed of in an appropriate receptacle in the
treatment room.
(6) Wash hands in
accordance with the above hand washing standards before putting on gloves and
immediately after gloves are removed.
(f)
Standards for patient/client health
history. A complete past and current health history is obtained from
each patient/client before treatment. The general health status of the
patient/client may be a factor in susceptibility to infection and normal
healing. It will also have an affect on the outcome of the treatment plan due
to any hormonal disorders or disease states. Professional interpretations
require careful observation and good judgment. The patient/client's health
status should be updated and evaluated on an on-going basis and referred to an
appropriate physician as indicated.
(g)
Standards for patient/client skin
preparation.
(1) Treatment should be
delayed if actual or potential signs or symptoms of infection are present. The
practitioner should refer to the appropriate physician when the health history
or skin assessment indicates
(2)
Before treatment, the treatment area should be thoroughly cleansed to remove
makeup or grime if present and reduce the bacterial count on the
skin.
(3) Wipe the treatment area
with an antiseptic skin preparation.
(4) After treatment, the treatment area
should be wiped with an appropriate product, taking into consideration the
patient/client's skin type and any skin allergies.
(5) Patient/clients are instructed on
appropriate post-treatment care to promote healing.
(h)
Standards for cleaning and
sterilization of instruments/items.
(1) Coordinating the cleaning, sterilization,
and disinfection of instruments/items to maintain asepsis technique is
required. Precautions should be taken to avoid puncture injuries from
instruments.
(2) All instruments
that will penetrate tissue should be either pre-sterilized disposable or
thoroughly cleaned and then sterilized before reuse to reduce the risk of
transmission of infection and disease.
(3) The endodontic dry heat sterilizer (glass
bead sterilizer) is no longer cleared to market by the Food and Drug
Administration (FDA). The endodontic dry heat sterilizer should not be used in
the practice of electrology.
(4)
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 a medical device is heat-stable, the proper method
of reprocessing is by using a heat-based method such as a steam autoclave or
dry heat oven.
(5) Carbon rollers
are porous and cannot be sterilized or disinfected, therefore, they should not
be used.
(6) Cleaning is the basic
first step for all decontamination. Cleaning physically removes debris and
reduces the number of microorganisms present. Cleaning is the removal of
organic material or soil from objects and is usually done by using
protein-dissolving enzyme detergent and water. Generally, cleaning is designed
to remove rather than kill microorganisms. Technology has provided cleaning
products and devices that are especially appropriate for the cleaning of
instruments used in electrology. A meticulous physical cleaning is always done
before sterilization or disinfection. For sterilization or disinfection, refer
to the manufacturers' instructions for exposure times and conditions as well as
recommendations for rinsing and subsequent handling of processed
items.
(7) Low-level and
intermediate-level disinfectants used in the practice of electrology should be
registered with the Environmental Protection Agency (EPA), whereas high-level
disinfectants/liquid chemical sterilants are cleared by the FDA for use in
sterilizing or disinfecting medical and dental instruments. Disinfectants are
to be used according to the manufacturer's instructions.
(8) An intermediate-level disinfectant is
capable of killing M. tuberculosis var. bovis, but not bacterial spores. It
will also inactivate organisms 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, and certain phenolic or iodophor
preparations.
(9) A high-level
disinfectant inactivates some, but not necessarily all, bacterial spores. It
will kill M. tuberculosis var. bovis, bacteria, fungi, and viruses. High-level
disinfection is the minimum treatment recommended by the CDC guidelines for
reprocessing of semi-critical instruments or devices. Examples of high-level
disinfectants include glutaraldehyde-, chlorine dioxide-, hydrogen-peroxide,
orthophthaldehyde-, and peracetic acid-based formulations.
(10) Chlorine solutions in concentrations of
0.05 to 0.5% free chlorine are generally considered intermediate-level
disinfectants for specific site disinfection. Solutions of 0.5% (household
bleach contains approximately 5% sodium hypochlorite) have broad-spectrum
germicidal activity, and exhibit sporicidal activity, are tuberculocidal,
inactivate vegetative bacteria, and are fungicidal and virucidal. Klein and
Deforest (1965) reported that all 25 viruses were inactivated in 10 minutes by
as little as 0.02% available chlorine. Bleach solutions used to process tips
for epilator needle holder are freshly made by mixing one tablespoon household
bleach to one quart tap water. Discard bleach solution after each
use.
(11) Critical items.
(A) Instruments
(i) Needles
(I) Single-use, pre-sterilized,
disposable
(II) Pre-sterilized,
re-useable
(ii)
Forceps
(B) Processing
(i) Single-use and re-useable needles
(I) Stored in a manner that will maintain
sterile condition, away from wetness or humidity extremes.
(II) Not to be recapped, bent, or manipulated
by hand prior to disposal to avoid accidental puncture injury.
(III) Place in a sharps container immediately
after use, or when opened and found damaged, or when not used before expiration
date.
(IV) When the sharps
container is full, it is to be sealed securely and disposed of properly as
specified by state and local health regulations as an item of regulated medical
waste. According to the Oklahoma Dept. of Labor's OSHA division, sharps
containers can be disposed of in the regular trash only after being filled with
cement. They recommend a more practical solution of taking them to a local
hospital or clinic that will include it with their regular biohazard waste
materials to be picked up by a biohazard waste company. They may charge a small
fee for this service.
(ii) Forceps and re-useable needles
(I) Forceps are cleaned and then sterilized
before their initial use.
(II) Used
critical items are placed in an ultrasonic unit, empty covered container or a
holding container, which holds either a liquid detergent solution or
protein-dissolving enzyme detergent, following manufacturer's instructions for
dilution.
(III) The holding
container is held under warm running water to rinse off detergent and debris,
then drained.
(IV) Forceps and
re-useable needles are then placed in the basket of an ultrasonic unit using
transfer forceps. If a protein-dissolving enzyme detergent was not used in the
holding container, it must be used now in the ultrasonic unit for proper
cleaning, following manufacturer's instructions for dilution and immersion
time.
(V) Basket is removed from
ultrasonic unit, rinsed under running water and drained. Forceps are dried with
disposable paper towels. Needles are drained and air-dried on disposable paper
towels.
(VI) Forceps and needles
are packaged individually or in small multiples for the sterilization process.
If sterilized in multiples, any instruments not used whose package has been
opened must be resterilized.
(VII)
Place packaged instruments in an autoclave or dry heat sterilizer using a
chemical indicator on each package or one with each individual load. This only
indicates items have been exposed to a sterilization process, it does not
guarantee sterility. Biological indicators are used no less than once a month
(per sterilizer) according to manufacturer's instructions to ensure proper
mechanical function. Lab reports are filed in a permanent Sterility Assurance
file to be kept in your office records.
(VIII) Autoclaves and dry heat sterilizers
are loaded, operated and maintained according to manufacturer's instructions.
Sterilizers must have visible physical indicators (thermometers,
timers).
(IX) Cleaned, dried and
packaged instruments are sterilized by either dry heat at 340 degrees F (170 C)
for 1 hour; 320 degrees F (160 C) for 2 hours or by following directions by the
manufacturer of the unit or by autoclave (steam under pressure) for 15-20
minutes at 250 degrees F (121 C); 15 psi (pounds per square inch). The above
temperature and exposure times for dry heat sterilizers and autoclaves relate
only to the time of exposure after attainment of the specific temperature and
do not include a penetration or heat-up lag time. Exposure time does not
include drying and cool-down time. Follow the manufacturer's instructions for
the unit you have if times and temperatures differ from those given
above.
(12) Semi-critical items.
(A) Instruments
(i) Tips for epilator needle
holders
(ii)
Anaphoresis/cataphoresis rollers
(B) Processing
(i) Tips for epilator needle holders
(I) Must be processed before initial use and
after use between each patient/client. Tips that are contaminated (e.g.
dropping or touching unsterilesurface) must be reprocessed before
use.
(II) Follow same processing
directions described earlier for re-useable critical items concerning holding
container and ultrasonic cleaning.
(III) Package tips individually or in small
multiples for sterilization in an auto-clave or disinfect by submersing in a
fresh solution of an intermediate- level disinfectant for 10 minutes or follow
manufacturer's directions. Dry the tips with disposable paper towels.
(IV) Store tips in a clean, dry, covered
container to prevent contamination.
(ii) Anaphoresis/cataphoresis rollers.
(I) Must be processed before initial use and
after use between each patient/ client.
(II) Rollers are cleaned, dried and
disinfected in the same manner as tips.
(13) Non-critical Items.
(A) Instruments/Items
(i) Indifferent electrodes
(ii) Needle cords
(B) Processing
(i) These items are cleaned, dried and
subjected to a low-level disinfection after each treatment.
(ii) Low-level disinfectants are capable of
inactivating most bacteria, some Viruses and fungi, but not bacterial spores or
M. tuberculosis var. bovis. Examples are quaternary ammonium compounds and
certain iodophors or phenolics.
(i)
Standards for environmental control
and housekeeping.
(1) A variety of
microorganisms are normal contaminants of environmental surfaces, most of which
are non-pathogens. Conscientious sanitation and disinfection techniques control
cross-infection.
(2) Hospital-grade
disinfectants registered with the Environmental Protection Agency (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 751 OC, Office of Pesticides Programs, 401 M Street SW,
Washington, DC 20460.
http://www.epa.gov/.
(3) Adequate levels of safety for surfaces of
medical 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.
(4) Cleaning schedules
and methods vary according to the type of surface to be cleaned and the amount
and type of soil present. Items on countertops should be maintained in a
sanitary manner. Sinks and toilet facilities should be clean at all times.
Environmental surfaces in the treatment room should be cleaned on a regular
basis. Equipment surfaces, doorknobs, telephones, and treatment tables should
be cleaned on a regular basis. Protective barrier film or appropriate
disinfectants should be used on surfaces touched during the treatment.
Treatment tables should be covered with either cloth or paper drapes and
changed after each patient/client. Floors and carpets should be vacuumed and
cleaned regularly. Walls, blinds and curtains should be cleaned when visibly
soiled.
(j)
Standards for potential exposures to blood-borne pathogens.
(1) Health care workers who have percutaneous
or mucous membrane exposure to blood and other body fluids are at risk for
infection, including HBV, HCV AND HIV infection. The Centers for Disease
Control and Prevention (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.
(2) 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.
(3) The following steps are to be taken when
a puncture injury has occurred:
(A) Remove and
discard gloves.
(B) Milk the
puncture site to expel blood. Clean the wound vigorously with one-half teaspoon
of soap and water for 10 to 15 seconds, using friction.
(C) Immediate contact is made to
practitioner's personal physician for appropriate consultation, and for
necessary post-exposure strategies.
(D) Documentation of the exposure is made
including: date, route of expo-sure, circumstance under which exposure
occurred, name of source patient/client, HIV and/or hepatitis status of source
patient/client, status of practitioner's testing, follow-up testing and any
necessary post-exposure prophylaxis.
Added at 21 Ok Reg 1056,
eff 5-14-04