Florida 2 Hour HIV/AIDS Barber Course (2 hours)
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Licensed by the Department of Business and Professional RegulationFlorida State Board of Barbers CE Provider #PVD57
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Florida 2 Hour HIV/AIDS Barber Course (2 hours)
TABLE OF CONTENTS page
HIV/AIDS and Other Communicable Diseases (2 hours) 2
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HIV/AIDS and Other Communicable Diseases (2 hours)
OutlineModes of TransmissionInfection Control ProceduresClinical ManagementPrevention of HIV and AIDSAttitudes towards HIV and AIDSAppropriate behavior Hepatitis
Learning objectivesAfter completing this lesson you will be able to:
define HIVdefine AIDSidentify the stages of transmissiondescribe clinical latencyexplain how you know that you have been infected with HIVdescribe home testing kitsidentify antiretroviral therapy identify the most common ways that HIV is transmitteddescribe people groups and their risksdefine methods of prevention and the challenges of preventing infection describe types of discriminationdefine hepatitis and the types of viral hepatits
Introduction
What is HIV?HIV stands for human immunodeficiency virus. It is the virus that can lead to acquired immunodeficiency syndrome, or AIDS. Unlike some other viruses, the human body cannot get rid of HIV. That means that once you have HIV, you have it for life.No safe and effective cure currently exists, but scientists are working hard to find one, and remain hopeful. Meanwhile, with proper medical care, HIV can be controlled. Treatment for HIV is often called anti-retro-viral therapy or ART. It can dramatically prolong the lives of many people infected with HIV and lower their chance of infecting others. Before the introduction of ART in the mid-1990s, people with HIV could progress to AIDS in just a few years. Today, someone diagnosed with HIV and treated before the disease is far advanced can have a nearly normal life expectancy. HIV affects specific cells of the immune system, called CD4 cells, or T cells. Over time, HIV can destroy so many of these cells that the body can’t fight off infections and disease. When this happens, HIV infection leads to AIDS.
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Where did HIV come from?Scientists identified a type of chimpanzee in West Africa as the source of HIV infection in humans. They believe that the chimpanzee version of the immunodeficiency virus (called simian immunodeficiency virus, or SIV) most likely was transmitted to humans and mutated into HIV when humans hunted these chimpanzees for meat and came into contact with their infected blood. Studies show that HIV may have jumped from apes to humans as far back as the late 1800s. Over decades, the virus slowly spread across Africa and later into other parts of the world. We know that the virus has existed in the United States since at least the mid- to late 1970s.
HIV disease has a well-documented progression. Untreated, HIV is almost universally fatal because it eventually overwhelms the immune system—resulting in acquired immunodeficiency syndrome (AIDS). HIV treatment helps people at all stages of the disease, and treatment can slow or prevent progression from one stage to the next.
Modes of Transmission
A person can transmit HIV to others during any of these stages: Acute infection: Within 2 to 4 weeks after infection with HIV, you may feel sick with flu-like symptoms. This is called acute retro-viral syndrome (ARS) or primary HIV infection, and it’s the body’s natural response to the HIV infection. (Not everyone develops ARS, however—and some people may have no symptoms.) During this period of infection, large amounts of HIV are being produced in your body. The virus uses important immune system cells called CD4 cells to make copies of itself and destroys these cells in the process. Because of this, the CD4 count can fall quickly. Your ability to spread HIV is highest during this stage because the amount of virus in the blood is very high. Eventually, your immune response will begin to bring the amount of virus in your body back down to a stable level. At this point, your CD4 count will then begin to increase, but it may not return to pre-infection levels.
Clinical latency (inactivity or dormancy)This period is sometimes called asymptomatic HIV infection or chronic HIV infection. During this phase, HIV is still active, but reproduces at very low levels. You may not have any symptoms or get sick during this time. People who are on anti-retro-viral therapy (ART) may live with clinical latency for several decades. For people who are not on ART, this period can last up to a decade, but some may progress through this phase faster. It is important to remember that you are still able to transmit
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HIV to others during this phase even if you are treated with ART, although ART greatly reduces the risk. Toward the middle and end of this period, your viral load begins to rise and your CD4 cell count begins to drop. As this happens, you may begin to have symptoms of HIV infection as your immune system becomes too weak to protect you .
AIDS (acquired immunodeficiency syndrome)This is the stage of infection that occurs when your immune system is badly damaged and you become vulnerable to infections and infection-related cancers called opportunistic illnesses. When the number of your CD4 cells falls below 200 cells per cubic millimeter of blood (200 cells/mm3), you are considered to have progressed to AIDS. (Normal CD4 counts are between 500 and 1,600 cells/mm3.) You can also be diagnosed with AIDS if you develop one or more opportunistic illnesses, regardless of your CD4 count. Without treatment, people who are diagnosed with AIDS typically survive about 3 years. Once someone has a dangerous opportunistic illness, life expectancy without treatment falls to about 1 year. People with AIDS need medical treatment to prevent death.
Infection Control
KnowingThe only way to know if you are infected with HIV is to be tested. You cannot rely on symptoms to know whether you have HIV. Many people who are infected with HIV do not have any symptoms at all for 10 years or more. Some people who are infected with
HIV report having flu-like symptoms (often described as “the worst flu ever”) 2 to 4 weeks after exposure. Symptoms can include:
• Fever • Enlarged lymph nodes • Sore throat • Rash
These symptoms can last anywhere from a few days to several weeks. During this time, HIV infection may not show up on an HIV test, but people who have it are highly infectious and can spread the infection to others.
However, you should not assume you have HIV if you have any of these symptoms. Each of these symptoms can be caused by other illnesses. Again, the only way to determine whether you are infected is to be tested for HIV infection.
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Clinical Management
Home Testing KitsTwo types of home testing kits are available in most drugstores or pharmacies: one involves pricking your finger for a blood sample, sending the sample to a laboratory, then phoning in for results. The other involves getting a swab of fluid from your mouth, using the kit to test it, and reading the results in 20 minutes. Confidential counseling and referrals for treatment are available with both kinds of home tests. If you test positive for HIV, you should see your doctor as soon as possible to begin treatment.
Testing SitesFor information on where to find an HIV testing site,
• Visit National HIV and STD Testing Resources and enter your ZIP code. • Text your ZIP code to KNOWIT (566948), and you will receive a text back with a
testing site near you. • Call 800-CDC-INFO (800-232-4636) to ask for free testing sites in your area.
These resources are confidential. You can also ask your health care provider to give you an HIV test.
Prevention of HIV/AIDS
For most people, the answer is no. Most reports of a cure involve HIV-infected people who needed treatment for a cancer that would have killed them otherwise. But these treatments are very risky, even life-threatening, and are used only when the HIV-infected people would have died without them. Anti-retro-viral therapy (ART), however, can dramatically prolong the lives of many people infected with HIV and lower their chance of infecting others. It is important that people get tested for HIV and know that they are infected early so that medical care and treatment have the greatest effect. The most common ways HIV is transmitted in the United States is through anal or vaginal sex or sharing drug injection equipment with a person infected with HIV. The following steps can reduce your risk:
• Know your HIV status. Everyone between the ages of 13 and 64 should be tested for HIV at least once. If you are at increased risk for HIV, you should be tested for HIV at least once a year.
• If you have HIV, you can get medical care, treatment, and supportive services to help you stay healthy and reduce your ability to transmit the virus to others.
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• If you are pregnant and find that you have HIV, treatments are available to reduce the chance that your baby will have HIV.
• Abstain from sexual activity or be in a long-term mutually monogamous relationship with an uninfected partner.
• Limit your number of sex partners. The fewer partners you have, the less likely you are to encounter someone who is infected with HIV or another STD.
• Correct and consistent condom use. Latex condoms are highly effective at preventing transmission of HIV and some other sexually transmitted diseases. “Natural” or lambskin condoms do not provide sufficient protection against HIV infection.
• Get tested and treated for STDs and insist that your partners do too.
• Male circumcision has also been shown to reduce the risk of HIV transmission from women to men during vaginal sex.
• Do not inject drugs. If you inject drugs, you should get counseling and treatment to stop or reduce your drug use. If you cannot stop injecting drugs, use clean needles and works when injecting.
• Obtain medical treatment immediately if you think you were exposed to HIV. Sometimes, HIV medications can prevent infection if they are started quickly. This is called post-exposure prophylaxis.
• Participate in risk reduction programs. Programs exist to help people make healthy decisions, such as negotiating condom use or discussing HIV status. Your health department can refer you to programs in your area.
Racial and Ethnic GroupsIn the United States, HIV is spread mainly by having unprotected anal or vaginal sex or by sharing drug-use equipment with an infected person. Although these risk factors are the same for everyone, some racial/ethnic groups are more affected than others, given their percentage of the population.
This is because some population groups have higher rates of HIV in their communities, thus raising the risk of new infections with each sexual or drug use encounter.
Additionally, a range of social, economic, and demographic factors—such as stigma, discrimination, income, education, and geographic region—affect their risk for HIV.
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In the United States, HIV is spread mainly by having unprotected anal or vaginal sex or by sharing drug-use equipment with an infected person. Although these risk factors are the same for everyone, some gender groups are far more affected than others. Gay, bisexual, and other men who have sex with men, for example, account for the majority of new infections despite making up only 2% of the population.
HIV among womenWomen account for one in four people living with HIV in the United States; African American women and Latinas are disproportionately affected at all stages of HIV infection.
Gay and Bisexual MenGay and bisexual men are more severely affected by HIV than any other group in the United States .
• Among all gay and bisexual men, blacks/African Americans bear the greatest disproportionate burden of HIV.
• From 2008 to 2010, HIV infections among young black/African American gay and bisexual men increased 20%.
Gay, bisexual, and other men who have sex with men (MSM)a represent approximately 2% of the US population, yet are the population most severely affected by HIV. In 2010, MSM accounted for 63% of all new HIV infections, and MSM with a history of injection drug use (MSM-IDU) accounted for an additional 3% of new infections. That same year, young MSM (aged 13-24 years) accounted for 72% of new HIV infections among all persons aged 13 to 24, and 30% of new infections among all MSM. At the end of 2010, an estimated 489,121 (56%) persons living with an HIV diagnosis in the United States
New HIV Infections
• In 2010, MSM accounted for 63% of estimated new HIV infections in the United States and 78% of infections among all newly infected men. Compared with other transmission groups, MSM accounted for the largest numbers of new HIV infections in 2010.
• Among all MSM, white MSM accounted for 11,400 (38%) estimated new HIV infections in 2010. The largest number of new infections among white MSM (3,300; 29%) occurred in those aged 25 to 34.
• Among all MSM, black/African American MSM accounted for 10,600 (36%) estimated new HIV infections in 2010. From 2008 to 2010, new HIV infections increased 22% among young (aged 13-24) MSM and 12% among MSM overall—an increase largely due to a 20% increase among young black/African American MSM.
• Among all MSM, Hispanic/Latino MSM accounted for 6,700 (22%) estimated new HIV infections in 2010. The largest number of new infections among Hispanic/Latino MSM (3,300; 39%) occurred in those aged 25 to 34.
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HIV and AIDS Diagnoses and Deaths
• In 2011, in the United States, MSM accounted for 79% of 38,825 estimated HIV diagnoses among all males aged 13 years and older and 62% of 49,273 estimated diagnoses among all persons receiving an HIV diagnosis that year.
• At the end of 2010, of the estimated 872,990 persons living with an HIV diagnosis, 440,408 (50%) were MSM. Forty-seven percent of MSM living with an HIV diagnosis were white, 31% were black/African American, and 19% were Hispanic/Latino.
• In 2011, MSM accounted for 52% of estimated AIDS diagnoses among all adults and adolescents in the United States. Of the estimated 16,694 AIDS diagnoses among MSM, 39% were in blacks/African Americans; 34% were in whites; and 23% were in Hispanics/Latinos.
• By the end of 2010, an estimated 302,148 MSM with an AIDS diagnosis had died in the United States since the beginning of the epidemic, representing 48% of all deaths of persons with an AIDS diagnosis.
Prevention ChallengesAs a group, gay, bisexual, and other MSM have an increased chance of being exposed to HIV because of the large number of MSM living with HIV. Results of HIV testing conducted in 21 cities as part of the National HIV Behavioral Surveillance System indicated that 19% of MSM tested in 2008 were HIV-positive and that HIV prevalence increased with increasing age and decreased with increasing education and income. Men aged 40 years and older had higher rates of HIV infection than men aged 18 to 39. Further, many gay and bisexual men with HIV do not know they have HIV, especially MSM of color and young MSM. Of MSM who tested positive for HIV in 2008, 44% did not know they were infected. Among those infected, young MSM (aged 18 to 29 years; 63%) and racial/ethnic minority MSM (54%) were more likely to be unaware they had HIV. Persons who don't know they have HIV don't get medical care and can unknowingly infect others. The Centers for Disease Control and Prevention (CDC) recommends that all MSM get tested for HIV at least once a year. Sexually active MSM might benefit from HIV testing every 3 to 6 months. Sexual risk behaviors account for most HIV infections in MSM. Unprotected receptive anal sex is the sexual behavior that carries the highest risk for HIV acquisition. For sexually active MSM, the most effective ways to prevent HIV and many other sexually transmitted infections (STIs) are to avoid anal sex, or for MSM who do have anal sex, to always use condoms. MSM are at increased risk for syphilis, gonorrhea, and chlamydia, and CDC recommends that all sexually active MSM be tested annually for these STIs.
Alcohol and illegal drug use increases risk for HIV and other STIs. Using substances such as alcohol and methamphetamines can impair judgment and increase risky sexual behavior.
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Prevention Strategies To prevent transmission of HIV to health care workers in the workplace, CDC offers the following recommendations. Health care workers should assume that the blood and other body fluids from all patients are potentially infectious. They should therefore follow infection control precautions at all times. These precautions include
• Routinely using barriers (such as gloves and/or goggles) when anticipating contact with blood or body fluids.
• Immediately washing hands and other skin surfaces after contact with blood or body fluids.
• Carefully handling and disposing of sharp instruments during and after use. Safety devices have been developed to help prevent needle-stick injuries. If used properly, these types of devices may reduce the risk of exposure to HIV. Many per-cutaneous injuries, such as needle-sticks and cuts, are related to the disposal of sharp-ended medical devices. All used syringes or other sharp instruments should be routinely placed in “sharps” containers for proper disposal to prevent accidental injuries and risk of HIV transmission. Although the most important strategy for reducing the risk of occupational HIV transmission is to prevent occupational exposures, plans for post-exposure management of health care personnel should be in place. CDC issued guidelines in 2005 for the management of health care worker exposures to HIV and recommendations for post-exposure prophylaxis (PEP): These guidelines outline considerations in determining whether health care workers should receive PEP and in choosing the type of PEP regimen. For most HIV exposures that warrant PEP, a basic 4-week, two-drug (there are several options) regimen is recommended, starting as soon as possible after exposure. For HIV exposures that pose an increased risk of transmission (based on the infection status of the source and the type of exposure), a three-drug regimen may be recommended. Special circumstances, such as a delayed exposure report, unknown source person, pregnancy in the exposed person, resistance of the source virus to anti-retro-viral agents, and toxicity of PEP regimens, are also discussed in the guidelines. Occupational exposures should be considered urgent medical concerns, and PEP should be started within 72 hours—the sooner the better; every hour counts.
Living With HIVToday, an estimated 1.1 million people are living with HIV in the United States. Thanks to better treatments, people with HIV are now living longer—and with a better quality of life—than ever before. If you are living with HIV, it’s important to make choices that keep you healthy and protect others.
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Stay healthy.It’s very important for you to take your HIV medicines exactly as directed. Not taking medications correctly may lower the level of immune system defenders called CD4 cells and cause the level of virus in your blood (viral load) to go up. The medicines then become less effective when taken. Some people report not feeling well as a reason for stopping their medication or not taking it as prescribed. Tell your doctor if your medicines are making you sick. He or she may be able to help you deal with side effects so you can feel better. Don’t just stop taking your medicines, because your health depends on it.
Do tell.Be sure that your partner or partners know that you have HIV. Then they will know it’s important to use condoms for all sexual activity and to be tested often for HIV. Health departments offer Partner Services to help you tell your partners about their exposure. Partner Services provides many free services to people with HIV or other STDs and their partners. Through Partner Services, health department staff help find sex or drug-injection partners to let them know of their risk of being exposed to HIV or another sexually transmitted disease (STD) and provide them with testing, counseling, and referrals for other services. Partner Services will not reveal your name unless you want to work with them to tell your partners.
Don’t take risks.HIV is spread through body fluids such as blood, semen (cum), vaginal fluids, and breast milk. In the United States, HIV is most commonly passed from one person to another through unprotected anal or vaginal sex and through sharing needles or other drug equipment. In addition, a mother can pass HIV to her baby during pregnancy, during labor, through breastfeeding, or if by pre-chewing her baby’s food. Viral load can range from undetectable levels of 40 to 75 copies per milliliter of blood to millions of copies. The higher your viral load, the greater the risk of spreading HIV to others. Protect your partners by keeping yourself healthy. Take all of your medicines and get tested and treated for other STDs. If you have HIV plus another STD or hepatitis, you are 3 to 5 times more likely to spread HIV than if you only have HIV. Your viral load goes up and your CD4 count goes down when you have an STD.Although having a low viral load greatly decreases your chance of spreading HIV, some risk remains, even when your viral load is lower than 3,500 copies per milliliter. You can avoid spreading the virus to others by making sure they do not come into contact with your body fluids.
• Abstinence (not having sex) is the best way to prevent the spread of HIV infection and some other STDs. If abstinence is not possible, use condoms whenever you have sex—vaginal, anal, or oral.
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• Do not share drug equipment. Blood can get into needles, syringes, and other equipment. If the blood has HIV in it, the infection can be spread to the next user.
• Do not share items that may have your blood on them, such as razors or toothbrushes.
Attitudes toward HIV and AIDS
Homophobia, stigma, and discrimination can put MSM at risk for multiple physical and mental health problems and affect whether MSM seek and are able to obtain high-quality health services. Negative attitudes about homosexuality can lead to rejection by friends and family, discriminatory acts, and bullying and violence. These dynamics may make it difficult for some MSM to be open about same-sex behaviors with others, which can increase stress, limit social support, and negatively affect health.
The Center for Disease Control Guided by the National HIV/AIDS Strategy for the United States, CDC and its partners are pursuing a high-impact prevention approach to reducing new HIV infections by using combinations of scientifically proven, cost-effective, and scalable interventions directed to the most vulnerable populations in the geographic areas where HIV prevalence is highest.
CDC is using this new approach to fund state and local health departments and community-based organizations to support HIV prevention services for MSM, including innovative behavioral health interventions. Through the Diffusion of Effective Behavioral Interventions (DEBI) project, CDC supports such programs as CDC supports such programs as Mpowerment, and d-up: Defend Yourself! for MSM. For information on other behavioral interventions and other high-impact prevention strategies, visit the .DEBI websiteThrough its Act Against AIDScampaigns (and other collaborative activities, CDC aims to provide MSM with effective and culturally appropriate messages about HIV prevention. The Testing Makes Us Stronger campaign encourages black gay and bisexual men aged 18 to 44 to get tested for HIV. To expand HIV prevention services for young gay and bisexual men of color, transgender youth of color, and their partners, CDC recently awarded $55 million over 5 years to 34 community-based organizations (CBOs) with strong links to these populations. This funding will be used to provide HIV testing to more than 90,000 young gay and bisexual men and transgender youth of color, with a goal of identifying more than 3,500 previously unrecognized HIV infections and linking those who are HIV-infected to care and prevention services. CBOs will also carry out proven behavioral change HIV prevention programs.
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Occupational HIV Transmission and Prevention Among Health Care WorkersOccupational transmission of HIV to health care workers is extremely rare.
• CDC recommends proper use of safety devices and barriers to prevent exposure to HIV in the health care setting.
• For workers who are exposed, CDC has developed recommendations to minimize the risk of developing HIV.
Fewer than 60 cases of occupational transmission of HIV to health care workers have occurred in the United States. The proper use of gloves and goggles, along with safety devices to prevent injuries from sharp medical devices, can help minimize the risk of exposure to HIV in the course of caring for patients with HIV. When workers are exposed, the Centers for Disease Control and Prevention (CDC) recommends immediate treatment with a short course of anti-retro-viral drugs to prevent infection.
• As of 2010, 57 documented transmissions and 143 possible transmissions had been reported in the United States.
• No confirmed cases of occupational HIV transmission to health care workers have been reported since 1999. Under-reporting of cases to CDC is possible, however, because case reporting is voluntary.
• Health care workers who are exposed to HIV-infected blood at work have a 0.3% risk of becoming infected. In other words, 3 of every 1,000 such injuries, if untreated, will result in infection.
At the end of 2009, an estimated 1,148,200 persons aged 13 and older were living with HIV infection in the United States, including 207,600 (18.1%) persons whose infections had not been diagnosed (1). CDC estimates that approximately 50,000 people are infected with HIV each year (2).
Hepatitis
HepatitisHepatitis is the inflammation of the liver and also refers to a group of viral infections that affect the liver . The most common types are Hepatitis A, Hepatitis B, and Hepatitis C.
Viral hepatitis Viral hepatitis is the leading cause of liver cancer and the most common reason for liver transplantation. An estimated 4.4 million Americans are living with chronic hepatitis; most do not know they are infected.
Hepatitis A Hepatitis A caused by infection with the Hepatitis A virus (HAV), has an incubation period of approximately 28 days (range: 15–50 days).
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HAV replicates in the liver and is shed in high concentrations in feces from 2 weeks before to 1 week after the onset of clinical illness. HAV infection produces a self-limited disease that does not result in chronic infection or chronic liver disease.
However, 10%–15% of patients might experience a relapse of symptoms during the 6 months after acute illness. Acute liver failure from Hepatitis A is rare (overall case-fatality rate: 0.5%). The risk for symptomatic infection is directly related to age, with >80% of adults having symptoms compatible with acute viral hepatitis and the majority of children having either asymptomatic or unrecognized infection. Antibody produced in response to HAV infection persists for life and confers protection against reinfection.
HAV infection is primarily transmitted by the fecal-oral route, by either person-to-person contact or consumption of contaminated food or water. Although viremia occurs early in infection and can persist for several weeks after onset of symptoms, blood-borne transmission of HAV is uncommon. HAV occasionally might be detected in saliva in experimentally infected animals, but transmission by saliva has not been demonstrated.
In the United States, nearly half of all reported Hepatitis A cases have no specific risk factor identified. Among adults with identified risk factors, the majority of cases are among men who have sex with other men, persons who use illegal drugs, and international travelers.
Because transmission of HAV during sexual activity probably occurs because of fecal-oral contact, measures typically used to prevent the transmission of other STDs (e.g., use of condoms) do not prevent HAV transmission. In addition, efforts to promote good personal hygiene have not been successful in interrupting outbreaks of Hepatitis A.
Vaccination is the most effective means of preventing HAV transmission among persons at risk for infection. Hepatitis A vaccination is recommended for all children at age 1 year, for persons who are at increased risk for infection, for persons who are at increased risk for complications from Hepatitis A, and for any person wishing to obtain immunity.
Hepatitis BHepatitis B is caused by infection with the Hepatitis B virus (HBV). The incubation period from the time of exposure to onset of symptoms is 6 weeks to 6 months. HBV is found in highest concentrations in blood and in lower concentrations in other body fluids (e.g., semen, vaginal secretions, and wound exudates). HBV infection can be self-limited or chronic.
In adults, only approximately half of newly acquired HBV infections are symptomatic, and approximately 1% of reported cases result in acute liver failure and death.
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Risk for chronic infection is inversely related to age at infection: approximately 90% of infected infants and 30% of infected children aged <5 years become chronically infected, compared with 2%–6% of adults.
Among persons with chronic HBV infection, the risk for premature death from cirrhosis or hepatocellular carcinoma is 15%–25%. HBV is efficiently transmitted by percutaneous or mucous membrane exposure to infectious blood or body fluids that contain blood.
The primary risk factors that have been associated with infection are unprotected sex with an infected partner, birth to an infected mother, unprotected sex with more than one partner, men who have sex with other men (MSM), history of other STDs, and illegal injection drug use.
CDC’s national strategy to eliminate transmission of HBV infection includes• Prevention of perinatal infection through routine screening of all pregnant women
for HBsAg and immunoprophylaxis of infants born to HBsAg-positive mothers and infants born to mothers with unknown HBsAg status
• Routine infant vaccination • Vaccination of previously unvaccinated children and adolescents through age 18
years • Vaccination of previously unvaccinated adults at increased risk for infection
High vaccination coverage rates, with subsequent declines in acute Hepatitis B incidence, have been achieved among infants and adolescents. In contrast, vaccination coverage among the majority of high-risk adult groups (e.g., persons with more than one sex partner in the previous 6 months, MSM, and injection drug users) have remained low, and the majority of new infections occur in these high-risk groups. STD clinics and other settings that provide services targeted to high-risk adults are ideal sites in which to provide
Hepatitis B vaccination to adults at risk for HBV infection. All unvaccinated adults seeking services in these settings should be assumed to be at risk for Hepatitis B and should receive Hepatitis B vaccination
Hepatitis C Hepatitis C virus (HCV) infection is the most common chronic blood-borne infection in the United States; approximately 3.2 million persons are chronically infected. Although HCV is not efficiently transmitted sexually, persons at risk for infection through injection drug use might seek care in STD treatment facilities, HIV counseling and testing facilities, correctional facilities, drug treatment facilities, and other public health settings where STD and HIV prevention and control services are available.
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Sixty to 70% of persons newly infected with HCV typically are usually asymptomatic or have a mild clinical illness. HCV RNA can be detected in blood within 1–3 weeks after exposure.
The average time from exposure to antibody to HCV (anti-HCV) seroconversion is 8–9 weeks, and anti-HCV can be detected in >97% of persons by 6 months after exposure. Chronic HCV infection develops in 70%–85% of HCV-infected persons; 60%–70% of chronically infected persons have evidence of active liver disease.
The majority of infected persons might not be aware of their infection because they are not clinically ill. However, infected persons serve as a source of transmission to others and are at risk for chronic liver disease or other HCV-related chronic diseases decades after infection.
HCV is most efficiently transmitted through large or repeated percutaneous exposure to infected blood (e.g., through transfusion of blood from unscreened donors or through use of injecting drugs). Although much less frequent, occupational, perinatal, and sexual exposures also can result in transmission of HCV.
The role of sexual activity in the transmission of HCV has been controversial. Case-control studies have reported an association between acquiring HCV infection and exposure to a sex contact with HCV infection or exposure to multiple sex partners.
Surveillance data also indicate that 15%–20% of persons reported with acute HCV infection have a history of sexual exposure in the absence of other risk factors. Case reports of acute HCV infection among HIV-positive MSM who deny injecting-drug use have indicated that this occurrence is frequently associated with other STDs (e.g., syphilis).
In contrast, a low prevalence (1.5% on average) of HCV infection has been demonstrated in studies of long-term spouses of patients with chronic HCV infection who had no other risk factors for infection.
Multiple published studies have demonstrated that the prevalence of HCV infection among MSM who have not reported a history of injecting-drug use is no higher than that of heterosexuals.
Because sexual transmission of other bloodborne viruses, such as HIV, is more efficient among homosexual men than in heterosexual men and women, the reason that HCV infection rates are not substantially higher among MSM is unclear. Overall, these findings indicate that sexual transmission of HCV is possible but inefficient.
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Hepatitis DHepatitis D, also known as "delta hepatitis," is a serious liver disease caused by infection with the Hepatitis D virus (HDV), which is an RNA virus structurally unrelated to the
Hepatitis A, B, or C viruses. Hepatitis D, which can be acute or chronic, is uncommon in the United States. HDV is an incomplete virus that requires the helper function of HBV to replicate and only occurs among people who are infected with the Hepatitis B virus (HBV).
HDV is transmitted through percutaneous or mucosal contact with infectious blood and can be acquired either as a coinfection with HBV or as superinfection in persons with HBV infection. There is no vaccine for Hepatitis D, but it can be prevented in persons who are not already HBV-infected by Hepatitis B vaccination.
Hepatitis EHepatitis E is a serious liver disease caused by the Hepatitis E virus (HEV) that usually results in an acute infection. It does not lead to a chronic infection. While rare in the United States, Hepatitis E is common in many parts of the world. Transmission: Ingestion of fecal matter, even in microscopic amounts; outbreaks are usually associated with contaminated water supply in countries with poor sanitation. Vaccination: There is currently no FDA-approved vaccine for Hepatitis E.
Summary
The purpose of this lesson was to review HIV/AIDS and other communicable diseases.By having this information, you can now be alert to health concerns for yourself, thesalon environment, and for your clients. Keep these facts in mind as we continue our study with the next topic, Sanitation.It is important that the salon professional realize the hazards that lurk in the salon, in order to protect against the spread of disease.
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Lesson 2. Sanitation and Sterilization (1 hour)
OutlineSanitationDisinfectionSterilizationHand washing MRSA
Learning objectivesAfter completing this lesson you will be able to:
define sanitationdefine disinfectiondefine sterilizationdescribe procedures for sanitationdescribe procedures for disinfectiondefine procedures for sterilizationidentify hand washing proceduresdescribe the importance of hand washing as it relates to infection controlidentify ingredients in hand washing agents and their purposeidentify precautions for preventing dermatitisdefine MRSA
Introduction
WHAT IS SANITATION?Sanitation is the first level of the sanitation process. Under this level soap and water areused to clean and remove dirt and debris. Then the next level of the sanitation processis ready!
DISINFECTIONDisinfection is the second level of the sanitation process. This process must be used for all items that come in contact with a client. This means that all tools/implements that touch a client’s skin, hair, nails, etc must be sanitized before being disinfected.Under this level, disinfectants kill most bacteria and must be performed after each client.Disinfectant products will have the word disinfectant on the cover of the bottle or can. Some products are even registered with the EPA stating how effective the product is at killing bacteria. After items that come in contact with clients are sanitized then disinfected, the next step may be required, but only when blood or body fluid is involved.
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STERILIZATIONSterilization is the final stage of the sanitation process and is only required when tools orimplements come in contact with blood or bodily fluids. This process kills all bacteriaand sterilizes the tools or implements. Many nail equipment and aesthetic equipment may fall under the category, but when there is the smallest blood spill or bodily fluids areexposed from the skin sterilization is a must! For sterilization product information, you may visit your local beauty supply store.
Proper Cleaning and Disinfection Everything in the salon has either a hard or soft surface. Any surface coming into direct contact with a client’s skin is considered contaminated. All contaminated surfaces must be thoroughly and properly:
1) cleaned and then 2) disinfected.
To be considered properly clean, a surface must first be thoroughly scrubbed free of all visible signs of debris or residue. Proper cleaning is the total removal of all visible residue from every surface of tables, tools and equipment, followed by a complete and thorough rinsing with clean water. Proper cleaning must be performed before continuing with the disinfection step. Proper disinfection is the destruction of potentially harmful or infection-causing microorganisms (pathogens) on a pre-cleaned surface.
Disposable (single-use) itemsItems that the manufacturer designs to be disposed of after one use are called “disposable” or “single-use”. These items must be properly disposed of after one use on a single client. Reusing these items is considered an unsanitary, improper and unprofessional practice. Some examples of disposable items are: cotton balls, gauze pads, wooden implements, disposable towels, toe separators, tissues, and wooden sticks. Items damaged during the cleaning and disinfecting process are considered single-use and must be discarded after every client.
Proper Product ApplicationSome types of products can become contaminated if improperly used. Some examples are: creams, lotions, scrubs, paraffin wax, masks, and oils. These products must always be used in a sanitary manner that prevents contamination. For example, paraffin and nail oils should not be applied with a brush (or spatula) that has touched the skin. These practices may introduce bacteria into the product and cause contamination that can render products unsafe for use.
To avoid product contamination always:(a) Dispose of used or remaining product between clients.(b) Use single-use disposable implements to remove products from containers for application or remove product with a clean and disinfected spatula and put product to be
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used into a disposable or disinfect-able service cup.(c) Use an applicator bottle or dropper to apply the product.
Proper Disinfection of Multi-use Tools and EquipmentSome items are designed to be used more than once and are considered to be “multi-use”. Multi-use items are sometimes referred to as “disinfect-able”, which means that the implement can be properly cleaned and disinfected while retaining its usefulness and quality. Multi-use items are designed for use on more than one client, but require proper cleaning and disinfection between each use. Examples of multi-use items include cloth towels, and manicure bowls. Hard and non-absorbent items constructed of hard materials that do not absorb liquid, like metal, glass, fiberglass or plastic should be cleaned and disinfected as described below.
Individual Client PacksTools/instruments kept in individual packs must be properly cleaned and disinfected after each use. State rules require all tools and equipment to be disinfected before being reused, even if used by the same client! Improperly cleaned and disinfected implements may grow infection/disease-causing organisms before the client returns for their next visit, thereby increasing the risk of infection. Never use air-tight bags or containers for storage as these can promote bacterial growth.
Methods of Proper CleaningProper cleaning requires liquid soap/detergent, water and the use of a clean and disinfected scrub brush to remove all visible debris and residue. All items should be scrubbed with a clean and disinfected scrub brush under running water.
Cleaning is not disinfection; disinfection is an entirely separate step. Different items are cleaned in different ways. This often depends on what the item is made of and how it was used.
NOTE: the cleaning step must be properly performed before an item can be disinfected. All items must be thoroughly rinsed and dried with clean cloth or paper towels prior to putting them into a disinfectant.
Methods of Proper DisinfectingAfter proper cleaning, all reusable implements and tools must be disinfected by complete immersion in an appropriate disinfecting solution. The item must be completely immersed so that all surfaces, including handles, are soaked for the time required on the disinfectant manufacturer’s label. In general, U.S. Environmental Protection Agency (EPA) registered disinfectants require 10 minute immersion.Remove items after the required time, using clean and disinfected tongs or gloves to avoid skin contact with the disinfectant solution.
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If required by the instruction label, rinse thoroughly in running water. Allow items to air dry completely by placing them on top of a clean towel and covering them with another clean towel.
Methods for Proper StorageAll properly cleaned, disinfected and dried implements must be stored in a sanitary manner.
Appropriate DisinfectantsHow do you know if a disinfectant product is suitable for professional salon use? Standards and requirements vary from country to country, but in the United States, the EPA registered Hospital disinfectants with bactericidal, fungicidal and virucidal claims on the label are best for use in salons. Disinfectant products are designed to destroy disease-causing microorganisms (pathogens) on non-living surfaces, such as those described in this document. They are not appropriate for use on living skin and contact with skin should be avoided.
Appropriate salon disinfectants include the following:(a) EPA-registered Hospital disinfectants with bactericidal, fungicidal and virucidal claims on the label.(b) 10% bleach solution (1 part bleach to 9 parts water)
Contact with Blood, Body Fluid or Unhealthy ConditionsIf blood or body fluid comes in contact with any salon surface, the nail professional should put on a pair of clean protective, disposable gloves and use an EPA-registered Hospital liquid disinfectant or a 10% bleach solution to clean up all visible blood or body fluid.
Disposable items, must be immediately double-bagged and discarded after use, as described at the end of this section. Any non-porous instrument or implement that comes in contact with an unhealthy condition of the nail or skin, blood or body fluid, must be immediately and properly cleaned, then disinfected using an EPA-registered Hospital disinfectant as directed or a 10% bleach solution.
Any porous/absorbent instrument that comes in contact with an unhealthy condition of the nail or skin, blood or body fluid must be immediately double-bagged and discarded in a closed trash container or bio-hazard box.
Some EPA disinfectants are registered for hospital use, but may not say “Hospital” on their label. In these cases, the product label MUST claim effectiveness against Salmonella choleraesuis, Staphylococcus aureus, and Pseudomonas aeruginosa.
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Additional Information about Disinfectants and Cleaners
1) Disinfectants must be mixed, used, stored and disposed of according to manufacturer’s label instructions (proper mixing ratio is of the utmost importance to be an effective disinfectant). Some are ready to use and do not require mixing.
2) U.S. Federal Law prohibits the use of EPA-registered disinfectants in a manner that is contrary to its label.
3) Disinfectants must be prepared fresh every day (including spray bottles). Further, they must be replaced immediately if the solution becomes visibly contaminated. Disinfectant solutions will lose their strength upon standing and become ineffective within 24 hours. Use a logbook to record when fresh disinfectant is made.
4) Disinfectants are ineffective if implement/tools are not properly cleaned prior to use.
5) Just spraying disinfectants on tools and equipment is inadequate.
6) Disinfectants can damage or rust some metal tools if improperly used.
7) All disinfectant containers must be properly labeled. Disinfectant solutions prepared in the salon must list on the container: the contents and percentage solution (concentration), and use a logbook to record the date and time of mixing. Check the label for the product’s expiration date.
8) All brushes used for cleaning purposes must be properly cleaned and disinfected between each use.
9) Ultra-violet light cabinets are not suitable replacements for liquid disinfectant solutions.
10) Read all warning labels and precisely follow manufacturer’s instructions.
• These guidelines are believed to be highly effective and are designed to help avoid unforeseen pitfalls, problems and complications.
• These guidelines are not a replacement for local government standards, rules or regulations.
• Always consult federal, state and local laws and regulations, which may vary somewhat from these recommendations.
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• Disinfectants used should indicate on the label that they're approved for hospital use.
• A disinfectant label should clearly show its uses and that it is EPA-approved.
►Study the following information.
Merriam-Webster's Medical Dictionary defines Disinfectants and Antiseptics as:
Antiseptic: a substance that inhibits the growth and reproduction of disease-causing microorganisms. For practical purposes, antiseptics are routinely thought of as topical agents, for application to skin and mucous membranes.Their uses include cleansing of skin and wound surfaces after injury, preparation of skin surfaces prior to injections or surgical procedures, and routine disinfection of the oral cavity as part of a program oral hygiene.
Disinfectant: Any chemical agent used chiefly on inanimate objects to destroy or inhibit the growth of harmful organisms.
Hand WashingHand washing, when done correctly, is the single most effective way to prevent the spread of communicable diseases. Good hand washing technique is easy to learn and can significantly reduce the spread of infectious diseases among both children and adults.
What types of disease can good hand washing prevent?• Diseases spread through fecal-oral transmission. Infections which may be
transmitted through this route include salmonellosis, shigellosis, hepatitis A, giardiasis, enterovirus, amebiasis, and campylobacteriosis. Because these diseases are spread through the ingestion of even the tiniest particles of fecal material, hand washing after using the toilet cannot be over-emphasized.
• Diseases spread through indirect contact with respiratory secretions. Microorganisms which may be transmitted through this route include influenza, Streptococcus, respiratory syncytial virus (RSV) and the common cold. Because these diseases may be spread indirectly by hands contaminated by respiratory discharges of infected people, illness may be avoided by washing hands after coughing or sneezing and after shaking hands with an individual who has been coughing and sneezing.
• Diseases may also be spread when hands are contaminated with urine, saliva or other moist body substances. Microorganisms which may be transmitted by one or more of these body substances include cytomegalovirus, typhoid, staphylococcal organisms, and Epstein-barr virus. These germs may be transmitted from person to person or indirectly by contamination of food or inanimate objects such as toys.
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What is good hand washing technique?By rubbing your hands vigorously with soapy water, you pull the dirt and the oily soils free from your skin. The soap lather suspends both the dirt and germs trapped inside and are then quickly washed away.
Follow these four steps to keeping hands clean:• Wet your hands with warm running water. • Add soap, then rub your hands together, making a soapy lather. Do this away from
the running water for at least 15 seconds, being careful not to wash the lather away. Wash the front and back of your hands, as well as between your fingers and under your nails.
• Rinse your hands well under warm running water. Let the water run back into the sink, not down to your elbows.
• Dry hands thoroughly with a clean towel. Then turn off the water with a clean paper towel and dispose in a proper receptacle.
May I use the over-the-counter alcohol gels for washing my hands instead of using soap and water?These products, which can be found wherever soap is sold, are very effective at killing germs on the hands as long as your hands are not visibly dirty. They should be used when soap and water are not readily available.To use correctly, apply about a teaspoonful of the alcohol gel on the palm of one hand. Then rub all over both hands, making sure you rub the front, back, and fingernail areas of both hands. Let the alcohol dry, which should take about 30 seconds.If your hands look dirty but you have no other way to wash your hands, use the gel but wash with soap and water as soon as you can.
Transmission of Pathogens on HandsTransmission of pathogens from one person to another happens when:
• Organisms present on the patron's skin transfers to the hands of the Salon Professional
• Hand washing or hand antisepsis by the Salon Professional are inadequate or omitted entirely, or the agent used for hand hygiene is inappropriate.
• The contaminated hands of the Salon Professional comes in direct contact with another person, or with an inanimate object that will come into direct contact with a person
Pathogens can be transported from one person to another. The number of organisms present on the skin varies. Persons with diabetes, patients undergoing dialysis for chronic renal failure, and those with chronic dermatitis are more likely to have colonized organisms. We shed microorganisms daily from normal skin onto nightgowns, bed linen, bedside furniture, and other objects in our environment.
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Scientific Study of Hand WashingInvestigators use different methods to study hand washing, antiseptic hand wash, and hand antisepsis protocols. Differences among the various studies include:
whether hands are purposely contaminated with bacteria before use of test agents,the method used to contaminate fingers or hands, the volume of hand-hygiene product applied to the hands, the time the product is in contact with the skin, the method used to recover bacteria from the skin after the test solution has been used, and the method of expressing the effectiveness of the product
Despite these differences, the majority of studies can be placed into one of two major categories:
1. studies focusing on products to remove transient flora and 2. studies involving products that are used to remove resident flora from the hands
The majority of studies of products for removing transient flora from the hands involve artificial contamination of the volunteer's skin with a defined test organism before the volunteer uses a plain soap, an antimicrobial soap, or a waterless antiseptic agent.
In the United States, antiseptic hand wash products are regulated by FDA's Division of Over-the-Counter Drug Products (OTC). Products are evaluated by using a standardized method. Tests are performed in accordance with use directions for the test material.
Plain (Non-Antimicrobial) Soap Soaps are detergent-based products that contain esterified fatty acids and sodium or potassium hydroxide. Their cleaning activity can be attributed to their detergent properties, which result in removal of dirt, soil, and various organic substances from the hands. Plain soaps have minimal, if any, antimicrobial activity. However, hand washing with plain soap can remove loosely adherent transient flora.
Alcohol-based Hand CleansersThe majority of alcohol-based hand antiseptics contain either isopropanol, ethanol, n-propanol, or a combination of two of these products. The majority of studies of alcohols have evaluated individual alcohols in varying concentrations.
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Alcohols, when used in concentrations present in alcohol-based hand rubs, also have activity against several viruses. For example, 70% isopropanol and 70% ethanol are more effective than medicated soap or nonmedicated soap in reducing viruses on fingers. Products containing 60% ethanol were also found to reduce the presence of viruses.
Other viruses such as hepatitis A and the polio virus may require 70%--80% alcohol to be reliably inactivated. However, both 70% ethanol and a 62% ethanol foam product with emollients reduced hepatitis A virus on whole hands or fingertips more than nonmedicated soap. However, depending on the alcohol concentration, the amount of time that hands are exposed to the alcohol, and viral variant, alcohol may not be effective against hepatitis A and other viruses. Alcohol can prevent the transfer some pathogens.
Alcohol-based products are more effective for standard hand washing than soap or antimicrobial soaps.
The effectiveness of alcohol-based hand-hygiene products is affected by several factors, including:• the type of alcohol used• concentration of alcohol • contact time• volume of alcohol used and • whether the hands are wet when the alcohol is applied
Frequent use of alcohol-based formulations for hand antisepsis can cause drying of the skin unless emollients, humectants, or other skin-conditioning agents are added to the formulations. The drying effect of alcohol can be reduced or eliminated by adding 1%--3% glycerol or other skin-conditioning agents.
Moreover, in several recent prospective trials, alcohol-based rinses or gels containing emollients caused substantially less skin irritation and dryness than the soaps or antimicrobial detergents tested. These studies, which were conducted in clinical settings, used various subjective and objective methods for assessing skin irritation and dryness.
Further studies are warranted to establish whether products with different formulations yield similar results.
Alcohols are flammable. As a result, alcohol-based hand rubs should be stored away from high temperatures or flames in accordance with National Fire Protection Agency recommendations.
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Irritant Contact Dermatitis Resulting from Hand-Hygiene Measures Frequency of Irritant Contact Dermatitis Frequent and repeated use of hand-hygiene products, particularly soaps and other detergents, is a primary cause of chronic irritant contact dermatitis. This is of great concern to all Salon Professionals.
The potential of detergents to cause skin irritation can vary considerably. Irritation associated with antimicrobial soaps may be caused by the antimicrobial agent or by other ingredients of the formulation. Affected persons often complain of a feeling of dryness or burning; skin that feels rough or even scaling.
Detergents can damage the skin. Irritant contact dermatitis is more commonly reported with iodophors. Other antiseptic agents that can cause irritant contact dermatitis (in order of decreasing frequency) include chlorhexidine, triclosan, and alcohol-based products.
Skin that is damaged by repeated exposure to detergents may be more susceptible to irritation by alcohol-based preparations.
Allergic Contact Dermatitis Associated with Hand-Hygiene Products Allergic reactions to products applied to the skin may present as delayed type reactions or less commonly as immediate reactions.
The most common causes of contact allergies are fragrances and preservatives; emulsifiers are less common causes. Liquid soaps, hand lotions or creams, and may contain ingredients that cause contact allergies.
Allergic contact dermatitis associated with alcohol-based hand rubs is uncommon. Allergic reactions to alcohol-based products may represent true allergy to alcohol, allergy to an impurity or aldehyde metabolite, or allergy to another constituent of the product.
Proposed Methods for Reducing Adverse Effects of Agents Potential strategies for minimizing hand-hygiene--related irritant contact dermatitis include reducing the frequency of exposure to irritating agents (particularly detergents), replacing products with high irritation potential with preparations that cause less damage to the skin, and increasing education on hand care.
Hand lotions and creams often contain humectants and various fats and oils that can increase skin hydration and replace altered or depleted skin lipids that contribute to the barrier function of normal skin.
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MRSA Methicillin-Resistant Staphylococcus AureusIn health news reports, awareness of one particular type of invasive staph infection has come to the forefront. It is called MRSA . It is also known as “the flesh eating disease”. The results of having this disease is often bodily disfigurement. Bodily damage occurs in varying degrees of severity.An outbreak of “USA300 strain” MRSA: methicillin-resistant Staphylococcus aureus occurred in a Cosmetologist and 2 of her customers. Eight other persons, who were either infected or colonized, were linked to this outbreak, including a family member, a household contact, and partners of customers.
The CA-MRSA USA300 strain is known to cause outbreaks among population groups, such as:
• native Americans, • prison inmates, • military personnel, • men who have sex with men, and • competitive sports participants, • and accounts for 97% of MRSA isolates obtained in emergency departments
across the United States from patients with soft tissue infections.
CA-MRSA is associated with invasive infections. The USA300 strain, which is also found in Europe was first isolated in the Netherlands in 2002.Overall prevalence of MRSA in the Netherlands is low (2%).
In 2006, 3.8% of all MRSA isolates sent to the National Institute for Public Health were identified as the USA300 strain. We report an outbreak of the USA300 strain related to a Beauty Salon in the Netherlands, in a:
CosmetologistA family memberA household contact and Customers and their partners.
The Study of MRSAIn September 2005, a medical microbiologist from the regional medical microbiology laboratory reported to the municipal health department a recurring MRSA infection in a Cosmetologist. From December 2004 onwards, the woman had recurrent infections on the:
legs, buttocks, and groin
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resulting in treatment to include incision and drainage of lesions. When an abscess developed in the genital area in July 2005, MRSA was cultured from a wound swab.
In December 2005, the Cosmetologist was declared MRSA-free after antimicrobial treatment. Swabs were taken 3 times in 1-week intervals from:
nose, throat, perineum, and wound
and used for enrichment culture of MRSA.
In March 2006, the woman was tested again for MRSA colonization; test results showed that she had been reinfected or that therapy had failed. The Cosmetologist had eczema. Because of the "hands on" nature of her work, she was advised to temporarily stop providing services to customers.The municipal health department conducted a risk assessment of the woman's household contacts and the Beauty Salon.
The Netherlands does not require that MRSA infections be reported. Therefore, the municipal health department depends upon the consent and full cooperation of index patients and contacts for further investigation of outbreaks.
Consequently, in this instance, household contacts for screening were identified but had not presented themselves for screening.
Contacts who had complaints sought treatment at the emergency department, where the observant infection control practitioner and microbiologists related them to the MRSA outbreak.
Nurses obtained specimens by swabbing each patient's nose, throat, and wounds. A case was defined as a patient who had a culture-confirmed MRSA infection during the outbreak period July 2005–December 2006 and a direct epidemiologic link to the index patient.
In April 2006, a salon customer was hospitalized with an abscess of the breast caused by MRSA; in July 2006, another customer who had had boils since February 2006 was found to be MRSA positive.
Both customers had been given wax treatments by the Cosmetologist during the period in which she had an infected hair follicle in her armpit.
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Swabs taken from this site showed that the beautician was infected with the same MRSA strain as before. Concern arose about the risk for infection to customers through:
• instruments, • materials (wax), or • contact with other employees.
The index patient and the other 6 employees of the salon regularly provided services to each another.
A nurse and a member of the municipal health department visited the salon in June 2006 to check on hygiene protocols and to advise on preventive measures to reduce risk for further transmission. All working procedures and protocols were investigated, and the salon was advised to clean and disinfect instruments and procedure rooms.
More specifically, the health department observed a total waxing procedure performed by the staff.
Ten swabs were taken from: used wax, wax implements, and the treatment room.
All 6 employees were screened and informed about MRSA and the current situation. Arrangements were also made to test 22 regular customers who had received wax treatments by the index patient in the previous 2 months.
In the following weeks, these customers were screened at the municipal health office and informed about MRSA. Of the 22 regular customers, 21 completed a questionnaire and 19 were actually screened for MRSA by culturing samples from nose and throats.
All employees and the 19 selected regular customers were negative for MRSA colonization. All environmental swabs were also negative for MRSA. It was noted that the 70% alcohol used to disinfect the skin after waxing was diluted with water because customers had complained about the stinging effect of the alcohol on treated skin. Furthermore, it became apparent that after performing waxing treatments the Cosmetologist would touch the waxed skin of customers with ungloved hands to check for remaining hairs. She did not wash her hands after removing the gloves.
During the outbreak investigation, more background information became available from those who were MRSA colonized or infected and who could be indirectly linked to the beautician or her customers.
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During the week that the first infected customer was identified (in April 2006), another customer was hospitalized with an abscess in the groin. Unfortunately, no culture was taken from this patient. The partner of the second infected customer was also infected with MRSA that was related to an abscess on his leg.
By the end of 2006, a MRSA-positive couple was identified as a contact of the second infected customer. In August 2006 another couple was reported to be MRSA positive; both had abscesses on the thighs.
Because no further epidemiologic data could be obtained, whether the couple's infection was linked to the beauty salon is not clear.
A total of 45 persons who had been in direct or indirect contact with the beautician were screened for MRSA: • 3 family members • 3 roommates• 11 other persons (including secondary contacts)• 6 beauty salon employees and • 22 customers (including regular customers)
Fifteen persons had skin infections and 10 of them were colonized with MRSA • Cosmetologist• family member • roommate• ex-partner of the roommate• customers and • partners of customers
Although skin infections never developed in the Cosmetologist's family members, tests did show MRSA colonization in one of them. The beautician's boyfriend, a native of the United States, had already lived for 2 years in the Netherlands. Although he had skin lesions, no MRSA was found. The girlfriend of a sport mate who regularly exercised with the partner of a customer was colonized with MRSA at the end of 2006.
She had immigrated recently from the United States to the Netherlands, but her first screening test results were negative. The mean age of the patients was 29 years (range 21–40 years).
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Eleven people were found to be MRSA positive. Of these 11:
3 persons with a direct link to the beauty salon (the Cosmetologist and 2 customers)
6 with an indirect link (family member, roommate, ex-partner of roommate, partner of a customer, sport mate of partner of a customer and his partner), and
a couple from whom no epidemiological data could be obtained were infected with the same MRSA strain as the Cosmetologist.
All MRSA isolates were identical and identified as the well-known CA-MRSA USA300 strain. All MRSA isolates had identical susceptibility patterns: resistant to oxacillin (and thus to all β-lactam antimicrobial drugs) and erythromycin, and susceptible to rifampicin, ciprofloxacin, gentamicin, clindamycin, vancomycin, teicoplanin, tetracycline, cotrimoxazole, mupirocin, and fusidic acid.
ConclusionsOutbreaks of CA-MRSA strains have been reported with increased frequency. Several reports involved outbreaks among:
competitive sports participants
military personnel
men who have sex with men
prisoners
native Americans
and drug users
SummaryIt is very important to maintain adequate sanitation, disinfection, sterilization, and handwashing as part of your customary practice throughout your professional career. When following sanitation guidelines, we avoid skin conditions and communicable diseases such as MRSA. Proper sanitation can literally save lives. Skin treatments in a beauty salon most likely led to MRSA transmission as a result of contact with an infected Cosmetologist. Don't let this happen in your salon. Be proactive and be a leader.
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Credits
ContinuingCosmetology.com © 2013 PO Box 691296 Orlando, FL 32869 407-435-9837 www.continuingcosmetology.com [email protected]
Florida Department of Business and Professional Regulation1940 North Monroe Street, Tallahassee, FL 32399-0783, www.myfloridalicense.com
Florida Board of Barbers1940 North Monroe Street, Tallahassee, FL 32399-0783, www.myfloridalicense.com
Milady's Standard Cosmetology (2008) Thomson Delmar Learningwww.milady.cengage.com, Executive Woods, 5 Maxwell Dr. Clifton Park New York, 12065
Milady's Standard Fundamentals for Estheticians, 9th Edition (2004) Delmar Learning
Nail Structure and Product Chemistry, Second Edition (2005) Thomson Delmar Learning
Milady's Standard Nail Technology, 5th Edition (2007) Thomas Delmar Learning
U.S. Environmental Protection Agencywww.epa.gov, Ariel Rios Building, 1200 Pennsylvania Avenue, N.W. Washington, DC 20460
U.S. Consumer Product Safety Commissionwww.cpsc.gov ; 4330 East West Highway, Bethesda, MD 20814
Center for Disease Control, www.cdc.gov,Food and Drug Administration, www.fda.gov
Occupational Safety and Health Administrationwww.osha.gov, 200 Constitution Ave., NW, Washington, DC 20210
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