Oregon Avoids Outbreaks, Deserves Applause 

Our fall and winter series focusing on safety and infection control continues.  The first three columns in the series focused on hand washing, disinfection and disposal, and infectioncontrol.  Specific Oregon Administrative Rules (OAR) numbers are included for your reference. 

The distressing news came from northern California in 2000 and 2004.  Hundreds of nail salon customers caught nasty leg infections from improperly cleaned and disinfected footbaths.    

Left with scars or worse, these damaged customers sued the owner of the nail salon, Fancy Nails, responsible for the initial outbreak in Watsonville, California.  After nearly four years of litigation, 73 customers settled for a split of nearly $3 million in what appeared to be the first litigated case related to a nail salon outbreak.  The multiple salons found responsible for the 2004 outbreaks in San Jose are also being sued.   

Now the good news:  Oregon has yet to suffer an outbreak of infections caused by improperly cleaned and disinfected footbaths.  But that doesn’t mean that Oregon practitioners are always following state regulations meant to prevent such outbreaks from occurring. 

Enforcement officers of the Oregon Health Licensing Agency (OHLA) who regularly inspect cosmetology facilities throughout the state provide me with enough examples of practitioners who are not following regulatory requirements and are putting their customers at risk. 

Still, it seems as though the majority of Oregon practitioners are following those requirements, substantially reducing the chance of Oregon customers experiencing the pain, suffering and scars experienced by those in California.  

So, how about a round of applause for those practitioners?  Good job! 

Don’t Rest on Your Laurels 

OK, now that the applause is subsiding, I should tell you that there have been reports of individual skin infections in Oregon similar to those in the California outbreaks.  I’m not sure if they were conclusively linked to a nail salon, but just because Oregon hasn’t had an outbreak doesn’t mean we should relax. 

The more recent San Jose outbreak involved a different type of bacteria.  I’m not a scientist, but it seems as though new and different types of nasty little microbes keep surfacing if given the chance.   

OHLA is working with the Department of Human Services, Public Health Division, to track any potential outbreaks or individual cases.  Practitioners can help the public protection effort by reviewing state requirements and going above and beyond in insuring their footbaths are free of infectious microbes. 

Oregon regulations regarding footbath safety and infection control are short and simple:  Oregon Administrative Rule (OAR) 817-010-0101(5) states:  “Foot spa equipment shall be cleaned and disinfected with a high-level disinfectant after use on each client.” 

OHLA provides practitioners with more detailed, step-by-step instructions (including the requirement to remove and clean/disinfect screens after each use!) in a free brochure that can be downloaded from ourWeb site at www.oregon.gov/OHLA or requested by calling the agency at 503-378-8667.   

And don’t forget client record requirements (also in brochure format), established to contact customers potentially affected by an infection outbreak should one ever occur in Oregon.  These brochures are reprinted for your convenience in this month’s Oregon Regulatory News. 

Beyond that, there are several other factors involved in keeping your customers safe and sound.   

Don’t Shave Before Service 

One of the most effective ways to prevent transmission of infectious microbes that isn’t a regulatory requirement is suggesting to your customers that they don’t shave their legs prior to a pedicure. 

Why?  Shaving may create tiny breaks in the skin that provide a more likely route for microbes to invade an unsuspecting customer.   

Besides using a high-level disinfectant, you should also be aware of the different types of cleaners to use beforedisinfection.  Basically, there are two types (enzymatic and surfactant) that work well to break down the build-up of dead skin, oils, lotions and other “bio-films” that can be found in footbaths. 

There are EPA-registered disinfectant products that include these types of cleaners, offering one-step cleaning and disinfection. 

The key tip to remember is that if you don’t break down the build-up of “bio-film” in the first place the disinfectant is less likely to do its important job of actually killing the microbes. 

Once again, give yourself a hand if you’re doing everything you can to prevent transmission of microbes while providing footbath services.  And, once again, if you have any questions or need clarification, contact OHLA at your convenience. 

Kraig Bohot is Communications Officer at the Oregon Health Licensing Agency (OHLA), a state consumer protection agency providing centralized regulatory oversight of multiple health and related professions.  He can be reached at (503) 378-8667, ext. 4330 or at kraig.bohot@state.or.us

OHLA Brochures on Footbath Safety, Client Records Reprinted Here for Your Convenience 

Footbath Safety 

Put your “best foot forward” by following these infection control requirements.  Be sure to follow these three steps between each of your clients: 

• Drain all water and remove all debris from the footbath. 
• Clean surfaces and walls of the footbath with soap or detergent and rinse with clean, clear water.
• Disinfect with bleach or an EPA-registered high-level disinfectant with demonstrated tuberculocidal activity used according to manufacturer’s instructions. The entire unit must be disinfected with a high-level disinfectant immediately after use on each client. 

After service for each customer, be sure to clean and disinfect the screen to keep bacteria from building up. 

• Remove the screen.  All debris trapped behind the screen of a footbath must be removed.  Wash the screen and inlet with soap or detergent and water.
• Before replacing the screen, totally immerse the screen in a bleach solution or high-level disinfectant with demonstrated tuberculocidal activity used according to the manufacturer’s instructions. 

At the end of the day, rinse the footbath as the last step in the infection control process by following these steps: 

• After following the outlined cleaning procedures, fill the footbath tub with a solution of a high-level disinfectant mixed with water.  Be sure to follow manufacturer’s instructions. 
• Turn on footbath and circulate the solution through the footbath system for at least 10 minutes. 
• Drain and flush the system. 
• Wipe dry with a clean towel. 

Required Client Records 

(1) Facility owners and independent contractors providing esthetic or nail technology services must maintain client records to ensure basic client information is available to safeguard the health and well being of both the client and practitioner. 

(2) Legible hand-written or electronic records are acceptable.  Basic client information includes the client’s name, address, telephone number, type of service and date of service. 

(3) The record must include the name and registration number of the practitioner providing service, and special instructions or notations that the practitioner believes to be pertinent to providing esthetic or nail technology services to the client, such as bleeding disorders, allergies or sensitivities to chemicals or products or complications during service(s). 

(4)  A practitioner may obtain medical advice if necessary to safeguard the client or the practitioner. 

(5) Client records must be kept at the facility premises for a minimum of two years and must be
made available immediately upon request from an enforcement officer of the Oregon Health
Licensing Agency. 

(6) A practitioner may not provide services to a client who refuses to provide the personal information required by (2) of this rule unless the client signs a waiver form documenting the client’s refusal to provide the required information. The signed waiver form must be retained on file in the manner required in subsection (5) of this rule for client records.

Shear Numbers 

How many cosmetology practitioners and facilities are active in Oregon?  (Numbers in parentheses +/- change from previous month.)  According to Oregon Health Licensing Agency (OHLA) records as of February 28, 2007:

Practitioners: 28,788 (+135) 
Facilities: 4,440 (+13) 
Independent contractors: 6,731 (+37) 
Certificate of ID: 172 (-3)

Barbering: 7,968 (-236) 
Esthetics: 13,417 (-107) 
Hair Design: 20,453 (+65) 
Nail Technology: 15,072 (-145)