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Cosmetology.EliteCME.com Page i Table of Contents

CE for Florida Salon Professionals All 16 Hrs ONLY $ 95 CHAPTER 1: THE FIVE STAR HAIRCOLORIST Page 1 21. (4 CE Hours) Elective

CHAPTER 2: CHEMICAL MAKEUP AND CONDITIONS OF HAIR Page 16

(2 CE Hours) Satisfies Chemical Makeup Requirement What if I Still Have Questions? CHAPTER 3: WORKERS’ COMPENSATION Page 23 No problem, we have several options for you to choose (1 CE Hour) Satisfies Workers’ Compensation Requirement from! Online at Cosmetology. EliteCME.com you will see our CHAPTER 4: HIV/AIDS Page 29 robust FAQ section that answers many of your questions, simply (2 CE Hours) Satisfies HIV/AIDS Requirement click FAQ in the upper right hand corner or Email us at office@ CHAPTER 5: FLORIDA LAWS AND RULES Page 39 elitecme.com or call us toll-free at 1-855-769-9888, Monday (2 CE Hours) Satisfies Laws and Rules Requirement - Friday 9:00 am - 6:00 pm. Please contact us if you have not CHAPTER 6: ENVIRONMENTAL ISSUES Page 54 received your certificate within 7-10 business days. (1 CE Hour) Satisfies Environmental Issues Requirement

CHAPTER 7: OSHA: PROTECTING THE HEALTH OF YOU AND YOUR CLIENT Page 58

(1 CE Hour) Satisfies OSHA Requirement Visit Cosmetology.EliteCME. com to view our entire course CHAPTER 8: SANITATION AND STERILIZATION Page 64 library and get your CE today!

(3 CE Hours) Satisfies Sanitation and Sterilization Requirement

PLUS... Lowest Price Guaranteed Final Examination Questions Page 78 A+ Rating from BBB Serving Professionals Since 1999 Student Final Examination Answer Sheet Page 81

Course Evaluation Page 82 Elite Continuing Education

All Rights Reserved. Materials may not be reproduced without the expressed written permission or consent of Elite Professional Education, LLC. The materials presented in this course are meant to provide the consumer with general information on the topics covered. The information provided was prepared by professionals with practical knowledge in the areas covered. It is not meant to provide medical, legal or professional advice. Elite Professional Education, LLC recommends that you consult a medical, legal or professional services expert licensed in your state. Elite Professional Education, LLC has made all reasonable efforts to ensure that all content provided in this course is accurate and up to date at the time of printing, but does not represent or warrant that it will apply to your situation or circumstances and assumes no liability from reliance on these materials.

Page ii Cosmetology.EliteCME.com Chapter 1: The Five Star Haircolorist

4 CE Hours (Elective)

By: JoAnn Stills

Learning objectives ŠŠ Hair color inspiration. This program is divided into 5 sections: INSPIRATION, ŠŠ Techniques. TECHNIQUES, CHEMISTRY, COLOR MAINTENANCE and ŠŠ Hair color chemistry. COLOR CORRECTION. ŠŠ Hair color correction. ŠŠ Increase your color business.

Increase your color business How many of us would like a raise? How much? 5%...10%...20%... While the demand for skilled colorists grows, most come out of school even 60%? rank amateurs in the art of science and color; and many are rightfully How many want to be a “genius” to our clients? How much hair color fearful of making mistakes. Above all, hair coloring requires technical are you currently doing? …10%...20%...50%? precision, and the only way to become an expert is by doing it many times. Stylists should find a good resource for hair samples and testing We know that in the rest of the World…98% of the clients receive materials and practice, practice, practice. The best hair colorists color services on a regular basis; both women and men. (The 2% are have done it a million times and have learned from failures as well as children.) This fact represents the potential of up to 60% new color successes. Running your own experiments will increase your skills as business! Why such a big difference between the U.S. and the rest of well as your confidence in the results. the World? The function and ingredients in home hair color products and THE REST OF THE WORLD CONSIDERS THE HAIR COLOR those found in the salon are essentially the same. The major TO BE THE MOST IMPORTANT “COSMETIC” TO THE SKIN. difference in home hair color versus Salon color is the expertise of IN ADDITION, STYLISTS WILL STUDY YEARS LONGER a professional colorist who is able to custom blend a specific color TO BECOME LICENSED AND TAKE CHEMISTRY VERY and control the amount of hydrogen peroxide or other products used. SERIOUSLY. Through experience, the stylist learns how the process will affect hair Also, Hair Color services can be the most lucrative and rewarding color and quality, and how long or short a time to process the color. service offered at a Salon. We can take a Hair Cut only client to a Hair New do-it-yourself products are both a boon and a burden. Many Cut AND Color client in a very short period of time; with very little clients may try to color their own hair with varying results. You may effort. Today’s client flow demands FOUR TIMES the number of have to correct a client’s mistake. Your knowledge and abilities will clients as in previous years. We simply MUST make each client more ensure that the client’s money is well-spent, and you’ll find your valuable to the Salon! confidence stretched with each success. Coloring accidents can be a Yet, many stylists remain apprehensive about color long after they nightmare; but great color correction can make you invaluable to that leave Cosmetology School. This is probably because hair coloring client. Remember, the product is only one part of the equation (and is about Chemistry. This can present problems and mistakes that can not the most important part). While a client can produce satisfactory drastically affect real people. This course will remind you about the results with the first application, re-touches will become problematic basics of the process, and discuss the products and techniques to help simply because different bases are involved and the hair’s condition is boost your confidence as you boost your knowledge. For those who compromised. have been using hair coloring products comfortably for years, this Careful reading is essential to successful hair coloring, starting with course will refresh and reinforce the important points, and perhaps the critical information in product directions and manufacturer’s introduce a few new concepts or products. information. One can also “read up” on new hair color developments Hair care services are constantly evolving, and there continues to be an and the latest technologies in magazines and on the Internet. Artful increasing demand for color services. From covering gray, restoring hair coloring is enhanced by reading and doing. Not only can you or “tweaking” the original color, “highlighting” or truly transformative find information about getting the best results with specific products, color; color can improve hair texture and strength, and increase such as details on how to mix and apply hair color; you also can see confidence as much as a good make-up application. Clients receiving photos of the results. The more you learn about hair color, the more color services tend to visit the Salon more frequently than other types valuable your services and the more your clients will appreciate you. of clients and spend more money each time, using both services Let your clients know the magic is not just in the materials, but also and products. Because application time is typically brief, there is a in the expert choice of product and application. Clients know little potential for substantial profits. Additionally, to maintain their look about their options in hair color products and services. YOU provide and address new growth, clients have a strong incentive to stay timely that knowledge. And as an experienced professional, you are able to about services. maximize a good product. This course will help you increase your value in the color equation. Instead of living in fear of hair coloring disasters, you might even

Cosmetology.EliteCME.com Page 1 get a reputation for correcting them. To really understand how color So that we are all speaking the same language, we will begin with a works, you need to have a basic understanding of a number of topics. GLOSSARY OF TERMS that will be used.

Glossary ACCELERATOR/ACTIVATOR: An additive used to quicken the CATALYST: A substance used to alter the speed of a chemical action or progress of a chemical. Another word for booster, protenator reaction. or catalyst. CATEGORY: A method of defining natural hair to help determine the ACCENT COLOR: A concentrated color product that can be added undertones. to permanent, semi-permanent or temporary haircolor to intensify CAUSTIC: Strongly alkaline materials. At very high pH levels; can or tone down the color. Another word for concentrate and COLOR burn or destroy protein or tissue by chemical action. ADDITIVE. CERTIFIED COLOR: A color which meets certain standards for ACID: An aqueous (water based) solution having a pH less than 7.0 purity and is certified by the FDA. on the pH scale. CETYL ALCOHOL: Fatty alcohol used as an emollient. It is also ALKALINE: An aqueous (water based) solution has a pH greater used as a stabilizer for emulsion systems, and in haircolor and cream than 7.0 on the pH scale. The opposite of acid. Another word for developer as a thickener. BASE/ALKALI. CHEMICAL CHANGE: Alteration in the chemical composition of a ALLERGY: A physical reaction resulting from extreme sensitivity to substance. exposure, contact and/or ingestion of certain foods or chemicals. CITRIC ACID: Organic acid derived from citrus fruits and used for ALLERGY TEST: A test to determine the possibility or degree of pH adjustment. Primarily used to adjust the acid-alkali balance. Has sensitivity; also known as a patch test, predisposition test or skin test. some antioxidant and preservative qualities. Used medicinally as a AMINO ACIDS: The group of molecules that the body uses to mild astringent. synthesize protein. There are 22 different amino acids found in living COATING: Residue left on the outside of the hair shaft. protein that serve as units of hair structure. COLOR: Visual sensation caused by light. AMMONIA: A colorless, pungent gas composed of hydrogen and nitrogen; in water solution is called ammonia water. Used in COLOR BASE: The combination of dyes which make up the tonal haircolor to swell the cuticle. When mixed with hydrogen peroxide, it foundation of a specific haircolor. Also DYE STOCK. activates the oxidation process on melanin, and allows the melanin to COLOR LIFT: The amount of change natural or artificial pigment decolorize. undergoes when lightened by a substance. AMMONIUM HYDROXIDE: An alkali solution of ammonia in COLOR MIXING: Combining two or more shades together for a water; commonly used in the manufacturing of permanent haircolor, custom color. lightener preparations and hair relaxers. COLOR REFRESHER: (1) Color applied to mid-shaft and ends to ANALYSIS (HAIR): An examination of the hair to determine its give a more uniform color appearance to the hair. (2) Color applied condition and natural color. by a shampoo-in method to enhance the natural color. Also called AQUEOUS: Descriptive term for water solution or any medium that color wash, color enhancer, color glaze. is largely composed of water. COLOR REMOVER: A product designed to remove artificial ASH: A tone or shade dominated by greens, blues, violets or grays. pigment from the hair. Also DYE REMOVER/DYE SOLVENT. May be used to counteract unwanted warm tones. COLOR TEST: The process of removing product from the hair BASE COLOR: The combination of dyes which make up the tonal strand to monitor the progress of color development during tinting or foundation of a specific haircolor. lightening. Also called STRAND TEST. BLEACH/LIGHTENER: The chemical compound which lightens COLOR WHEEL: The arrangement of primary, secondary and the hair by dispersing, dissolving and decolorizing the natural hair tertiary colors in the order of their relationships to each other. A tool pigment. for formulating. BLEEDING: Seepage of tint/lightener from the packet containing the COMPLEMENTARY COLORS: A primary and secondary color hair to be colored or frosting cap due to improper application. positioned opposite each other on the color wheel. When these two colors are combined, they create a neutral color. Combinations are as BLENDING: A merging of one tint or tone with another. follows: Blue/Orange, Red/Green, Yellow/Violet. BLONDING: A term applied to lightening the hair. CONDITION: The existing state of the hair; its elasticity, strength, BONDS: The means by which atoms are joined together to make texture, porosity and evidence of previous treatments. molecules. CONSULTATION; Verbal communication with a client to determine BRASSY TONE: Undesirable red, orange or gold tones in the hair. desired result. BREAKAGE: A condition in which hair splits and breaks off. CONTRIBUTING PIGMENT: The current level and tone of the BUFFER ZONE: Applying color away from the scalp to avoid hair. Refers to both natural contributing pigment and decolorized chemical overlapping. (lightened) contributing pigment. BUILD-UP: Repeated coatings on the hair shaft. CORRECTIVE COLORING: The process of correcting an undesirable color. BUMPING THE BASE: A term used to describe a gentle degree of lift of the natural color. CORTEX: The second layer of the hair. A fibrous protein core of the hair fiber, containing melanin pigment. CAP METHOD: A disposable rubber or plastic cap used to highlight or lowlight; hair is pulled through and selectively colored or bleached.

Page 2 Cosmetology.EliteCME.com COVERAGE: Reference to the ability of a color product to color GRAY HAIR: Hair with decreasing amounts of natural pigment. Hair gray, white or other colors of the hair. with no natural pigment is actually white. White hairs look gray when CUTICLE: The translucent, protein outer layer of the hair fiber. mingled with pigmented hair. Also referred to as UNPIGMENTED HAIR. CYSTEIC ACID: A chemical substance in the hair fiber, produced by the interaction of hydrogen peroxide on the disulfide bond (cystine). HAIR: A slender threadlike outgrowth on the skin of the head and body. CYSTINE: The disulfide amino acid which joins protein chains together. HAIR ROOT: That part of the hair contained within the follicle, below the surface of the skin. D & C COLORS: Colors selected from a certified list approved by the FDA for use in drug and cosmetic products. HAIR SHAFT: Visible part of each strand of hair. It is made up of an outer layer called the cuticle, an innermost layer called medulla and DECOLORIZE: A chemical process involving the lightening of the an in-between layer called the cortex. The cortex layer is where color natural color pigment or artificial color from the hair. changes are made. DEGREE: Term used to describe various units of measurement. HARD WATER: Water that contains minerals and metallic salts as DEMI-COLOR/DEPOSIT-ONLY COLOR: A category of color impurities. products between permanent and semi-permanent colors. Formulated HENNA: A plant extracted coloring that produces bright shades of to only deposit color; not lift. They contain oxidative dyes and utilize red. The active ingredient is lawsone. Henna permanently colors the a low volume developer. hair by coating and penetrating the hair shaft. DENSE: Thick, compact or crowded. HIGH LIFT TINTING: A single process color with a higher degree DEPOSIT: Describes the color product in terms of its ability to add of lightening action and a minimal amount of color deposit. color pigment to the hair. Color added equals deposit. HIGHLIGHTING: The introduction of a lighter color in small DEPTH: The lightness or darkness of a specific hair color. sections to increase lightness of the hair. DEVELOPER: An oxidizing agent, usually hydrogen peroxide that HYDROGEN PEROXIDE: An oxidizing chemical made up of 2 reacts chemically with coloring material to develop color molecules parts hydrogen, 2 parts oxygen (H2O2) used to aid the processing of and create a change in natural hair color. permanent haircolor and lighteners. Also referred to as a developer; available in liquid or cream. DEVELOPMENT TIME/OXIDATION PERIOD: The time required for a permanent color or lightener to completely develop. LEVEL: A unit of measurement used to evaluate the lightness or darkness of a color, excluding tone. DIFFUSED: Broken down, scattered; not limited to one spot. LEVEL SYSTEM: In haircoloring, a system colorists use to analyze DIRECT DYE: A preformed color that dyes the fiber directly without the lightness or darkness of a haircolor. the need for oxidation. Also referred to as a STAIN. LIFT: The lightening action of a haircolor or lightening product on DISCOLORATION: The development of undesired shades through the hair’s natural pigment. chemical reaction. LINE OF DEMARCATION: An obvious difference between two DOUBLE PROCESS: A technique requiring two separate procedures colors on the hair shaft. in which the hair is decolorized or pre-lightened with a lightener, before the depositing color is applied. LITMUS PAPER: A chemically treated paper used to test the acidity or alkalinity of products. DRAB: Term used to describe haircolor shades containing no red or gold. Also ASH. MEDULLA: The center structure of the hair shaft. Very little is known about its actual function. Very fine hair many times does not DRABBER: Concentrated color used to reduce red or gold highlights. have it. DULL: A word used to describe hair or haircolor without sheen. MELANIN: The tiny grains of pigment in the hair cortex which DYE: Artificial pigment. create natural color. ELASTICITY: The ability of the hair to stretch and return to normal. MELANOCYTES: Cells in the hair bulb that manufacture melanin. ENZYME: A protein molecule found in living cells which initiates a MELANOPROTEIN: The protein coating of melanosome. chemical process. METALLIC DYES: Soluble metal salts such as lead, silver and FADE: To lose color through exposure to the elements or other bismuth produce colors on the hair fiber, by progressive build-up and factors. exposure to air. FILLERS: (1) Color product used as a color refresher or to replace MODIFIER: A chemical found as an ingredient in permanent undertones in damaged hair in preparation for haircoloring. (2) Any haircolors. Its function is to alter the dye intermediates. liquid-like substance to help fill the need for natural undertones. MOLECULE: Two or more atoms chemically joined together; the FORMULAS: Mixture of two or more ingredients. smallest part of a compound. FORMULATE: The art of mixing to create a blend or balance of two NEUTRAL: (1) A color balanced between warm and cool, which or more ingredients. does not reflect a highlight of any primary or secondary color. (2) Also refers to a pH of 7.0. FROSTING: The introduction of lighter strands to the hair; generally executed with a frosting cap. NEUTRALIZATION: The process that counter-balances or cancels the action of an agent or color. GLAZING: A term used to describe a translucent color used on the hair after a previous haircolor; a blending color. NEUTRALIZE: Render neutral; counter-balance of action or influence.

Cosmetology.EliteCME.com Page 3 NEW GROWTH: The part of the hair shaft that is between PROCESSING TIME: the time required for the chemical treatment previously chemically treated hair and the scalp. Also REGROWTH. to react on the hair. NONALKALINE: Same as ACID. PROGRESSIVE DYES/PROGRESSIVE DYE SYSTEM: (1) OFF THE SCALP LIGHTENER: Generally a stronger lightener A coloring system which produces increased absorption with each (usually in powder form), not to be used directly on the scalp. application. (2) Color products that deepen or increase absorption over a period of time during processing. ON THE SCALP LIGHTENER: A liquid, cream or gel form of lightener that can be used directly on the scalp. RESISTANT HAIR: Hair that is difficult to penetrate with moisture or chemical solutions. OPAQUE: Allowing no light to shine through; flat; lack of translucency. RETOUCH: Application of color or lightener mixture to new growth of hair. OUTGROWTH: Same as NEW GROWTH. SALT AND PEPPER: the descriptive term for a mixture of dark and OVER-LAP: Occurs when the application of color or lightener goes gray or white hair. beyond the line of demarcation. SECONDARY COLOR: Colors made by combining two primary OVER POROUS: The condition where hair reaches an undesirable colors in equal proportions; green, orange and violet are secondary stage of porosity requiring correction. Also SENSITIZED. colors. OXIDATION: (1) The reaction of dye intermediates with hydrogen SEMI-PERMANENT HAIR COLORING: A pre-oxidized hair peroxide found in haircoloring developers. (2) The interaction of color requiring no catalyst that lasts through several shampoos. It hydrogen peroxide on the natural pigment. stains the cuticle layer; slowly fading with each shampoo. OXIDATIVE HAIR COLOR: A product containing oxidation dyes SENSITIZED: Referring to the condition of the hair. May be slight which require hydrogen peroxide to develop the permanent color. (dry) to extreme (over-porous). PARA TINT: A tin made from oxidation dyes. SENSITIVITY: Skin that is highly reactive to the presence of a PARA-PHENYLENEDIAMINE: An oxidative dye used in most specific chemical. Skin reddens or becomes irritated shortly after permanent haircolors, often abbreviated as P.P.D.. application of the chemical. The reaction subsides when the chemical has been removed. PATCH TEST: A test required by the FDA. Performed by applying a small amount of the haircoloring preparation to the skin of the arm, or SHADE: (1) A term used to describe a specific color. (2) The visible behind the ear to determine possible allergies (hypersensitivity). Also difference between two colors. called pre-disposition or skin test. SHEEN: The ability of the hair to shine, gleam or reflect light. PENETRATING COLOR: Color that penetrates the cortex or SINGLE PROCESS COLOR: Refers to an oxidative tint solution second layer of the hair shaft. that lifts or lightens, while depositing color in one application. Also PERMANENT COLOR: (1) Haircolor products that do not wash OXIDATIVE HAIR COLOR. out by shampooing. (2) A category of haircolor products mixed with SOFTENING AGENT: A mild alkaline product applied prior to the developer that create a lasting color change. color treatment to increase porosity, swell the cuticle layer of the hair PEROXIDE RESIDUE: Traces of peroxide left in the hair after and increase color absorption. treatment with lightener or tint. SOLUTION: A blended mixture of solid, liquid or gaseous PERSULFATE: In haircoloring, a chemical ingredient commonly substances in a liquid medium. used in activators that increases the speed of the decolorization SOLVENT: Carrier liquid in which other components may be process. dissolved. pH: The quantity that expresses the acid /alkali balance. A pH of 7 SPECIALIST: One who concentrates on only one part or branch of a is the neutral value for pure water. Any pH below 7 is acidic; any pH subject or profession. above 7 is alkaline. The skin is mildly acidic, and generally in the pH 4.5 to 5.5 range. SPECTRUM: The series of colored bands diffracted and arranged in the order of their wavelengths by the passage of a white light through a pH SCALE: A numerical scale from 0 (very acid) to 14 (very prism. Shading continuously from red (produced by the longest wave alkaline), used to describe the degree of acidity or alkalinity. visible) to violet (produced by the shortest): red, orange, green, blue, PIGMENT: Any substance or matter used as coloring; natural or indigo and violet. artificial haircolor. SPOT LIGHTENING: Color correcting using a lightening mixture POROSITY: Ability of the hair to absorb water or other liquids. to lighten darker areas. POWDER LIGHTENER: Same as OFF THE SCALP STABILIZER: General name for ingredient which prolongs life, LIGHTENER. appearance and performance of a product. PREBLEACHING/PRELIGHTEN: Generally the first step of STAGE: A term used to describe a visible color change that natural double process haircoloring. To lift or lighten the natural pigment.. hair color goes through while being lightened. PRESOFTEN: The process of treating gray or very resistant hair to STAIN REMOVER: Chemical used to remove tint stains from the allow for better penetration of color. skin. PRIMARY COLORS: Pigments or colors that are fundamental and STRAND TEST: Test given before treatment to determine cannot be made by mixing colors together. Red, yellow and blue are development time, color results and the ability of the hair to withstand the primary colors. the effects of chemicals. PRISM: A transparent glass or crystal that breaks up white light into STRIPPING: Also referred to as COLOR REMOVER. its component colors; the spectrum.

Page 4 Cosmetology.EliteCME.com SURFACTANT: An abbreviation for Surface Active Agent. A TONER: A pastel color to be used after pre-lightening. molecule which is composed of an oil-loving (oleophillic) part and TONING: Adding color to modify the end result. a water-loving (hydrophilic) part. They act as a bridge to allow oil and water to mix. Wetting agents, emulsifiers, cleansers, solubilizers, TOUCH-UP: Also RETOUCH. dispersing aids and thickeners are usually surfactants. TRANSLUCENT: The property of letting diffused light pass TABLESPOON: ½ ounce; 2 teaspoons. through. TEASPOON: 1/6 ounce; ½ of a tablespoon. TYROSINE: The amino acid (tyrosine) which reacts together with the enzyme (tyrosinase) to form the hair’s natural melanin. TEMPORARY COLOR/RINSES: Color made from preformed dyes that are applied to the hair for a short-term effect. This type of product TYROSINASE: The enzyme (tyrosinase) which reacts together with is readily removed with shampoo. the amino acid (tyrosine) to form the hair’s natural melanin. TERMINOLOGY: The special words or terms used in science, art or UNDERTONE : The underlying color in melanin that emerges during business. the lifting process and contributes to the end result. When lightening hair, a residual warmth in tone always occurs. TERTIARY COLORS: The mixture of a primary and an adjacent secondary color on the color wheel. Red-orange, yellow-orange, VALUE: Also referred to as LEVEL and DEPTH. yellow-green, blue-green, blue-violet, red-violet. Also referred to as VEGETABLE COLOR: A color derived from plant sources. intermediary colors. VIRGIN HAIR: Natural hair that has not undergone any chemical or TEXTURE, HAIR: The diameter of an individual hair strand. physical abuse. Termed: coarse, medium or fine. VISCOSITY: A term referring to the thickness of a solution. TINT: Permanent oxidizing haircolor product, having the ability to lift and deposit color in the same process. Requires a developer. VOLUME: The concentration of hydrogen peroxide in water solution. Expressed as volumes of oxygen liberated per volume of TINT BACK: To return hair back to its original or natural color. Also solution. 20 volume peroxide would thus liberate 20 pints of oxygen referred to as REPIGMENT. gas for each pint of solution. TONE: A term used to describe the warmth or coolness in color. WARM: A term used to describe haircolor containing red, orange, gold or yellow tones.

Psychology of hair color We, as professional haircolorists, should never lose sight of our role sense of empathy toward the client. Empathy is having the ability to in society. We have the opportunity to make dramatic changes in the put you in the client’s shoes and view the world as they see it. This lives of individuals seeking to improve their appearance. Often times, does not mean acceptance or agreement, only a recognition that clients a change of haircolor can be the catalyst to start the individual in a have their own point of view. positive direction. Because a change of haircolor is so immediate and Direct eye contact is important. Position yourself at eye level with relatively inexpensive (compared to cosmetic surgery), it’s often the the client and look directly at them when consulting. Avoid looking choice for many clients. at the client in the mirror. One of the biggest challenges we face as Just as we must first acquire the skills to perform the necessary haircolorists is negotiating with our clients. Compromise is the key. techniques, it is equally important we never lose sight of the fact Terminology and presentation must be professional. Clients have been that we are working on a living, breathing human being. Our pallet lost because the colorist is too “professional” and not “down to earth”. is never a canvas or a piece of clay. All of us have been exposed to Making a photo album with a variety of haircolors is a great aid apathy by someone who just didn’t care or who may have been having for helping the client find the color they are attempting to describe. a bad day. Bad service or apathy is something a client should not have Clients will often describe or refer to a celebrity who has a haircolor to tolerate. We must fight apathy toward someone because of their they are attracted to. It is a good practice to have them find the same appearance. haircolor in your photo album. Taking the haircolor off the celebrity’s We have the opportunity to take someone less attractive and make face and placing it on a “regular person” could make your client view them more attractive by simply changing their haircolor. The color the haircolor differently. change will create a positive change. Showing a client a book of various haircolors on finished styles is We, as haircolorists, are similar to the artists who restore paintings. insurance that both of you are talking about the same color. It can Through the years, paintings become veiled with a cover of soot also be used to give direction and make recommendations. Without and lose their vibrant color. Artists have the ability to remove the common ground to start from, formulating for the client becomes a veil of soot and restore the painting to its original vivid colors. As gamble. Some clients come to the Salon knowing exactly what they haircolorists, we have the ability to perform the same service on want. The haircolorist should verify the color with a photograph. The our clients. We can take a client, who through the years has lost the haircolorist may approve of the haircolor or may make suggestions vibrancy in their hair, and restore it to its original youthful appearance. of their own. This is when professionalism becomes important. An Or, in another case, transform dull, drab natural hair color to important point to remember when consulting with the client is their spectacular color with glints of beautiful highlights. natural hair color category. If they wore a color at one point in their Client consultation, communication and negotiating are key skills. life, they can wear it again. People in the warm brown category can As we gain confidence and become more proficient in our technical wear the greatest variety of hair color. Review the natural hair color skills, consultation becomes much easier. The more “tools” we have category and remember when a client is placed into a natural hair color at our disposal, the easier it is to solve a greater variety of haircolor category, he/ she stays in that category for life. challenges and in turn, the more we grow our business. It is not recommended that the client be shown a manufacturer’s During the consultation, recognize that most people have a subjective haircolor chart, regardless of how beautiful it looks. The haircolor opinion regarding their appearance. Understanding this can induce a chart is a tool used by the haircolorist to help formulate. The color

Cosmetology.EliteCME.com Page 5 chart will not help the client select a haircolor; rather it conveys erase these fears you will have a comfortable, relaxed client when apprehension on the part of the client. What a color chart will often performing the service. The most common fears a client will have are do is put the client in charge of the consultation. Soon, the client is as follows: selecting her own haircolor. When the client returns for the next ●● HOW WILL MY NEW HAIRCOLOR LOOK ON ME? WILL I appointment, she will again ask to see the color chart to adjust the LIKE IT? formula. Soon, the haircolorist is taking direction from the client. ●● WHAT WILL THE INVESTMENT BE IN TIME AND MONEY? We should always remember the Salon on the next block or in the next ●● IF I DON’T LIKE IT, WHAT WILL IT LOOK LIKE WHEN IT IS city is not our only competition. Our major competition is the drug GROWING OUT? store and the super market. We must always strive to use professional The consultation period is one in which all aspects of the above techniques and methods of application to create haircolors that can not concerns should be addressed. The ability to put the client at ease be duplicated at home. Our goal should be to do whatever possible during her first visit to your salon is paramount. It does no harm to to keep haircoloring a professional service and draw a distinct line embellish the haircolor service by utilizing descriptive terms such as between professional hair color and home hair color. It is not the “growing out gracefully” or “give your hair a youthful appearance” or product you use as much as it is the application method. “soften your appearance”. Utilizing your own terminology will make If the client is coloring their hair for the first time, there is usually the client feel good about the upcoming service. some apprehension. These fears of a client are real. If you can

A word about words! Words can cement or destroy a relationship, bring “color” to your “Wow! Your hair is fried!” Keep your descriptions positive and avoid presentations and make a connection with another person. Above all emotional outbursts. A better description would be: “Yes, your hair else, be careful not to insult the client; especially if he/she has been has lost moisture and needs to have the color replaced; and here is my applying color at home. Once overheard, a colorist said to the client: plan…”

The client consultation We suggest draping the client in white and have a white light above the 2. Discuss the TIME and frequency of the treatment. How often head (or are in natural daylight or have a natural-daylight fluorescent must this be done to assure great results? lighting system). Seat yourself next to the client with a clear view of 3. Be honest with the costs of the services. (MONEY) The client the mirror. It is important to have finished color examples available for should not be surprised by charges either for the initial or retouch the client to view and discuss. Again, this is preferred to showing the services. client a color chart. Fill out a client analysis sheet. This should also 4. The APPOINTMENT TIME should be discussed. Do not attempt contain all relative information including health/medicines and history to give complicated services on the lunch hour or with a screaming of any problems that the client may have had in the past. child in tow. 5. Prescribe MAINTENANCE PRODUCTS. This is your insurance policy that the hair’s integrity is being properly protected. WRITE EVERYTHING DOWN. Now, begin to make suggestions within the parameters set down. Keep the conversation open, friendly and professional. Above all, LISTEN to what the client is saying! More mistakes have been made from a “lack of understanding” than any other situation.

Remember also that as we develop unpigmented (gray) hair, we lose 1. Come to an agreement on the TARGET SHADE. Analyze the pigments in the skin. A safe rule for the conservative client or the natural level of color and find out what the client has in mind. Is a gentleman client is to stay within 1-2 Levels (either lighter or darker) subtle or radical change desired? from the natural color.

Inspiration: Pigment study VOLUMES have been written about which colors go with which Most WARMS will have a peach or copper under-tone to the skin. We skin tones and eye colors. Personally, I have always found these both can also observe pigment bundles (freckles) on the face, arms, chest or confusing and difficult to use when consulting with a client. Fashion upper back. color is a hot topic and trends usually appeal to the young client. Look for points of inspiration in the iris…i.e. flecks of gold, copper However, the mature woman and most men will accept natural-looking and/or bronze. hair color, done in good taste. ANY OF THESE TONES WILL BE ENHANCING TO THAT Easy color analysis can be accomplished by using a lighted magnifying PERSON. glass. Look into the eye; either from the front or the side, and observe the ring around the IRIS (the pigmented area of the eye). BECAUSE THESE PIGMENTS ARE PART OF THE PERSONS’ NATURAL GENETIC MAKE-UP, THE PRINCIPLE OF THE TWO IF THE OUTER RING OF THE IRIS IS BLUE (It could be blue- COLOR FAMILIES WILL APPLY REGARDLESS OF RACE OR grey…to as dark as navy blue) THE PERSON IS COOL-TONED. NATIONALITY. ONLY THE CONCENTRATION OF PIGMENTS Note: Even brown eyes can have a blue ring. Observe the skin. Most WILL BE DIFFERENT. THIS APPLIES TO THE LEVEL OF COOLS will have a yellow base or somewhat sallow complexion. COLOR; THAT IS, VARIATIONS FROM PASTEL (FAIR), IF THE OUTER RING OF THE IRIS IS GREEN (It could be aqua… MEDIUM, TO INTENSE (DEEP). to as dark as forest green) THE PERSON IS WARM-TONED. Note: even blue eyes can have a green ring.

Page 6 Cosmetology.EliteCME.com Who can wear what? (I’m glad you asked that question.) IF YOU WISH TO EQUATE THIS INFORMATION TO SEASONAL THE COOLS CAN WEAR: COLOR, WE CAN DO THAT TOO. NATURALS/NEUTRALS A PERSON, WHO IS COOL-TONED WITH A FAIR ALL COOL TONES COMPLEXION, IS A SUMMER. BURGUNDY/BLUE-REDS A PERSON, WHO IS COOL-TONED WITH A MEDIUM TO DEEP VIOLET REDS COMPLEXION, IS A WINTER. IRRIDESCENT TONES BIEGE TONES A PERSON, WHO IS WARM-TONED WITH A FAIR SOFT GOLD TONES COMPLEXION, IS A SPRING. THE WARMS CAN WEAR: A PERSON, WHO IS WARM-TONED WITH A MEDIUM TO DEEP NATURALS/NEUTRALS COMPLEXION, IS AN AUTUMN. STRONG GOLDS (The above information can be used to advise clients in make-up and COPPER TONES wardrobe selection. This makes you a savvy fashion consultant.) BRONZE TONES SCARLET REDS Note the color family and the points of inspiration on the CLIENT HONEY BLONDES ANALYSIS SHEET. CLEAR REDS

Tht categories of hair color Internationally, all of the color manufacturers use a numbering system rather than referring to “shades”. The reason for this is that numbers translate into an accurate relationship of the pigments present.

All hair color, both natural and artificial, is comprised of Yellow, Red and Blue pigments. Starting with #10 on the International scale, Yellow is the evident pigment. Progressing down, we see the introduction of Red. The darker the hair or hair color, the greater the concentration of these pigments. At #8, we start to see the introduction of Red; represented by the appearance of some orange. At #6, we see the evidence of Red. This increase of concentration provides us with the progression of depth down to #1; which is commonly referred to as Blue-Black. The Blue pigment is most responsible for “buffering” the Red. We experience this when lightening natural hair color. The Blue is the first to be neutralized, thereby exposing the Red, Orange or Yellow.

As a review of the Basic Color Wheel: The three Primary colors are Basically, there are only three color categories: BLONDES; #10, #9, YELLOW, RED and BLUE. Mixed together, they produce BROWN. #8 AND #7; BROWNS; #6, #5 AND #4; AND BLACKS; #3, #2 AND The Naturals/Neutrals are usually represented by the Number or #1. I know…you are thinking: “What happened to reds?” Reds get Level by itself…i.e. #8, Medium Blonde. The Secondary colors into TONES. A Red can be light, and therefore fall into the Blonde are: ORANGE (YELLOW & RED), GREEN (YELLOW & BLUE) Category; and Red can be dark and will fall into the Brown Category. and VIOLET (RED & BLUE). The resulting TONES are produced using the Secondary and Tertiary colors. These are also represented by numbers/letters in some color lines. Below is the most common reference to this. ASH .1 BLUE OR GREEN IRRIDESCENT .2 VIOLET GOLD .3 YELLOW COPPER .4 ORANGE BURGUNDY .5 RED-VIOLET AUBURN .6 RED An example of this would be #8.3, known as Medium Golden Blonde.

Cosmetology.EliteCME.com Page 7 Many exciting combinations are produced by mixing Tones in unequal Working with the color and making swatches will help recognize the parts; that is to produce a Primary and Secondary Tone insertion. An actual color. example of this would be #8.43 known as Medium Coppery Golden REMEMBER: A COOL tone will appear darker than the indicated Blonde. The Copper is the first or dominant tone and Gold is the level; while a WARM tone will appear lighter; due to the reflection of secondary tone. This can be accomplished by using the 2/3 to 1/3 light. ratio. Note: A Tertiary color, i.e. Burgundy Brown, is produced from both A variety of terms are used to describe the tone of a haircolor. Direct and Indirect Dyes. These fade rather quickly and can produce Neutral, natural, drab, gold, ash, smoky, red and auburn red, to run-off each time shampooed. Many fashion shades are produced this mention a few. It is important to know the degree of concentration way. of the tone. For example: The color identified as gold could be a very intense yellow gold or have slightly more gold than a neutral. Again, referring to the Color Wheel, the rule is: OPPOSITE COLORS ON THE COLOR WHEEL WILL NEUTRALIZE ONE ANOTHER.

Types of colors There are many different types of haircoloring products available. ●● Deposit-only haircolor utilizes oxidative and direct dyes, and They include pigmented shampoos, weekly rinses, semi-permanent, requires a developer. The catalyst is generally a low volume permanent lift/deposit haircolor and deposit-only haircolor. oxidative solution. Deposit-only/demi-permanent haircolors are longer lasting than semi-permanent haircolor. The major distinction between semi-permanent and deposit-only/demi- permanent haircolors is that a catalyst is required with deposit- only and demi-permanent color. These are also referred to as deep colors. NOTE: Some deposit only haircolors may create a small amount of lift depending on the volumes of the developer. PERMANENT HAIR COLOR: (deposits in the Cortex layer) Will lift natural hair color and deposit new color. ●● Works with natural pigments. TEMPORARY COLORS: (deposits on the Cuticle layer of the hair) ●● Generally produced from para-phenyene-diamine, para-toluene- ●● Shampoos diamine and meta-toluene-diamine. ●● Rinses ●● Permanent Colors are produced from INDIRECT DYES. They are ●● Mascara clear until processing with the natural pigments. ●● Generally produced from Vegetable Dyes/Stains ●● Permanent (lift/deposit) haircolors are available in a variety of ●● The weekly rinse or temporary haircolor is primarily used to add forms: Gels, liquids and creams. They are packaged in tubes, color to gray hair, faded blondes or brassy hair. This haircolor is as well as bottles. The majority utilize equal parts of peroxide; not generally used to cover gray; but rather give a “blend” to the although some utilize a one to two ratio of haircolor to peroxide. all-over appearance. It does not have the ability to lighten hair. Permanent haircolor works in basically the same manner; they The color will rub off if applied excessively. create a certain degree of lift and deposit. Permanent haircolors SEMI-PERMANENT COLORS: (deposits in the Cuticle layer; may are the only haircolors that are formulated to lighten hair. penetrate slightly deeper if heat is used) The international system of defining the lift/deposit ratio of hair ●● Non-Ammonia and no peroxide (may use heat) color is called the LEVEL SYSTEM. The level system gives the ●● Produced from Vegetable dyes and sometimes Metallic dyestuff colorist an indication of the lift/deposit ratio in a bottle or tube ●● Semi-permanent hair color is not mixed with a catalyst; although of haircolor. Although most manufacturers of haircolor products the application of heat may be used to make the color more utilize the level system, not all manufacturers utilize the same level durable. It is simple to use because the color you see is the color system. When comparing products that are labeled the same level you get. It is a direct dye and does not require oxidation for the from two different manufacturers, the haircolorist must be aware color to stain the hair. In areas where the hair is more porous, that the product could vary as much as two levels. It may not this type of color will show greater intensity. Caution must be produce the same results. How much lightening can we expect? exercised when utilizing a semi-permanent haircolor on porous The lightening action is caused by a combination of the amount of hair; it can stain the hair permanently. ammonia in the color and the volumes of the developer: i.e. 20V DEEP COLOR/NON-AMMONIA COLORS: (deposits in the Cortex H2O2=2 Levels of lift; 30V H2O2=3 Levels of lift; etc. Another layer) tip for formulation is to count the NATURAL LEVEL along with ●● More durable the TARGET LEVEL: i.e. Natural Level #6 to Target #8=3 Levels. ●● Has a low-volume developer (2 1/2 to 12 volume peroxide) This is true because we must lift THROUGH the sixth level to ●● May be natural or metallic in origin reach the seventh level and then up to the desired eighth level. A rule to remember when choosing a color is The darker the color, the smaller the number. This may vary less deposit of color. The lower levels provide less lifting action depending on the manufacturer. Some start with #0, others with #1. and greater concentration of color deposit and thereby contain less The same variance can be found on the other end of the scale. Some ammonium sulphate. manufacturers choose to use #10 as the lightest haircolor, while Permanent (lift/deposit) haircolor contains dye, alkaline substances, others choose to use #12. Permanent haircolor contains ingredients conditioners, stabilizers, fragrance detergents and emulsifiers. These which create lift and deposit color. The lifting action is provided by are all utilized in various proportions to create the vast numbers of the ammonium sulphate. Generally, the higher the number/level the haircolors that are available to the haircolorist. The advantage of more lightening is provided. Also, with the higher lightening comes

Page 8 Cosmetology.EliteCME.com professional haircoloring is greater selection, professional formulation all will apply. The colorist cannot rely on level and tone indicators and professional application techniques. from a manufacturer alone to accurately predict a final color. The level system only indicates lift/deposit ratio. The tone or NOTE: Ask your manufacturer for the MSDS on each product. shade defines the actual color and is generally listed on the product. Another important consideration is to ask if the colors are developed Manufacturers often add a letter or series of numbers to identify level on a pigmented or white base. This will adjust the depth of final and indicate tone. While this information is provided to help the results by as much as one full number…i.e. a #6 that is formulated on haircolorist determine formulation, the final color is determined by a a white base, will appear as deep as a #5 in the final results. For this number of factors that the colorist must consider. Category of natural reason, a color chart or swatch book can be deceiving. haircolor, presence/amount of gray hair and the condition of the hair

Chemistry…Color mixing Example: #5 (Medium Brown) is too dark and #6 (Light Brown) is too light. Customize the formula by mixing ½ of each to produce a #5 and ½ Level. Example: A natural level #7 (Dark Blonde) has difficulty maintaining a strong red tone. Consider mixing at least ¼ of the formula in a deeper warm color or work with a lower volume of developer or use both adjustments. Always strand test to predict results. Example: Decreasing the intensity of a tone. CAUTION: Mixing more than two colors may give unsatisfactory A red tone is too bright for the client’s taste: mix ½ of the formula results; because mixing the three Primary colors or mixing a Primary in a Natural color of the same number/Level. color with a Secondary color will produce BROWN.

A tip for formulating browns The client wishing to match her natural color states that her hair is Using a BROWN in either case will produce warm results. In the first LIGHT BROWN and doesn’t have any red in it. Should we use #6 case, the choice would be #7 DARK BLONDE. For the gentleman, LIGHT BROWN? the solution would be to use #3 NATURAL BLACK. The gentleman client with natural dark brown hair wants to cover his When we use a BROWN, we automatically deposit red into the hair. gray hair. He does not wish to see any warmth in the color. Should we And, while we can mix in a drabbing agent, this toning will wash away use #4 DARK BROWN? revealing the warmth underneath. The better choice is to avoid this The answer to both scenarios is: NO. pitfall.

Formulating for unpigmented (gray) hair As long as recorded history, there has been an attempt, by those The perception of the general public is that gray hair is associated with turning gray, to disguise it. Every imaginable concoction was used aging. Individuals in today’s society are constantly being bombarded in an attempt to retain a youthful appearance. It’s been a curse to with advertising to persuade them to retain their youthful appearance. those whose demeanor is youthful. It’s been a mixed blessing to the This is a benefit to the haircolorist. haircolorist. The introduction of gray hair is often the catalyst to After identifying the client’s natural haircolor category, it is prompt individuals to color their hair. At the same time, gray hair necessary to identify the percentage of gray hair. It is also presents a special challenge to the haircolorist. No one has really important to identify the placement and distribution of gray hair. determined why hair turns gray. Stories have been circulating as long A person who is 50% gray, with the gray hair sprinkled equally as there has been gray hair, as to why and how it turns. Hair turns throughout the pigmented hair would require a different approach than gray (or more accurately white) because at some point melanin stops a person who is 80% gray in the front and 20% gray in the back. In being produced. Why it stops is still unknown. It’s believed by most each case, half of the hair is white and half is pigmented. scientific communities that graying hair is a result of genetics. When a person is born, each follicle on the head is genetically coded to stop Refer to the GLOSSARY and the MARKETING IDEAS for producing melanin. techniques to present to the client. For an appreciable amount of gray hair *White hair is missing OXYMELANINE (yellow base) and the reason In addition to the above solutions, we can add these: that it is so difficult to cover. Mix up to ½ of the formula with a ●● “Dial the clock back” by simply combing on the natural level (stay golden tone in the same number. This will provide a base on which the back from the hairline) mixed with 10V developer. The Balayage colors will develop. technique works great for this and the 10V mixture controls the Another trick is to use the “pre-softening” technique: warmth we see so many times in level #5 and deeper. This is also ●● Dab 30V developer onto areas of resistance (the most white referred to as LOW-LIGHTING. concentration). ●● Avoid using blue and green based colors on white hair. This will ●● Allow 5 to 10 minutes. finish as “silver” on the hair and is aging to the skin. Use the ●● Mix your formula while waiting. “iridescent” tone (.2). This has some yellow in the formula to keep ●● Blot areas well with a towel. the hair from going ash. ●● Proceed with application. ●● If the target is #7 warm, add in up to ½ of the mixture in #7 gold. This will prevent “hot” roots. And don’t forget the pre-softening trick. Through study on the scanning Electron microscope, we

Cosmetology.EliteCME.com Page 9 know that white hair can have as many as 10 cuticle layers. This When a client requests “highlights”, usually she visualizes the #7 or #8 fact is what gives us the challenge in covering gray and white hair. natural level with a #9 or #10 strands throughout. But what if she is a ●● When formulating for the first time color on hair that is more than natural #6? Easy! Bring the base to a #8 (Medium Blonde); and then 50% white, label the white hair #10 and analyze the natural level highlight that. (let’s say #6, Light Brown). Add the two numbers together: 10 We always need to work within the parameters of the product that we plus 6 = 16 and divide in half; which equals eight. are using. ●● Level #8. Because the client has lost pigments in the skin along with the lack of pigments in the hair, this level will blend When preparing the mixture, place the peroxide in the container first; beautifully. Add the suitable tone and you have given the client a then add the cream color/colors. Peroxide acts as a gas…and gases natural-looking result. release upwards. If you are using a liquid, mix the colors together ●● Many times a client wants to return to the natural color that first; then add this to the peroxide. This will produce a more accurate she had 30 years ago. This is NOT a good idea. The dark color lifting action. will cast a shadow to the skin and emphasize every line on the face. The client does not realize that she has been accustomed to viewing the lighter/softer reflection. For this reason, we can adjust PEROXIDE (H2O2) VOLUME REDUCTION the formula up by ¼ to ½ level at least every 6 to 12 months. FORMULA RESULTS COLOR MIXTURE ●● Use a Deep color in a Golden Blonde on a client with Level #6 USE and 50% white hair. This resembles a highlighting. Or we can 1 OZ. 20V H2O2 + 1 2 OZS. 10V H2O2 Color for hair that is highlight the hair with a high-lift color to camouflage the gray/ OZ. H2O = permed. white hair. Color for hair that Hydrogen peroxide is the catalyst that causes permanent haircolor fades to work. A qualified haircolorist should be able to utilize various Quickly. volumes of peroxides. Twenty (20) volume peroxide is the typical Correction on over developer used in most cases. lightened Hair. Higher volumes of peroxide are used when a greater degree of lift White hair (areas of is desired. As the volume of peroxide increases, the color deposit Resistance). diminishes. Also, be aware that higher volumes of developer brings up Color for the same more warmth in the final results. Clients with sensitive scalps may not level or be able to withstand additional activity from higher volume peroxide. Darker than the The opposite occurs when the volume of peroxide is lowered; less natural. lifting action and greater deposit is realized. *A 10V mixture is permanent in the Cortex but does not provide You have probably seen this scenario: The natural level is #5 and unnecessary lift. Target is #9. The client insists that you perform this in a single process 1 OZ. 20V H2O2 + 3 4 OZS. 5V H2O2 Toner on pre- (not use a bleach). First off, this is a chemical impossibility. A high- OZS. H20 = lightened hair. lift color mixed with 40V H2O2 will still give only 3-4 levels of lift (from #5 to #9 is 5 levels). Why? I am hearing you ask. Because the (or) Deposit-only color product will stop working before the desired lift is achieved. Have you 2 OZS. 10V H2O2 + 4 OZS. 5V H2O2 A tone corrector tried accelerating with heat and added activators and covered with a 2 OZS. H2O = plastic bag? I’m sure; and the results have been a very warm level #7, (orange) no matter what you did. Do not expect a color to accomplish 1 OZ. 20V H2O2 + 8 OZS. 2 1/2V H2O2 Semi-Permanent what a bleach was designed to do. YOU CANNOT BREAK THE 7 OZS. H2O = color LAWS OF CHEMISTRY AND EXPECT PERFECT RESULTS. (or) Two suggestions for this: 4 OZS. 5V H2O2 + 8 OZS. 2 1/2V H2O2 1. Pre-lighten the hair to Level 7; then apply the high-lift #9 with the 4 OZS. H2O = suitable tone. 2. Use the #9 color with 30V peroxide to bring the hair to level 8; *Cream developer is preferred over clear peroxide because of stability. then highlight the hair in a weave with powdered lightener. This will give the illusion of an all-over NOTE: We recommend using distilled water for these adjustments to the developer. Check your Volumes with a Peroxide Hydrometer and Level #9. The base color MUST be re-touched in three weeks and the keep containers tightly closed and clearly marked. highlights re-done in 8 weeks. *MARKET YOUR SKILLS (They won’t know if you don’t tell them!) *DON’T FORGET TO ADD $$$ FOR CUSTOM FORMULAS

Marketing terms BAN DE SOLEIL/BALAYAGE: Touched by the sun. Lightness the FROSTING: A method of lighting individual strands of hair. This way the sun would do it. This process is generally utilized on lighter term is generally associated with a cap that is placed on the head and hair and is accomplished with a form of hair painting. the hair is pulled through. BLONDE ON BLONDE: A technique utilized to create a blend of CARMELIZING/TORTOISE SHELLING: Different amounts of blonde shades on the same head of hair. May be utilized on a natural tortoise colors added to a brown head of hair. blonde or on someone that is coloring their hair blonde; gives the hair COLLAGE: A mixture of colors weaving through the hair, generally a dimensional effect. achieved by various stages of lighting. BROWN ON BROWN: A technique utilized to add dimension to a solid brown form by adding additional lightness with a mild contrast.

Page 10 Cosmetology.EliteCME.com COLOR ON COLOR: the use of no lift color on the hair, making the MINKING: Darker hair on lighter hair. Generally done on short hair. hair darker. NATURALIZING: A technique using several colors within the same FRAMING: Lightness around the face generally achieved by natural range. utilizing a dimensional color effect. NUANCES: A technique adding delicate shadings; reflections in a FUR LIGHT: Achieved on short hair that is standing out from the dimensional effect. head like a porcupine. The hair is bleached; then a dark color added PAINTING: Painting color or bleach on the hair with an artists brush. to the ends. Use “shoe shine” technique with product on the foil. Also known as hair painting. FOILING: Referring to applying foils to the hair to create a REVERSE HIGHLIGHTING: The addition of a darker color to dimensional effect. previously lightened hair. First isolating some of the blonde strands, GLAZING: A deposit only color applied over a highlight. Can also then coloring all of the remaining hair, creating a highlighting effect. be a lifting toner to change the natural color slightly. SCRUNCHING: Painting color or bleach on gloved hands and GRABBING: With gloved hands, bleach or tint is painted on the scrunching the hair. This technique is done on dry, backcombed hair, hands; then you grab the hair depositing the tint or bleach in an allowed to process; and then shampooed off. irregular pattern. SHADING: The subtle blending of lighter to darker colors. ALWAYS GRAY REDUCTION: Adding additional natural color to gray hair to blur adjoining areas together. reduce the amount of gray. SLICING: A foil technique placing 1/16” of hair section in the foil. HALOING: Creating a halo by lightening only the hair around the A faster method than WEAVING. face on short hair, creating a halo effect. SHOE SHINING: Painting a layer of bleach or color on a long strip HIGH/LOW LIGHTING: Lightening isolated strands and darkening of foil and transferring it on to the hair as if using a shoe shine rag. strands on the same head at the same time. STREAKING: Larger, more well defined strands of hair. ICICLING: Color or lightener added to the ends of highly teased THREE, TWO, ONE: Slices (1/16”) back to back; avoid 1” of hair hair. and repeat. ICING: Adding light strands to resemble gray hair. TIPPING: A form of lightening at the ends of the hair, rather than the INNER GLOW: Bleaching only the hair close to the scalp on dark entire shaft. hair. TONE ON TONE: Changing the natural haircolor, than adding LOW LIGHTING: A corrective technique used to tone down overly lighter strands. lightened hair by adding a darker color to selected strands. The TORTOISE SHELLING: Different amounts of tortoise colors added opposite of highlighting. to a brown head of hair, aka CARMELIZING. MARBLEIZING: Thin ribbons of lighter hair weaving through WEAVING: A term used to define a method of selecting strands for darker natural hair. dimensional haircoloring.

Blondes that steal the show! PALOMINO GOLD: A soft gold that is a combination of fine WHITE LIGHTENING AND PLATINUM PLUS: Not for the faint weaves in three different shades of warm blonde. of heart. GOLD OF THE MOON: An all-over dark blonde with fine slices Blondes are more natural-looking, meaning they’re wearable by lots lighter, especially in the top and sides. more clients. In fact, guys are getting into the blonding scene; asking SUNSET: A slightly warmer blonde that shows off sparks of gold and for highlights that extend that Summer-Sun look well into the Fall. red. If already a blonde, the hottest shades to switch to are strawberry or TUPELO HONEY: A medium warm blonde with slices of pale gold spun gold; which are so delicate because fine strands are integrated accentuating the lines of the style. into the hair for a multi-dimensional effect. Even Brunettes are joining the Blonde scene with highlights strategically placed to bring light to the face and add tonal sparkle.

“Buzz words” to get them buzzing Sun-Kissed. Pale chiffon. Upscale (14-carat gold). Sassy (warm). Wheat (cool). Golden Copper. Funky (violet or pink). Honey-gold.

RADICAL REDS The latest red hues to have are red hot and super cool! Copper top. High glossed. Crimson queen. Super-streaked. Pure flame. Marbleized beauty. Fire & spice. Brightly burnished. Shimmering scarlet.

Cosmetology.EliteCME.com Page 11 Red alert…red alert! While both “warms” and “cools” can wear reds, care must be taken to And, don’t forget to fire up your reds with blonde lights. A few slices choose the correct tone for each. The “warms” can wear the golden- or balayage strands in the front and top completes the look. red, copper-red and scarlett or clear-red. Also important on the scene are the combination reds. Choose 2 or 3 Whereas, the “cools” should choose the lavender-red, burgundy and colors of red at least 1 level (number) apart from each other and block blue-red. the head in three zones (darker at the bottom, medium in the middle and light at the top. Spark the whole thing with blonde lights and you have a “show stopping” effect.

Chocolate kisses Whatever the shade of brunette, a touch of chocolate sweetens it up! At any level, there’s nothing boring about the brunettes! Mocha treat. Customize the formula using ½ natural brown with ½ gold,copper, Chocolate cherry. auburn or burgundy shade and voila! The finished results are dynamite Caramelized candy. Of course, we suggest that you sprinkle the finished confection with Hints of hazel. gold or honey lights. Neutral (natural) browns ‘n spice. Honey brunettes. Mmmmmmmmmmm…delicious! Crystal pecan.

Tools of the trade COLOR SLEEVES: A tool that resembles a perm rod used for NOTE: Remember to lift the hair away from the cap during reverse highlighting. application. FOIL TECHNIQUE: The use of aluminum foil for isolating COLOR SLIPS: Coated paper used to isolate selected sections of segments of hair for bleaching or coloring. NOTE: Keep foils FLAT hair. or ROLLED. Do not fold or crimp! LITHO PADS/TRANSFER PADS: Pressed cotton pads used to This can cause a heat point that will weaken that section of the hair isolate selected strands of hair to be lightened or colored. strand. COTTON COIL/FLAT PRESSED COTTON COIL: Used with SUPER STREAK CUPS: A cup shaped device used to isolate and BALAYGE technique to segregate layers of hair. contain strands for coloring or lightening. COLOR SPATULA: A specialized color tool used to distribute PAPER WRAPS: Paper wraps used in conjunction with color powder bleach through the hair. sleeves or for isolating hair strands for bleaching or coloring. Also, COLOR EASEL: A plastic or masonite board used to support the one side waxed paper can be used instead of foil (wax side against section of hair to be lightened or colored with foil or paper wraps. product). PLASTIC APPLICATOR: A pliable squeeze bottle used to apply TAIL COMB/PIN COMB: A comb with a pointed end used to weave color or lightener. Generally works well with liquid or gel products. out and section hair. PLASTIC WRAP: Transparent, reusable or disposal plastic sheets CROCHET HOOK: A small device with a hook on the end used for used to isolate sections of hair. pulling hair through a frosting cap. NOTE: Remember to approach the hair from the front of the head toward the back. This will prevent SHAKER: A non-metallic container used to measure and mix color or tangling or knotting. lightener. FROSTING CAP: A plastic, rubber or foam cap that fits snugly over TINT BOWL: A non-metallic container use to mix color or lightener. the head. Once in place, hair is pulled through and lightener or color is TINT BRUSH: A tool used to apply color or lightener to the hair. applied to the hair outside the cap. Available in many sizes for convenience.

Techniques…techniques…techniques It is understood that you have many techniques already in your with a plastic tennis visor. Spray 15V developer on the areas desired repertoire. The most popular and probably best practiced are foils, (usually the top and around the face); then sprinkle powdered lightener using either slices or weaves. But let’s be honest, these are time- from a salt shaker with large holes onto the beads of developer. Allow consuming and labor intensive. To increase the color services, we to develop from 5 to 15 minutes. This will give an all-over glow to must look at easier and faster methods to accomplish the multi- your design with glints of lighter tones and sparkle throughout. The dimensional effect. Here are a few ideas for your consideration. gentleman client loves this one, as it is undetectable. It resembles TOUCH-COLOR: Back-comb small squares of hair (down to what the sun does to the hair. You may wish to combine these two the base) and apply lightener/color formula to the hair above the techniques for more dramatic results. backcombing. Use your fingers with the aid of a color brush. This BALAYAGE (the French word for “sweeping”) lights into the hair: works great for partial highlights/low-lights. I like to use 40V Use a styling comb as a “palette” to brace small sections of hair. developer in the mixture for maximum lift and work on short to mid- Apply lightener/color formula with a small brush to the strands; then length hair. (By the way, the backcombing falls out when the products use cotton coil or a small wad of cotton to segregate those strands. are removed and the hair is conditioned.) Work in whatever area or pattern that you decide. SUN-DUSTING: Either use the “touch-color” preparation or simply Another method is to use your choice of comb (small tooth for fine comb the finished direction of the design. *Protect the client’s face strands and larger for heavier strands) to apply the formula to the

Page 12 Cosmetology.EliteCME.com strands. Then, use the cotton coil as a band to segregate from the next efficient method for re-touching existing highlights, as you can work layer. Also, you need to use the front edge of the comb (first three with as little as 2” of re-growth and not over-lighten the remaining teeth) PARALLEL to the strands and tip the comb down to release hair. With a little practice, you will be able to do the application in 15 the strand. Accomplish as many layers as desired working from the minutes. hairline toward the top of the head in ½ to 1” horizontal sections. *NOTE: To stop the action from an area, simply DRY the product This can accomplish a multi-dimensional effect by using 1-3 different from the hair with a towel. DO NOT SPRAY THE HAIR WITH formulas. Color formulas will cease to work within their time; but WATER! This will re-activate the developer; especially with lighteners will continue to work while still wet. This also is a time- powdered lightener

Color maintenance-four guidelines It is my belief that all retouch applications should be considered a How does the colorist maintain the hair from retouch to retouch? “corrective” procedure. When should I pull color through the mid-lengths and ends? The hair is not stagnant. Color, even natural color, fades with daily How long should I leave it on? wear. Now that clients are shampooing, blow-drying and using heat When do I need to make a color adjustment and add more color to appliances daily, all of this mechanical abuse increases fading. the mixture? *The only way to answer these questions with predictability is to take Referring back to our CLIENT CONSULTATION, a suggestion is to a strand test. There must be some degree of color loss in order to book scientifically; i.e. book the re-touch appointment after you finish apply product to mid-lengths and ends. We should not guess or do it the initial service. out of habit. If the new color is one to two numbers lighter than the natural, allow The test strand will determine the formula and the amount of time 3-4 weeks between services. However, if the lightening is greater; necessary for the color to be on the mid-lengths and ends. This allows i.e. an all over blonde, re-touch should be done in 2 weeks to prevent the colorist the ability to predict the end results and make changes in “gold banding”. Highlights should be re-touched after the haircut the formula if necessary. if you are using one of the fast methods. Otherwise, re-touch the highlights within 12 weeks. A client that walks around with 2-3 inches First, apply the full-strength formula to the new growth. Then, in the of re-growth is not doing your business justice! crown, take a small section and bring the formula down over the mid- lengths and ends. Wait 10 minutes. Now, dry that section with a towel COLOR MAINTENANCE GUIDELINES will answer the following and observe the results. color mysteries:

GUIDELINE 1

Retouch or maintain color When lengths and ends are not faded and only need reviving: and ends for 2-3 minutes. All color mixtures contain Phenol (a ●● Apply formula to new growth (take test strand). soap). This mixture will remove color stains from the skin and ●● Develop 25-30 minutes (or total time). set the color. Rinse thoroughly and shampoo once. Condition if ●● Add a small amount of warm water to the hair and emulsify (mix necessary. until creamy) at the basin, working the product through the lengths

GUIDELINE 2

Replace tone When only the tone needs to be restored: ●● Apply to mid-lengths and ends. ●● Apply to new growth (take test strand). ●● Allow to develop another 10-15 minutes (or total time). ●● Allow to develop 15 minutes (or ½ of total time). ●● Add warm water; emulsify, rinse and shampoo. ●● Add equal water to remaining mixture.

GUIDELINE 3

Replace depth and tone When lengths and ends have lost both depth and tone and are very ○○ Light Auburn. faded: ○○ Dark copper-gold. ●● Apply to new growth (take test strand). ○○ Medium Copper-gold. ●● Allow to develop 15 minutes (or ½ of total time). ○○ Light copper. ●● Add equal water to remaining mixture. ○○ Light golden-copper. ●● Just prior to running the leftover mixture through the lengths and ○○ Gold. ends, add in a warm or red color of a darker level than the target ●● Develop 15 minutes or remainder of time. color applied to the new growth. It is recommended to add in 1 or ●● Emulsify, rinse and shampoo. 2 capfuls of any of these shades: ○○ Dark Auburn.

Cosmetology.EliteCME.com Page 13 GUIDELINE 4

Pre-pigmentation/filling When color has lightened more than 2 numbers/levels and is ●● Re-mix target shade with 10V H2O2 and apply over pigment sensitized, or the client wishes to have a deeper color replacement. ●● Apply target to new growth. ●● Begin full processing time upon completion of application. ●● Pre-pigment with desired shade (1-2 levels deeper and warmer ●● Emulsify. than target). ●● Rinse, until water runs clear and shampoo. ●● Use only liquid color mixed with a small amount of hot water; It is always imperative to analyze the condition of the hair. This brings apply to mid-lengths and ends. Make sure that the hair is me to the “GOLDEN RULE OF COLOR CORRECTION”. saturated, but not dripping. Blot with paper towel, if necessary.

The sensitivity and condition of the hair determines the degree and method of corrective coloring The hair did not get to this state overnight. It may be the product of many applications before her trip to the color expert, YOU. So, she repeated failures on the part of the client to “do it yourself”. must understand that it may take 3-4 visits before she is completely Sometimes the hairdresser must become a detective to determine what satisfied. This way the expectations are out in the open from the start. has been used previously. Some color products are not compatible Money is very important. You should give her an idea of the range with permanent color or color removers. Ask questions such as: Were (i.e. my corrective prices are $60. an hour). Give some indication of two bottles mixed together? Did you also have a perm? Is this from what this is going to cost. the sun? Was it a “natural” color? (Henna) How many times was Time is of the essence, both hers and yours. She should not have any the formula applied? All of this will help you determine your course prior commitments on the day of correction. No colorist needs the of action. If the condition of the hair is very poor, do not attempt to additional pressure of time constraints. As we know, correction can correct. Suggest conditioning treatments and frequent haircuts. The range from 45 minutes to 8 hours. Your schedule should allow you the client will appreciate your honesty and professionalism. proper amount of time to allocate to that client and her specific needs. The client consultation should begin by establishing a realistic TARGET SHADE. Never make promises. It may have taken

COLOR CORRECTION-3 BASIC PROBLEMS

#1 Results too dark/removing artificial color *FACT: NO COLOR CAN REMOVE ANOTHER COLOR. blot with a towel and proceed with the stronger mixture and Chemically, there are only two ways to remove permanent color that is continue processing. too dark or the client whishes to go to a lighter shade: BLEACHING ●● When a suitable base is achieved (slightly lighter than TARGET AND COLOR REMOVER. COLOR REMOVER is the preferred LEVEL), rinse, shampoo gently and dry the hair. procedure because it unlocks the bond of the artificial color and ●● Proceed with the application of the TARGET SHADE. is less caustic to the hair. It is an ammonium solution designed to *EVEN DARK COLORS LIGHTEN NATURAL PIGMENTS DUE neutralize indirect dyes (permanent hair color). This is the answer TO THE DEVELOPER. for clients who come in with home color build-up, muddy-looking When dealing with direct dyes, removal is totally different. Some color that lacks clear tone from too many color changes, or an uneven manufacturers (gratefully) provide a removal system for these “rinses”, deposit of color. Remember the term “chemical back-log”. The hair “semi-permanent”, “deep” and non-ammonia colors; many do not. “remembers” what was used on it; and it shows through in the final And most of non-professional products are formulated with metallic results. Also, many products are Cationic (sticks to itself) and darken salts. with repeated applications. The application of a color remover is related to your end result. Remember, your goal is to create a suitable This formula has worked on many of these color products: and even base for a new color. ●● 4 ozs. Mineral Oil mixed with 4 ozs. Alcohol. ●● Mix color remover with the developer from that manufacturer or ●● Apply to dry hair and saturate well. suitable 20V. ●● Place cotton coils around the hairline to prevent run-off. ●● Apply to dry hair, starting in the darkest areas; usually the ends. ●● Cover the head with a processing cap. A tint brush allows for better control. You can place the product ●● Seat client under a hot dryer for 20 minutes. where it is needed and avoid contact with natural pigment. Make ●● Take the client to the shampoo bowl…DO NOT WET THE HAIR sure that the hair is saturated evenly. WITH WATER! ●● Process from 10 to 45 minutes or according to manufacturers ●● Saturate the hair with SHAMPOO and work into a lather. directions. ●● Rinse and shampoo/condition as needed. ●● It may be necessary to re-apply to darker areas using a 30V ●● Dry the hair. mixture. In this event, do not wash the first application; simply ●● Continue with other services.

#2 Changing the tone/cleansing If a cool tone (Blue, Green or Violet) has been used on the hair, it will Prepare this mixture in an applicator bottle: dominate the finished results. That is to say, applying Natural/Neutral, ●● 4 ozs. Hot water. Red, Copper or Gold will result in a flat or muddy shade. THIS COOL ●● 1 package color remover. TONE MUST BE REMOVED TO ACHIEVE THE CLARITY OF ●● 2 squirts of shampoo. THE TARGET SHADE. ●● Shake to mix thoroughly.

Page 14 Cosmetology.EliteCME.com At the shampoo bowl, saturate the hair with this mixture. Check ●● Shampoo gently/condition if necessary. results at 10 minutes, by drying a section. Usually, this is enough. ●● Dry the hair. ●● Rinse well. ●● Proceed with TARGET SHADE application.

#3 Re-establishing depth & tone/pre-pigmentation This is necessary when the client’s hair is 2 or more levels lighter than (A few examples) the TARGET. Mix the liquid color with a small amount of hot water and apply to the It is critical to replace the missing pigments for color durability. hair. Make sure that the hair is saturated, but NOT dripping. Results The product of choice is a liquid permanent hair color followed by will be too warm if too much fill color is used. Comb through the hair an application of a cream permanent hair color mixed with 10V to assure even distribution. Blot with paper towel if there is an excess developer. on the comb. * NEVER APPLY RAW COLOR TO THE HAIR. TO DO SO COULD CAUSE CHEMICAL BURNS. It is recommended that the shade be 1 – 2 Levels DEEPER & ●● Return with the TARGET mixed with 10V developer; apply and WARMER than TARGET. process for the full time. THE MORE SENSITIZED THE HAIR, THE GREATER THE NEED ●● Finish service as usual. FOR DEPTH & TONE. The pre-pigmentation shades must contain A helpful practice for all corrective color work is to draw the strand Gold, Copper and/or Auburn or a combination of these. While this out in a line; placing the representative levels and tones along the sounds extreme, we know that it is possible to lose up to 20% from “strand”. This makes it possible for you to SEE what actions are daily wear. needed to be taken. Write these down to help with your decisions. EXISTING LEVEL TARGET LEVEL PRE-PIGMENTATION And, as with the basic analysis and consultation, it is suggested to work with the best lighting available. # 9-10 #8 Natural #8 or #7 Gold We sincerely hope that the tips, formulas and ideas in this course will #8 #6 Copper #5 Auburn help to make YOU the FIVE STAR HAIRCOLORIST in your Salon. #8 #6 Auburn #4 Dark Auburn

Cosmetology.EliteCME.com Page 15 Chapter 2: Chemical Makeup and Conditions of Hair

2 CE Hours (Satisfies Chemical Makeup Requirement)

By: JoAnn Stills

Learning objectives ŠŠ Describe the basic anatomy and chemical composition of hair. ŠŠ Identify ingredients in common hair care products that may be ŠŠ Describe how the pH scale pertains to hair care. problematic to clients. ŠŠ List and compare the three main types of hair color. ŠŠ Associate common symptoms with conditions and diseases of the ŠŠ Explain the significance of material safety data sheets. hair and scalp. Introduction This chapter will review the chemical composition of the hair and step in protecting your clients from possible harm that a variety of discuss various conditions that you are likely to encounter in your products can cause. clients. Understanding the composition and nature of hair is the first

Structure of hair Like other mammals, humans are covered by hair. Human body hair, however, is much finer than that of our nonhuman brothers and sisters, and is concentrated primarily on our heads, underarms, and genital regions. Most men, and some women, also have hair on their faces. Each hair grows from an individual follicle that is adjacent to a sebaceous gland. Sebaceous glands produce sebum, which moisturizes skin and hair and is a barrier to toxins. Sebum also manufactures the body’s vitamin D, triggered by exposure to the sun. Hair is outgrowth of skin but has no sense of feeling due to the lack of nerve endings. It is made up of the protein keratin (also found in skin and nails). Keratin protein is formed by the joining of amino acids. The fact that the acids join at some places along the protein chain makes keratin relatively resistant to change. The chemical makeup of hair also contains carbon, hydrogen, nitrogen, sulfur, and oxygen. Hair protects the body from heat loss and ultraviolet rays. Hair follicles extend down into the dermis (skin layer). A nerve ending surrounds the bulb of each hair follicle. Glands secrete an oily substance directly onto the hair follicle, lubricating the hair shaft. Hair is composed of cells arranged in three layers: the cuticle, the cortex, and the medulla. The cuticle is the outside layer composed of transparent, scale-like cells. Chemicals raise these scales so solutions This is a cross section of a hair fairly close to the surface. You can tell such as chemical relaxers, hair color, or permanent wave solutions can where it’s been cut because there’s a bit of sebaceous gland (SbG) next enter. The cortex is the inner layer of cells that give hair its strength. It to it. The cortex and medulla of the hair are both present. Some short, is composed of numerous parallel fibers of hard keratin. These fibers curly wool hairs lack a medulla. The outer epithelial root sheath (ORS) are twisted around one another like a rope. This layer gives hair its is a continuation of the epidermis down into the follicle. color. The medulla is the innermost layer and is composed of round The cuticle is responsible for much of the mechanical strength of cells. If you have very fine hair, medulla cells may be absent. the hair fiber. It consists of scale-shaped layers. Human hair typically Hair’s inner cortex is composed of spindle-shaped cells and an outer has 6-8 layers of cuticle. Wool has only one, and other animal hair may sheath, called the cuticle. Within each cortical cell are the many fibrils, have many more layers. Hair responds to its environment, and to its running parallel to the fibre axis, and between the fibrils is a softer mechanical and chemical history. For example, hair which is wetted, material called the matrix. It grows from a hair follicle. styled and then dried, acquires a temporary ‘set’, which can hold it in style. This style is lost when the hair gets wet again. For more permanent styling, chemical treatments (perms) break and re-form the disulphide links within the hair structure. In people of European descent, blond hair and black hair are at the finer end of the scale, while red hair is the coarsest. The hair of people of Asian descent is typically coarser than the hair of other groups. Hair with a round cross-section will fall straight, as opposed to curly hair, which has a flat cross-section. The cross-sectional shape of human

Page 16 Cosmetology.EliteCME.com hair is typically round in people of Asian descent, round to oval in The speed of growth is roughly 11 cm/yr = 0.3 mm/day = 3 nm/s. Cells European descent, and nearly flat in African peoples; it is that flatness at the base of the hair follicle divide and grow extremely rapidly. A which allows African hair to attain its frizzly form. In contrast, hair single strand of human hair can hold approximately 100 g (3.5 ounce) that has a round cross section will be straight. A strand of straight of weight, although this will vary greatly with thickness. Wet hair, round cross-section hair that has been flattened, for example, with an however, is very fragile. edge of a coin, will curl up into a micro-afro.

Pathology of hair The term “pathology” refers to the study of disease, including its potential health risks, to determine when and how to proceed with nature and origins, as well as its effect on the structure and function service – or if you should proceed at all. This information is not of the body. A closely related subject is etiology, which investigates meant to be used for self-diagnosis or as a substitute for consultation the causes or reasons for disease. This chapter reviews diseases and with a health care provider. If you have any questions or concerns other common conditions of the hair and scalp, which are all part of regarding the conditions or diseases described below, consult a health the integumentary system. The information presented in the following care provider. section will help you develop workplace guidelines for recognizing

Disorders of the hair and scalp The condition and appearance of the hair and scalp are influenced by and may spread through the common use of brushes, hair clips, or many factors, including physical health, nutrition, blood circulation, styling implements. emotional state, function of the endocrine glands, and medications Fragilitas crinium is the formal term for brittle hair, which may consumed. Common disorders of the hair and scalp include vegetable include split ends. Conditioners may improve hair flexibility. and animal parasitic infections, staphylococci infections, which cause furuncles (boils), and the following conditions, which may affect the Hair loss occurs naturally as part of hair growth and regeneration. In hair follicle and/or sebaceous glands. women, childbirth, stress, crash dieting, emotional stress and shock can cause greater than normal hair loss, though it is usually temporary. Alopecia is the formal term for any abnormal hair loss. It should not be Some older women experience female-pattern hair loss with thinning confused with natural hair loss, which occurs when the hair has grown of the crown and hairline. to its full length, falls out, and is replaced by a new hair. Alopecia senilis is hair loss associated with old age, alopecia prematura may Drugs used in cancer chemotherapy frequently cause a temporary loss occur any time before middle age, and is characterized by slow of hair, noticeable on the head and eyebrows, because they kill all thinning over time. Alopecia areata is relatively sudden, patchy hair rapidly dividing cells, not just the cancerous ones. Other diseases and loss, including the spotty baldness that is associated with anemia and traumas can cause temporary or permanent loss of hair, generally or in typhoid fever, among other conditions. Tension alopecia is caused by patches. tight braiding or hair styles that pull the hair’s roots. Hirsutism (or hypertrichosis) is excess hair on the body. Genetic Canities is the formal term for gray hair, which is caused by the loss background and age can impact how much hair a woman has on the of pigment. Acquired canites is usually associated with aging, while cheeks, upper lip, arms and legs. There are a variety of methods congenital canites, a condition existing at birth, includes albinism. to cope with unwanted hair, such as tweezing, waxing, shaving, bleaching, depilatories and electrolysis. Electrolysis is the only Dandruff (or pityriasis) is a condition in which small white flakes or permanent hair-removal method, and is typically among the most scales appear on the scalp and hair. Excessive dandruff can lead to expensive and time-consuming means of removal. baldness, if the condition is severe and neglected. Dandruff may be due to microbial infection, poor circulation, nerve stimulation, or diet, Monilethrix is the formal term for beaded hair, which breaks between and may be associated with specific shampoos, or insufficient rinsing the nodes or beads. Hair and scalp treatments may prove helpful. of shampoos. Tinea capitis (ringworm) is a fungal infection that forms a scaly, ring- Pityriasis capitis simplex, or dry type dandruff is characterized by an like lesion on the scalp. It is highly contagious. itchy scalp and white scales scattered throughout the hair. Pityriasis Trichoptilosis is the formal term for split ends. steatoides, a greasy or waxy type of dandruff, is characterized by a scaly skin surface mixed with sebum, and may include bleeding Trichorrhexis nodosa, or knotted hair, is characterized by dry, or oozing of the sebum when scales tear off. Refer the client to a brittle hair with nodular swellings along the length of the hair shaft. physician for medical attention. Dandruff is considered contagious Hair breaks easily, but the condition may be remedied somewhat by conditioners.

Changes in the hair during pregnancy Women may experience changes in their hair during pregnancy. In this condition generally dissipates. Telogen effluvium refers to most cases, these changes are temporary and will return to their excessive hair loss that occurs within five months after pregnancy. original condition after the birth. Hirsutism, or excessive hair This condition does not cause permanent hair loss or baldness, growth, can appear on the face and/or chest due to hormonal changes typically returning to normal after six to twelve weeks. experienced during pregnancy. Within six months after giving birth,

Hair color change Hair color change is probably one of the most obvious signs of aging. begins at the temples and extends to the top of the scalp. Hair becomes Hair color is caused by a pigment (melanin) produced by hair progressively lighter, eventually turning white. follicles. With aging, the follicle produces less melanin. Graying Many people have some gray scalp hair by the time they are in their often begins in the 30s, although this varies widely. Graying usually 40s. Body and facial hair also turn gray, but usually later than scalp hair. The hair in the armpit, chest, and pubic area may gray less or not

Cosmetology.EliteCME.com Page 17 at all. Graying is genetically determined. Gray hair tends to occur vitamins, and other products will not stop or decrease the rate of earlier in Caucasians and later in Asian races. Nutritional supplements, graying.

Chemical-induced hair color changes There have been reports of blond hair, as well as darker hair, turning Chronic smoking has been associated with premature gray hair green after prolonged exposure to chlorine in swimming pools. because toxic substances in tobacco smoke are able to block Usually, the problem is associated with concentrations of copper melanocyte cell pigment producing activity. Heavy smokers with dissolved in the pool water, which can chemically interact with white or gray hair may develop a yellow hair color due, most likely to chlorine. High levels of copper in tap water can also turn hair green. prolonged exposure to air laden with tar from cigarette smoke. The tar may chemically react with, and preferentially adhere to, the hair fiber.

Hair thickness changes and hair loss Hair is a protein strand that grows through an opening (follicle) in Male pattern baldness is the most common type of hair loss in men. It the skin. A single hair has a normal life of about 4 or 5 years. That usually follows a typical pattern of receding hairline and hair thinning hair then falls out and is replaced with a new hair. Hair loss usually on the crown, and is caused by hormones and genetic predisposition. develops gradually and may be patchy or diffuse (all over). Roughly Ultimately, one may have only a horseshoe ring of hair around the 100 hairs are lost from your head every day. The average scalp sides. In addition to genes, male-pattern baldness seems to require the contains about 100,000 hairs. presence of the male hormone testosterone. Men who do not produce Hair grows about an inch every couple of months. Each hair grows testosterone (because of genetic abnormalities) do not develop this for 2 to 6 years, remains at that length for a short period, then falls pattern of baldness. out. A new hair soon begins growing in its place. At any one time, Women may also develop a typical pattern of hair loss as they age about 85 percent of the hair on your head is in the growing phase and (female-pattern baldness). In female pattern baldness, the hair becomes 15 percent is not. Each individual hair survives for an average of 4 ½ less dense all over and the scalp may become visible. Female-pattern years, during which time it grows about half an inch a month. Usually baldness is a pattern of hair loss (alopecia) caused by hormones, in its 5th year, the hair falls out and is replaced within 6 months by a aging and genetics. Unlike male-pattern baldness, female-pattern new one. baldness is an over-all thinning which maintains the normal hairline. Genetic baldness is caused by the body’s failure to produce new Body and facial hair are also lost, but the hairs that remain may hairs and not by excessive hair loss. The amount of hair you have on become coarser. Some women may notice a loss of body hair, but may your body and head is determined by your genes. Almost everyone find that they have coarse facial hair, especially on the chin and around experiences some hair loss with aging, and the rate of hair growth the lips. slows. Many hair follicles stop producing new hairs altogether. The Baldness is not usually caused by a disease, but is related to aging, hair strands become smaller and have less pigment, with thick, coarse heredity, and testosterone. In addition to the common male and female hair of a young adult eventually becoming thin, fine, light-colored hair. patterns from a combination of these factors, other possible causes of Both men and women tend to lose hair thickness and amount as they hair loss, especially if in an unusual pattern, include: age. Inherited or “pattern baldness” affects many more men than ●● Hormonal changes (for example, thyroid disease, childbirth, or use women. About a quarter of men begin to show signs of baldness by of the birth control pill). the time they are 30 years old, and about two-thirds of men have ●● A serious illness (like a tumor of the ovary or adrenal glands) or significant baldness by age 60. Men develop a typical pattern of fever. baldness associated with the male hormone testosterone (male-pattern ●● Medication such as cancer chemotherapy. baldness). Hair may be lost at the temples or at the top of the head. ●● Excessive shampooing and blow-drying. ●● Emotional or physical stress. Each hair sits in a cavity in the skin called a follicle. Baldness in men ●● Nervous habits such as continual hair pulling or scalp rubbing. occurs when the follicle shrinks over time, resulting in shorter and ●● Burns or radiation therapy. finer hair. The end result is a very small follicle with no hair inside. Ordinarily, hair should grow back. However, in men who are balding, Alopecia areata – bald patches that develop on the scalp, beard, and, the follicle fails to grow a new hair. Why this occurs is not well possibly, eyebrows. Eyelashes may fall out as well. This is thought to understood, but it is related to your genes and male sex hormones. be an immune disorder. Even though the follicles are small, they remain alive, suggesting the Tinea capitis (ringworm of the scalp). possibility of new growth.

What is pH? pH is a unit of measurement; just as degrees measure temperature each step or number increase by multiples of 10. Each whole pH and inches measure distance, pH numbers measure the amount of value below 7 is ten times more acidic than the next higher value. acid or alkali in water-based solution. All solutions that contain water For example, a pH of 4 is ten times more acidic than a pH of 5 and and products that dissolve in water have an acidic or alkaline nature. 100 times (10 times 10) more acidic than a pH of 6. The same holds Acidic and basic are two extremes that describe chemicals, just like true for pH values above 7, each of which is ten times more alkaline hot and cold are two extremes that describe temperature. Mixing acids (another way to say basic) than the next lower whole value. For and bases can cancel out their extreme effects, much like mixing hot example, a pH of 10 is ten times more alkaline than a pH of 9. If you and cold water can even out the water temperature. A substance that is are using a product that is pH 6 or only one number away from acid neither acidic nor basic is neutral. balanced, it is actually 10 times less acidic, which is a huge difference. The pH scale measures how acidic or basic a substance is. It ranges One number variation in pH will greatly affect the acidity or alkalinity from 0 to 14. A pH of 7 is neutral. A pH less than 7 is acidic, and a of your cosmetic preparations. pH greater than 7 is basic. The pH scale is logarithmic, which means

Page 18 Cosmetology.EliteCME.com Pure water is neutral, with a pH of 7.0. When chemicals are mixed with water, the mixture can become either acidic or basic. Vinegar and lemon juice are acidic substances, while laundry detergents and ammonia are basic. Chemicals that are very basic or very acidic are called “reactive.” These chemicals can cause severe burns. Automobile battery acid is an acidic chemical that is reactive, and household drain cleaners often contain lye, a very alkaline chemical that is reactive.

pH of hair How does the pH scale pertain to hair? On the pH scale, hair falls surface of the scalp is measured at 4.8, the pH of the hair at further on average between 4.5 and 5.5. This measurement is not the pH distances from the scalp will increase, showing that less of the acid of the actual hair, but of the protective film of oily acidic secretions mantle reaches the ends of longer hair. which coats and lubricates the surface of the skin, hair and nails. This When high pH products, such as alkaline permanent waves or tints, combination of oils and water-soluble materials is referred to as our come in contact with the hair, the solution is absorbed through the acid mantle, which is produced by the skin. Products with a pH of 4.5 cuticle layer into the inner layer of the hair called the cortex. The to 5.5 are compatible with the natural biology of the hair and scalp. high pH causes the cortex layer to swell. This swelling forces the These products maintain a mildly acidic environment that closely rigid cuticle layers to be stretched. At this point, the hair is in a very resembles the environment of our acid mantle. We call these products delicate condition and vulnerable to excess stretching and breaking. “acid balanced.” This condition is necessary for permanent waves to successfully curl The scalp’s oils keep the hair lubricated and shiny. The scalp’s acidity the hair and for tints to deposit color molecules into the cortex for keeps the fiber compact and strong. Part of the reason long hair tends lasting color. Therefore, a high pH is essential for some chemical to be weaker at the ends and dull in appearance is that less of the acid services to work properly. mantle reaches these ends. If, for example, the average pH on the pH and hair care products Shampoos, conditioners, hair colors, and tints all require the proper out and becoming brittle and dull. Acid-balanced products create combination of ingredients and appropriate pH, which plays a crucial an environment that resembles the environment of our natural acid role in the success of almost all salon services. Without the correct mantle. Also, the hair is structurally compact at a mildly acidic pH pH, permanent wave solutions could not create curls or waves, and value. Swelling is minimized. color molecules from tints would not deposit themselves into the How many times have you heard marketing promotions touting their cortex. Continuous use of shampoos and reconditioners with a high product as “acid- or pH-balanced?” We have been told that a low pH, however, can damage and dry out the hair. pH is good for our hair while a high pH is less desirable. This is true Shampoo is the most common chemical applied to the hair and when pertaining to products like shampoo and reconditioners, but there therefore is especially important that it be acid-balanced. Do not are some services, such as permanent waves and tints, that rely on high confuse pH balanced and acid balanced. pH balanced means the pH is pH chemicals. balanced at a certain number, but not necessarily at 4.5 to 5.5. Acid Some products do not have the pH number listed on their labels. If balanced means that it is balanced at the appropriate acidic level. you want to find out the pH of any product you are using, you can use Repeated use with shampoo of high pH could make the hair feel dry, pH test paper or nitrazine paper. Just dip the paper into the solution. dull, and less manageable. There are three basic reasons for using A product with a 4.5 pH or below will not change the paper from its acid-balanced shampoos and conditioners. original yellow shade. A higher pH will change the color to dark blue The natural pH environment of a healthy hair and scalp is 4.5 to 5.5. (4.6 to 7.4) and any product with a pH over 7.5 will turn the paper Using acid balanced products keep the hair and scalp within this purple. natural range. The acid mantle protects hair and skin from drying

Permanent waves and pH Alkaline waves have a pH of approximately 8.5 to 9.5. The high conditioners that are made to return hair to its natural pH after alkalinity softens and swells the hair fibers, making it easier for the chemical services. It is a good idea to use one after giving an alkaline chemicals of the wave to penetrate the hair structure. Because of permanent wave. the high alkalinity, cautious and skillful use of the perm is essential When high alkaline solutions are used, such as tints and bleaching to prevent damage to the hair structure. There are pH normalizing solutions, they will change the pH of the hair and skin. In this

Cosmetology.EliteCME.com Page 19 situation, as with alkaline permanent waves, this is desirable. The work properly such as permanent waves and tints. To control damage important thing is to neutralize any extra alkalinity and bring the pH that might occur from these services, finish with products that have a back to 4.5 to 5.5. This minimizes the swelling and strengthens the pH lower than 5.5. hair. You use chemicals and products every day. It is important to know pH products work together to assure successful results and beautiful what these products do to the hair and why. PH is more than a number. hair. Acid-balanced shampoos protect the hair during cleansing. It is a measuring tool, a way for us to select and control products and Conditioners and reconditioners that are acid balanced help return hair services. Knowledge of pH enables you to leave the hair and skin in a to its natural mildly acidic state. Some products need to be alkaline to natural and healthy condition.

Hair color People have been coloring their hair for thousands of years using Some natural colorants last through several shampoos, but they plants and minerals. Some of these natural agents contain pigments aren’t necessarily safer or more gentle than modern formulations. It’s (e.g., henna, black walnut shells) and others contain natural bleaching difficult to get consistent results using natural colorants, plus some agents or cause reactions that change the color of hair (e.g., vinegar). people are allergic to the ingredients. Natural pigments generally work by coating the hair shaft with color.

Health and hair care ingredients In pursuit of cleanliness and beauty, we buy approximately $20 (EWG) and the Washington Toxics Coalition. You can also visit billion worth of personal care products every year. More than EWG’s Skin Deep report, (http://www.ewg.org/reports/skindeep2/), an 5,000 ingredients are allowed for use in personal care products. online searchable database of potentially toxic chemicals in personal Unfortunately, many ingredients are linked to damaging effects care products, including phthalates, which are often not listed on on human health. Many are identified by government agencies labels. The database also offers brand-specific information and what as hazardous, but many others remain untested. Unlike the the group considers safer alternatives.2 pharmaceutical industry, the government does not require safety Do not underestimate the importance of a patch test before trying any testing for these products before they go to market. Some ingredients hair color products, even if they are semi-permanent or temporary with known health hazards are very common in personal care products, hair dyes3. The best way is to test for allergic reaction is to apply the both conventional products and alternative ones. product to a quarter-sized spot behind the ear or neck several days To avoid potentially harmful ingredients, consult the list below, prior to actually using the product on your scalp. compiled with information from the Environmental Working Group

Predisposition test Federal law mandated under the Pure Food, Drug and Cosmetic Act or predisposition test. Allergies may appear suddenly and without of 1938 provides that a skin test designed to determine an individual’s warning even if the client has successfully used a product for years. oversensitivity to certain chemicals be performed on all clients 24 NOTE: Before the application of any chemicals, a thorough analysis of hours prior to the application of the chemicals. Hypersensitivity to hair must be done to determine the presence of metallic salts. chemical products can only be determined by administering a patch

Client protection Technician’s hands must be washed with soap and warm water before NOTE: It is always important to read and follow manufacturer’s the operation begins. directions for any chemical service. Because of the variance in Drape the client appropriately: products available for use, in actual practice the manufacturer’s ●● Skin of the client’s neck must be protected from the re-usable directions take precedence. drape by a neck strip. Select an area on the back of the neck below the ear lobe to apply the ●● Drape must be snug at the neckline and extend over the back of the chemical. chair to protect the client’s clothing and the chair. NOTE: Manufacturer’s directions may indicate a different area ●● Two towels must be used to protect the client from solutions that on the body for the application of the chemical; be guided by the may drip during the service. One must be under the drape and one manufacturer’s directions. must be on top of the drape.

Cleansing Cleanse a quarter-size area behind client’s ear or in the inner portion of Area should air dry. the elbow. Water on a sanitary cotton ball or swab should be used for cleansing.

Application Product for the test must be mixed in correct proportions according to Area must be left uncovered and undisturbed for 24 hours. Do not manufacturer’s directions. wash off. Product must be applied to test area with a sterile cotton swab. After 24 hours, the test area must be examined. If any sign of swelling, Sufficient amount of product must be applied to be effective for burning, itching, redness, or inflammation occurs, the client may testing. be allergic to the product tested and unable to receive an aniline derivative application. (This would be a positive reaction.)

Page 20 Cosmetology.EliteCME.com NOTE: Only if the reaction is NEGATIVE (no reaction) may the coal tar colors, which are associated with some risk, so read ingredient product tested be used. labels carefully. Because labels are often difficult to decipher and not NOTE: Chemical burns may occur if solution saturated cotton is left all ingredients are necessarily disclosed, finding safer personal care on the skin. products can be a challenge. Remember it is also the amount, not just the presence, of an ingredient that determines risk. In case of chemical burns: ●● Wash away the chemical with large amounts of water for at least 5 Women with hair loss or other hair and scalp disorders should minutes. not assume hair products are safe. Trying a different hair color or ●● Remove the victim’s clothing from the affected area to prevent highlights to create the illusion of thicker hair using hair dyes may further skin contact. actually further hair loss or aggravate existing hair and scalp disorders. ●● Consult the product MSDS for additional first aid information. This is because most professional hair color products contain loads of harsh chemicals such as peroxide, ammonia and p-phenylenediamine Regardless of your current health, it’s important to know the that can cause serious damage to the hair and scalp and increase hair ingredients in your personal care items. Shampoo and styling products loss. contain various combinations of parabens, phthalates, fragrance and

Danger to eyes Whether applying hair chemicals at home or in a hair salon, consumers eyebrow tinting and dyeing has been known to cause serious eye and beauticians should be careful to keep them away from the eyes. injuries and even blindness. There are no color additives approved by FDA has received reports of injuries from hair relaxers and hair dye FDA for dyeing or tinting eyelashes and eyebrows. accidentally getting into eyes. The use of permanent eyelash and

Hair care ingredients The following ingredients hold some risk or are associated with Fragrance is a known trigger of asthma, and fragrances more often negative reactions in some individuals: cause allergic contact dermatitis than any other ingredient, including Ammonia, used in hair dyes and bleaches, can irritate the eyes and watery eyes and respiratory tract irritation. Other negative symptoms skin and can be toxic when inhaled. reported to the FDA have included headaches, dizziness, rashes, skin discoloration, violent coughing and vomiting, and allergic skin Bronopol may break down in products into formaldehyde and also irritation. Clinical observations by medical doctors have shown cause the formation of carcinogenic nitrosamines, compounds shown that exposure to fragrances can affect the central nervous system, to cause cancer in laboratory animals, under certain conditions. causing depression, hyperactivity, irritability, and other behavioral Bronopol is often listed as 2-bromo-2-nitropropane-1,3-diol. changes. Many of the compounds in fragrance are suspected or proven Diethanolamine (DEA), widely used in shampoos as an emulsifier carcinogens. or foaming agent, is a suspected carcinogen, and its compounds and Hydrogen peroxide is an irritant included in oxidation dyes, which derivatives include triethanolamine (TEA), and monoethanolamine contain a combination of hydrogen peroxide, dye and ammonia. (MEA), all of which can be contaminated with nitrosamines, Contamination is more likely if the product also contains bronopol Nonylphenols (nonoxynol or nonylphenol ethoxylate) are surfactants (see above). DEA, TEA, and MEA are hormone disrupters that (substances that reduces the surface tension of liquids, making it are also known to combine with nitrates to form cancer-causing easier for them to disperse) used for their detergent properties. This nitrosamines. If a product contains nitrites, which are used as a substance is found in some shampoos and hair color, resulting when preservative or present as a contaminant not listed on labels, chemical certain chemicals commonly found in these products break down. reactions between nitrites and these substances may occur during These chemicals can act as hormone disrupters, potentially threatening the manufacturing process and while products are stored in their reproductive capacity. They are of such concern that many European containers. This reaction leads to the formation of nitrosamines. countries are phasing them out. Some manufacturers have voluntarily Most nitrosamines, including those formed from DEA or TEA, discontinued their use. are carcinogenic. There is no way to know which products contain Parabens, an ingredient in many relaxers, are preservatives with nitrosamines because government does not require manufacturers to antibacterial properties. Widely used in all kinds of personal care disclose this information on the label. products, paraben is usually preceded by the prefixes methyl-, ethyl-, A study by the U.S. National Toxicology Program found that these butyl-, propyl, or isobutyl-. Parabens, which are included in some compounds themselves might also be carcinogenic. Repeated skin conditioners, can cause allergic reactions or contact dermatitis in application of DEA was found to cause liver and kidney damage some people. (Preservatives are one of the leading causes of contact in animals. The study also discovered that when absorbed through dermatitis.) The U.S. Food and Drug Administration (FDA) also warns the skin, DEA accumulated in organs. TEA may also cause contact consumers to use caution when using relaxers, as chemicals may dermatitis in some individuals. accidentally enter the eyes. Fragrance: Synthetic fragrances are the most common ingredients Additionally, parabens, according to research published in a 2004 found in personal care products. In a recent study, the US National issue of the Journal of Applied Toxicology, have been found in breast Institute of Occupational Safety and Health evaluated 2,983 fragrance tumors. An accompanying article suggested that adolescents and close chemicals for health effects. They identified 884 of them as toxic relatives of breast-cancer patients may be at an increased risk due to substances. The term “fragrance” on a label can indicate the presence continued exposure. Parabens can affect the endocrine system (the of up to 4,000 separate ingredients. A common shampoo and glands that produce hormones). conditioner ingredient, fragrance can include possible skin irritants Appropriate recommendations on use of concentrations, restrictions and allergens. The FDA does not require companies to disclose the and warnings for such application are critical as after active ingredients listed as “fragrance” which many include phthalates, sensitization there may be extensive cross reactivity to other chemicals that have been found to produce cancer of the liver and birth commonly encountered chemical substances to which the consumer defects in lab animals.

Cosmetology.EliteCME.com Page 21 may be exposed. These include other hair coloring agents, textile dyes, products have undergone this process. Labels are not required to list drugs and rubber chemicals. this information. The U.S. Food and Drug Administration (FDA) proposed legislation Polyvinylpyrrolidone (PVP), widely used in hair-care products, that would have required warning labels on products, advising that especially sprays, has been found to stay in the body for months. In this ingredient can penetrate skin and has been determined to cause rats it contributed to tumor development. cancer in lab animals. If passed, beauty salons would have had to post Propylene glycol, a humectant, or moisture-attracting ingredient, warnings for their customers. Cosmetic industry opposition helped found in personal care products, can irritate the skin in sensitive defeat the proposal. individuals. Phthalates are found in many products from plastics to shampoo. Propylene glycol is recognized as a neurotoxin by the National Phthalates are widely used in hair products (sprays and shampoos) Institute for Occupational Health and Safety in the U.S. It is known to enhance fragrances, as solvents, and to denature alcohol. The oily to cause contact dermatitis, kidney damage and liver abnormalities. It texture of phthalates helps lotions penetrate skin. These hormone- is widely used as a moisture-carrying ingredient in place of glycerine disrupting chemicals are suspected of contaminating breast milk and because it is cheaper and more readily absorbed through the skin. causing damage to the kidneys, liver, lungs and reproductive organs. The Material Safety Data Sheet for propylene glycol warns workers Recent product tests found the chemical in every fragrance tested in handling this chemical to avoid skin contact. the United States. Sodium hydroxide is an active ingredient in lye relaxers that can Manufacturers are not required to list phthalates on product labels, so cause skin irritation, burns and necrosis as well as breathing difficulty they are difficult to avoid. Phthalates in DEHP, DHP, and DBP5 are when inhaled. Although “no lye” relaxers do not contain sodium not identified on cosmetic labels when they are in fragrance. Since, hydroxide and result in less skin irritation than lye products, they too phthalates often “hide” behind the term “fragrance,” choose products can burn the scalp if used incorrectly. labeled “fragrance-free” or that are scented exclusively with pure botanical or essential oils. Sodium lauryl sulfate (sodium laureth sulfate, SLS) are used as lathering agents, and are present in 90 percent of commercial One type of phthalate, diethyl phthalate (DEP) is commonly found shampoos. This chemical is a known skin irritant and appears to in fragrances and other personal care products. A study published in increase allergic response to other toxins and allergens, according to Environmental Health Perspectives found that DEP is damaging to the Cosmetics Ingredient Review (CIR), a panel of cosmetics-industry the DNA of sperm in adult men at current levels of exposure. DNA experts established to safety-test ingredients (cir-safety.org). After a damage to sperm can lead to infertility and may also be linked to review of over 250 existing SLS studies, the CIR concluded that SLS miscarriages, birth defects, infertility and cancer in offspring. DEP is is not cancer-causing. However, some doctors are not convinced and the phthalate found in the highest levels in humans. recommend avoiding SLS. Polyethylene and polyethylene glycol (PEG ingredients), which The U.S. government has also warned manufacturers of unacceptable are found in hair straighteners, are safe in themselves but can be levels of dioxane formation in some products containing SLS. contaminated with 1,4- dioxane, which produced liver cancer in 1,4-Dioxane or para-dioxane is also commonly referred as simply rodents in National Cancer Institute (NCI) studies. dioxane. However, 1,4-dioxane should not be confused with dioxin (or Polysorbate compounds 60 and 80 are emulsifiers, used in lotions dioxins), which are a different class of chemical compounds. While and creams, that can also become contaminated with the carcinogen dioxane can be removed from products easily and economically by 1,4-dioxane. Dioxane readily penetrates the skin. While dioxane can be vacuum stripping during the manufacturing process, there is no way to removed from products easily and economically by vacuum stripping determine which products have undergone this process. Labels are not during the manufacturing process, there is no way to determine which required to list this information.

Safer straightening The Food and Drug Administration (FDA) has received complaints be avoided right before using a relaxer. Parents should be especially about scalp irritation and hair breakage related to both lye and “no cautious when applying chemicals to children’s hair and should keep lye” relaxers. Some consumers falsely assume that compared to lye relaxers out of children’s reach. There have been reports of small relaxers, “no lye” relaxers take all the worry out of straightening. children ingesting straightening chemicals and suffering injuries that People may think because it says “no lye” that it’s not caustic, but both include burns to the face, tongue, and esophagus. types of relaxers contain ingredients that work by breaking chemical How often to relax hair is a personal decision. Relaxing at intervals of bonds of the hair, and both can burn the scalp if used incorrectly. Lye six to eight weeks is common, and the frequency depends on the rate relaxers contain sodium hydroxide as the active ingredient. With no- of a person’s hair growth. Some professionals feel that straightening lye relaxers, calcium hydroxide and guanidine carbonate are mixed to every six weeks is too frequent, as relaxers can cause hair breakage in produce guanidine hydroxide. the long term, with blow drying and curling doing further damage. Research has shown that this combination in no-lye relaxers results in Consumers should be aware that applying more than one type of less scalp irritation than lye relaxers, but the same safety rules apply chemical treatment, such as coloring hair one week and then relaxing for both. They should be used properly, left on no longer than the it the next, can increase the risk of hair damage. The only color prescribed time, carefully washed out with neutralizing shampoo, and recommended for relaxed hair is semi-permanent because it has no followed up with regular conditioning. For those who opt to straighten ammonia and less peroxide, compared with permanent color. their own hair, it’s wise to enlist help simply because not being able to The FDA encourages voluntary reporting of adverse reactions to hair see and reach the top and back of the head makes proper application of products to the FDA, Center for Food Safety and Applied Nutrition, the chemical and thorough rinsing more of a challenge. Office of Cosmetics and Colors. Some stylists recommend applying a layer of petroleum jelly on the scalp before applying a relaxer because it creates a protective barrier between the chemical and the skin. Scratching, brushing, and combing can make the scalp more susceptible to chemical damage and should

Page 22 Cosmetology.EliteCME.com Chapter 3: Workers’ Compensation

1 CE Hour (Satisfies Workers’ Compensation Requirement)

By: Staff Writer

Learning objectives ŠŠ Define workers’ compensation. ŠŠ Understand the rights and benefits available to you under the ŠŠ Know the history of workers’ compensation in Florida. Florida Workers’ Compensation Act. Workers’ compensation, a brief history Simply defined, workers’ compensation recompenses, gives something Under the various workers’ compensation systems, insurance is to a worker, one who performs labor for another, for services rendered purchased or provided by employers through individual insurance or for injuries. This simple definition is taken in part from Webster’s companies, funds, or self insurance plans to provide the worker with Ninth New Collegiate Dictionary, and in studying this subject closely, the indemnity and medical benefits required by the laws or acts of we find this definition extremely accurate.Workers’ compensation the various states or provinces. The Jones Act, Harbor workers’, is not “insurance”; rather, it is social insurance, much the same as Longshoremen’s Act and the Federal Workers’ Compensation act are unemployment compensation and social security. It is however, the all under governmental regulation and administration, but the purpose oldest form of social insurance. of these laws are all the same, to compensate the injured worker for Insurance, as defined, is coverage by contract whereby one party loss of wages and medical benefits. All are meant to be self-executing undertakes to indemnify or guarantee another against loss by a and are constantly changing, but they are still there, protecting not only specified contingency or peril. The very word “insurance” comes the worker but the employer as well and have been for many years. from the Latin word for “security.” The word “policy” comes from the Moving through history, very little is found regarding workers’ Italian language meaning “promise.” The first evidence of insurance compensation, although other forms of protection against the appeared in China around 3000 BC when merchants would divide their liability of one against another come to light and the term known as cargo into several ships, protecting their investments and dividing any “insurance” becomes popular. Common law was the avenue for claims losses among themselves. This system was continued forward, and in against another. Under liability, the “duty” and “breach of duty” of one 1750 BC, the Babylonians devised a system where the merchant would to and against another was the rule to follow. It wasn’t until the early borrow money to finance his shipment of goods. He paid the lender an 18th century that the “respondeat superior” doctrine under Old English additional sum of money and in exchange for this additional sum, the law came into being. Under this doctrine, the master (employer) was lender agreed to cancel the loan should the shipment be lost or stolen. held to be liable for damages to a third person caused by a servant’s This system was recorded in the Code of Hammurabi around 1750 BC. (employee) act or omission while the servant was acting within the The Romans are credited with developing life and health insurance course and scope of employment. Not many workers were protected through guilds or clubs around 600 AD. under this doctrine unless they were injured by a fellow worker. Overall, it was still another step in the right direction.

The Florida experience Florida moved slowly in enacting a workers’ compensation law D. Roosevelt’s New Deal brought many reforms including workers’ primarily because Florida had a smaller work force, virtually no compensation. manufacturing and no major problems until the Great Depression of This new law was signed May 23, 1935, as House Bill 29 and became the 1930s. Florida industry was limited and consisted primarily of effective July 1,1935. Florida made the headlines across the country phosphate mining, agricultural harvesting of fruits and vegetables, several months later on Labor Day, September 1, 1935, when the tobacco, cattle and logging. In addition, there was a steady movement most vicious hurricane ever to hit North America came ashore and of people, mostly unemployed, moving down from the north, seeking devastated the Keys and coastal areas. The loss of life was in the their fortune as well as Florida sunshine. Florida started an aggressive hundreds with hundreds more missing. Two records were set that day. campaign to attract business to the warmer, more economical climate The barometer recorded a low of 26.35 inches of mercury and winds in mid-Depression and the 1935 legislature meeting in regular session blew in excess of 250 miles per hour. and Governor David Sholtz, who was considered to be a liberal and full of new ideas recognized the necessity for this legislation. A The new act provided for creation of a new Florida Industrial workers’ compensation law was necessary to meet the demands and Commission, which began actual operations in June 1935. The requirements of the increased and industrial employment in the state commission consisted of three members, two of them appointed by the and as an inducement and invitation to other industries to move to governor to serve during the governor’s term of office and the third and operate in Florida. Prospective employers knew that they would member to be appointed by the governor to serve a four-year term and be open to lawsuits from workers injured on the job. Most states had be chairman of the commission. adopted legislation entering into the tradeoff and now it was Florida’s The Florida Industrial Commission’s first chairman was Wendall C. turn. Employers who had been in Florida for many years saw these Heaton, and he received a salary of $4,200 yearly. The commission new residents bring an increase in accidents and injuries. Lawsuits was responsible for administering the provisions of the workers’ were on the rise and workers demanded protection. President Franklin compensation law, making studies and investigations with respect

Cosmetology.EliteCME.com Page 23 to safety provisions and the causes of injuries in employment. They In the first year of the Florida Industrial Commission, 10,977 cases were authorized to make rules and regulations dealing with workers’ on workers’ compensation were reported by Florida’s 67 counties. Of compensation. The cost of administering the law was borne by a tax these, 2,983 were reported in Dade County, and 1,985 were reported in on workers’ compensation insurance premiums and upon self-insurers. Duval County. Benefits paid were approximately $290,434. It is interesting to note that this method of financing the cost of By 1937, approximately 40,380 cases were handled by the administering the law still exists today. commission, providing benefits of $963,711 to injured employees in The way the law was structured regarding benefits to the injured compensation and medical treatment. This figure also includes the worker is extremely interesting. Initially, no compensation was costs of funerals in the recorded 89 fatalities. allowed for the first fourteen days of the disability. Compensation Between 1935 and 1978 few major changes were made in Florida’s for disability was not to exceed $18 per week nor be less than $4 per workers’ compensation system. The first medical fee schedule was week; provided, however, that if the employee’s wages were less than adopted in 1938 during the regular legislative session. The special $4 per week, he was to receive his full weekly wage. Compensation disability trust fund was established in 1955. Also referred to as for disability was paid at the rate of 50 percent, 55 percent, and 60 the “second injury fund,” the purpose of the fund is to encourage percent of the employee’s average weekly earnings, depending upon employers to hire workers with disabilities. The same year, the the number of dependents of the employee. Medical treatment was rehabilitation and medical services section within the Bureau of furnished at a cost not to exceed $250, except in surgical cases in Workers’ Compensation was established. In 1960, Florida enacted its which the maximum expense to the employer was $500. Under no own coding and description system. By 1978, Florida adopted, for circumstances would compensation be paid for more than 350 weeks, the first time, a conversion index linking Florida’s fee schedule to the nor would the total amount paid exceed $5,000. Employees not Florida Medical Association relative value coding system, which was included under the act were domestic servants, and agriculture and fully adopted and completed by 1981. horticultural farm laborers.

A major overhaul In 1978, major changes in the state workers’ compensation system reductions for over a decade as the wage loss concept proved not to be were underway in the state legislature, the first major change since the answer to lowering costs. 1935. The law had basically been a “fixed benefit” system, with In 1980, House Bill 1677, as amended by the Florida Senate and workers paid on the basis of the severity and type of injury related to passed by the State House of Representatives, was the major a fixed schedule of benefits. Those who were able to or even returned legislative cleanup effort. The year of 1981 saw the revised bill for to work received lump sum payments while those who could not work the Workers’ Compensation Act. This bill essentially deleted obsolete were limited to the schedules. This system was replaced by the “wage provisions relating to the Industrial Relations Commission and Deputy loss concept” under the new compensation act. Now called workers’ Commissioners of Industrial Claims. The Workers’ Compensation act compensation instead of workers’ compensation, effective August 1, of 1986 incorporated pre-1979 and post-1979 concepts, definitions and 1979, this new act was to apply to all claims for injury arising out of directions. accidents occurring on or after August 1,1979. The industrial relations commission was abolished on October 1, 1979. After September By 1988 another major cleanup effort was the talk of state legislators. 30,1979, appeals from orders of deputy commissioners (eventually Consequently, new reforms were adopted in 1989, followed by major called Judges of Compensation Claims 10 years later in 1989) were to changes in the benefit structure during the 1990 session. Also, in 1990, be heard by the First District Court of Appeal (1st DCA). The Bureau the Bureau Of Workers’ Compensation Fraud was established in the of Workers’ Compensation under the Department Of Commerce was Department Of Insurance to combat fraud within the system, and the expanded and replaced by the Division of Workers’ Compensation Bureau Of Safety within the Division Of Workers’ Compensation was under the newly created Department Of Labor And Employment upgraded to full division status to fill the needs of customers for safety Security, which was vested with extensive powers. inspections and program establishment. The Workers’ Compensation Drug-Free Workplace Program was added to the law this same year. This major reform actually reduced premiums nearly 23 percent Recognizing the role that drugs and alcohol played in accidents on the for employers from 1978 through 1982. They were to be the last job.

Today We have seen wage loss come in 1979 and go in the 1993 reform, worker back to work as soon as able, therefore reducing costs and replaced by impairment income and supplemental benefits. The closing increasing productivity. years of the 20th Century brought many changes as litigation and In 2003, our law again underwent a major reform, with changes to medical care continued to be a problem not only in Florida but on a the permanent total, impairment income and death benefit structures, national level as well. The 1993 reform act introduced our system construction industry exemptions, compliance enforcement, medical to managed health care arrangements (MCAs). The Employee’s services; and examination and investigation of carrier and claim Assistance Office (EAO), designed to prevent litigation through handling entities. education, information, and the Early Intervention Program and to resolve disputes quickly and effectively, became a reality. In addition, The Division of Workers’ Compensation through reorganization the Employer Help Line, known today as Customer Information and continues to emphasize education and information both externally Services, was established to assist employers and other customers with and internally to all customers the division serves. Through outreach their questions and problems. In the 1993 Reform Act the emphasis programs, workshops, conferences, seminars, brochures, pamphlets was, and still is today, placed on re-employment, getting the injured and other materials, the division’s customers will better understand and take a proactive role in improving the system.

The future We are just a few years into 21st century and have already seen and Employment Security and the Division of Safety and the Special sweeping changes with the abolishment of the Department of Labor Disability Trust Fund. The Agency for Health Care Administration

Page 24 Cosmetology.EliteCME.com was elevated to full department status in 2001 and received the 1, 2002. The Department of Insurance and Department of Banking Medical Services portion of the Division of Workers’ Compensation and Finance merged into the new Department of Financial Services in February 2001, with permanent transfer effective July 1, 2002. effective January 1, 2003. The Re-employment section transferred to Department of Education, Yes, there will be changes as we progress into this new century, but Division of Vocational Rehabilitation with the remainder of the workers’ compensation is still here for the citizens of Florida. division moving to the department of Insurance, also effective July

Federal Health Care Reform: What does it mean for workers’ compensation? H.R.3590 - Patient Protection and Affordable Care Act (PPACA ) Beginning in 2011, Medicare and Medicaid will provide financial and of H.R. 4872 - Health Care and Education Reconciliation Act incentives over multiple years of up to $40,000 to $65,000 per eligible of 2010. These sweeping federal health care reform bills did not physician and up to $11 million per hospital for “meaningful” use of directly address workers’ compensation or implicate its medical health information technology, such as the electronic exchange of data benefit structure or payment models. Nonetheless, these federal health and reporting of clinical quality measures. Starting in 2015, physicians care reform bills (referred to as PPACA) will usher in a number of and hospitals that do not use certified products in a meaningful way changes that, once implemented, have the potential to impact workers’ will be penalized. The Congressional Budget Office (CBO) projects compensation generally and Florida’s workers’ compensation program that the incentives will boost the proportions of physicians and specifically. hospitals adopting comprehensive electronic health records by 2019 to 90% and 70%, respectively, from the 65% and 45% that would be The first thing to note is that there is no language in the health 23 care reform law that would directly and explicitly affect workers’ expected to do so anyway. compensation. The PPACA references workers’ compensation twice: The expected increased ability by doctors and hospitals to send ●● Section 2401, in connection with a mandate to have certain and receive electronic records aligns well the current International community health service agencies carry workers’ compensation Association of Industrial Accidents Boards and Commissions insurance; and (IAIABC) initiative to support state efforts to mandate electronic ●● Section 10109, which calls for the Secretary of Health and Human systems for workers’ compensation medical billing. Resources to develop rules that will facilitate the exchange of Under another provision of the federal health care reform the pre- financial and administrative transactions for the purpose improving existing medical condition exclusion, which currently applies to many the operation of the health care system and administrative costs. group health plans, will fade away from these plans in 2014. Some analysts believe that this provision will diminish the incentive for This second provision warrants watching because it encourages employees to claim, as work related, long standing “wear and tear” comments to the Secretary of the Department of Health and Human conditions. There may also be much greater demand on employers Resources on whether the implementing rule should include property for workplace and job accommodations leading to new exposures and and casualty insurance, including workers’ compensation. safety issues. Note - The United States Congress is contemplating amending In another development resulting from the federal health care reform, or repealing some provisions of PPACA. There are also ongoing the Center for Medicare and Medicaid Services (CMS) and Highmark discussions about repealing PPACA in its entirety. Medicare Services (one of its contractors) have awarded two health One of the more intriguing aspects of the federal health care reform information technology contracts to create and maintain systems and law is the way it will incent doctors and hospitals to start to use applications that support claims payments. Electronic health records electronic means of transmitting bills and records. According to the (EHR), or electronic medical records (EMR), are considered a key New England Journal of Medicine: component in controlling health costs.

Frequently Asked Questions For employees How long after an accident do I have to report it to my employer? What kind of medical treatment can I get? You should report it as soon as possible but no later than thirty The medical provider, authorized by your employer or the (30) days or your claim may be denied. insurance company, will provide the necessary medical care, When should my employer report the injury to their insurance treatment and prescriptions related to your injury. company? Do I have to pay any of my medical bills? Your employer should report the injury as soon as possible, but No, all authorized medical bills should be submitted by the no later than seven (7) days after their knowledge. The insurance medical provider to your employer’s insurance company for company must send you an informational brochure within three payment. (3) days after receiving notice from your employer. The brochure Will I be paid if I lose time from work? will explain your rights and responsibilities, as well as provide Under Florida law, you are not paid for the first seven days of additional information about the workers’ compensation law. disability. However, if you lose time because your disability A copy of the brochure can be viewed on this website under extends to over 21 days, you may be paid for the first seven days “Publications”. by the insurance company. My employer will not report my injury to the insurance company. How much will I be paid? What can I do? In most cases, your benefit check, which is paid bi-weekly, will be You have the right to report the injury to their insurance company. 66 2/3 percent of your average weekly wage. If you were injured However, if you need assistance, contact the Employee Assistance before October 1, 2003, this amount is calculated by using wages Office (EAO) at (800) 342-1741 or e-mail wceao@myfloridacfo. earned during the 91-day period immediately preceding the date of com. your injury, not to exceed the state limit. If you worked less than 90% of the 91 day period, the wages of a similar employee in the

Cosmetology.EliteCME.com Page 25 same employment who has worked the whole of the 91-day period My employer and the insurance company have denied my claim or your full-time weekly wage may be used. If you were injured on for workers’ compensation benefits. Do I need legal representation or after October 1, 2003, your average weekly wage is calculated to get my benefits? What should I do? using wages earned 13 weeks prior to your injury, not counting the It is your decision whether or not to hire an attorney. However, the week in which you were injured. EAO can assist you and attempt to resolve the dispute. If unable to resolve, the EAO can further assist you in completing and filing a In addition, if you worked less than 75% of the 13 week period, a Petition for Benefits. This service is provided at no cost to you. For similar employee in the same employment who has worked 75% assistance call: (800) 342-1741 or e-mail wceao@myfloridacfo. of the 13-week period or your full time weekly wage shall be used. com . For the location of the nearest EAO, click on: www. Do I have to pay income tax on this money? myfloridacfo.com/WC/dist_offices.html. No. However, if you go back to work on light or limited duty and What is the time limit for filing a Petition for Benefits? are still under the care of the authorized doctor, you will pay taxes In general, there is a two (2) year period to file a Petition. on any wages earned while working. For additional information on However, it depends on the type of issue in dispute. You may call Income Tax, you may want to visit the Internal Revenue Service the EAO at (800) 342-1741 or e-mail [email protected] website at: www.irs.gov. for specific information. When will I get my first check? Is there a period of time after which my claim is no longer open? You should receive the first check within 21 days after reporting If you were injured on or after January 1, 1994 , the claim is your injury to your employer. closed one (1) year from the date of your last medical treatment or If I’m only temporarily disabled, how long can I get these checks? payment of compensation. This period of time is referred to as the You can receive Temporary Total, Temporary Partial Disability Statute of Limitations. If you were injured before January 1, 1994 , payments or a combination of the two benefits during the continuance the period is two (2) years. of your disability for no more than a maximum of 104 weeks. Can I get a settlement from my claim? Can I receive social security benefits and workers’ compensation Settlements may be made under certain circumstances and are benefits at the same time? voluntary; not automatic or mandatory. Yes. However an offset, or reduction in your workers’ If I settle my claim for medical benefits with the insurance compensation check may be applied because the law states that the company and my condition gets worse later, who pays for my two combined may not exceed 80 percent of your average weekly future medical care, surgeries, etc? wage earned prior to your injury. For further information on Social You are responsible for your future medical needs after your claim Security, you may contact the Social Security Administration at for medical benefits is settled. (800) 772-1213 or visit their website at www.ssa.gov. What can I do when it is difficult to get a prescription filled or I Can I receive unemployment compensation and workers’ am having problems with the pharmacy where I get my workers’ compensation benefits at the same time? compensation medication? No, not if you are receiving temporary total or permanent total In Florida, an injured worker has the right to select a pharmacy disability benefits as you must be medically able and available or pharmacist. Florida law prohibits interference with your right for work to qualify for unemployment. For additional information to choose a pharmacy or pharmacist. However, a pharmacy is not on Unemployment Compensation, you may want to utilize the required to participate in the workers’ compensation program. Unemployment Compensation website at: www.floridajobs.org. If at any time, you become dissatisfied with your pharmacy or What can I do if I am not receiving my benefit check? pharmacist’s services, you can seek another pharmacy to fill your Call the insurance company and ask for the adjuster or claims prescriptions. representative. If you still have questions and don’t understand I am one of the individuals covered by s. 119.071 (4) (d), Florida why the checks have stopped, call the EAO at (800) 342-1741 or Statutes who is eligible to have my “personal information” exempt e-mail [email protected]. from a public record release. If I am injured on the job, and my If I am unable to return to work until my doctor releases me, does First Report of Injury or Illness is reported to your office, will my employer have to hold my job for me? your agency automatically withhold my personal information from No, there is no provision in the law that requires your employer to a public record request? hold the job open for you. No. -- The “personal information” in s. 119.071 (4)(d), F.S. is Can my employer fire me if I am unable to work because of an defined as your address, telephone number, photograph, and injury and am receiving workers’ compensation benefits? social security number. Although photographs are not collected No, it is against the law to fire you because you have filed or by our office, your social security number will always be redacted attempted to file a workers’ compensation claim. from any public record request pursuant to s. 119.071 (5) 5., F.S.. However, s. 119.071 (4) (d) 2., F.S., requires you or your employer If I am unable to return to the type of work I did before I was to formally write to the custodial agency that is in possession of injured, what can I do? your personal information in order to claim the exempt status. If eligible, the law provides, at no cost to you, reemployment Our office accepts emails, faxes or written correspondence when services to help you return to work. Services may include claiming the personal information exempt status. You must provide vocational counseling, transferable skills analysis, job-seeking your occupation (title or description), name of employer, and skills, job placement, on-the-job training, and formal retraining. To date of injury associated with any Florida workers’ compensation find out more about this program, you may contact the Department claim you filed, if applicable. You must also provide your date of of Financial Services, Division of Workers’ Compensation, Bureau birth and the last 4 digits ONLY of your social security number in of Employee Assistance and Ombudsman Office (EAO) at (800) order for us to establish accurate confidential record information. 342-1741 option 4 or by e-mail to [email protected].

Page 26 Cosmetology.EliteCME.com To request exemption of personal information maintained by our Tallahassee, FL 32399-4226 Division, you should email, fax or write to the following: [email protected] Division of Workers’ Compensation Fax: 850-488-3453 Bureau of Data Quality and Collection Records Privacy Forms are located at http://www.myfloridacfo. ATTN: Records Privacy Section com/wc/employee/records.html 200 E. Gaines Street

For employers Who needs Workers’ Compensation coverage? your insurance carrier for determination of responsibility within 7 ●● If you are in an industry, other than construction, and have four days of your first knowledge of the accident/injury. (4) or more employees, full-time or part-time, you are required to What injuries are not covered? carry workers’ compensation coverage (an exempted corporate The law does not provide compensation for the following conditions: officer does not count as an employee). ●● A mental or nervous injury due to stress, fright, or excitement; ●● If you are in the construction industry, and have one (1) or more ●● A work related condition that causes an employee to have fear employees (including yourself), you are required to carry workers’ or dislike for another individual because of the individual’s race, compensation coverage (an exempted corporate officer or member color, religion, sex, national origin, age, or handicap; of a limited liability company does not count as an employee). ●● “Pain and suffering” has never been compensable in Florida, nor ●● If you are a state or local government, you are required to carry is it compensable in any other state. The employer may not sue workers’ compensation coverage. an injured worker for causing a catastrophe nor can the injured ●● If you are a farmer, and have more than five (5) regular employees worker sue the employer for their injury. This trade-off makes it and/or twelve (12) or more other workers for seasonal agricultural possible for injured workers to receive immediate medical care, at labor lasting thirty (30) days or more, you are required to carry no cost to the injured worker, without any consideration for who workers’ compensation coverage. was at fault, the employer or the employee. In civil law, negligence If you have additional questions, contact the Customer Service must be established through litigation before any compensation is Unit at (850)413-1601. awarded. ●● Reference: Section 440.02(1), Florida Statutes. How does an employer obtain workers’ compensation insurance? You have several options: Compensation will not be paid in several other instances: ●● By purchasing a policy from an insurance agent that represents ●● If the injury is caused by the employee’s willful intention to injure approved insurance companies. or kill himself or another; ●● From the Joint Underwriting Association (JUA), http://www. ●● If the injury is caused primarily because the employee is fwcjua.com. intoxicated or under the influence of drugs; ●● By qualifying as an individual self-insured; for additional ●● If the injury or death of the employee is covered by the Federal information, contact the Division of Workers’ Compensation at Employer’s Liability Act, the Longshore and Harbor Workers’ (850)413-1784. Compensation Act, or the Jones Act (if the injured worker is a ●● Or, an employer may contract with a professional employer “seaman” or member of a crew). organization (employee leasing) that has secured workers’ compensation coverage. Can an employer be liable for double compensation? ●● Reference: Section, 440.02, Florida Statutes. An employer can be liable for double compensation if a minor child is injured while employed in violation of any of the Where do I get a supply of the injury report forms that I am conditions of the child labor laws of Florida. The employer alone, required to complete when one of my employees is injured? not the insurance carrier, is liable for up to double the normal Your insurance carrier is required to provide you a supply of the compensation as provided by the Workers’ Compensation Law. To Form DWC-1 First Report of Injury or Illness. Forms can also be receive further information regarding the Child Labor Law, call the downloaded from the Florida Workers’ Compensation web site Child Labor Office at (800)226-2536. Rules & Forms page. As a small business owner, I fail to see how I can be sued by an Who can I contact with questions or concerns regarding risk injured worker if I provide all the necessary care, light duty work, classification codes and premium amounts? and offer to retrain the employee. Call your insurance carrier or service representative. If you have Under the provisions of Chapter 440, Florida Statutes, an injured a dispute regarding the risk classification codes, you can call the worker has two years from the date of the accident to file a petition National Council on Compensation Insurance (NCCI) at 1-800- for benefits with the Division of Administrative Hearings. If an 622-4123. employer is providing benefits and return to work options, that Does the injured worker pay any part of my workers’ should be sufficient to meet the ultimate goal of returning an compensation insurance premium? injured worker to gainful employment. However, an employer/ The law is very specific on this point. It is the employer’s carrier’s definition of “necessary care” and that of an injured responsibility to pay the entire premium for workers’ worker may differ. When that happens, the injured worker has no compensation insurance coverage. remedy except to file a petition for benefits and have a judge of compensation claims determine whether the benefits that are being What kinds of employee injuries are covered? provided are sufficient, or if additional benefits not being provided The law covers all accidental injuries and occupational diseases are required by Florida law. If the employer is providing benefits, arising out of and in the course and scope of employment. This all expenditures must be reported to the employer’s workers’ includes diseases or infections resulting from such injuries. The compensation insurance carrier for statistical purposes. law also covers death resulting from such injuries within specified periods of time. Even if you do not think an injury is covered, you must still file the First Report of Injury or Illness (DWC-1) with

Cosmetology.EliteCME.com Page 27 If I suspect an employer should have Workers’ Compensation If a terminated employee files for unemployment compensation insurance coverage, but does not, or if I suspect fraudulent activity benefits, may I inform the adjudicator that the employee was in a workers’ compensation claim, where do I report this? terminated as a result of a positive drug test? Suspected workers’ compensation fraud can be reported directly The adjudicator is bound to maintain this information confidential to the Department of Financial Services, Bureau of Workers’ under s.443.1715(3)(b), Florida Statutes, until introduced into the Compensation Fraud, 200 E. Gadsden Street, Suite 100A, public record pursuant to a hearing conducted under s.443.151(4), Tallahassee, Florida 32301, or to the bureau’s toll free hotline Florida Statutes. Under all other instances employers may not number at 1-800-378-0445. Suspected fraud can also be reported release any information concerning drug test results obtained to the Florida Workers’ Compensation, Bureau of Compliance’s pursuant to section s.440.102(8), Florida Statutes, unless such toll free hotline at 1-800-742-2214. Anonymous calls are accepted. release is compelled by an administrative law judge, a hearing You can also fill out the Non-Compliance Referral Form to report officer, or a court of competent jurisdiction or is deemed employer’s who do not have workers’ compensation insurance appropriate by a professional or occupational licensing board in a coverage. This form can be accessed at the Division’s website at related disciplinary proceeding. www.myfloridacfo.com/wc/databases.html. Can I post the results of my employees’ drug tests? What in the system would prevent an injured worker, who wanted All information, interviews, reports, statements, memoranda and to leave his employer anyway, from claiming to be hurt, waiting drug test results, written or otherwise, received by the employer out the treatment, still claiming to be hurt and then trying to through a drug testing program is confidential and cannot be settle? It would not cost him anything but a few hours to do this posted in any public manner. and he would have nothing to lose. Am I responsible for payment for services when my employee By law, pain or other subjective complaints alone, in the absence participates in an Employee Assistance Program (EAP)? of objective relevant medical findings, are not compensable. No, but if you choose to pay for an Employee Assistance Program, However, sometimes these types of claims do occur and they are you have the right to choose the facility providing treatment. If an sometimes settled by insurance carriers for a nominal amount of employee does participate in an Employee Assistance Program, money to rid the employer/carrier of a nuisance case. you, the employer, are required to extend the same considerations Is compensation payable if an employee refuses to use a safety as reflected under the federal guidelines established for the appliance like a hard hat, safety goggles or observe a safety rule? Americans with Disabilities Act and the Family and Medical Compensation will still be paid, but indemnity benefits (partial Leave Act. wage replacement) may be reduced by 25 percent if the employee How many days does the employee have to re-test the specimen if knew about the safety rule prior to the accident and failed to he or she wishes to contest a positive test result? observe the rule, or if the employee knowingly chooses not to use During the 180 day period after written notification of a positive a safety appliance which the employer has directed him to use. test result, the employee who has provided the specimen shall Will becoming a drug-free workplace save me money on my be permitted by the employer to have a portion of the specimen insurance premiums? re-tested, at the employee’s expense, an Agency for Health Care If you implement a drug-free workplace program in accordance Administration (AHCA) licensed or a USHHS certified laboratory with the criteria set forth in s.440.102, Florida Statutes, you may of his or her choice. be eligible for a 5 percent premium credit from your insurance Who pays for the drug test? carrier to your workers’ compensation insurance premium. In The employer is responsible for payment of all drug tests they may addition to the premium credit, having a Workers’ Compensation require. However, if an employee wishes to have the specimen Drug-Free Workplace Program may make your workplace safer, re-tested at a laboratory certified by the Agency for Healthcare resulting in fewer accidents, which may reduce your workers’ Administration (AHCA), it will be at the employee’s expense. If compensation costs. the workers’ compensation insurance carrier uses a positive test Am I required to become a carrier certified drug-free workplace? result to determine the compensability of a claim, the carrier would Becoming a carrier certified drug-free workplace is voluntary. be responsible to cover the costs of the test. However, without the certification, you would not be eligible for any of the benefits provided under this program. Under the Workers’ Compensation Drug-Free Workplace Program, can I conduct random drug testing of my employees? In addition to the situations in which testing is mandatory, the law does not prohibit a private employer from conducting random testing or any other lawful testing of employees. A public employer may institute random testing of employees in “safety sensitive” or “special risk” occupations. Can I use a breathalyzer as a valid drug testing method? Under the Workers’ Compensation Drug-Free Workplace Program, the use of a breathalyzer cannot be used as a testing method for initial or confirmation tests. What if an employee refuses to take a drug test? If an injured worker refuses to submit to a test for drugs or alcohol, the employee may forfeit eligibility for medical and indemnity benefits. If an employee or job applicant refuses to submit to a drug test, the employer is permitted to discharge or discipline the employee or may refuse to hire the applicant (if specified in the written Drug-Free Workplace Policy), since, by law, refusal to submit to a drug test is presumed to be a positive test result.

Page 28 Cosmetology.EliteCME.com Chapter 5: HIV/AIDs

2 CE Hours (Satisfies HIV/AIDs Requirement)

By: Staff Writer

Learning objectives ŠŠ Define HIV, AIDS, their relationship and the differences between ŠŠ List ways a person who is HIV positive can avoid transmitting the them. virus to others. ŠŠ Identify how HIV is transmitted from one person to another – and ŠŠ Name some common “opportunistic infections.” how it is NOT spread. ŠŠ Explain HIV “drug cocktails” and their role in treating people with ŠŠ List risk factors for being infected by HIV. HIV. ŠŠ Describe HIV tests and what they measure. ŠŠ List common side effects of HIV/AIDS drugs. ŠŠ Define CD4 counts and “viral loads.” Introduction Four decades ago, when doctors first noticed a strange illness that According to the CDC, over the past decade, the number of people became known as acquired immune deficiency syndrome, or AIDS, living with HIV has increased, while the annual number of new HIV the diagnosis was nearly always a death sentence. While there still is infections has remained relatively stable at about 50,000 new HIV no cure for AIDS or a way to eradicate the virus that causes it – the infections each year. Still, the pace of new infections continues at human immunodeficiency virus (HIV) – the number of people who are far too high a level— particularly among certain groups. Those who surviving the infection has consistently risen in the past 20 years. are gay, bisexual, or men who have sex with other men (MSM), of Two sports legends, NBA star Magic Johnson and Olympic diving all races and ethnicities remain the most affected by HIV. New HIV gold medalist Greg Louganis, are among the well-known people living infections among women are primarily attributed to heterosexual with HIV or AIDS. Both say that while the virus remains in their contact (84% in 2010) or injection drug use (16% in 2010). bodies, it is now undetectable. Both are known to keep fit, and both If we look at HIV infection by race and ethnicity, we see that African say they owe their good health to their medications, the anti-HIV drug Americans are most affected by HIV. In 2010, African Americans “cocktails” that have helped millions worldwide maintain their health made up only 12% of the US population, but had 44% of all new HIV despite having HIV infection. infections. Additionally, Hispanic/Latinos are also strongly affected. “I take my meds and go about my business of living,” Louganis told They make up 17% of the US population, but had 21% of all new HIV People magazine in a February 2010 interview. “I don’t really dwell infections. on it.” The Henry J. Kaiser Family Foundation released a report on its survey Johnson, who has become a savvy businessman as well as an advocate of American attitudes and knowledge of AIDS, noting, “A sense of for AIDS education and prevention, told the Washington Post in 2006: urgency about HIV/AIDS has fallen considerably from recent years, “The only thing that saved my life was early detection and taking my and personal concern about becoming infected has declined steadily, medicine.” including among young adults.” But they are hardly alone. Today, more than 1.1 million people in the So, in addition to research efforts (in June 2010, the government United States are living with HIV infection and almost 1 in 6 (15.8%) listed more than 800 ongoing HIV/AIDS research projects on are unaware of their infection, and thanks to new drug therapies, many various websites), health officials are trying to put more emphasis on people who are HIV positive are living symptom free, and like Magic prevention and early detection. Johnson after nearly 20 years, they have yet to develop the illness For those already infected with HIV, the future is brighter for the many AIDS. who continue to live, and live well, with HIV/AIDS. But with that Researchers and health officials agree that new drug therapies have comes the challenges of adapting to lifestyle and behavioral changes helped to slow down the number of deaths attributed to HIV/AIDS and a new commitment to good health. This course, adapted from in the past 20 years. But they fear complacency may have developed information from the U.S. Department of Veterans Affairs and other among people at high risk for the disease. While many more people government agencies, presents those challenges and the reality of are living with HIV/AIDS, the reality is that people continue to living with HIV/AIDS. be diagnosed with HIV every day – in fact, one person every 9½ minutes, according to the CDC. THE BASICS OF HIV/AIDS What is HIV? HIV stands for the human immunodeficiency virus: infections, such as bacteria and viruses. Once attacked by HIV, the H – Human. This virus infects human beings. immune system becomes deficient and doesn’t work properly. I – Immunodeficiency. This virus attacks a person’s immune V – Virus. A virus is a type of germ too small to be seen even with system. The immune system is the body’s defense against a microscope.

Cosmetology.EliteCME.com Page 29 Some viruses, like the ones that cause colds or flu, stay in the body infected with HIV is said to be “HIV positive.” Once a person is HIV for only a few days. HIV, however, never goes away. A person who is positive, that person will always be HIV positive.

What does the virus do? All viruses must infect living cells to reproduce. HIV takes over When HIV takes over a CD4 cell, it turns the cell into a virus factory. certain immune system cells that are supposed to defend the body. It forces the cell to produce thousands of copies of the virus. These These cells are called CD4 cells, or T cells. copies infect other CD4 cells. Infected cells don’t work well and die early. Over time, the loss of CD4 cells weakens the immune system, making it harder for the body to stay healthy.

What is AIDS? AIDS stands for acquired immunodeficiency syndrome: person is said to have AIDS when his or her immune system becomes A – Acquired. This condition is acquired, meaning that a person so weak it can’t fight off certain kinds of infections and cancers. becomes infected with it. Even without one of these infections, an HIV-positive person is I – Immuno. This condition affects a person’s immune system, the diagnosed with AIDS if his or her immune system becomes severely part of the body that fights off germs such as bacteria or viruses. weakened. This is measured by a lab test that determines the number D – Deficiency. The immune system becomes deficient and does of CD4 cells a person has. A CD4 cell count less than 200 in an HIV- not work properly. infected person counts as a diagnosis of AIDS. It can take between S – Syndrome. A person with AIDS may experience other diseases two to 10 years or longer for an HIV-positive person to develop AIDS, and infections because of a weakened immune system. even without treatment. AIDS is the most advanced stage of infection caused by HIV. Most people who are HIV positive do not have AIDS. An HIV-positive

How is HIV spread? HIV is spread through four body fluids: HIV is NOT spread through: ●● Semen. ●● Tears. ●● Vaginal fluid. ●● Sweat. ●● Blood. ●● Feces. ●● Breast milk. ●● Urine.

How is HIV spread through sex? A person can get infected from sexual contact with someone who is Unprotected sex with someone who is infected doesn’t mean a person infected with HIV. Sexual contact that can transmit HIV includes: will automatically be infected, too. But there is always a chance. Using ●● Vaginal sex. a condom reduces the risk. ●● Anal sex. HIV is NOT spread by: ●● Oral sex. ●● Hugging or massage. The best thing for sexually active people to do is to practice “safer ●● Fantasizing. sex” all the time. To do so, always use a condom or other latex barrier. ●● Dry kissing. They should make sure that any lubricant used with condoms is water ●● Daily living with someone who has HIV. based, not oil-based. Oil-based lubrications can cause latex condoms to deteriorate.

How is HIV spread through blood? People can become infected if they have contact with the blood of ●● Accidental needle sticks. someone who is infected with HIV. Blood-borne infection with HIV ●● Blood transfusions. can occur through: ●● Splashing blood in the eyes. ●● Sharing needles when shooting drugs. ●● Tattoos or body piercings with unsterilized needles. HIV is NOT spread by blood passed through insect bites.

Can mothers give HIV to their babies? Pregnant women who are HIV positive can give the virus to their way to prevent infection. With proper care, however, most babies of babies in the womb and during birth. Taking anti-HIV drugs during HIV-infected women now are born free of the virus. pregnancy and childbirth can help lower the risk, but there is no sure

HIV and salons Salons have come under intense scrutiny in the past decade because of U.S. – have come from bacterial and fungal infections transmitted in various outbreaks of infectious diseases that were traced to improperly manicures and pedicures. cleaned equipment. Most states have implemented strict laws for But Texas dermatologist Shelley A. Sekula-Gibbs, MD, says the health handling, cleaning and sterilizing the tools of the trade. To date, the risks in the beauty industry also include viral infections such as HIV, most serious problems – which included at least three deaths in the hepatitis B and C, and warts. Sekula-Gibbs warns that “Nail clippers,

Page 30 Cosmetology.EliteCME.com acrylic nail drills, cuticle scissors, callus paring blades, reusable razors As yet, no cases of HIV transmission through blood contact at a and blades all have the potential to transmit infectious diseases if they salon have been documented. However, cosmetologists know that the are not properly sterilized. presence of blood during nail procedures is not that unusual. They also “As more and more consumers frequent hair and nail salons each know that they could be just one slip away from a minor nick on the year, the risk of becoming infected with hepatitis, HIV and other ear of a client during a haircut. If that blood contains harmful viruses, transmittable diseases increases as well,” Sekula-Gibbs said. She the potential for transmission is there, as close as the hands of the advocates a “proactive stance” on the issue by ensuring workers in the stylist with an open cut on her finger, or the one at the next station who cosmetology and barbering industry are educated about the risks of just needs to “borrow” those specialty scissors for moment, or the feet such diseases and ways to prevent their transmission. She also urges of the next client of the nail technician who forgot to throw away the workers to learn about and get vaccines for some of these diseases to cuticle pusher she used on the client still soaking at the next seat. protect themselves and their clients. But is that likely to happen? The risks of HIV transmission at a Most salon workers know their state licensing boards have set strict salon indeed are much lower than those for Staph and other rules for salon procedures and the exact steps for proper sanitation harmful – and sometimes deadly – bacteria and germs. However, and sterilization of equipment to make sure disease transmission can’t a “perfect storm” of circumstances could allow it to happen. And what happen in their salon. Among the most important is the simplest: a storm that first case of HIV transmission through beauty procedures Workers must wash their hands frequently, between clients and would be for that salon – and for the entire industry. sometimes more often when there is a chance of any kind of disease You can avoid it at your salon: Just follow proper sanitation rules and transmission. Salons that endorse and enforce those rules will have procedures to protect yourself and your clients. little to worry about.

What are the symptoms of HIV? You can’t tell if a person is HIV positive by looking at them. Most headache, a sore throat, swollen lymph nodes (usually on the neck), people with HIV infection don’t look sick. Even so, when a person first fatigue, a rash or sores in the mouth. becomes infected, he or she may experience certain symptoms. This If symptoms appear, they usually do so within days or weeks after period of early infection is called acute HIV infection. Symptoms can infection, and end after one to two weeks. The only way to tell whether be different for each person, and sometimes there are no symptoms at the symptoms are from a cold, the flu or HIV is to have an HIV test. all. It might feel like a cold or the flu. A person might experience fever,

Who is at risk? As of 2006, guidelines from the U.S. Centers for Disease Control and ●● Have shared injection drug needles and syringes. Prevention have recommended that any sexually active person aged ●● Have had a sexually transmitted disease, like chlamydia or 13-64 be tested for HIV during routine health screenings every year, gonorrhea. even if that person is at low risk of contracting the virus. ●● Received a blood transfusion/blood clotting factor between 1978 However, health officials say people are at above-average risk of and 1985. getting HIV if they: ●● Have had unprotected sex with anyone who falls into an above ●● Have had unprotected sex with someone who is infected with category. HIV.

How is HIV treated? Many treatments now can help people with HIV. As a result, many blood is called the “viral load,” and it can be measured by a test. The people with HIV are living much longer and healthier lives than lower the viral load, the longer a person can stay healthy and fight off before. infections. Currently, medicines can slow the growth of the virus or stop it from There are several types of anti-HIV drugs. Each type attacks the virus making copies of itself. Although these drugs don’t kill the virus, they in its own way. keep the amount of virus in the blood low. The amount of virus in the

How are the drugs taken? Most people being treated for HIV take three or more drugs. This is name: highly active antiretroviral therapy, or HAART.) Combination called combination therapy, or “the cocktail.” (It also has a longer therapy is the most effective treatment for HIV.

Is it hard to take these drugs? HIV medicines have become much easier to take in recent years. Some other hand, the drugs help keep HIV under control and let people newer drug combinations package three separate medicines into only infected with HIV live longer and healthier lives. one or two pills, taken once a day, with minimal side effects for most Once on medications, patients must work with their doctors to monitor individuals. Still, taking medicine for HIV can be complicated and how well the drugs are working, deal with side effects, if any, and depends on the particular patient. On one hand, some of the drugs decide what to do if the drugs stop working. The good news is that are difficult to take, can cause serious side effects, and don’t work experts are learning more about the virus and creating new treatments for everyone. Even when a drug does help a particular person, it may for HIV that are easier to take. become less effective over time or stop working altogether. On the

Cosmetology.EliteCME.com Page 31 Do people with HIV have to be treated for the rest of their lives? Right now, there is no cure for HIV infection or AIDS. So once a person starts treatment, he or she must continue it to be sure that the virus doesn’t multiply out of control.

Are there long-term effects? Over time, people who are HIV-positive may experience symptoms lose a lot of fat in unusual areas of the body, or they may develop heart from the infection and side effects from their anti-HIV drugs. disease or diabetes. Sometimes it is not clear whether the virus or the medications are Eventually, people may get sick with other infections or cancers causing the problems. because their weakened immune system can’t protect the body One long-term effect that some people experience is a change in the anymore. They may reach the advanced stage of infection called AIDS. way their bodies handle fats and sugars. For example, they may gain or

Is HIV always fatal? Most people with HIV probably will have the virus in their body when Since 1996, improved treatments have given renewed hope to many they die because there is currently no way to get rid of it. Whether HIV people who are HIV-positive. While the treatments are not a cure and will be what causes someone’s death, however, is not always clear. are far from perfect, they may help to keep people with HIV healthy What many people want to know is whether it is possible to get HIV for a long time. and have a normal, relatively healthy life. HIV is often thought of as How long? No one knows, really. Some people may do very well for an incurable, fatal illness, and it certainly can be – especially after many, many years. Others may eventually get sick and die despite a person’s immune system is weakened to the point that he or she being treated. Recent studies suggest that people who take the has AIDS. Without treatment, most people with HIV will eventually treatments can gain, on average, 24 extra years of life. There is a great develop AIDS and die. When someone dies of AIDS, it is usually need for research to find new and better treatments for HIV. because of an opportunistic infection or other long-term effect of having HIV.

HIV and hepatitis C HIV and hepatitis C, although caused by different viruses, are very spread mainly by blood, but rarely by sex. In many cases, hepatitis C different illnesses that are increasingly found together in people with never goes away. Over time, it can cause other health problems, such HIV. as cirrhosis (or scarring of the liver) and liver cancer. HIV is spread mainly through the blood and through sexual contact. It HIV affects the whole immune system, including the body’s ability can wear down the body’s immune system, making it hard for the body to fight off hepatitis C. As a result, a person with HIV might develop to fight off dangerous infections. Hepatitis C is a disease that affects a case of hepatitis C that is worse than it would be if he or she didn’t the liver. It is caused by a virus called the hepatitis C virus, and it is have HIV.

THE HIV TEST What does the test measure? The HIV test is designed to determine whether a person has been HIV in the person’s body; they are different from antibodies for the infected with HIV, the virus that causes AIDS. When a person is flu, a cold or other infections. So a person who has HIV antibodies infected with HIV, the body produces cells and particles to fight the has been infected with HIV. The test does not tell whether people have virus, called antibodies. The HIV test can detect these antibodies to AIDS, how long they have been infected or how sick they might be.

What does the test involve? The HIV test requires a sample of blood or fluid from inside the handling, and not every medical center or clinic offers them. What’s mouth. more, positive results from rapid tests must be confirmed by another, For the blood test, blood is drawn either from the arm or from the more sensitive, test – and getting those results can take one to two finger with a needlestick. Results from oral-fluid or blood tests usually weeks. A negative result from the rapid test does not need to be take one to two weeks. confirmed. For the oral-fluid test (called OraSure), a probe sits in the mouth In most people, the body will produce antibodies to the virus between between the cheek and gums for two to five minutes. 2 and 12 weeks after exposure to HIV. But in some people, it may take three months after exposure for the test results to be 97 percent However, there are now rapid tests for both oral fluid and blood accurate, and six months to be absolutely certain, meaning people that give results in less than 30 minutes. Rapid tests require special whose initial tests are negative should retest.

Page 32 Cosmetology.EliteCME.com A positive HIV test A positive HIV test does not equal death: It means people need to ●● Show up at medical appointments. take care of themselves to stay healthy. Many people who have been ●● Follow the doctor’s instructions about lifestyle, diet, nutrition and infected since the 1980s are alive today, living healthy and productive treatment. lives. The most important things people who get a positive result can ●● Learn about HIV disease and how to take care of themselves. do immediately are: ●● Ask for help or support. ●● Start seeing a doctor or other health care provider.

LIVING WITH AIDS Understanding the diagnosis Soon after a diagnosis, a person’s doctor will run other tests to make common illnesses much worse than they would be for people determine his or her overall health and the condition of the immune who don’t have HIV. system. This is key because HIV affects the immune system, and can

Learn about HIV and AIDS The more people know about HIV and how to treat it, the less of them provide phone numbers, hotlines and ways to obtain confused and anxious they and others will be about the diagnosis. And informative brochures in the mail. the more they learn, the better they will be at making decisions about Use the local library: The most current information will be in the their health. library’s collection of newspapers and magazines (books about There are many ways to learn about HIV and AIDS: HIV and AIDS may be out of date by the time they are published). The U.S. government has many informative, reputable websites A newly diagnosed person should talk with others who have been that provide accurate information about living with HIV for diagnosed with HIV and AIDS. Doctors may know where to find patients and caregivers, friends and partners. An excellent place support groups. Or people can go online, where there are message to start is at an online centralized site called AIDS.gov (http:// boards and chat rooms. However, they should always discuss what aids.gov/), which links to dozens of federal agencies and outside they learn from these sources with the doctor. The information resources for people wanting to learn about HIV/AIDS. Many may not be accurate, and even if it is, it may not be right for this person’s particular situation. Telling others People who find they are HIV-positive need support from family, Deciding to tell others that he or she is HIV positive is an important friends and colleagues, and they must be people who are willing to personal choice. It can make a big difference in how the person copes help them through the emotional and physical issues they are going to with the disease, and can affect his or her relationships with people. face. Those who want to help loved ones and friends who are facing People who decide to share information about their diagnosis should HIV should: tell people they trust or those who are directly affected. These include ●● Offer support and understanding. family members; good friends; all health care providers, such as ●● Provide assistance, such as running errands and helping with doctors, nurses and dentists; and personal services workers such as childcare, doctor visits and work. cosmetologists, nail technicians, and facial specialists. ●● Learn from the person with HIV how it is spread and spur the However, people don’t have to tell everyone about their HIV status discussion on how to prevent the person from spreading it. right away. They might want to talk with a counselor or social worker first.

Support groups Joining a group of people who are facing the same challenges can deal with common experiences associated with being HIV positive. have important benefits. These include helping people feel better Support groups are especially helpful for people who live alone or about themselves, finding a new life focus, making new friendships, don’t have family and friends nearby. (See more resources at the end improving their mood and better understanding their own needs and of this chapter for tips on finding a support group.) those of their families. People in support groups often help each other

Working with the doctor If ignored, HIV can lead to illness and death. This is why it is so Many doctors who treat HIV are specialists in infectious disease. They important for a person with HIV to get medical care. They should work with a team of other health professionals who focus on HIV as a not be afraid to seek a doctor or nurse practitioner with experience in chronic, or lifelong, disease. treating HIV-infected patients – he or she can help them to stay well.

Before appointments People with HIV – indeed any patient with any serious disease – ●● A list of the medications they are taking (include herbs and should prepare for an appointment with a doctor by writing down: vitamins). ●● Any questions they have. ●● Upcoming tests or new information they’ve heard about. ●● Any symptoms or problems they want to tell the doctor about ●● Changes in their living situation, such as a job change. (include symptoms such as poor sleep, trouble concentrating, feeling tired).

Cosmetology.EliteCME.com Page 33 If it seems appropriate, a family member or friend who is aware of the to take notes and pay attention to what the doctor is saying at the same situation might volunteer to go with the person and take notes of the time. answers and facts the person is given. For a patient, it can be difficult

During appointments Patients with HIV should learn about the important lab tests that will Patients must be encouraged to be honest. If they have sex with track their health and the progress of HIV. They should not be afraid someone of the same sex or someone other than their spouse, it’s OK to question the doctor about any tests ordered, and ask the doctor to tell the doctor. He or she isn’t there to judge a patient, but to make what the tests are to measure. If they don’t understand what the doctor decisions based on the person’s particular circumstances. The patient is saying, they must ask him or her to explain it in everyday terms. must tell the doctor about his or her sexual or drug use history, because Friends who are part of the person’s support team should be ready to those behaviors can put the person at risk of getting other sexually encourage an HIV patient to do so. transmitted diseases as well as hepatitis. When the body is fighting off Patients have the right to ask questions of a doctor or exercise their these other diseases, it will not be able to fight off HIV as effectively. legal right to see their medical records. After all, it’s their body. A person who is HIV positive may get sicker, faster.

Monitoring health Once people are diagnosed with HIV, they need to pay closer attention often show signs of illness before there are any noticeable symptoms. to their health than they did before. The most important is to track Second, they must listen to what their bodies are telling them and be the condition of their immune systems. First, regular lab tests can on the alert for signs that something isn’t right.

Regular lab tests While many doctors use laboratory tests to check patients’ general ●● How rapidly HIV is progressing. health, they are especially important for people with HIV. For those ●● Check certain basic body functions (tests look at the kidneys, liver, people, the tests: cholesterol and blood cells). ●● Show how well their immune system is functioning. ●● Whether they have other diseases that are associated with HIV.

Possible complications Certain changes can happen to people who are HIV-positive and living Also, by weakening the immune system, HIV can leave people longer because of HIV medicines. Some people have experienced vulnerable to certain cancers and infections. These infections are called visible changes in body shape and appearance. Sometimes these “opportunistic” because they take the opportunity to attack patients changes can raise the risk of heart disease and diabetes. when their immune systems are weak. Protecting others A person with HIV can give the virus to others by having unprotected Sometimes it can be difficult for a person with HIV to explain that sex or by sharing needles (or if she is pregnant or has an infant, during they have the virus to people with whom they have had sex or shared pregnancy, childbirth or by breast-feeding). This is true even if the needles in the past. However, it is important those people be told so person feels perfectly fine. Using condoms and clean needles can that they can decide whether to be tested. Most city or county health prevent a person from infecting others. It can also protect a person departments will tell them for a patient without using the patient’s with HIV from getting other sexually transmitted diseases. name. A doctor can help arrange this service.

Moving forward with life Life does not end with a diagnosis of HIV. In fact, with proper ●● Exercise regularly. treatment, people with HIV can live very healthy lives. Taking care of ●● Avoid smoking and recreational drug use. their overall health can help them deal with HIV. They should: ●● Go easy on alcohol. ●● Get regular medical and dental checkups. ●● Practice safer sex (it can protect others from getting HIV, and can ●● Eat a healthy diet. There are many sources for information on protect the person from other sexually transmitted diseases). healthy diets for those with HIV. (Find more resources on HIV/ AIDS and diet at the end of this chapter).

Understanding lab tests Laboratory tests can help keep tabs on patients’ health; a doctor will The CD4 count is like a snapshot of how well the immune system set up a schedule for patients with HIV. The lab tests look at: is functioning. CD4 cells (also known as CD4+ T cells) are white ●● How well their immune systems are functioning (CD4 count). blood cells that fight infection. The more a person has, the better. ●● How rapidly HIV is progressing (the viral load). These are the cells that HIV kills. As HIV infection progresses, the ●● How well their bodies are functioning (tests look at kidneys, liver, number of these cells declines. When the CD4 count drops below cholesterol and blood cells). 200 because of advanced HIV disease, a person is diagnosed with ●● Whether they have other diseases that are associated with HIV AIDS. A normal range for CD4 cells is between 600 and 1,500. (tests for certain infections). The higher the CD4 count, the better.

The most important tests include: Viral load (or HIV RNA) CD4 count (or T-cell test) Viral load tests measure the amount of HIV in the blood. Lower levels are better than higher levels. The main goal of HIV drugs is to reduce viral load as much as possible for as long as possible.

Page 34 Cosmetology.EliteCME.com Some viral load tests measure down to 400 or 500 copies of HIV Other tests look at whether the person with HIV may be resistant per unit of blood; others go as low as 50 or even 25 copies. High to certain medications, meaning the drugs don’t work well for this levels – from 30,000 (in women) to 60,000 (in men) and above person, usually because a disease has mutated or changed. Other – are linked to faster disease progression. Levels below 50 offer lab tests look at a person’s blood counts, which measure things like the best outcome for people’s health. The lower the viral load, the whether a person has anemia or a high white blood cell count, which better. indicates the body is fighting off an infection; blood chemistries, which CD4 counts and viral load tests are usually done every three months. measure things like cholesterol levels; other ailments, such as sexually Results can help a patient and doctor to decide when it’s time to start transmitted diseases; and screenings for tuberculosis and hepatitis A, taking anti-HIV drugs. B and C.

Body changes People who are taking HIV medicines and living longer sometimes Possible changes in body appearance: experience visible changes in body shape and appearance. A buildup of ●● Increased fat in the abdomen. fat is called lipoaccumulation (“lipo” means fat). A loss of fat is called ●● Increased fat in neck, shoulders, breasts or face. lipoatrophy. ●● Fatty bumps on the body. ●● Loss of fat in the face, legs or arms.

Blood sugar levels The body may become less sensitive to insulin because blood sugar Experts aren’t sure whether these changes are due to HIV itself or to levels increase. This can lead to diabetes. the anti-HIV drugs. There are no proven cures at this time, but there Exercise may be able to lessen the fat deposits around the gut. Diet can are steps a person can take to reduce the effects, including treatment by help lower the blood fats (cholesterol and triglycerides) that increase plastic surgeons with liposuction to remove fat and injections to fill out the risk of heart disease. sunken areas, particularly in the face.

Opportunistic infections and AIDS-related cancers HIV weakens the immune system, leaving a person vulnerable opportunistic infection long before they become infected with HIV. to certain infections and cancers. The infections are called Their functioning immune system keeps it under control, so they “opportunistic” because they take the opportunity to attack when don’t have any symptoms of the infection. Once HIV damages their the immune system is weak. The cancers are called “AIDS-related” immune system enough, the infectious disease becomes uncontrolled because they appear mostly in people who have advanced, later-stage and makes them sick. In fact, many HIV-negative people have HIV infection, known as AIDS. opportunistic infections but don’t know about it because their immune Most people who die of AIDS do not die from the virus itself. They system keeps the infections in check. die from opportunistic infections. Often, people are infected with the

Common types of illnesses Opportunistic infections can be caused by viruses, bacteria, fungus, loss of appetite and coughing. TB can be prevented and usually is even parasites. Common opportunistic infections for people with HIV curable. If left untreated, it can kill. are: Pneumocystis pneumonia (PCP) Tuberculosis (TB) An unusual fungus found in many places in the environment Tuberculosis is caused by a bacteria passed through the air when causes this kind of pneumonia. Nearly two out of three children someone coughs, sneezes or talks. It is spread easily in confined have been exposed to it by age 4. The fungus can affect many spaces. Tuberculosis (TB) can occur early in the course of HIV organs, the most common being the lungs. Symptoms can include infection, often when CD4 counts are slightly below normal. fever, shortness of breath, a dry cough, night sweats and fatigue. Symptoms can include fever, night sweats, weight loss, fatigue,

HIV wasting syndrome Wasting syndrome refers to unwanted weight loss that is equal to The condition may be preventable, to some degree, by eating a good more than 10 percent of a person’s body weight. For a 150-pound diet. A “good diet” for an HIV-positive person may not be the low-fat, man, this means a loss of 15 pounds or more. Weight loss can result in low-calorie diet recommended for healthy people. Compared with loss of both fat and muscle. Once lost, the weight is difficult to regain. other people, someone with HIV may need to take in more calories and The condition can be caused by many things: HIV, inflammation or protein to keep from losing muscle mass. Foods to add to meals to do opportunistic infections. The weight loss may be accompanied by low- that include peanut butter, legumes (dried beans and peas), cheeses, grade fever and sometimes diarrhea. The person may get full easily or eggs, instant breakfast drinks, milkshakes and sauces. People living have no appetite at all. with HIV can also maintain or increase muscle mass through exercise, especially with progressive strength-building exercises. These include resistance and weight-lifting exercise. Candidiasis (thrush) Candidiasis (or thrush) is a fungal infection of the mouth or lungs. back of the tongue; painful areas in the mouth; changes in taste and Most people already have the Candida fungus in their body, but the sensitivity to spicy foods; and decreased appetite. body keeps it in check. Someone whose immune system is weakened is more likely to develop problems. Some people have no symptoms, but others may experience white patches or smooth red areas on the

Cosmetology.EliteCME.com Page 35 Herpes zoster (shingles) Shingles is caused by a virus, the same one that causes chickenpox. can be extremely painful. Treatment is available to help the blisters People with shingles usually had chickenpox as a child, and the virus heal, but there is no cure. Bathing them in mild soap and water can is becoming active again. Symptoms can include painful skin blisters help. Antibiotic ointments can help keep the infection from spreading. on one side of the face or body and some vision loss. The skin blisters

HIV dementia Sometimes called “HIV encephalopathy” or “AIDS dementia,” this and personality changes. This condition is less common now that there disease is caused by HIV invading the brain. Symptoms can include are drugs available to treat HIV. It may even be prevented by using memory loss, depression, unsteadiness walking, irritability or apathy HIV drugs that cross into the brain.

Common AIDS-related cancers Kaposi sarcoma (KS) is the most common cancer seen in HIV. This Lymphomas associated with HIV include a large group of cancers cancer is caused by the human herpes virus 8 (HHV-8). The virus can that begin in the cells of the immune system. The cancers can go on to be spread by deep kissing, unprotected sex and sharing needles. It invade different parts of the body, such as the central nervous system, also can be spread from mother to child. Symptoms include brown, liver, bone marrow and gastrointestinal tract. Symptoms depend on purple or pink lesions (or blotches) on the skin, usually on the arms where the cancer resides. Treatment varies depending on the specific and legs, neck or head, and sometimes in the mouth. Sometimes there cancer, but can include radiation and chemotherapy. HIV drugs, by is tooth pain or tooth loss, weight loss, night sweats or fever for longer boosting the immune system, can help the body fight the cancer, than two weeks. KS can also affect internal organs, most seriously the too. In fact, the development of effective combination HIV therapy lungs. HIV drugs can slow the growth of lesions or even reverse the has greatly improved the outlook for persons with HIV-associated condition itself. KS has become less common and much more treatable lymphoma. since the development of effective combination HIV therapy.

AIDS-defining illnesses Certain serious and life-threatening diseases that occur in HIV-positive The Centers for Disease Control and Prevention (CDC) has developed people are called “AIDS-defining” illnesses. When a person gets one a list of these illnesses. No single patient is likely to have all of these of these illnesses, he or she is diagnosed with the advanced stage problems. Some of the conditions, in fact, are rare. The list includes of HIV infection known as AIDS, regardless of CD4 and viral load 24 different diseases or illnesses. Detailed information on these counts. opportunistic diseases can be found online at the CDC website http:// www.cdc.gov/hiv/living/opportunisticinfections.html.

Treatment Treatment decisions HIV is a virus that can multiply quickly in the body. Even though no Without treatment, however, HIV can make the immune system very cure exists for HIV infection or the later stage of HIV disease known weak. Because the immune system is what allows the body to fight off as AIDS, there are many different drugs that can slow down the virus, bacteria and viruses, the person will have a hard time staying well. and we know that the slower the virus grows, the longer people live Deciding to start taking anti-HIV drugs is a very personal choice, and and the healthier they remain. Most people who take medicine for their one that cannot be made alone. A patient must talk with his or her HIV infection can now expect to live healthy lives for many years. doctor, who can help the person make a wise, appropriate decision.

Symptoms (the patient’s “clinical status”) “Clinical status” refers to how well the patient is doing in general, HIV disease, which can be signs that HIV is weakening the immune including how well he or she feels. Before starting treatment, a system, and includes things such as weight loss, chronic fevers and doctor normally will look at whether the person has symptoms of opportunistic infections.

AIDS means treatment is needed Most experts agree that anyone diagnosed with AIDS should take anti- Once a person and his or her doctor have decided the patient should HIV drugs unless there is some reason why doing so would make that start taking drugs for HIV, the doctor will come up with a personal person sicker. treatment plan.

What kinds of drugs are available? Anti-HIV drugs are also called antiretroviral drugs or antiretrovirals. may be combined into one tablet to make it easier to take medications. They work because they attack the HIV virus directly. The drugs These are known as fixed-dose combinations. cripple the ability of the virus to make copies of itself. When the HIV virus enters a healthy cell, it attempts to make copies of There are five main classes of anti-HIV drugs and at least 25 different itself. It does this by using an enzyme; some drugs work because they drugs, with more still in the experimental stage. Each group attacks block that enzyme. Another drug group also blocks the enzyme, but HIV and helps the body fight the infection in its own way. Most of in a different way. A third group keeps another enzyme that allows the these drugs come as pills, capsules or coated tablets. Several of them virus, once reproduced, from leaving its cell home and infecting other

Page 36 Cosmetology.EliteCME.com cells. The fourth group of medicines stops the HIV virus from getting for as long as possible. These medicines do different things to the into healthy cells in the first place. To infect a cell, HIV must bind to virus – they attack it in different ways – so using the different drugs in two types of molecules on the cell’s surface. The fifth group of drugs combination works better than using just one by itself. keeps the virus from binding to the molecules. Experts haven’t come up with one combination of HIV medications Anti-HIV drugs are used in combination with one another in order to that works best for everyone. Each combination has its pluses and get the best results. The goal is to get the viral load as low as possible minuses.

Questions patients should ask doctors about all drugs One of the most important things all people can do to make sure they ●● How often should the drug be taken? take medications correctly is to talk with their doctors about their ●● Does it matter if it is taken with food, or on an empty stomach? lifestyle, such as their sleeping and eating schedules. When a doctor ●● Does the drug have to be kept in a refrigerator? prescribes a drug for any illness, patients should be sure to ask the ●● What are the side effects of the drug? following questions (and make sure they understand the answers): ●● What should be done to deal with the side effects? ●● What dose of the drug should be taken? How many pills does this ●● How severe do side effects have to be before a doctor is called? mean?

Staying on a treatment plan During every visit to the doctor, a patient with HIV taking combination medicine in the right way get the best results: their viral loads stay therapy should talk about whether he or she is having trouble staying down, their CD4 counts stay up and they feel healthier. on the treatment plan. Studies show that patients who take their

What are drug interactions? Anti-HIV medications can be affected by other medicines, including When something in food affects how a drug behaves, it is called a drugs people buy over the counter at a drugstore. Even herbal therapies drug-food interaction. For example, grapefruit juice, taken at the same and some things found in common foods can affect HIV medicines. time as certain drugs, can boost the amount of these drugs in a person’s When one drug affects how another drug behaves, this is called a drug- bloodstream to an undesirable level. People taking anti-HIV drugs drug interaction. For example, some drugs become less effective when need to be very careful about these interactions. Doctors are familiar taken together. with these interactions and can provide patients a list of drugs and foods to avoid, depending on what kind of medicine the patient takes.

Side effects Among the most common side effects of anti-HIV drugs are: Headaches can be caused by these medications as well as by tension or Anemia, or a low red blood cell count. Symptoms include feeling stress. They usually can be treated by over-the-counter drugs such as tired, fatigued or shortness of breath. aspirin. Diarrhea, which can be a minor hassle or a serious medical problem. Nausea and vomiting can occur with some medications. This usually A person’s doctor should be told if goes on for a long time, is bloody goes away a few weeks after starting a new medication. Vomiting is or accompanied by a fever, or just worries the person. cause to call a doctor. Dry mouth, which can make it difficult to chew, swallow and talk. If it Pain and nerve damage can be caused by HIV itself as well as is severe or doesn’t go away, a doctor should be consulted. medications to fight HIV. Called peripheral neuropathy, when these Fatigue, which can cause people to have a hard time getting out of nerves are damaged, the feet, toes and hands can feel like they’re bed, walking up stairs or even concentrating on something for very burning or stinging, or numb and stiff. A doctor should be consulted. long. If the fatigue doesn’t go away after a person gives his or her Rashes can be caused by medication. Often they come and go, but can body and mind time to rest, this fatigue can get worse. signal a bad reaction to a medication. Skin changes, especially after Hair loss can occur with certain medications. Stress can make it worse. starting new medication, should be reported to a doctor. Weight loss can be the result of many other side effects. People who are losing weight without trying should talk to their doctor.

How do doctors know when a drug is working? Doctors will look at how much virus is in a patient’s bloodstream The CD4 count also should stay the same or go up if the drugs are (the viral load) to see how well the drug therapy is working. If the working. Regular health checkups should show that the treatment is medicines are working, the viral load goes down and there is less of it helping the person fight off infections and diseases and remain healthy. in the bloodstream.

What if viral load is undetectable? If a viral load becomes undetectable (doesn’t show up on tests), can a it doesn’t mean treatment can be stopped. If the treatment is stopped, person stop treatment? the virus will start reproducing again, and the viral load will increase. Having an undetectable viral load, meaning that the virus isn’t showing Even though the virus is undetectable in the blood, it is still hidden up on tests, is a sign that the anti-HIV medications are working. But in other parts of the body, such as the brain, reproductive organs and lymph nodes.

Cosmetology.EliteCME.com Page 37 What if the treatment isn’t working? Even when a person has tried different combinations of drugs, the People who have a strain of HIV that is resistant to most or all treatment plan doesn’t always work. This often occurs because the available drugs could consider joining a clinical trial that is testing drugs don’t completely stop the virus from reproducing. As the virus new drugs that have not yet been approved by the U.S. Food and Drug makes copies of itself, changes (or mutations) sometimes occur. These Administration (FDA). General information on participating in clinical changes may result in a new strain of the virus that is resistant to the trials can be found at http://www.clinicaltrials.gov/. action of the drugs. A blood test can help identify other drugs that might still work for the person. Even if a virus is resistant to most or all available drugs, some people can still stay healthy by continuing to take the same combination of drugs.

Page 38 Cosmetology.EliteCME.com Chapter 5: Florida Laws and Rules

2 CE Hours (Satisfies Laws and Rules Requirement)

By: Staff Writer

Learning objectives ŠŠ List and describe your legal responsibilities according to the ŠŠ Define and recall your duties and responsibilities under Florida Florida Cosmetology Practice Act and Florida Administrative Statutes. Code. Introduction Two primary areas of law pertaining to the practice of cosmetology in Other sections or chapters of the Florida Statutes [FS] and Florida the State of Florida are: Administrative Code [FAC] that apply to the practice of cosmetology ●● The Florida Cosmetology Practice Act: Chapter 477 of the Florida (such as Chapter 456: Health Professions and Occupations; or Chapter Statutes. 120: Administrative Procedure Act; among others) are not addressed in ●● Chapter 61G5 of the Florida Administrative Code. this chapter.

The following pages simplify excerpts of these documents, clarifying Text in full for the Laws of Florida may be found at http://www.state. the regulations that address you as a cosmetologist, and explaining fl.us/dbpr/pro/cosmo/cos_codes.shtml. Please refer directly to the your legal responsibilities and obligations. Laws of Florida to determine the effective date of a creating act or a particular amendment.

CHAPTER 477 COSMETOLOGY 477.011 Short title. 477.0212 Inactive status. 477.012 Purpose. 477.023 Schools of cosmetology; licensure. 477.013 Definitions. 477.025 Cosmetology salons; specialty salons; requisites; licensure; 477.0132 Hair braiding, hair wrapping, and body wrapping inspection; mobile cosmetology salons. registration. 477.0263 Cosmetology services to be performed in licensed salon; 477.0135 Exemptions. exception. 477.015 Board of Cosmetology. 477.0265 Prohibited acts. 477.016 Rulemaking. 477.028 Disciplinary proceedings. 477.017 Legal services. 477.029 Penalty. 477.018 Investigative services. 477.031 Civil proceedings. 477.019 Cosmetologists; qualifications; licensure; supervised 477.011 Short title.This act shall be known and may be cited as the practice; license renewal; endorsement; continuing education. “Florida Cosmetology Act.” 477.0201 Specialty registration; qualifications; registration renewal; endorsement.

477.012 Purpose.— The Legislature deems it necessary in the interest of public health to which will unreasonably affect the competitive market. Further, regulate the practice of cosmetology in this state. However, restrictions consumer protection for both health and economic matters shall be shall be imposed only to the extent necessary to protect the public afforded the public through legal remedies provided for in this act. from significant and discernible danger to health and not in a manner

477.013 Definitions.—As used in this chapter 1. “Board” means the Board of Cosmetology. compensation. This term also includes performing hair removal, 2. “Department” means the Department of Business and Professional including wax treatments, manicures, pedicures, and skin care Regulation. services. 3. “Cosmetologist” means a person who is licensed to engage in the 5. “Specialist” means any person holding a specialty registration in practice of cosmetology in this state under the authority of this one or more of the specialties registered under this chapter. chapter. 6. “Specialty” means the practice of one or more of the following: 4. “Cosmetology” means the mechanical or chemical treatment of the a. Manicuring, or the cutting, polishing, tinting, coloring, head, face, and scalp for aesthetic rather than medical purposes, cleansing, adding, or extending of the nails, and massaging including, but not limited to, hair shampooing, hair cutting, hair of the hands. This term includes any procedure or process for arranging, hair coloring, permanent waving, and hair relaxing for

Cosmetology.EliteCME.com Page 39 the affixing of artificial nails, except those nails which may be are performed solely for the purpose of preparing the model or applied solely by use of a simple adhesive. client for the photographic session without shampooing, cutting, b. Pedicuring, or the shaping, polishing, tinting, or cleansing of coloring, permanent waving, relaxing, or removing of hair or the nails of the feet, and massaging or beautifying of the feet. performing any other service defined as cosmetology. c. Facials, or the massaging or treating of the face or scalp with 12. “Body wrapping” means a treatment program that uses herbal oils, creams, lotions, or other preparations, and skin care wraps for the purposes of cleansing and beautifying the skin of the services. body, but does not include: 7. “Shampooing” means the washing of the hair with soap and water a. The application of oils, lotions, or other fluids to the body, or with a special preparation, or applying hair tonics. except fluids contained in presoaked materials used in the 8. “Specialty salon” means any place of business wherein the practice wraps; or of one or all of the specialties as defined in subsection (6) are b. Manipulation of the body’s superficial tissue, other than that engaged in or carried on. arising from compression emanating from the wrap materials. 9. “Hair braiding” means the weaving or interweaving of natural 13. “Skin care services” means the treatment of the skin of the body, human hair for compensation without cutting, coloring, permanent other than the head, face, and scalp, by the use of a sponge, brush, waving, relaxing, removing, or chemical treatment and does not cloth, or similar device to apply or remove a chemical preparation include the use of hair extensions or wefts. or other substance, except that chemical peels may be removed 10. “Hair wrapping” means the wrapping of manufactured materials by peeling an applied preparation from the skin by hand. Skin around a strand or strands of human hair, for compensation, care services must be performed by a licensed cosmetologist or without cutting, coloring, permanent waving, relaxing, removing, facial specialist within a licensed cosmetology or specialty salon, weaving, chemically treating, braiding, using hair extensions, or and such services may not involve massage, as defined in s. performing any other service defined as cosmetology. 480.033(3), through manipulation of the superficial tissue. 11. “Photography studio salon” means an establishment where the hair-arranging services and the application of cosmetic products

477.0132 Hair braiding, hair wrapping, and body wrapping registration.— 1. a. Persons whose occupation or practice is confined solely and other communicable diseases, sanitation and sterilization, to hair braiding must register with the department, pay the disorders and diseases of the skin, and studies regarding laws applicable registration fee, and take a two-day 16-hour course. affecting body wrapping. The course shall be board approved and consist of 5 hours d. Only the board may review, evaluate, and approve a course of HIV/AIDS and other communicable diseases, 5 hours of required of an applicant for registration under this subsection sanitation and sterilization, 4 hours of disorders and diseases in the occupation or practice of hair braiding, hair wrapping, or of the scalp, and 2 hours of studies regarding laws affecting body wrapping. A provider of such a course is not required to hair braiding. hold a license under chapter 1005. b. Persons whose occupation or practice is confined solely to hair 2. Hair braiding, hair wrapping, and body wrapping are not required wrapping must register with the department, pay the applicable to be practiced in a cosmetology salon or specialty salon. When registration fee, and take a one-day 6-hour course. The course hair braiding, hair wrapping, or body wrapping is practiced shall be board approved and consist of education in HIV/AIDS outside a cosmetology salon or specialty salon, disposable and other communicable diseases, sanitation and sterilization, implements must be used or all implements must be sanitized in a disorders and diseases of the scalp, and studies regarding laws disinfectant approved for hospital use or approved by the federal affecting hair wrapping. Environmental Protection Agency. c. Unless otherwise licensed or exempted from licensure under 3. Pending issuance of registration, a person is eligible to practice this chapter, any person whose occupation or practice is body hair braiding, hair wrapping, or body wrapping upon submission wrapping must register with the department, pay the applicable of a registration application that includes proof of successful registration fee, and take a two-day 12-hour course. The course completion of the education requirements and payment of the shall be board approved and consist of education in HIV/AIDS applicable fees required by this chapter.

477.0135 Exemptions.— 1. This chapter does not apply to the following persons when 2. A license is not required of any person whose occupation or practicing pursuant to their professional or occupational practice is confined solely to shampooing. responsibilities and duties: 3. A license or registration is not required of any person whose a. Persons authorized under the laws of this state to practice occupation or practice is confined solely to cutting, trimming, medicine, surgery, osteopathic medicine, chiropractic polishing, or cleansing the fingernails of any person when said medicine, massage, naturopathy, or podiatric medicine. cutting, trimming, polishing, or cleansing is done in a barbershop b. Commissioned medical or surgical officers of the United States licensed pursuant to chapter 476 which is carrying on a regular Armed Forces hospital services. and customary business of barbering, and such individual has been c. Registered nurses under the laws of this state. practicing the activities set forth in this subsection prior to October d. Persons practicing barbering under the laws of this state. 1, 1985. e. Persons employed in federal, state, or local institutions, 4. A photography studio salon is exempt from the licensure hospitals, or military bases as cosmetologists whose practices provisions of this chapter. However, the hair-arranging services are limited to the inmates, patients, or authorized military of such salon must be performed under the supervision of a personnel of such institutions, hospitals, or bases. licensed cosmetologist employed by the salon. The salon must use f. Persons whose practice is limited to the application of disposable hair-arranging implements or use a wet or dry sanitizing cosmetic products to another person in connection with the system approved by the federal Environmental Protection Agency. sale, or attempted sale, of such products at retail without 5. A license is not required of any individual providing makeup, compensation from such other person other than the regular special effects, or cosmetology services to an actor, stunt person, retail price of such merchandise. musician, extra, or other talent during a production recognized

Page 40 Cosmetology.EliteCME.com by the Office of Film and Entertainment as a qualified production to an actor, stunt person, musician, extra, or other talent, or as defined in s. 288.1254(1). Such services are not required to providing makeup or special effects services to the general public. be performed in a licensed salon. Individuals exempt under this The term “theme park or entertainment complex” has the same subsection may not provide such services to the general public. meaning as in s. 509.013(9). 6. A license is not required of any individual providing makeup or special effects services in a theme park or entertainment complex

477.015 Board of Cosmetology.— 1. There is created within the department the Board of Cosmetology 5. The board shall, in the month of January, elect from its number a consisting of seven members, who shall be appointed by the chair and a vice chair. Governor, subject to confirmation by the Senate, and whose 6. The board shall hold such meetings during the year as it may function it shall be to carry out the provisions of this act. determine to be necessary, one of which shall be the annual 2. Five members of the board shall be licensed cosmetologists and meeting. The chair of the board shall have the authority to call shall have been engaged in the practice of cosmetology in this other meetings at his or her discretion. A quorum of the board shall state for not less than 5 years. Two members of the board shall be consist of not less than four members. laypersons. Each board member shall be a resident of this state 7. Each member of the board shall receive $50 for each day spent in and shall have been a resident of this state for not less than 5 the performance of official board business, with the total annual continuous years. compensation per member not to exceed $2,000. Additionally, 3. The Governor may at any time fill vacancies on the board for the board members shall receive per diem and mileage as provided in remainder of unexpired terms. Each member of the board shall s. 112.061, from place of residence to place of meeting and return. hold over after the expiration of his or her term until a successor is 8. Each board member shall be held accountable to the Governor for duly appointed and qualified. No board member shall serve more the proper performance of all his or her duties and obligations. The than two consecutive terms, whether full or partial. Governor shall investigate any complaints or unfavorable reports 4. Before assuming his or her duties as a board member, each received concerning the actions of the board, or its members, and appointee shall take the constitutional oath of office and shall file shall take appropriate action thereon, which action may include it with the Department of State, which shall then issue to such removal of any board member. The Governor may remove from member a certificate of his or her appointment. office any board member for neglect of duty, incompetence, or unprofessional or dishonorable conduct.

477.016 Rulemaking.— 1. The board may adopt rules pursuant to ss. 120.536(1) and 120.54 related to the use of a cosmetic product or any substance used in to implement the provisions of this chapter conferring duties upon the practice of cosmetology if the board finds that the product or it. substance poses a risk to the health, safety, and welfare of clients 2. The board may by rule adopt any restriction established by a or persons providing cosmetology services. regulation of the United States Food and Drug Administration

477.018 Investigative services.— The department shall provide all investigative services required by the board or the department in carrying out the provisions of this act.

477.019 Cosmetologists; qualifications; licensure; supervised practice; license renewal; endorsement; continuing education.— 1. A person desiring to be licensed as a cosmetologist shall apply to b. A cosmetology program within the public school the department for licensure. system. 2. An applicant shall be eligible for licensure by examination to c. The Cosmetology Division of the Florida School for practice cosmetology if the applicant: the Deaf and the Blind, provided the division meets the a. Is at least 16 years of age or has received a high school standards of this chapter. diploma; d. A government-operated cosmetology program in this b. Pays the required application fee, which is not refundable, state. and the required examination fee, which is refundable if the The board shall establish by rule procedures whereby the applicant is determined to not be eligible for licensure for any school or program may certify that a person is qualified reason other than failure to successfully complete the licensure to take the required examination after the completion of a examination; and minimum of 1,000 actual school hours. If the person then c. 1. Is authorized to practice cosmetology in another state or passes the examination, he or she shall have satisfied this country, has been so authorized for at least 1 year, and requirement; but if the person fails the examination, he or does not qualify for licensure by endorsement as provided she shall not be qualified to take the examination again for in subsection (5); or until the completion of the full requirements provided by 2. Has received a minimum of 1,200 hours of training as this section. established by the board, which shall include, but shall 3. Upon an applicant receiving a passing grade, as not be limited to, the equivalent of completion of services established by board rule, on the examination and paying directly related to the practice of cosmetology at one of the the initial licensing fee, the department shall issue a license following: to practice cosmetology. a. A school of cosmetology licensed pursuant to chapter 4. If an applicant passes all parts of the examination for 1005. licensure as a cosmetologist, he or she may practice in

Cosmetology.EliteCME.com Page 41 the time between passing the examination and receiving Continuing education courses shall include, but not be a physical copy of his or her license if he or she practices limited to, the following subjects as they relate to the under the supervision of a licensed cosmetologist in a practice of cosmetology: human immunodeficiency licensed salon. An applicant who fails any part of the virus and acquired immune deficiency syndrome; examination may not practice as a cosmetologist and may Occupational Safety and Health Administration immediately apply for reexamination. regulations; workers’ compensation issues; state 5. Renewal of license registration shall be accomplished and federal laws and rules as they pertain to pursuant to rules adopted by the board. cosmetologists, cosmetology, salons, specialists, 6. The board shall certify as qualified for licensure by specialty salons, and booth renters; chemical makeup endorsement as a cosmetologist in this state an applicant as it pertains to hair, skin, and nails; and environmental who holds a current active license to practice cosmetology issues. Courses given at cosmetology conferences may in another state. The board may not require proof of be counted toward the number of continuing education educational hours if the license was issued in a state that hours required if approved by the board. requires 1,200 or more hours of prelicensure education and b. Any person whose occupation or practice is confined passage of a written examination. This subsection does not solely to hair braiding, hair wrapping, or body apply to applicants who received their license in another wrapping is exempt from the continuing education state through an apprenticeship program. requirements of this subsection. 7. (a) The board shall prescribe by rule continuing c. The board may, by rule, require any licensee in education requirements intended to ensure protection violation of a continuing education requirement to take of the public through updated training of licensees a refresher course or refresher course and examination and registered specialists, not to exceed 16 hours in addition to any other penalty. The number of hours biennially, as a condition for renewal of a license for the refresher course may not exceed 48 hours. or registration as a specialist under this chapter.

477.0201 Specialty registration; qualifications; registration renewal; endorsement.— 1. Any person is qualified for registration as a specialist in any one or 3. Upon paying the initial registration fee, the department shall more of the specialty practices within the practice of cosmetology register the applicant to practice one or more of the specialty under this chapter who: practices within the practice of cosmetology. a. Is at least 16 years of age or has received a high school 4. Renewal of registration shall be accomplished pursuant to rules diploma. adopted by the board. b. Has received a certificate of completion in a specialty pursuant 5. The board shall adopt rules specifying procedures for the to s. 477.013(6) from one of the following: registration of specialty practitioners desiring to be registered in 1. A school licensed pursuant to s. 477.023. this state who have been registered or licensed and are practicing 2. A school licensed pursuant to chapter 1005 or the in states which have registering or licensing standards substantially equivalent licensing authority of another state. similar to, equivalent to, or more stringent than the standards of 3. A specialty program within the public school system. this state. 4. A specialty division within the Cosmetology Division of 6. Pending issuance of registration, a person is eligible to practice the Florida School for the Deaf and the Blind, provided as a specialist upon submission of a registration application the training programs comply with minimum curriculum that includes proof of successful completion of the education requirements established by the board. requirements and payment of the applicable fees required by 2. A person desiring to be registered as a specialist shall apply to the this chapter, provided such practice is under the supervision of a department in writing upon forms prepared and furnished by the registered specialist in a licensed specialty or cosmetology salon. department.

477.0212 Inactive status.— 1. A cosmetologist’s license that has become inactive may be require more than one renewal cycle of continuing education to reactivated under s. 477.019 upon application to the department. reactivate a license. The board shall prescribe by rule a fee not to 2. The board shall adopt rules relating to licenses that become exceed $50 for the reactivation of an inactive license and a fee not inactive and for the renewal of inactive licenses. The rules may not to exceed $50 for the renewal of an inactive license.

477.023 Schools of cosmetology; licensure.— No private school of cosmetology shall be permitted to operate cosmetology training programs within the public school system or to without a license issued by the Commission for Independent prevent government operation of any other program of cosmetology in Education pursuant to chapter 1005. However, nothing herein shall be this state. construed to prevent certification by the Department of Education of

477.025 Cosmetology salons; specialty salons; requisites; licensure; inspection; mobile cosmetology salons.— 1. No cosmetology salon or specialty salon shall be permitted to and sanitary requirements, and the license application and granting operate without a license issued by the department except as process. provided in subsection (11). 3. Any person, firm, or corporation desiring to operate a cosmetology 2. The board shall adopt rules governing the licensure and operation salon or specialty salon in the state shall submit to the department of salons and specialty salons and their facilities, personnel, safety an application upon forms provided by the department and

Page 42 Cosmetology.EliteCME.com accompanied by any relevant information requested by the b. Each mobile salon must comply with all licensure and department and by an application fee. operating requirements specified in this chapter or chapter 455 4. Upon receiving the application, the department may cause an or rules of the board or department that apply to cosmetology investigation to be made of the proposed cosmetology salon or salons at fixed locations, except to the extent that such specialty salon. requirements conflict with this subsection or rules adopted 5. When an applicant fails to meet all the requirements provided pursuant to this subsection. herein, the department shall deny the application in writing and c. A mobile cosmetology salon must maintain a permanent shall list the specific requirements not met. No applicant denied business address, located in the inspection area of the licensure because of failure to meet the requirements herein shall local department office, at which records of appointments, be precluded from reapplying for licensure. itineraries, license numbers of employees, and vehicle 6. When the department determines that the proposed cosmetology identification numbers of the licenseholder’s mobile salon salon or specialty salon may reasonably be expected to meet shall be kept and made available for verification purposes by the requirements set forth herein, the department shall grant the department personnel, and at which correspondence from the license upon such conditions as it shall deem proper under the department can be received. circumstances and upon payment of the original licensing fee. d. To facilitate periodic inspections of mobile cosmetology 7. No license for operation of a cosmetology salon or specialty salons, prior to the beginning of each month each mobile salon may be transferred from the name of the original licensee to salon licenseholder must file with the board a written monthly another. It may be transferred from one location to another only itinerary listing the locations where and the dates and hours upon approval by the department, which approval shall not be when the mobile salon will be operating. unreasonably withheld. e. The board shall establish fees for mobile cosmetology 8. Renewal of license registration for cosmetology salons or specialty salons, not to exceed the fees for cosmetology salons at fixed salons shall be accomplished pursuant to rules adopted by the locations. board. The board is further authorized to adopt rules governing f. The operation of mobile cosmetology salons must be in delinquent renewal of licenses and may impose penalty fees for compliance with all local laws and ordinances regulating delinquent renewal. business establishments, with all applicable requirements 9. The board is authorized to adopt rules governing the periodic of the Americans with Disabilities Act relating to inspection of cosmetology salons and specialty salons licensed accommodations for persons with disabilities, and with all under this chapter. applicable OSHA requirements. 10. (a) The board shall adopt rules governing the licensure, 11. Facilities licensed under part II of chapter 400 or under part I of operation, and inspection of mobile cosmetology salons, chapter 429 are exempt from this section, and a cosmetologist including their facilities, personnel, and safety and sanitary licensed pursuant to s. 477.019 may provide salon services requirements. exclusively for facility residents.

477.0263 Cosmetology services to be performed in licensed salon; exceptions.— 1. Cosmetology services shall be performed only by licensed cosmetology services in a location other than a licensed salon cosmetologists in licensed salons, except as otherwise provided in when such services are performed in connection with the this section. motion picture, fashion photography, theatrical, or television 2. Pursuant to rules established by the board, cosmetology services industry; a photography studio salon; a manufacturer trade show may be performed by a licensed cosmetologist in a location other demonstration; or an educational seminar. than a licensed salon, including, but not limited to, a nursing home, 4. Pursuant to rules adopted by the board, any cosmetology or hospital, or residence, when a client for reasons of ill health is specialty service may be performed in a location other than a unable to go to a licensed salon. Arrangements for the performance licensed salon when the service is performed in connection with of such cosmetology services in a location other than a licensed a special event and is performed by a person who is employed salon shall be made only through a licensed salon. by a licensed salon and who holds the proper license or specialty 3. Any person who holds a valid cosmetology license in any state registration. An appointment for the performance of any such or who is authorized to practice cosmetology in any country, service in a location other than a licensed salon must be made territory, or jurisdiction of the United States may perform through a licensed salon.

477.0265 Prohibited acts.— 1. It is unlawful for any person to: d. Obtain or attempt to obtain a license or registration for money, a. Engage in the practice of cosmetology or a specialty without other than the required fee, or any other thing of value or by an active license as a cosmetologist or registration as a fraudulent misrepresentations. specialist issued by the department pursuant to the provisions e. Use or attempt to use a license to practice cosmetology or a of this chapter. registration to practice a specialty, which license or registration b. Own, operate, maintain, open, establish, conduct, or have is suspended or revoked. charge of, either alone or with another person or persons, a f. Advertise or imply that skin care services or body wrapping, cosmetology salon or specialty salon: as performed under this chapter, have any relationship to the 1. Which is not licensed under the provisions of this chapter; practice of massage therapy as defined in s. 480.033(3), except or those practices or activities defined in s. 477.013. 2. In which a person not licensed or registered as a g. In the practice of cosmetology, use or possess a cosmetic cosmetologist or a specialist is permitted to perform product containing a liquid nail monomer containing any trace cosmetology services or any specialty. of methyl methacrylate (MMA). c. Permit an employed person to engage in the practice of 2. Any person who violates any provision of this section commits a cosmetology or of a specialty unless such person holds a valid, misdemeanor of the second degree, punishable as provided in s. active license as a cosmetologist or registration as a specialist. 775.082 or s. 775.083.

Cosmetology.EliteCME.com Page 43 477.028 Disciplinary proceedings.— 1. The board shall have the power to revoke or suspend the license this chapter, to deny subsequent licensure of such salon, or to of a cosmetologist licensed under this chapter, or the registration reprimand, censure, or otherwise discipline the owner of such of a specialist registered under this chapter, and to reprimand, salon in either of the following cases: censure, deny subsequent licensure or registration of, or otherwise a. Upon proof that a license has been obtained by fraud or discipline a cosmetologist or a specialist licensed or registered misrepresentation. under this chapter in any of the following cases: b. Upon proof that the holder of a license is guilty of fraud or a. Upon proof that a license or registration has been obtained by deceit or of gross negligence, incompetency, or misconduct in fraud or misrepresentation. the operation of the salon so licensed. b. Upon proof that the holder of a license or registration is guilty 3. Disciplinary proceedings shall be conducted pursuant to the of fraud or deceit or of gross negligence, incompetency, or provisions of chapter 120. misconduct in the practice or instruction of cosmetology or a 4. The department shall not issue or renew a license or certificate specialty. of registration under this chapter to any person against whom or c. Upon proof that the holder of a license or registration is guilty salon against which the board has assessed a fine, interest, or costs of aiding, assisting, procuring, or advising any unlicensed associated with investigation and prosecution until the person or person to practice as a cosmetologist. salon has paid in full such fine, interest, or costs associated with 2. The board shall have the power to revoke or suspend the license investigation and prosecution or until the person or salon of a cosmetology salon or a specialty salon licensed under 477.029 Penalty.— 1. It is unlawful for any person to: i. Violate or refuse to comply with any provision of this chapter a. Hold himself or herself out as a cosmetologist, specialist, hair or chapter 455 or a rule or final order of the board or the wrapper, hair braider, or body wrapper unless duly licensed or department. registered, or otherwise authorized, as provided in this chapter. 2. Any person who violates the provisions of this section shall be b. Operate any cosmetology salon unless it has been duly subject to one or more of the following penalties, as determined by licensed as provided in this chapter. the board: c. Permit an employed person to practice cosmetology or a a. Revocation or suspension of any license or registration issued specialty unless duly licensed or registered, or otherwise pursuant to this chapter. authorized, as provided in this chapter. b. Issuance of a reprimand or censure. d. Present as his or her own the license of another. c. Imposition of an administrative fine not to exceed $500 for e. Give false or forged evidence to the department in obtaining each count or separate offense. any license provided for in this chapter. d. Placement on probation for a period of time and subject to f. Impersonate any other licenseholder of like or different name. such reasonable conditions as the board may specify. g. Use or attempt to use a license that has been revoked. e. Refusal to certify to the department an applicant for licensure. h. Violate any provision of s. 455.227(1), s. 477.0265, or s. 477.028.

477.031 Civil proceedings.— As cumulative of any other remedy or criminal prosecution, the any person who is or has been violating any of the provisions of this department may file a proceeding in the name of the state seeking chapter or the lawful rules or orders of the department. issuance of a restraining order, injunction, or writ of mandamus against

CHAPTER 61G5-18 COSMETOLOGIST

61G5-18.00015 Cosmetologist and Compensation Defined. A cosmetologist is a person who is licensed to perform the mechanical F.S., manicures, pedicures, and skin care services. For the purposes or chemical treatment of the head, face, and scalp for aesthetic rather of this act “compensation” is defined as the payment of money or its than medical purposes, including, but not limited to, hair shampooing, equivalent, the receipt or delivery of property, or the performance of a hair cutting, hair arranging, hair braiding, hair coloring, permanent service, or the receipt or delivery of anything of value in exchange for waving, and hair relaxing, for compensation. A cosmetologist may cosmetology services. For the purposes of this act “medical purposes” also perform non-invasive hair removals, including wax treatments is defined as any form of bodily intrusion into the orifices, skin, but not including electrolysis as that term is defined in Chapter 478, muscles, or any other tissues of the body.

CHAPTER 61G5-20 COSMETOLOGY SALONS 61G5-20.001 Salon Defined 61G5-20.008 Employment of Applicants for Licensure as a Cosmetologist 61G5-20.0015 Performance of Cosmetology or Specialty Services Prior to Licensure; Employment of Applicants for Registration as a Outside a Licensed Salon Specialist Prior to Registration 61G5-20.002 Salon Requirements 61G5-20.010 Mobile Salons 61G5-20.004 Display of Documents 61G5-20.007 Communicable Disease

Page 44 Cosmetology.EliteCME.com 61G5-20.001 Salon Defined. Salon means any establishment or place of business wherein licensed barbershop, or the practice of barbering in a licensed cosmetology as defined in Section 477.013(4), F.S., or any specialty cosmetology salon, provided the salon employs a licensed as defined in Section 477.013(6), F.S., is practiced for compensation, cosmetologist. Except as provided in Rule 61G5-20.010, F.A.C., a however this does not prevent the practice of cosmetology in a salon must be at a fixed location.

61G5-20.0015 Performance of Cosmetology or Specialty Services Outside a Licensed Salon. 1. “Special events” is defined as weddings, fashion shows, and other be performed by a licensed Florida cosmetologist or under events as approved by the board. the supervision of a licensed cosmetologist employed by the 2. Cosmetology or specialty services may be performed by a salon. “Under the supervision of a licensed cosmetologist” licensed cosmetologist or specialist in a location other than a shall mean that an individual who then holds a current, active licensed salon, including a hospital, nursing home, residence, Florida license as a cosmetologist shall be physically present at or similar facility, when a client for reasons of ill health is the photography studio salon at all times when hair-arranging unable to go to a licensed salon. Such services are not to be services or applications of cosmetic products are being performed upon employees or person who do not reside in the performed. facility, or any other non-qualified persons. c. When performing hair-arranging services, the photography 3. Cosmetology services may only be performed in a photography studio salon shall use either disposable hair-arranging studio salon subject to the following requirements: implements or shall use a wet or dry sanitizing system a. Only hair-arranging services and the application of cosmetic approved by the federal Environmental Protection Agency. products may be performed in a photography studio salon; 4. The following procedures shall be followed when performing and, may only be performed for the purpose of preparing a cosmetology services outside of a licensed salon: model or client of the photography studio for a photographic a. Information as to the name of the client and the address at session. Shampooing the hair, hair cutting, hair coloring, which the services are to be performed shall be recorded in the permanent waving of the hair, hair relaxing, removing of hair, appointment book. manicuring, pedicuring, and the performance of any other b. The appointment book shall remain at the salon and be made service defined as cosmetology may not be performed in a available upon request to any investigator or inspector of the photography studio salon. Department. b. All hair-arranging services and applications of cosmetic products to be performed in the photography studio salon shall

61G5-20.002 Salon Requirements. 1. Definitions: For the purposes of this rule, the following definitions To be adequate, such facilities shall have at least one toilet apply: and one sink with running water. Such facilities shall be a. “Clean” means the removal of visible debris from a surface equipped with toilet tissue, soap dispenser with soap or such as washing with soap/water. other hand cleaning material, sanitary towels or other b. “Disinfect” means the use of a chemical to destroy potential hand-drying device such as a wall-mounted electric blow pathogens. dryer, and waste receptacle. Such facilities and all of the c. “Sterilize” means the complete destruction of all microbial foregoing fixtures and components shall be kept clean, life, commonly achieved through the use of heat and/or in good repair, well-lighted, and adequately ventilated to pressure. remove objectionable odors. d. “Wet disinfection container” means a tub or jar with a lid, 3. A salon, or specialty salon, may be located at a place filled with disinfectant and large enough for all items to be of residence. Salon facilities must be separated from completely immersed. the living quarters by a permanent wall construction. e. “Infection control” means the process for reducing the risk of A separate entrance shall be provided to allow entry to spreading disease causing pathogens. the salon other than from the living quarters. Toilet and 2. Prior to opening a salon, the owner shall: lavatory facilities shall comply with subparagraph (c)2. a. Submit an application on forms prescribed by the Department above and shall have an entrance from the salon other than of Business and Professional Regulation; and the living quarters. b. Pay the required registration fee as outlined in the fee schedule 4. Animals: No animals or pets shall be allowed in a salon, in Rule 61G5-24.005, F.A.C.; and with the exception of service animals and fish kept in c. Meet the safety and sanitary requirements as listed below and closed aquariums. these requirements shall continue in full force and effect for 5. Shampoo Bowls: Each salon shall have shampoo bowls the life of the salon: equipped with hot and cold running water. The shampoo 1. Ventilation and Cleanliness: Each salon shall be kept well bowls shall be located in the area where cosmetology ventilated. The walls, ceilings, furniture and equipment services are being performed. A specialty salon that shall be kept clean and free from dust. Hair must not be exclusively provides specialty services, as defined in allowed to accumulate on the floor of the salon. Hair must Section 477.013(6), F.S., need not have a shampoo bowl, be deposited in a covered waste receptacle. Each salon but must have a sink or lavatory equipped with hot and which provides services for the extending or sculpturing of cold running water on the premises of the salon. nails shall provide such services in a separate area which d. Comply with all local building and fire codes. These is adequately ventilated for the safe dispersion of all fumes requirements shall continue in full force and effect for the life resulting from the services. of the salon. 2. Toilet and Lavatory Facilities: Each salon shall provide – 3. Each salon shall comply with the following: on the premises or in the same building as, and within 300 a. Linens: Each salon shall keep clean linens in a closed, feet of, the salon – adequate toilet and lavatory facilities. dustproof cabinet. All soiled linens must be kept in a closed

Cosmetology.EliteCME.com Page 45 receptacle. Soiled linens may be kept in open containers if 1. After each client, all pedicure units must be cleaned entirely separated from the area in which cosmetology services with a low-foaming soap or detergent with water to are rendered to the public. A sanitary towel or neck strip shall remove all visible debris, then disinfected with an EPA be placed around the patron’s neck to avoid direct contact of registered hospital grade bactericidal, fungicidal, virucidal, the shampoo cape with a patron’s skin. and pseudomonacidal disinfectant used according to b. Containers: Salons must use containers for waving lotions and manufacturer’s instructions for at least ten (10) minutes. other preparations of such type as will prevent contamination If the pipe-free foot spa has a foot plate, it should be of the unused portion. All creams shall be removed from removed and the area beneath it cleaned, rinsed, and wiped containers by spatulas. dry. c. Disinfection: The use of a brush, comb or other article on 2. At the end of each day of use, the following procedures more than one patron without being disinfected is prohibited. shall be used: Each salon is required to have sufficient combs, brushes, a. All filter screens in whirlpool pedicure spas or basins and implements to allow for adequate disinfecting practices. for all types of foot spas must be disinfected. All Combs or other instruments shall not be carried in pockets. visible debris in the screen and the inlet must be d. Disinfectants: All salons shall be equipped with and utilize removed and cleaned with a low-foaming soap or disinfecting solutions with hospital level disinfectant or EPA detergent and water. For pipe-free systems, the jet approved disinfectant, sufficient to allow for disinfecting components or foot plate must be removed and cleaned practices. and any debris removed. The screen, jet, or foot plate 1. A wet disinfection container is any receptacle must be completely immersed in an EPA registered, containing a disinfectant solution and large enough to hospital grade bactericidal, fungicidal, virucidal, and allow for a complete immersion of the articles. A cover pseudomonacidal disinfectant that is used according shall be provided. to manufacturer’s instructions. The screen, jet, or foot 2. Disinfecting methods which are effective and approved plate must be replaced after disinfection is completed for salons: First, clean articles with soap and water, and the system is flushed with warm water and low- completely immerse in a chemical solution that is hospital foaming soap for 5 minutes, rinsed, and drained. level or EPA approved disinfectant as follows: b. After the above procedures are completed, the basin a. Combs and brushes, remove hair first and immerse in should be filled with clean water and the correct hospital level or EPA approved disinfectant; amount of EPA registered disinfectant. The solution b. Metallic instrument, immerse in hospital level for EPA must be circulated through foot spa system for 10 approved disinfectant; minutes and the unit then turned off. The solution c. Instruments with cutting edge, wipe with a hospital should remain in the basin for at least 6 to 10 hours. level or EPA approved disinfectant; or Before using the equipment again, the basin system d. Implements may be immersed in a hospital level or must be drained and flushed with clean water. EPA approved disinfectant solution. 3. Once each week, subsequent to completing the required e. Shampoo bowls, facial beds, and neck rests, clean and end-of-day cleaning procedures, the basin must be filled disinfect between each use. with a solution of water containing one teaspoon of 5.25% 3. For purposes of this rule, a “hospital level disinfectant or bleach for each gallon of water. The solution must be EPA approved disinfectant” shall mean the following: circulated through the spa system for 5 to 10 minutes and a. For all combs, brushes, metallic instruments, then the solution must sit in the basin for at least 6 hours. instruments with a cutting edge, and implements that Before use, the system must be drained and flushed. have not come into contact with blood or body fluids, 4. A record or log book containing the dates and times of a disinfectant that indicates on its label that it has been all pedicure cleaning and disinfection procedures must be registered with the EPA as a hospital grade bacterial, documented and kept in the pedicure area by the salon and virucidal and fungicidal disinfectant; made available for review upon request by a consumer or a b. For all combs, brushes, metallic instruments with a Department inspector. cutting edge, and implements that have come into 4. No cosmetology or specialty salon shall be operated in the same contact with blood or body fluids, a disinfectant that licensed space allocation with any other business which adversely indicates on its label that it has been registered with affects the sanitation of the salon, or in the same licensed space the EPA as a disinfectant, in accordance with 29 C.F.R. allocation with a school teaching cosmetology or a specialty 1910.1030. licensed under Chapter 477, F.S., or in any other location, space, or 4. All disinfectants shall be mixed and used according to the environment which adversely affects the sanitation of the salon. In manufacturer’s directions. order to control the required space and maintain proper sanitation, e. After cleaning and disinfecting, articles shall be stored in a where a salon adjoins such other business or school, or such other clean, closed cabinet or container until used. Undisinfected location, space or environment, there must be permanent walls articles such as pens, pencils, money, paper, mail, etc., shall separating the salon from the other business, school, location, not be kept in the same container or cabinet. For the purpose space, or environment and there must be separate and distinctly of recharging, rechargeable clippers may be stored in an area marked entrances for each. other than in a closed cabinet or container, provided such area 5. Evidence that the full salon contains a minimum of 200 square feet is clean and provided the cutting edges of such clippers have of floor space. No more than two (2) cosmetologists or specialists been disinfected. may be employed in a salon which has only the minimum floor f. Ultra Violet Irradiation may be used to store articles and space. instruments after they have been cleansed and disinfected. 6. A specialty salon offering only one of the regulated specialties g. Pedicure Equipment Disinfection: shall evidence a minimum of 100 square feet used in the The following cleaning and disinfection procedures must be performance of the specialty service and shall meet all the used for any pedicure equipment that holds water, including sanitation requirements stated in this section. No more than one sinks, bowls, basins, pipe-less spas, and whirlpool spas: specialist or cosmetologist may be employed in a specialty salon with only the minimum floor space. An additional 50 square feet

Page 46 Cosmetology.EliteCME.com will be required for each additional specialist or cosmetologist building material, which is physically connected to a salon’s floor employed. and ceiling, and which serves to delineate and protect the salon. 7. For purposes of this rule, “permanent wall” means a vertical continuous structure of wood, plaster, masonry, or other similar

61G5-20.004 Display of Documents. 1. All holders of a cosmetology or specialty salon license shall or body wrapping services. The license or registration on display display within their salons, in a conspicuous place which is clearly shall be the original certificate or a duplicate issued by the visible to the general public upon entering the salon, the following Department and shall have attached a 2’’ by 2’’ photograph taken documents: within the previous two years of the individual whose name a. The current salon license, appears on the certificate. The certificate with photograph attached b. A legible copy of the most recent inspection sheet for the shall be permanently laminated as of July 1, 2007. salon. 3. By July 1, 2008, all holders of a cosmetology or specialty salon 2. All holders of a cosmetology or specialty salon license shall license shall display at each footbath a copy of the Consumer require and ensure that all individuals engaged in the practice Protection Notice regarding footbaths, sanitation, and safety. of cosmetology, any specialty, hair braiding, hair wrapping, or Copies of this notice (revised 10/15/07, and incorporated herein by body wrapping display at the individual’s work station their reference) may be obtained from the Department of Business and current license or registration at all times when the individual is Professional Regulation at 1940 North Monroe St., Tallahassee, FL performing cosmetology, specialty, hair braiding, hair wrapping, 32399-0783, and the Call Center by calling (850)487-1395.

61G5-20.007 Communicable Disease. 1. No person engaged in the practice of cosmetology or a specialty in 2. No cosmetologist or person registered to practice any specialty a salon shall proceed with any service to a person having a visible in Florida, who has a visible disease, pediculosis, or open sores disease, pediculosis, or open sores suggesting a communicable suggesting a communicable disease, shall engage in the practice disease, until such person furnishes a statement signed by a of cosmetology or any specialty, until such cosmetologist or physician licensed to practice in the State of Florida stating that registrant obtains a statement signed by a physician licensed to the disease or condition is not in an infectious, contagious or practice in the State of Florida stating that the disease or condition communicable stage. is not in an infectious, contagious, or communicable stage.

61G5-20.008 Employment of Applicants for Licensure as a Cosmetologist Prior to Licensure; Employment of Applicants for Registration as a Specialist Prior to Registration. 1. Holders of a cosmetology salon license who wish to permit an the cosmetology salon license holder proof of having been applicant for licensure as a cosmetologist by examination to issued a cosmetology license by the Department. perform cosmetology services in their salon pursuant to Rule d. Ensure that all cosmetology services performed by the 61G5-18.0055, F.A.C., shall: applicant in the salon are performed in accordance with the a. Prior to permitting an applicant to perform cosmetology conditions as set forth in Rule 61G5-18.0055, F.A.C. services in their salon, obtain from the applicant a copy e. Display in a conspicuous place at the cosmetology salon of the completed application for licensure by examination location in which the applicant performs cosmetology services submitted to the Department by the applicant, and a copy of under Rule 61G5-18.0055 a copy of the completed application the notification by the Department to the applicant that he or for licensure by examination submitted to the Department she has been scheduled to take the licensure examination. The by the applicant, and a copy of the completed application for cosmetology salon license holder shall not permit an applicant reexamination submitted to the Department by the applicant to practice cosmetology or perform cosmetology services in if such reexamination is required under Rule 61G5-18.0055, the salon until after the date of the licensure examination as F.A.C. indicated on the notification from the Department. 2. Holders of a cosmetology or specialty salon license who wish b. Upon learning or in any way becoming aware that an applicant to permit an applicant for registration as a specialist to perform who is performing cosmetology services in their salon specialty services in their salon pursuant to Rule 61G5-29.004, pursuant to Rule 61G5-18.0055, F.A.C., has either failed F.A.C., or who wish to permit applicants for registration as a hair to take the first licensure examination as scheduled by the braider or hair wrapper to perform hair braiding or hair wrapping Department, or has failed to achieve a passing grade on the services in their salon pursuant to Rule 61G5-31.006, shall: first licensure examination taken by the applicant, immediately a. prior to permitting an applicant to perform any specialty cease to permit the applicant to further perform cosmetology services or hair braiding or hair wrapping services in their services until the applicant provides to the cosmetology salon, obtain from the applicant a copy of the completed salon license holder a copy of the completed application for application for registration submitted to the Department by the reexamination submitted to the Department by the applicant applicant; for the next available licensure examination immediately b. upon learning or in any way becoming aware that an applicant following the licensure examination which the applicant failed who is performing specialty services in their salon pursuant to take or pass. to Rule 61G5-29.004, F.A.C., or performing hair braiding or c. Upon learning or in any way becoming aware that an applicant hair wrapping services in their salon pursuant to Rule 61G5- who is performing cosmetology services in their salon 31.006, F.A.C., has been notified that his or her application pursuant to Rule 61G5-18.0055, F.A.C., has either failed to is incomplete, or has been determined by the Board to be not take the next available licensure examination immediately qualified for registration as a specialist, shall immediately following the licensure examination which the applicant failed cease to permit the applicant to further perform specialty to pass, immediately cease to permit the applicant to further services; perform cosmetology services until the applicant provides to

Cosmetology.EliteCME.com Page 47 c. ensure that all specialty services performed by the applicant in e. display in a conspicuous place at the cosmetology or specialty the salon are performed in accordance with the conditions as salon location in which the applicant performs specialty set forth in Rule 61G5-29.004, F.A.C., and all other applicable services pursuant to Rule 61G5-29.004, F.A.C., or hair laws and Rules of the Board; braiding or hair wrapping services pursuant to Rule 61G5- d. ensure that all hair braiding and hair wrapping services 31.006, a copy of the completed application for registration as performed by the applicant in the salon are performed in a specialist or application for registration as a hair braider or accordance with all applicable laws and Rules of the Board; hair wrapper submitted to the Department by the applicant.

61G5-20.010 Mobile Salons. 1. The operation of all mobile cosmetology salons shall meet and at numbers of employees, and vehicle identification numbers all times remain in compliance with all local laws and ordinances of the license holder’s mobile salon shall be kept and made regulating business establishments in all areas in which the mobile available for verification purposes by Department personnel, salon operates, with all applicable requirements of the Americans and at which correspondence from the Department can be with Disabilities Act relating to accommodations for persons with received. Post Office box or private mail box addresses may disabilities, and with all applicable OSHA requirements. not be used for these purposes. 2. Each mobile salon shall meet and at all times remain in 4. Due to the inherent problems of providing water and sewage compliance with the requirements of this rule, all licensure and service to mobile salons, the following requirements shall apply: operating requirements specified in Chapters 455 and 477, F.S., a. Each mobile salon shall be equipped with a functional and all other rules of the Board and the Department which apply restroom which includes a self-contained, flush chemical toilet to cosmetology salons at fixed locations except to the extent those with a holding tank. The restroom shall also be in substantial rules of the Board conflict with this rule. compliance with the toilet and lavatory requirements specified 3. To facilitate inspections by the Department: in Rule 61G5-20.002, F.A.C. a. Prior to the beginning of each month, each mobile salon b. Each mobile salon shall have storage capacity for at least 35 license holder shall file with the Board a written monthly gallons of clean water for each cosmetologist working in the itinerary which lists the locations where and the dates and mobile salon and a total storage capacity for waste water equal hours when the mobile salon will be operating. to or greater than the mobile salon’s total capacity for clean b. The salon name and salon license number shall be in lettering water. at least five inches in height and shall be visibly displayed and c. Operation of a mobile salon shall promptly cease: clearly legible on at least two exteriors sides of each mobile 1. When the mobile salon’s clean water supply is depleted or salon. so diminished that further cosmetology service cannot be c. If a mobile salon is in a motor vehicle, the vehicle’s completed; identifications number shall be included on the mobile salon’s 2. When the mobile salon’s waste water storage capacity if application for licensure and shall also be listed on the mobile reached; salon’s monthly itinerary required in paragraph (a) of this 3. When the mobile salon’s restroom is in need of servicing. subsection. d. No mobile salon shall operate or resume operation unless it d. Each mobile salon shall have a telephone or other means has a sufficient amount of clean water as well as waste water of telecommunication by which it can be contacted by the capacity necessary for completing all cosmetology services Department personnel. The salon’s telephone number shall be undertaken and its restroom is functional. included on the mobile salon’s application for licensure and e. In disposing of sewage and waste water, each mobile salon shall also be listed on the mobile salon’s monthly itinerary shall comply with applicable state and local environmental and required in paragraph (a) of this subsection. sanitation regulations. e. Each salon shall be operated only at the times and places 5. No cosmetology services shall be preformed and no patrons shall specified in its monthly itinerary. remain within a mobile salon while it is in motion. f. Each mobile salon license holder shall maintain a permanent 6. Applicants for licensure of a mobile salon shall be subject to and business address in the inspection area of the local district shall pay the same fees which licensed salons at fixed locations are office at which records of appointments, itineraries, license subject to.

CHAPTER 61G5-25 LICENSURE STATUS AND NOTICE OF ADDRESS CHANGE 61G5-25.001 Active Status 61G5-25.005 Notice to the Department of Mailing Address and Place 61G5-25.002 Inactive Status; Reactivation of Practice of Licensee 61G5-25.001 Active Status. 1. The department shall renew an active cosmetology license or 2. The term “completed application” for purposes of active status or specialty registration upon timely receipt of the completed inactive status shall mean either a completed renewal notice or a application for status, the biennial renewal fee, and certification written request from the licensee or registrant accompanied by a that the licensee or registrant has demonstrated participation in the statement affirming compliance with the applicable requirements continuing education required by Rule 61G5-32.001, F.A.C. for renewal.

61G5-25.002 Inactive Status; Reactivation. 1. Any licensee or registrant may elect at the time of license renewal by Rule 61G5-25.001(2), F.A.C., and by paying the inactive status to place the license or registration into inactive status by filing with fee. the Board a completed application for inactive status as defined 2. An inactive status licensee or registrant may change to active status at any time provided the licensee or registrant meets the

Page 48 Cosmetology.EliteCME.com continuing education requirements of Rule 61G5-32.001, F.A.C., with the laws and rules for the practice of cosmetology in the State pays the reactivation fee, and if the request to change licensure of Florida before the license or registration can be placed into status is made at any time other than at the beginning of a licensure active status. cycle, pays the additional processing fee. However, a licensee or 3. Any inactive licensee or registrant who elects active status is not registrant whose license or registration has been in inactive status eligible to elect to return to inactive status until the next licensure for more than two consecutive biennial licensure cycles shall renewal period. be required to submit a statement affirming that the licensee or 4. A cosmetologist or specialist may not work with an inactive or registrant has read within the last thirty (30) days and is familiar delinquent license or registration.

61G5-25.005 Notice to the Department of Mailing Address and Place of Practice of Licensee. 1. It shall be the duty of each licensee or registrant to provide written days of the change. Written notice shall be sent to the following notification to the Department of the licensee’s or registrant’s address: Florida Board of Cosmetology, Department of Business current mailing address and place of practice. For purposes of and Professional Regulation, Northwood Centre, 1940 North this rule, “place of practice” means the address of the physical Monroe Street, Tallahassee, Florida 32399-0790. location where the licensee or registrant practices cosmetology or 3. It shall be a violation of this rule for a licensee or registrant to a specialty. fail to advise the Department within ninety (90) days of a change 2. Any time that the current mailing address or place of practice of mailing address. It shall not be a violation of this rule to fail of any licensee or registrant changes, written notification of the to advise the Department of a change of one’s place of practice change shall be provided to the Department within ninety (90) within ninety (90) days.

CHAPTER 61G5-29 SPECIALTY LICENSING 61G5-29.001 Definitions 61G5-29.013 Registration Renewal Procedures 61G5-29.004 Supervised Specialty Practice Exception

61G5-29.001 Definitions. 1. “Specialty Registration” means a registration to practice one or Facials shall be performed only by individuals licensed more of the following specialties: manicuring/pedicuring/ nail pursuant to Sections 477.019 and 477.0201, F.S., and extension, facials (skin care and hair removal). performed in schools licensed pursuant to Chapter 1005, F.S., 2. “Certificate of Completion” means a certificate from one of the or salons licensed pursuant to Section 477.025, F.S. following: 4. “Cosmetic Demonstration” means the application or removal a. A school licensed pursuant to Chapter 1005, F.S., or the of cosmetic products for the purposes of demonstration of the equivalent licensing authority of another state. cosmetic products as part of a sales or promotion program b. A specialty program within the public school system. rendered without compensation for the service from the c. A specialty division within the Cosmetology Division of individual or individuals who are the recipients or audience of the the Florida School for the Deaf and the Blind, provided demonstration. the training programs comply with minimum curriculum 5. “Cosmetic products” means any external preparation which is requirements established by the board. intended to cleanse, tone, color or beautify the face or neck, 3. “Facials” means: including but not limited to skin cleansers, astringents, skin a. The massaging or treating of the face, neck or scalp with or fresheners, lipstick, eyeliner, eye shadow, foundation, rouge or without the use of mechanical devices using oils, creams, cheek color, mascara, face powder or corrective stick. lotions or other cosmetic products which are used to cleanse 6. “Simple Adhesive” as used in Section 477.013(6)(a), F.S., means and condition the skin, to prevent or correct problems or a substance by which artificial nails (such as “press on nails”) conditions of the face, neck, and scalp and to color and can be attached to and then easily detached from a patron with beautify the face, neck and scalp or enhance their features; slight pressure only, without the application of any nail primer or and, solvents of any kind, and without removing the natural oils from or b. Skin care services for the body as defined in Section roughing of such patron’s nails. 477.013(13), F.S.

61G5-29.004 Supervised Specialty Practice Exception. 1. Following the submission of a complete application for registration same specialty for which the applicant has applied, or an as a specialist which included proof of the successful completion individual who then holds a current, active Florida license as a of all educational requirements for the specialty applied for and cosmetologist shall be physically present at all times when the the payment of all applicable application and registration fees, applicant is performing specialty services. and pending the issuance by the Department of a registration as b. All specialty services performed by the applicant under this a specialist under Chapter 477, F.S., an applicant for registration exception shall be performed in a licensed cosmetology as a specialist shall be eligible to perform specialty services in or specialty salon. All times during which the applicant is the specialty for which the applicant has applied for registration performing specialty services in the salon, the license for the subject to the following conditions: cosmetology or specialty salon shall be in a current and active a. All specialty services to be performed by the applicant under status. this exception shall be performed under the supervision of a 2. Prior to beginning the performance of specialty services under registered specialist. “Under the supervision of a registered this exception, all applicants shall provide to the cosmetology or specialist” shall mean that an individual who then holds specialty salon license holder or his or her representative a copy of a current, active Florida registration as a specialist in the

Cosmetology.EliteCME.com Page 49 the completed application for registration as a specialist submitted immediately cease performing specialty services under this to the Department by the applicant. exception until the applicant shall have corrected any deficiencies 3. Upon being notified by the Department that his or her application in their earlier application as noted by the Department, or shall is incomplete, or that he or she has been determined to be have submitted a new application which demonstrates that the not qualified for registration as a specialist, an applicant shall applicant is qualified for registration as a specialist, and shall have immediately inform the cosmetology or specialty salon license paid all applicable application and registration fees. holder or his or her representative of the notification; and shall

61G5-29.013 Registration Renewal Procedures. 1. All specialty registrations shall be valid for a period of two years education requirements as set forth in Rule 61G5-32.001, F.A.C., or until the end of the biennial licensure renewal cycle in which including a Board approved HIV/AIDS training course as provided they are first issued, whichever occurs first. The biennial licensure in Section 455.2228, F.S. All HIV/AIDS training courses shall renewal cycle for all specialty registrations shall coincide with comply with the requirements as set forth in Rule 61G5-18.011, the biennial licensure renewal cycle used for the renewal of F.A.C. cosmetology licenses. 3. Spouses of members of the Armed Forces of the United States 2. At the time of registration renewal, all specialty registrants are exempted from all registration renewal provisions, but only shall pay all applicable renewal fees and charges as provided in in cases of absence from the state because of their spouses’ duties Chapter 61G5-24, F.A.C. Prior to the expiration of their specialty with the Armed Forces. registration, all specialty registrants shall complete all continuing CHAPTER 61G5-30 DISCIPLINARY GUIDELINES 61G5-30.001 Disciplinary Guidelines 61G5-30.005 Mediation 61G5-30.004 Citations 61G5-30.006 Notice of Non Compliance

61G5-30.001 Disciplinary Guidelines. 1. The Board shall act in accordance with the following guidelines when it finds the enumerated violations in disciplinary cases.The Board shall impose a penalty within the range of each applicable disciplinary violation set forth below unless the Board finds an aggravating or mitigating circumstance, in which case the Board may deviate from the guideline penalty.

2. VIOLATION PENALTY RANGE a. Unlicensed cosmetology or specialty practice. (Section 477.0265(1)(a) or 477.029(1)(a), F.S.) For an individual who was never licensed, a fine of $500. For a licensee or registrant who fails to properly renew, a fine of $50 for every month or partial month during which the individual was unlicensed or unregistered, up to a maximum of $500. b. Unlicensed Salon and Delinquent Salon License. (Section 477.0265(1)(b)1. or 477.029(1)(b), F.S.) For a salon which has never been licensed, or for which the salon license has expired, a fine of $500. For a salon license which has become delinquent, a fine of $50 for every month or partial month of delinquency during which the salon has operated, up to a total of $500. c. Permitting a person without a license or registration, unless exempt, For a violation involving a person who was never licensed or registered to perform cosmetology services or any specialty in a salon. in Florida, a fine of $250 to $500. For a violation involving a person (Section 477.0265(1)(b)2., F.S.) who failed to properly renew or whose exemption has terminated, a fine of $50 for every month or partial month during which the violation took place, up to $500. d. Permitting an employee to practice cosmetology or a specialty For employing a person who was never licensed or registered in Florida, without being duly licensed, registered, or otherwise authorized. or who is not exempt, a fine of $250 to $500. For employing a person (Section 477.0265(1)(d) or 477.029(1)(c), F.S.) who failed to properly renew or whose exemption has terminated, a fine of $50 for every month or partial month during which the person was employed, up to $500. e. Obtain or attempt to obtain a license or registration for money, other A fine of $500 and denial or revocation of the license or registration. than the required fee, or any other thing of value or by fraudulent misrepresentations. (Section 477.0265(1)(d), F.S.) f. Using or attempting to use a suspended or revoked cosmetology A fine of $500 and suspension for one year of any license or registration license or specialty registration to practice cosmetology or a issued pursuant to Chapter 477, F.S., or denial or revocation of license specialty. or registration. (Section 477.0265(1)(c) or 477.029(1)(g), F.S.) g. Advertising or implying that skin care services or body wrapping A fine of $100 to $200 for the first offense; a fine of $500 for subsequent are related to massage therapy, except as allowed by statute. offenses. (Section 477.0265(1)(f), F.S.)

Page 50 Cosmetology.EliteCME.com h. Use or possess a product containing a liquid nail monomer A fine of $500 for the first offense; a fine of $500 and suspension with containing any trace of methyl methacrylate (MMA). a reinspection of the premises prior to reinstatement of the license, or (Section 477.0265(1)(g), F.S.) revocation for a subsequent offense. i. License or registration obtained by fraud or false or forged evidence. A fine of $500 and revocation of the salon license, cosmetology license, (Section 477.028(1)(a), 477.028(2)(a) or 477.029(e), F.S.) or specialty registration. j. Guilty of fraud, deceit, gross negligence, incompetency, or A fine of $200 to $500 and suspension or revocation of the salon misconduct in practice or instruction of cosmetology or specialty, or license, cosmetology license, or specialty registration. in operation of the salon. (Section 477.028(1)(b) or 477.028(2)(b), F.S.) k. (k) License or registration holder is guilty of aiding, assisting, A fine of $250 for the first offense. A fine of $500 and revocation procuring, or advising any unlicensed person to practice as a or suspension of salon license, cosmetology license, or specialty cosmetologist. registration for a subsequent offense. (Section 477.028(1)(c), F.S.) l. Present license of another as his or her own license. A fine of $500 and a reprimand for the first offense. A fine of $500 and (Section 477.029(1)(d), F.S.) refusal to certify for licensure for a subsequent offense. m. Impersonate any other licenseholder of like or different name. A fine of $500 and a 6 month suspension of any other license or (Section 477.029(1)(f), F.S.) registration held pursuant to Chapter 477, F.S. n. Violate or refuse to comply with: 1. Any provision of Chapter 455, F.S., or final order of the Board A fine of $500 and suspension, revocation, or refusal to certify to the or the Department; department for licensure. 2. Any provision of Chapter 477, F.S., or a rule of the Board or the A fine of $100 to $200 for the first violation. A fine of $300 to $500 for Department except as otherwise provided; a subsequent violation. A fine of $500 and suspension or revocation of license or registration for a refusal to comply. 3. Salon requirements subsections 61G5-20.002(3)-(7), F.A.C., A fine of $50 per violation for less than three violations. A fine of $250 relating to sanitation and safety; or for three to four violations. A fine of $500 for five or more violations, and suspension of the license with a reinspection prior to reinstatement of the license. A fine of $250 for a salon operating without proper disinfection practices. 4. Display of documents Rule 61G5-20.004, F.A.C., relating to A fine of $100 for each violation for the first offense. A fine of $200 to display of licenses and inspection sheets. $300 for each subsequent offense. (Section 477.029(1)(h)-(i), F.S.) 3. Based upon consideration of the following factors, the Board may a. Issuance of a reprimand or censure. impose disciplinary action other than the penalties recommended b. Imposition of an administrative fine not to exceed $500 for above: each count or separate offense. a. The danger to the public; c. Placement on probation for a period of time and subject to b. The length of time since date of violation; such reasonable conditions as the Board may specify. c. The number of complaints filed against the licensee; d. Revocation or suspension of any license or registration issued d. The length of time licensee or registrant has practiced; pursuant to Chapter 477, F.S. e. The actual damage, physical or otherwise, caused by the e. Refusal to certify to the Department an applicant for licensure violation; or registration. f. The deterrent effect of the penalty imposed; 5. The provisions of subsections (1) through (5) above shall not be g. The effect of the penalty upon the licensee’s or registrant’s construed so as to prohibit civil action or criminal prosecution as livelihood; provided for in Section 477.0265(2) or Section 477.031, F.S., and h. Any efforts for rehabilitation; the provisions of subsections (1) through (5) above shall not be i. The actual knowledge of the licensee or registrant pertaining to construed so as to limit the ability of the Board to enter into binding the violation; stipulations with accused parties as per Section 120.57(3), F.S. j. Attempts by licensee or registrant to correct or stop violations 6. In every case the Board imposes a monetary fine, it shall also or refusal by licensee or registrant to correct or stop violations; suspend the Respondent’s license(s). However, to enable the k. Related violations against a licensee or registrant in another Respondent to pay the fine, the suspension shall be stayed for state including findings of guilt or innocence, penalties the time period specified in the Board’s final order in accordance imposed and penalties served; with Rule 61G5-17.016, F.A.C. If the fine is paid within that l. Actual negligence of the licensee or registrant pertaining to time period, the suspension shall not take effect; if the fine is not any violations; paid within that time period, then the stay shall expire and the m. Penalties imposed for related offenses under subsection (1) suspension shall take effect. Thereafter, upon payment of the fine, above; the suspension shall be lifted. n. Any other mitigating or aggravating circumstances. 4. Penalties imposed by the Board pursuant to Rule 61G5-30.001, F.A.C., may be imposed in combination or individually but may not exceed the limitations enumerated below:

Cosmetology.EliteCME.com Page 51 61G5-30.004 Citations. 1. Definitions. As used in this rule; b. Operating a salon with a delinquent license for more than three a. “Citation” means an instrument which meets the requirements months but not more than four months; set forth in Section 455.224, F.S., and which is served upon c. Employing a person to practice cosmetology or a specialty a subject for the purpose of assessing a penalty in an amount with an inactive or expired license for more than three months established by this rule; but not more than four months; b. “Subject” means the licensee, applicant, person, partnership, 8. The Board hereby designates the following as citation violations, corporation, or other entity alleged to have committed a which shall result in a penalty of two hundred and fifty dollars violation designated in this rule. ($250.00): 2. In lieu of the disciplinary procedures contained in Section a. Operating a salon without disinfecting solutions as required by 455.225, F.S., the Department is hereby authorized to dispose of paragraph 61G5-20.002(3)(d), F.A.C.; any violation designated herein by issuing a citation to the subject b. Three violations of the safety, sanitary, or other salon within six months after the filing of the complaint which is the requirements specified in Rule 61G5-20.002, F.A.C.; basis for the citation. c. Practicing cosmetology or a specialty with an inactive or 3. Citations shall be issued for the first offense violations only. expired license for more than four months but not more than 4. The Board hereby designates the following as citation violations, five months; which shall result in a penalty of fifty dollars ($50.00): d. Operating a salon with a delinquent license for more than four a. Except as otherwise provided herein, any violation of the months but not more than five months; and safety, sanitary, or other salon requirements specified in Rule e. Employing a person to practice cosmetology or a specialty 61G5-20.002, F.A.C. – however, if it is an initial offense and with an inactive or expired license for more than four months there are no other violations, then the subject shall be given a but not more than five months. Notice of Noncompliance; 9. The Board hereby designates the following as citation violations, b. Practicing cosmetology or a specialty with an inactive or which shall result in a penalty of three hundred dollars ($300.00): expired license for one month or part of a month; a. Practicing cosmetology or a specialty with an inactive or c. Operating a salon with a delinquent license for one month or expired license for more than five months but not more than part of a month; six months; d. Employing a person to practice cosmetology or a specialty b. Operating a salon with a delinquent license for more than five with an inactive or expired license for one month or part of a months but not more than six months; month. c. Employing a person to practice cosmetology or a specialty e. Unless otherwise permitted in Chapter 477, F.S., performing with an inactive or expired license for more than five months cosmetology services in a salon which does not have a license but not more than six months; and in violation of Section 477.0263(1), F.S. d. Four violations of the safety, sanitary, or other salon 5. The Board hereby designates the following as citation violations, requirements specified in Rule 61G5-20.002, F.A.C. which shall result in a penalty of one hundred dollars ($100.00): 10. The Board hereby designates the following as citation violations, a. Transferring ownership or changing location of a salon without which shall result in a penalty of three hundred and fifty dollars the approval of the Department pursuant to Rule 61G5- ($350.00): 20.006, F.A.C., provided the transfer of ownership or change a. Practicing cosmetology or a specialty with an inactive or of location has not exceeded 90 days and the salon owner can expired license for more than six months but not more than provide proof that a completed application has been filed with seven months; the Department; b. Operating a salon with a delinquent license for more than six b. Practicing cosmetology or a specialty with an inactive or months but not more than seven months; and expired license for more than one month but not more than two c. Employing a person to practice cosmetology or a specialty months; with an inactive or expired license for more than six months c. Operating a salon with a delinquent license for more than one but not more than seven months. month but not more than two months; 11. The Board hereby designates the following as citation violations, d. Employing a person to practice cosmetology or a specialty which shall result in a penalty of four hundred dollars ($400.00): with an inactive or expired license for more than one month a. Practicing cosmetology or a specialty with an inactive or but not more than two months; expired license for more than seven months but not more than e. Two violations of the safety, sanitary, or other salon eight months; requirements specified in Rule 61G5-20.002, F.A.C. b. Operating a salon with a delinquent license for more than 6. The Board hereby designates the following as citation violations, seven months but not more than eight months; and which shall result in a penalty of one hundred and fifty dollars c. Employing a person to practice cosmetology or a specialty ($150.00): with an inactive or expired license for more than seven months a. Practicing cosmetology or a specialty with an inactive or but not more than eight months. expired license for more than two months but not more than 12. Board hereby designates the following as citation violations, which three months; shall result in a penalty of four hundred and fifty dollars ($450.00): b. Operating a salon with a delinquent license for more than two a. Practicing cosmetology or a specialty with an inactive or months but not more than three months; expired license for more than eight months but not more than c. Employing a person to practice cosmetology or a specialty nine months; with an inactive or expired license for more than two months b. Operating a salon with a delinquent license for more than eight but not more than three months. months but not more than nine months; and 7. The Board hereby designates the following as citation violations, c. Employing a person to practice cosmetology or a specialty which shall result in a penalty of two hundred dollars ($200.00): with an inactive or expired license for more than eight months a. Practicing cosmetology or a specialty with an inactive or but not more than nine months. expired license for more than three months but not more than 13. The Board hereby designates the following as citation violations, four months; which shall result in a penalty of five hundred dollars ($500.00):

Page 52 Cosmetology.EliteCME.com a. Practicing cosmetology or a specialty without a license; e. Operating a salon with a delinquent license for more than nine b. Operating a salon without a license; months but not more than twelve months; and c. Employing a person to practice cosmetology or a specialty f. Employing a person to practice cosmetology or a specialty without a license; with an inactive or expired license for more than nine months d. Practicing cosmetology or a specialty with an inactive or but not more than twelve months. expired license for more than nine months but not more than twelve months; 61G5-30.005 Mediation. 1. “Mediation” means a process whereby a mediator appointed by the b. Failure of the licensee to timely respond to a continuing department acts to encourage and facilitate resolution of a legally education audit; sufficient complaint. It is an informal and non-adversarial process c. Failure to submit change of address for a salon; and with the objective of assisting the parties to reach a mutually d. Failure to timely notify the department of the licensee’s or acceptable agreement. registrant’s change of mailing address or place of practice. 2. The Board finds that mediation is an acceptable method of dispute 3. A “mediator” means a person who is certified in mediation by resolution for the following violations as they are economic in the Florida Bar, the Florida Supreme Court, or the Division of nature or can be remedied by the licensee: Administrative Hearings. a. Failure of the licensee to timely pay any assessed administrative fines or costs; 61G5-30.006 Notice of Non Compliance. 1. In accordance with Section 455.225(3), F.S., when a complaint is 2. In accordance with Section 120.695, F.S., the agency shall issue received, the agency may provide a licensee with a notice of non- a notice of non-compliance as first enforcement action against compliance for an initial offense of a minor violation. Failure of a licensee for a minor violation of a rule. Pursuant to Section a licensee to take action in correcting the violation within 15 days 120.695(2)(b), F.S., the Board designates the following rules for after notice may result in the institution of regular disciplinary which a violation would be a minor violation of a rule for which a proceedings. “Minor violations” as used in Section 455.225(3), notice of non-compliance is issued: F.S., are defined as follows: a. Violations of Rule 61G5-20.004, F.A.C. a. Violations of Rule 61G5-20.004, F.A.C. b. Violations of subsection 61G5-18.011(1), F.A.C., in failing to b. Violations of subsection 61G5-18.011(1), F.A.C., in failing to maintain a copy of his or her certificate of course completion maintain a copy of his or her certificate of course completion in instruction on Human Immunodeficiency Virus and in instruction on Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome. Acquired Immune Deficiency Syndrome. c. Violations of paragraph 61G5-20.008(2)(a), F.A.C., in failing c. Violations of paragraph 61G5-20.008(2)(a), F.A.C., in failing to retain copies of an employee’s high school diploma or GED to retain copies of an employee’s high school diploma or equivalency certificate and cosmetology school diploma or G.E.D. equivalency certificate and cosmetology school certificate of completion. diploma or certificate of completion. d. (d) An initial offense and no other violations of Rule 61G5- d. An initial offense and no other violations of Rule 61G5- 20.002, F.A.C. 20.002, F.A.C.

Cosmetology.EliteCME.com Page 53 Chapter 6: Environmental Issues

1 CE Hour (Satisfies Environmental Issues Requirement)

By: Staff Writer

Learning objectives ŠŠ Know the causes of indoor air problems. ŠŠ Understand the health risks associated with poor indoor air quality. ŠŠ Recognize the most effective means for reducing indoor air ŠŠ Discuss common sense ways to reduce water and energy pollutants. consumption in your salon. What causes indoor air problems? Indoor pollution sources that release gases or particles into the air sources and by not carrying indoor air pollutants out of the home. High are the primary cause of indoor air quality problems in homes and temperature and humidity levels can also increase concentrations of buildings. Inadequate ventilation can increase indoor pollutant levels some pollutants. by not bringing in enough outdoor air to dilute emissions from indoor

Pollutant sources There are many sources of indoor air pollution in any home. These adjusted gas stove can emit significantly more carbon monoxide than include combustion sources such as oil, gas, kerosene, coal, wood, one that is properly adjusted. and tobacco products; building materials and furnishings as diverse as Some sources, such as building materials, furnishings, and household deteriorated, asbestos-containing insulation, wet or damp carpet, and products like air fresheners, release pollutants more or less cabinetry or furniture made of certain pressed wood products; products continuously. Other sources, related to activities carried out in the for household cleaning and maintenance, personal care, or hobbies; home, release pollutants intermittently. These include smoking, the central heating and cooling systems and humidification devices; and use of unvented or malfunctioning stoves, furnaces, or space heaters, outdoor sources such as radon, pesticides, and outdoor air pollution. the use of solvents in cleaning and hobby activities, the use of paint The relative importance of any single source depends on how much strippers in redecorating activities, and the use of cleaning products of a given pollutant it emits and how hazardous those emissions are. and pesticides in house-keeping. High pollutant concentrations can In some cases, factors such as how old the source is and whether it remain in the air for long periods after some of these activities. is properly maintained are significant. For example, an improperly

Amount of ventilation If too little outdoor air enters a home, pollutants can accumulate to into and out of the home may have higher pollutant levels than other levels that can pose health and comfort problems. Unless they are built homes. However, because some weather conditions can drastically with special mechanical means of ventilation, homes that are designed reduce the amount of outdoor air that enters a home, pollutants can and constructed to minimize the amount of outdoor air that can “leak” build up even in homes that are normally considered “leaky”.

How does outdoor air enter a building? Outdoor air enters and leaves a building by: infiltration, natural ventilation devices, from outdoor-vented fans that intermittently ventilation, and mechanical ventilation. In a process known as remove air from a single room, such as bathrooms and utility rooms, infiltration, outdoor air flows into the building through openings, to air handling systems that use fans and duct work to continuously joints, and cracks in walls, floors, and ceilings, and around windows remove indoor air and distribute filtered and conditioned outdoor air to and doors. In natural ventilation, air moves through opened windows strategic points throughout the building. The rate at which outdoor air and doors. Air movement associated with infiltration and natural replaces indoor air is described as the air exchange rate. When there is ventilation is caused by air temperature differences between indoors little infiltration, natural ventilation, or mechanical ventilation, the air and outdoors and by wind. Finally, there are a number of mechanical exchange rate is low and pollutant levels can increase.

Indoor air pollution and health Health effects from indoor air pollutants may be experienced soon after exposure or, possibly, years later.

Immediate effects Immediate effects may show up after a single exposure or repeated eliminating the person’s exposure to the source of the pollution, if exposures. These include irritation of the eyes, nose, and throat, it can be identified. Symptoms of some diseases, including asthma, headaches, dizziness, and fatigue. Such immediate effects are hypersensitivity pneumonitis, and humidifier fever, may also show up usually short-term and treatable. Sometimes the treatment is simply soon after exposure to some indoor air pollutants.

Page 54 Cosmetology.EliteCME.com The likelihood of immediate reactions to indoor air pollutants depends Certain immediate effects are similar to those from colds or other on several factors. Age and preexisting medical conditions are two viral diseases, so it is often difficult to determine if the symptoms important influences. In other cases, whether a person reacts to a are a result of exposure to indoor air pollution. For this reason, it is pollutant depends on individual sensitivity, which varies tremendously important to pay attention to the time and place symptoms occur. If from person to person. Some people can become sensitized to the symptoms fade or go away when a person is away from home, biological pollutants after repeated exposures, and it appears that some for example, an effort should be made to identify indoor air sources people can become sensitized to chemical pollutants as well. that may be possible causes. Some effects may be made worse by an inadequate supply of outdoor air or from the heating, cooling, or humidity conditions prevalent in the home.

Long-term effects Other health effects may show up either years after exposure has While pollutants commonly found in indoor air are responsible for occurred or only after long or repeated periods of exposure. These many harmful effects, there is considerable uncertainty about what effects, which include some respiratory diseases, heart disease, and concentrations or periods of exposure are necessary to produce specific cancer, can be severely debilitating or fatal. It is prudent to try to health problems. People also react very differently to exposure to improve the indoor air quality in your home even if symptoms are not indoor air pollutants. Further research is needed to better understand noticeable. which health effects occur after exposure to the average pollutant concentrations found in homes and which occurs from the higher concentrations that occur for short periods of time.

An introduction to indoor air quality ●● Pollutants and sources of indoor air pollution. ●● Lead. ●● Asbestos. ●● Nitrogen dioxide. ●● Biological pollutants. ●● Pesticides. ●● Carbon monoxide. ●● Radon. ●● Formaldehyde/pressed wood products. ●● Respirable particles. ●● Household cleaning and maintenance, personal care, or hobbies. ●● Secondhand smoke/environmental tobacco smoke.

Improving indoor air quality There are three basic strategies to improve indoor air quality: ●● Improved ventilation. ●● Source control. ●● Air cleaners.

Source control Usually the most effective way to improve indoor air quality is to amount of emissions. In many cases, source control is also a more eliminate individual sources of pollution or to reduce their emissions. cost-efficient approach to protecting indoor air quality than increasing Some sources, like those that contain asbestos, can be sealed or ventilation because increasing ventilation can increase energy costs. enclosed; others, like gas stoves, can be adjusted to decrease the

Ventilation improvements For most indoor air quality problems in a building, source control is It is particularly important to take as many of these steps as possible the most effective solution. while you are involved in short-term activities that can generate high Another approach to lowering the concentrations of indoor air pollutants levels of pollutants - for example, painting, paint stripping, heating in your workplace is to increase the amount of outdoor air coming with kerosene heaters, or engaging in maintenance like sanding. You indoors. Most commercial heating and cooling systems, including might also choose to do some of these activities outdoors, if you can forced air heating systems, do not mechanically bring fresh air into the and if weather permits. building. Opening windows and doors, operating window or attic fans, Advanced designs of new structures are starting to feature mechanical when the weather permits, or running a window air conditioner with systems that bring outdoor air into the building. Some of these designs the vent control open increases the outdoor ventilation rate. Local fans include energy-efficient heat recovery ventilators (also known as air- installed in a bath, break or utility room that exhaust outdoors remove to-air heat exchangers). contaminants directly from the room where the fan is located and also increase the outdoor air ventilation rate.

Air cleaners There are many types and sizes of air cleaners on the market, ranging low air-circulation rate will not be effective, nor will a cleaner with from relatively inexpensive table-top models to sophisticated and a high air-circulation rate but a less efficient collector. The long-term expensive whole-building systems. Some air cleaners are highly performance of any air cleaner depends on maintaining it according to effective at particle removal, while others, including most table-top the manufacturer’s directions. models, are much less so. Air cleaners are generally not designed to Another important factor in determining the effectiveness of an air remove gaseous pollutants. cleaner is the strength of the pollutant source. Table-top air cleaners, The effectiveness of an air cleaner depends on how well it collects in particular, may not remove satisfactory amounts of pollutants pollutants from indoor air (expressed as a percentage efficiency rate) from strong nearby sources. People with a sensitivity to particular and how much air it draws through the cleaning or filtering element sources may find that air cleaners are helpful only in conjunction with (expressed in cubic feet per minute). A very efficient collector with a concerted efforts to remove the source.

Cosmetology.EliteCME.com Page 55 Over the past few years, there has been some publicity suggesting that At present, EPA does not recommend using air cleaners to reduce levels indoor plants have been shown to reduce levels of some chemicals of radon and its decay products. The effectiveness of these devices is in laboratory experiments. There is currently no evidence, however, uncertain because they only partially remove the radon decay products that a reasonable number of houseplants remove significant quantities and do not diminish the amount of radon entering a structure. EPA plans of pollutants in homes and offices. Indoor plants should not be to do additional research on whether air cleaners are, or could become, a over-watered because overly damp soil may promote the growth of reliable means of reducing the health risk from radon. microorganisms, which can affect allergic individuals.

What is eco-efficiency? Eco-efficiency is a common sense approach that businesses can strategies into your everyday business, you are able to do more with undertake to reduce costs, increase profits by saving on resources less, while maintaining product and services quality creating and such as water and energy. It involves changing current practices and providing quality and reducing resource use, waste and pollution. The finding alternatives. It also includes maximizing the use of renewable ultimate goal of eco-efficiency is to establish sustainable businesses resources. Quite simply you will find that by introducing conservation while keeping environmental solutions in mind.

Limit chemical exposure ●● Use less toxic, safer, natural products. ●● Use products with low volatile organic compound content. ●● Use pumps instead of aerosol containers. ●● Use non-toxic products for disinfecting and cleaning.

Solid waste Reducing solid waste from a salon is one of the easiest ways to ●● Ask your suppliers to take back cardboard and plastic bottles for “green” your business. Here are some straightforward ways to recycling. accomplish this: If appropriate, make packaging (e.g., Styrofoam peanuts and ●● Replace paper towels with reusable cloth towels. cardboard) available to other business or organizations (www. ●● Ask your suppliers to provide their products in refillable or nsmaterials.com). It is important to make sure that used containers and recyclable containers. boxes are clean, and that they do not contain chemicals. ●● Provide clients with refillable containers, and offer a discounted refill service for gels, shampoos, conditioners, skin care and nail Additionally, recycling bins and compost collection containers products. should be installed in every business. This can facilitate recycling of ●● Ask your suppliers for alternative packaging that uses less packing paper and many plastics, as well as separation of organic materials material. like coffee grinds and food materials. Talk to your waste hauler or ●● Completely empty product bottles before discarding. landlord to ensure that separated materials are reaching the appropriate destination, and not being recombined after hauling.

Water/energy considerations Water and energy is consumed in every hair and beauty salon. So it makes good business sense as well as good environmental sense, to reduce energy and water use wherever possible.

Water conservation The following are some easy water conservation practices: ●● Use cold water instead of hot water wherever possible. Hot water ●● Use water only as necessary. Check for and repair any leaks in the may be a big cost item in small shops. piping. Remind employees to turn off faucets and report leaks. Consider steps to reduce heat loss, and therefore energy use related to ●● Install flow restrictors, aerators, toilet dams, urinal flushing your hot water. These include: controls, or other low-flow devices. Install automatic shutoffs on ●● Improving tank insulation. faucets and fountains. ●● Using heat traps or insulating pipes where hot water flows. ●● Use appropriate settings on equipment and appliances to maximize ●● Using solar energy to heat water. Hot water temperature should water efficiency. be kept to a minimum comfortable level to minimize the use of electricity, oil or propane required for heating.

Reuse ●● Give used magazines to other organizations, friends and ●● Make empty containers and cardboard available to other customers. businesses. ●● Require suppliers to take back empty refillable containers.

Heating, ventilation and air conditioning Control temperature settings whenever possible. Turn heat down or off Improve building envelope (ceilings, floors, walls, weather-stripping, during off hours. Limit access to thermostats. On older units, install caulking, doors seals, replace broken or cracked windows, storm timers or computer controls. windows, vestibules). Conduct routine maintenance on heating and ventilation equipment to Use daylight control measures, such as blinds or curtains, to reduce ensure it is operating efficiently; replace old equipment with newer, loads on HVAC systems. more efficient equipment.

Page 56 Cosmetology.EliteCME.com Ensure enough air is circulating to clear hazardous fumes from the air changes are not needed as frequently. This will reduce loads on HVAC (six to ten fresh air changes per hour) but modify settings when air systems.

Did you know? If a faucet drips once every second, over 2,500 gallons of water are wasted in one year!

Lighting At present, electricity is responsible for about 25% of the nation’s 1. Ventilate the room. total energy consumption. Of that, about 20% is due to lighting. ○○ Open a window. Thus lighting represents a significant portion of energy consumption. ○○ Leave the room and restrict access for at least 30 minutes. However, conventional lighting technology, consisting primarily of ○○ If available, point a floor or pedestal fan at the open window. incandescent bulbs and fluorescent tubes, is remarkably inefficient. Using a ceiling fan will not be as helpful at moving the air out Incandescent bulbs, which represent the major residential lighting of the window. source, convert only about 5-6% of their power consumption into 2. Pick up all materials you can. visible light. The rest is converted to waste heat, which contributes ○○ Wear disposable gloves. significantly to building cooling loads. Fluorescent lighting, which ○○ Carefully scoop up the fragments and powder with stiff paper dominates industrial and commercial areas, is considerably better, with or cardboard. 25% energy efficiency, but nonetheless wastes a significant amount of ○○ Sticky tape (such as duct tape) can be used to pick up small energy as heat, as well. pieces and powder. New lighting products are rapidly entering the marketplace and ○○ Wipe the area clean with a damp paper towel or disposable wet promise much greater energy efficiency, superior lighting or lumens wipe. and much longer life span than the conventional incandescent or 3. Double bag and recycle. fluorescent systems that have been around for years. ○○ Place the broken CFL and cleanup materials in doubled plastic bags and seal the bags. One of the newer lighting choices that we all may be familiar with ○○ Take the materials to a local household hazardous waste center is the compact fluorescent lamp or CFL. CFLs are small fluorescent or collection event, a fluorescent lamp recycling facility, or put light bulbs that can be screwed into a regular light socket, use about 75 into the household trash stored outside if no other recycling percent less energy than standard incandescent bulbs and last up to 10 options are available. times longer. According to the U.S. Environmental Protection Agency 4. Wash your hands. (EPA), if every American home replaced just one light bulb with an ENERGY STAR qualified CFL, it would save enough energy to light Florida has first-rate household hazardous waste programs that accept more than three million homes for a year and prevent greenhouse gas fluorescent bulbs in nearly every county. To find a place to recycle emissions equivalent to more than 800,000 cars. these bulbs and other household hazardous waste items, visit www. earth911.org or call 1-800-CLEANUP to use your zip code to learn Each CFL does contain a very small amount of mercury – usually about the recycling options in your area of Florida. around 5 milligrams, or about the amount that would cover the tip of a ball-point pen. In comparison, a mercury fever thermometer Other energy efficient lighting products available are solid state usually contains about 500 milligrams of mercury. If a CFL or other technologies such, as light-emitting diodes (LEDs) and organic light- fluorescent lamp should break in your salon, the Florida Department emitting diodes or OLEDs. of Environmental Protection recommends the following guidelines for It is estimated that, converting existing lighting to energy efficient cleanup: lighting can cut a salon’s lighting energy consumption by up to 50%.

Laundry Doing laundry can use a surprising amount of energy and water machines that tumble clothes, much like a traditional dryer does, are resources. By using newer, high efficiency machines, water use can be the most efficient. Be sure to look for Energy Star symbols when reduced by up to 50% and electrical use by as much as 40%. Washing considering any new appliance.

Hand drying In bathrooms, high efficiency hand dryers or cloth towel rolls are a good alternative to paper towel use. These high efficiency hand dryers will dry hands faster than traditional units, while still using less electricity.

Cosmetology.EliteCME.com Page 57 Chapter 7: OSHA: Protecting the Health of You and Your Client

1 CE Hour (Satisfies OSHA Requirement)

By: Staff Writer

Learning objectives ŠŠ Understand OSHA’s Bloodborne Pathogen Standard. ŠŠ Know how to safely work with chemicals. ŠŠ Describe a material safety data sheet (MSDS). ŠŠ Be aware of how workplace injuries can occur. ŠŠ Know the purpose of an MSDS. Summary of OSHA’s Bloodborne Pathogen Standard In March 1992, OSHA’s Bloodborne Pathogen Standard, 29 CFR ensure appropriate packaging of specimens and regulated wastes and 1910.1030 took effect. This standard was designed to prevent more decontaminate equipment or label it as contaminated before shipping than 200 deaths and 9,000 bloodborne infections every year. While to servicing facilities. the standard was primarily aimed at hospitals, funeral homes, nursing Employers must provide, at no cost, and require employees to use homes, clinics, law enforcement agencies, emergency responders, and appropriate personal protective equipment such as gloves, gowns, HIV/HBV research laboratories, anyone who can “reasonably expect masks, mouthpieces and resuscitation bags and must clean, repair and to come in contact with blood or potentially infectious materials” as replace these when necessary. Gloves are not necessarily required for part of their job is covered by the standard. OSHA’s summary of the routine phlebotomies in volunteer blood donation centers but must be standard is below. made available to employees who want them. Purpose: Limits occupational exposure to blood and other potentially The standard requires a written schedule for cleaning, identifying infectious materials since any exposure could result in transmission of the method of decontamination to be used, in addition to cleaning bloodborne pathogens which could lead to disease or death. following contact with blood or other potentially infectious materials. Scope: Covers all employees who could be “reasonably anticipated” It specifies methods for disposing of contaminated sharps and sets as the result of performing their job duties to face contact with blood forth standards for containers for these items and other regulated and other potentially infectious materials. OSHA has not attempted to waste. Further, the standard includes provisions for handling list all occupations where exposures could occur. “Good Samaritan” contaminated laundry to minimize exposures. acts such as assisting a co-worker with a nosebleed would not be HIV and HBV Research Laboratories and Production Facilities: considered occupational exposure. Calls for these facilities to follow standard microbiological practices Infectious materials include semen, vaginal secretions, cerebrospinal and specifies additional practices intended to minimize exposures of fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, employees working with concentrated viruses and reduce the risk of amniotic fluid, saliva in dental procedures, any body fluid visibly accidental exposure for other employees at the facility. These facilities contaminated with blood and all body fluids in situations where it is must include required containment equipment and an autoclave for difficult or impossible to differentiate between body fluids. They also decontamination of regulated waste and must be constructed to limit include any unfixed tissue or organ other than intact skin from a human risks and enable easy clean up. Additional training and experience (living or dead), human immunodeficiency virus (HIV)- containing requirements apply to workers in these facilities. cell or tissue cultures, organ cultures and HIV or hepatitis B (HBV)- Hepatitis B Vaccination: Requires vaccinations to be made available containing culture medium or other solutions as well as blood, organs to all employees who have occupational exposure to blood within or other tissues from experimental animals infected with HIV or HBV. 10 working days of assignment, at no cost, at a reasonable time and Exposure Control Plan: Requires employers to identify, in place, under the supervision of licensed physician/licensed healthcare writing, tasks and procedures as well as job classifications where professional and according to the latest recommendations of the U.S. occupational exposure to blood occurs--without regard to personal Public Health Service (USPHS). Prescreening may not be required as a protective clothing and equipment. It must also set forth the schedule condition of receiving the vaccine. Employees must sign a declination for implementing other provisions of the standard and specify form if they choose not to be vaccinated, but may later opt to receive the procedure for evaluating circumstances surrounding exposure the vaccine at no cost to the employee. Should booster doses later be incidents. The plan must be accessible to employees and available to recommended by the USPHS, employees must be offered them. OSHA. Employers must review and update it at least annually--more Post-Exposure Evaluation and Follow-Up: Specifies procedures often if necessary to accommodate workplace changes. to be made available to all employees who have had an exposure Methods of Compliance: Mandates universal precautions, (treating incident plus any laboratory tests must be conducted by an accredited body fluids/materials as if infectious) emphasizing engineering laboratory at no cost to the employee. Follow-up must include a and work practice controls. The standard stresses handwashing and confidential medical evaluation documenting the circumstances of requires employers to provide facilities and ensure that employees exposure, identifying and testing the source individual if feasible, use them following exposure to blood. It sets forth procedures to testing the exposed employee’s blood if he/she consents, post- minimize needlesticks, minimize splashing and spraying of blood, exposure prophylaxis, counseling and evaluation of reported illnesses.

Page 58 Cosmetology.EliteCME.com Healthcare professionals must be provided specified information the standard and explanation of its contents, general discussion on to facilitate the evaluation and their written opinion on the need for bloodborne diseases and their transmission, exposure control plan, hepatitis B vaccination following the exposure. Information such engineering and work practice controls, personal protective equipment, as the employee’s ability to receive the hepatitis B vaccine must be hepatitis B vaccine, response to emergencies involving blood, how to supplied to the employer. All diagnoses must remain confidential. handle exposure incidents, the post-exposure evaluation and follow- Hazard Communication: Requires warning labels including the up program, signs/labels/color-coding. There must be opportunity orange or orange-red biohazard symbol affixed to containers of for questions and answers, and the trainer must be knowledgeable in regulated waste, refrigerators and freezers and other containers which the subject matter. Laboratory and production facility workers must are used to store or transport blood or other potentially infectious receive additional specialized initial training. materials. Red bags or containers may be used instead of labeling. Recordkeeping: Calls for medical records to be kept for each When a facility uses universal precautions in its handling of all employee with occupational exposure for the duration of employment specimens, labeling is not required within the facility. Likewise, when plus 30 years, must be confidential and must include name and social all laundry is handled with universal precautions, the laundry need security number; hepatitis B vaccination status (including dates); not be labelled. Blood which has been tested and found free of HIV or results of any examinations, medical testing and follow-up procedures; HBV and released for clinical use, and regulated waste which has been a copy of the healthcare professional’s written opinion; and a copy of decontaminated, need not be labeled. Signs must be used to identify information provided to the healthcare professional. Training records restricted areas in HIV and HBV research laboratories and production must be maintained for three years and must include dates, contents of facilities. the training program or a summary, trainer’s name and qualifications, Information and Training: Mandates training within 90 days of names and job titles of all persons attending the sessions. Medical effective date, initially upon assignment and annually - employees records must be made available to the subject employee, anyone with who have received appropriate training within the past year need only written consent of the employee, OSHA and NIOSH--they are not receive additional training in items not previously covered. Training available to the employer. Disposal of records must be in accord with must include making accessible a copy of the regulatory text of OSHA’s standard covering access to records.

Safety and health add value OSHA’s stated mission is to assure – so far as possible – that every Safety and health also make big reductions in indirect costs, due to: working man and woman in the nation has safe and healthful working ●● Increased productivity. conditions. According to OSHA they believe that providing workers ●● Higher quality products. with a safe workplace is central to their ability to enjoy health, security ●● Increased morale. and the opportunity to achieve the American dream. Addressing safety ●● Better labor/management relations. and health issues in the workplace also saves the employer money ●● Reduced turnover. and adds value to the business. Recent estimates place the business ●● Better use of human resources. costs associated with occupational injuries at close to $170 billion – Employees and their families benefit from safety and health because: expenditures that come straight out of company profits. ●● Their incomes are protected. When workers stay whole and healthy, the direct-cost savings to ●● Their family lives are not hindered by injury. businesses include: ●● Their stress is not increased. ●● Lower workers’ compensation insurance costs. Implementing an accident prevention program will allow a small ●● Reduced medical expenditures. business to learn firsthand that the cost of accident prevention is far ●● Smaller expenditures for return-to-work programs. lower than the cost of accidents. Consultation offers free help in ●● Fewer faulty products. identifying workplace hazards and establishing or improving safety ●● Lower costs for job accommodations for injured workers. and health management systems corporate-wide. ●● Less money spent for overtime benefits.

OSHA and you OSHA has not formulated any rules and regulations that deal ●● Health hazards, i.e., possible physical side effects of product specifically with the cosmetology industry. While no specific usage. rules exist, individuals engaged in the practice of cosmetology are ●● Primary routes of entry into the body. expected to abide by basic rules contained within the Code of Federal ●● Permissible exposure limits. Regulations (29 CFR) that deal with workplace safety and health. ●● Carcinogen (cancer causing) hazard of the chemical. These rules describe the responsibilities of employers and employees ●● Precautions and handling procedures. in dealing with hazardous chemicals, personal protective devices, ●● Control and protection measures. proper ventilation, prevention from over exposure to dusts, and overall ●● Emergency and first aid procedures. health and safety plans. ●● Storage and disposal information. One regulation that directly impacts the cosmetology profession is Your local product supplier is required by federal law to provide you placed on the manufacturers of many of the products that you may with an MSDS for each product you purchase from them. It is the legal use in your business. The federal government requires that product responsibility of salon owners to collect MSDS for each product that manufacturers make available to customers material safety data sheets you use in your business and to make them available for reference. The (MSDS). Each MSDS must contain basic information on the each following page is a sample of OSHA form 174 (MSDS) Sheet. product manufactured. There is no standard format for an MSDS, but each one must contain the following: ●● Identity chemicals that may present physical or chemical hazards. ●● Physical hazards, i.e., volatility, evaporation rate and interaction with other chemicals.

Cosmetology.EliteCME.com Page 59 Page 60 Cosmetology.EliteCME.com Labels Each container of a hazardous substance must have a label attached to it. If the contents of a container are unknown, it should be labeled: The label must be in English and state the product name, risk and safety CAUTION DO NOT USE UNKNOWN SUBSTANCE phrases. The label may also state the ingredient’s chemical name. Store all unknown substances in isolation until its contents can be If a hazardous substance is transferred from one container into a identified and properly labeled. If the substance cannot be identified, second container, and the substance is not entirely used immediately, dispose of it. You should contact the Environmental Protection Agency you must ensure that the second container is properly labeled. for advice on disposal requirements. Chemicals must not be decanted into a food or beverage container.

Working with hazardous chemicals The issue of most concern to cosmetologists is chemical exposure in the workplace. According to National Institute for Occupational Redesign Safety and Health (NIOSH), the chemicals used in a hair salon can ○○ Make sure there is good ventilation so that exposure to cause a range of allergies and lung problems, from hairspray-induced airborne contaminants can be prevented or minimized, e.g., coughs to rashes caused by certain chemicals in hair dye. Dyes and local exhaust ventilation. bleaches can cause dermatitis, or skin rashes, among some salon ○○ Protect against eye splash by installing splash shields in areas professionals. where chemicals are mixed. Dermatitis (a general term meaning inflammation of the skin) There Administrative controls are two types of dermatitis. Irritant contact dermatitis results from ○○ Make sure MSDSs are available for all chemicals used in the contact with irritant substances, such as water and detergents in salon. shampoo. Allergic contact dermatitis occurs when a person develops ○○ Make sure workers are provided with suitable information, an allergic response to a chemical. training and supervision on the safe use of chemicals and PPE (personal protective equipment). Asthma (a respiratory disease, which narrows the air passages and ○○ Store chemicals away from energy sources, such as fuse boxes, results in breathing difficulties) Chemicals used in the hairdressing, naked flames, heat and intense light sources. nail and beauty industry may aggravate pre-existing asthma or cause ○○ Store flammable chemicals in a cool place in a securely locked occupational asthma. fireproof cabinet. Hazardous substances can enter the body through the skin, by ○○ Make sure chemicals are out of reach of children. inhalation or by swallowing. Acute health effects, such as eye and ○○ Make sure procedures are in place for the cleanup of spills throat irritation, may occur almost immediately. Chronic health effects, using a suitable absorbent material. Refer to the MSDS. such as allergic contact dermatitis, take some time to develop. ○○ Clean up chemical spills promptly. ○○ Make sure that spilled chemicals and equipment used for The likelihood of a hazardous substance causing health effects depends chemical clean up are disposed of appropriately. Contact the on a number of factors, including: Environmental Protection Agency for further advice. ●● The toxicity of the substance. ○○ Purchase chemicals in ready-to-use packages rather than ●● The amount of substance that workers are exposed to. transferring from large containers. ●● The length of exposure. ○○ Do not eat, drink or smoke in areas that contain chemicals. ●● The frequency of exposure. ○○ Wash hands with a pH neutral soap or barrier cream before ●● The route of entry into the body, e.g., skin absorption, inhalation or eating, drinking or smoking. ingestion. Personal protective equipment Here are a few tips to avoid exposure to hazardous chemicals: ○○ Provide gloves, glasses, aprons and respiratory protection Substitution as required by your hazardous substances risk assessment. ○○ Replace a substance with an alternative product that contains Guidance can be found in the MSDS. a less hazardous substance. Health information found in ○○ Provide workers with training on the fit, maintenance and use an MSDS may assist in the selection of a less hazardous of personal protective equipment. substance. ○○ Make sure workers apply barrier creams on exposed skin areas ○○ Replace pressurized aerosol containers, with pump sprays, if bothered by skin irritation. e.g., pressurized wrap catalyst, hairsprays. ○○ Make sure workers cover broken skin with a waterproof dressing. ○○ Make sure workers wear eye protection and covered shoes to protect against chemical splashes. ○○ Other control measures apply specifically to each industry.

Salon industry Many products used in salons are classed as hazardous substances. Some products, such as shampoos, are not classified as “hazardous” but may still cause adverse health effects such as dermatitis.

Specific control measures Do not use products that are known to contribute to dermatitis or cause ●● Glycerol monothioglycolate (present in some “acid” permanent sensitization, such as: wave solutions – also known as GMTG). ●● Formaldehyde/formalin (present in low concentration in some ●● Thioglycolic acid (present in some hair straighteners). shampoos as a preservative). ●● Do not use nickel-plated equipment with permanent wave ●● P-phenylene diamine and paratoluene diamine (present in some solutions containing ammonium thioglycolate. Use high quality hair colors and tints – also known as PPD and PTD). stainless steel or plastic equipment.

Cosmetology.EliteCME.com Page 61 Everyday hazards facing the cosmetologist Manual tasks The manual tasks performed in the hairdressing, nail and beauty back pain, neck and shoulder pain, tendonitis of the shoulder or wrist, industry can be physically demanding and are responsible for the leg discomfort and carpal tunnel syndrome. majority of musculoskeletal disorders. Disorders can include lower

How do manual task injuries occur? Injuries from manual tasks result from ongoing wear and tear to the ●● Performing repetitive movements that are fast and/or involve a lot joints, ligaments, tendons, muscles and discs. Although uncommon, of muscular effort. injuries can be caused by a one overload situation. If insufficient breaks are taken, muscle fatigue can lead to Over a period of time, damage can gradually build up through: inflammation and tissue damage. Injury is more likely to occur when ●● Holding fixed positions for a prolonged time. this happens repeatedly.

What are the risk factors? Risk factors are part of the demands of a job that affect the worker and These are set out in the table below. can contribute to injury. Common manual task risk factors in the beauty industry Risk factor Contribution to injury Examples of work problems Working postures. Awkward postures require greater muscular effort and lead ●● Back bent or twisted, e.g., washing hair. to greater fatigue, particularly when holding a position for ●● Neck bent forward or twisted, e.g., applying color. a long time. ●● Shoulders raised. Awkward postures occur when joints are working away ●● Upper arms held out to the sides and away from the body, from the normal position. e.g., massage, cutting hair. ●● Wrist bent or twisted, e.g., setting rollers, stabilizing hand when filing nails. Repetition and Continually repeating a movement, particularly with a ●● Rolling hair. duration. forceful exertion, increases the risk of injury. ●● Applying color. Long durations of awkward postures or repetitive work are ●● Filing nails. also a risk. ●● Prolonged sitting or standing. ●● Prolonged bending or leaning, e.g., electrolysis. Work area design. The work area design and layout may require workers to ●● Equipment and materials not located close to the worker bend or reach to perform tasks. causing workers to bend, reach or twist. ●● Non-adjustable chairs and benches. ●● Work surfaces too high or too low. ●● Poor lighting. ●● Hard, slippery floors. ●● Work surfaces too wide or narrow. ●● Leaning or supporting elbows or arms on work surfaces. Use of tools. Poor design and excessive use of hand tools contributes to ●● Working with heavy tools. disorders of the wrist, elbow and shoulder. ●● Difficult or awkward hand grips. Load handling. Supporting a weight while holding arms away from the ●● Working with heavy tools e.g., holding a blow dryer away body increases stress to the back and shoulders. from the body. ●● Holding a body part while waxing. ●● Carrying heavy boxes of product to storage. Individual factors. For new, young, older, pregnant and inexperienced ●● Lack of training in specific tasks. workers, the risk of injury is increased. The type of clothes ●● No period of physical adjustment provided. people wear can also have an impact. ●● Wearing shoes with an elevated heel. Work organization. Continuous work of a similar nature, poor equipment ●● Too little task variation. maintenance and inadequate rest breaks can result in ●● Inadequate rest breaks. fatigue and lead to injury. ●● Insufficient staff to cope with peak periods.

Page 62 Cosmetology.EliteCME.com Control measures /design controls ●● Redesign the work area. ●● Place required work items within reach and close to waist height. ●● Provide adequate lighting for the task to decrease bending of the ●● Provide trolleys with castors to reduce carrying. back or neck. ●● Provide padding on table for nail work to protect elbows and ●● Make sure there is enough room for easy movement around underside of arms from nerve damage, e.g., a towel. furniture and work areas. ●● Make sure the work surface for nail work is wide enough so that ●● Provide non-slip surfaces that are comfortable for standing, e.g., you do not bump knees with your client or have to stretch to reach cork. client’s hands. ●● Provide adjustable styling chairs and stools to avoid working with ●● Provide access to chairs in lunchroom or office so workers can rest arms above shoulder height or constantly bending head forward. from prolonged standing. ●● Provide adjustable tables/benches/massage couches.

Select well designed tools ●● Discuss the selection and purchase of new tools and equipment ●● Provide scissors with bent shaped handles that keep your wrists with staff prior to purchase. straight and do not dig into the hand. ●● Make sure that tools such as blow dryers are as light as possible.

Redesign work methods ●● Work as close as possible to the client to reduce bending and reaching.

Administrative controls ●● Make sure workers alternate tasks so that different muscles are ●● Make sure workers alternate between sitting and standing when used, e.g., recover from cutting hair by folding towels, sweeping performing tasks such as cutting or drying hair, waxing, facials. floors or reception duties, variation in artificial nail filing ●● Make sure all tools are maintained so they do not need extra effort techniques. to use. ●● Manage the number of bookings per worker, particularly those ●● Train workers to do tasks so that problem working postures are involving demanding tasks, e.g. highlighting hair. avoided or kept to a minimum. ●● Make sure workers take short breaks frequently to give wrists, shoulders or back a rest.

Personal protective equipment ●● Wear footwear with low heels and shock-absorbing soles or inserts.

Noise and vibration The main risk to health from noise exposure, other than permanent Equipment, such as hand-held hair dryers, body massagers and electric loss of hearing, is stress and fatigue. Noise levels of most equipment, nail files and drills emit vibration. Workers who use this equipment such as hair dryers and radios, in the health and beauty industry are are at risk of developing Raynaud’s disease and/or carpal tunnel generally not high enough to cause hearing loss. However, some syndrome; the onset of these conditions depends on: workers and clients may find the noise levels annoying. ●● Type of equipment used. If a worker has used a personal security alarm in an emergency ●● Length of use. situation, he or she should be tested by an audiologist or ear, nose ●● Postures when using the equipment. or throat specialist to establish whether or not hearing damage has Employers should consult with workers and take steps to minimize occurred. risk from exposure to noise and vibration at work.

Control measures Substitution ●● Replace existing equipment with equipment that emits a lower level of noise and vibration.

Redesign ●● Rearrange the layout of the workplace to separate noisy work ●● Install sound absorbing material on ceiling and walls to reduce the activities from less noisy activities. sound level.

Administrative controls ●● Adopt a “buy quiet” policy for all new equipment. ●● Provide workers with training and information about noise and ●● Make sure all equipment is maintained and in a good condition. vibration. ●● Make sure workers vary working postures regularly to minimize exposure to vibration, e.g., alternate the equipment between hands.

Cosmetology.EliteCME.com Page 63 Chapter 8: Sanitation and Sterilization

3 CE Hours (Satisfies Sanitation and Sterilization Requirement)

By: Staff Writer

Learning objectives ŠŠ Describe recent events that require your knowledge of sanitation ŠŠ List the steps necessary to properly clean your hands and to techniques. disinfect, handle and store tools appropriately. ŠŠ Explain the difference between pathogenic and nonpathogenic ŠŠ List infection-control responsibilities according to universal bacteria. sanitation precautions. ŠŠ Contrast disinfectants and antiseptics and explain the significance ŠŠ Contrast sanitation and sterilization and explain the significance of of those differences. those differences. ŠŠ Describe the proper way to use an autoclave. Why must I have to complete sanitation continuing education? Salon professionals need to be aware that we have reached a time nose, throat, and wounds. A case was defined as a patient who had a where, quite simply, antibiotic-resistant organisms can kill, and culture-confirmed MRSA infection during the outbreak period July the frequency of infections from them are increasing. Due to the 2005-December 2006 and a direct epidemiologic link to the index sheer nature of people touching people in a salon atmosphere, the patient. killer organisms can occur in your facility if you aren’t informed In April 2006, a salon customer was hospitalized with an abscess of and following the proper procedures. The following articles/studies the breast caused by MRSA; in July 2006, another customer who had emphasize how important sanitation is in your salon. had boils since February 2006 was found to be MRSA positive. Both Methicillin-Resistant Staphylococcus customers had been given wax treatments by the stylist during the aureus in a Beauty Salon (Summary period in which she had an infected hair follicle in her armpit. Swabs from the Centers for Disease Control, taken from this site showed that the stylist was infected with the same November 2008) MRSA strain as before. Concern arose about the risk for infection to In September 2005, a medical customers through instruments, materials (wax), or contact with other microbiologist from a regional medical employees. The index patient and the other six employees of the salon microbiology laboratory in the regularly provided services to each other. Netherlands reported to the municipal A nurse and the infection control practitioner of the municipal health health department a recurring MRSA department visited the salon in June 2006 to check on hygiene – methicillin-resistant Staphylococcus protocols and to advise on preventive measures to reduce risk for aureus – infection in a stylist. From further transmission. All working procedures and protocols were December 2004 onward, the woman investigated, and the salon was advised to clean and disinfect had recurrent infections on the legs, instruments and procedure rooms. More specifically, the practitioner buttocks and groin resulting in incision and drainage of lesions. observed a total waxing procedure performed by the staff. Ten swabs When an abscess developed in the genital area in July 2005, MRSA were taken from used wax, wax implements and the treatment room. was cultured from a wound swab. In December 2005, the stylist was All six employees were screened and informed about MRSA and the declared MRSA-free after antimicrobial treatment. current situation. Arrangements were also made to test 22 regular Swabs were taken three times in one-week intervals from nose, throat, customers who had received wax treatments by the index patient in the perineum and wounds and used for enrichment culture of MRSA. In previous two months. March 2006, the woman was tested again for MRSA colonization; test In the following weeks, these customers were screened at the results showed that she had been reinfected or that therapy had failed. municipal health office and informed about MRSA. Of the 22 regular The stylist had eczema. Because of the “hands on” nature of her work, customers, 21 completed a questionnaire and 19 were actually she was advised to temporarily stop providing services to customers. screened for MRSA by culturing samples from nares and throats. The municipal health department conducted a risk assessment of the All employees and the 19 selected regular customers were negative woman’s household contacts and the beauty salon. The Netherlands for MRSA colonization. All environmental swabs were also negative does not require that MRSA infections be reported. Therefore, the for MRSA. It was noted that the 70 percent alcohol used to disinfect municipal health department depends upon the consent and full the skin after waxing was diluted with water because customers cooperation of index patients and contacts for further investigation had complained about the stinging effect of the alcohol on treated of outbreaks. Consequently, in this instance, household contacts skin. Furthermore, it became apparent that after performing waxing for screening were identified but had not presented themselves treatments, the stylist would touch the waxed skin of customers with for screening. Contacts who had complaints sought treatment at ungloved hands to check for remaining hairs. She did not wash her the emergency department, where the observant infection control hands after removing the gloves. practitioner (ICP) and microbiologists related them to the MRSA During the outbreak investigation, more background information outbreak. Nurses obtained specimens by swabbing each patient’s became available from those who were MRSA colonized or infected

Page 64 Cosmetology.EliteCME.com and who could be indirectly linked to the stylist or her customers. was colonized with MRSA at the end of 2006. She had emigrated During the week that the first infected customer was identified (in recently from the United States to the Netherlands, but her first April 2006), another customer was hospitalized with an abscess in the screening test results were negative. The mean age of the patients was groin. 29 years (range 21-40 years). Unfortunately, no culture was taken from this patient. The partner of Eleven people were found to be MRSA positive. Of these 11, three the second infected customer was also infected with MRSA that was persons with a direct link to the beauty salon (the stylist and two related to an abscess on his leg. By the end of 2006, an MRSA-positive customers), six with an indirect link (family member, roommate, ex- couple was identified as a contact of the second infected customer. In partner of roommate, partner of a customer, sport mate of partner of a August 2006, another couple was reported to be MRSA positive; both customer and his partner), and a couple from whom no epidemiologic had abscesses on the thighs. Because no further epidemiologic data data could be obtained were infected with the same MRSA strain could be obtained, whether the couple’s infection was linked to the as the stylist. Outbreaks of CA-MRSA strains have been reported beauty salon is not clear. with increased frequency. Several reports involved outbreaks among A total of 45 persons who had been in direct or indirect contact competitive sports participants, military personnel, prisoners, Native with the stylist were screened for MRSA: three family members, Americans and drug users. Skin treatments in a beauty salon likely led three roommates, 11 other persons (including secondary contacts), to MRSA transmission as a result of contact with an infected stylist. six beauty salon employees, and 22 customers (including regular Clearly, the study and others show that CA-MRSA is an emerging customers). Fifteen persons had skin infections and 10 of them were problem in the community setting. colonized with MRSA (stylist, family member, roommate, ex-partner In the Netherlands, patients are generally only tested after recurrent of the roommate, customers and partners of customers). Although infections. Unless outbreaks occur in a defined group, MRSA skin infections never developed in the stylist’s family members, tests remains undetected in the general population because reporting is did show MRSA colonization in one of them. The stylist’s boyfriend, not mandatory. Although the prevalence of MRSA is still low, local a native of the United States, had already lived for two years in the microbiologic laboratories should report outbreaks, when detected, to Netherlands. the local municipal health department for further investigation. More Although he had skin lesions, no S. aureus was found. The girlfriend research is necessary to better understand the risk factors involved in of a sport mate who regularly exercised with the partner of a customer these outbreaks. You will learn more about MRSA later in this chapter.

Deaths from dirty salons Most salon professionals are surprised when they hear that people settings. The following summarized articles describe how deaths have can actually die if proper sanitations techniques are not followed. been suspected in dirty salons in Texas and California: Licensees think that these types of infections occur only in health care

A case in California An infection contracted from a pedicure may have caused the death of is necessary to protect the public health and safety. A licensee found Gerry Ann Schabarum, wife of former California State Assemblyman in violation could be placed on probation for one year, required to and longtime Los Angeles County Supervisor Pete Schabarum. undertake remedial training in health and safety laws and regulations, According to the Pasadena Weekly, Schabarum had been battling a subject to re-inspection at the cost of establishment owner, as well as staphylococcus infection for more than a year and because she suffered new citation fines. from rheumatoid arthritis, it was able to take hold in her body. “AB 409 was a good first step, but we need more inspectors and we “It is tragic that another life may have been lost because of an need better testing,” said Yee. “Currently, only visual inspections are unsanitary salon,” said Sen. Leland Yee (D-San Francisco/San Mateo), made at salons; I plan to pursue further legislation that will require the author of legislation signed into law to help clean up dirty salons. bacterial testing at salons to make sure consumers are protected from “While progress has been made to address these outbreaks, clearly potentially deadly infections.” more needs to be done to protect the health of nail salon consumers.” There has been a dramatic rise in the number of people complaining In September 2007, Gov. Arnold Schwarzenegger signed Yee’s AB 409 of persistent lesions and infections after visiting salons. California has into law. AB 409 allows the Board of Barbering and Cosmetology to been especially hard-hit by the outbreak, with hundreds of women immediately suspend any license without advance hearing if the action reporting cases of a rare bacterial infection linked to pedicures and manicures.

In the News Mother blames pedicure for daughter’s death A number of women have reported similar infections following SAN JOSE, CALIF. – The mother of a woman who died in June 2006 pedicures. They are believed to be caused by harmful bacteria that has sued a nail salon alleging an infection from a pedicure contributed accumulate in improperly cleaned whirlpool footbaths. An outbreak to her daughter’s death. Jessica Mears, of Sunnyvale, died in late June traced to a single salon in Santa Cruz County affected more than at age 43. Her mother, Diana Mears, filed a wrongful death lawsuit in 100 pedicure customers in October 2000. Another outbreak of skin Santa Clara County Superior Court against Top Hair and Nails Salon infections, involving 33 different salons and over 140 customers in of Mountain View. Santa Clara County, was reported in November 2004. The suit claims Jessica Mears contracted a bacterial infection during No previous deaths in California had been attributed to bacteria from a 2004 pedicure at the salon that left a large lesion on her left calf. pedicures, according to California’s Department of Consumer Affairs. Jessica Mears had lupus, a chronic disease that compromises the Family is sure pedicure led to woman’s death immune system, and the lesion never completely healed, said Robert Kimberly Jackson believed something as simple as a pedicure caused Bohn Jr., the San Jose attorney representing Diana Mears. what eventually led to her death. A MRSA staph bacteria that is sometimes found in salons is extremely aggressive. David Jackson is

Cosmetology.EliteCME.com Page 65 confident that his ex-wife got the infection from a dirty salon during course of seven months. Doctors treated it with a strong combination a pedicure. David said Kimberly went to the salon in June 2005 and of antibiotics, but on February 12, 2006, she lost her life. was receiving a pedicure when she looked down and saw that she was The Texas Department of Licensing and Regulation (TDLR) could cut by a pumice stone and was bleeding. Several days later, she sought not link the death to the salon, but the family is confident that it is the out medical help for an infection on the foot and was treated over a source of the infection.

Violations continue Brad Watson from WFAA TV has done several undercover Watson’s investigations showed evidence of salon professionals not investigations and has found that while improvements have been washing hands between customers, illegal blades, improper cleaning made, many salons continue unsanitary practices. and disinfecting of spa chairs, and the potential cross-contamination of creams/lotions and reuse of buffing blocks, which expose a customer to the previous customer’s nail and skin tissue.

Other recent salon incidents These cases are not isolated. Below is list of other recent reported ●● Reba Burgess (Kansas City) had to have a finger amputated after injuries from salon mistakes: receiving an infection as a result of poor sanitation techniques. ●● An unnamed woman nearly died after getting a bikini wax ●● Jeanine Camerlengo (New York) contracted herpetic and then contracting a life threatening bacteria, Streptococcus heratoconjunctivitis after an eyebrow waxing. pyogenes. ●● A woman (Aurora, Colo.) was awarded $3.75 million after ●● Paula Abdul’s injury made worldwide news, and she nearly lost contracting herpes in a salon. her thumb because of an infection following a manicure. ●● Geremie Hoff (St. Louis) was awarded $6,000 because of a bad ●● Kristina Preston was diagnosed with herpes after receiving a hair treatment. manicure, and was awarded $3 million in a settlement. ●● Mary Reddish (Georgia) was awarded $15,000 because of a bad hair treatment.

Are cases going unreported? Many doctors believe that salon bacterial infections are not being modify their current practices and reduce the potential transmission linked or reported to state agencies, health departments or the CDC. of infectious diseases. Dr. Sekula explained that using disposable Dallas County’s Chief Epidemiologist, Dr. John Carlo, has been instruments whenever possible, properly sterilizing instruments, quoted as saying that serious infections are often mistaken as other employing proper hand washing practices, and teaching the Center for illnesses, such as bites from insects or spiders. Dr. Carlo believes that Disease Control’s (CDC) “universal precautions” in cosmetology and an emerging threat is at hand. barber schools would virtually eliminate the risks of contracting viral, Dermatologist Shelley A. Sekula, MD, has suggested that states need bacterial and fungal infections. to modify current cosmetology and barbering industry regulations. “Since there is an inherent risk that customers may accidentally be Before AIDS and hepatitis became household names, the cosmetology cut during a routine hair or nail appointment, it makes sense to use and barbering industries were under little scrutiny as risks for sterile instruments,” said Dr. Sekula. “Nail clippers, acrylic nail drills, spreading infectious diseases. However, since the 1980s, an epidemic cuticle scissors, callus paring blades, reusable razors and blades of blood-borne diseases has forced a reexamination of the beauty all have the potential to transmit infectious diseases if they are not industry. properly sterilized. Unfortunately, we are finding that not all salons are following this simple rule of thumb.” Based on her experience in Texas, it is Dr. Sekula’s belief that legislators and public health officials need to look seriously at the risks “As more and more consumers frequent hair and nail salons each that threaten both clients and operators of the beauty industry. “Poorly year, the risk of becoming infected with hepatitis, HIV and other trained technicians using dirty instruments are a cause of great concern transmittable diseases increases as well,” said Dr. Sekula. for consumers,” said Dr. Sekula. Among the diseases that have the potential to be transmitted at a The health risks associated with the beauty industry include viral hair or nail salon, hepatitis B and C pose the biggest threat to public infections such as HIV, hepatitis B and C, and warts; bacterial health. There are over 5 million people infected with hepatitis in the infections such as staphylococcus, streptococcus, and pseudomonas; U.S. Every year, approximately 100,000 people in the U.S. contract fungal infections such as athlete’s foot, nail fungus and yeast; reactions hepatitis B – which is 100 times more contagious than HIV. Between to nail, hair and facial products such as hand eczema, eyelid dermatitis, 28,000 and 140,000 people contract hepatitis C. Hepatitis B can be chemical burns and loss of hair or nails; and toxicity from acrylic and infectious for at least a week on surfaces commonplace to salons, such lacquer fumes and inappropriate use of chemical peeling solutions. as headrests, chairs and tools and instruments. Although each of these risks poses considerable health problems There is now evidence that hepatitis C, which prior to 1990 was for consumers, there are simple ways beauty establishments can commonly transmitted through blood transfusions, can be transmitted by razors, nail files and barber’s scissors, among other things.

Your responsibilities As a salon professional, you have responsibilities to the state and precautionary measures discussed in this chapter. Violations can result your profession to learn and use appropriate precautionary measures in penalization by the state of Florida, as well as infection. and cleaning procedures, to protect both you and your clients, reduce The remainder of this chapter will review these subjects: the incidence of bacterial, viral, and fungal infection, and prevent the ●● The biology of pathogens, how they function, reproduce, and spread of disease. You, your instruments and workstation must be infect. kept as clean as possible, meaning no shortcuts or omissions of any ●● Universal sanitation and sterilization precautions.

Page 66 Cosmetology.EliteCME.com ●● State of Florida regulations that apply to cosmetology. ●● How to effectively disinfect tools and surfaces in your ●● The difference between decontamination, sanitation, sterilization, environment, and clean hands. and disinfection.

Microorganisms and infectious agents Microorganisms are tiny living particles (organisms) with many with infection or disease; others are harmless or even helpful. Bacteria, different characteristics. They live in our air, water and earth, and are viruses and parasites are three major categories of microorganisms that found everywhere on the planet. Some microorganisms are associated you encounter every day.

Bacteria Bacteria are tiny one-celled vegetable microorganisms (plants) that majority (about 70 percent) of bacteria are nonpathogenic. Called can be seen only with a microscope. The most plentiful organisms saprophytes, these organisms do not produce disease and carry out on the earth, bacteria are found virtually everywhere around us, necessary functions, such as decomposing dead matter, for example. existing in dust, dirt and decay, our skin and body tissues, the air we Nonpathogenic bacteria also exist in the human digestive tract and in breathe and the water we drink. Bacteria produce slimy fluids or waxy the mouth and intestines, where they facilitate digestion by breaking coatings, which moisten them and help them survive in inhospitable down food. environments. Fimbri, hairlike tendrils that anchor the bacteria to A much smaller minority (about 30 percent) of organisms are an object, make bacteria sticky, requiring one to use some degree of pathogenic organisms, also called microbes or germs. These are pressure when scrubbing, to break the hold of these tenacious fibers. harmful and produce disease when they invade animal or plant Bacteria exist in one of two modes: an active, vegetative mode, and an life. Pathogenic bacteria commonly exist in the salon environment. inactive, spore-forming mode. In the active stage, bacteria grow and Bacterial infection occurs when a body is exposed to and cannot multiply at an astonishing speed. successfully fight off bacterial invasion. Reproducing through binary fission (a process in which one bacteria General infections typically begin as local infections, which may start splits into two), bacteria produce millions of copies within hours. as a boil or pimple accompanied by pus (a compilation of bacteria, Bacteria are only able to reproduce when the environment meets their decayed tissue, waste and blood cells) that is often associated with specific needs in temperature and degree of moisture. They require a infection. Bacterial toxins from local infections can spread to different warm, damp, usually dark and often dirty environment that provides parts of the body through the bloodstream, increasing the likelihood of a supply of food adequate to sustain the bacteria and provide fuel general infection. for reproduction. If conditions are not favorable for reproduction, the bacteria will move into a spore-forming stage, producing spores Pathogenic bacteria are distinguished by their characteristic shapes: with tough outer surfaces that are almost impervious to wind, heat, Bacilli are rod-shaped, and the most common bacteria, causing cold, harsh cleaners or disinfectants. These characteristics help spores diseases such as influenza, tetanus and diphtheria. Spirilla are spiral- survive for long periods between reproductive phases. shaped bacteria, and cocci are round bacteria that produce pus. Cocci rarely move on their own, but are usually transported through the air in While there are hundreds of different kinds of bacteria, they are dust particles or other substances. Bacilli and spirilla are both capable primarily sorted into one of two types, according to the danger of self-movement (motility), using hairlike projections (flagella or they pose to us. Potentially harmful bacteria are called pathogenic; cilia) to propel themselves. harmless or beneficial bacteria are called nonpathogenic.The great

Methicillin-resistant Staph aureas (MRSA) Methicillin-resistant Staphylococcus aureus (MRSA), the virus that without signs of infection. With infection, the bacteria have entered killed Kimberly Jackson as previously noted, is caused by bacteria the body and have begun to multiply and cause damage to the organ or known as staphylococcal aureas. Staph aureas is a common bacteria body tissue involved. Signs of infection include fever, warmth, redness found on skin and mucous membranes. In MRSA, a type or strain of the area, pain, and an elevated white blood cell count. MRSA of Staph aureas has become resistant to antibiotics in the penicillin is spread by direct contact with affected areas and is normally family, which includes methicillin. not spread by casual contact. Good hand washing and the use of People can become either colonized or infected with MRSA. In gloves for contact with mucous membranes will avoid transferring the colonization, people have MRSA on their skin or mucous membranes bacteria from one person to another.

How common are Staph and MRSA infections? Staph bacteria are one of the most common causes of skin infection infections occur among patients in hospitals or other health care in the United States and are a common cause of pneumonia, surgical settings. But they are becoming more common in the community wound infections and bloodstream infections. The majority of MRSA setting.

What does a staph or MRSA infection look like? Staph bacteria, including MRSA, can cause skin infections that may pus or other drainage. Infections that are more serious may cause look like a pimple or boil and can be red, swollen, painful, or have pneumonia, bloodstream infections, or surgical wound infections.

Are certain people at increased risk for community-associated staph or MRSA infections? Factors that have been associated with the spread of MRSA skin as cuts or abrasions, contaminated items and surfaces, crowded living infections include: close skin-to-skin contact, openings in the skin such conditions and poor hygiene.

Cosmetology.EliteCME.com Page 67 How can I prevent staph or MRSA skin infections? ●● Practice good hygiene. ●● Avoid contact with other people’s wounds or bandages. ●● Keep your hands clean by washing thoroughly with soap and water ●● Avoid sharing personal items such as towels or razors. or using an alcohol-based hand sanitizer. ●● Practice good disinfection techniques. ●● Keep cuts and scrapes clean and covered with a bandage until healed.

If I have a staph or MRSA skin infection, what can I do to prevent others from being infected? You can prevent spreading staph or MRSA skin infections to others by alcohol-based hand sanitizer, especially after changing the bandage or following these steps: touching the infected wound. Cover your wound. Keep wounds that are draining or have pus Do not share personal items. Avoid sharing personal items such as covered with clean, dry bandages. Follow your health care provider’s towels, washcloths, razors, clothing or uniforms that may have had instructions on proper care of the wound. Pus from infected wounds contact with the infected wound or bandage. Wash sheets, towels and can contain staph and MRSA, so keeping the infection covered will clothes that become soiled with water and laundry detergent. Drying help prevent the spread to others. Bandages or tape can be discarded clothes in a hot dryer, rather than air-drying, also helps kill bacteria in with the regular trash. clothes. Clean your hands. You, your family and others in close contact should Talk to your doctor. Tell any health care providers who treat you that wash their hands frequently with soap and warm water or use an you have or had a staph or MRSA skin infection.

Viruses Viruses are infectious biological entities that are very small – much to-surface and hand-to-hand contact are highly effective methods for smaller than bacteria – and cause disease by entering a healthy cell, transferring virus particles from one individual to another. maturing and reproducing. Unlike bacteria, viruses do not survive for Viruses are hardy organisms. They can live for up to 48 hours on the any length of time without the protection of a living cell. Viruses are surfaces of toys, coffeemakers, doorknobs, computer keyboards and dangerous because their replication inside the cell eventually causes other hard surfaces in a salon. It can take up to a week for that virus the death of that cell. They are parasites, taking the cell’s nutrients that infected you to produce symptoms. and destroying the cell in the process. The cell is then used to breed hundreds, thousands and even millions of new mature infectious Plant parasites, such as fungus or mold, mildew and yeasts are viruses that leave to infect other cells. Viruses cause diseases like multicellular organisms that are as prevalent as bacteria and consume hepatitis, influenza and measles, and are the source of colds, chicken both live and dead tissue to survive. Fungi usually prefer a damp pox, cold sores and genital herpes, mononucleosis, hepatitis and HIV/ environment, but can also survive in a warm, dry climate. They AIDS. reproduce and spread a number of different ways, and can invade the human body easily, requiring no break in the skin. Viruses are a particular concern in salons because of their potential severity and the way they spread. Viruses occupy the surfaces Ringworm and athlete’s foot are two common contagious diseases of objects you touch, including door handles, coffee mugs and that are spread by fungi. Another is favus, which affects the scalp. scissors; they can be inhaled on tiny dust particles or travel on the Cosmetologists should not serve any individual with signs of any minute amount of saliva expelled in a cough. Viral infections can be fungal infection. If you have a fungal infection, do not work and seek transmitted from one person to another through casual contact with an treatment immediately. If you think a client has ringworm, identified infected individual or contact with what he or she touched. Both hand- by a ring-shaped, circular pattern on the skin, or athlete’s foot, do not provide service to the individual, as it is highly contagious. Tell the individual to consult a physician for treatment.

Precautions with plant parasites Fungal infections can be stubborn. Many affect the skin, but fungal Greenish bacterial infections, which may appear yellowish or infections can also cause severe respiratory infections. More common yellow-green initially, can continue to stain the nail plate long after versions of fungal infections are those caused by yeast, including nail an infection has subsided, and are sometimes mistakenly attributed to fungus, athletes foot, jock itch and ringworm. Both over-the-counter mold. Nails can harbor dangerous bacteria, which can thrive on the oils and prescription treatments are available for relief from the unpleasant, and moisture that exist between an improperly prepared or unsanitized itchy symptoms of many yeast infections. nail plate and an applied enhancement. Plant parasites, like fungus and mold, are contagious, with nail fungus Clients with nail fungus or other infections should not receive nail a significant risk to clients receiving nail services, as fungi can spread, services, but can be assisted in removing an artificial nail from the not only from one nail to another but also from a client to a technician infected natural nail. If you are asked to expose the natural nail, follow or the reverse, given improper sanitation techniques at a salon. these precautionary steps: Nail fungus appears as discoloration of the nail plate (on either the ●● Wear gloves during the removal of artificial nails. fingernails or toenails), initially appearing white, but growing darker ●● Follow the manufacturer’s instructions for removal. over time. Clients with nail fungus should be referred to a physician ●● Discard any implements, including orangewood sticks, items with for treatment. porous surfaces, and any abrasives used. Molds and mildews do not infect fingernails, and rarely, if ever, appear ●● Disinfect all implements and work surfaces. under the nail. ●● Refer the client to a physician for treatment once the natural nail is exposed.

Page 68 Cosmetology.EliteCME.com Animal parasites Animal parasites may be single-cell (protozoans) like amoebas or For any individual with a visible communicable disease, like malaria, or multicell, like mites or lice. Protozoans consume both plant pediculosis (head lice), open sores or marks suggesting scabies, it is and animal tissue, and are found in blood and body fluids, water and recommended that the person furnish a statement signed by a physician food. Multicell animals, such as lice and mites, can hide in the hair that the disease or condition is not in an infectious, contagious or and burrow under the skin. Be aware of the signs of scabies, identified communicable stage. The same is true if the cosmetologist has by bite marks on a client; Rocky Mountain spotted fever, or typhus, symptoms or indications of a visible disease, lice or open sores; he caused by rickettsia; and animal parasites carried by fleas, lice and or she should not practice cosmetology until obtaining a statement ticks that are even smaller than bacteria. signed by a physician stating that the disease or condition is not in an infectious, contagious or communicable stage.

Modes of contamination Diseases are communicable or contagious when they move from one some of this organic matter on another surface. Simple actions, such individual to another. Working with the public means encountering as touching a client’s hair, brushing some of your hair out of your eyes potentially dangerous pathogens and opportunistic organisms every with your hand or touching a spray bottle can move microorganisms day. Always assume your clients, co-workers and environment could from one item to another, from you to your client, or your client to be carrying illness, and use proper infection control procedures every you. day. Individuals who are susceptible to infection, due to a compromised Humans have some level of immunity against infection, but our level protection system or some failure in their ability to resist invasion, of protection varies with age, health and a range of other factors. Skin are also the targets of opportunistic microorganisms. In contrast to is our first line of defense. When there are no cuts or scrapes, skin is pathogens, opportunistic organisms do not cause initial illness but will excellent protection against pathogens. infect an individual once pathogenic organisms have already weakened In the vast majority of cases, bacteria, fungi and viruses enter the body its immune system. Opportunistic organisms cling to the skin and the through the portals of the nose and mouth, small tears or openings hair and exist in the bodies of healthy people. in the skin, and to a lesser extent, the eyes and ears. Once inside the Microbes also contaminate ventilation systems; to discourage their body, the pathogen reproduces rapidly at a rate that can overwhelm the growth, vents, filters, humidifiers and dehumidifiers should be cleaned immune system, resulting in disease. and maintained regularly. Investigate any mildew or musty odors, Transmission may occur through direct or indirect contact. For which are a good indication of microbe growth. Germs in a ventilation example, indirectly inhaling contaminated droplets in the air system easily spread throughout a salon, landing on people, surfaces (airborne transmission), or touching a contaminated surface and then and implements, whenever the blower or fan turns on. touching one’s nose, eyes or a mucous membrane is an easy way for Germs not only float through the air, settling constantly on salon transmitting germs. Try to avoid touching your face during the day, surfaces, such as sinks and countertops, they can also “hitchhike” on and always wash your hands between clients. human skin, hair and clothing, contaminating anything with which Yeast, scabies, lice and many other skin infections do not require an they come into contact. open sore or mucosal surface to infect. Athlete’s foot contaminates Pathogenic and opportunistic microorganisms are able to thrive in through indirect transmission. When someone with athlete’s foot a salon’s warm, moist places, like the drain of the shampoo sink, walks barefoot on a wet bathroom floor, for example, the person the footbaths, hot and cold-water handles and taps. Implements leaves behind spores that will stick to the foot of anyone else walking such as scissors, files, brushes or nippers can be major sources of barefoot on that floor, infecting the individual even if he or she has no contamination because they often contain organic matter, an optimum cuts or openings on the feet. growth environment for pathogenic and opportunistic microorganisms. Fungi, like athlete’s foot, will survive for some time on a damp or wet Some of the most dangerous areas in your salon are the places floor. Spa shower stalls and soaking baths that retain small amounts of you keep contaminated manicuring tools or equipment, including water must be thoroughly cleaned and disinfected with the appropriate the manicure table and the trashcans in which you deposit dirty disinfectant. implements. Microbes can also exist on seemingly unlikely The primary modes of travel for common contagions are: products, like bars of soap, for example. Because germs and other ●● Unclean hands. microorganisms have been shown to thrive on bar soap, many salons ●● Unclean implements. prefer to use liquid soap that can be dispensed from a container for ●● Open sores. each customer. In addition, soaking solutions, lotions and creams that ●● Pus. initially are uncontaminated may lose preservatives that keep them ●● Mouth and nose discharge. safe from pathogenic or opportunistic microbes from growing in ●● Shared cups or towels. them. Changes in color, texture, appearance or odor can be signs of ●● Coughing or sneezing. contamination. ●● Spitting. Fighting infection may be a matter of staying home when you are ●● Pathogenic bacteria can also enter the body through: sick. Just as you should avoid working with contagious clients, you ●● A break in the skin, including pimples, scratches or cuts. should not go to work if you have an infection, such as a bad cold or ●● The nose and the mouth during breathing. flu. Cover your mouth and nose to control pathogens escaping through ●● The mouth during eating and drinking. sneezes and coughs. Avoid causing wounds if your client’s skin is dry Humans are excellent sources of contamination because we are or fragile; tears and breaks can occur easily, even when filing nails. constantly leaving organic particles behind wherever we go; a mixture Use abrasive instruments with care and a gentle touch, especially of dead skin cells, with viral, bacterial and fungal particles, along around the nail bed. with other microorganisms that consume skin cells or use us to travel to an appropriate host. Every time you touch something, you deposit

Cosmetology.EliteCME.com Page 69 Viruses Viruses cause: Antibiotics cannot kill viruses. This is a common misconception. ●● All colds and flu. Many of us demand antibiotics from our doctor when we have a severe ●● Most coughs. cold, but antibiotics in that situation can actually do you more harm ●● Most sore throats. than good.

Bacteria Bacteria causes: Each time you take an antibiotic, bacteria are killed. Sometimes ●● Most ear infections. bacteria may be resistant or become resistant. Resistant bacteria do not ●● Some sinus infections. respond to the antibiotics and continue to cause infection. ●● Urinary tract infections. Each time you take an antibiotic unnecessarily or improperly, you ●● Antibiotics do kill specific bacteria. increase your chance of developing drug-resistant bacteria. So it is ●● Drug-resistant bacteria. really important to take antibiotics only when necessary. Because of these resistant bacteria, some diseases that used to be easy to treat are now becoming nearly impossible to treat. What do you need to know about antibiotics? Remember that antibiotics don’t work against colds and flu, and that Antibiotic resistance is particularly dangerous for children, but it can unnecessary antibiotics can be harmful. occur in adults as well. Talk to your health care provider about antibiotics and find out about One final note is that taking antibiotics appropriately and getting the differences between viruses and bacteria – and when antibiotics immunized will help prevent having to take more dangerous and more should and shouldn’t be used. costly medications. If we use antibiotics appropriately, we can avoid If you do get an antibiotic, be sure to take it exactly as prescribed; that developing drug resistance. We just need to take our medicine exactly as may help decrease the development of resistant bacteria. it is prescribed and not expect to take antibiotics every time we’re sick.

The problem of antibiotic resistance Overview The triumph of antibiotics over disease-causing bacteria is one of our strongest antibiotics. These even stronger drug-resistant bacteria modern medicine’s greatest success stories. Since these drugs first continue to prey on vulnerable hospital patients. became widely used in the World War II era, they have saved countless To help curb this problem, the Centers for Disease Control and lives and blunted serious complications of many feared diseases and Prevention (CDC) provides hospitals with prevention strategies and infections. After more than 50 years of widespread use, however, many educational materials to reduce antimicrobial resistance in health care antibiotics don’t pack the same punch they once did. settings. Over time, some bacteria have developed ways to outwit the effects of According to CDC statistics: antibiotics. Widespread use of antibiotics is thought to have spurred ●● Nearly 2 million patients in the United States get an infection in evolutionary changes in bacteria that allow them to survive these the hospital each year. Those patients, about 90,000, die each year powerful drugs. While antibiotic resistance benefits the microbes, it as a result of their infection – up from 13,300 patient deaths in presents humans with two big problems: It makes it more difficult to 1992. purge infections from the body, and it heightens the risk of acquiring ●● More than 70 percent of the bacteria that cause hospital-acquired infections in a hospital. infections are resistant to at least one of the drugs most commonly Diseases such as tuberculosis, gonorrhea, malaria and childhood ear used to treat them. infections are now more difficult to treat than they were decades ago. ●● Persons infected with drug-resistant organisms are more likely to Drug resistance is an especially difficult problem for hospitals because have longer hospital stays and require treatment with second- or they harbor critically ill patients who are more vulnerable to infections third-choice drugs that may be less effective, more toxic and more than the general population and therefore require more antibiotics. expensive. Heavy use of antibiotics in these patients hastens the mutations in ●● In short, antimicrobial resistance is driving up health care costs, bacteria that bring about drug resistance. Unfortunately, this worsens increasing the severity of disease and increasing the death rates the problem by producing bacteria with greater ability to survive even from certain infections.

Environment forces evolutionary change A key factor in the development of antibiotic resistance is the ability The advantage microbes gain from their innate adaptability is of infectious organisms to adapt quickly to new environmental augmented by the widespread, and sometimes inappropriate, use of conditions. Bacteria are single-celled creatures that, compared with antibiotics. A physician wishing to placate an insistent patient ill with higher life forms, have small numbers of genes. Therefore, even a a cold or other viral condition sometimes inappropriately prescribes single random gene mutation can greatly affect their ability to cause antibiotics. And when a patient does not finish taking a prescription disease. And because most microbes reproduce by dividing every few for antibiotics, drug-resistant microbes not killed in the first days of hours, bacteria can evolve rapidly. treatment can proliferate. Hospitals also provide a fertile environment A mutation that helps a microbe survive exposure to an antibiotic drug for drug-resistant germs as close contact among sick patients and will quickly become dominant throughout the microbial population. extensive use of antibiotics force bacteria to develop resistance. Microbes also often acquire genes, including those that code for Another controversial practice that some believe promotes drug resistance, from each other. resistance is adding antibiotics to agricultural feed.

Page 70 Cosmetology.EliteCME.com A growing problem For all these reasons, antibiotic resistance has been a problem for hospital had reported any vancomycin resistant enterococci, but nearly as long as we’ve been using antibiotics. Not long after the over the next decade, such microbes have become common in U.S. introduction of penicillin, a bacterium known as Staphylococcus hospitals, according to CDC. aureus began developing penicillin-resistant strains. A 2003 study in The New England Journal of Medicine found Today, antibiotic-resistant strains of Staphylococcus aureus bacteria that the incidence of blood and tissue infections known as sepsis as well as various enterococci – bacteria that colonize the intestines – almost tripled from 1979 to 2000. are common and pose a global health problem in hospitals. More and Other federal agencies are involved in combating the problem of more hospital-acquired infections are resistant to the most powerful drug-resistant microbes. See the links below for more information. antibiotics available, methicillin and vancomycin. These drugs are ○○ Centers for Disease Control and Prevention reserved to treat only the most intractable infections in order to slow http://www.cdc.gov/drugresistance/community/ development of resistance to them. ○○ Food and Drug Administration There are several signs that the problem is increasing: http://www.fda.gov/oc/opacom/hottopics/antiresist.html In 2003, epidemiologists reported in The New England Journal ○○ National Library of Medicine Medline Database of Medicine that 5-10 percent of patients admitted to hospitals http://www.nlm.nih.gov/medlineplus/antibiotics.html acquire an infection during their stay, and that the risk for a ○○ Public Health Action Plan to Combat Antimicrobial Resistance hospital-acquired infection has risen steadily in recent decades. http://www.cdc.gov/drugresistance/actionplan/index.htm Strains of S. aureus resistant to methicillin are endemic in hospitals APUA: Alliance for the Prudent Use of Antibiotics Antibacterial Agent and are increasing in non-hospital settings such as locker rooms. Information Sheet. Since September 2000, outbreaks of methicillin-resistant S. aureus ●● What is an antibacterial and how are antibacterials classified? infections have been reported among high school football players ●● What are some common antibacterials? and wrestlers in California, Indiana and Pennsylvania, according ●● How common are antibacterials in consumer products? to the CDC. ●● Is the use of antibacterial agents regulated in the U.S.? The first S. aureus infections resistant to vancomycin emerged in the ●● What is the difference between bacteriostats, sanitizers, United States in 2002, presenting physicians and patients with a serious disinfectants and sterilizers? problem. In July 2002, the CDC reported that a Michigan patient with ●● How beneficial are antibacterials? diabetes, vascular disease and chronic kidney failure had developed the ●● Are antibacterial agents safe? first S. aureus infection completely resistant to vancomycin. A similar ●● Do antibacterials create resistant bacteria? case was reported in Pennsylvania in September 2002. ●● Can the widespread use of antibacterial agents lead to bacteria that are more resistant? Increasing reliance on vancomycin has led to the emergence of ●● Are there other concerns about the use of antibacterial agents? vancomycin-resistant enterococci infections. Prior to 1989, no U.S. ●● When are antibacterials useful? What is an antibacterial and how are antibacterials classified? In its broadest definition, an antibacterial is an agent that interferes commonly described as agents used to disinfect surfaces and eliminate with the growth and reproduction of bacteria. While antibiotics and potentially harmful bacteria. Unlike antibiotics, they are not used as antibacterials both attack bacteria, these terms have evolved over medicines for humans or animals, but are found in products such as the years to mean two different things. Antibacterials are now most soaps, detergents, health and skincare products and household cleaners.

What are some common antibacterials? Antibacterials may be divided into two groups according to their speed chlorine, peroxides and aldehydes. The second group consists mostly of action and residue production. The first group contains those that of newer compounds that leave long-acting residues on the surface to act rapidly to destroy bacteria, but quickly disappear (by evaporation be disinfected and thus have a prolonged action (referred to as residue or breakdown) and leave no active residue behind (referred to as producing). Common examples of this group are triclosan, triclocarban non-residue-producing). Examples of this type are the alcohols, and benzalkonium chloride.

How common are antibacterials in consumer products? All products that claim to kill bacteria and/or viruses have some kind Many cleaning compounds contain quaternary ammonium compounds. of antibacterial agent. Alcohols, chlorine and peroxides have been used Because these compounds have very long chemical names, they for many decades in health care and cleaning products. Within the past often are not easily recognized as antibacterial agents on packaging two decades, the residue-producing antibacterials once used almost labels. More recently, triclosan has been bonded into the surface of exclusively in health care institutions have been added to increasing many different products with which humans come into contact, such numbers of household products, particularly soaps and cleaning as plastic kitchen tools, cutting boards, highchairs, toys, bedding and agents. A recent survey reported that 76 percent of liquid soaps from other fabrics. 10 states in the U.S. contained triclosan, and approximately 30 percent of bar soaps contained triclocarban.

Is the use of antibacterial agents regulated in the U.S.? Whether an antibacterial agent is regulated depends upon its intended substance is not intended for use on or in the body, it is registered by use and its effectiveness. The U.S. Food and Drug Administration the U.S. Environmental Protection Agency (EPA) under the Federal (FDA) regulates antibacterial soaps and antibacterial substances that Insecticide, Fungicide and Rodenticide Act. Substances are registered will either be used on the body or in processed food, including food either as public health or as non-public health antimicrobial agents. wrappers and agents added to water involved in food processing. If a

Cosmetology.EliteCME.com Page 71 What is the difference between bacteriostats, sanitizers, disinfectants and sterilizers? The EPA classifies public health antimicrobials as bacteriostats, necessarily their spores. Sterilizers destroy all forms of bacteria, fungi sanitizers, disinfectants and sterilizers based on how effective they are and other microorganisms and their spores. in destroying microorganisms. Bacteriostats inhibit bacterial growth Disinfectants can be further categorized as broad- or limited-spectrum in inanimate environments. Sanitizers are substances that kill a certain agents. A broad-spectrum disinfectant destroys both gram-negative and percentage of test microorganisms in a given time span. Disinfectants gram-positive bacteria. A limited-spectrum disinfectant must clearly destroy or irreversibly inactivate all test microorganisms, but not specify the specific microorganisms against which it works.

How beneficial are antibacterials? Antibacterials are definitely effective in killing bacteria, but there is neonatal nurseries and other health care facilities where there may considerable controversy surrounding their health benefits. The non- be a high risk of infection. A certain few consumer products have residue-producing agents have been used for many years and continue demonstrated effectiveness for specific conditions: antibacterial to be effective agents for controlling disease organisms in a wide toothpaste helps control periodontal (gum) disease; antibacterial variety of health care and domestic settings. deodorants suppress odor-causing bacteria; and antidandruff shampoos When used under strict guidelines of application, the residue- help control dandruff. However, to date, there is no evidence to producing agents have proven effective at controlling bacterial and support claims that antibacterials provide additional health benefits fungal infection in clinical settings such as hospitals, nursing homes, when used by the general consumer.

Are antibacterial agents safe? When used as directed for external surfaces, antibacterial agents are on single agents and do not consider the effects of multiple uses or considered to be relatively non-toxic. However, some may cause skin multiple compounds. and eye irritation, and all have the potential for doing harm if not Recently, triclosan has been reported in surface waters, sewage stored or used properly. Furthermore, evaluations of risk are based treatment plants, the bile of fish and breast milk, but the significance of these findings is presently unknown.

Do antibacterials create resistant bacteria? Because of their rapid killing effect, the non-residue-producing wall structure. Additional experiments found that some bacteria can antibacterial agents are not believed to create resistant bacteria. combat triclosan and other biocides with export systems that could Resistance results from long-term use at low-level concentrations, a also pump out antibiotics. It was demonstrated that these triclosan- condition that occurs when consumers use residue-producing agents resistant mutants were also resistant to several antibiotics, specifically such as triclosan and triclocarban. Until recently, it was accepted chloramphenicol, ampicillin, tetracycline and ciprofloxacin. that these agents did not affect a specific process in bacteria, and Resistance to antibacterials has been found where these agents are because of this, it was unlikely that resistant bacteria could emerge. used continuously (as in the hospital and food industry); however, at However, recent laboratory evidence indicates that triclosan inhibits the present time, this modest increase in resistance has not yet created a specific step in the formation of bacterial lipids involved in the cell a clinical problem.

Can the widespread use of antibacterial agents lead to bacteria that are more resistant? Many scientists feel that this is a potential danger, but others argue that development of resistance. However, such products have only been the laboratory conditions used in the research studies do not represent in use for a relatively short time, and studies of their effects are still the “real world.” So far, studies of antibacterial use in home products extremely limited. such as soap, deodorant and toothpaste have not shown any detectable

Are there other concerns about the use of antibacterial agents? Yes, experts believe that the use of these agents creates a false sense pathogens. This may cause shifts in bacterial populations and create a of security that may cause individuals to become lax in their hygiene “space” for disease-causing bacteria to enter and establish infection. habits. Antibacterial use should not be considered an alternative In addition, some scientists have gathered evidence showing that to normal hygiene, except where normal hygiene practices are overly hygienic homes during early childhood may be linked to the impossible. appearance of allergies later in life. In this “hygiene hypothesis,” It should always be remembered that most bacteria are harmless and in allergies develop because the childhood immune system fails to mature many cases, even beneficial. Very few bacteria actually cause disease. properly due to lack of contact with immune-stimulating bacteria. Antibacterials are not discriminating, and an all-out attack on bacteria This hypothesis remains controversial and requires further research for in general is unjustified. Constant use of disinfecting agents tends validation. to disrupt the normal bacteria that act as barriers against invading

When are antibacterials useful? While there is no evidence that the routine use of antibacterials confer of infectious bacteria. In the home environment, they may be needed a health benefit, they are useful where the level of sanitation is critical for the nursing care of sick individuals with specific infections, or for and additional precautions need to be taken to prevent spread of those whose immune systems have been weakened by chronic disease, disease. chemotherapy or transplants. Under these circumstances, antibacterials Thus, they are important in hospitals, day care centers, salons and should be used according to protocol, preferably under the guidance of health care facilities and other environments with high concentrations a health care professional.

Page 72 Cosmetology.EliteCME.com Please visit the following link to learn more about antibiotics: http://www.cdc.gov/ncidod/op/antibiotics.htm. Decontaminating your environment You have a responsibility to control exposure to pathogens by harmful pathogens, so all must be decontaminated to some degree. decontaminating your environment and tools. Remember that Cleaning is only the first step of the process. The following sections pathogens collect any time an object or surface is exposed to air. review the meaning of sanitation, sterilization, and disinfection, terms Doorknobs, handles, the telephone, money, cabinets, the cash register that are commonly used interchangeably, but have very different – all are surfaces touched by co-workers and clients that may harbor meanings and require different procedures. Sanitation Sanitation is the lowest level of decontamination. Sanitation will Water and soap, in fact, are not sterile, and can introduce new bacteria reduce germs on a surface, but will not kill all organisms. Sanitation and infectious agents. provides a minimum level of cleanliness, protecting public health Your hands are populated by both resident and transient organisms. by preventing the spread of some, but not all, bacteria and fungi. Resident organisms are a normal part of your skin’s environment, their Instruments that are sanitized are not sterile. Countertops and natural habitat. They grow and multiply in an oxygen environment, workstations should also be sanitized, wiped down with soap and and rarely cause infection or harm the individual who is their host. water; this process should not be confused with, and does not replace, These organisms cannot be removed easily by hand washing. disinfection, which requires an appropriate disinfectant. Remember Sanitation controls minimize exposure to transient organisms. These that soap and water will kill most of the bacteria on your hands, organisms, like E. coli and salmonella, cause dangerous infections in workstation or chair, but will not kill all the bacteria or fungal spores. humans. In contrast to resident organisms, transient organisms cannot The term “sanitation” is most often used in reference to cleaning the live long on the surface of our skin. They function poorly in an oxygen hands. Hand washing is absolutely essential to controlling bacteria environment, usually surviving less than 24 hours. These organisms and the most effective way to prevent the spread of infectious agents can be removed easily through the process of hand washing, using from one person to another. Hands cannot be sterilized, because it is friction, soap and water. impossible to remove all microorganisms from the surface of the skin. Wash your hands (http://www.cdc.gov/Features/Hand washing/) In health care settings, hand washing can prevent potentially fatal Hand washing is a simple thing, and it’s the best way to prevent infections from spreading from patient to patient and from patient to infection and illness. health care worker and vice-versa. The basic rule in the hospital is to cleanse hands before and after each patient contact by either washing Clean hands prevent hands or using an alcohol-based hand rub. infections. Keeping hands clean prevents illness at At home, hand washing can prevent infection and illness from home, at school, and at spreading from family member to family member and sometimes work. Hand hygiene throughout a community. In the home, the basic rule is to wash hands practices are key prevention before preparing food and after handling uncooked meat and poultry; tools in healthcare settings, before eating; after changing diapers; after coughing, sneezing, or in daycare facilities, in schools and public institutions, and for the blowing one’s nose into a tissue; and after using the bathroom. safety of our food.

Wash your hands: The right way When washing hands with soap and water: http://www.health.state.mn.us/handhygiene/wash/fsgermbuster.html ●● Wet your hands with clean running water Hand washing: The beginning of infection control and apply soap. Use warm water if it is http://www.cdc.gov/Features/HandWashing/ available. Ignaz Semmelweis, an Austrian-Hungarian physician, first ●● Rub hands together to make a lather and demonstrated over 150 years ago that hand hygiene can prevent the scrub all surfaces. spread of disease. Hand hygiene as a practice includes performing ●● Continue rubbing hands for 15-20 seconds. hand washing, or using antiseptic hand wash, alcohol-based hand rub Need a timer? Imagine singing “Happy or surgical hand hygiene/antisepsis. Birthday” twice through to a friend. ●● Rinse hands well under running water. Dr. Semmelweis worked in a hospital in Vienna whose maternity ●● Dry your hands using a paper towel or air patients were dying at such an alarming rate that they begged to be dryer. If possible, use your paper towel to turn off the faucet. sent home. Most of those dying had been treated by student physicians ●● Always use soap and water if your hands are visibly dirty. who worked on corpses during an anatomy class before beginning ●● If soap and clean water are not available, use an alcohol- their rounds in the maternity ward. based hand rub to clean your hands. Alcohol-based hand rubs Because the students did not wash their hands effectively between significantly reduce the number of germs on skin and are fast- touching the dead and the living – hand washing was an unrecognized acting. hygienic practice at the time – pathogenic bacteria from the corpses When using an alcohol-based hand sanitizer: regularly were transmitted to the mothers via the students’ hands. ●● Apply product to the palm of one hand. The result was a death rate five times higher for mothers who delivered ●● Rub hands together. in one clinic of the hospital than for mothers who delivered at another ●● Rub the product over all surfaces of hands and fingers until hands clinic not attended by the student physicians. are dry.

Cosmetology.EliteCME.com Page 73 In an experiment considered quaint at best by his colleagues, Dr. readily accepted in Dr. Semmelweis’s era. Indeed, his pleas to make Semmelweis insisted that his students wash their hands before treating hand washing a routine practice throughout the hospital were largely the mothers – and deaths on the maternity ward fell fivefold. met with derision. Another 50 years would pass before the importance Unquestioned today as the most important tool in the health care of hand washing as a preventive measure would be widely accepted by worker’s arsenal for preventing infection, hand washing was not the medical profession. Sanitation is now a standard and thousands of lives have been saved because of Dr. Semmelweis’s discovery. Cleaning agents for hands Cleaning agents assist in the process of removing substances from ingredients, instructions and recommendations for use on the item’s surfaces. Soaps and detergents are two common cleaning agents that label. are often confused for one another, but are composed of very different ingredients, with different cleaning properties. Soaps are the product of a chemical reaction, formed by vegetable oil reacting with lye, for example, and chemicals that add a desirable smell or quality to the soap, such as glycerine, to make it milder. While soap does not kill microorganisms, soap and water will help remove them from surfaces. Detergents are manufactured for the express purpose of cleaning specific substances off specific items, and are created using chemicals that can be very harsh to skin. In contrast to detergents that do not leave a residue or require rinsing, soaps leave a coating or residue on the body, typically one designed to make skin smoother or more attractive. Soaps also remove less fat from the skin than detergents, which have a drying quality and may strip the skin. Be sure to use the appropriate cleaning agent for the job. Different cleaning and disinfecting agents have many different properties. Always read the Sterilization and disinfection “Sterile” means free from all germs; sterilization is the most Disinfection is the process of killing specific microorganisms, bacteria effective level of decontamination, involving the removal of all or germs using physical or chemical processes. Disinfectants are bacterial life from a surface. This is the level of decontamination chemical agents that destroy organisms on contaminated instruments required for tools and surfaces in hospital surgeries. Hospitals use or surfaces. Disinfectants can be dangerous and must be used with steam autoclaves to heat instruments to a very high temperature and caution. Disinfectants are used to destroy bacteria on equipment many salons are investing in autoclaves to reinsure clients that their and implements, but they should not be used on the skin. In a salon safety is the number one priority. atmosphere, disinfectants must be able to kill viruses, fungus and dangerous bacteria. Disinfectants Controlling bacteria in a salon requires some degree of effort, vigilance To ensure safety, use an appropriate ratio of concentration in and good sense. In choosing a disinfectant, always look for the the solution, and clean only approved items, according to label EPA registration number (awarded by the Environmental Protection instructions. Wear gloves and safety glasses, as indicated when Agency) to ensure you are using an approved disinfectant. This mixing and using solutions. Do not confuse disinfectants, which number indicates a level of safety for specific kinds of disinfection. destroy harmful microorganisms, with antiseptics, products designed To be registered by the EPA, it must be effective in killing bacteria, to slow the growth of microorganisms. Antiseptics do not kill including Staphylococcus, aures, salmonella and pseudomonas. microorganisms and should not be confused with disinfectants or Cosmetology salons must use not only EPA-approved disinfectants, used for salon disinfection. but also those with an EPA rating of hospital-level (tuberculocidal) Household disinfectants, commonly used to clean offices and homes, quality. These disinfectants are especially effective for salon use and may be used to clean floors, doorknobs, walls, etc., as directed on the are capable of killing viruses, dangerous bacteria and fungus. container label, but should not be used in place of a hospital-grade Disinfectants can be hazardous if prepared incorrectly. Consult the salon disinfectant, which is required to sterilize instruments. manufacturer’s Material Safety Data Sheets (MSDS) for information Bleach can be used as an effective disinfectant, but it is not a on preparing the solution; check the listing of chemicals in the cleaning agent and should only be applied to clean surfaces. Bleach disinfectant and how they can pose safety hazards, if any. Be certain must be used with caution because it can release toxic fumes when to follow manufacturers’ instructions and all written directions for mixed with certain substances. Bleach is far too harsh for day-to-day the preparation and use of a specific disinfectant. Remember to disinfection and will damage instruments. It may be used for washing follow all directions when using this type of disinfectant or any other towels and other salon laundry. disinfectant. What are efficacy tests? The tests used to measure the effectiveness of disinfectants on various effective at its recommended dilution in killing target pathogens in the pathogenic (disease-causing) organisms are called efficacy tests. The presence of 400 ppm hard water and 5 percent organic serum and must EPA must pre-approve all “efficacy test methods” used to measure the kill 100 percent of the target test organisms. effectiveness of disinfectants against specific microorganisms. The It is a good idea for you to require the manufacturer and/or distributor most common efficacy test prescribed by EPA is the Association of of a disinfectant or disinfectant-cleaner to provide efficacy data to you Official Analytical Chemist (AOAC) test. Currently, for a disinfectant before you select it for use in your salon. cleaner to be registered by EPA as hospital strength, it must be

Page 74 Cosmetology.EliteCME.com What factors affect how well a disinfectant works? There are six main factors: ●● Temperature – Certain disinfectants work best in cold water ●● Concentration – This is dilution rate. Proper dilution is very (bleach). important. Read label for complete dilution directions. ●● Soil load – Disinfectants do not know the difference between soil ●● Contact time – For disinfectants, such as bleach, contact time is and bacteria. That is why heavy soil should be removed before not very critical. disinfecting. See explanation above for more details. ●● PH – Certain disinfectants work best under acidic conditions ●● Organism type – Not all disinfectants work on all types of (bleach), and others work best under alkaline conditions. organisms. When in doubt, read the product label for a complete list.

How can you calculate active parts per million (ppm) of the disinfectant you are using? To calculate active ppm, you’ll need three things – the active Step 2: ingredient list from the disinfectant label, dilution rate of the product ○○ Multiply by 10,000: and a calculator. The following is an example of how this would be ○○ 8.45 X 10,000 = 84,500 done using Neutral Germicidal Cleaner: Step 3: Step 1: ○○ Divide the result of Step 2 by the dilution rate (128 in this ○○ Add together active ingredient percentages from the label: example): ○○ For example, 5.07 percent + 3.38 percent = 8.45 percent total ○○ 84,500 / 128 = 660 ppm. active ingredients. Parts per million (ppm) is a ratio figure that represents the amount of one substance that is in one million parts of another substance. Introduction to the autoclave While autoclaves are not required in Florida, many salons are microbial life. To ensure safety and quality control, all biohazardous purchasing them. They provide your salon with an increased layer materials and items contaminated with potentially infectious agents of safety and you can market to clients by stressing that you use should be decontaminated before use or disposal. Such items include, an autoclave. This section will give you the basics of autoclave but are not limited to, toenail clippers, cuticle nippers and metal procedures. cuticle pushers. Steam sterilization is not recommended for anhydrous The autoclave that uses saturated steam under pressure is one of the substances, flammable materials, electrical equipment or any item that most dependable methods available for the inactivation of all forms of may be damaged in the autoclaving process.

How the autoclave works The most common steam sterilizer found is the gravity displacement The sterilization procedure consists of three phases. These are the type. Saturated steam enters the top of the chamber by a steam autoclave heat-up time, the contact time and the cool-down time. Once pressure-control valve. As the steam enters, it pushes the air out the temperature has come to equilibrium, a minimum of 20 minutes through a trap in the drain line. Once all the air is evacuated, the trap contact time for all surfaces that require sterilization is necessary closes. Steam continues to fill the autoclave chamber until a pre-set to insure complete biological inactivation. Usually the heat-up time temperature and pressure are reached. Common autoclave operating section of the sterilization procedure is the time given for the autoclave conditions are 270 degrees Fahrenheit and 15 pounds per square inch chamber to heat up to the prescribed temperature; therefore, the run gauge (psig) pressure. time used must be long enough for the entire package to equilibrate at 270 degrees and still give the load a 20-minute contact time.

Autoclave safety procedures All potentially infectious materials must be autoclaved before being Most autoclaves have a safety interlocking system that prevents the washed or stored. Personnel who operate the autoclave must be trained instrument from working if the door is not properly closed; however, to understand proper packaging, loading, labeling as well as operation same older units may not have such a built-in safety mechanism. and emergency procedures. This training should also be documented Should the autoclave that services your salon not have an interlocking by the principal owner of the salon. Autoclaves generate high heat system, special precautions must be observed to ensure that the door is and pressure; therefore, all users must understand and respect the properly sealed before the process begins. If steam is leaking around associated risks. Always manipulate hot items with a thick glove the door during the sterilization process, the door has not been sealed designed for this purpose. At the completion of the cycle, allow the properly. In this event, shut down the system as safely as possible. Let autoclave unit to cool down before opening. Then, stand back and the unit cool and reset the door. Give special attention to making sure crack the door slowly to allow the excess steam to escape. Some older that the door is sealed tight, and restart the run. If this problem persists, autoclaves have little or no heat shielding. the unit needs to be serviced by a qualified technician. Warning signs alerting users to these hot surfaces should be placed Never leave unsterilized material inside the autoclave or sitting in the next to the autoclave to remind personnel of this hazard. Do not stack autoclave room overnight. Never autoclave materials that contain toxic or store combustible materials such as cardboard, plastic containers or agents or volatile chemicals. flammable liquids next to the autoclave.

Autoclave operation parameters The parameters for the sterilization cycle will depend upon the amount model and various loads will differ; therefore, the responsible user and type of material. The cycle time should be developed for a worst- should write a complete standard operating procedure (SOP) for the case scenario. Denser loads will take longer than less dense loads of steam sterilization operation. This SOP should include the sterilization the same weight. The exact operating procedure for each autoclave

Cosmetology.EliteCME.com Page 75 procedure for each type of load autoclaved. It is prudent practice to as documentation of the autoclave operation. Each autoclave unit document each autoclave load in an autoclave log. should have preventative maintenance and be placed on a preventative This log should include the type of load, amount, run program, date, maintenance schedule with a qualified repair technician. It should be time and operator’s name. Keep charts or printout strips in the logbook inspected annually. The service technician will ensure that the unit operates safely and properly.

Other recommended guidelines Here are some more guidelines you should follow: times may be required to achieve decontamination if an autoclave 1. Do not overfill an autoclave bag. Steam and heat cannot penetrate is tightly packed. as easily to the interior of a densely packed autoclave bag. 3. Do not mix contaminated and clean items together during the same 2. Whether you are using autoclave bags or not, be sure you do not autoclave cycle. overload an autoclave. An overpacked autoclave chamber does not If there is a spill inside the autoclave chamber, allow the unit to cool allow efficient steam distribution. Considerably longer sterilization before attempting to clean up the spill.

Steps in cleaning your instruments in an autoclave Step 1 Note: The units of pressure marked on an autoclave’s pressure gauge In a sink, put instruments in warm water and detergent, then hold may vary from one autoclave to another. The following amounts the instruments under the water and scrub them, paying attention to of pressure (which are approximately equivalent) are the desired crevices and grooves with a clean brush. pressures for autoclaving: Rinse clean instruments in warm water and dry using a lint-free 15 lb/in2 (15 pounds per square inch). disposable towel. 106 kPa (106 kilopascals). 1 atm (1 atmosphere). Step 2 1 kgf/cm2 (1 kilogram of force per square centimeter). Open or unlock all jointed instruments and other items, such as 776 torr. cuticle nippers and nail clippers, and disassemble those with sliding 776 mm Hg (776 millimeters of mercury). or multiple parts. This allows steam to reach all surfaces of the item. Step 6 Avoid arranging the instruments and other items together tightly If the autoclave is automatic, the heat will shut off and the pressure because this prevents steam from reaching all surfaces. will begin to fall once the sterilization cycle is complete. If the Step 3 autoclave is not automatic, turn off the heat or remove the autoclave If instruments and other items are to be wrapped before steam from the heat source after 20 minutes if items are unwrapped. Wait sterilization, use two layers of paper, newsprint or cotton or muslin until the pressure gauge reads “zero” to open the autoclave. Open the fabric (do not use canvas). Instruments and other items should not be lid or door to allow the remaining steam to escape. Leave instruments placed in a closed container. or items in the autoclave until they dry. Step 4 Step 7 Arrange your instruments according to operator so they do not get Remove the instruments, trays, or unwrapped items from the autoclave mixed up. using sterile pickups. To prevent condensation after removing the items from the autoclave, place them on a surface padded with sterile If you have multiple sets of instruments and operators in your salon, paper or fabric until they are cool. you may want to invest in an autoclave that has trays. This way each tray can be assigned to an operator, and instruments will be easily Wait until the instruments, trays, or items reach room temperature identified. You could also invest in autoclave bags so that each set of (which may take up to several hours) before storing. instruments belonging to an individual operator can have its own bag. If using autoclave bags, check the indicator color on the bag to be sure This will reduce arguments over whose instruments belong to whom. the items in the bag have been sterilized long enough. Store the sealed Step 5 dry autoclave bag in a clean, dry protected area. Mark the bag with the Because there are many types of autoclaves in use around the world, it date of autoclaving for future reference. is difficult to provide guidance on the specific instructions of operating Step 8 each. Follow the manufacturer’s instructions whenever possible. In If you are not using autoclave bags, store items in a clean, closed general, sterilize items for 20 minutes at 121 degrees C (270 degrees container. F) and 106 kPa (15 lb/in2) pressure. (Do not begin timing until the autoclave reaches the desired temperature and pressure.)

Conclusions While the autoclave is extremely efficient in sterilizing instruments, instruments are in the autoclave or open the autoclave before it the process requires much longer than chemical disinfection. has completed sterilizing. Opening an autoclave in the middle of a Therefore, it is highly recommended that you have several sets cleaning can result in severe burns. of instruments. You must not ever shorten the length of time your

Cleaning your autoclave Unfortunately, even your autoclave needs cleaning. Experts believe These cleaning tips are for a chamber autoclave, but no matter what about 25 to 35 percent of repairs could be avoided if autoclaves were type of autoclave you purchase, follow the manufacturer’s instructions cleaned on a regular basis. on cleaning. First, be sure to unplug your autoclave. Then, move your autoclave to a sink. Remove trays or racks. Sometimes trays can be somewhat

Page 76 Cosmetology.EliteCME.com difficult to remove, so call your service representative or manufacturer Let the cleaning solution soak in for a few minutes and then scrub with if you need help. a scouring pad. Pour out the solution and rinse with water. Now, pour TIP: It may help to have a slightly warm chamber for the cleaning a small amount of solution in the reservoir with water and run two process. to three cycles and cancel drying cycles. After completion, drain the reservoir and refill with distilled water and run another cycle. Drain Pick up the unit and empty the sterilizer chamber. Replace the unit one more time and refill. back on the counter top and pour some cleaner into the chamber. You may purchase a cleaner from the manufacturer or buy some CLR (tm) Wipe the door gasket weekly with a wet damp towel and clean the from your hardware store. If you must use a manufacturer’s cleaning cabinet gasket as well. Your autoclave is now ready for use. Repeat solution to maintain a warranty, by all means do so. this cleaning about every 10 days or so.

Cleaning the salon computers and reception areas Almost all modern salons now work with computers and computer Germs from unwashed hands can remain alive for days. In other appointment books. These computer appointment books are generally words, if you share computer keyboards in your salon, a phone or a at the reception desk and are also found in break areas so that salon desk, you are sharing germs. workers can view their schedules. To combat the problem, you must assign cleaning duties to staff. First, Few people think about the germ havens these areas have become. you should remove the screws on the underside of the keyboard and Experts say the computer keyboard, phone and desk areas of salons are separate the two parts. Brush the debris away and then wipe with a major germ areas that must be sanitized. sanitizing cloth. Believe it or not, you could put your fingers on a toilet seat and collect Once you put it back together, spray the entire keyboard with a fewer germs than the average desk or keyboard. Charles Gerba, a disinfectant spray like Lysol. Do this lightly so as not to ruin the microbiologist at the University of Arizona, counted bacteria on electronics. You can also use sanitation wipes commonly found in drug several surfaces. stores. He found the office toilet seat had an average of 49 germs per square Staff should clean phones daily with a disinfectant spray and more inch. When he looked at keyboards, he found 3,295 bacteria per square often when someone is known to be sick or feels sick. Also, remember inch, 60 times higher than the toilet seat. Even worse were tops of to daily disinfect your workstation. Often stylists forget to perform desks at 21,000 bacteria per square inch and telephones at 25,000 per this important step, yet they routinely place combs, scissors and other square inch. People are constantly coughing and sneezing on them. items on top of the workstation.

Disease and infestation Salons and schools should not knowingly permit a person afflicted Pertussis (“whooping cough”), until five days of antibiotic therapy has with an infection or parasitic infestation capable of being transmitted been completed. to a patron to serve patrons or train in the establishment or school. Varicella (“chicken pox”), until the sixth day after onset of rash or In addition, salons and schools should not knowingly require or sooner if all lesions have dried and crusted. permit a licensee or student to work upon a person with an infection Mumps, until nine days after onset of parotid gland swelling. or parasitic infestation capable of being transmitted to the licensee or student. Tuberculosis, until a physician or local health department authority states that the individual is noninfectious. Infections or parasitic infestation capable of being transmitted between licensee or student and patron include, but are not limited to, the Impetigo (bacterial skin infection), until 24 hours after treatment has following: begun. Cold, influenza or other respiratory illness accompanied by a fever, Pediculosis (head lice), until the morning after first treatment. until 24 hours after resolution of the fever. Scabies, until after treatment has been completed. No person working Streptococcal pharyngitis (“strep throat”), until 24 hours after or training in an establishment or school should massage any person treatment has been initiated, and 24 hours after resolution of upon a surface of the skin or scalp where such skin is inflamed, broken symptoms. (e.g., abraded, cut) or where a skin infection or eruption is present. Purulent conjunctivitis (“pink eye”), until examined by a physician The cosmetology industry is booming and one of the only factors and approved for return to work. that has a chance to harm your industry is if clients do not feel safe. Therefore, you must make safe sanitation techniques a part of your daily routine and encourage co-workers to do the same.

Conclusion As you can see from the preceding section, sanitation issues have a direct impact on the health and welfare of clients and the livelihood of the salon professional. The importance of maintaining proper sanitation procedures cannot be overstated; it can literally be a matter of life or death! Following proper sanitation guidelines will greatly reduce the potential risks to you, your clients and co-workers.

Cosmetology.EliteCME.com Page 77 Florida Cosmetologists Final Examination Questions Select True or False for questions 1-35 and mark your answers on the Final Examination Answer Sheet found on page 81 or complete your test online at Cosmetology.EliteCME.com.

There will be an additional $4.95 convenience fee added for all tests completed by phone.

1. The function and ingredients in home hair color products and those 15. Hair color is caused by a pigment (melanin) produced by hair found in the salon are essentially the same. follicles. ¨¨ True  False ¨¨ True  False

2. Making a photo album with a variety of haircolors is a great aid for 16. Hormones, aging or genetics have no impact on female pattern helping the client find the color they are attempting to describe. baldness. ¨¨ True  False ¨¨ True  False

3. The ability to put the client at ease during her first visit to your 17. Workers’ compensation is not insurance; rather, it is social salon is not important. insurance, much the same as unemployment compensation and ¨¨ True  False social security. ¨¨ True  False 4. Neutral, natural, drab, gold, ash, smoky, red and auburn are used to describe the tone of a haircolor. 18. In most cases, individuals receiving a workers’ compensation ¨¨ True  False benefit check will receive 66 2/3 percent of their average weekly wage. 5. Semi-permanent hair color is not mixed with a catalyst; although ¨¨ True  False the application of heat may be used to make the color more durable. 19. Workers’ Compensation benefits are taxable by the Internal ¨¨ True  False Revenue Service (IRS) and must be reported as income. ¨¨ True  False 6. The darker the color, the higher the number. ¨¨ True  False 20. According to the Centers for Disease Control (CDC), one new HIV case is diagnosed every 9 ½ minutes in the United States. 7. The colorist can rely on level and tone indicators from a ¨¨ True  False manufacturer alone to accurately predict a final color. ¨¨ True  False 21. Once a person is classified HIV positive, that person will always be HIV positive. 8. After identifying the client’s natural haircolor category, it is ¨¨ True  False necessary to identify the percentage of gray hair. ¨¨ True  False 22. The risks of HIV transmission at a salon indeed are much lower than those for Staph and other harmful – and sometimes deadly – 9. Hydrogen peroxide is the catalyst that causes permanent haircolor bacteria and germs. to work. ¨¨ True  False ¨¨ True  False 23. Wasting syndrome refers to unwanted weight loss that is equal to 10. Framing refers to applying foils to the hair to create a dimensional less than 5 percent of a person’s body weight. effect. ¨¨ True  False ¨¨ True  False 24. Cosmetology services may be performed by a licensed 11. Paper wraps used in conjunction with color sleeves or for isolating cosmetologist in a location other than a licensed salon, including, hair strands for bleaching or coloring. but not limited to, a nursing home, hospital, or residence, when a client for reasons of ill health is unable to go to a licensed salon. ¨¨ True  False ¨¨ True  False 12. Hair is outgrowth of skin but has no sense of feeling due to the lack of nerve endings. 25. Ultra Violet Irradiation may be used to store articles and instruments after they have been cleansed and disinfected. ¨¨ True  False ¨¨ True  False 13. If you have very fine hair, medulla cells are present. 26. A wet sanitizer is any receptacle with a cover and containing a ¨¨ True  False disinfectant solution and large enough to allow for a complete 14. The cortex is responsible for much of the mechanical strength of immersion of the articles. the hair fiber. ¨¨ True  False ¨¨ True  False

Page 78 Cosmetology.EliteCME.com 27. Indoor pollution sources that release gases or particles into the air are the primary cause of indoor air quality problems in homes and buildings. ¨¨ True  False

28. If a faucet drips once every second, less than 100 gallons of water is wasted in one year. ¨¨ True  False

29. OSHA’s Bloodborne Pathogen Standard was designed to prevent more than 200 deaths and 9,000 bloodborne infections every year. ¨¨ True  False

30. The issue of most concern to cosmetologists is chemical exposure in the workplace. ¨¨ True  False

31. Seventy-five percent of all bacteria are classified as pathogenic or harmful. ¨¨ True  False

32. Methicillin-resistant Staph aureas (MRSA) is almost always spread by casual contact. ¨¨ True  False

33. Sterilization is the least effective level of decontamination. ¨¨ True  False

34. Antiseptics do not kill microorganisms and should not be confused with disinfectants. ¨¨ True  False

35. Bleach can be used as an effective disinfectant, but it is not a cleaning agent and is far too harsh for day-to-day disinfection, as it will damage instruments. ¨¨ True  False

CFL16E15B

Cosmetology.EliteCME.com Page 79 2015 Continuing Education Course for Florida Salon Professionals

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