Cleanliness, hygiene, infection & cross infection control

DISCLAIMER Online Laser Training Ltd / GCG Healthcare Ltd (OLT/GCG) makes no guaranty or warranty as to the accuracy or completeness of any information published herein. OLT/GCG disclaims liability for any injury to persons or property or other damages of any nature whatsoever, whether special, indirect, consequential or compensatory, directly or indirectly resulting from the publication, use of, or reliance on this document. In issuing and making this document available, OLT/GCG is not undertaking to render professional or other services for or on behalf of any person or entity. Nor is the OLT/GCG undertaking to perform any duty owed by any person or entity to someone else. Anyone using this document should rely on his or her own independent judgment or, as appropriate, seek the advice of a competent professional in determining the exercise of reasonable care in any given circumstances. OLT/GCG has no power, nor does it undertake, to police or enforce compliance with the contents of this document. Nor does OLT/GCG list, certify, test or inspect products, designs, or installations for compliance with this document. Any certification or statement of compliance with the requirements of this document shall not be attributable to the OLT/GCG and is solely the responsibility of the certifier or maker of the statement.

This information is provided to inform cosmetic care providers intending to re-start laser and intense light source services to clients post regulatory Health Protection Coronavirus Restrictions which have resulted in closing premises during the emergency period.

Coronavirus COVID-19 is a severe and acute respiratory infection. Facts emerging about possible additional safety precautions in respect of cleanliness, hygiene, infection and cross infection control are current at the time of writing but may change as further scientific and clinical information becomes available from reliable sources.

This discussion document is provided by:

www.onlinelasertraining.co.uk Tel: 0344 800 8909

Online Laser Training Ltd. provides distance learning courses in laser and intense light source safety and applications including laser & IPL hair reduction & skin rejuvenation, laser tattoo & benign pigmented blemish removal. All courses can be booked online. &

www.gcghealthcare.co.uk Tel: +44 (0)1444 484911

GCG Healthcare Ltd. provides Laser Protection Adviser (LPA) services to clinics, salons and spas intending to use laser and intense light source technology in compliance with Environmental Health or insurance requirements..

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Enhanced Cleaning, Infection & Cross-Infection in the Laser/ILS Clinic - Policy & Procedures

POLICY It is the policy of the laser / ILS clinic to ensure that the establishment provides an environment and system of care which minimises the risk of infection to clients, staff and visitors. To ensure compliance with national regulations, policy and guidance related to infection prevention and control.

NATIONAL REGULATIONS, POLICY AND GUIDANCE The Coronavirus (COVID-19) pandemic indicates that enhanced hygiene and cross-infection prevention measures in the laser / intense light source (ILS) clinic may be required. Employers are under a legal obligation (under control of substances hazardous to health - COSHH) to adequately control the risk of exposure to hazardous substances where exposure cannot be prevented. See: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/ file/872745/ Infection_prevention_and_control_guidance_for_pandemic_coronavirus.pdf

All employers have a common-law duty of care to their employees. In addition, under the Health and Safety at Work Act 1974 (HASAWA) every employer has a duty to ensure that, so far as is reasonably practicable, the health, safety and welfare of employees are protected. See: https://www.hse.gov.uk/workers/employers.htm

PROCEDURES - GENERAL PRINCIPALS Hand hygiene is necessary at all times and should be performed immediately before every direct client care activity including removing personal protective equipment (PPE), equipment decontamination and waste removal.

Workplace, furniture, furnishings, telephones and fittings shall be kept clean and free from visible dirt.

The installation of ‘no touch’ taps, soap and paper towel dispensers and light motion switches should be considered. High-touch points such as door handles, knobs, handrails, switches, chair armrests, telephones, keyboards, desks, examination couches, table tops, wash handbasins and toilets should be wiped regularly with suitable alcohol wipes (>60%). The use of disposable paper towels for hand drying is more hygienic than jet air-dryers.

Where possible, use single use, packaged items and discard after use. Follow protocols for the disposal of sharps, such as razors, which need to be discarded in designated sharp containers.

Alcohol-based (>60% ethanol) hand sanitizer dispensers should be made available in each separate clinic area.

In addition to safety eyewear, gloves, aprons and masks will be worn when treating clients.

All lighting, heating and ventilation installations will be in accordance with the Health & Safety Commission Approved Code of Practice (Workplace – Health, Safety & Welfare Regulations 1992) [1]

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TREATMENT AREA CLEANING – Contact precautions The laser/ILS treatment room should have a daily and weekly environmental cleaning schedule. Depending on the surface material, floors should be vacuumed daily or mopped clean utilizing a general-purpose disinfectant. All horizontal surfaces should be cleaned with a disinfectant solution dilution of 1,000 parts per million available chlorine (ppm available chlorine (av.cl.) or equivalent. Note: Glutaraldehyde and phenol are not recommended as disinfectants because of the health risks involved in their usage.

High-touch points such as door handles, knobs, handrails, switches, chair armrests, telephones, keyboards, desks, examination couches, table tops, wash handbasins and toilets should be wiped regularly with suitable alcohol wipes (>60% ethanol, >70% isopropanol). Clean and disinfect couches and change disposable couch roll between clients. Empty waste receptacles daily.

Toilet facilities with hot and cold running water must be cleaned and disinfected at least twice daily and after client use. Liquid soap and disposable paper towels will be provided. Clean from the cleanest areas to the dirtiest and don’t pass twice over the same area.

Towels and washcloths used when washing the skin or used to maintain client privacy and dignity when treating intimate body areas, should be changed after every client. A laundry service or machine-washing of these towels and washcloths should be performed using in a dedicated washing machine at 90°C and dried using a high heat cycle.

HAND HYGIENE Educate staff and clients by having signs all around the clinic instructing everyone to use alcohol- based (>60%) hand sanitizer for 20-30 seconds when arriving. Hand hygiene and frequent hand washing up to the wrist by all workplace staff is paramount. Use disposable paper towels after hand washing. Change any reusable towels between clients. Wash reusable towels in a dedicated washing machine at 90°C.

Good hand washing technique is an ESSENTIAL part of infection control as many infections are spread by hand contact. Hand washing should be performed before and after contact with a client and includes the use of liquid antimicrobial soap and water for at least 20 seconds to inactivate the virus; alternatively, alcohol-based hand rubs can be substituted for unsoiled hands but must be left to dry on the hands and not wiped with a tissue. Of course, continue to wash hands before and after eating or after using the toilet with liquid soap for at least 20 seconds. • Before and after commencing each specified service; • use of liquid antimicrobial soap and water for at least 40-60 seconds to inactivate the virus; • alcohol based hand rubs can be substituted for unsoiled hands; • before and after eating or after using the toilet; • immediately after using any handkerchief or nasal tissue or smoking.

Staff developing skin reactions to hand disinfectant products or with pre-existing skin conditions should seek medical advice

Water based: • Wet hands and wrists before applying antimicrobial soap; • Apply disinfectant cleanser; • Ensure all hand and wrist surfaces are well covered with lather and rub this between the fingers; • Rinse off lather; • Dry hands thoroughly to avoid chapping; • Do not use air devices to dry your hands.

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Alcohol based: • Antimicrobial and alcohol (>60%) hand rub should be used on unsoiled dry hands as well as in-between the fingers; • Ensure all hand and wrist surfaces are well covered with the hand rub, and then massage hands together until dry.

Use hand lotion (supplied in pump dispenser) to regularly to avoid chapping of hands. The hand lotion dispenser will need to be wiped down between clients.

PERSONAL PROTECTIVE EQUIPMENT (PPE) GLOVE POLICY & PROCEDURE As the hands of laser/ILS practitioners are one of the most likely means of transmitting infection to others, disposable examination gloves must be worn when providing direct client care and during cleaning / decontamination procedures. The purpose of wearing sterile examination or surgical gloves is to: • protect the hands from becoming contaminated with viruses and bacteria; • prevent the transfer of viruses and bacteria already present on the skin of the hands and to minimise cross infection during cleaning / decontamination procedures.

Gloves of appropriate quality should be used i.e. domestic type rubber for cleaning purposes and well-fitting, single-use, nitrile or vinyl sterile examination or surgical gloves for client procedures.

Gloves must be changed at the end of each procedure or during a procedure if other areas are touched that have not been prepped for the procedure;

Gloves must be made easily available for staff use;

Gloves must be changed between performing each procedure.

Hands should always be washed after wearing gloves.

Disposal: Gloves are clinical waste and disposed of in the designated waste containers.

MASK POLICY & PROCEDURE – Droplet and airborne precautions As it will be difficult to maintain recommended physical distancing between clinic staff and as COVID- 19 and other viruses are transmitted in water droplets and aerosol, suitable approved masks as recommended in official guidance by Public Health England (PHE) must be worn by clinic staff. The FFP3 mask should be used where there is a risk of the laser operator inhaling blood aerosol or other airborne particulates such as are produced during tattoo pigment removal, skin ablation, etc.

DISPOSABLE APRON Disposable plastic aprons must be worn to protect medical gowns, staff uniform or other clothes from contamination when providing direct client care and during cleaning / decontamination procedures. Disposable aprons must be changed between clients and immediately after completion of cleaning / decontamination procedures.

ORGANISATIONAL PROCEDURE WHEN TREATING CLIENTS PRIOR TO CLIENT ARRIVAL • Check with the client that they are feeling well and have no symptoms of infection (questionnaire / check-list). Checklist should include – Has the patient had a temperature of 37.8°C or above in the past 7 days or shivers, a new headache, a cough that has persisted that is

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new to them, shortness of breath that is new to them, a sore throat, any change in their sense of taste or smell, a runny nose or new nasal congestion AND have they been in contact with anyone else who has been diagnosed with COVID 19 or awaiting a result for testing or who is self- isolating due to possible symptoms of COVID 19. • Obtain client permission for temperature screening on arrival at the clinic (in accordance with GPSD regulations). • Reassure the client that you and/or the laser/ILS practising operator is fit and well and has been tested for COVID-19 virus. • Advise clients that you will be using surgical masks, examination gloves and aprons during their visit and that they will be requested to wear a cloth face covering made at home or suitable mask as recommended in official guidance by Public Health England (PHE) (except during facial treatments). • Allow a 15 minute ‘exclusion break’ between each client permitting extra time for a deep clean before they arrive and after they leave.

WHEN COMMENCING CLIENT TREATMENT • As the COVID-19 virus can survive for up to 5 days on hard surfaces, each time you go into a treatment room to start a session, wipe down the external surfaces and touch screens of all laser/IPL machines with alcohol (>60%) anti-bacterial surface wipes. • Laser/IPL practitioners should clean their own eyewear thoroughly with soap and water before use or using suitable antibacterial/viral wipes e.g. ‘Clinell’ wipes, allowing to air dry. • After first washing hands and putting on examination or surgical gloves, all staff using lasers or ILS equipment should clean client safety eyewear thoroughly in front of the client. • If it is necessary to place the client safety eyewear down before giving or putting onto the client, take a sheet of hand towel from dispenser, place it on the work surface and rest the clean eyewear on the hand towel. • Unless otherwise instructed by the manufacturer, the surface of handpieces should be wiped with saline solution from sterile saline pods using soft gauze so there is no risk of alcohol in contact with the lenses. • Handpieces/end pieces that either come into contact with client’s skin or are likely to have plume, skin cells or blood on should be sterilised appropriately in between clients – please check with your laser manufacturer whether your end pieces can be fully sterilised. • Consider using disposable client ocular shields.

INSTRUMENT CLEANING Cleaning and disinfection of the laser handpiece / IPL applicator head / LED array, along with regular washing and disinfection of safety eyewear and cooling gel packs, should be conducted under the protocols recommended by the manufacturer. Other supplies routinely used in the laser clinic are single-use items and should be disposed of after each client.

REFERENCES

[1] Approved Code of Practice and guidance. Health and Safety Executive Books, Second edition 2013; Available at: http://www.hse.gov.uk/pubns/priced/l24.pdf

OTHER RESOURCES 1. How to wash your hands available at: https://www.nhs.uk/live-well/healthy-body/best-way-to-wash- your-hands/ 2. NHS WSWRD poster available at: https://www.england.nhs.uk/south/wp- content/uploads/sites/6/2017/09/hand-hygiene-poster.jpg 3. Corona Virus Wash Your Hands NHS video available at: https://youtu.be/GldAajY4UGM

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4. COVID-19: infection prevention and control guidance available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/ 881489/COVID-19_Infection_prevention_and_control_guidance_complete.pdf 5. Local Resumption of Elective Surgery Guidance. American College of Surgeons. 17th April 2020. 6. Level 4 COVID-19 lockdown – AAMSSA Guideline for the Aesthetic Practitioner. 28th April 2020. 7. Kampf G, Todt D, Pfaender S, Steinmann E. Persistence of coronaviruses on inanimate surfaces and their inactivation with biocidal agents. J Hosp Infect. 2020; 104(3):246-251. 8. Australasian College of Cosmetic Medicine (ACAM) Autumn Newsletter April 2020. Available at: https://mailchi.mp/31959816f0d9/acam-spring-newsletter-special-conference-edition- 3036370?e=7288a30982 9. Auckland Council: Health and hygiene Code of Practice 2013 Updated 5th March 2014. 10. BS EN 14683:2019 Medical face masks – Requirements and test methods. 11. CIE Technical Report UV-C Photocarcinogenesis Risks from Germicidal Lamps. CIE 187:2010. ISBN 978 3 901906 81 7. 12. Australian Government Department of Health; HOW TO PROTECT YOURSELF AND THE PEOPLE YOU ARE CARING FOR FROM INFECTION WITH COVID-19. Available at: https://www.health.gov.au/resources/apps-and-tools/covid-19-infection-control-training 13. Illuminating Engineering Society. IES CR-2-20-V1 IES Committee Report: Germicidal Ultraviolet (GUV) - Frequently Asked Questions April 15th 2020. ISBN 978-0-87995-389-8.

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