1-888-857-6920(toll free) 386-615-1812 (fax)

Dear Licensee:

As you know, all cosmetology licensees whose licenses expire in January of 2007 are required to complete 8 hours of continuing education prior to renewal. You are allowed to complete these hours by correspondence. I have been in the salon business for 14 years and I know how valuable your time and money is to you , that is why I set out to create a home study course that would be comprehensive, but at a low cost to you. You can complete all 8 hours for just $15.00. I also know you have choices when it comes to completing your 8 hours so I hope you will consider the following when choosing your continuing education provider:

• We Are on Your Side- We set the standard on quality continuing education at reasonable prices and we were the only provider at Board meetings fighting for you to be allowed to continue to do your hours by correspondence or internet. We succeeded and the result is you get to save time and money and don't have to travel to take your continuing education hours. • We Guarantee the Lowest Price. If somebody beats our price simply enclose their price special or coupon with your test and pay that amount. No questions asked. • Quality - We double check your license number before we transmit your hours to the state. The result is your hours are transmitted accurately. Some providers do not take the time to do this. • Speed - We process your test the very same day it is received and if you complete the course on the internet you instantly receive your certificate of completion. Then we report your hours electronically to the state within 24 hours. I hope you will choose Elite Continuing Education to complete your hours. Should you have any questions or need a course book do not hesitate to contact us toll free at 1-888-857-6920 or visit us online at www.elitecontinuingeducation.com .

Sincerely,

Annette Mowl President

Courses approved by the Ohio State Board of Cosmetology. Web Page Address to view state approval: www.cos.ohio.gov

I Completing Your Continuing Education is Easy. Carefully read the instructions below. Why am I receiving this course? Ohio Board of Cosmetology now allows you to complete your continuing education through home study. Records indicate that your license will need to be renewed in January 2007. Completing your Continuing Education is required before license renewal. How do I get my test graded and get my certificate of completion? After reviewing the material, you must complete the final exam on pages 58 - 60 marking your answers on the answer sheet on page 62. Fill out all information on the answer sheet (be sure to fill in your license number) and include payment of $15.00 made payable to Elite CME. As long as you receive a 75% or better on your exam you will be issued a certificate of completion. How can I complete this course? MAIL You can complete the final exam and mail it to us in the envelope provided. If you have misplaced your envelope you can mail it to us at: Elite CME, Inc. * 1453 N. Hwy US #1, Unit 32 * Ormond Beach, FL 32174. FAX For faster service you can fill in your credit card number and expiration date and fax your test to us at (386) 615-1812. ONLINE For an even more convenient way of completeing your CEU’s you can take the test online at www.elitecontinuingeducation.com, upon passing you will then be requested to fill in your information and will be able to print out a certificate of completion for your records. I cannot get your webpage up on my computer.. Be sure you are entering our web address in your address bar, not your search engine bar (see below).

Place our web address here to go directly to our homepage. Do not use your search engine Will Elite CME notify the Ohio State Board of Cosmetology that I have com pleted my continuing education?

Yes, we will submit to the Board an Attendance Record Report. To avoid any delay in the reporting process it is important that you complete all the information on the test page. What if I hold both a Manager License and an Instructor License, how many hours do I need to complete? New Rules & Regulations state that Licensees holding both a manager and instructor license shall need eight hours for each license, beginning with the renewals after January 2005.

I still have questions.

No problem, we are here to help you. Call us toll free at 1-888-857-6920.

II Elite CME 8 hour Continuing Education for Ohio Salon Professionals

Table of Contents

Chapter 1 HIV/AIDS & Communicable Diseases Education (2 Hours)...... Page 1

Chapter 2 (OSHA) Education and Salon Safety (1 Hour)...... Page 11

Chapter 3 Instruction on Sanitation and Sterilization State of Ohio (2 Hours)...... Page 21

Chapter 4 Cosmetology: Pathology and conditions of the Skin, Hair and Nails (2 Hour)...... Page 36

Chapter 5 Federal Tax Rules for the Salon Professional (1 hour)...... Page 49

Final Examination Questions...... Page 58

Endnotes ...... Page 61

Final Examination Answer Sheet...... Page 62

Course Evaluation...... Page 63

All Rights Reserved. Materials may not be reproduced without the expressed permission or consent of Elite CME Inc. 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 service advice. If necessary, it is recommended that you consult a medical, legal or professional service expert in the State of Ohio.

III Chapter I mucous membranes and infected body fluids. For example, if HIV/AIDS & Communicable Diseases Education someone infected with HBV cut his or her finger on a piece of ( 2 Credit Hours) glass, and then you cut yourself on the now infected piece of Learning Objectives: glass, it is possible that you could contract the disease. Know the difference between HIV Infection and Anytime there is blood-to-blood contact with infected blood or AIDS body fluids, there is a slight potential for transmission. Detail how HIV is transmitted Unbroken skin forms an impervious barrier against blood- Describe ways to prevent the spread of HIV/AIDS borne pathogens. However, infected blood can enter your sys- Know how HIV/AIDS is treated tem through: Learn about Tuberculosis (TB) and Hepatitis Detail how TB and Hepatitis are transmitted and Open sores treated Cuts Bloodborne Pathogens Abrasion Bloodborne pathogens are microorganisms such as viruses or Acne bacteria that are carried in the blood and can cause disease in Any sort of damaged or broken skin such as sun burn or blisters people. There are many different bloodborne pathogens including malaria, syphilis, and brucellosis, but Hepatitis B Bloodborne pathogens may also be transmitted through the Virus (HBV) and the Human Immunodeficiency Virus (HIV) mucous membranes of the: are the two diseases specifically addressed by the OSHA (Occupational Safety & Hazard Administration) Bloodborne Eyes Pathogen Standard. Hepatitis C Virus (HCV) is another virus Nose that has dramatically increased in the United States. Mouth Modes of Transmission For example, a splash of contaminated blood to your eye, nose Bloodborne pathogens such as, HBV, HCV and HIV can be or mouth could result in transmission. transmitted through contact with infected human blood and What Is HIV? other potentially infectious body fluids such as: The Human Immunodeficiency Virus or HIV for short is the Semen virus that causes AIDS. HIV is transmitted from one person to Breast Milk another through blood-to-blood and sexual contact. Vaginal secretions Additionally, infected pregnant women can pass HIV to their Cerebrospinal fluid unborn child during pregnancy, delivery and breast-feeding. Synovial fluid Most people that have the HIV infection will develop AIDS. Pleural fluid The following bodily fluids have been proven to spread HIV: Amniotic fluid blood Saliva (in dental procedures), and semen Any body fluid that is visibly contaminated with vaginal fluid blood breast milk HBV, HCV and HIV are most commonly transmitted other body fluids containing blood through: What is AIDS? Sexual contact (Less likely for HCV) AIDS stands for acquired immunodeficiency syndrome. An Sharing of hypodermic needles HIV-infected person receives a diagnosis of AIDS after devel- From mothers to their babies at/before birth oping one of the defined AIDS indicator illnesses. A positive Accidental puncture from contaminated needles, HIV test result does not mean that a person has AIDS. A diag- broken glass, or other sharps nosis of AIDS is made by a physician using certain clinical Contact between broken or damaged skin and criteria (e.g., AIDS indicator illnesses). Infection with HIV infected body fluids can weaken the immune system to the point that it has diffi- Contact between mucous membranes and infected culty fighting off certain infections. These types of infections body fluids are known as "opportunistic" infections because they take the opportunity a weakened immune system gives to cause illness. In most work situations, transmission is most likely to occur Many of the infections that cause problems or may be life- because of accidental puncture from contaminated needles, threatening for people with AIDS are usually controlled by a broken glass, or other sharps; contact between broken or dam- healthy immune system. The immune system of a person with aged skin and infected body fluids; or contact between

1 AIDS is weakened to the point that medical intervention may frequently in persons who report no identified risk for infec- be necessary to prevent or treat serious illness. tion. All reported cases suggesting new or potentially unknown routes of transmission are promptly and thoroughly Today there are medical treatments that can slow down the investigated by state and local health departments with the rate at which HIV weakens the immune system. There are assistance from the federal government. To date, no additional other treatments that can prevent or cure some of the illnesses routes of transmission have been recorded; despite a national associated with AIDS. As with other diseases, early detection alert system designed to detect just such an occurrence. offers more options for treatment and preventative care. HIV and AIDS Statistics The Origins of HIV and AIDS United States: The Center for Disease Control (CDC) esti- Scientists have different theories about the origin of HIV, but mates that between 800,000 and 900,000 people are living none have been proven. The earliest known case of HIV was with HIV with approximately 40,000 new infections every from a blood sample collected in 1959 from a man in year. Through December 2000, a total of 774,467 cases of Kinshasha, Democratic Republic of Congo (how he became AIDS had been reported to the CDC. 640,022 reported among infected is not known.) Genetic analysis of this blood sample men, 134,441 reported among women, and 8,908 reported suggests that HIV-1 may have stemmed from a single virus in among children under 12 the late 1940s or early 1950s. We do know that the virus has existed in the United States since at least the mid- to late HIV and AIDS in Ohio 1970s. From 1979-1981 rare types of pneumonia, cancer, and The following charts will give you an indication of just how other illnesses were being reported by doctors in Los Angeles serious HIV/AIDS continues to be in the state of Ohio: and New York among a number of gay male patients. These were conditions not usually found in people with healthy immune systems. Demographic Characteristics of Ohio’s Population, 2000 Census and Reported Persons Living with HIV/AIDS as of December 31,2001 Ohio In 1982 public health officials began to use the term "acquired immunodeficiency syndrome," or AIDS, to describe the occur- Demographics Population Census Reported Persons rences of opportunistic infections, Kaposi's sarcoma, and 2000 Living with HIV/AIDS Pneumocystis carinii pneumonia in previously healthy men. # % # % Formal tracking (surveillance) of AIDS cases began that year Gender in the United States. The cause of AIDS is a virus that scien- Male 5,512,262 48.6% 9,192 80.8% 2,189 19.2% tists isolated in 1983. The virus was at first named HTLV- Female 5,840,878 51.4% Unknown 2 <.1% III/LAV (human T-cell lymphotropic virus-type III/lym- phadenopathy- associated virus) by an international scientific Race/Ethnicity committee. This name was later changed to HIV (human White 9,538,111 84.0% 5,596 49.2% immunodeficiency virus). African American 1,290,662 11.4% 4,802 42.2% Hispanic 197,008 1.7% 532 4.7% How is AIDS transmitted? Asian/Pacific Islander 134,006 1.2% 38 0.3% Native American 21,985 0.2% 19 0.2% The ways in which HIV can be transmitted have been clearly Unknown 396 3.5% identified. Unfortunately, some widely dispersed information does not reflect the conclusions of scientific findings. The fol- Age lowing information is provided to help correct a few common- <13 2,071,345 18.2% 98 0.9% ly held misperceptions about HIV. 13 - 19 1,144,610 10.1% 59 0.5% 20 - 29 1,464,510 12.9% 1,008 8.9% Transmission of HIV is spread by sexual contact with an 30 - 39 1,668,083 14.7% 4,381 38.5% infected person, by needle-sharing among injecting drug users, 40 - 49 1,756,376 15.5% 4,128 36.3% 3,248,216 28.6% 1,709 15.0% or, less commonly (and now very rarely in countries where 50+ blood is screened for HIV antibodies), through transfusions of Race/Gender* infected blood or blood clotting factors. Babies born to HIV- White Male 4,638,241 40.9% 4,832 42.4% infected women may become infected before or during birth, White Female 4,899,870 43.2% 764 6.7% or through breast-feeding after birth. African American Male 610,872 5.4% 3,628 31.9% Some people fear that HIV might be transmitted in other African American Female 679,790 6.0% 1,173 10.3% 178,536 1.6% 422 3.7% ways; however, no scientific evidence to support any of these Other Male Other Female 174,463 1.5% 167 1.5% fears has been found. If HIV were being transmitted through Unknown 397 3.5% other routes (for example, through air or insects), the pattern of reported AIDS cases would be much different from what Total 11,353,140 11,383 has been observed, and cases would be occurring much more

2 Reported new HIV diagnosis in 2003, reported persons living with HIV/AIDS as of December 31,2003 and reported deaths among persons with HIV/AIDS as of December 31,2003, Ohio , by County Total HIV Reported Persons Known Total HIV Reported Persons Known a a Diagnoses Living with HIV/AIDS Dead Diagnoses Living with HIV/AIDS Dead 2003 2003 HIV/AIDS HIV/AIDS County b No. Rate c No. No. County b No. Rate c No. No. Adams -- 40.2 11 5 Logan 2 45.6 21 13 Allen 8 106.9 116 47 Lorain 13 73.8 210 125 Ashland -- 17.1 9 8 Lucas 59 173.2 788 367 Ashtabula 8 45.8 47 24 Madison -- 44.8 18 12 Athens 2 46.6 29 19 Mahoning 29 123.5 318 164 Auglaize 4 34.3 16 7 Marion 1 64.9 43 30 Belmont 1 34.2 24 18 Medina -- 16.5 25 22 Brown -- 30.7 13 6 Meigs -- 43.7 8 2 Butler 5 58.8 195 107 Mercer -- 14.7 6 8 Carroll -- 20.8 6 6 Miami 5 71.8 71 29 Champaign 1 54.0 21 12 Monroe -- 19.8 3 4 Clark 6 75.3 109 102 Montgomery 67 178.7 999 518 Clermont 5 25.8 46 32 Morgan -- 20.1 3 1 Clinton -- 29.6 12 15 Morrow -- 15.8 5 10 Columbiana 1 39.3 44 28 Muskingum 1 60.3 51 25 Coshocton -- 24.6 9 4 Noble -- 14.2 2 0 Crawford 1 44.7 21 16 Ottawa 2 41.5 17 13 Cuyahoga 176 234.6 3,270 1,805 Paulding -- 49.3 10 4 Darke 3 41.3 22 16 Perry 1 35.2 12 7 Defiance -- 53.2 21 11 Pickaway 2 39.8 21 18 Delaware 7 47.3 52 23 Pike -- 50.6 14 8 Erie 3 74.2 59 36 Portage 3 37.5 57 38 Fairfield 3 45.6 56 37 Preble 1 37.8 16 8 Fayette -- 42.2 12 9 Putnam -- 8.6 3 7 Franklin 239 239.1 2,556 1,417 Richland 10 66.7 86 68 Fulton 2 38.0 16 11 Ross 2 68.2 50 30 Gallia 1 41.8 13 6 Sandusky 1 48.5 30 23 Geauga 2 24.2 22 16 Scioto 5 51.8 41 26 Greene 7 52.7 78 65 Seneca -- 29.0 17 18 Guemsey -- 49.0 20 5 Shelby 1 33.4 16 17 Hamilton 84 203.8 1,723 1,033 Stark 18 70.6 267 162 Hancock 2 54.7 39 22 Summit 33 109.2 593 357 Hardin -- 25.0 8 8 Trumbull 11 54.2 122 68 Harrison -- 18.9 3 5 Tuscarawas 1 16.5 15 11 Henry -- 30.8 9 5 Union 1 31.8 13 11 Highland -- 39.1 16 10 Van Wert -- 6.7 2 2 Hocking -- 56.7 16 7 Vinton -- 7.8 1 1 Holmes -- 20.5 8 2 Warren 2 41.0 65 28 Huron 1 20.2 12 12 Washington 1 53.8 34 32 Jackson -- 42.9 14 9 Wayne 5 33.2 37 22 Jefferson 2 55.5 41 44 Williams 2 61.2 24 9 Knox -- 34.9 19 13 Wood 5 43.8 53 29 Lake 3 40.0 91 78 Wyandot -- 13.1 3 4 Lawrence 3 46.5 29 23 No County 61 * 1,187 182 Licking 7 55.0 80 63 Total 932 126.9 14,410 7,779 aTotal HIV diagnosis reflect all cases of HIV infection diagnosed for the first time, including cases that are diagnosed with HIV infection, not AIDS; cases that are diagnosed with HIV and progressed to AIDS within the same year; and cases concurrently diagnosed with HIV and AIDS. bCounty is based on county of residence at time of HIV diagnosis for data reflecting total HIV diagnoses, and county of most recent known residence for data reflecting persons living with HIV/AIDS. Cases whose residence is a correctional facility or whose county is unknown are included in No County. cLiving with HIV/AIDS rate is the number of persons living with HIV/AIDS per 100,000 population calculated using 2000 census data.

Dash indicates no cases were reported for the given category. Asterisk indicates rates are not calculated because census data is not applicable to the respective category.

3 Demographic Characteristics of Persons Living with HIV/AIDS The following paragraphs specifically address some of the by Geographic Region more common misconceptions about HIV transmission. The table below shows the demographic distribution of persons living with HIV/AIDS in Ohio for the three categories. While there are dif- HIV in the Environment ferences across regions regarding the distribution of persons living Scientists and medical authorities agree that HIV does not sur- with HIV/AIDS, the rate for each population group is highest in vive well in the environment, making the possibility of envi- MSA’s with greater than 500,000 population, followed by MSA’s ronmental transmission remote. HIV is found in varying con- with 50,000 - 500,000, and then non-metropolitan areas. centrations or amounts in blood, semen, vaginal fluid, breast The age distribution of persons living with HIV/AIDS is very similar milk, saliva, and tears. In order to obtain data on the survival across regions with the majority of persons living with HIV/AIDS of HIV, laboratory studies have required the use of artificially between the ages of 30 and 49. Minorities are disproportionately high concentrations of laboratory-grown virus. Erroneous impacted by HIV in each of the areas, in MSA’s greater than 500,000, interpretation of conclusions drawn from laboratory studies African Americans make up 42% of persons living with HIV/AIDS have alarmed people unnecessarily. but only 14% of the population. Similarly, in MSA’s with 50,000 - 500,000 African Americans account for 28% of those infected and Results from laboratory studies should not be used to deter- 6% of the population, and in non-metropolitan areas, they comprise mine specific personal risk of infection and to date no one has 10% of those living with HIV/AIDS and 2% of the population. The been identified with HIV due to contact with an environmental proportion of persons living with HIV/AIDS that are female is simi- surface; Additionally, since HIV is unable to reproduce outside lar across the regions with a larger percentage (26%) in MSA’s with a its living host (unlike many bacteria or fungi, which may do population of 50,000 to 500,000. so under suitable conditions), except under laboratory condi- Due to a large percentage of reports that do not contain risk informa- tions, it does not spread or maintain infectiousness outside its tion (>30%), it is difficult to draw valid conclusions pertaining to risk host. factors among persons living with HIV/AIDS. However, the patterns among reports with risk information suggests a similar distribution Other Settings across the three geographic regions with male/male sex the leading Although HIV has been transmitted between family members risk exposure, followed by high risk heterosexual contact, and then in a household setting, this type of transmission is very rare. injection drug use. These transmissions are believed to have resulted from contact between skin or mucous membranes and infected blood. To Reported Persons Living with HIV/AIDS as of December 31,2001 prevent even such rare occurrences, precautions, as later by Geographic Region described in this course, should be taken in all settings-includ- MSA>500,000 MSA>50,000 Non-Metropolitan Total ing the home-to prevent exposures to the blood of persons - 500,000 who are HIV infected, at risk for HIV infection, or whose Demographics Rate** # % Rate** # % Rate** # % Rate** # % infection and risk status are unknown. Age as of 12/31/2001 For example: <13 5.3 80 1% 4.6 8 2% 2.6 10 1% 4.7 98 1% 13 - 19 6.3 51 1% -- 3 1% -- 4 1% 5.2 59 1% Gloves should be worn during contact with blood or 20 - 29 73.1 791 9% 38.8 45 9% 22.9 61 9% 68.8 1008 9% other body fluids that could possibly contain blood. 30 - 39 275.7 3390 39% 142.1 197 39% 87.0 261 39% 262.6 4381 38% 40 - 49 258.7 3294 36% 112.6 178 35% 72.6 236 35% 235.0 4128 36% Personal service workers (e.g., barbers, cosmetolo- 50+ 61.6 1419 16% 24.1 77 15% 16.1 101 15% 52.6 1709 15% gists) should wear gloves when waxing, giving mani- Race cures/pedicures, facials, tweezing or any other service White 66.7 4398 49% 37.9 348 69% 27.9 566 84% 58.7 5596 49% African American 328.7 3803 42% 228.0 140 28% 163.8 69 10% 372.1 4801 42% that could possibly draw blood. Hispanic 285.4 455 5% 130.1 10 2% 36.8 11 2% 270.0 532 5% Asian/Pacific Cuts, sores, or breaks on both the personal-service Islander 29.1 35 <1% -- 0 -- 1 <1% 28.4 38 <1% worker's and the client or customer's exposed skin Native American 118.1 18 <1% -- 0 -- 1 <1% 86.4 19 <1% Unknown 316 4% 10 2% 25 4% 396 3% should be covered with bandages. Gender Hands and other parts of the body should be washed Male 181.9 7216 80% 77.0 378 74% 51.1 538 80% 166.8 9192 81% Female 42.6 1807 20% 25.2 130 26% 12.4 135 20% 37.5 2189 19% immediately after contact with blood or other bodily Unknown 2 <1% 0 0 2 <1% fluids. Total 110.0 9025 50.4 508 31.5 673 100.3 11383 Surfaces soiled with blood should be disinfected with an EPA registered tuberculocidal disinfectant *Geographic region is based on known residence. Cases whose resi- dence is a correctional facility or whose county is unknown are only Practices that increase the likelihood of blood con- included in the Total numbers. tact, such as the careless use of razors, scissors and clippers, should be avoided. **Living with HIV/AIDS rate is the number of persons living with Needles and other sharp instruments should be used HIV/AIDS per 100,000 population using 2000 census data. Rates are only when medically necessary and handled accord- not calculated when the number is less than 5. ing to recommendations for health-care settings.

4 In 1985, CDC issued routine precautions that all personal Where can I get tested for HIV infection? service workers (e.g., barbers, cosmetologists, massage thera- Many places provide testing for HIV infection. Common test- pists) should follow, even though there is no evidence of trans- ing locations include local health departments, offices of pri- mission from a personal-service worker to a client or vice vate doctors, hospitals, and sites specifically set up to provide versa. Instruments that are intended to penetrate the skin (e.g., HIV testing. tattooing and acupuncture needles, ear piercing devices) should be used once and disposed of or thoroughly cleaned Home testing kits: and sterilized. • Can be purchased in most pharmacies and via the Internet and involve no actual testing of the blood by Instruments not intended to penetrate the skin but which may the person using the kit. The only "at-home" compo- become contaminated with blood (e.g., razors) should be used nents of the testing process involve the collection of a for only one client and disposed of or thoroughly cleaned and small sample of blood using a finger stick and the disinfected after each use. Personal-service workers can use receipt of the results over the phone. First, the blood the same cleaning procedures that are recommended for sample is mailed to the manufacturer for a standard health-care institutions. EIA test. The consumer must call a phone number several days later to receive the results and be offered Simple Steps You Can Take To Prevent HIV Infection: the choice of speaking to a trained counselor. A posi- Do not have sex with an infected person. tive result must be confirmed with a blood-based Do not share needles with an infected person. Western Blot (which cannot be done with a home- To prevent the spread of HIV infection, avoid behav- based test kit). ior that might result in contact with blood, semen, Rapid tests: vaginal secretions, or body fluids with visible blood. • A rapid test is a screening test that produces very Specifically, avoid sex with anyone who might be quick results, in approximately 20-60 minutes. In infected with HIV and do not share "injecting drug comparison, results from the other more commonly works." used HIV antibody screening test, the enzyme Effectiveness of Condoms immunoassay (EIA), are not available for several When condoms are used reliably, they have been shown to days to a few weeks. prevent pregnancy up to 98 percent of the time among couples Both the rapid test and the EIA look for the presence using them as their only method of contraception. Similarly, of antibodies to HIV. As is true for all screening tests, numerous studies among sexually active people have demon- a reactive rapid HIV test result must be confirmed strated that a properly used latex condom provides a high with a follow-up confirmatory test before a final degree of protection against a variety of sexually transmitted diagnosis of infection can be made. Visit diseases, including HIV infection. Condoms are classified as www.cdc.gov for more information on rapid tests. medical devices and are regulated by the Food and Drug Administration. Each latex condom manufactured in the Treatment of HIV/AIDS United States is tested for defects, including holes, before it is In recent years, medical science has made great progress in packaged, and several studies clearly show that condom break- our ability to successfully treat HIV infection and associated age rates in this country are less than 2 percent. Latex con- opportunistic infections (OIs). Wider use of medications for doms can provide up to 98-99 percent protection against preg- preventing tuberculosis, Pneumocystis carinii pneumonia nancy and most sexually transmitted diseases, including HIV (PCP), toxoplasmosis, and Mycobacterium avium complex infection, but only if they are used consistently and correctly. (MAC), for example, has helped reduce the number of people with HIV who develop serious illness and die from AIDS. How long after a possible exposure should I wait to get test- Also, several new compounds in a new class of drugs, called ed for HIV? protease inhibitors, have been federally approved to treat HIV The tests commonly used to detect HIV infection actually look infection. These drugs, when taken in combination with previ- for antibodies produced by your body to fight HIV. Most peo- ously approved drugs such as AZT, 3TC and ddI, reduce the ple will develop detectable antibodies within 3 months after level of HIV particles circulating in the blood to very low lev- infection, the average being 25 days. In rare cases, it can take els in many individuals. Treatment results using these drugs up to 6 months. For this reason, the CDC currently recom- have been extremely encouraging, as these drug combinations mends testing 6 months after the last possible exposure are more effective than any previously available therapies. (unprotected vaginal, anal, or oral sex or sharing needles). It would be extremely rare to take longer than 6 months to Coinfection with HIV and Hepatitis C Virus develop detectable antibodies. It is important, during the 6 About one quarter of HIV-infected persons in the United months between exposure and the test, to protect yourself and States are also infected with hepatitis C virus (HCV). HCV is others from further possible exposures to HIV. one of the most important causes of chronic liver disease in

5 the United States and HCV infection progresses more rapidly HCV can adopt measures to prevent acquiring HCV. Such to liver damage in HIV-infected persons. HCV infection may measures will also reduce the chance of transmitting their HIV also impact the course and management of HIV infection. The infection to others. latest U.S. Public Health Service/Infectious Diseases Society of America (USPHS/IDSA) guidelines recommend that all Not injecting or stopping injection drug use would HIV-infected persons should be screened for HCV infection. eliminate the chief route of HCV transmission Prevention of HCV infection for those not already infected Toothbrushes, razors, and other personal care items and reducing chronic liver disease in those who are infected that might be contaminated with blood should not be are important concerns for HIV-infected individuals and their shared. Although there are no data from the United health care providers. States indicating that tattooing and body piercing Likely Candidates for HIV-HCV coinfection? place persons at increased risk for HCV infection, The hepatitis C virus (HCV) is transmitted primarily by large these procedures may be a source for infection with or repeated direct percutaneous (i.e., passage through the skin any bloodborne pathogen if proper infection control by puncture) exposures to contaminated blood. Therefore, practices are not followed coinfection with HIV and HCV is common (50%-90%) among Although consistent data are lacking regarding the HIV-infected injection drug users (IDUs). Coinfection is also extent to which sexual activity contributes to HCV common among persons with hemophilia who received clot- transmission, persons having multiple sex partners ting factor concentrates before concentrates were effectively are at risk for other sexually transmitted diseases treated to inactivate both viruses (i.e., products made before (STDs) as well as for transmitting HIV to others. 1987). The risk for acquiring infection through perinatal or They should be counseled accordingly sexual exposures is much lower for HCV than for HIV. For persons infected with HIV through sexual exposure (e.g., How should individuals coinfected with HIV and HCV be male-to-male sexual activity), coinfection with HCV is no managed? more common than among similarly aged adults in the general population (3%-5%). General guidelines Persons coinfected with HIV and HCV should be encouraged Effects of coinfection on disease progression of HCV and to adopt safe behaviors (as described in the previous section) HIV? to prevent transmission of HIV and HCV to others. Chronic HCV infection develops in 75%-85% of infected per- Individuals with evidence of HCV infection should be given sons and leads to chronic liver disease in 70% of these chroni- information about prevention of liver damage, undergo evalua- cally infected persons. HIV-HCV coinfection has been associ- tion for chronic liver disease and, if indicated, be considered ated with higher titers of HCV, more rapid progression to for treatment. Persons coinfected with HIV and HCV should HCV-related liver disease, and an increased risk for HCV- be advised not to drink excessive amounts of alcohol. related cirrhosis (scarring) of the liver. Because of this, HCV Avoiding alcohol altogether might be wise because the effects infection has been viewed as an opportunistic infection in of even moderate or low amounts of alcohol (e.g., 12 oz. of HIV-infected persons and was included in the 1999 beer, 5 oz. of wine or 1.5 oz. hard liquor per day) on disease USPHS/IDSA Guidelines for the Prevention of Opportunistic progression are unknown. When appropriate, referral should Infections in Persons Infected with Human Immunodeficiency be made to alcohol treatment and relapse-prevention pro- Virus. It is not, however, considered an AIDS-defining illness. grams. Because of possible effects on the liver, HCV- infected As highly active antiretroviral therapy (HAART) and prophy- persons should consult with their health care professional laxis of opportunistic infections increase the life span of per- before taking any new medicines, including over-the-counter, sons living with HIV, HCV-related liver disease has become a alternative or herbal medicines. major cause of hospital admissions and deaths among HIV- infected persons. Susceptible coinfected persons should receive hepatitis A vac- cine because the risk for infection with hepatitis A is increased The effects of HCV coinfection on HIV disease progression in persons with chronic liver disease. Susceptible patients are less certain. Some studies have suggested that infection should receive hepatitis B vaccine because most HIV-infected with certain HCV genotypes is associated with more rapid persons are at risk for HBV infection. The vaccines appear progression to AIDS or death. However, the subject remains safe for these patients and more than two-thirds of those vac- controversial. Since coinfected patients are living longer on cinated develop antibody responses. Prevaccination screening HAART, more data are needed to determine if HCV infection for antibodies against hepatitis A and hepatitis B in this high- influences the long-term natural history of HIV infection. prevalence population is generally cost-effective. Postvaccination testing for hepatitis A is not recommended, Prevention of coinfection with HCV but testing for antibody to hepatitis B surface antigen (anti- Persons living with HIV who are not already coinfected with HBs) should be performed 1-2 months after completion of the

6 primary series of hepatitis B vaccine. Persons who fail to ly people who have weak immune systems, the bacteria respond should be revaccinated with up to three additional become active and cause TB disease. doses. The Basic Facts on Hepatitis Tuberculosis Tuberculosis, also known as TB, is an infectious disease that Viral Hepatitis may affect almost any tissue in the body especially the lungs. Hepatitis is an inflammation of the liver caused by medica- It is caused by the bacteria mycobacterium tuberculosis and tions, alcohol, or a variety of other agents including the virus- characterized by tubercles, the characteristic lesion of tubercu- es that cause mumps, measles, herpes and infectious mononu- losis. cleosis. However, when health professionals talk about viral hepatitis, they usually mean hepatitis caused by the hepatitis Nearly one-third of the world's population is infected with A, hepatitis B, or hepatitis C virus. Tuberculosis (TB), which kills almost 3 million people a year. TB is the leading cause of death due to an infectious agent in The Differences between Hepatitis A, B and C the world. In the mid-1980s a resurgence of outbreaks in the Although hepatitis A, B and C have similar symptoms, the United States brought new attention to TB. viruses themselves are quite different. The hepatitis A virus can enter a person's body when he/she eats or drinks some- Increases in the incidence of TB are related to the high risk thing contaminated with the stool or blood of someone who among immunosuppressed persons, particularly those infected has the disease. Symptoms usually appear within 2-6 weeks, with human immunodeficiency virus (HIV). Drug resistant but are not followed by the chronic problems that hepatitis B strains of this deadly disease have contributed to the problem. and C viruses can cause. The hepatitis B and C viruses can Outbreaks have occurred in hospitals, correctional institutions, infect a person if his/her mucous membranes or blood are homeless shelters, nursing homes, and residential care facili- exposed to an infected person's blood, saliva, wound exudates, ties for AIDS patients. Nationwide, at least several hundred semen or vaginal secretions. Symptoms appear more gradual- employees have become infected and have required medical ly than in hepatitis A. Unlike the hepatitis A virus, the hepati- treatment after workplace exposure to TB. tis B and C viruses can stay in the body - sometimes for a life- time - and eventually cause chronic, serious liver diseases. TB is spread through the air from one person to another. The bacteria are put into the air when a person with TB disease of Protections against Infection the lungs or throat coughs or sneezes. People nearby may Because the different viruses that cause hepatitis enter the breathe in these bacteria and become infected. When a person body in different ways, there are several steps you can take to breathes in TB bacteria, the bacteria can settle in the lungs and protect yourself from infection. Practicing good hygiene and begin to grow. From there, they move through the blood to safer sexual behaviors is a good first step. For more specific other parts of the body, such as the kidney, spine, and brain. information, see the individual sections for hepatitis A, B and TB in the lungs or throat can be infectious. This means that C. the bacteria can be spread to other people. TB in other parts of the body, such as the kidney or spine, is usually not infectious. The Symptoms of Viral Hepatitis Early Symptoms of Viral Hepatitis Include: People with TB disease are most likely to spread it to people fatigue they spend time with everyday. This includes family members, tenderness in the upper right abdomen friends, and coworkers. In most people who breathe in TB sore muscles & joints bacteria and become infected, the body is able to fight the bac- loss of appetite teria to stop them from growing. The bacteria become inac- an altered sense of taste & smell tive, but they remain alive in the body and can become active nausea, vomiting & diarrhea later. This is called TB infection. low-grade fever People with TB infection: malaise Have no symptoms Other symptoms can include: Don't feel sick jaundice - abnormally yellow skin & eyes caused by Can't spread TB to others bile entering the blood Usually have a positive skin test reaction darkened urine; light-colored or gray stool Can develop TB disease later in life if they do not receive preventive therapy Diagnosis of Hepatitis Although health providers use information about a person's Many people who have TB infection never develop TB dis- symptoms, health history and behaviors to help make a diag- ease. In these people, the TB bacteria remain inactive for a nosis, only blood tests can confirm the diagnosis and pinpoint lifetime without causing disease. But in other people, especial- which type of hepatitis a person has.

7 Treatments for Viral Hepatitis Sharing food with an infected person or drinking Since there's no medication that can treat the initial illness that water contaminated with sewage. viral hepatitis causes, health professionals manage symptoms Oral or anal sexual contact with an infected person. as they occur and try to help the body's immune system fight Traveling to developing countries where the disease the infection. If you have viral hepatitis, your health care is common. provider may tell you to: Sharing needles can also put you at risk. The hepati- tis A virus can be transmitted through blood if nee- Avoid alcohol and other drugs, large doses of vita- dles are shared. However, poor hygiene - either mins, and prescription drugs metabolized by the liver among people who use drugs or among drug produc- (sometimes including birth control pills) ers - is probably a more important reason for the high Drink high-calorie fluids such as fruit juices and eat a prevalence among drug users. balanced diet that includes dairy products; meat, poultry or seafood; breads and cereals; and fruits and Prevention of Hepatitis A vegetables (To control nausea, try eating several Practice good personal hygiene. Always wash your hands smaller meals) after any contact with blood, when cleaning or after using the Limit activity if your hepatitis is symptomatic; this toilet, and before preparing or eating food. Avoid foods that typically means bed rest at first, progressing to nor- could be contaminated, such as under-cooked shellfish or food mal activity as symptoms disappear that's been prepared by someone who has the virus. When traveling to developing countries, drink only bottled or boiled Your health professional may recommend hospitalization if water, don't use ice, and don't eat raw fruits or vegetables you experience severe vomiting or do not feel better after sev- unless they've been peeled. It is also a good idea to get the eral weeks. You should know that researchers are making hepatitis A vaccine. gains in treating the chronic liver disease associated with both hepatitis B and C. There is not much available for treatment. Exposure to Hepatitis A Interferon has been approved in chronic hepatitis B and C If you think you've been directly exposed to the hepatitis A cases for those aged 18 or older. Prevention is still the best virus, visit your health care provider immediately for treat- option. ment. Some treatments can help ward off the infection if administered in time (hepatitis A vaccine and IgG). All people Hepatitis A (HAV) who have close household or sexual contact with an infected Hepatitis A infects 125,000 - 200,000 people each year and person also need treatment. can be easily transmitted. You can become infected by eating or drinking something that has been contaminated with the Preventing the Spread of Hepatitis A stool (feces) or blood of someone who has the disease. If you think you may be infected with hepatitis A: Always wash your hands well after using the toilet. Facts about Hepatitis A Don't prepare or handle food for others while you are Symptoms occur 2-6 weeks after exposure and can last from infectious. several days to six months. The virus usually causes mild ill- Avoid sexual contact with other people until you are ness and is often mistaken for a stomach virus, although occa- fully recovered. sionally symptoms are more serious. It is rarely fatal and does not cause permanent liver damage. Hepatitis B (HBV) In the United States, approximately 300,000 people are infect- A person with hepatitis A is considered contagious, which ed with HBV annually. Of these cases, a small percentage is means they can transmit the virus to others as early as two fatal. weeks before symptoms appear. "Hepatitis" means "inflammation of the liver," and its name The hepatitis A virus does not cause the long-term, chronic implies, Hepatitis B is a virus that infects the liver. Hepatitis symptoms that other hepatitis viruses can cause. B is transmitted through 'blood-to-blood` contact. Hepatitis B Behavior Practices Associated with Hepatitis A Infection initially causes inflammation of the liver, but it can lead to Eating contaminated food, such as undercooked shell more serious conditions such as cirrhosis and liver cancer. fish from contaminated water or food handled by There is no "cure" or specific treatment for HBV, but many someone who has hepatitis A. people who contract the disease will develop antibodies, Using silverware, cups or glasses that an infected per- which help them get over the infection and protect them from son touched with unwashed hands. getting it again. It is important to note, however, that there are Changing diapers or linens that contain stool from different kinds of hepatitis, so infection with HBV will not someone with hepatitis A and neglecting to wash stop someone from getting another type. your hands.

8 The Hepatitis B virus is very durable, and it can survive in Amazon, Bahia, Haiti, and the Dominican Republic dried blood for up to seven days. For that reason, this virus is are at risk the primary concern for employees such as housekeepers, funeral directors, custodians, laundry personnel and other Risk Behaviors for Contracting HBV employees who may come in contact with blood or potentially 1) Practicing unsafe sex. The more partners with whom you infectious materials in a non first aid or medical care situation. have vaginal, anal or oral contact, the higher your risk of becoming infected with hepatitis B. Abstinence is the most Symptoms effective way to prevent sex-related transmission. If you The symptoms of HBV are very much like a mild "flu". have vaginal, anal or oral contact, always use barrier pro- Initially there is a sense of fatigue, possible stomach pain, loss tection. People who have sex with multiple partners should of appetite, and even nausea. As the disease continues to ask their health provider about getting vaccinated for hepa- develop, jaundice (a distinct yellowing of the skin and eyes), titis B. and darkened urine often develop. However, people who are infected with HBV will often show no symptoms for some 2) Sharing needles. No matter what drug is injected, whether time. After exposure it can take 1-9 months before symptoms its crack, heroin or steroids, sharing needles is extremely become noticeable. Loss of appetite and stomach pain, for risky. In fact, an estimated 60-80 percent of the people who example, commonly appears within 1-3 months, but can occur share needles are or have been infected with hepatitis B. as soon as 2 weeks or as long as 6-9 months after infection. Similarly, beware of needles that could be contaminated when getting tattoos, having acupuncture or your ears Hepatitis B (HBV) and Sexually Transmitted Disease pierced. Select a reputable professional for these services. Prevented by HBV Vaccine The hepatitis B virus infects people of all ages. It is one of the 3) Close, frequent contact with the blood, semen, vaginal fastest-spreading sexually transmitted infections (STI), and secretions or saliva of infected persons. Occasionally, peo- also can be transmitted by sharing needles or by any behavior ple who share living quarters for a long time with others in which a person's mucus membranes are exposed to an who have hepatitis B have gotten infected. Receiving a infected person's blood, semen, vaginal secretions, or saliva. blood transfusion or other blood products no longer carries While the initial sickness is rarely fatal, 10 percent of people the threat of hepatitis B that it once did. Today, all blood is who get hepatitis B are infected for life and run a high risk of screened for hepatitis B before it is used. developing serious, long-term liver diseases such as cirrhosis Prevention of Hepatitis B of the liver or liver cancer which can cause serious complica- If you are at risk of contracting hepatitis B, get vaccinated. tions or death. A safe, effective vaccine that prevents hepatitis The hepatitis B vaccine is an inactivated antigen (genetically B is available. If you or someone you know practices behav- engineered; not a live or killed virus). It is administered in a iors that can spread hepatitis B, ask a medical professional series of three injections over a six-month period. about the vaccine. Don't become one of the 300,000 Approximately 95% of persons who receive the three injec- Americans who contracts hepatitis B every year. tions obtain full immunity after receiving the vaccine. You are Facts about Hepatitis B (HBV) asked to report side effects (rash, nausea, joint pain, and/or fatigue) to your health care provider. Also, avoid high-risk Symptoms, if they occur, appear from one to six behaviors and practice good personal hygiene when sharing months after exposure to the virus food and using bathrooms. Don't share razors, toothbrushes or An infected person can begin infecting others four to pierced earrings with anyone. six weeks before symptoms appear, and can continue infecting others long after symptoms subside Exposure to Hepatitis B About one in ten people infected with hepatitis B If you have not been vaccinated against hepatitis B but are become chronic carriers; they continue carrying the exposed to the virus, your health professional can treat you virus and spread it to others even though their symp- with hepatitis B immune globulin (HBIG), combined with the toms have disappeared. About one-quarter of these hepatitis B vaccination. Don't delay - get immunized and vac- chronic carriers eventually die of severe, chronic liver cinated as soon as possible after exposure. diseases, including cirrhosis - a serious scarring of the liver - and liver cancer Preventing the Spread of Hepatitis B About half of the people infected with hepatitis B Don't engage in sexual contact without a condom virus never develop symptoms; but they can become Don't donate blood. Bandage all cuts and open sores chronic carriers Don't share anything that could be contaminated with Since some areas of the world have high rates of your blood, semen, vaginal secretions or saliva - such infection, people from places such as Southeast Asia, as needles, razors or toothbrushes South Pacific Islands, sub-Saharan Africa, Alaska, Wash your hands well after using the toilet If you have hepatitis B and you're pregnant, your

9 baby must be immunized at birth. All pregnant HIV/ AIDS & Communicable Diseases Education women should be screened for hepatitis B Review Practice Questions Answers to each question can be found in this section Hepatitis B Vaccinations The Hepatitis B virus vaccination is given in a series of three shots. The second shot is given one month after the first, and 1) The Human Immunodeficiency Virus (HIV) is the virus the third shot follows five months after the second. This series that causes: gradually builds up the body's immunity to the Hepatitis B virus. A) Hepatitis B B) Hepatitis C Hepatitis C (HCV) HCV is widely viewed as one of the most serious of the five C) AIDS D) Tuberculosis hepatitis viruses. The Hepatitis C virus is spread primarily through contact with infected blood and can cause cirrhosis (irreversible and potentially fatal liver scarring), liver cancer, 2) Describe some common misconceptions about HIV trans- or liver failure. Hepatitis C is the major reason for liver trans- mission: plants in the United States, accounting for 1,000 of the proce- dures annually. The disease is responsible for between 8,000 and 10,000 deaths yearly. Some estimates say the number of 3) ______are microorganisms such as HCV-infected people may be four times the number of those viruses or bacteria that are carried in the blood and can infected with the AIDS virus. Hepatitis C is less likely than cause disease in people. the other hepatitis viruses to cause serious illness at first (only one-quarter of the people infected actually develop symp- toms); about 70% of those infected develop chronic liver dis- 4) Hepatitis A infects 125,000 - 200,000 people each year ease. and can be easily transmitted.

Like hepatitis B, hepatitis C can be spread by contact with True False infected blood, and possibly semen, vaginal secretions and saliva. Hepatitis C infects about 150,000 Americans each year. Risk Behaviors 5) The ways in which HIV can be transmitted have been You are at risk if you share needles; receive contaminated clearly identified. blood during a blood transfusion; or have sexual contact with- out barrier protection with infected partners. True False Prevention of Hepatitis C Since hepatitis C is transmitted in much the same way as hep- atitis B, you can help avoid infection by using some of the same precautions. Always use barrier protection during sexual contact; practice good personal hygiene; and never share nee- dles, razors, toothbrushes or pierced earrings with anyone. All donated blood is screened for the virus. Drugs are licensed for treatment of persons with chronic infection, though they are only about 15-30% effective. Currently, there is no vaccine available. Hepatitis D (HDV) The delta virus (also known as hepatitis D) is a defective virus that may cause infection only in the presence of active hepati- tis B infection. The symptoms and routes of transmission are similar to those of hepatitis B infection, but are particularly significant with intravenous drug abusers and pregnant women.

10 Chapter 2 (OSHA) EDUCATION AND SALON SAFETY (1 Credit Hour)

Learning Objectives Describe a Material Safety Data Sheet (MSDS) Know the purpose of an MSDS Know how to safely work with chemicals Be aware of how workplace injuries can occur Be able to describe fire dangers in a salon

OSHA and You OSHA has not formulated any rules and regulations that deal specifically with the Cosmetology industry. While no specific rules exist, individuals engaged in the practice of cosmetology are expected to abide by basic rules contained within the Code of Federal Regulations (29 CFR) that deal with workplace safety and health. These rules describe the responsibilities of employers and employees in dealing with hazardous chemi- cals, personal protective devices, proper ventilation, and pre- vention from over exposure to dusts, and overall health and safety plans.

One regulation that indirectly impacts the cosmetology profes- sion is placed on the manufacturers of many of the products that you may use in your business. The federal government requires that product manufacturers make available to cus- tomers Material Safety Data Sheets (MSDS). Each MSDS must contain basic information on the each product manufac- tured. There is no standard format for an MSDS but each one must contain the following:

Identity of chemicals that may present physical or chemical hazards Physical hazards, i.e. volatility, evaporation rate and interaction with other chemicals Health hazards, i.e. possible physical side effects of product usage Primary routes of entry into the body Permissible exposure limits Carcinogen (cancer causing) hazard of the chemical Precautions and handling procedures Control and protection measures Emergency and first aid procedures Storage and disposal information

Your local product supplier is required by federal law to pro- vide you with an MSDS for each product you purchase from them. It is the legal responsibility of salon owners to collect MSDS for each product that you use in your business and to make them available for reference. The following is a sample of OSHA form 174 (MSDS) Sheet:

11 Material Safety Data Sheet U.S. Department of Labor May be used to comply with OSHA's Hazard Communication Occupational Safety and Health Administration Standard, 29 CFR 1910 1200. Standard must be consulted for (Non-Mandatory Form) specific requirements. Form Approved OMB No. 1218-0072 IDENTITY (as Used on Label and List) Note: Blank spaces are not permitted. If any item is not applicable or no information is available, the space must be marked to indicate that. Section I Manufacturer's name Emergency Telephone Number Address (Number, Street, City, State and ZIP Code) Telephone Number for Information Date Prepared Signature of Preparer (optional) Section II-Hazardous Ingredients/Identity Information Hazardous Components (Specific Chemical Identity, Common Other Limits Name(s)) OSHA PEL ACGIH TLV Recommended % (optional)

Section III-Physical/Chemical Characteristics Boiling Point Specific Gravity (H20 = 1) Vapor Pressure (mm Hg) Melting Point Vapor Density (AIR = 1) Evaporation Rate (Butyl Acetate = 1) Solubility in Water Appearance and Odor Section IV-Fire and Explosion Hazard Data Flash Point (Method Used) Flammable Limits LEL UEL Extinguishing Media Special Fire Fighting Procedures

Unusual Fire and Explosion Hazards

(Reproduce locally) OSHA 174 Sept. 1985

12 Section V-Reactivity Data Stability Unstable Conditions to Avoid Stable Incompatibility (Materials to Avoid) Hazardous Decomposition or Byproducts Hazardous May Occur Conditions to Avoid Polymerization Will Not Occur Section VI-Health Hazard Data Route(s) of Entry Inhalation? Skin? Ingestion? Health Hazards (Acute and Chronic)

Carcinogenicity NTP? IARC Monographs? OSHA Regulated?

Signs and Symptoms of Exposure

Medical Conditions Generally Aggravated by Exposure

Emergency and First Aid Procedures

Section VII-Precautions for Safe Handling and Use Steps to Be Taken in Case Material Is Released or Spilled

Waste Disposal Method

Precautions to Be Taken in Handling and Storing

Other Precautions

Section VII-Control Measures Respiratory Protection (Specify Type) Ventilation Local Exhaust Special Mechanical (General) Other Protective Gloves Eye Protection Other Protective Clothing or Equipment Work/Hygienic Practices

13 Working with Hazardous Chemicals chronic trouble, whether it's with your respiratory The issue of most concern to cosmetologists is chemical expo- system or your skin, you may want to reconsider your sure in the workplace. According to National Institute for career. Occupational Safety and Health (NIOSH), the chemicals used in a hair salon can cause a range of allergies and lung prob- Safe Work Environment lems, from hairspray-induced coughs to rashes caused by cer- Individuals engaged in the cosmetology industry today are tain chemicals in hair dye. The products most often cited are with a variety of health and safety issues. Exposure to chemi- aerosol hair sprays; formaldehyde and alcohol-based disinfec- cal vapors, dusts and other air contaminants are and should be tants, which are associated with an increase in the risk of a cause for concern. This is especially prevalent in full service spontaneous abortion; and methyl methacrylate liquid nails salons. To protect the salon professional as well as the monomers (MMA) and ethyl methacrylate (EMA). The latter client it is recommended that you institute some simple safe chemicals, used in nail products, can cause asthma, contact work guidelines. The following are a few examples: dermatitis, and allergies of the eyes and nose, according to 1) Have an action plan ready to deal with accidents. NIOSH. Although the Food and Drug Administration banned Keep emergency numbers handy. the use of all products containing 100 percent MMA in 1974, 2) Keep caps on all products such as nail polishes, sol- some nail products still contain a lower concentration of the vents and wrap glues. chemical. Other chemicals used in nail salons -- acetate and 3) Label all containers. This will avoid possible contam- toluene -- are also linked to headaches and skin and respirato- ination. ry disorders. Dyes and bleaches can cause dermatitis, or skin 4) Store all products in a cool dry area. This will extend rashes, among some salon professionals. the life of your product. Also, some products are highly flammable and could ignite if stored in an area Don't Let this Happen to You of excessive heat. A 49-year-old Knoxville businesswoman suffered third- 5) Avoid skin contact with acrylic liquids, wraps, adhe- degree burns over 15 percent of her body in a mishap at sives, etc. her business. She was injured while heating a glass 6) Empty your trash on a regular basis. This will avoid a bowl of acetone in a microwave. The flammable fluid, build-up of vapors or possible contaminants. used to remove fingernail polish, exploded in the 7) Do not allow smoking anywhere in the salon. microwave, springing open the door and engulfing her 8) Always wash your hands before touching any types in flames. of food or sensitive areas of your body such as your eyes or mouth. The woman ran from the back of the business with her face, hair and clothing on fire. Employees told authori- Ventilation v. Air Purification ties they regularly heated the acetone in the microwave In discussing the air -quality in salons today, there are really because the warmed fluid worked better. two acceptable methods to use in removing dusts and vapors. The most recommended method is ventilation to the outside. The Knoxville fire marshal cited the business for Your goal should be to remove vapors and dusts from the improper storage of flammable chemicals, because the building. Most methods such as fans, open doors or windows, substances were not kept in a fireproof cabinet. or ceiling vents simply recirculate the vapors and dusts. They do little to remove them from the air. The surest method is to Here are a few tips to avoid exposure to hazardous chemicals: install an exhaust fan that will literally suck up the vapors and Wear gloves: When doing a chemical process, dust and ventilate them to the outside. whether it's bleaching color or highlighting, you should always put rubber gloves on because all those Sometimes a building does not allow for ventilation. In these chemicals are very drying to the skin. Repeated expo cases the use of an air purifier is recommended. An air purifier sure to these chemicals can dry the skin to the point works by removing dusts and vapors from the air and trapping that cracking and bleeding can occur. Gloves are a them in an internal filter system. There are a wide variety air- good idea even when shampooing, because the deter- filtration systems on the market today. The one you choose gent in some products can be harsh on hands. really depends on your individual needs. However, when Proper ventilation: Hair spray and other fumes need selecting an air purifier, it is recommended purchasing one to be ventilated -- pumped out through exhaust fans with a HEPA filter and a canister packed with charcoal. or aired out through open windows or doors (prefer- ably both). Electric air cleaners are also recomm FIRE SAFETY AND PREVENTION ended. The Record of laundry fires Know your limits: Some people are simply more sen- One in six laundries, commercial industrial or institutional, sitive to chemicals than others. If you're running into reports a fire each year, more than 3000 fires annually. Many

14 small fires likely go unreported. National Fire Protection HOTEL FIRE CAUSES $1.5 MILLION LOSS. Orlando, Association statistics blame dryers for up to 70% of laundry Fl. (March 23, 1989). fires, only 5% are thought to be the result of spontaneous igni- According to officials the fire at Marriott/Orlando Hotel, tion. All other causes, electrical and machinery failures, faulty which originated in the hotel laundry, was the result of heating equipment, smokers' carelessness, arson, etc., total linens self-combusting in a laundry cart. The fire, which 25%. was reported about midnight, completely destroyed the The Evidence of Spontaneous Ignition building which housed the hotel's laundry and mainte- Analysis of the facts leads to the conclusion that it is not dryer nance facility. heat alone but spontaneous ignition that causes the vast major- AFTER HOURS BLAZE GUTS NURSING HOME ity of laundry fires. You may be asking yourself, "Why is this LAUNDRY. Litchfield, IL. topic important to the salon operators?" Due to the various (June 16, 1992). The County Care Center laundry, which chemicals, oils and cosmetics used daily in the operation of a served five area nursing homes, was totally destroyed in salon, the threat of spontaneous ignition is very real. The fol- a $1.5 million fire which started several hours after the lowing are examples of spontaneous ignition incidents in the plant closed. The fire originated in linens which had workplace. been piled in a cart. The source of ignition was sponta- neous combustion caused by residual chemicals in the IN THE NEWS laundered fabric reacting to heat from the dryer. SALON NARROWLY AVERTS DISASTER (October14 EARLY MORNING FIRE DESTROYS LAUNDRY. 2003) The Veranda Pampering Salon in Florida narrow- Findlay, Oh. (July 2, 1994). ly escape a deadly fire due to spontaneous ignition. Fire officials blame spontaneous combustion of Facialist, Mary Jane recounted the story. She had processed linens piled in a laundry cart for the 3:30 a.m. removed her laundry from the dryer and placed it in a blaze that caused an estimated $5 million damage to City laundry basket and returned to her room to start work on Laundry. Test results indicate the clean, warm garments her next client. Several minutes later her client began to piled in a cart, waiting to be folded during the next shift, complain about smelling smoke. Both Mary Jane and contained traces of linseed oil. her client looked everywhere in the room for a possible source, but could find nothing. The smell eventually What Is Spontaneous Ignition/Combustion? became worse and the decision was made to contact the There are three variations of spontaneous ignition. They differ fire department. After contacting the fire department she mainly in the nature of initiation. returned to her room and picked up her laundry basket to move it and a puff of smoke shot out of the basket. The Classic Wet Hay Fire Upon further investigation she discovered the bottom Spontaneous combustion may occur in piles of moist organic towels were charred and were obviously ready to burst material where heat is regenerated in the early stages by the into flames. respiration of bacteria, molds, and fungi. This type of heating can only raise the material temperature range of 50 to 70 MIDNIGHT BLAZE STRIKES PRISON. Chino, Ca. degrees C (120 to 160F), where the living orgasms die. (January 8, 1989). The laundry at the California Beyond this point, some form of chemical reaction must take Institute for Men sustained heavy damage during early over if ignition is to occur. morning fire. Investigators attribute the fire to spontaneous com- The second variation takes place in materials that are reactive bustion of items which had been removed hot from dry- at normal ambient temperatures. Biological heating or an out- ers and placed in polyethylene plastic transport carts. side source of heat is not required. This form often occurs in The loss was estimated at $1.5 million. piles of soiled laundry when the soiling agent(s) are reactive and heat the fabric until ignition takes place. HOSPITAL LAUNDRY FIRE DESTROYS Victoria, BC (March 18, 1989). NFPA's Fire Protection Handbook lists seventy common mate- Spontaneous combustion was blamed for the fire which rials which are subject to self-heating. Twenty-five are liquids, gutted the Glendale laundry. Despite the laundry's auto- each listed with the precaution "avoid contact of leakage from matic alarm system, which was activated at 10:12 p.m., containers with rags, cotton or other fibrous combustible the fire caused an estimated $2.5 million damage. Fire materials". Any of the twenty-five liquids and many of the officials found evidence that the fire had started in three solids could be in the soiled fabric coming into a laundry. or four of a group of 25 plastic laundry carts which were Other materials are probably capable of self-heating and any filled with linen waiting to be ironed. number of combinations of materials may be active enough to self-heat.

15 Third Variation of Spontaneous Ignition not react at low temperatures may react at higher tempera- The Whirlpool Corporation conducted a series of tests investi- tures. Reactions will be more vigorous at higher temperatures gating spontaneous combustion of just washed and dried fab- and lesser concentrations of reactive material will be required. rics. Several fires Phad occurred in freshly washed and dried laundry which was found to contain vegetable oil. Making Laundry Safer You can make a difference. Soiled laundry should be The tests were done with cotton and cotton polyester blend processed immediately, not stored. If storage is unavoidable, toweling containing vegetable oil. Test specimens were storage should be outside, away from other combustibles. washed using detergents and bleach. Measured amounts of Most spontaneous ignition occurs in washed and dried linens vegetable oil were then added to the toweling to simulate con- which contain residual materials. Laundry needs to be washed ditions found at the origin of the fires. Whirlpool conducted and rinsed clean. sixteen tests. Large stacks or piles of laundry should be avoided. When In some, the dried load was left in a dryer, in others the towel- stacking is necessary, linens should be spread to provide venti- ing was removed from the dryer and stacked. Some samples lation and cooling. Equipment must be maintained to were line dried and stacked. All samples were kept warm perform as the manufacturer intended. Perhaps most important using temperature controlled equipment. Every test produced of all, the cool down portion of the drying cycle must never be spontaneous ignition. shortened or eliminated. Subsequently the Consumer Products Safety Commission car- Limiting the Damage ried out four similar tests. In the CPSC tests the toweling was Salons should be equipped with sprinklers and fire detection soiled with vegetable oil prior to washing. In each test the equipment. The fire detection system should be connected to a washed and dried toweling was stacked in a temperature con- central station monitor. Linens need to be stored away from trolled oven approximating the effect of a large stack of other combustibles in noncombustible or fire-retardant con- processed laundry warm from a dryer or ironer. Spontaneous tainers. ignition occurred in two of the tests. In one test the tempera- ture at the center of the stack rose at an average rate of more What employers should do to protect workers from fire than 27 degrees per minute once the chemical reaction started. hazards Employers should train workers about fire hazards in the The Whirlpool and CPSC tests show that at elevated tempera- workplace and about what to do in a fire emergency. tures small quantities of soiling material can react and cause Employers should train employees on how to escape a possi- ignition. It is likely that at higher temperatures the list of ble fire. material that self-heat may be much longer. What does OSHA require for emergency fire exits? The Stage Is Always Set Every workplace must have enough exits suitably located to The elements of spontaneous ignition: heat, combustible mate- enable everyone to get out of the facility quickly. rial and reactive chemicals are always present in laundries and Considerations include the type of structure, the number of other settings. Soiled linens can contain all sorts of potentially persons exposed, the fire protection available, the type of reactive materials. Residual chemicals may remain in linens, industry involved, and the height and type of construction of after washing, in sufficient concentration to react when heated the building or structure. In addition, fire doors must not be in a dryer or ironer. Detergent, bleach and urine have been blocked or locked when employees are inside. Delayed open- implicated in fires which started in washed and dried linens. It ing of fire doors, however, is permitted when an approved has been suggested that cosmetics can also react when heated. alarm system is integrated into the fire door design. Exit The danger of spontaneous ignition is exacerbated because the routes from buildings must be free of obstructions and proper- process takes time. ly marked with exit signs. In the Whirlpool tests ignition took from three to more than 57 Develop an emergency action/fire prevention plan hours. Each of the major fires cited in the introduction Not every employer is required by OSHA to have an emer- occurred hours after the laundry had shut down. Spontaneous gency action plan but establishing one for your particular ignition occurs in laundry when the stack or pile is unable to workplace is a good rule to follow. adequately dissipate the heat generated by the reaction of materials in the fabric. In soiled laundry the reaction may The rules for fixed extinguishing systems? occur at normal room temperature or be triggered by heat Fixed extinguishing systems throughout the workplace are from some external source. among the most reliable fire fighting tools. These systems detect fires, sound an alarm, and send water to the fire and In washed and dried linens it is the heat from the dryer or heat. To meet OSHA standards employers who have these sys- ironer that sets off the chemical reaction. Materials that will tems must:

16 • Substitute (temporarily) a fire watch of trained Electrical Tools employees to respond to fire emergencies when a fire Inspect electrical tools (curling irons, hair clippers, suppression system is out of service. nail grinders, etc.) often and make sure the electrical • Ensure that the watch is included in the fire preven- cords are free of defects. tion plan and the emergency action plan. Store tools in a dry area. Dampness can damage tools • Post signs for systems that use agents (e.g., carbon and create a shock hazard when they are used. dioxide, Halon 1211, etc.) posing a serious health Never use tools around wet areas or when standing hazard. on a wet surface. Fireproof your Business Electrical Wiring Some 5,000 fires occur annually in businesses. Many of these Electrical appliances will not function properly if a business is losses could have been avoided had the business had a simple not adequately wired. Commercial wiring must meet or exceed employee fire safety plan in place. The following suggestions recognized local, state and national building standards. are made to help you to fireproof your business: The following are symptoms of inadequate wiring: Create a fire plan - Lights blink or dim when appliances are turned on. Should a fire occur, the best response is predicated on A television picture "draws in" or there is screen how well the employees prepared before the out interference when other appliances are operating. break. Knowing how to react to a fire should be Fuses blow or breakers trip frequently when appli- learned and regularly practiced. ances are used. Be sure to keep all exit ways clear. Heating appliances are slow to perform. It is best to have at least 2 exit routes in different Electric motors run slowly or overheat. locations in the building. They should be located as far away as possible from each other in case one is Electrical Cords blocked by fire. Inspect appliance cords periodically and replace Pick a designated meeting place far away from the frayed or damaged ones. building so that you can ensure that in case of a fire If you use an extension cord, choose a heavy duty all employees and customers have safely exited the cord and make sure it is in good condition. building. Always connect appliances to a convenience outlet and not to a light fixture. Electrical Safety - Disconnect appliances by grasping the plug, never by The following are a few precautions to follow when working pulling on the cord. around electricity indoors: Never run appliance or extension cords under a car- Using Appliances pet or rug. Friction caused by walking on the rug can Never use an electrical appliance near water, or when erode insulation on the cords, increasing the risk of your hands are wet or when you are working around electric shock or fire. wet areas. Never place electrical outlets near a sink. Outlets and Sockets Use and store appliances away from these locations. Never put anything into an electrical outlet except the plug to Never touch an appliance and a sink or faucet at the an appliance. Never leave light bulb sockets empty. If a bulb same time. burns out, leave it in the socket until it can be replaced. Never touch an electrical appliance while standing on a wet floor. Ground Fault Circuit Interrupters Keep hair dryers, curling irons and similar devices A Ground Fault Circuit Interrupter (GFCI) constantly monitors away from water. the flow of electric current going into and out of an appliance, and shuts off the flow if there is a danger of electric shock. Appliance Care GFCIs are required in receptacles installed in bathrooms, Before cleaning or repairing any appliance, be sure it garages, basements, outdoor locations and kitchens within six is disconnected or the circuit is turned off. feet of a sink. GFCIs are relatively inexpensive and easy to Never use an appliance that is sparking, making install in place of standard two-plug outlets. A GFCI can also unusual noises or not operating properly. Never be installed in a circuit box to control an entire circuit. bypass or destroy any safety switch or control that is part of the appliance. Electrical Fires Keep clean filters in room air purifiers or exhaust Never use water to extinguish an electrical fire. Water fans. is a good conductor of electricity. Instead, use a fire Have pressure-temperature relief valves installed on extinguisher rated for electrical fires. electric water heaters.

17 If a fire extinguisher is not available, materials such and heating appliances. as dry sand, dry dirt or baking powder can be used to Read the operator's manual to learn how to inspect smother the fire. and maintain your fire extinguisher. Extinguishers If possible, shut off the main disconnect switch require routine care. before extinguishing the fire. That will cut power to Rechargeable extinguishers must be serviced after the problem area before anyone can get hurt. every use. There is a list of service companies in the yellow pages. Disposable fire extinguishers can only Employee Responsibilities - be used once. Replace disposable extinguishers after Contact help immediately by calling 9-1-1. use. Fire can generate blinding smoke and often causes electrical failure. Consequently, employees should Before Fighting the Fire know the work area well enough so that if they are Before you fight the fire, make sure that... unable to see, they can still safely exit the building. 1. Everyone has left, or is leaving, the building, and that It is important for them to be keenly aware of the exit the fire department has been called. routes. As a rule, it is best to have the evacuation 2. The fire is confined to a small area and is not spread- routes posted in several locations around the salon. ing. Employees should be familiar with the location and 3. You have an unobstructed escape route to which the use of fire suppression devices such as fire extin- fire will not spread. guishers. 4. The extinguisher is the right type for the fire. 5. You have read the instructions and that you know Fire Extinguishers - how to use the extinguisher. Classifications of Fire: There are 3 basic classes of fires. All fire extinguishers are Instructions labeled with standard symbols for the classes of fires they can Keep your back to an unobstructed exit and stand 6 to 8 feet put out. The classes are at the right on the diagram on the fol- away from the fire. Follow this 4 step procedure. lowing page. Remember the PASS word: Pull, Aim, Squeeze, Sweep Many household fire extinguishers are "multipurpose" A-B-C Pull the pin. This unlocks the operating ever and allows you models. In other words, they can be used on all 3 classes of to discharge the extinguisher. Some extinguishers may have a fire. For example, if you are faced with a Class A fire, and you different release device. don't have an extinguisher with an "A" symbol, don't hesitate to use one with the B or C symbols. Aim low: Point the extinguisher at the base of the fire with the nozzle or hose. Class A: Wood, paper and other Squeeze the lever above the handle: This will discharge the combustible solids extinguisher's contents. To stop the discharge, release the Ordinary combustibles such as lever. Some extinguishers may have a button instead of a wood, cloth, and paper. lever. Class B: Fuel, Oil, and other com- Sweep from side to side: Aim and keep the extinguisher at the bustible liquids base of the fire and sweep back and forth until the flames Flammable liquids such as gasoline, appear to be out. While doing this, move carefully toward the oil, and oil-based paint. fire. Repeat the process if the fire reignites.

Class C: Electrical In Case of Fire - Energized electrical equipment Immediately call 9-1-1, notify all employees of the including wiring, fuse boxes, cir- fire, and exit the building. cuit breakers, machinery, and Never return to the building for any reason. appliances. Be sure to close all exit doors behind you. If there is smoke present, crawl on the floor, where WARNING! It is dangerous to use water or an extinguisher there is more air and improved visibility. labeled "ONLY for Class A Fires" on a grease or electrical Test exit doors before they are opened. This is done fire. by placing your hand on the door to check for heat. If the door is hot, find another exit route. If the door Installation and Maintenance is cool, carefully open and check for smoke or fire. Install your fire extinguishers in plain view. Keep Once you have exited the building, proceed to the them out of reach of children and away from stoves designated meeting place.

18 Everyday Hazards Facing the Cosmetologist and give you tips on how to avoid them. If pain per- While the salon profession can be extremely rewarding, it can sists, see your doctor. have its drawbacks, the least of which the impact that daily work in a salon can have on an individuals overall health. Preventing Repetitive Injuries Salon professionals have at least three major complaints about Many salon professionals also suffer from repetitive strain their work: they suffer from back and leg problems, hand and injuries from the repetitive nature of haircutting and other arm stress, and allergic reactions to the chemicals they use in salon work. These injuries, caused by repeating the same the salon. Moreover, a study by the NIOSH found that cosme- motions hundreds and even thousands of times a day, are a tologists in North Carolina who worked full-time and per- serious hazard. Tendonitis can cause excruciating pain and formed a range of chemical services had a moderately make it difficult or impossible to perform even the simplest of increased risk of miscarriage. Another agency study concluded tasks. Carpal tunnel syndrome, a pinching of the median nerve that cosmetologists had a higher risk of developing lung disor- in the wrist, may cause irreversible nerve damage and require ders as a result of exposure to hair spray. surgery. Staying on Your Feet If you feel like your fingers and arms are starting to ache, tin- Standing all day can put a strain on feet - especially in salons gle at night, or cramp up for long periods of time, experts sug- where concrete floors are the rule. A regular shift for a stylist gest the following precautions: lasts from eight to ten hours, and hairdressers are usually on Take breaks: When working on a job like this, take their feet for most of that time. This can result in stabbing breaks as often as possible. Stretch your hands and pains radiating up the legs and development of varicose veins. shoulders. If time allows, try to schedule jobs that Lower back, knee and joint paint can also result from several take more than a couple of hours over a two-day peri- of the repetitive movements that a stylist makes such as lean- od. ing over to shampoo clients. Upper back pain is another com- Get professional help: See a physician immediately if plaint particularly pain in the shoulder blades that causes the you suffer numbness or tingling in your fingers: this most problems. is a sign of carpel tunnel syndrome. You should also see a doctor if you feel chronic pain or a heavy feel- Here are a few steps you can take to help alleviate some of ing in the arms or hands, which can signal tendonitis. these pains: The treatments may include prolonged rest, physical Support your weight on both feet. If you lean to one therapy, and (in the case of carpel tunnel) surgery. side constantly and do not distribute your weight Invest in ergonomically correct tools: You might want evenly, it can result in pinched nerves to check out, for example, a relatively new product Invest in a side chair. To give your feet a rest, invest called swivel-thumb scissors, which allow your in one of the versatile working stools available for thumb to rotate 360 degrees while cutting hair and salon professionals. These are little seats with no gives you more mobility in your wrist and elbow, arms that can be adjusted according to the client's thus relieving pressure on those areas. height. At the same time, these chairs can help raise the cosmetologist to a more appropriate level, which Why safety and health are important to small business own- might alleviate the shoulder blade problem. ers As an employer, small business owners have a duty to protect Exercise and watch your diet. The more weight you carry, the more strain is placed on your feet, legs, and workers from injury and illness on the job. Protecting workers back. also makes good business sense. Accidents and injuries are more expensive than many realize. Costs mount up quickly Use a rubber mat in your workspace. Covering the but substantial savings in workers' compensation and lost floor around your client's chair with a rubber mat will workdays are possible when injuries and illness decline. help cushion your feet and protect your back. Invest in a good pair of shoes. Experts recommend How small business owners can reduce employee injuries that employees should wear flat shoes with no more and illnesses than a 2-inch heel. Ideally, the shoes should have Compliance with OSHA regulations is essential. Compliance shock absorbent pads, skid resistant soles, and laces, along with an effective voluntary safety and health program which provide more support. Salon professionals who can help reduce costs, injuries and illnesses. An organized, already have foot pain might want to buy a pair of carefully crafted plan that systematically focuses on workplace insoles or orthotic devices, according to the associa- hazards and employee training is critical. Buy-in from every tion. manager and employee is essential. Everyone has to work at Get regular massages. Take time to pamper your safety and health. body. Massage can help alleviate back pain, and mas- sage therapists can determine your specific problems

19 Occupational Safety and Health Administration (OSHA) NOTES Education Review Practice Questions Answers to each question can be found in this section

1) The federal government requires that product manufacturers make available to customers Material Safety Data Sheets (MSDS). Each MSDS must contain basic information on each product manufactured. Describe the seven parts of MSDS sheet:

______

______

______

______

______

2) When selecting an air purifier for your salon, it is recom- mended that you select one with a ______filter and a canister filled with ______.

3) It is recommended you wear gloves when using chemi- cals such as bleach or dyes to prevent your hands from drying out.

True False

4) Methyl methacrylate liquid monomers (MMA) and ethyl methacrylate (EMA) can cause asthma, dermatitis and aller- gies of the eyes and nose.

True False

5) Describe some of the precautions you can take to prevent injuries in the work place.

______

______

______

______

20 CHAPTER 3 fail, news stories and media attention will undoubtedly contin- INSTRUCTION ON SANITATION AND ue to highlight such disturbing cases, putting the health of STERILIZATION clients, the reputation of the industry, and your business at State of Ohio risk. (2 Credit Hours) Your Responsibilities Learning Objectives As a professional cosmetologist, you have responsibilities to Explain the difference between pathogenic and non the state and your profession to learn and use appropriate pre- pathogenic bacteria cautionary measures and cleaning procedures, to protect both Identify the primary forms of pathogenic microorgan- you and your clients, reduce the incidence of bacterial, viral, isms and explain their relationship to disease and fungal infection, and prevent the spread of disease. You, List infections caused by common viruses, bacteria, your instruments, and workstation must be kept as clean as and fungus that may exist in a salon possible; meaning no short cuts, or omissions, of any precau- Contrast disinfectants and antiseptics and explain the tionary measures discussed in this chapter. Violations can significance of those differences result in penalization by the board of cosmetology, as well as List the steps necessary to properly sanitize hands, infection. and to disinfect, handle, and store tools appropriately The following chapter will review these subjects: List infection control responsibilities required by the 1. The biology of pathogens, how they function, repro- Ohio State Board of Cosmetology for salon operation duce, and infect and the practice of cosmetology in Ohio 2. Universal sanitation and sterilization precautions List Environmental Protection Agency (EPA) regula- 3. State of Ohio regulations that apply to cosmetology tions relating to nail salons, beauty shops, and barber 4. The difference between decontamination, sanitation, shops in Ohio sterilization, and disinfection List infection control responsibilities according to 5. How to effectively disinfect tools and surfaces in universal sanitation precautions your environment, and sanitize hands Contrast sanitation and sterilization and explain the significance of those differences Microorganisms and Infectious Agents Microorganisms are tiny living particles (organisms) with The Significance of Sterilization in Cosmetology many different characteristics. They live in our air, water, and Late in the year 2000, a mysterious outbreak of bacterial earth, and are found everywhere on the planet. Some microor- infections in Watsonville, California baffled health profession- ganisms are associated with infection or disease; others are als for many weeks. Painful sores appeared on the skin of harmless or even helpful. Bacteria, viruses, and parasites are more than 140 women who were found to have visited the three major categories of microorganisms that you encounter same beauty salon. The infections were difficult to treat, even every day. with the use of antibiotics. After some weeks, investigators in the health department determined that these women had been Bacteria infected with bacteria in the course of receiving a spa pedi- Bacteria are tiny one-celled vegetable microorganisms cure. The salon was shut down after testing indicated high lev- (plants) that can only be seen with a microscope. The most els of tuberculosis-related bacteria in all of the salons foot- plentiful organisms on the earth, bacteria are found virtually baths. Dangerous bacteria had built up on the suction screens everywhere around us, existing in dust, dirt, and decay, our of the footbaths, which had not been properly cleaned. While skin and body tissues, the air we breathe, and the water we the boils and skin ulcers eventually healed, the infections left drink. Bacteria produce slimy fluids or waxy coatings, which deep purple scars on the legs of more than 100 women.1 moisten them and help them survive in inhospitable environ- ments. Fimbri, hairlike tendrils that anchor the bacteria to an Soon after the Watsonville discovery, a 20/20 investigation object, make bacteria "sticky," requiring one to use some revealed salons in Phoenix, Boston and Houston were also degree of pressure when scrubbing, to break the hold of these guilty of unsanitary conditions, with many testing positive for tenacious fibers. potentially harmful bacteria. Other examples followed: Investigations in California noted potentially harmful condi- Bacteria exist in one of two modes: an active, vegetative, tions in 16 out of 18 examined salons; an undercover inspec- mode, and an inactive, spore-forming mode. In the active tion in Philadelphia found technicians reusing unclean instru- stage, bacteria grow and multiply at an astonishing speed. ments; and in Westminster, Colorado, a jury awarded $3 mil- Reproducing through binary fission (a process in which one lion dollars to a woman who contracted herpes from a nail bacteria splits into two), bacteria produce millions of copies technician using unsterilized tools.2 Until licensees and salon within hours. Bacteria are only able to reproduce when the owners follow the necessary disinfection procedures without environment meets their specific needs in temperature and

21 degree of moisture. They require a warm, damp, usually dark, cause diseases like hepatitis, influenza, and measles, and are and often dirty environment that provides a supply of food the source of colds, chicken pox, cold sores and genital her- adequate to sustain the bacteria and provide fuel for reproduc- pes, mononucleosis, hepatitis, and HIV/AIDS. tion. If conditions are not favorable for reproduction, the bac- teria will move into a spore-forming stage, producing spores Viruses are a particular concern in salons because of their with tough outer surfaces that are almost impervious to wind, potential severity and the way they spread. Viruses occupy heat, cold, harsh cleaners, or disinfectants. These characteris- the surfaces of objects you touch, including door handles, cof- tics help spores survive for long periods between reproductive fee mugs, and scissors; they can be inhaled on tiny dust parti- phases. cles, or travel on the minute amount of saliva expelled in a cough. Viral infections can be transmitted from one person to While there are hundreds of different kinds of bacteria, they another through casual contact with an infected individual or are primarily sorted into one of two types, according to the contact with what he or she touched. Both hand-to-surface danger they pose to us. Potentially harmful bacteria are called and hand-to-hand contact are both highly effective methods pathogenic; harmless or beneficial bacteria are called non- for transferring virus particles from one individual to another. pathogenic. The great majority (about 70%) of bacteria are nonpathogenic. Called saprophytes, these organisms do not Plant Parasites produce disease and carry out necessary functions, such as Plant parasites, such as fungus or mold, mildew, and yeasts decomposing dead matter, for example. Nonpathogenic bacte- are multi-cellular organisms that are as prevalent as bacteria, ria also exist in the human digestive tract, and in the mouth and consume both live and dead tissue to survive. Fungi usu- and intestines, where they facilitate digestion by breaking ally prefer a damp environment, but can also survive in a down food. warm, dry climate. They reproduce and spread a number of different ways, and can invade the human body easily, requir- A much smaller minority (about 30%) of organisms are patho- ing no break in the skin. genic organisms, also called microbes or germs. These are harmful, and produce disease when they invade animal or Ringworm and athlete's foot are two common contagious dis- plant life. Pathogenic bacteria commonly exist in the salon eases that are spread by fungi. Another is favus, which affects environment. Bacterial infection occurs when a body is the scalp. Cosmetologists should not serve any individual with exposed to and cannot successfully fight off bacterial invasion. signs of any fungal infection. If you have a fungal infection, General infections typically begin as local infections, which do not work and seek treatment immediately. If you think a may start as a boil or pimple accompanied by pus (a compila- client has ringworm, identified by a ring-shaped, circular pat- tion of bacteria, decayed tissue, waste, and blood cells) that is tern on the skin, or athlete's foot, do not provide service to the often associated with infection. Bacterial toxins, from local individual, as it is highly contagious. Tell the individual to infections, can spread to different parts of the body through consult a physician for treatment. the bloodstream, increasing the likelihood of general infection. Precautions With Plant Parasites Pathogenic bacteria are distinguished by their characteristic Fungal infections can be stubborn. Many affect the skin, but shapes: Bacilli are rod-shaped, and the most common bacte- fungal infections can also cause severe respiratory infections. ria, causing diseases such as influenza, tetanus, and diptheria. More common versions of fungal infection are those caused Spirilla are spiral-shaped bacteria, and cocci are round bacte- by yeast, including nail fungus, athletes foot, jock itch, and ria that produce pus. Cocci rarely move on their own, but are ringworm. Both over-the-counter and prescription treatments usually transported through the air in dust particles or other are available for relief from the unpleasant, itchy symptoms of substances. Bacilli and spirilla are both capable of self-move- many yeast infections. ment (motility), using hairlike projections (flagella or cilia) to Plant parasites, like fungus and mold, are contagious, with nail propel themselves. fungus a significant risk to clients receiving nail services, as Viruses fungi can spread, not only from one nail to another, but from a Viruses are infectious biological entities that are very small- client to a technician, or the reverse, given improper sanitation much smaller than bacteria-and cause disease by entering a techniques at a salon. Nail fungus appears as discoloration of healthy cell, maturing, and reproducing. Unlike bacteria, the nail plate (on either the fingernails or toenails), initially viruses do not survive for any length of time without the pro- appearing white, but growing darker over time. Clients with tection of a living cell. Viruses are dangerous because their nail fungus should be referred to a physician for treatment. replication inside the cell eventually causes the death of that Molds and mildews do not infect fingernails, and rarely if cell. They are parasites; taking the cell's nutrients, and ever appear under the nail. Greenish bacterial infections, destroying the cell in the process. The cell is then used to which may appear yellowish or yellow-green initially, can breed hundreds, thousands and even millions of new mature continue to stain the nail plate long after an infection has sub- infectious viruses that leave to infect other cells. Viruses sided, and are sometimes mistakenly attributed to mold. Nails

22 can harbor dangerous bacteria, which can thrive on the oils Transmission may occur through direct or indirect contact. and moisture that exist between an improperly prepared or Germs may spread from one individual to another through unsanitized nail plate and an applied enhancement. direct contact-holding hands or kissing, for example-or indi- rectly-inhaling contaminated droplets in the air (airborne Clients with nail fungus or other infections should not receive transmission), or touching a contaminated surface and then nail services, but can be assisted in removing an artificial nail touching one's nose, eyes, or a mucous membrane. Try to from the infected natural nail. If you are asked to expose the avoid touching your face during the day, and always wash natural nail, follow these precautionary steps: your hands between clients. 1. Wear gloves during the removal of artificial nails 2. Follow the manufacturer's instructions for removal Yeast, scabies, lice and many other skin infections do not 3. Discard any implements, including orangewood require an open sore or mucosal surface to infect. Athlete's sticks, items with porous surfaces, and any abrasives foot contaminates through indirect transmission. When some- used one with athlete's foot walks barefoot on a wet bathroom floor, 4. Disinfect all implements and work surfaces for example, the person leaves spores behind, which will stick 5. Refer the client to a physician for treatment once the to the foot of anyone else walking barefoot on that floor, natural nail is exposed infecting the individual, even if he or she has no cuts or open- ings on the feet. Fungi, like athlete's foot, will survive for Animal Parasites some time on a damp or wet floor. Shower stalls and soaking Animal parasites may be single-cell (protozoans) like amoe- baths that retain small amounts of water must be thoroughly bas or malaria, or multi-cell, like mites or lice. Protozoans cleaned and disinfected with the appropriate disinfectant. consume both plant and animal tissue, and are found in blood and body fluids, water, and food. Multi-cell animals, like lice The primary modes of travel for common contagions are: and mites, can hide in the hair and burrow under the skin. Be • Unclean hands aware of the signs of scabies, identified by bite marks on • Unclean implements client, Rocky Mountain spotted fever, or typhus, caused by • Open sores rickettsia, animal parasites carried by fleas, lice, and tics that • Pus are even smaller than bacteria. • Mouth and nose discharge • Shared cups or towels For any individual with a visible communicable disease, like • Coughing or sneezing pediculosis (head lice), open sores, or marks suggesting sca- • Spitting bies, it is recommended that the person furnish a statement signed by a physician that the disease or condition is not in an Pathogenic bacteria can also enter the body through: infectious, contagious or communicable stage. The same is • A break in the skin, including pimples, scratches, or true if the cosmetologist has symptoms or indications of a vis- cuts ible disease, lice, or open sores; he or she should not practice • The nose and the mouth, during breathing cosmetology until obtaining a statement signed by a physician • The mouth, during eating and drinking stating that the disease or condition is not in an infectious, contagious, or communicable stage. Humans are excellent sources of contamination because we are constantly leaving organic particles behind, wherever we Modes of Contamination and Transmission go; a mixture of dead skin cells, with viral, bacterial, and fun- Diseases are communicable or contagious when they move gal particles, along with other microorganisms that consume from one individual to another. Working with the public skin cells or use us to travel to an appropriate host. Every means encountering potentially dangerous pathogens and time you touch something, you deposit some of this organic opportunistic organisms everyday. Always assume your matter on another surface. Simple actions, like touching a clients, co-workers, and environment could be carrying illness, client's hair, brushing some of your hair out of your eyes with and use proper infection control procedures every day. your hand, or touching a spray bottle can move microorgan- isms from one item to another, from you to your client, or Humans have some level of immunity against infection, but your client to you. our level of protection varies with age, health, and a range of other factors. Skin is our first line of defense; when there are Individuals who are susceptible to infection, due to a compro- no cuts or scrapes, skin is excellent protection against mised protection system or some failure in their ability to pathogens. In the vast majority of cases, bacteria, fungi, and resist invasion, are also the targets of opportunistic microor- viruses enter the body through the portals of the nose, and ganisms. In contrast to pathogens, opportunistic organisms do mouth, small tears or openings in the skin, and to a lesser not cause initial illness, but will infect an individual once extent, the eyes and ears. Once inside the body, the pathogen pathogenic organisms have already weakened its immune sys- reproduces rapidly, at a rate that can overwhelm the immune tem. Opportunistic organisms cling to the skin and the hair, system, resulting in disease. and exist in the bodies, of healthy people.

23 Microbes also contaminate ventilation systems; to discourage Sanitation their growth, vents, filters, humidifiers, and dehumidifiers Sanitation is the lowest level of decontamination. Sanitation should be cleaned and maintained regularly. Investigate any will reduce germs on a surface, but will not kill all organisms. mildew or musty odors, which are a good indication of Sanitation provides a minimum level of cleanliness, protecting microbe growth. Germs in a ventilation system easily spread public health by preventing the spread of some, but not all, throughout a salon, landing on people, surfaces, and imple- bacteria and fungi. Instruments that are sanitized are not ster- ments, whenever the blower or fan turns on. ile. Countertops and workstations should also be sanitized, wiped down with soap and water; this process should not be Germs not only float through the air, settling constantly on confused with, and does not replace, disinfection, which salon surfaces, such as sinks and countertops, they can also requires and appropriate disinfectant. Remember that soap and "hitchhike" on human skin, hair, and clothing, contaminating water will kill most of the bacteria on your hands, worksta- anything with which they come into contact. Pathogenic and tion, or chair, but will not kill all the bacteria or fungal spores. opportunistic microorganisms are able to thrive in a salon's warm, moist places; like the drain of the shampoo sink, the The term sanitation is most often used in reference to cleaning footbaths, hot and cold water handles and tap, etc. the hands. Hand washing is absolutely essential to controlling Implements like scissors, files, brushes, or nippers can be bacteria and the most effective way to prevent the spread of major sources of contamination because they often contain infectious agents from one person to another. Hands cannot organic matter, an optimum growth environment for pathogen- be sterilized, because it is impossible to remove all microor- ic and opportunistic microorganisms. ganisms from the surface of the skin; water and soap, in fact, are not sterile, and can introduce new bacteria and infectious Some of the most dangerous areas in your salon are the places agents. (Even anti-bacterial soaps will not remove all the you keep contaminated manicuring tools or equipment, includ- organisms on your hands.) ing the manicure table and the trash cans in which you deposit dirty implements. Microbes can also exist on seemingly Your hands are populated by both resident and transient unlikely products, like bars of soap, for example. Because organisms. Resident organisms are a normal part of your germs and other microorganism have been shown to thrive on skin's environment; their natural habitat. They grow and mul- bar soap, many salons prefer to use liquid soap that can be dis- tiply in an oxygen environment, and rarely cause infection, or pensed from a container for each customer. In addition, soak- harm the individual who is their host. These organisms cannot ing solutions, lotions, and creams, which initially are unconta- be removed easily by hand washing. Sanitation controls mini- minated, may lose preservatives that keep them safe from mize exposure to transient organisms. These organisms, like pathogenic or opportunistic microbes from growing in them. E. coli and salmonella, cause dangerous infections in humans. Changes in color, texture, appearance, or odor can be signs of In contrast to resident organisms, transient organisms cannot contamination. live long on the surface of our skin. They function poorly in an oxygen environment, usually surviving less than 24 hours. Fighting infection may be a matter of staying home when you These organisms can be removed easily through the process of are sick. Just as you should avoid working with contagious hand washing, using friction, soap, and water. clients, you should not go to work if you have infection, such as a bad cold or flu. Cover your mouth and nose to control Effective Hand Washing pathogens escaping through sneezes and coughs. Avoid caus- To wash hands in way that removes transient organisms ing wounds; if your client's skin is dry or fragile, tears and requires soap, water, and friction. Soap need not be anti-bac- breaks can occur easily, even when filing nails. Use abrasive terial, as it is no more effective against pathogens than tradi- instruments with care and a gentle touch, especially around the tional soaps. Friction is perhaps the most crucial component, nail bed. as it is friction that typically removes the transient organisms. The entire procedure should take at least 10 to 20 seconds and Decontaminating Your Environment be repeated after each client. You have a responsibility to control exposure to pathogens by 1. Wet hands with running water decontaminating your environment and tools. Remember that pathogens collect anytime an object or surface is exposed to 2. Apply soap in the middle of the wet hands; use an air. Doorknobs, handles, the telephone, money, cabinets, the FDA listed, antimicrobial liquid hand soap. cash register-all are surfaces touched by coworkers and clients 3. Lather well that may harbor harmful pathogens, so all must be decontami- 4. Use vigorous friction by rubbing the hands together; nated to some degree. Cleaning is only the first step of the pay attention to nail beds and the webs between the process. The following sections review the meaning of sanita- fingers and thumbs tion, sterilization, and disinfection, terms that are commonly used interchangeably, but have very different meanings and 5. Rinse hands thoroughly with water (leave the water require different procedures. running)

24 6. Dry hands with a paper towel Ultraviolet Sanitizers should not be used to disinfect tools, as 7. Turn water off, using a paper towel they are ineffective against viruses and do not clean the crevices of instruments. Bead sterilizers are also ineffective in Cleaning Agents for Hands sterilizing or disinfecting implements. Cleaning agents assist in the process of removing substances from surfaces. Soaps and detergents are two common clean- A critical part of sterilization is effectively storing the steril- ing agents that are often confused for one-another, but are ized items without recontaminating them. Touching sterilized composed of very different ingredients, and have very differ- instruments with bare hands, placing them on a surface that is ent cleaning properties. Soaps are the product of a chemical not sterile, or storing in an unsterile compartment will contam- reaction, formed by vegetable oil reacting with lye, for exam- inate the instrument, and require resterilization. After cleaning ple, and chemicals that add a desirable smell or quality to the and disinfecting instruments, place them in a clean, dry stor- soap, such as glycerine, to make it milder. While soap does age container until ready for use. Ultraviolet electrical sani- not kill microorganisms, soap and water will help remove tizers may be used as a dry storage container. Do not keep them from surfaces. articles such as pens, pencils, money, paper, mail etc., in the same container as sterilized or unsterilized instruments. Detergents are manufactured for the express purpose of clean- Disposable instruments may be a practical alternative, espe- ing specific substances off of specific items, and are created cially for instruments or objects, such as needles, that can eas- using chemicals that can be very harsh to skin. In contrast to ily penetrate the skin. detergents that do not leave a residue or require rinsing, soaps leave a coating or residue on the body; typically one designed Disinfectants to make skin smoother or more attractive. Soaps also remove Controlling bacteria in a salon requires some degree of effort, less fat from the skin than detergents, which have a drying vigilance, and good sense. In choosing a disinfectant, always quality and may strip the skin. Be sure to use the appropriate look for the EPA registration number (awarded by the cleaning agent for the job. Different cleaning and disinfecting Environmental Protection Agency) to ensure you are using an agents have many different properties. Always read the ingre- approved disinfectant. This number indicates a level of safety dients, instructions, and recommendations for use on the item's for specific kinds of disinfection. To be registered by the EPA, label. the disinfectant must be effective in killing bacteria including staphylococcus, aures, salmonella, and pseudomonas. Sterilization and Disinfection Cosmetology salons must use not only EPA-approved disin- "Sterile" means free from all germs; sterilization is the most fectants, but one with an EPA rating of hospital-level (tuber- effective level of decontamination, involving the removal of culocidal) quality. These disinfectants are especially effec- all bacterial life from a surface. This is the level of decontami- tive for salon use and are capable of killing viruses, dangerous nation required for tools and surfaces in hospital surgeries, bacteria, and fungus. Hospitals use steam autoclaves to heat instruments to a very high temperature, but this is an impractical method for salon Disinfectants can be hazardous if prepared incorrectly. Be cer- sterilization. Some businesses choose to boil instruments, but tain to follow manufacturers' instructions and all written direc- most cosmetology salons sterilize instruments with the use of tions for the preparation and use of a specific disinfectant. disinfectants. Wear gloves and safety glasses, as indicated by instructions, when mixing and using solutions. Consult the manufacturer's Disinfection is the process of killing specific microorganisms, Material Safety Data Sheets (MSDS) for information on bacteria or germs, using physical or chemical processes. preparing a solution; be aware of what chemicals exist in the Disinfectants are chemical agents that destroy organisms on disinfectant; and what kinds of safety hazards are associated contaminated instruments or surfaces, but they should not be with each. Always use the recommended amount of solution to used on the skin. Disinfectants can be dangerous and must be water, and clean only approved items, according to label used with caution. In a salon atmosphere, disinfectants must instructions. be able to kill viruses, fungus, and dangerous bacteria. Sanitation procedures in the state of Ohio require a wet disin- Do not confuse disinfectants, which destroy harmful microor- fectant soaking container large enough to immerse objects ganisms, with antiseptics, products designed to slow the completely in a hospital grade EPA registered disinfectant growth of microorganisms. Antiseptics do not kill microor- solution. See Ohio sanitation requirements, below, for specific ganisms and should not confused with disinfectants or used instructions. for salon disinfection. Antiseptics may be safely applied to the skin and can be used as sanitizers. Disinfectants may be used in ultrasonic cabinets if desired. These cleaners use high-frequency sound waves to form bub- Household disinfectants, commonly used to clean offices and bles that clean instruments. Ultrasonic cleaners, however, are homes, may be used to clean floors, doorknobs, walls, etc., as only effective when used with an appropriate disinfectant. directed on the container label, but should not be used in place

25 of a hospital grade salon disinfectant, which is required to the state in accordance with Chapter 4713 of the Revised sterilize instruments. Code who are vested with both statutory and discretionary authority. Bleach can be used as an effective disinfectant, but it is not a cleaning agent and should only be applied to clean surfaces. (2) Who Must Comply with Rules (Ref: 4713-1-03) Bleach must be used with caution because it can release toxic Ohio Administrative Codes rules shall become effective the fumes when mixed with certain substances. Do not use bleach tenth (10) day after filing their final form with the Secretary of to disinfect instruments, as it can damage tools. It may be State and the Director of the Legislative Reference Bureau, as used for washing towels and other salon laundry. provided by Section 119.04 of the Revised Code. All rules promulgated under agency level 4713 of the Administrative Formalin and formalin tablets are not accepted disinfectants Code shall apply to all types of licensed cosmetology facilities and should not be used in a salon. Both release formalde- and licensees unless otherwise specified. Out-of-state licenses hyde, a toxic cancer-causing gas that is highly irritating to the are not valid in this state. All service providers must be eyes, nose, lungs, and throat. Long-term exposure to formalde- licensed by the State of Ohio. hyde may damage the respiratory track, causing bronchitis or other respiratory conditions (3) Where Cosmetology Services May Be Performed No person shall practice a branch of cosmetology, for pay, Quaternary ammonium compounds ("quats") are the most free, or otherwise, without one of the following: A current, widely used disinfectants in cosmetology salons. They are fast valid license, a current, valid temporary pre-examination, spe- acting and safe to use. Most instruments can be disinfected in cial occasion or valid temporary work permit issued under 15-20 minutes with a quat solution, but can damage instru- section 4713.08, 4713.22, or 4713.37 of the Revised Code. ments if immersed for too long a period of time, causing rust or erosion of the cutting edges. New super quats destroy bac- (4) Inspection of Salons (Ref: 4713-13-05) teria quickly and can disinfect your instruments in ten to fif- A salon shall be deemed "OPEN for BUSINESS" if no hours teen minutes. If using quats, leave the instruments in the solu- are posted and the doors are unlocked. All authorized agents tion for the recommended time interval, remove them and of the State Board of Cosmetology shall have the power to place them in storage in a closed cabinet. Quats can also be enter and make reasonable inspections of any salon or school used on surface areas that come in contact with food; while during its regular business hours for the purpose of determin- they are effective against some easy-to-kill bacteria, they do ing whether or not the Board's rules are being observed. not kill tuberculosis bacteria. Persons duly authorized to make an inspection of salons shall Phenolic disinfectants ("phenols") are excellent disinfectants prepare a report. Such report shall be signed by the inspector with few limitations. They kill a broad range of germs, and by the owner of the salon or by a person authorized to including resistant microbes like tuberculosis. Their disadvan- sign for the owner. A copy of such inspection report shall be tages include their relative expense, danger to the skin, and left with the owner or manager. potential reactions with some types of rubber and plastics used (5) Independent Contractor (Ref: 4713-13-02) on implements, causing them to soften and corrode. Where a license for an independent contractor ("salon within a Concentrated or undiluted phenol disinfectants can cause salon") has been issued, the "Board" shall hold the individual severe burns to the skin and eyes and are toxic if swallowed. operator and the salon owner responsible for the compliance Even diluted phenols can irritate the eyes and skin,. If phenol with all cosmetology statutes and rules. All independent con- disinfectants are used in the salon, they must be kept safely tractors shall also hold a managing license for their branch of out of children's reach, be clearly labeled and, be used strictly cosmetology in order for their independent contractor license according to manufacturer's instructions. to be valid. Independent Contractors are responsible for sta- Ohio State Board of Cosmetology: Salon Operation and tions and areas permanently assigned and being used when an Sanitation Rules inspection occurs. Independent Contractors are equally respon- The following information regarding salon operation and sani- sible for common areas when present. tation in Ohio can be found at http://www.cos.ohio.gov/ (6) License Must Be Displayed Conspicuously (Ref: 4713.56) SOSR4-03.pdf [Revised 7/03]. Please refer to this site directly (Ref: 4713.14) (Ref: 4713-13-04) (Ref: 4713.14c) for current text or recent regulatory changes. All persons practicing any branch of cosmetology must dis- The following information must be displayed in a conspicuous play a current "Board" license in a public and conspicuous place within the salon place with a recent photograph for inspection by authorized agents of the "Board". Each salon owner shall be responsible (1) Definition of Board of Cosmetology (Ref.: 4713.02) for hiring only individuals licensed by the "Board" and shall "The Board of Cosmetology", hereinafter referred to as the require that all persons employed for cosmetological services "Board", mean those members appointed by the governor of hold a current applicable and valid Ohio license. Salon owners

26 who employ persons holding a temporary work permit are skills, and abilities to provide the cosmetology serv- responsible for ensuring that the work permit holder has a ice; valid and conspicuously displayed work permit. Pre-examina- • The licensees maintain documentation satisfactory to tion work permits are valid until the date of the examination the "Board" of meeting the requirements set forth in and extended for thirty (30) days providing the examinee suc- Paragraphs (D) (1) and (D) (2) of this rule; The cos- cessfully completes all portions of the examination. Special metology service does not involve a function or pro- occasion work permits are valid for thirty (30) days. cedure, which is prohibited by any other law or rule and does not exceed the definition of the practice of (7) Student Internship (Ref: 4713-6-04) cosmetology in section 4713.01 of Revised Code. Students enrolled in a cosmetology school licensed by the Licensees shall not provide any service that claims to State of Ohio may obtain ten percent (10%) of their required have a medical or healing benefit. The scope of prac- course work through an in salon Internship. All schools and tice is limited to beautification and relaxation servic- salons participating in the program shall be in good standing es only. The scope of practice is limited to non-inva- with the "Board". Participating schools are responsible for sive services only. Services offered using the term submitting necessary forms and enrollment information to the therapy shall be within the meaning defined in rule "Board". Student Interns are required to wear an identification 4713-8-01(C) (6) of the Administrative Code. badge provided by the "Board." Cosmetologists and Estheticians may exfoliate stra- (8) Scope of Practice (Ref: 4713-8-02) tum corneum cells only. With proper postgraduate A Board licensee who does not practice cosmetology services training cosmetologists may use any chemical, according to acceptable and prevailing standards of safe cos- mechanical or electrical service that only exfoliates metology care, as set forth in this chapter, may be subject to cells of the stratum corneum. Proper postgraduate discipline. All licensees shall provide cosmetology services training from the manufacturer or the manufacturer's within the scope of practice of cosmetology for their branch of certified representative shall be required prior to serv- cosmetology as set forth in Section 4731.01 of the Revised ice to the public. The manufacturer's certificate of Code and the rules of the "Board". training shall be displayed in a publicly conspicuous place. A licensee shall maintain knowledge of the duties, responsibil- • Cosmetologists and Estheticians may use a lancet to ities, and accountabilities of practice and shall practice in enhance the opening in a comedo or to create a small accordance with the following: opening in the dead surface corneum to facilitate • The laws regulating the practice of cosmetology; extraction of milia in order to better extract the con- • The rules of the "Board"; tents. Cosmetologists and Estheticians shall not • Any other applicable federal and state laws and rules; pierce the stratum corneum or use a lancet for any and other purpose. Cosmetologists and Estheticians shall • Position statements, standards for practice, or guide not perform a comedo enhancement or milia extrac- lines for practice from nationally recognized profes- tion with a lancet unless they have had specific docu- sional cosmetology entities; provided these state mented training for this procedure. Only sterile, one- ments, standards, or guidelines are consistent with use, disposable lancets shall be used and they shall be existing laws or rules. disposed of in a "sharps box" medical waste contain- A licensee shall demonstrate competence and accountability in er. Licensees may perform services that are unregu all areas of practice in which the licensee is engaged, which lated by the state in salons upon completing postgrad- includes, but is not limited to, the following: uate training for those services as established by poli- • Consistent performance of all aspects of cosmetology cy of the Board and required by rule 4713-13-12 of services according to acceptable and prevailing stan- the Administrative Code. These services include but dards; and are not limited to body wraps, ear piercing, hypnosis • Appropriate recognition, referral or consultation, and for relaxation, etc. intervention, when a complication arises during or (9) Necessity of Manager (Ref: Oac4713.41 (A)(2) , 4713- after the performance of a specific service or proce- 13-03) dure. A manager must be present in a salon at all times in which a • A licensee may provide advanced cosmetology serv- salon is open except that a manager may be absent from a ices provided: salon for a period of sixty minutes two times a day so long as • The licensee obtains appropriate education, which the manager is readily accessible by phone, or the equivalent, emanates from a recognized body of knowledge rela- and can return to the salon within thirty minutes. A manager tive to the cosmetology service to be provided; must return to the salon when requested by a "Board" inspec- • The licensees demonstrate appropriate knowledge, tor, when requested by an employee, and whenever any situa-

27 tion arises which may affect any person's safety. A person Services on the public shall not be performed at trade shows holding a current, valid managing cosmetologist license to or other public events. Demonstrations on models are allowed. manage that type of salon has charge of and immediate super- Models shall have a written contract with a performance pay- vision over the salon at all times when the salon is open for ment. business except for the following: A business establishment (15) Other Business Co-Located in a Licensed Facility (Ref: that is engaged primarily in retail sales but is also licensed as 4713-13-11) a salon shall have a person holding a current, valid managing Non-cosmetology related businesses may be located in the license for that type of salon in charge of and in immediate same building or facility, but they shall have their own supervision of the salon during posted or advertised service entrance and separate rooms and walls. hours, if the practice of cosmetology is restricted to those posted or advertised service hours. (16) Special Services Certification (Ref: 4713-13-12) "A special service" means any procedure, and the devices used (10) Service List (Ref: 4713-11-10) to perform the procedure, which cause entry into skin, or the Salons shall post a listing of all services provided, and the reg- application of chemicals, electricity, or non-medical cosmeto- ulatory agency that provides oversight of said services, if any. logical service to skin or hair, for example, microdermabra- The certificates of specialized training of the providers, if any, sion, ear piercing, etc. Salons and schools shall not provide shall be posted in the area where services are being provided any special service until the "Board" has reviewed and within the salon. Only "Board" licensees as required by rules approved the service for use in licensed salons and schools. 4713-8-03/04/05/06/07 of the Administrative Code or The "Board" at the time of approval will provide requirements licensees of other Ohio regulatory boards shall provide all for use of each specific device and procedure covered by this non-regulated services. The services listing shall be posted in rule which must be followed by the licensed salons and a conspicuous public place in the salon. The salon may make schools; in addition the salons and schools must comply with the listing on forms provided by the "Board" or an equivalent the following general requirements: document. The listing shall have three columns: (1) the servic- • Salon and school owners must ensure only licensees es provided; (2) the regulatory agency for that service; (3) the who have received approved manufacturers training license type of providers. If the service is unregulated the third are permitted to operate devices. column should list the "Board" licensee or other Ohio board • Each individual trained must have a certificate of licensee providing the service with a statement that the training for the device from the manufacturer or the provider meets the minimum training requirements of the manufacturers' authorized representative posted in the "Board" for that service. All services in the salon shall be pro- room in which services are provided. vided by "Board" licensees or other Ohio board licensee's • Operators must comply with manufacturers' direc- only. tions in the use of all equipment and products. (11) Licensee List (Ref: 4713-13-06) • Operators must advise clients of the necessity of any The owner, manager, or person in charge of each licensed cos- manufacturers' recommended follow-up care, such as metology facility shall do the following: Make available upon sunscreen protection, etc. request of a board inspector a current list, on a form pre- • Only licensed salons or schools may provide the scribed by the board, containing the name of each person board approved special service. employed by or leasing space in the salon, the type of • Products and devices used in salons and schools must license(s) that each person holds, the identification number of meet all Federal Drug Administration, Cosmetic each such license, and current address. Ingredient Review and/or guidelines of the Esthetics Manufacturers Alliance. (12) Non-Cosmetology Ohio Professional Regulatory Board (17) Food in a Salon (Ref: 4713-15-16) Licensees (Ref: 4713-11-12) Salons offering food shall comply with local health board All licensees from any Ohio professional regulatory board are requirements. eligible to work in salons in keeping with the laws and rules of their governing boards. Any issue that arises concerning a (18) Resident Salons (Ref: 4713-11-08) licensee shall be referred to the appropriate governing board. Salon rooms in a residential building shall maintain a separate entrance which shall not open off the living quarters and (13) Retailing of Items in Salons (Ref: 4713-13-09) which shall not have any doors or openings leading to the liv- Salons may retail any legal merchandise in their salon as long ing quarters. Entrance through garages or any other rooms as the merchandise does not create a health, safety or sanita- shall not be permitted. (Draft changes to this rule are pending, tion problem. refer to the Board website for the most recent changes). (14) Demonstrations at Trade Shows and Other Events (Ref: (19) Change of Ownership (Ref: 4713-13-01) 4713-13-10) Salon facility licenses are not transferable from one address to

28 another or from one owner to another. A new salon license area must be equipped with properly maintained exhaust fans application must be filed within thirty days of any change of or air filtration equipment that meets local and state building ownership. Salons are permitted to open or offer services codes. The Ohio building code that applies is rule 4101:2-39- while the application is processed and are subject to the 03 of the Administrative Code (TABLE 403.3). "Board's" approval under the rules contained in chapter 4713- 1 of the administrative code. Any salon with an administrative (25) Water Supply - Waste Disposal (Ref: 4713-11-03) action(s) pending cannot transfer a license until the adminis- Every salon shall be equipped with an adequate supply of hot trative action(s) is resolved. and cold running water and proper plumbing. Every salon shall adhere to the following standards promulgated by the (20) Salon Dispensary (Ref: 4713-00-06) Ohio department of health: (A) Every salon facility shall have a separate, fully functional • Every salon shall have a safe water supply; dispensary room equipped with a door, and totally contained • Sewage and other liquid wastes shall be disposed of within the licensed salon. Each salon dispensary shall measure in a sanitary manner; no less than twenty-four square feet, with minimum six-foot • The storage and collection of solid waste shall be high walls, which shall be used for storing and dispensing of conducted so as to avoid creation of health hazards, supplies and sanitizing of implements. The dispensary shall be rodent harborages, insect breeding areas and acci- equipped with a sink with hot and cold running water, wet dents; sanitizer of sufficient size to entirely immerse all implements • Solid waste shall be stored in waste containers; to be sanitized, and covered waste containers with solid sides • Solid wastes shall be collected at least once each or liner. Floor covering of the dispensary shall be totally non- week. absorbent. Covered wet sanitizers may also be located else- where within the salon. Sanitized instruments, combs and (26) Proper Laundering Methods and Storage (Ref: 4713-15- appropriate items must be stored in such a manner as to avoid 11) recontamination. The public shall not be allowed access to the All cloth towels, robes and similar items shall be laundered in dispensary room. Dispensary room and restroom shall be total- a washing machine with laundry detergent and chlorine bleach ly separate with each having its own entrance. Entry or access used according to manufacturer's directions for sanitation pur- to the restroom shall not be accessible by going through the poses. A closed dust proof cabinet must be provided for clean dispensary nor access to the dispensary by going through the towels and linen and a covered hamper or receptacle must be restroom. provided for all soiled towels, robes and linens. (21) Restrooms (Ref: 4713-11-05) (27) Policy on Prohibiting Pets (Ref: 4713-15-14) All salon facilities shall be equipped with at least one rest- Dogs (except dogs providing assistance to individuals with room, including a toilet and hand-washing sink with hot and physical handicaps) cats, birds, or other animals shall not be cold running water. The restroom shall be kept clean, sanitary permitted in a cosmetology salon. This definition does not and functional at all times. The restrooms shall have a pump include fish, in an aquarium, provided they are maintained in a soap container, covered waste containers with solid sides or sanitary condition. liner, and paper towel dispenser or equipment for hand-drying. (28) Personal Hygiene (Ref: 4713-15-12) Salons located in a mall, office building or nursing homes Every person engaged in the practice of cosmetology or any of with available public restrooms do not need a separate rest- its branches shall thoroughly cleanse his or her hands with room internal to the salon. soap and water immediately before serving each patron. All (22) Walls and Floors (Ref: 4713-15-10) licensees shall wear a clean washable outer garment while Walls, floors and fixtures shall be sanitary and kept clean at all serving a patron in a salon. No licensees shall carry instru- times. Floor covering shall be totally nonabsorbent and extend ments in their pockets, in a belt, or in an apron. at least in a five (5) foot radius from any styling or shampoo (29) Contagious/Communicable Diseases (Ref: 4713-15-13) service chair. No patron with definite open sores, exhibiting symptoms of (23) Floor Plan (Ref: 4713-11-02) infectious or contagious disease or disorder of the skin, or par- Whenever a licensed salon desires to alter the original floor asitic infestations will be served unless written permission plan filed with the "Board", or desires to add other services, from a physician has been secured. No licensee who knowing- the proposed revised floor plan shall be filed with the "Board" ly has an infectious or contagious disease, or parasitic infesta- prior to commencing any such construction or the offering of tion, in a communicable stage shall give service in a salon. other services. The "Board" shall have the right to require a physical exami- nation of any person employed in any salon who is suspected (24) Exhaust Fumes from Service Areas (Ref: 4713-11-09) of having a contagious or infectious disease, or parasitic infes- In any facility licensed as a salon by the "Board," the service tation, in a communicable stage.

29 (30) Proper Protection of Neck (Ref: 4713-15-05) All alcohol shall be kept in a covered container. Alcohol is No shampoo apron, hair cloth, or similar article shall be flammable and shall be kept in a cool well, ventilated area, placed directly against the neck of the patron but shall be kept away from heat or flame. Alcohol evaporates rapidly, which from direct contact with the patron by means of a paper neck makes extended contact times difficult to achieve unless the band or clean towel. No neck band of paper or cloth shall be items are immersed. Alcohol deteriorates some plastics, metals used more than once. No towels shall be used more than once and rubber items. When using alcohol on surfaces other than without proper laundering. non-porous materials, the time of complete immersion shall be a minimum of fifteen minutes after pre-cleaning thoroughly (31) General Sanitation (Ref: 4713-15-01) with a plastic or metal brush and warm soap/water to remove Sanitation procedures shall be followed for the general clean- debris. ing of tools, implements, table chairs, shampoo areas, non- porous surfaces and work station areas. The entire licensed Household bleach is an effective disinfectant for all purposes facility also would include all employees and implements con- in a salon. Bleach solutions shall be mixed daily and used in a tained therein must be continually maintained in a sanitary ten to one solution (nine parts tap water and one part bleach). manner satisfactory to the "Board". All items which come into Bleach shall be kept in a closed covered container and not contact with skin shall be disinfected per rule 4713-15-03. exposed to sunlight. Bleach may produce eye irritation or mouth, esophageal, and gastric burns. Bleach is corrosive to (32) Sanitation, Disinfection, and Blood and Bodily Fluid metals. Bleach vapors might react with vapors from other Spills (Ref: 4713-15-02) chemicals, and therefore should not be placed or stored near Disinfectants are inactivated and ineffective when visibly con- other chemicals used in salons (i.e. acrylic monomers, alcohol, taminated with debris, hair, dirt, particulates and/or when other disinfecting products, or near flame). Used or soiled heavily soiled. Thus, implements and surfaces shall first be bleach solution shall be discarded every day by pouring down thoroughly cleaned prior to disinfection. Disinfectants shall be sink basin or toilet bowl. All bottles and/or containers other prepared fresh daily or more often if solution becomes diluted than the original manufacturers' container used for application or soiled. All used implements shall first be cleaned of visible of "appropriate disinfectant" shall be properly labeled as to dirt, debris and/or bodily fluids with warm soapy/detergent contents, percentage solution and date mixed. Cleanup items water and then disinfected by thoroughly wetting surfaces from minor cuts shall be double bagged or placed in biohazard with an "appropriate disinfectant". containers, regardless of quantity. Double bagging could mean All non-porous implements, which come in contact with use a zip lock baggie for the waste, and then put the baggie in intact skin, shall be thoroughly cleaned before application of a normal trash bag. If the spill or cleaning materials are of a an "appropriate disinfectant". An "appropriate disinfectant" for relatively larger volume, those materials used to clean spills, objects, which come in contact with intact skin is an environ- which do contain blood spills or bodily fluids, shall be mental protection agency registered, hospital grade bacterici- weighed logged on a disposal log sheet and double bagged for dal (esp. pseudomonacidal), virucidal, and fungicidal that is disposal in the normal trash. When in doubt of what to do, call mixed and used according to the manufacturer's directions or the local health board for directions. household bleach in a ten percent solution for ten minutes, or All food and drug administration designated "medical devices" seventy percent isopropyl alcohol or ninety percent ethyl alco- shall only be disinfected by appropriate environmental protec- hol for ten minutes. tion agency approved disinfectants, for example microder- All non-porous implements and/or surfaces, which have mabrasion service wand, tip or head. Environmental protection come in contact with blood or body fluids, shall be thoroughly agency approved disinfectants are indicated by their registra- cleaned before application of an "appropriate disinfectant". An tion number on the product label and the manufacturer's direc- "appropriate disinfectant" includes an environmental protec- tions for use shall always be followed. tion agency registered tuberculocides or products registered (33) Equipment Sanitation (Ref: 4713-15-15) against "HIV/"HBV" or household bleach in a ten percent All equipment used in a salon shall be maintained in a sanitary solution for ten minutes. manner. Salons shall maintain a copy of the manufacturer's/ For personal protection against blood-borne pathogens, owner's manual for all equipment in service. Electrical equip- cleanup should always be done wearing protective gloves and ment, (whether professional or consumer design) which pro- also gowns, and eye protection for large spills. All imple- vides circulating, whirlpool or vacuum effects, (for example, ments, which have come in contact with blood or body fluids, all microdermabrasion machines, facial machines, pedicure shall be disinfected by complete immersion in an "appropriate stations, nail drills and body treatment equipment) shall be disinfectant". Alcohol is a low level disinfectant as defined by cleaned and disinfected after each use. Such equipment shall the Association for Professionals in Infection Control and also be flushed, cleaned and disinfected on a bi-weekly sched- Epidemiology, inc. Alcohol shall not be used for blood spills. ule. A record of such cleaning shall be kept on forms provided by the "Board" and available upon any salon inspection. The

30 bi-weekly cleaning shall include the use of a hospital grade (40) License Renewal and Continuing Education (Ref.: disinfectant, ten per cent bleach solution or an equivalent solu- 4713-21-03) tion approved by the "Board" and circulated through the Any license issued by the state board of cosmetology is valid machine for the minimum time recommended by the manufac- until the last day of January of the odd numbered year follow- turer. Heated electrical equipment such as, all types of thermal ing its original issuance or renewal. The board may refuse to irons, pressing combs and stoves are sanitized by the heat renew a license if the person holding the license has an out- source. Unheated parts of such equipment shall be cleaned and standing unpaid fine under section 4713.64 of the Revised disinfected as well, according to manufacturers' recommenda- Code. (Ref: 4713.57) The continuing education requirement tions. Any other electrical equipment, including clippers and for all licensees is eight hours per biennium. No licensee shall attachments shall be cleaned and disinfected after each use. receive credit for identical course instruction completed during Electrical clipper blades and attachments shall be disinfected the biennial licensing period. Any licensee holding multiple using the following method: Remove hair and/or all foreign branches of cosmetology licenses must complete the continu- matter; Completely saturate clipper blade and attachment with ing education requirements for each branch license. All an EPA-registered high-level disinfectant solution, spray, or other licenses holding multiple licenses in the same branch of foam used according to the manufacturer's instructions. cosmetology need only complete the continuing education requirements for one license. Licensees age sixty-five or older (34) Special Solution Containers (Ref: 4713-15-08) prior to the beginning of a renewal period are exempt from the All licensed service providers shall use product containers to requirement to obtain continuing education requirements for prevent the contamination of unused solution. renewal of their active license. Out-of-state continuing educa- (35) Use of Powder (Ref: 4713-15-09) tion hours shall be submitted for approval to the "Board" with- All powder shall be dispensed from a shaker or similar recep- in thirty days of completing the course in order to be accept- tacle and shall be applied with disposable puffs or cotton pled- able in meeting biennial requirements. gets or other disposable applicators. Ohio EPA Regulations Relating To Nail Salons, Beauty (36) Use of Creams (Ref: 4713-15-06) Shops, Or Barbershops All creams, makeup and other semi-solid substances shall be The following information regarding EPA (Environmental removed from containers with a clean sanitized spatula. Protection Agency) regulations for salon operation and sanita- Spatulas made of a washable nonabsorbent material shall be tion in Ohio can be found at sanitized before being used again. Spatulas made of wood http://www.cos.ohio.gov/BSAPB803.pdf. Please refer to this shall be discarded after one use. site directly for current text and recent regulatory changes: If you are running a nail salon, beauty shop or barbershop, (37) Use of Styptics (Ref: 4713-15-07) you need to be aware of the Ohio EPA regulations that apply Styptics to arrest bleeding shall be used only in liquid or pow- to your business. If you have wastewater discharges from your der form and shall be applied by clean gauze, cotton or any business or generate other wastes, Ohio EPA may regulate other sanitary item. these activities. It is important to understand and comply with the regulations to help avoid violations. (38) Chemicals and Service Approval (Ref: 4713-1-08) All chemicals, and any equipment used in providing any cos- This fact sheet highlights some of the major Ohio EPA metology service, used in any type of licensed salon or school, requirements that could apply to your salon, but may not cover are subject to the approval of the "Board" to ensure the health every requirement, but will provide you with a starting point and safety of licensees and patrons. All salons must provide in identifying where you might be subject to regulation. You Material Safety Data Sheets (MSDS) for all chemicals used in will also need to contact other agencies such as the the salon. ( Draft changes to this rule are pending, refer to the Cosmetology Board, local building department, fire depart- Board website for the most recent updates). ment, health department, Occupational Safety and Health Administration (OSHA) and others to find out what additional (39) Therapeutic Medical or Therapeutic Massage Services requirements apply to your business. (Orc 4713.14(D)) If massage is offered in the salon, the therapist must hold a Managing Wastes current license issued by the Ohio State Medical Board and Under Ohio's regulations, any business that generates a waste must abide by all cosmetology sanitary rules. Relaxation mas- needs to evaluate it to see if it is hazardous waste. sage as a part of a skin beautification treatment may be pro- Nonhazardous wastes that you generate include clippings, vided by cosmetologist and estheticians who have met post packaging, paper and empty containers that you put in the graduate requirements and must know contra-indication for trash. Products you use in your business include tints, color- massage services. ing, peroxide, toners, lighteners, relaxers, polish removers and other chemicals. Some of these may contain acids, alkalies or flammable solvents. You are trained to protect you and your

31 customers from any harmful effects from these chemicals. plans for installing or changing a well. In addition, well sys- These same harmful properties may make these products tems must be tested periodically and the test results reported become hazardous wastes when you can no longer use them. to Ohio EPA. A waste that is ignitable, corrosive, reactive or toxic is defined as a characteristic hazardous waste. In addition, there are spe- Contact your local Ohio EPA district office, Division of cific lists of hazardous wastes in Ohio EPA's regulations. Drinking & Ground Water for more information on well sys- tem requirements. Outdated products, partially full containers or unwanted prod- ucts are considered wastes. And, these may be hazardous Need Additional Help? wastes. Spent solvent from processing nails may also be haz- If you have additional questions about Ohio EPA's regulations, ardous waste. Under the regulations, hazardous waste must be please contact the Ohio EPA, Small Business Assistance sent for disposal at a permitted hazardous waste disposal facil- Office for FREE and CONFIDENTIAL help at 800-329-7518 ity. Hazardous waste CANNOT be disposed of in the trash. or 614-728-8573. You can also contact your local Ohio EPA To help reduce hazardous waste generation, use up all of the District Office for assistance. products that you purchase and consider reusing solvents Beauty/Barber Combination Facilities where possible. The Board of Cosmetology and the Barber Board will approve You can call your local Ohio EPA district office, Division of and license a combination beauty/barber facility within the Hazardous Waste Management, for more information on the following guidelines: hazardous waste regulations. • The facility must have BOTH a salon license issued by the Ohio Cosmetology Board and barber shop Wastewater license issued by the Barber Board. Are the sinks in your salon connected to a public wastewater • The beauty and barber areas must be clearly marked treatment plant? If so, you may be able to discharge your as "Beauty Salon" or "Barber Shop." The purpose of process wastewater to the treatment plant. Many wastewater the signage is to leave no doubt in the public's mind treatment plants (also called POTWs) are operated by the city. as to the services provided in each area. These areas Before you discharge wastewater to the POTW though, you must also be clearly labeled on the facility floor plan. need to contact the POTW to see if they can handle the type of wastewater your shop will generate. Depending on the size • The other areas of the facility can be shared. and nature of your business, you may be required to get a per- • The facility must also have a separate dispensary mit before you can discharge your wastewater to the POTW. It room which is enclosed with walls at least six (6) feet is important to know that Ohio EPA's regulations DO NOT high and which is no less than 24 square feet in area. allow for the discharge of process wastewater or chemicals The dispensary room must be equipped with a sink into an on-site sewage treatment system, like a septic tank and with hot and cold running water and a door. Flooring leach field. Discharging chemicals into an on-site septic sys- in the dispensary must be non-absorbent. Carpet and tem can kill the helpful bacteria that break down sewage other absorbent materials are not permitted. wastes. In addition, chemicals can leach from the system into nearby groundwater. • The facility must have a restroom equipped with both a toilet and a sink with hot and cold running water. If you want to run a salon from your home or from a business location that is connected to an on-site sewage treatment sys- • Each station would be permanently designated for the tem, contact Ohio EPA to discuss options for managing your licensed activity. Any changes to the floor plan or wastewater. any added services would necessitate a new floor plan be filed and approved by both Barber and You can contact your local Ohio EPA district office, Division Cosmetology Boards. of Surface Water for more information on the wastewater dis- charge and permitting requirements. If you are unsure of who • As required by the Barber Board, each designated your local POTW contact is, you can also call the Division of "Barber " station must have a shampoo bowl. Surface Water for assistance. • Each station would be maintained at the standards Drinking Water required for the respective license (health, safety, and If your business has its own well that supplies water for drink- sanitation). ing, cooking, washing hands, washing dishes, or bathing, it • Signage would be posted to inform patrons and may meet Ohio EPA's definition of a public water system. A inspectors as to the type of service to be provided at public water system is one that has at least 15 service connec- that station. tions or regularly provides water to 25 or more people for 60 or more days a year. Under these regulations, you must submit • Licenses would be conspicuously posted at the sta-

32 tion for each service provider. Contact both the Ohio 20. Do not place items in your mouth, such as combs, State Board of Cosmetology and the Ohio State bobby pins, tools etc. Barber Board.3 21. Do not place combs or other instruments in pockets 22. The use of a brush, comb or other article on more OHIO STATE BOARD OF COSMETOLOGY 101 SOUTHLAND MALL than one patron without being disinfected is prohibit- 3700 S. HIGH ST. ed COLUMBUS, OH 43207-4041 23. Avoid touching your client's face or eye area Web Page Address: www.state.oh.us/cos 24. Clean dust and nail filings from your work area after E-mail Address: [email protected] every client 25. Make-up should never be shared Universal Sanitation Precautionary Measures 26. Capes should not touch clients' skin For sanitation procedures not addressed by the Ohio State 27. Place all disinfected implements in a covered con- Board of Cosmetology, above, follow the universal sanitation tainer. Each container should be labeled with cosme- and sterilization checklist below, including the steps for nail tologist's or nail tech's name, especially for booth and foot spa sanitation and laundry. Never take short-cuts or licensees. omit necessary steps in your personal hygiene practices or use 28. Never use the same towel on more than one client of sanitizers, disinfectants, gloves, or goggles, to maintain 29. Discard emery board, orangewood stick, and any salon cleanliness and provide a safe environment for you, your other disposable materials after use with one client clients, and coworkers. 30. Clippers and other nail-care tools should be cleaned 1. Walls, ceilings, floors, and equipment must be free after every use and stored only with other cleaned from dust instruments 2. Clean floors, sinks, and toilets with commercial prod- 31. Sanitize your work area with a disinfectant ucts that kill germs 32. Always wash hands after using the restroom 3. Working area must be well lighted, heated, and venti- 33. Always use a hospital level disinfectant on salon lated implements 4. Plumbing must be installed properly and provide both 34. Disinfecting products should be available at all times hot and cold water to clean scissors, razors, clippers, etc. 5. You must have one running sink and toilet. Toilet tis 35. Have a first-aid kit available in case of a blood spill. sue and waste receptacles must be provided The kit should include adhesive bandages, gauze, 6. Hand cleaning with antimicrobial liquid soap, sani- antiseptic, and disposable latex gloves. ary towels or a hand drying blower must be provided 36. All products used directly on patrons should be 7. Premises must be kept free from rodents, vermin, or labeled, be clean and be in closed containers. other animals 37. Capes and towels should not be used to cover perm 8. A drinking fountain with paper cups should be pro- rods, rollers, etc. vided 38. Clippers can be stored in a drawer only if in a closed 9. Clean doorknobs, especially in restrooms container. Hanging is recommended. 10. Clean linens should be kept in dustproof cabinet 39. Clipper guards should be disinfected and kept closed 11. Soiled linens should be kept in closed receptacles in a covered container, away from clippers. 12. Sanitary towel/neck strips need to be provided for 40. Scissors should be disinfected and kept in a closed every patron clean drawer or closed clean container. 13. Keep your nail services in a separate area of the salon 41. Cotton should be in a storage area or covered con- 14. Hair needs to be removed from the floor and placed tainer so hair does not contaminate. in a closed container 42. All paraffin wax that has come in contact with a 15. Do not allow pets or animals in a salon, except those client's skin should be disposed after each use. Used trained to assist impaired or disabled individuals wax should never be re-used. 16. Cosmetologists should wear a clean uniform 43. Head rests of chairs should be cleaned with a hospital 17. Do not treat any inflammatory disease or condition of grade EPA registered disinfectant. skin, scalp, face or hands Steps for Nail Sanitation 18. Gloves need to be worn during manicuring, waxing, 1. Spray manicure table-top with an EPA-approved dis facials, shampoos, pedicuring, tweezing and any serv- infectant and wipe dry before starting on new client. ice where you may come in contact with any blood or 2. Cover table and manicuring cushion with clean towel body fluids 3. Have the client sanitize his/her hands, and sanitize 19. Always use clean cotton balls, sponges or tissues your own hands using the procedure outlined above. when applying any cosmetics or skin creams

33 Provide instructions for your clients, listing the steps After following the cleaning procedure for the end of required for effectively sanitizing their hands. the day fill the foot spa tub with water and 4 tea 4. Set out a new emery board, orange-wood stick, cot- spoons of 10 % bleach solution or use 2 ounces of ton balls, and other disposable materials on manicur- concentrated tuberculocidal disinfectant per one ing table. gallon of water. Check with the manufacturer to 5. After concluding service with the client, discard dis- determine which solution will not cause damage to posable materials in a closed waste receptacle. the surface of your spa pedicure. Be sure to read Empty waste receptacle daily. manufacturer's instructions before using any disinfec- 6. Spray the table with disinfectant. tant. 7. Disinfect metal equipment or tools with an EPA-reg- Circulate the solution through the foot spa system for istered disinfectant and store them in a clean, closed, 5 to 10 minutes and clearly labeled container after use with each Let the solution sit overnight or 6 hours client. The following morning drain and flush the system and make a record of the cleaning Other tips: (Draft changes that have been made to Rule 4713-15-15 are Have at least two complete sets of implements; on pending, refer to the Board website for the most recent busy days, one set can be disinfecting while you updates). work. Laundry For regular customers, keep their single-use imple- Soiled linens may harbor pathogens, but rarely trans- ments in a separate closed container labeled with mit disease. Handle used linens as little as possible to their name and only use these implements on that avoid contamination customer. All soiled linen should be bagged or placed in con- Use a dusk mask and safety goggles when appropri- tainers at the location where it was used and should ate. not be sorted or rinsed in the location of use. Keep caps on all products to reduce the amount of Gloves and other appropriate protective apparel vapor that escapes into the air. should be worn by employees while sorting soiled Steps for Foot Spa Sanitation linen. Follow these steps to assure proper disinfection of foot spas:. Commercial laundry facilities often use water tem- peratures of at least 160°F and 50-150 ppm of chlo- Between each customer: rine bleach to remove significant quantities of Drain all water and remove all debris from the foot microorganisms from contaminated linen. In the spa. salon, normal washing and drying cycles including Clean the surfaces and walls of the foot spa with anti "hot" cycles are adequate to ensure client safety bacterial soap and water (studies suggest that satisfactory reduction of micro- After cleaning the surface, disinfect with an EPA- bial contamination can be achieved at water tempera- registered disinfectant with demonstrated bactericidal, tures lower than 160°F if laundry chemicals suitable fungicidal, and virucidal activity used according to for low-temperature washing are used at proper con- manufacturer's instructions centrations). Follow instructions by the manufacturers Wipe dry with a clean towel. of the machine and the detergent or wash additive At the end of each day: should be followed closely. Remove the screen. All debris trapped behind the Handle clean linen in ways that ensure cleanliness, screen of each foot spa should be removed, and the and store in a closed cabinet or closet. screen and the inlet should be washed with antibac- terial soap and water. Before replacing the screen immerse it in an EPA - registered disinfectant with demonstrated bactericidal, fungicidal, and virucidal activity which must be used according to the manufacturer's instructions, then Flush the system with low sudsing soap and warm water for 10 minutes, then rinse and drain Make a record of the date and time of the cleaning and disinfecting and keeping the record for each spa.

Every other week: Sanitation and Sterilization

34 Review Practice Questions You can find all the answers to these questions in this section.

1. Athlete's foot cannot infect through indirect transmission.

True False

2. Which of the following best describes the difference between an antiseptic and disinfectant?

a) An antiseptic retards the growth of bacteria and is safe to use on skin. Disinfectants destroy bacteria and are used to decontaminate equipment.

b) Disinfectants are safe to use on skin, and antiseptics are dangerous to use on skin.

c) Antiseptics destroy all bacteria. Disinfectants retard growth of bacteria without destroying it.

d) None of the above

3. What type of disinfectant should primarily be used in a salon?

a) bleach or alcohol

b) EPA registered hospital-level disinfectant

c) Formalin

d) None of the above

4. Nail dust filings contain pathogens.

True False

5. List the steps and materials required to disinfect your tools.

______

______

______

35 Chapter 4 those that are a reaction to environmental agents. Dermatitis Cosmetology: Pathology and Conditions of the Skin, can be endogenous, caused by a malfunction in the skin, or Hair, and Nails exogenous, caused by external factors. Examples of both con- (2 credit hours) ditions are listed in more detail below. Learning Objectives Atopic dermatitis, also known as eczema, is a hereditary Define the meaning of pathology and etiology, and non-contagious condition that may first appear in infancy, and discuss their significance to cosmetology can continue into adulthood. The condition is characterized Associate symptoms with conditions and diseases of by extreme dryness, as well as itchy, thick, and cracked skin, the skin, hair and scalp, and nails occurring in the folds of the body. Lesions resulting from the List common disorders and conditions of the nail that itchy condition tend to appear on the neck, face, and bend of can be treated cosmetically in a salon the knee. In adults, redness and scaling on the hands are com- Identify diseases or conditions that should not be mon. Exposure to stress, certain medications, and temperature treated in a salon extremes can trigger symptoms, especially in individuals with Pathology sensitivities to these exogenous factors. Eczema may also be The term "pathology" refers to the study of disease, including associated with increased incidence of asthma. Hydrocortisone its nature and origins, as well as its effect on the structure and lotions can treat mild cases, while intermediate or high-poten- function of the body. A closely related subject is etiology, cy corticosteroids may be required in more severe cases. which investigates the causes or reasons for disease. This Antihistamines are also useful to combat the itching associated chapter reviews diseases and other common conditions of the with eczema, but may have a sedating effect. Eczema is cur- skin, hair and scalp, and nails, which are all part of the rently not curable. integumentary system. The information presented in the fol- Irritant or allergic contact dermatitis is another type of der- lowing pages will help you develop workplace guidelines for matitis that occurs when the skin is exposed to an irritant, such recognizing potential health risks, to determine when and how as a powerful household cleaner, or an allergen, like poison to proceed with service-or if you should proceed at all. This ivy. Some common allergens are nickel, used in earrings and information is not meant to be used for self-diagnosis or as a jewelry, and many substances used in cosmetics and perfumes. substitute for consultation with a health care provider. If you Redness, swelling and itching at the contact site are common have any questions or concerns regarding the conditions or symptoms of both irritant and allergic contact dermatitis. diseases described below, consult a health care provider. Blistering, as well as cracking, dry skin may occur in more Skin Disorders severe cases. Children with eczema may have a greater ten- Common skin conditions include contagious skin disorders, dency to develop irritant or allergen contact dermatitis as such as herpes or athlete's foot; noncontiguous inflammatory adults. Treatment for contact dermatitis involves identifying skin disorders, such as acne or eczema; neoplastic skin dis- the irritant or allergen, and minimizing or eliminating expo- orders, such as melanoma or psoriasis, and may include skin sure. Topical treatments, as well as antihistamines, can be injuries, such as burns or scars. Use appropriate caution with used to reduce itching. any unknown condition. Seborrheic dermatitis, more commonly known as dandruff, Acne usually appears as an inflammation of the scalp, but may also Acne is caused when skin cells plug a hair follicle. Usually cause red, scaly patches around the nose, eyebrows, behind the results in blackheads or whiteheads if the plug is near the sur- ears, as well as on the chest, armpits or groin. Dandruff sham- face of the skin. Pimples result when sebum forms behind the poo is usually effective in treating mild cases, but more severe cell plug, pushing it out of the skin. Hormones, stress, and cases may require a dermatologist's attention. use of cosmetics may all play a role in the production of acne. Stasis dermatitis is a kind of dermatitis that occurs primarily Acne can be treated with prescription and non-prescription in older women who have varicose veins. The constant drugs, depending on the severity of the condition. In some inflammation of the varicose vein may cause the skin to cases, gentle cleansing and a topical benzoyl peroxide solution become thick, scarred, and discolored. Wearing support stock- can be very helpful. In more severe cases, antibiotics or ings and elevating the legs can help prevent or alleviate symp- Retin-A can be prescribed by a dermatologist. While often toms. associated with puberty, acne is common in adults of all ages. Hives (urticaria) Dermatitis Hives may appear as a single red welt or as inflammation all Dermatitis refers to several different itching, inflamed condi- over the body, and may take a matter of hours, to days or even tions of the skin that are characterized by scaling, swelling, weeks, to resolve. Single hives are usually a reaction to an redness, and the formation of papules. Dermatitis can refer to insect bite or other irritant. More widespread outbreaks can be conditions with unknown, as well as known, origins, including

36 caused by medications like penicillin, or foods like chocolate Solar keratoses are flat or slightly raised, red, scaly spots and shellfish. Stress is also thought to play a part, in some caused by exposure to the sun. These should be removed as instances, in the development of hives. Keeping a diary of they become cancerous more than 20% of the time. one's diet and medications and noting the timing of reactions can be helpful in identifying the cause of hives. Treatments Warts are caused by viral infection. While they can occur include antihistamines, lotions, and/or adrenaline injections. anywhere on the body, they appear most commonly on the hands and feet. While they usually disappear on their own, Psoriasis over-the-counter medications, cryotherapy, and other medical Psoriasis is a skin disorder that affects over three million interventions can also be effective in their removal. Americans, and, like eczema, tends to occur within families. Men and women are equally affected, with Caucasians more Skin Cancer likely to have psoriasis than either African or Asian More than 500,000 Americans develop skin cancer each year, Americans. The condition occurs when the skin cells multiply with more than 90 percent of these cases occurring on body more rapidly than normal, and move quickly through the der- parts that are commonly exposed to the elements. Fair skin mis, toward the epidermis, where they are shed in scales. and blue eyes (both characteristics of low melanin production) There are several theories regarding the cause of psoriasis, are associated with increased risk of skin cancer. Skin cancer which may be due to a genetic component, immune system is also correlated with geographic location, with skin cancer abnormalities, and/or cellular, biochemical, or metabolic more prevalent among light skinned people exposed to con- defects. Psoriasis initially resembles red patches on the skin, stant high levels of UV radiation, cumulative exposure to the but develops into sharply demarcated, crusty patches with sil- sun, or other sources of UV radiation, such as tanning beds very scales. Knees, palms, scalp, elbows, trunk, soles of the and sunlamps, over many years. feet and genitalia are common sites for psoriasis. There are three types of skin cancer, basal cell carcinoma, Additionally, the condition can appear on the finger and toe- squamous cell carcinoma, and malignant melanoma. Basal nails, causing thickened, discolored nails, or nails that separate cell carcinoma, the most common, is slow growing, and rarely from the nailbed. There is no known cure for psoriasis, but invades other tissues. Squamous cell carcinoma is found existing treatments offer months, or years, of relief from mostly on areas exposed to sunlight, such as the head, face symptoms. Topical medications such as corticosteroids or and hands. It can spread to other parts of the body, so early crude coal tar ointments can be very effective in mild cases, detection is important. Malignant melanoma is the most dead- while drugs like methotrexate, etretinate, and cyclosporine can ly form of cancer, with the highest risk of spreading to other be useful in more severe cases. Non-pharmaceutical methods parts of the body. like UV light therapy may also be effective treatment options. In all three types of skin cancer, the first indicator is usually a Growths and Tumors noticeable change in a skin growth or the surface of the skin. Benign tumors and growths become more prevalent as we age. It can take the form of a new mole, a change in an existing Unless they become irritated, most growths and tumors need mole, or a sore that fails to heal. A small, smooth, shiny or not be removed, but many individuals choose to do so for cos- waxy bump, a red bump that bleeds, or a flat red spot that is metic reasons. rough, dry or scaly can all be signs of skin cancer. Cherry angiomas are small red bumps on the skin that are Remembering "ABCD" when evaluating your moles can help usually harmless, but should be removed if they begin to you assess whether they might be cancerous. "A" for asym- bleed. metry, or irregularly shaped; "B" for jagged borders; "C" for color variations, especially blue-black; and "D" for a diameter Liver spots are flat, light brown or black spots common in greater than 5 mm (the size of a No. 2 pencil eraser). fair-skinned individuals over the age of 50 that typically occur Regularly scan your skin and take note of any changes. Your on the face and backs of the hands. They are usually harm- physician should also scan your skin as a regular part of your less, associated with sun exposure, and can be removed by physical. Treatments for skin cancer include surgical exci- cryosurgery, acid peeling, or electrosurgery. sions of the tumor, cryosurgery, topical chemotherapy and laser therapy are some of the treatments available for skin can- Moles are fleshy brown or black growths that result from cers. melanocyte overgrowth. Most moles are harmless, but each should be checked, and possibly removed, if changes are Skin Disorders Common in Children observed. Babies are born with a skin coating, called vermix, that wash- es off, but sometimes causes the baby's skin to peel when Seborrheic keratoses are flat or slightly elevated rough, exposed to the air. This peeling is normal, and doesn't require brown spots on the back, chest, face and arms that can be treatment. Bathing the baby a couple of times a week is usu- removed by cryosurgery. ally sufficient to keep the skin clean and healthy; more fre-

37 quent bathing may dry the skin. Be sure to use products cutaneous tissue. Fever, headache and chills followed by a specifically formulated for a baby's skin to ensure that they rash with patches of red, swollen, hot skin are characteristic of contain no irritating chemicals. Greasy, yellowish-brown the infection. Immediate medical treatment is necessary as the patches on the scalp or behind the ears are characteristic of a condition can be fatal if left untreated. Antibiotics are the condition called cradle cap. Washing the scalp with a mild most common and effective treatment. baby-shampoo formula, or rubbing the scalp with baby oil or petroleum jelly, will remove the coating. Impetigo is a bacterial skin infection common in babies and young children. Streptococcus bacteria enter through a small Babies may experience persistent or widespread rashes, as cut or bite, causing the infected area to become covered with well as birthmarks that enlarge or change shape. Pinkish, blisters that form a honey-colored or gray crusty rash on the brown, red, or purple patches on the body have many causes; face, near the mouth and nose. Topical treatments or oral pink or brown angiomas, or flat red stains, will usually disap- antibiotics may be prescribed, depending on the severity of the pear by the time the child is 18 months old. Hemangiomas, or infection. bright strawberry-red marks, grow rapidly but disappear by the time a child reaches age five to seven. Port wine stains may Fungal infections be permanent; consult a pediatrician regarding treatment or Athlete's foot is caused by a fungus related to ringworm and removal options. Babies of Asian and African heritage may be jock itch. The fungus is especially prevalent among adoles- born with large blue-gray marks that look like bruises. Called cents, although people of any age can get it. Over-the-counter Mongolian spots, they usually disappear by the time the child and prescription medications are both used to treat fungal reaches 5 years of age. infections, depending on the severity of infection. Yellow-white spots on the nose, upper lip, cheeks or forehead Yeast infections, or candidal dermatitis, are common among can be caused by sebaceous hyperplasia, milia, (whiteheads) infants who wear diapers, as well as among adolescent girls or miliaria (prickly heat). Sebaceous hyperplasia and milia and women. are caused by enlarged oil glands. Pustular melanosis is a Viral infections condition with small, quick-drying blisters that leave spots like Canker sores, the cause of which are unknown, appear inside freckles. All these conditions require no treatment and will the mouth, and can make eating difficult or painful. eventually resolve on their own, although prickly heat, as well Antihistamine mouthwashes are available for treatment. as other skin conditions, can be aggravated by tight-fitting clothing or abrasive material rubbing against the skin. Chicken pox are caused by herpes zoster, the virus responsi- Diaper rash is an extremely common condition characterized ble for shingles in adults. The disease is most common in by a red, spotty rash in the diaper area. Changing diapers fre- children, with symptoms including red, itchy blisters and quently, exposing the area to open air as much as possible, and fever. In severe cases, permanent scarring can result from using a cornstarch-based powder should help resolve the con- scratching chicken pox. Tingling or pain in the affected area is dition. If there is no improvement within three or four days, typically the first sign of shingles. After that, red skin and contact a pediatrician. Also consult a pediatrician if a child blistering on one side of the body or face may appear, along a has red scaly patches on the cheeks, diaper area, or elsewhere, spinal nerve path. Pain can last from two to three weeks, or as they may be the result of eczema. longer, in some cases. Acyclovir or oral corticosteroids are effective treatments. Skin Infections Many bacterial and viral skin infections initially appear rela- Cold sores or fever blisters are caused by the herpes sim- tively minor and easy to treat, but can develop into serious and plex I virus, and are contagious. Sun exposure, stress, and even life-threatening conditions if improperly treated. even menstruation can trigger an outbreak. Over-the-counter treatments as well as prescription acyclovir can help treat cold Bacterial infections sores. Boils are caused when staphylococcus bacteria infect hair follicles and cause inflammation to the skin. They can be Herpes simplex virus 2 is a variation of the herpes virus that accompanied by fever or fatigue, and present as painful, red is usually spread by sexual contact, and is characterized by and swollen nodules on the skin. They can appear anywhere itching, sores, and rashes, primarily of the genital area. but are most common on the upper back and nape of the neck. Measles is no longer prevalent due to the existence of a vac- Hot compresses can help bring them to a head, releasing the cine; Symptoms include fever, coughing, and a skin rash. pus and allowing the infection to heal. For recurrent boils, medical attention is needed. Cellulitis or erysipelas is also caused by streptococcus bacte- ria entering the skin, causing an infection of the skin and sub-

38 Describing Skin Conditions or Appearance cryosurgery a surgery technique that uses liquid The following terms may be useful in describing skin condi- nitrogen to freeze the skin tion or appearance: cyst a deep lesion filled with pus acne a disorder of the hair follicles and dermatitis a number of skin conditions that cause sebaceous glands that is characterized inflammation by pimples, cysts, infected abscesses, and/or scarring dermatofibroma small red or brown bumps albinism a rare, inherited disorder characterized dermis the middle layer of skin, made up of by a total lack of melanin (skin pig- blood vessels, lymph vessels, hair folli- ment) in the skin cles, and sweat glands angioma a benign tumor in the skin that is com- dermoid cyst a benign tumor made up of hairs, seba- posed of blood or lymph vessels ceous, and sweat glands atrophic thin and wrinkled epidermis the outer layer of skin made up of the basal cells cells that are found in the outer layer older squamous and basal cells of skin and responsible for producing erysipelas a skin infection that usually affects the squamous cells arms, legs, or face; characterized by basal cell carcinoma the most common form of skin cancer; shiny, red areas, swollen lymph nodes, characterized by small, shiny, bumps and blisters on the skin that may bleed erythema multi- a skin condition characterized by sym- birth marks areas of raised and/or discolored skin forme metrical red, raised skin areas that is present at birth or appears short- ly thereafter erythema nodosum a skin condition characterized by red bed sores skin ulcers that form due to long-term bumps; usually appearing on the shins pressure without relief; the result of erythrasma a skin infection affecting the top layer sitting or lying in the same position; of skin and characterized by irregular can be associated with physical disabil- pink patches that turn into brown ity, illness, wearing a cast, etc. scales biopsy the procedure of removing tissue for excoriation a hollowed out or linear area of the microscopic examination skin covered by a scab or crust blister a fluid filled bump folliculitis an inflammation of the hair follicles boil tender, swollen area around a hair folli- caused by infection cle freckles dark, flat spots that appear on areas of candidiasis/yeast a skin infection caused by yeast; skin exposed to the sun infection occurs in skin folds, including those of granuloma annulare a chronic skin condition characterized the navel, vagina, penis, mouth, and by small, raised bumps that form a ring nail beds with either an even or sunken center carbuncles collection of skin boils herpes zoster/shin- a common viral infection of the nerves, capillary heman- a raised, strawberry-red mark on the gles characterized by a painful skin rash gioma skin with small blisters cavernous heman- raised red or purple mark made up of hives/wheals a pink swelling of the skin gioma enlarged blood vessels impetigo a skin infection characterized by pus filled blisters cellulitis a bacterial infection of the skin that is keloids smooth, raised, pink, fibrous growths swollen and tender that form over healed wounds cold sore small blisters around and in the mouth Keratinocytes/squa- cell types prevalent in the epidermis, caused by the herpes simplex virus mous cells or outer layer of skin collagen a protein produced by skin cells that keratoacanthomas round, flesh-colored growths surround- provides strength and resilience to the ing craters that contain a pasty material skin keratosis pilaris a common skin condition characterized creeping eruption a skin infection caused by hookworms by small, pointed pimples and characterized by severe itching lice tiny insects that infest the skin and cause intense itching

39 lichenification thickened skin rosacea a common skin condition characterized lipomas round or oval lumps caused by fatty by redness, pimples, and broken blood deposits under the skin vessels lymphangioma raised, yellow, tan, or red mark on the salicylic acid a drug that removes the outer layer of skin made up of enlarged lymphatic skin (keratolytic), used to treat a num- vessels ber of skin conditions macular stains faint, red marks that appear in the skin sarcoidosis inflammation affecting organs includ- at birth; also called "angel's kisses" ing the lymph nodes when located on the forehead and eye- scab a crusty formation of dried blood, pus, lids, and "stork bites" when located on or other fluid over a break in the skin the back of the neck scabies mite infestation of the skin, character- macule smaller version of a patch; a flat, dis- ized by small pimples that itch colored spot scales dead skin cells that look dry or flaky malignant melanoma a rare, but deadly, skin cancer that begins as a mole scar fibrous tissue that forms after a skin melanocytes cells in the epidermis that produce skin injury pigment (melanin) sebaceous glands glands that secrete oil in the skin melasma dark, brown symmetrical patches of seborrheic keratosis flesh-colored, brown, or black wart- pigment that appear on the face like spots moles small marks on the skin caused by skin tags soft, small, flesh colored skin flaps that melanocytes occur on the neck, armpits, or groin mites Tiny arthropods that drink blood, cause spider angioma a bright red mark with a dark spot scabies, and can be spread through squamous cell carci- highly treatable form of cancer charac- close contact with skin, infested sheets, noma terized by red, scaly skin that becomes or clothing an open sore; constitutes about 20 per- Mongolian spots bluish-black marks appearing the lower cent of all skin cancer patients back and buttocks (primarily affects subcutis the deepest layer of skin, which con- individuals of African or Asian sists of collagen and fat cells descent) tinea versicolor a common fungal skin infection char- nodule/papule a solid, raised bump acterized by white or light brown skin paranychia a skin infection occurring around a fin- patches ger or toenail toxic epidermal a life-threatening skin disorder charac- patch a flat, discolored spot necrolysis terized by a blistering and peeling top pityriasis rosea a common skin condition characterized layer of skin by pink, scaly, inflamed skin tretinoin a drug chemically related to vitamin A port wine stains/nevi permanent flat, pink, red, or purple that is used to treat acne and other flammeus marks on the skin scaly skin disorders prickly heat a rash caused by sweat trapped under urushiol resin in poison ivy plants that causes the skin skin reaction psoriasis a chronic skin condition characterized vitiligo smooth, white skin patches caused by by inflammation and red, raised areas the loss of pigment-producing cells that develop silvery scales wart a noncancerous skin growth caused by pustule/pimple pink, bumpy lesions a virus pyogenic granuloma red, brown, or bluish-black raised Hair marks caused by excessive capillary Like other mammals, humans are covered by hair. Human growth body hair is much finer than that of our mammalian brothers ringworm a fungal skin infection characterized by and sisters, and is concentrated primarily on our heads, under- ring-shaped, red, scaly, or blistery arms, and genital regions. Most men, and some women, also patches 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

40 a barrier to toxins. Sebum also manufactures the body's vita- Genetic background and age can impact how much hair a min D, triggered by exposure to the sun woman has on the cheeks, upper lip, arms and legs. There are a variety of methods to cope with unwanted hair, such as Disorders of the Hair and Scalp tweezing, waxing, shaving, bleaching, depilatories and elec- The condition and appearance of the hair and scalp are influ- trolysis. Electrolysis is the only permanent hair-removal enced by many factors, including physical health, nutrition, method, and is typically among the most expensive and time- blood circulation, emotional state, function of the endocrine consuming means of removal. glands, and medications consumed. Common disorders of the hair and scalp include vegetable and animal parasitic infec- Monilethrix is the formal term for beaded hair, which breaks tions, staphylococci infections, which cause furuncles (boils), between the nodes or beads. Hair and scalp treatments may and the following conditions, which may affect the hair folli- prove helpful. cle and/or sebaceous glands. Tinea capitis (ringworm) is a fungal infection that forms a Alopecia is the formal term for any abnormal hair loss. It scaly, ring-like lesion on the scalp. It is highly contagious. should not be confused with natural hair loss, which occurs when the hair has grown to its full length, falls out, and is Trichoptilosis is the formal term for split ends. replaced by a new hair. Alopecia senilis is hair loss associated Trichorrhexis nodosa, or knotted hair, is characterized by with old age, alopecia prematura may occur any time before dry, brittle hair with nodular swellings along the length of the middle age, and is characterized by slow thinning over time. hair shaft. Hair breaks easily, but condition may be remedied Alopecia areata is relatively sudden, patchy hair loss, includ- somewhat by conditioners. ing the spotty baldness that is associated with anemia and typhoid fever, among other conditions. Tension alopecia is Conditions Affecting the Nails caused by tight braiding or hair styles that pull the hair's roots. While many harmless nail irregularities can easily be correct- ed through cosmetic treatment, be sure to refer any condition Canities is the formal term for gray hair, which is caused by associated with pain, infection, or irritation to a physician for the loss of pigment. Acquired canites is usually associated consultation and treatment. Nail technicians should never treat with aging, while congenital canites, a condition existing at nail disorders, but should be able to recognize and distinguish birth, includes albinism. between normal and abnormal growth of the nail. Common Dandruff (or pityriasis) is a condition in which small white disorders affecting the nail include bacterial, fungal, yeast, flakes or scales appear on the scalp and hair. Excessive dan- and viral infections; paronychia, infection of the nail fold; druff can lead to baldness, if the condition is severe and neg- disorders associated with specific skin diseases (like psoria- lected. Dandruff may be due to microbial infection, poor cir- sis); and nail injuries, which sometimes lead to nail malfor- culation, nerve stimulation, or diet, and may be associated mation as the nail grows back. For images (reproductions of with specific shampoos, or insufficient rinsing of shampoos. photographs from Milady's Standard Textbook of Pityriasis capitis simplex, or dry type dandruff is character- Cosmetology) and further information regarding the following ized by an itchy scalp and white scales scattered throughout nail conditions, refer to these web sites and the resources list- 4 the hair. Pityriasis steatoides, a greasy or waxy type of dan- ed at the end of this chapter: druff, is characterized by a scaly skin surface mixed with http://www.hooked-on-nails.com/naildisorders.html. sebum, and may include bleeding or oozing of the sebum http://www.nsc.gov.sg/cgi-bin/WB_ContentGen. when scales tear off. Refer the client to a physician for med- pl?id=102 ical attention. Dandruff is considered contagious and may Common Nail Disorders spread through the common use of brushes, hair clips, or bacterial infec- caused by harmful microscopic organisms styling implements. tion that live on our skin, hair and nails. Fragilitas crinium is the formal term for brittle hair, which Bacterial infections may be introduced may include split ends. Conditioner may improve hair flexibil- through trauma or exposure to harsh irri- ity. tants. Redness, swelling and pain are signs of bacterial infection. Consult a health care Hair loss occurs naturally as part of hair growth and regenera- professional. tion. In women, childbirth, stress, crash dieting, emotional Beau's lines characterized by horizontal indented lines stress and shock can cause greater than normal hair loss, of darkened cells across the nail surface, though it is usually temporary. Some older women experience caused by trauma, illness, or poor nutrition, female-pattern hair loss with thinning of the crown and hair- among other conditions, that interfere with line. protein metabolism and formation of the Hirsutism (or hypertrichosis) is excess hair on the body. nail plate. Seek a physician's diagnosis.

41 blue nails may be caused by poor blood circulation or hematoma occurs when blood is trapped between the impairment of the heart nail bed and the nail plate due to trauma, brittle nails characterized by vertical splits in, or sepa- like slamming a finger or toe in a car door. ration of, nail plate layers at the distal, or A hematoma can be infected by fungi or open, edge of the nail plate. Vertical ridges bacteria; seek medical attention if the blood and splits can occur, naturally, with aging. clot becomes painful. Exposure to water and harsh cleaning solu- koilonychia usually caused by a deficiency of iron (ane- tions or chemical solvents can strip the nail mia), and characterized by thin and con- of moisture and reduce flexibility of the cave nail ridges. Seek a physician's advice nail plate. and treatment. bruises appear dark purple, black, or brown. leuconychia characterized by white lines or spots in the Usually the result of trauma, a result of nail plate that are caused by tiny air bub- dried blood attaching to the nail and grow- bles, which are the result of trauma or a ing out along with it. Avoid pressure. hereditary condition. The markings will corrugations harmless wavy ridges caused by uneven eventually disappear as the nail grows out nail growth that results from injury or poor of the nail plate. health malformation distortions or discolorations of the nail that eggshell nails Very thin, fragile nails where the nail plate occur with new nail growth, after injury to separates from the nail bed and curves at the nail bed and loss of damaged nail. the free edge melanonychia vertical pigmented bands, sometimes referred to as nail 'moles'. In rare cases, fungal infections at the root of many nail disorders; fungal they may signify a malignant melanoma or infections access the nail plate from the lesion. See a physician if you see any sud- free margin and sides of the nail. Infections den changes in the nail plate. can cause discoloration of the nail if debris MMA damaged MMA (methyl methacrylate) is a liquid becomes trapped under the nail plate, may nails monomer that has been banned by the cause the nail plate to become brittle and FDA. Its' use with acrylic nails is prohibit- thick, or result in loss of the nail, in cases ed in nail salons. MMA nails have no flexi- where the nail plate becomes separated bility; when one breaks, it also breaks, and from the bed. Fungal infections are more can cause substantial damage to, the natural prevalent among toenails, as the enclosed nail. environment of shoes and stockings nail biting/pick- Nail biting and/or picking can result in nail encourages fungal growth. A diagnosis of ing injury. Prevalent among children, this fungal nail infection can be confirmed by common habit can be a health risk, as it microscopic examination of the nail or nail helps microorganisms access the body, clippings, and oral antifungal tablets or moving from surfaces, to hands, to the lotion may be prescribed by your doctor. mouth, or entering through broken skin sur- Fungal infections can be stubborn; treat- rounding the nail. ments typically lasts at least 2, and up to nail dysplasia presents a variety of different symptoms, 12, months, depending on the type of infec- including nails that are small, concave, tion and medication prescribed, and nails have lengthwise ridges, are splitting, pitted, may take months to return to a normal soft, discolored, or brittle. Nails of the fin- appearance. gers generally show more symptoms than furrows are depressions in the nails that can run toe nails. either horizontally or vertically across the nail patella syn- a rare genetic disorder characterized by nail. Often the result of illness or injury to drome skeletal deformities that occurs in about the matrix, furrows also accompany preg- two out of every 100,000 people. nancy and occur during periods of high onychatrophia A wasting (atrophy) of the nail plate, stress. Use extreme care in manicuring caused by injury or disease, causing it to furrowed nails as they are very fragile. grow smaller, and, in some cases, to shed hangnail/agnail occurs when the cuticle splits from the nail; completely. typically the result of dryness or overcut- onychauxis/hype a thickening of the nail plate that may be ting of the cuticle; can be an access point rtrophy the result of a medical disorder; refer to a for infection. physician.

42 onychogryposis clawlike nails that curve inward and are tinea unguis also known as ringworm; characterized by characterized by a thickened nail plate. nail thickening and deformity; may result The condition may result from trauma. in loss of the nail plate. Surgical intervention to relieve pinching of tumors or warts tumors are characterized as either cancer- the nail bed is sometimes required. ous or benign. Warts are a type of benign onychorrhexis brittle nails that split vertically, peel and/or tumor, caused by a viral infection. have vertical ridges. While sometimes the Treatment includes freezing or a chemical result of heredity, use of strong solvents, application, and may require surgery to such as household cleaning solutions, may remove. result in this condition. See a physician to vertical ridges can be a characteristic of aging, but are not rule out the possibility of disease. limited to the elderly. A symptom of the paronychia an inflammation of the nail fold caused by loss of the nail plates' natural oils and infection involving bacteria, fungi, or moisturizers, which decline as we age. Re- viruses; occurs as a result of a tear or break hydration of the nail plate will reduce in the seal between the nail plate and its ridges to some degree. surrounding tissue. Infection is character- ized by pain, redness, and/or swelling of Use Caution When Exposing the Natural Nail the nail folds. Paronychia is highly conta- Use precautionary measures and do not tend to clients' nails if gious. Avoid keeping hands in water for they are discolored. Fungal infections can occur when mois- extended periods of time or biting nails as ture is trapped between an unsanitized natural nail and artifi- this may encourage some types of infec- cial products like tips, wraps, gels, or acrylic nails. In cases tion. Refer to a physician for treatment, of infection, the client may ask you to remove an artificial which may include medication with oral nail, to expose the natural nail so it can be treated by a physi- antibiotics or use of topical antifungal and cian. In such cases, follow manufacturer instructions for arti- antiseptic lotions. ficial nail removal and wear gloves during the procedure. pseudomonas bacterial infection that occurs between the Once the artificial nail has been removed, all porous supplies natural nail plate and the nail bed, and/or and implements should be discarded and all remaining sur- between an artificial nail and the natural faces, implements, and materials must be sanitized. nail that may have a greenish color. The Changes in the Hair, Skin, and Nails During Pregnancy infection will eventually cause the nail Women may experience changes in their hair, skin, and nails plate to darken and soften underneath the during pregnancy. In most cases, these changes are temporary artificial nail. In some cases, will cause the and will return to their original condition after the birth. nail plate to separate from the nail bed. Existing skin conditions may either be exacerbated or psoriasis characterized by raw, scaly skin; sometimes improved with pregnancy; eczema, for example, generally confused with eczema. Psoriasis leaves the becomes more severe during pregnancy, while psoriasis typi- nail plate pitted, dry, and crumbly. The cally appears less severe. plate may separate from the nail bed, or appear reddish, orange, or brown, with red Herpes gestationis, is characterized by blisters on the spots. Do not attempt to treat this condi- abdomen that usually appear during the second trimester of tion. Refer the client to a physician. pregnancy, then disappear, and reappear at delivery. Topical pterygium the inward growth of skin over the nail and oral corticosteroids can provide relief. plate, causing the loss of the nail plate and Hirsutism, or excessive hair growth, can appear on the face the formation of scar tissue; usually the and/or chest due to hormonal changes experienced during result of trauma. Do not attempt to treat pregnancy. Within six months after giving birth, this condi- pterygium; refer to a physician. tion generally dissipates. pterygium inver- an acquired condition characterized by sum unguis growth of the hyponychium, in which live Hyperpigmentation, characterized by the appearance of dark tissue (including a blood supply and spots on the skin, affects more than 90% of pregnant women. nerves) attaches to the nail plate. Causes This condition is caused by an overproduction of melanin, include systemic and hereditary factors, as which may turn the breasts, nipples, and genitals, as well as well as allergic reactions to acrylics or sol- freckles and scars, a shade or two darker than is usual, but will vents. Never force the hyponychium back; return to normal a few months after pregnancy. consult a physician for diagnosis and treat- ment. Melasma, or "the mask of pregnancy" affects about 70% of

43 pregnant women. It is caused by an increase of pigmentation What do head lice look like? in areas that have previously been exposed to the sun. Three There are three forms of lice: the nit, the nymph, and the common patterns of melasma are the centro-facial pattern, adult. with pigmentation occurring on the cheeks, forehead, upper lip, nose and chin; the malar pattern, showing pigmentation on Nit: Nits are head lice eggs. They are hard to see and are often the cheeks and nose; and the mandibular pattern, appearing on confused for dandruff or hair spray droplets. Nits are found the cheeks and jawline. Proper use of sunscreen may be help- firmly attached to the hair shaft. They are oval and usually ful. This condition returns to normal after pregnancy. yellow to white. Nits take about 1 week to hatch. Nymph: The nit hatches into a baby louse called a nymph. It Pruritic urticarial papules and plaques of pregnancy looks like an adult head louse, but is smaller. Nymphs mature (PUPPP) typically appear in the third trimester, and is the into adults about 7 days after hatching. To live, the nymph most common skin condition associated with pregnancy. mustfeed on blood. Small red bumps or hives form a rash on the abdomen that may spread to the thighs, buttocks, breasts and arms. Topical Adult: The adult louse is about the size of a sesame seed, has anti-itch medications generally provide relief, and the condi- six legs, and is tan to greyish-white. In persons with dark hair, tion disappears after delivery. the adult louse will look darker. Females lay nits; they are usu- ally larger than males. Adult lice can live up to 30 days on a Stretch marks are a common condition especially prevalent person's head. To live, adult lice need to feed on blood. If the in Caucasians, but may exist among other populations in louse falls off a person, it dies within 2 days. women who lose or gain a great deal of weight. The condition is characterized by pink or purple bands that appear on the Where are head lice most commonly found? abdomen, breasts or thighs. Exercise and some topical prepa- On the scalp behind the ears and near the neckline at the back rations may reduce or lessen their appearance. of the neck. Head lice hold on to hair with hook-like claws found at the end of each of their six legs. Head lice are rarely Telogen effluvium refers to excessive hair loss that occurs found on the body, eyelashes, or eyebrows. within five months after pregnancy. This condition does not cause permanent hair loss or baldness, typically returning to What are the signs and symptoms of head lice infestation? normal after six to twelve weeks. • Tickling feeling of something moving in the hair. • Itching, caused by an allergic reaction to the bites. Fact Sheets from the Centers for Disease Control and • Irritability. Prevention • Sores on the head caused by scratching. These sores The following fact sheets present information from the can sometimes become infected. Centers for Disease Control and Prevention, National Center for Infectious Diseases, Division of Parasitic Diseases, regard- How did my child get head lice? ing lice infestation. These useful handouts can be helpful in • By contact with an already infested person. Contact is providing necessary information to clients with a minimum of common during play at school and at home (slumber embarrassment and fuss. To refer to this information directly, parties, sports activities, at camp, on a playground). see: http://www.cdc.gov/ncidod/dpd/parasites/lice/default.htm. • By wearing infested clothing, such as hats, scarves, coats, sports uniforms, or hair ribbons. • By using infested combs, brushes, or towels. • By lying on a bed, couch, pillow, carpet, or stuffed Head Lice Infestation animal that has recently been in contact with an (Pediculosis) infested person. What are head lice? Also called Pediculus humanus capitis (peh-DICK-you-lus How is head lice infestation diagnosed? HUE-man-us CAP-ih-TUS), head lice are parasitic insects By looking closely through the hair and scalp for nits, found on the heads of people. Having head lice is very com- nymphs, or adults. Finding a nymph or adult may be difficult; mon. However, there are no reliable data on how many people there are usually few of them and they can move quickly from get head lice in the United States each year. searching fingers. If crawling lice are not seen, finding nits within a 1/4 inch of the scalp confirms that a person is infest- Who is at risk for getting head lice? ed and should be treated. If you only find nits more than 1/4 Anyone who comes in close contact with someone who inch from the scalp, the infestation is probably an old one and already has head lice, contaminated clothing, and other does not need to be treated. If you are not sure if a person has belongings. Preschool and elementary-age children, 3-10, and head lice, the diagnosis should be made by a health care their families are infested most often. Girls get head lice more provider, school nurse, or a professional from the local health often than boys, women more than men. In the United States, department or agricultural extension service. African-Americans rarely get head lice.

44 This fact sheet is for information only and is not meant to be 1. To kill lice and nits, machine wash all washable clothing used for self-diagnosis or as a substitute for consultation with and bed linens that the infested person touched during a health care provider. If you have any questions about the the 2 days before treatment. Use the hot water (130o F) disease described above or think that you may have a para- cycle. Dry laundry using high heat for at least 20 min- sitic infection, consult a health care provider. utes This page last reviewed November 6, 2003 2. Dry clean clothing that is not washable, (coats, hats, Centers for Disease Control and Prevention scarves, etc.) OR National Center for Infectious Diseases 3. Store all clothing, stuffed animals, comforters, etc., that Division of Parasitic Diseases cannot be washed or dry cleaned into a plastic bag; seal for 2 weeks. 4. Soak combs and brushes for 1 hour in rubbing alcohol, Lysol*, or wash with soap and hot (130o F) water. Treating Head Lice How can I treat a head lice infesta- 5. Vacuum the floor and furniture. Do not use fumigant tion? By treating the person infested with head lice, other infested sprays; they can be toxic if inhaled or absorbed through family members, and by cleaning the house. the skin. Treat the infested person: Requires using an over-the-counter Prevent Reinfestation: Lice are most commonly spread direct- (OTC) or prescription medication. Follow these treatment ly by head-to-head contact and indirectly though contaminated steps: clothing or belongings. Teach your child to avoid playtime and 1. Before applying treatment, remove all clothing. other activities that are likely to spread lice. 2. Apply lice medicine, also called pediculicide (peh- • Avoid head-to-head contact common during play at DICK-you-luh-side), according to label instructions. If school and at home (slumber parties, sports activities, your child has extra long hair, you may need to use a at camp, on a playground). second bottle. • Do not share clothing, such as hats, scarves, coats, WARNING: Do not use a crème rinse or combina- sports uniforms, or hair ribbons. tion shampoo/conditioner before using lice medicine. • Do not share infested combs, brushes, or towels. Do not re-wash hair for 1-2 days after treatment. • Do not lie on beds, couches, pillows, carpets, or 3. Have the infested person put on clean clothing after stuffed animals that have recently been in contact treatment. with an infested person. 4. If a few live lice are still found 8-12 hours after treat- My child has head lice. I don't. Should I treat myself to ment, but are moving more slowly than before, do not prevent being infested? retreat. Comb dead and remaining live lice out of the No, although anyone living with an infested person can get hair. The medicine may take longer to kill lice. head lice. Check household contacts for lice and nits every 2-3 5. If, after 8-12 hours of treatment, no dead lice are found days. Treat only if crawling lice or nits (eggs) within a 1/4 and lice seem as active as before, the medicine may not inch of the scalp are found. be working. See your health care provider for a different medication; follow treatment directions. Should my pets be treated for head lice? 6. Nit (head lice eggs) combs, often found in lice medicine No. Head lice do not live on pets. packages, should be used to comb nits and lice from the My child is under 2 years old and has been diagnosed with hair shaft. Many flea combs made for cats and dogs are head lice. Can I treat him or her with prescription or OTC also effective. drugs? 7. After treatment, check hair and comb with a nit comb to For children under 2 years old, remove crawling bugs and nits remove nits and lice every 2-3 days. Continue to check by hand. If this does not work, ask your child's health care for 2-3 weeks until you are sure all lice and nits are provider for treatment recommendations. The safety of head gone. lice medications has not been tested in children 2 years of age 8. If using OTC pediculicides, retreat in 7-10 days. If using and under. malathion, retreat in 7-10 days only if crawling bugs are found. What OTC medications are available to treat head lice? Many head lice medications are available at your local drug Treat the household: Head lice do not survive long if they fall store. Each OTC product contains one of the following active off a person. You do not need to spend a lot of time or money ingredients. on house cleaning activities. 1. Pyrethrins (pie-WREATH-rins): often combined with Follow these steps to help avoid re-infestation by lice that piperonyl butoxide (pie-PER-a-nil beu-TOX-side): have recently fallen off the hair or crawled onto clothing or Brand name products include A-200*, Pronto*, R&C*, furniture. Rid*, Triple X*.

45 Pyrethrins are natural extracts from the chrysanthemum the disease described above or think that you may have a flower. Though safe and effective, pyrethrins only kill crawl- parasitic infection, consult a health care provider. ing lice, not unhatched nits. A second treatment is recom- mended in 7-10 days to kill any newly hatched lice. Treatment I have heard that head lice medications do not work, or failures are common. that head lice are resistant to medication. Is this true? A recent study done by Harvard University did show that 2. Permethrin (per-meth-rin): SOME, but NOT ALL (or even most) head lice are resistant to Brand name product: Nix*. common prescription and over-the-counter medications Permethrins are similar to natural pyrethrins. Permethrins are (OTC). There is no information on how widespread resistance safe and effective and may continue to kill newly hatched eggs may be in the United States. Resistance (medication not work- for several days after treatment. A second treatment may be ing) is more likely in people who have been treated many necessary in 7-10 days to kill any newly hatched lice. times for head lice. There are many reasons why medications Treatment failures are common. may seem not to work. Below are some of those reasons: 1. Misdiagnosis of a head lice infestation. A person What are the prescription drugs used to treat head lice? has head lice if they have crawling bugs on their head Malathion (Ovide*): Malathion has just been reapproved for or many lice eggs (also called nits) within a quarter the treatment of head lice infestations. Malathion treats both inch (approximately the width of your pinky finger) lice and head lice eggs. When used as directed, malathion is of the scalp. Nits found on the hair shaft further than very effective in treating lice. Few side-effects have been 1/4 inch from the scalp have already hatched out. reported. Open sores from scratching may cause malathion to Treatment is not recommended for people who only sting the scalp. have nits further than one-quarter inch away from the scalp. Lindane (Kwell*): Lindane is one of the most common prod- 2. Not following treatment instructions fully. See ucts used to treat head lice. When used as directed, the drug is instructions below for how to treat a head lice infes- probably safe. Overuse, misuse, or accidentally swallowing tation. Using medication alone is not likely to cure a Lindane can be toxic to the brain and other parts of the nerv- head lice infestation. ous system. Lindane should not be used if excessive scratch- 3. Medication not working at all (resistance). If head ing has caused open sores on the head. lice medication does not kill any crawling bugs, then Which head lice medicine is best for me? resistance is likely. If the medication kills some of the If you aren't sure, ask your pharmacist or health care provider. bugs, then resistance to medication is probably not When using the medicine, always follow the instructions pro- the reason for treatment failure (see item #2 and #4). vided. 4. Medication kills crawling bugs, but is not able to penetrate the nits. It is very difficult for head lice When treating head lice medication to penetrate the nit shell. Medication may 1. Do not use extra amounts of the lice medication unless effectively kill crawling bugs, but may not treat the instructed. These drugs are insecticides and can be dan- nits. This is why follow-up treatment is recommend- gerous when misused or overused. ed. See instructions below for a detailed summary. 2. Do not treat the infested person more than 3 times with 5. New infection. You can get infested more than once the same medication if it does not seem to work. See with head lice. Teach family members how to prevent your health care provider for alternative medication. re-infection. 3. Do not mix head lice drugs. For More Information Should household sprays be used to kill adult lice? Williams LK, Reacher A, Mac Kenzie WR, Hightower AW, No. Spraying the house is NOT recommended. Fumigants and Blake PA. Lice, nits, and school policy. Pediatrics room sprays can be toxic if inhaled or absorbed through the 2001;107:1011-1015. skin. Communicable Disease Surveillance Center. Working docu- Should I have a pest control company spray my house? ment combs out guidance on head lice. Commun Dis Rep No. Vacuuming floors and furniture is enough to treat the CDR Wkly 1998;8:405. household. Pollack RJ, Kiszewski AE, Spielman A. Overdiagnosis and *Use of trade names is for identification purposes only and consequent mismanagement of head louse infestations in does not imply endorsement by the Public Health Service or North America. Pediatr Infect Dis J 2000;19:689-793. by the U.S. Department of Health and Human Services. This fact sheet is for information only and is not meant to be Pray WS. Head lice: perfectly adapted human predators. used for self-diagnosis or as a substitute for consultation American Journal of Pharmaceutical Education 1999;63:204- with a health care provider. If you have any questions about 209.

46 Juranek DD. Pediculus capitis in school children: epidemio- be treated with special medication to kill the mites. Until your logic trends, risk factors, and recommendations for control. In: pet is successfully treated, mites can continue to burrow into Orkin M, Malback HL, eds. Cutaneous Infestations and Insect your skin and cause you to have symptoms. Bites. New York, NY:Marcel Kekker, Inc: 1985;199-211. How soon after infestation will symptoms begin? The information on these pages was last reviewed August 15, For a person who has never been infested with scabies, symp- 1999 and May, 2001 toms may take 4-6 weeks to begin. For a person who has had Centers for Disease Control and Prevention scabies, symptoms appear within several days. You do not National Center for Infectious Diseases become immune to an infestation. Division of Parasitic Diseases How is scabies infestation diagnosed? Diagnosis is most commonly made by looking at the burrows or rash. A skin scraping may be taken to look for mites, eggs, Scabies or mite fecal matter to confirm the diagnosis. If a skin scrap- (SKAY-bees) ing or biopsy is taken and returns negative, it is possible that What is scabies? you may still be infested. Typically, there are fewer than 10 Scabies is an infestation of the skin with the microscopic mite mites on the entire body of an infested person; this makes it Sarcoptes scabei. Infestation is common, found worldwide, easy for an infestation to be missed. and affects people of all races and social classes. Scabies spreads rapidly under crowded conditions where there is fre- Can scabies be treated? quent skin-to-skin contact between people, such as in hospi- Yes. Several lotions are available to treat scabies. Always fol- tals, institutions, child-care facilities, and nursing homes. low the directions provided by your physician or the directions on the package insert. Apply lotion to a clean body from the What are the signs and symptoms of scabies infestation? neck down to the toes and left overnight (8 hours). After 8 • Pimple-like irritations, burrows or rash of the skin, hours, take a bath or shower to wash off the lotion. Put on especially the webbing between the fingers; the skin clean clothes. All clothes, bedding, and towels used by the folds on the wrist, elbow, or knee; the penis, the infested person 2 days before treatment should be washed in breast, or shoulder blades. hot water; dry in a hot dryer. A second treatment of the body • Intense itching, especially at night and over most of with the same lotion may be necessary 7-10 days later. the body. Pregnant women and children are often treated with milder • Sores on the body caused by scratching. These sores scabies medications. can sometimes become infected with bacteria. Who should be treated for scabies? How did I get scabies? Anyone who is diagnosed with scabies, as well as his or her By direct, prolonged, skin-to-skin contact with a person sexual partners and persons who have close, prolonged contact already infested with scabies. Contact must be prolonged (a to the infested person should also be treated. If your health quick handshake or hug will usually not spread infestation). care provider has instructed family members to be treated, Infestation is easily spread to sexual partners and household everyone should receive treatment at the same time to prevent members. Infestation may also occur by sharing clothing, tow- reinfestation. els, and bedding. How soon after treatment will I feel better? Who is at risk for severe infestation? Itching may continue for 2-3 weeks, and does not mean that People with weakened immune systems and the elderly are at you are still infested. Your health care provider may prescribe risk for a more severe form of scabies, called Norwegian or additional medication to relieve itching if it is severe. No new crusted scabies. burrows or rashes should appear 24-48 hours after effective How long will mites live? treatment. Once away from the human body, mites do not survive more This fact sheet is for information only and is not meant to be than 48-72 hours. When living on a person, an adult female used for self-diagnosis or as a substitute for consultation with mite can live up to a month. a health care provider. If you have any questions about the Did my pet spread scabies to me? disease described above or think that you may have a para- No. Pets become infested with a different kind of scabies mite. sitic infection, consult a health care provider. If your pet is infested with scabies, (also called mange) and This page last reviewed August 15, 1999 they have close contact with you, the mite can get under your Centers for Disease Control and Prevention skin and cause itching and skin irritation. However, the mite National Center for Infectious Diseases dies in a couple of days and does not reproduce. The mites Division of Parasitic Diseases may cause you to itch for several days, but you do not need to

47 Cosmetology: Pathology and Conditions of Skin, NOTES Hair and Nails Review Practice Questions

1. Describe what Head Lice look like: ______

______

______

2. Name some of the disorders of the hair and scalp: ______

______

______

3. Cold sores, or fever blisters are not contagious.

True False

4. What medications are available to treat head lice? ______

______

______

48 Chapter 5 Social Security and Medicare Taxes) by completing Schedule Federal Tax Rules for the Salon Professional SE. (1 credit hour) Learning Objectives Unemployment Compensation If you become unemployed, benefits are paid to you based on Know the benefits of filing a correct tax return the wages and tips you have reported. Unemployment com- Identify your worker classification pensation is available for employees only. As an employee, Learn how to report income your employer makes payments to an unemployment fund. Know how to identify business expenses Note: The laws governing unemployment benefits vary by Understand your federal income tax responsibilities jurisdiction. For more information, contact the appropriate Benefits of Filing a Correct Tax Return agency in your state that handles unemployment Reporting all of your income and paying the appropriate compensation. amount of tax may be confusing. You may wonder why you Workers' Compensation Benefits should comply with the law. This section helps to put into per- If you are an employee and are injured on the job, you are spective the positive side of tax compliance. entitled to collect workers' compensation. Workers' compensa- Applying for Credit tion is based on wages and tips reported. Workers' compensa- When you apply for a loan or credit to purchase business tion is not a federal program. As of 2002 all states, except equipment, a car, a house, or your own business, the financial Texas, mandate that employers carry workers' compensation institution will review your current and prior year's federal insurance. This is an employer paid private insurance. income tax returns to determine your loan suitability. The Other Benefits amount of money you can borrow will be based (in part) on Filing a correct tax return and claiming all the ordinary and the earnings/income you have reported. By accurately report- necessary business expenses that you are entitled to may ing all income received, including tips, your financial picture reduce the amount of tax you owe and will provide greater is clearer, and you will be more apt to receive the amount of working capital for you to use in your business. Your employ- loan proceeds you desire. er may offer other benefits based on your wages and reported Example tips; such as life insurance, disability insurance, 401K retire- ment plans, and the right to purchase stock options. You will Lynette wanted to buy new stylist chairs. She did not have need to check with your employer about these benefits. Filing the funds to purchase the equipment so she went to the a correct tax return will provide you with peace of mind. If bank and applied for a loan. Lynette submitted her prior you are selected for an audit, you will feel confident that your and current year tax returns. Lynette was denied a loan tax return was accurately prepared. because the bank determined that she did not have ade- quate income. Lynette reviewed her income tax returns Your "Worker Classification" and realized that she had not included her tip income in The Cosmetology Industry is unique because it offers you a her gross receipts on her Schedule C. Based on the addi- variety of career and employment opportunities. tional income reported, Lynette was then able to qualify for the loan. Different Types of Worker Classifications The obligations and responsibilities for each worker category Social Security Benefits are different. Proper worker classification will enable you to The benefits you receive from Social Security are calculated file and pay the correct tax. on the total combined earnings that have been recorded under The choices are: employee, salon owner, booth renter, and your Social Security Number (SSN). Correctly reporting all of independent contractor. your income, including tips, will determine how much Social • Employees receive Form W-2 for wages earned and are Security is paid into your account. Social Security is not only responsible for reporting their tips to their employer as for retirement purposes. The benefits also cover individuals well as maintaining records of their non-reimbursed who are injured or become disabled. If something happens to employee business expenses. you, your spouse and your children can receive benefits based • Salon owners are in business for themselves. They are on your reported earnings. If you are an employee, based upon responsible for recording all income and expenses; with the amount of wages earned and tips reported, your employer holding employment taxes if they have employees, and provides matching funds for Social Security and Medicare paying all taxes due. Taxes. • Booth renters, who are not employees of the salon, are If you are a self-employed person, you are responsible for self-employed. They are responsible for record keeping reporting and paying self-employment tax (which is your and the timely filing of returns and payment of taxes relat- ed to their business.

49 • Independent contractors are always self-employed and are of working in the same establishment. Salon owners are responsible for record keeping and timely filing of returns responsible for classifying workers correctly as employees, and payment of taxes related to their business. booth renters, or independent contractors. It is important that this classification is correct so that workers can determine What Determines Worker Classification their personal tax responsibilities. The courts have considered many facts in determining whether a worker is an employee or self-employed. These relevant Example facts fall into three main categories: behavioral control; finan- Rina owns "Rina's Massage and Day Spa". Rina buys all cial control; and relationship or intent of the parties. In each her own supplies and sets her own work hours and fees. case, it is very important to consider all the facts - no single Rina is self-employed. fact provides the answer. Behavioral Control Booth Renter Behavioral control is having the authority to determine what A booth renter is a person who rents or leases space in some- to do, when to do it, why it needs to be done, and how it will one else's salon. The booth renter pays the owner an agreed be accomplished. amount for the use of the booth space. Booth renters set their own business hours and fees for their services. They are finan- Financial Control cially responsible for profit or loss in their own business and Financial control is having the right to direct or control the receive all income generated from their work. Booth renters business part of the work, such as how much to charge cus- who are not subject to the direction or control of the salon tomers, how much to spend on business expenses and equip- owner are not employees. ment, and the opportunity to realize a profit or loss. Example Relationship and Intent of the Parties Relationship or intent of the parties illustrates how the busi- Graciella signed a lease with a salon owner that provided ness owner and the worker perceive their relationship. Items to booth space and use of shampoo and hair dryer stations. In consider would be employee benefits and written contracts. return for the space, she will pay $500 on the 10th of each month to the salon owner. The contract does not specify Employee the number of days or times Graciella will use the booth. An employee is an individual who performs services subject The lease does say that the salon owner would like to the will and control of his or her employer, who has the Graciella to use, whenever possible, the products the salon authority to tell him or her what to do and how to do it. owner markets to customers. Graciella establishes her own Salary, tips, and commissions are the most common forms of schedule and collects payments from her customers. payment made to employees in the Cosmetology Industry. Graciella is a self-employed booth renter. Example Example Lee works at Brett's Nail Salon. Lee is told to be at work, Monday through Friday, 9:00 am - 5:00 pm. Brett Graciella signed a lease with a salon owner that provided observes the work that Lee does and has the right to pro- booth space and use of shampoo and hair dryer stations. In vide direction. Lee reports all of her tips to Brett. Lee is return for the space, she will pay $500 on the 10th of each Brett's employee and will receive Form W-2 at the end of month to the salon owner. The contract specifies that the year. Graciella must work four days a week, 9:00 am - 5:00 pm and can only use the products the salon owner markets. Self-Employed Graciella does not set her own prices. Graciella is a booth A self-employed person works for himself or herself and is not renter employee. subject to the "will and control" of another person. A self- employed person may be called a salon owner, a booth renter, Note: The lease agreement by itself does not make the booth or an independent contractor. renter a self-employed person. Fees, tips, and retail sales are the most common forms of Independent Contractor income received by a self-employed person and may include Independent contractors may provide their services at several the following categories: different locations. They are always in control of their hours, the fees they charge, and the products they use. They are self- Salon Owner employed. A salon owner is an individual (not a corporation) who owns and operates a salon. Salon owners may have employees, booth renters, independent contractors, or a combination there-

50 Example ant, and the fair market value of the tax return preparation is taxable to the cosmetologists) Bonnie is a manicurist and esthetician that has a business contract with two large salons where she provides her Tips services. In her contracts, she is provided with a worksta- As previously mentioned, all income is taxable income and tion for which she pays $450 per month to each salon. She tips are income. There is a false belief that tips received are keeps her own appointment book and sets her own hours gifts and, therefore, not considered income. of operation at her convenience. She also provides her Tips Are Not Gifts own tools, nail polish supplies, and makeup. Bonnie han- A gift is something that is given to you freely, voluntarily, and dles her own monetary receipts from customers and is without an expectation for any services performed. For responsible for filing and paying tax on her income and instance, it is your birthday; your customer brings in cham- tips. Bonnie does not receive a Form W-2 from the salon pagne and cake. This is a gift, not a tip. If you provide a serv- because she is an independent contractor (self-employed). ice to a customer and they pay you more than what you have stated as your fee, then that additional amount is a tip and tax- Reporting Income able. If the customer pays you at a later date or at a different The money you receive from your work, whether it is wages, location for the service you previously provided, it is still tax- commissions, tips, sales, or rent; whether paid by cash, check, able income. The date and location are irrelevant when the charge or bartering is taxable. monies paid are for a service provided. All income is taxable unless specifically excluded by the Tips paid to you in cash, charge, checks, and non-cash (i.e., Internal Revenue Code. tickets to sporting events) are subject to income tax. If you are You must report all your income on your tax return including licensed and performing a service these tips are subject to tips. If you are an employee and receive tips, you must report Social Security Tax also known as the Federal Insurance that amount to your employer. If you are a self-employed Contributions Act (FICA). Students, employees, salon owners, salon owner, booth renter, or independent contractor, all booth renters, and independent contractors earn tips. income received, including tips, must be reported on your How do I treat tips received as an unpaid apprentice or as a Federal Income Tax Return. Whether you prepare your own student of a barber/cosmetology school? tax return or pay a tax preparer, you need to know the tax law so you can file an accurate tax return. Internal Revenue Code While you are an unpaid apprentice or student of a school, the Section 61 states: "Gross income means all income from what- tips you receive are subject to income tax but not Social ever source received." In the case of workers in the Security Tax (FICA). This type of tip income is not reported to Cosmetology Industry, taxable income includes such payments the school, as you are not an employee of the school. Report as: wages, fees, commissions, retail sales, rent/lease payments, this type of tip income as "other income" on Form 1040, if tips, and bartering. you are required to file an income tax return. Examples of Reportable Income Any employee, including paid apprentices who receive tips in Wages- Money paid to you as an employee Fees Payments you excess of $20 in any given month, must report to their receive from customers for services you perform as a self- employer all tips received that month. This must be done in employed person Commissions Payments you receive for writing and must include your name, SSN, and the name and products sold, or as a percentage of fees for services (i.e., pay place of employment. This report must be done at least once a agreements/ commissions) month and submitted to your employer, no later than the 10th calendar day of the following month after the tips are earned. Retail Sales- Sales of merchandise or other products such as brushes, shampoo, makeup, etc. An employee who receives tips of less than $20 in a calendar month does not have to report the tips to his or her employer; Rent/Lease Payments- Payments the salon owner receives for however, the tips must be reported as other income on the space rented employee's income tax return. Tips- Gratuities received from clients in the form of cash, Tip Records charges, and nonmonetary payments You are required to keep records to show the amount of tip Bartering- Bartering is an exchange of one taxpayer's property income you received during the year. IRS has created or services for another taxpayer's property or services. The fair Publication 1244, Employee's Daily Record of Tips. This market value of property or services received through barter is handy publication allows you to record your tips on a daily taxable income (i.e., if a cosmetologists agrees to give an basis by completing Form 4070A, which is included in accountant a hair cut in exchange for tax return preparation, Publication 1244. This form is given to your employer no later the fair market value of the hair cut is taxable to the account- than the 10th calendar day of the following month after the

51 tips are earned. Keep a record of the amount of "tip-outs" you Not all expenses incurred are deductible. In fact, you should pay to other employees through tip sharing, tip pooling, or any be aware that there are a number of abusive tax schemes, such other arrangement. It is to your benefit to have both the names as the Home-Based Business Tax scheme. An abusive tax of employees to whom you paid the tips and the date you paid scheme is any investment plan or promotion that claims to them. allow a person to deduct what would normally be considered a personal expense. As always, a true business purpose must If you are not a student or an employee, you are a self- exist prior to claiming any business expense. employed person. You may be called a salon owner, a booth renter, independent contractor or have some other title. As a Deducting Business Expenses self-employed person, report all income including tips on your Generally, expenses are deducted in the year they are paid. If Schedule C. you borrow money or use a credit card to make your business purchases, regardless of when the loan or credit card is repaid, Business Expense Reporting the business expense is deductible in the year purchased. There are many kinds of business expenses. It is important to keep track of all of them, as they may reduce the amount of Reporting Business Expenses tax you have to pay. If you are an employee, your deductible business expenses are listed on Form 2106, Employee Business Expenses. The total Deductible Business Expenses is carried forward to Schedule A, if you itemize. If you do not To be deductible, the expense must be: itemize, you will not be able to deduct your employee busi- • Ordinary - one that is common and accepted in your trade ness expenses. or business • Necessary - one that is helpful and appropriate for your NOTE: If your standard deduction exceeds the amount of your trade or business allowable Schedule A deductions, the standard deduction amount should be used, because it is more beneficial to you. An expense does not have to be crucial to your business to be deductible. Some common business expenses are: If you are a self-employed salon owner, booth renter, or inde- pendent contractor, your deductible business expenses are list- • Utilities ed on part two of Schedule C. • Employee salaries • Trade association dues Recordkeeping • Rental expenses Record keeping is any system you use to keep track of and • Supplies - Salon supplies for client use (not sold for retail) document all items of income and expenses. such as perms, papers, colors, and shampoos • Continuing education - A class that enhances your current You want to keep good records for preparing your income tax business knowledge return and for budgeting purposes. There are many deductions and tax credits for which you may qualify that will lower your Deducting Cost of Goods Sold (COGS) tax. If you do not keep good records, you may not have verifi- cation to claim your expenses. There are many reasons why Cost of Goods Sold (COGS) is a formula used to calculate you need to keep good records. The most important reasons the cost of retail products or merchandise sold during the are listed below: year. The formula is as follows: 1. To monitor your business success Beginning inventory (Items that you have on hand for resale on the first day of the year.) You will be able to answer questions such as: How much is my business earning each week? What were my expenses last Plus week, month, or year? Purchases (Items that you buy for resale during the year.) In addition, good record keeping enables you to identify Minus changes you need to make in your business to be more suc- Personal Use cessful. For example, if you eliminated unwanted services or (Items purchased for resale but used personally during the year.) products, which did not sell, you could increase your profits. Minus 2. To identify your sources of income Ending Inventory You may receive money from many sources. Good record (Items that you have on hand for resale on the last day of the year.) keeping helps you identify and separate business and non- Equals business income and taxable and nontaxable income. For Cost of Goods Sold example, good records will allow you to distinguish between the $500 birthday gift that you deposited, which is not taxable, from the $500 tip income you deposited, which is taxable.

52 3. To identify deductible expenses The manner in which you store your records is up to you - a Regardless of your employment status, you may have file cabinet, shoebox, or other type of container. What's impor- deductible expenses that could reduce your taxable income. A tant is that you organize the documents by date and type of good record keeping system will help you to identify and doc- income and expense. You may want to separate deductible ument these deductible expenses throughout the year. Without business expenses into categories such as rent, utilities, insur- an accurate record keeping system, you risk losing the benefit ance, advertising, and professional publications. No matter of a business deduction. how you keep your records, they should be organized and easy to find. 4. To accurately prepare your tax return A record keeping system supports the income, expenses, and Keep all records until the statute of limitations expires for that credits you report on your income tax return and promotes particular tax return. Generally, the statute of limitations accurate return preparation. Without good record keeping you expires three years after the return becomes due or is filed, or may overlook taxable income, deductible expenses, or tax two years from the date the tax is paid, whichever is later. credits to which you are entitled. Keep all employment tax records for at least four years after 5. To support income, expenses, and credits reported on your the tax return becomes due or is filed or two years from the tax return date the tax is paid, whichever is later. Employment taxes are You must keep records to support all items shown on your discussed in the chapter, "What are my federal tax responsibil- income tax return. If the IRS examines any of your tax ities." returns, you may be asked to explain or verify items you Note: Major purchases, such as buildings and equipment, may reported. If you are unable to present the required information, have special record keeping requirements. Please refer to you may be subject to payment of additional taxes and penal- Publication 946, How to Depreciate Property, for additional ties. information. Types of Records You Should Keep Consequences of Filing an Incorrect Tax Return You should keep records for any items you have listed on your Filing accurate tax returns and paying taxes when due is the tax return. It is strongly recommended that you keep business LAW. Penalties are assessed for noncompliance of tax laws. and personal funds separate. Maintaining a separate bank account for your business is one way to do this. Consequences of Not Filing an Income Tax Return "on time" If you are an employee, employer or self-employed person and Some examples of business records are as follows: you fail to file your personal income tax return and/or employ- Business income records: ment tax return by the due date, including extensions, you • Bank deposit slips and bank statements may be subject to the failure to file penalty. The failure to file • Credit card charge slips penalty will be assessed at 41/2% of the unpaid tax for the • Appointment book/calendar first month the penalty applies and an additional 41/2% for • Receipt books each additional month or fraction of the month that the return • Form(s) 1099-MISC received remains un-filed, not to exceed 22 1/2% of the tax due. Business expense records: Minimum penalty is the lesser of 100% of the tax due or $100. • Invoices • Receipts Note: Percentage figures may be subject to change. • Cancelled checks Penalties for Late Filing • Sales slips If you are an employee, employer or self-employed person and • Credit card receipts you fail to fully pay your income tax liability and/or your Your supporting documents should show the amount paid and employment tax liability by the due date of your return, the how it relates to your business. You must provide proof (i.e., failure to pay penalty may be assessed. The failure to pay supporting documents) that the purchase was for business use penalty is 1/2 of 1% of the unpaid tax. This penalty will be only. assessed each additional month or fraction of a month until the tax is paid, not to exceed 25% of the tax. Keeping Your Records There are no specific guidelines for maintaining your records; Estimated Tax Payments however, a good record keeping system should be easy to use, If you are an employee or self-employed person and you did understandable, reliable, accurate, and consistent. You should not pay enough tax either through withholding or by making select a record keeping system and accounting method that is your estimated tax payments, you will have an underpayment suitable for your business, which will allow you to determine of tax. Based on this underpayment you may be assessed a your income and deductible expenses. You can use something penalty. as simple as a notebook to record taxable income, as it is received, and deductible expenses, as they are paid.

53 Failure to File an Income Tax Return • Federal income tax is the tax calculated on the net (or If you fail to file an income tax return and/or employment tax adjusted gross) income, after all deductions have been return when required, the IRS may file a "substitute for return" taken. on your behalf, without crediting you with the exemptions, deductions, or credits of which you may be entitled. You may • Self-employment tax is comprised of 100% of your also be subject to additional penalties and interest as described Social Security and Medicare Taxes. above. NOTE: It is possible to not owe any federal tax but still owe Consequences for employers who fail to make Form 940 and self-employment tax. Form 941 deposits timely Penalties may apply if you do not make the required deposits, If you are self-employed you may be required to make quar- are late making deposits, make deposits for less then the terly estimated tax payments based upon your net income and required amount, or if you do not use Electronic Federal Tax any self-employment taxes. For help in calculating your esti- Payment System (EFTPS) when required. mated payment amounts, refer to Publication 505, Tax Withholding and Estimated Tax. Form 1099-MISC is required For any amounts not properly or timely deposited the penalty to be issued to any person (not a corporation) to whom you rates are: have paid $600 or more during the year, who is not your • 2% - Deposits made 1 to 5 days late. employee. If you, yourself have received $600 or more from • 5% - Deposits made 6 to 15 days late. one person for services you provided, you should also receive • 10% - Deposits made 16 or more days late. The Form 1099-MISC. If you do not receive this form, but have penalty also applies to amounts paid within 10 days received the income, you are still required to report that of the date of the first notice the IRS sent asking income on your return. for the tax due. Employer's Federal Tax Responsibilities The penalties do not apply if any failure to make a proper and If you are an employer, in addition to your own personal tax timely deposit was due to reasonable cause and not to willful obligations, you will have employment tax responsibilities. neglect. As an employer, you are responsible for all of the following: Note: Penalties and interest assessed on tax and penalties are • Form 941, which is filed quarterly, shows the amounts not deductible on your tax return. that have been withheld and paid for each employee's federal income, Social Security and Medicare Taxes. It Federal Tax Responsibilities will also include the employer's matching portion of Your federal tax liability will be based upon your worker clas- Social Security and Medicare Taxes. As the employer, sification. The tax system is a pay-as-you-go system. you must deposit all income tax withheld and both the As an employee, you will receive a Form W-2, Wage and Tax employer and employee's share of Social Security and Statement, from each employer you have worked for during Medicare Taxes. Refer to Publication 15 for further infor- the year. Employers issue these forms in January of the fol- mation. lowing year. Form W-2 combines all wages and reported tips. • Form 940, the Employer's Annual Federal Unemploy- It shows the amount of federal taxes withheld and paid ment Tax return (FUTA) form is filed annually. The tax is throughout the year. Taxes are withheld based upon how you paid 100% by the employer. Refer to Publication 15 for completed your Form W-4, Employee's Withholding specific filing requirements. Allowance Certificate. Tax withheld may differ depending • Form W-2, reflects total wages paid and tips reported, is upon the filing status you chose and the number of allowances filed annually and is issued to each employee. you claimed. When you file your federal income tax return • Form 1099-MISC is required to be issued to any persons you should report the income shown on all Form W-2's. (not a corporation or your employee) to whom you have paid $600 or more during the year for services provided. If you do not report all of your tips to your employer during the year, you may be required to pay additional income tax Tax Credits such as Social Security and Medicare Taxes on any unreported When you file your income tax return, there are many tax tips when you file your federal income tax return. A penalty credits to which you may be entitled. This section will focus for underpaying your required taxes during the year may be on the Earned Income Tax Credit and the Education Credits. assessed. Earned Income Tax Credit (EITC) If you are self-employed, you are responsible for filing and EITC is a tax break for people who work, but do not earn high paying all of your own taxes, which include both federal incomes. Those who qualify could pay less federal tax, no tax, income and self-employment taxes. or even get a tax refund.

54 Qualifying for EITC? • $11,060 ($12,060 MFJ) if you do not have a qualifying You may qualify for EITC if you meet the following: child • You must have a valid Social Security Number (SSN) • $29,201 ($30,201 MFJ) if you have one qualifying child • Your filing status cannot be Married Filing Separate • $33,178 ($34,178 MFJ) if you have more than one quali- • You must be a U.S. Citizen or resident alien all year fying child • You cannot file Form 2555 or Form 2555 EZ • Your investment income (as of 2002) must be $2,550 or Note: Income limits are subject to change less When you file your tax return (1040 EZ, 1040 A, or a 1040), • You must have earned income you can calculate your EITC by using a worksheet included in Additionally, if you are claiming EITC and you have a child, the tax form instruction booklet or you can let the IRS calcu- you must meet the following: late your Earned Income Credit for you. For more information on the Earned Income Tax Credit, please refer to Publication • The child must meet the relationship, age, and residence 596, Earned Income Tax Credit. test Education Credits • If the child being claimed for EITC is the qualifying Education credits are tax credits for students only. You may be child for more than one person, only one person may eligible for education credits, depending on your filing status, claim the EITC for that child. You and the other qualify- income level, and other factors. There are two kinds of educa- ing person may choose which person gets the credit. If tion credits: you cannot agree on who is to file for the credit, refer to • The Hope Credit Publication 596 to determine the criteria for un-agreed • The Lifetime Learning Credit Expenses that qualify for cases. the education credits are based on qualified tuition and • You cannot be the qualifying child of another person and related expenses. claim EITC for your child Qualifying for the Hope Credit If you are claiming EITC and you do not have a qualifying The Hope Credit is available to students for the first two years child, you must meet the following: of undergraduate education including trade and/or vocational • You must be at least age 25 but under age 65 schools. You might be entitled to a credit of up to $1,500 of • You cannot be the dependent of another person the money you paid out for tuition or other qualifying expens- • You cannot be the qualifying child of another person es. • You must have lived in the U. S. for more than half of the year Here are some of the requirements: 1) The student has not completed the first two years of The Advance Earned Income Tax Credit (Advance EITC)? post-secondary education The Advance EITC allows those taxpayers who expect to 2) The student is enrolled in a program that leads to a qualify for the Earned Income Tax Credit (EITC) and have at degree, certificate or other recognized education creden- least one qualifying child to receive part of the credit in each tial paycheck during the year the taxpayer qualifies for the credit. 3) The student is taking at least half of the normal full-time Receiving Advance EITC payments workload for his/her course of study for at least one aca- First you must determine if you qualify for Advance EITC demic period, beginning during the calendar year payments. To do so, obtain from your employer the Form W-5, 4) The student has no felony drug conviction Earned Income Credit Advance Payment Certificate, making Example sure to answer the five questions on the back of the form that determine qualification. If you qualify, complete the bottom Phillip is a first year student at Chicago Barber College. part of the Form W-5, and give it to your employer. Then, Phillip is attending school full time. His tuition costs are based on your income, your employer adds additional money $5,800, which includes lab fees and books. Phillip is a to your take-home pay in each paycheck. dependent on his parents' tax return. Brian is not entitled to take the Hope credit on his return, but Phillip parents' Note: If your only income is from self-employment, you cannot may be entitled to take the Hope Credit for Phillip's educa- qualify for Advance EITC payments. tional costs on their tax return. Income Limits for Claiming EITC? In order to qualify for earned income tax credit, as of 2002, Qualifying for the Lifetime Learning Credit your earned income and adjusted gross income must be less The Lifetime Learning Credit is a tax credit, but unlike the than: Hope credit, there is no limit to the number of years you can

55 claim the credit! You may be able to claim up to $1,000 of the • 940 money you paid out for tuition or other qualifying expenses. • 941 - Certain qualified filers may use the 941 TeleFile program These are the requirements: • 1065 - The IRS accepts nearly all related forms and 1) The student only has to take one (or more) courses, it's schedules 29 not based on workload 2) The student can be beyond their first two years of post What Are The Benefits Of E-Filing? secondary education * Electronic acknowledgement within 48 hours of filing 3) It is available for an unlimited number of years confirming the IRS has accepted your return for process- 4) The student does not have to be pursuing a degree or any ing recognized education credential Beginning in 2003, the * Chances of getting an error notice from the IRS are maximum Lifetime Learning Credit increases to $2,000. reduced * There is only a 1% error rate on e-filed returns Education Credit * Receive your refund in half the time of paper filing, even The education credit cannot be more than the amount of your faster with direct deposit tax. You cannot get a refund for any part of the credit that is more than your tax. Neither the Hope nor the Lifetime To find a list of software companies (authorized providers) or Learning Credits are "dollar-for-dollar" credits. The amount of tax professionals who participate in the e-file program, visit credit you qualify for will be based upon your income. Just the IRS Web site at www.irs.gov. because you claim $1,500 in expenses, does not mean your tax credit is $1,500. WHAT IS ELECTRONIC FEDERAL TAX PAYMENT SYS- TEM (EFTPS)? Example EFTPS enables individual taxpayers to pay all their federal taxes electronically including estimated taxes, balance due Lance is taking a hair braiding class so he can offer an payments, installment payments, and estate and gift taxes. additional service to his clients. This class is not part of a Business taxpayers can pay employment taxes, excise taxes, certificate or degree program from an accredited school. and corporate income taxes. EFTPS is easy, fast, accurate, and This class qualifies for the Lifetime Learning Credit. convenient. Who Can Use EFTPS? Can the Hope and the Lifetime Learning Credit be claimed in Any individual taxpayer making more then one tax payment a the same year? year can use EFTPS. Any business taxpayer can use EFTPS No. If a student qualifies for both the Hope and Lifetime for all taxes. Learning Credit for the same year, you can claim either credit, but not both. You will want to determine which credit gives What Are The Benefits Of Using EFTPS? you the best benefit. EFTPS offers you many benefits over the traditional paper system: What is E-Filing? • It's fast… you can make a tax payment in minutes e-file is the preferred way of filing your tax return. It is so • It's accurate… because there are verification steps along easy, that in 2002 over 46 million people used it. the way, you can check and review your information before it is sent Who Can Participate in E-File? • It's convenient… EFTPS is available 24 hours a day, 7 • Individual taxpayers days a week via Internet, PC software, or telephone - and • Sole proprietors can be used to schedule payments in advance • Employers • It's easy to use… a step-by-step process that tells you the • Partnerships information you need to successfully complete your fed- • Tax practitioners eral tax payments How Can I Participate In E-File? • It's secure… EFTPS offers the highest levels of security • Telefile - direct to the IRS via a telephone - you must on the Internet receive a Telefile package to participate How Can I Participate In EFTPS? • IRS e-file using an authorized e-file provider You can enroll through the Internet at www.eftps.gov or by • E-file through your personal computer completing an enrollment form which is available from What Tax Forms Can You Currently E-File? EFTPS Customer Service at 1-800-945-8400 or 1-800-555- • 1040 4477. Once EFTPS receives and verifies your information, • 1040 A confirmation materials including instructions on how to obtain • 1040 EZ your Internet password will be mailed to you within 10 - 15

56 days after you complete your enrollment. Your Personal FEDERAL TAXATION Identification Number (PIN) will also be mailed to you. Review Practice Questions Answers to each question can be found in this section Do I Have To Use EFTPS? No, you do not have to use EFTPS unless you are a business whose total deposits for all federal deposits exceed $200,000 1) ______is not only for retirement purposes. during the calendar year. The benefits also cover individuals who are injured or Can I Schedule Payments In Advance? become disabled. Yes. If you are an individual, you can schedule payments up to 365 days in advance of the due date. If you are in business, you can schedule payments up to 120 days in advance of the 2) If you are responsible for recording all income and expens- due date. es; withholding employment taxes if you have employees, and paying all taxes due. You are classified as: How Do I Know My Payment Was Received? Every EFTPS transaction receives an immediate acknowledg- A. Employee B. Salon Owner ment number that can be used as your receipt of the transac- tion. This number is used to check status, tracking, and to C. Booth Renter D. Independent Contractor communicate with the IRS.

3) Tips are considered gifts and not taxable income.

True False

4) All income is taxable unless specifically excluded by the Internal Revenue Code.

True False

5) An abusive tax scheme is any investment plan or promo- tion that claims to allow a person to deduct what would normally be considered a personal expense.

True False

57 Course Final Examination 11. The most effective way to remove vapors and dusts Select the best answer for each question and mark them on from your salon is by ventilating to the outside. the answer sheet on page 62. True False 1. Pregnant women can not pass HIV to their unborn children. 12. A Ground Fault Circuit Interrupter (GFCI) constantly monitors the flow of electric current going into and True False out of an appliance and shuts off the flow if there is a danger of electric shock. 2. Human Immunodeficiency Virus is the virus that causes AIDS. True False

True False 13. Signs of Carpel Tunnel Syndrome include numbness and tingling of fingers. 3. HIV is transmitted from one person to another through blood to blood and sexual contact. True False

True False 14. There are five basic classes of fires.

4. In most work situations, transmission of HIV is likely True False to occur because of accidental puncture from broken glass, needles or other sharps like scissors. 15. Shortening or eliminating a dryer's cool down cycle has no effect on spontaneous ignition. True False True False 5. Studies show that HIV can be easily transmitted between members in a household setting. 16. Microorganisms are tiny living particles (organisms) with many different characteristics. True False True False 6. The center for Disease Control (CDC) estimates that between 800,000 and 900,000 people are living 17. Bacteria are tiny one-celled vegetable microorgan- with HIV isms (plants) that can only be seen with a micro- scope. True False True False 7. 42.4 % of individuals living with HIV/AIDS are white males. 18. Heating acetone in a microwave is not dangerous.

True False True False

8. The HIV virus survives well in the environment. 19. There are three variations of spontaneous ignition.

True False True False

9. HIV is unable to reproduce outside its living host. 20. Nearly 1,000 fires occur annually in businesses.

True False True False

10. Hands and other parts of the body should be washed 21. Harmless or beneficial bacteria are called nonpatho- immediately after contact with blood or other bodily genic. fluids. True False True False

58 22. Viruses are a particular concern in salons because of 32. Soiled linens should always be placed in a closed their potential severity and the way they spread. container.

True False True False

23. Sanitation will not only reduce germs on a surface, 33. Head rests of chairs should be cleaned with a hospital but will kill all organisms. grade EPA registered disinfectant.

True False True False

24. Disinfection is the process of killing specific 34. The Food and Drug Administration banned all prod- microorganisms, bacteria or germs, using physical or ucts containing 100% MMA in 1974. chemical processes. True False True False 35. The side effects of using nail products that contain 25. You do not need to remove debris, hair or dirt before MMA are few and are not dangerous. disinfecting your implements. True False True False 36. More than 10 million Americans develop skin cancer 26. Salons should use only EPA approved disinfectants each year. that have a rating of hospital -level quality. True False True False 37. Pathology refers to the study of disease. 27. Formalin and formalin tablets are not accepted disin- fectants and should not be used in a salon. True False

True False 38. Seborrheic Dermatitis is commonly known as dan- druff. 28. It is acceptable to use orangewood sticks on multiple clients. True False

True False 39. Melasma effects about 10% of pregnant women.

29. Animals are prohibited in a salon, except for individ- True False uals with physical disabilities. 40. Many bacterial and viral skin infections initially True False appear relatively minor and easy to treat, but can develop into serious and even life-threatening condi- 30. When performing manicures or pedicures, keep caps tions if improperly treated. on all products to reduce the amount of vapor that escapes into the air. True False

True False 41. You can only get infested once with head lice.

31. Foot spas do not need to be disinfected after every True False use. 42. In situations where a building does not allow for ven- True False tilation to the outside, the use of an indoor air purifier is recommended.

True False

59 43. Nits are head lice eggs.

True False

44. Scabies is an infestation of the skin with the micro- scopic mite Sarcoptes Scabei.

True False

45. It may take 1 year for symptoms of scabies to appear.

True False

46. Booth renters are considered employees of the salon.

True False

47. Salary, tips, and commissions are the most common forms of payment made to employees in the Cosmetology Industry.

True False

48. The money you receive from your work, whether it is wages, commissions, tips, sales, or rent; whether paid by cash, check, charge or bartering is taxable.

True False

49. For tax purposes tips are treated as income and not gifts.

True False

50. All wage earners, regardless of income, are eligible to file for the Earned Income Tax Credit (EITC).

True False

60 Endnotes

1Sims, Amy C. "Dangers Lurk in Dirty Salons," Friday, May 4, 2002, in Fox Life, a feature of foxnews.com Copyright 2004 ComStock, Inc Fox News Network LLC See: http://www.foxnews.com/story/0,2933,53589,00.html

2Getting Nailed, Investigation Uncovers Unsanitary Conditions at Nail Salons, June 8, 2001, Homepage 20/20 feature ABC News. See: http://more.abcnews.go.com/sec tions/2020/2020/2020_010517_nails.html

3 http://www.cos.ohio.gov/BSAPB803.pdf

4 For further information and discussion of nail disorders or conditions, please refer to: http://www.nsc.gov.sg/cgi- bin/WB_ContentGen.pl?id=102

61 ELITE CME 8 HOUR CEU COURSE FOR OHIO QUESTIONS? CALL US TOLL FREE:1-888-857-6920 SALON PROFESSIONAL ______FINAL EXAMINATION ANSWER SHEET Please fill in all the information below in CAPITAL LETTERS. Upon completion, please place this sheet in the envelope provided and mail. If paying by check or money order, please make payable to Elite CME, for $15.00. For faster service, specify your credit card information on this form in the space provided and fax to 1-386-615-1812. For even faster service, we offer this test online with instant grading and certificate issuance. Please visit www.elitecontinuingeducation.com to complete your test on the web. ______Please PRINT NEATLY in CAPITAL LETTERS in the areas below using black or blue pen only:

FIRST NAME MI LAST NAME

STREET ADDRESS

Suite,Floor/Apartment Number City(do not abbreviate) State

Zip Code Area Code + Telephone Number Cosmetology ID Number - ‰COS ‰COSM - ‰MAN ‰MANM ‰EST ‰ESTM Payment Method Choose the up to 6 numbers ‰ Check/MO Enclosed for $15.00 appropriate box ‰ Visa/Mastercard

/ Visa/Mastercard Number

Expiration Date Final Test Answer Sheet Final Exam Questions are located on page 58 - 60 Unanswered questions will be scored incorrect True False True False True False True False True False 1 ‰‰ 11 ‰‰ 21 ‰‰ 31 ‰‰ 41 ‰‰ 2 ‰‰ 12 ‰‰ 22 ‰‰ 32 ‰‰ 42 ‰‰ 3 ‰‰ 13 ‰‰ 23 ‰‰ 33 ‰‰ 43 ‰‰ 4 ‰‰ 14 ‰‰ 24 ‰‰ 34 ‰‰ 44 ‰‰ 5 ‰‰ 15 ‰‰ 25 ‰‰ 35 ‰‰ 45 ‰‰ 6 ‰‰ 16 ‰‰ 26 ‰‰ 36 ‰‰ 46 ‰‰ 7 ‰‰ 17 ‰‰ 27 ‰‰ 37 ‰‰ 47 ‰‰ 8 ‰‰ 18 ‰‰ 28 ‰‰ 38 ‰‰ 48 ‰‰ 9 ‰‰ 19 ‰‰ 29 ‰‰ 39 ‰‰ 49 ‰‰ 10 ‰‰ 20 ‰‰ 30 ‰‰ 40 ‰‰ 50 ‰‰ For Internal Use Only - Please Do Not Mark This Area COH08E05 Page 62 COURSE EVALUATION This is the attendee's evaluation of the continuing education course (any comments will be appreciated).

Course Name ______8 Hour Continuing Education Course for Salon Professional (circle one - 1 being the Worst 10 being the Best)

I would rate this course...... 1 2 3 4 5 6 7 8 9 10 The content of this course met my expectations...... 1 2 3 4 5 6 7 8 9 10 The course material was presented in a clear,concise and well organized format...... 1 2 3 4 5 6 7 8 9 10 I would recommend this course...... YES NO The material presented met the course’s stated objective...... YES NO I found this course affordable...... YES NO

Comments______

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ˆ I agree to allow Elite Continuing Education to use my above comments.

Did you remember: 1) To clearly print your name and address on the answer sheet. 2) To fill out your License Number. 3) To include your payment or credit card information? 4) A $10.00 fee will be added for all returned checks.

Thank you for choosing Elite CME for your continuing education

Elite CME’s continuing eduction course is approved by the Ohio State Board of Cosmetology

Elite CME, Inc. Π1453 N. Hwy US #1, Unit 32 ΠOrmond Beach, FL 32174 Telephone (888)857-6920 ΠFax (386) 615-1812

63