Salon profeSSionalS

Transcription

Salon profeSSionalS

Continuing Education & Training For
Salon
professionals
North Carolina
2015-2016
Recommended
by Professionals
Includes 8 Hours
Complete For
$13.99
www.ParagonCET.com/NCSP15
Salon Professionals* Complete All 8 Hours
OR Select Any Combination of the Enclosed
Courses for a Maximum Payment of $13.99.
#P5051 • Environmental Issues • 1 CE Hour
#P6011 • OSHA Regulations • 1 CE Hour
#P2011 • Chemical Makeup of Hair, Skin, and Nails • 2 CE Hours
#P424 • Communicable Diseases • 4 CE Hours
Special Offer Expires September 30, 2016 - $13.99
*Manicurists, Estheticians, and Cosmetologists
Table of Contents
(These courses are printed in their entirety on the following pages.)
How Our Service Works .................................................................................................................................................. 2
#P5051 Environmental Issues ....................................................................................................................................... 3
#P6011 OSHA Regulations ............................................................................................................................................ 9
#P2011 Chemical Makeup of Hair, Skin, and Nails ...............................................................................................16
#P424 Communicable Diseases .................................................................................................................................28
Customer Information/Answer Sheet/Evaluation ...................................... Located between pages 28–29
Copyright © 2015 by Paragon CET, Sacramento, California
w w w.Par a gonCET. c om
Letter from the Director
Dear Friends,
Welcome to Paragon CET. As a colleague, I know it is essential to be able to complete
your continuing education requirements quickly and easily. I also know you have a
commitment to life-long learning that allows you to provide safe and effective services
to clients. I have developed the enclosed study book with this in mind. Inside, you will
find 8 hours of continuing education to complete your North Carolina requirement at
the low price of $13.99.
We have set the standard of excellence by providing approved continuing education
to professionals for over 20 years. You can complete your continuing education in
three easy ways: mail or fax, or for faster results, ONLINE. All for no extra charge!
At Paragon CET, our knowledgeable customer service representatives are here to help
you, and we guarantee a quick turnaround time. Please contact us at 800-707-5644 or
[email protected] if we can be of assistance.
Sincerely,
Jillian Meinyer
Director of Cosmetology
www.ParagonCET.com
w w w.Par a gonCET. c om
#P5051 Environmental Issues _________________________________________________________________
How Our Service Works
1. Read the enclosed courses.
2. Complete the tests, found immediately after each course.
A passing grade of at least 75% must be achieved on each
course in order to receive your certificates of successful
completion. If you have not passed, you will be asked
to take the course tests again, at no additional charge.
3. Transfer your answers to the Answer Sheet/Evaluation found on the insert located between pages 28–29.
Complete the Customer Information and Answer
Sheet/Evaluation in full. Please be sure to include your
license number on the Customer Information form.
This number is required on your certificates of successful completion. Incomplete information may result in
delayed processing.
4. Mail your Customer Information and Answer Sheet/
Evaluation with a payment of $13.99 (check, money order
or credit card) to Paragon CET in the envelope provided,
or fax your Customer Information and Answer Sheet/
Evaluation and credit card information to 916-878-5497.
5. Receive your certificates of successful completion and
study guide (which indicates where the correct answers
are located in the text) via first class mail, fax or email.
You should always keep your certificates of completion
for your records. Additional certificates are available at
no extra charge.
6. Complete the tests online and get your results
immediately. Read the course material, take the tests
interactively (electronically processed) and receive your
test results immediately. Your certificates of successful
completion will be immediately available to print from
your personal transcript. Visit our website at www.
ParagonCET.com.
7. Or Prepay (using check, money order, or credit card) and
submit your completed tests to Paragon CET at your
convenience.
We gladly accept photocopies of the Customer Information and Answer Sheet/Evaluation. Or, call us
for additional copies. Our goal is to provide salon
professionals with the finest continuing education,
written by professionals, offered in a unique format.
We welcome your comments! Call us at 800-707-5644,
email at [email protected], or write to P.O. Box
997581, Sacramento, CA 95899-7581.
If you have a question about your
license renewal, or state requirements,
please contact your board. A list of CE
requirements are available on our website
at www.ParagonCET.com.
2
Paragon CET • April 2015, Vol. 5, No. 4
Copyright © 2015 Paragon CET
www.ParagonCET.com
_________________________________________________________________
#P5051 Environmental Issues
Course #P5051 — 1 CE HOUR
Release Date: 11/01/14
Expiration Date: 10/31/17
Environmental Issues
Faculty
Paragon CET Staff
Division Planner
Leah Pineschi Alberto, licensed cosmetologist and instructor of cosmetology, has been educating students in Northern
California since 1975. In addition, she has been responsible
for training educators in cosmetology, esthetics, and manicuring for more than 30 years.
Mrs. Alberto began her career with Don’s Beauty School
in San Mateo, California. She held a 30-year position at
Sacramento City College and is currently the State Board
Specialty Learning Leader for Paul Mitchell the School at
MTI College in Sacramento, California. She is a salon owner,
a former Department of Consumer Affairs examiner, and a
speaker at the Esthetics Enforcement Conference.
The health and safety of the community of stylists, salon owners, and school owners has been the focus of Mrs. Alberto’s
career. She served on the State Board Task Force on Pedicure
Disinfection commissioned by Governor Schwarzenegger to
investigate the cleanliness of the pedicure industry. The Task
Force was responsible for developing foot spa safety regulations in response to illnesses and deaths resulting from unsafe
pedicure practices.
Mrs. Alberto is currently a member of the California Cosmetology Instructors Association.
Audience
This course is designed for all salon and spa professionals.
Accreditation
Paragon CET courses meet the requirement for continuing
education as set forth by the North Carolina Board of Cosmetic Art Examiners.
Designation of Credit
Paragon CET designates this continuing education activity
for 1 CE hour.
About the Sponsor
The purpose of Paragon CET is to provide challenging curricula to assist professionals to raise their levels of expertise
while fulfilling their continuing education requirements,
thereby improving the quality of service to their clients.
A full Works Cited list is available online at www.ParagonCET.com.
Paragon CET • Sacramento, California
Course Objective
The purpose of this course is to outline environmental issues
that may be encountered in the salon or spa setting as well
as steps to manage air and water quality.
Learning Objectives
Upon completion of this course, you should be able to:
1. Discuss factors that contribute to poor indoor
air and water quality in the salon environment.
2. Outline steps for managing air and water
quality in salons.
3. Review the importance of fire and hazardous
materials safety.
HOW TO RECEIVE CREDIT FOR
THE ENCLOSED SPECIAL OFFER
1. Read the enclosed course.
2. Complete the test questions found after the
course.
3. Submit the completed Customer Information,
Answer Sheet/Evaluation, and payment to
Paragon CET by mail or fax, or complete
online at www.ParagonCET.com/NCSP15.
4. A full Works Cited list is available online
Highlighted sections will appear throughout
the course to help create a link between the
test questions and content.
Thank you for allowing Paragon CET to be your
resource for quality continuing education.
Phone: 800-707-5644 • Fax: 916-878-5497
Email: [email protected]
Mention of commercial products does not indicate endorsement.
Phone: 800 / 707-5644 • FAX: 916 / 878-5497
3
INTRODUCTION
Salon professionals often spend more than 40 hours a week
at work and therefore should be knowledgeable of the safety
issues present in their work environment. Issues such as
indoor air quality, water quality, fire hazards, and exposure to
chemicals are present every day in the workplace. In fact, the
concentrations of many pollutants indoors exceed those outdoors [1]. Many take for granted that their workplace is safe,
not realizing that problems may exist and go unnoticed. It is
imperative that salon professionals be aware of their working environment and the possible dangers that exist around
them. In addition to health concerns for the occupants of a
building, business owners and employers should also be wellversed on environmental issues in the work place. It has been
estimated that indoor environmental quality-related health
issues cost businesses $20 to $70 billion annually due to lost
productivity, decreased performance, and sick days [2].
INDOOR AIR QUALITY
Indoor air quality, or IAQ, ranges from issues relating to
comfort, such as air temperature, humidity, and ventilation, to hazardous conditions, such as secondhand smoke,
chemical exposure, and biological pollutants. Although
IAQ is not currently regulated in the United States, several
states and government organizations have developed guidelines to help increase awareness and decrease unwanted
exposure. For example, the U.S. Occupational Safety and
Health Administration (OSHA) does not have a general
IAQ standard, but has developed IAQ guidelines to address
common complaints, including ventilation and certain air
contaminants. These guidelines are available at https://www.
osha.gov/Publications/3430indoor-air-quality-sm.pdf [3].
In the event that IAQ becomes hazardous or may lead to
physical harm or death, all employers must comply with
Section 5(a)(1) of the OSH Act, often referred to as the
General Duty Clause, which requires employers to “furnish
to each of his employees employment and a place of employment which are free from recognized hazards that are causing
or are likely to cause death or serious physical harm to his
employees.” Section 5(a)(2) requires employers to “comply
with occupational safety and health standards promulgated
under this Act” [4].
SICK BUILDING SYNDROME
Q The familiar term for a problem with indoor air quality is
1 “sick building syndrome” (SBS). First used in the 1970s, SBS
refers to a situation in which the occupants of a building
report health-related symptoms that may be associated with
4
their presence in that building [1]. Key signs and symptoms Q
of SBS include fatigue, headache, dizziness, nausea, sensi- 1
tivity to odors, and irritated eyes, nose, and throat. A main
identifiable factor in SBS is the absence of symptoms when
the individual is out of the suspected building. Causes may
include poor ventilation as a result of poor design, maintenance, or operation of the air conditioning system or the
interior design of the building, which may prevent proper
air flow [1]. Humidity level (too high or too low), lighting,
temperature, and other environmental stressors may also be
of impact. Many individuals may suspect SBS based on their
symptoms; however, it is important to be aware that other
building-related illnesses may affect occupants’ health.
POLLUTION
Tobacco Smoke
Many of the state and federal guidelines on IAQ were
originally developed to address the effects of tobacco smoke
in the work environment. OSHA originally proposed IAQ
standards in 1994, with a primary goal of reducing tobacco
smoke in the workplace [5]. The proposal was subsequently
withdrawn in 2001, as it was found that many state and local
governments and private employers had already banned
smoking in public areas and in workplaces [6].
Many states have enacted “smoke-free environment” laws
restricting smoking in most public areas and buildings [7].
Health issues related to secondhand smoke exposure include
lung and other cancers and lung and heart diseases.
Indoor Contaminants
Indoor air pollutants may originate from both inside and
outside the building. Signs and symptoms of exposure may
include nasal congestion, nosebleeds, cough, wheezing, shortness of breath, lung disease, eye irritation, headache, dizziness,
fatigue, nausea, rash, fever, muscle pain, and hearing loss [1].
Outdoor pollutants that affect IAQ are largely a result of
improper ventilation. Sources include motor vehicle exhaust,
new construction, and contaminants from building maintenance and public works and utilities. The primary mitigation
measure to reduce outdoor pollutants is to place ventilation
intakes away from any source of outside pollution [8].
There are a number of sources of indoor pollutants. Many are
from the building itself; however, there are industry-specific
pollutants as well. Sources can be broadly categorized as
chemical, physical, and biological [9]. Transmission can be
through air, water, or direct contact. The number of possible
contaminates for each category is too great in scope to be
addressed in this course. Instead, the most common types of
pollutants relevant to the salon professional will be briefly
later in this course.
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_________________________________________________________________ #P5051 Environmental Issues
TUBERCULOSIS
Tuberculosis (TB) is a bacteria spread by airborne transmission. Droplets originate in the airway, including the mouth,
pharynx, larynx, or lungs. Simply coughing, sneezing, laughing, or singing can spread thousands of the infected particles
into the air. Those working in poorly ventilated areas are
at a greater risk of acquiring TB. In 2013, a total of 9,588
new TB cases were reported in the United States, at a rate
of 3 cases per 100,000 population [10]. Sixty-four percent of
these cases were from foreign-born persons, with those from
Mexico (1,233), the Philippines (776), India (495), Vietnam
(454), and China (377) composing the top five countries.
Florida was one of four states that reported more than 500
cases of TB in 2013, according to the Centers for Disease
Control and Prevention (CDC) [10]. Symptoms of TB may
be subtle and include fever, night sweats, weight loss, and a
cough that may or may not be productive [11]. Those with
suspected cases of TB should contact either their doctor or
local health department immediately.
AIRBORNE ALLERGENS
Airborne allergens can include pollens, molds, spores, and
dust. Symptoms such as nasal congestion, eye irritation,
dermatitis, and asthma are common physical reactions to
airborne allergens. Among the various airborne allergens,
the dust mite is responsible for a large percentage of allergic
reactions [1]. Dust mites are present in carpeting, furniture,
and bedding and thrive in moist environments. Molds and
spores also thrive in moist environments and can trigger
an allergic reaction. Increasing ventilation and decreasing
humidity will help mitigate many problems associated with
these allergens.
In the salon environment, dust from the filing of artificial
nails may be detrimental to one’s health. Artificial nails are
composed of glues, benzoyl peroxide, silica, and acrylic polymers. Some artificial nails contain liquid methyl methacrylate
(MMA) monomer. However, use of MMA has been banned
in Florida after consumer complaints to the U.S. Food and
Drug Administration (FDA). Alternative safe products are
now available. In all cases, to reduce nail dust, technicians
should use masks when filing and minimize the need to file
by shaping the nail correctly [12]. When possible, the use of
a ventilated table is recommended.
VOLATILE ORGANIC COMPOUNDS (VOCs)
Q Volatile organic compounds, or VOCs, are a varied group
2 of chemicals that may have short- and long-term adverse
health effects. The airborne concentrations of VOCs are
consistently higher indoors (up to ten times higher) than
outdoors. Beauty salons, in particular, use a wide diversity of
chemical products that contain VOCs, including cleansers, Q
cosmetics, polish and polish removers, depilation products, 2
hair dyes, and glues and adhesives. One international study
found that the most common VOCs found in salons and spas
were from scent-containing compounds such as acetones,
ketones, toluenes, and esters [13; 14]. The odor common
to salons is evidence of the presence of these compounds.
Formaldehyde has been classified as a probable human
carcinogen by the U.S. Environmental Protection Agency
(EPA). Airborne formaldehyde is present in salons in many
cosmetics and disinfectants. Salons often use a type of dry
sanitizer in their cabinets and drawers to sterilize equipment
that emits formaldehyde vapor. Exposure may irritate the eyes
and respiratory tract. Individuals with asthma may be more
sensitive to the effects of airborne formaldehyde [13; 14; 15].
Other possible sources of formaldehyde in salons are certain
“Brazilian Blowout” and similar “professional use only” hair
smoothing or straightening products. Some of these products
fail to list formaldehyde on their labels or Material Safety
Data Sheets, as required by law. According to OSHA, air
tests showed formaldehyde at levels above OSHA’s limits in
salons using Brazilian Blowout Acai Professional Smoothing
Solution (labeled “formaldehyde free”), Copomon/Coppola
Keratin Complex Smoothing Therapy, several Marcia Teixeira products (e.g., Brazilian Keratin Treatment, Chocolate
Treatment), and Cadiveu Brasil Cacau [32]. Both federal and
state OSHAs have found violations by several manufacturers,
importers, and distributors.
Another VOC common to salons and spas is benzene.
Benzene is a colorless, highly flammable liquid with a sweet
smell that evaporates quickly. It is known to cause cancer
in humans. Sources of benzene include detergents, plastics,
resins, nylon, and other synthetics fibers [16]. It has been
found that long-term exposure to benzene can affect red
blood cells, possibly leading to anemia or excessive bleeding.
Women who breathe benzene over a long period may have
irregular menstrual periods and smaller ovaries [16].
VOCs are common and widespread in indoor settings. It is Q
imperative that the salon professional is aware of the possible 3
health effects of exposure. Signs and symptoms include rash,
itchiness, headache, nausea, vomiting, shortness of breath,
and irritation of the eyes, nose, and throat. Cosmetologists
and other salon professionals can decrease their exposure to
VOCs by following certain practices, such as good ventilation of the areas, closing the packages of beauty products
when not in use, and selecting safer beauty products without
strong odors.
Phone: 800 / 707-5644 • FAX: 916 / 878-5497
5
MANAGEMENT OF AIR QUALITY
WATER QUALITY
The most effective way to successfully manage IAQ is to
identify and reduce or eliminate the sources of pollution.
Integral to mitigation is a properly working heating, ventilating, and air conditioning system, known as HVAC. An
inadequate HVAC system can increase indoor pollutant
levels by not bringing in enough outdoor air to dilute emissions from indoor sources and by not carrying indoor air pollutants out of the building. High temperature and humidity
levels can also increase concentrations of some pollutants,
and the design of a building’s interior may affect ventilation
as well. In particular, partitions and furniture may prevent
the proper flow of air.
Water is a reservoir for several types of chemical pollutants Q
and micro-organisms, including bacteria, fungi, and viruses, 4
that may affect one’s health. Tap water must be safe to drink
and use for baths according to criteria dictated by local
regulations and public health standards. A common microorganism identified in whirlpools and baths is the bacteria
Pseudomonas aeruginosa [28]. Infections from Pseudomonas
bacteria are commonly known as “hot tub rash” and “swimmer’s ear.” Symptoms are usually mild, but rash lesions may
become inflamed and infected.
In the salon environment, source control is key. Measures to
mitigate and control pollutants include [8]:
• Avoiding aerosols and sprays
• Diluting solutions to their proper strength
• Using proper protocol when diluting and mixing
solutions
• Storing products properly with containers closed
and lids tight
• Eliminating return air for storage spaces
• Storing mops “top up” to dry
• Establishing good pest management and cleaning
practices
The control of relative humidity and mold growth may be a
challenge in Florida, especially in the salon environment. To
manage moisture and mold, keep relative humidity low by
setting the air conditioning in accordance with outside air
temperature and dew point. Clean and dry spills immediately,
and do not allow standing water in any location. Ensure that
surfaces that are frequently wet are cleaned thoroughly and
often, lowering the susceptibility of mold growth. All porous
materials, such as towels, upholstered furniture, and carpets,
should be discarded if there are signs of mold growth [8].
A study of 18 nail salons in California found that 97% of
the tested whirlpools footbaths were infected with Mycobacterium fortuitum. Mycobacteria may pose an infectious risk
for pedicure customers, causing painful boils [18]. Although
California has experienced the largest outbreak to date, cases
have been reported in other states, including Florida [30; 31].
Legionella, which causes infection of the respiratory tract, is
another micro-organism commonly found in tap water and
bath water. The highest concentrations of Legionella are found
in areas of water distribution systems (e.g., hot water storage,
cooling towers, condensers), where it colonizes [19]. Legionella
is transmitted only through water, not through person-toperson contact. Inhalation of contaminated water droplets
from shower heads or faucet aerators may cause disease [20].
In addition, high humidity levels in a room may promote the
growth of Legionella and molds [21]. Infection with Legionella
may result in Legionnaires’ disease, a pneumonia that primarily attacks exposed individuals older than 50 years of age,
especially those who smoke, abuse alcohol, or already have
a compromised immune system [1].
Water filtration devices may help to reduce the risk of infections related to water [22]. Ducts, humidifiers, dehumidifiers,
and other areas of a ventilation system should be kept clean
and dry, as micro-organisms can colonize in water that accumulates in these areas [21]. Whirlpools and tubs should be
regularly sanitized to prevent infection.
FIRE SAFETY
Workplaces such as salons that handle flammable chemicals
and potentially hazardous material and that service clients
should be concerned with the risks of fire. Fire safety should
be part of any employee training program. Smoke alarms,
sprinklers, and/or fire extinguishers must be present. All
employees must know the fire risks associated with chemicals,
gases, or equipment used, as well as how to respond to a fire,
including assisting clients and employees and the location
and proper use of fire extinguishers [29].
6
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_________________________________________________________________ #P5051 Environmental Issues
Fire safety plans must include fire emergency preparation
with alarm systems, marked exits, and written emergency
plans. Many businesses use acronyms such as RACE (Rescue,
Alert, Confine, Extinguish) to help employees remember the
proper steps for fire emergency response.
Q Annual inspections by the fire marshal, quarterly fire drills,
5 annual fire safety in-services, and monthly fire extinguisher
documentation are all elements of the successful fire safety
program. Staff education and documentation of education
forms another integral part of the fire safety plan.
HAZARDOUS CHEMICALS
Exposure to hazardous chemicals through direct contact is a
common occurrence in the salon environment. Hairdressers
are exposed daily to chemicals found in hair dyes and relaxers, and nail technicians handle nail polishes, artificial nails,
glues, and adhesives. These chemicals enter the body through
the skin and, to a lesser extent, through inhalation and may
result in burns, irritation to mucous membranes, dermatitis,
coughing, and airway irritation. Both the professional and
the client may be adversely affected.
Studies suggest that certain substances in hair dyes can be
extremely harmful to health. P-phenylenediamine (PPD),
a substance found in many hair dyes, may cause severe
dermatitis, eye irritation, asthma, abdominal pain, kidney
failure, convulsions, and coma in humans [23]. PPD has been
the leading permanent hair coloring agent in the Western
world since the 1890s, but the rate of adverse reactions to
PPD among hairdressers appears to be on the increase [24].
Certain “progressive” hair dye products contain lead acetate
as a color additive. These dyes add color gradually over the
course of several applications and are often used to cover grey
hair. Lead acetate is a known toxic substance; however, its
safety in hair products is in question. Although banned in
Canada and the European Union, the FDA has concluded
that products containing lead acetate are safe. The FDA does
require that safety be established before products containing
the dye can be marketed, and a warning label cautioning
consumers must appear on all products [25].
A link between hair dye and bladder cancer has been suggested, with the strongest association for occupational
exposure (as with hairdressers and salon workers) rather
than personal use [26]. One study found that “women who
used permanent hair dyes at least once a month for one year
experienced a 2.1-fold risk of bladder cancer relative to nonusers” [17]. In this same study, the highest risk was among
hairdressers. Individuals who worked for 10 or more years as
hairdressers or barbers experienced a 5-fold increase in risk
of bladder cancer compared to individuals not exposed [17].
There is conflicting evidence as to the risk to customers,
but the occupational hazard to cosmetologists is generally
accepted [26].
In the United States, cosmetics are regulated by the FDA’s
Center for Food Safety and Applied Nutrition. According
to the FDA, the two most important laws pertaining to cosmetics marketed in the United States are the Federal Food,
Drug, and Cosmetic Act (FD&C Act) and the Fair Packaging
and Labeling Act (FPLA) [27]. The FD&C Act prohibits
the commerce of unsafe and misbranded substances. Under
FPLA, all products require labeling to allow the consumer
to make informed decisions. Although the FDA does not
pre-approve cosmetic products, they may inspect cosmetic
manufacturing facilities to ensure product safety. Cosmetic
companies are responsible for the safety of their products. The
FDA requires that if a product has not been safety tested, it
must include a label that warns the consumer that the safety
of the product has not been determined [27].
Hairdressers should report reactions or complaints about hair
dye to the FDA’s Center for Food Safety and Applied Nutrition Adverse Events Reporting System at 301-436-2405 or
[email protected].
Salon professionals, employers, and owners should be
familiar with OSHA’s Right-to-Know Law, which ensures
that chemical hazards in the workplace are identified and
evaluated and that information concerning these hazards
is communicated to employers and employees. In addition,
every salon should have protocol in place for spills of hazardous chemicals. Proper storage of hazardous chemical is also
of utmost importance.
CONCLUSION
The salon environment is full of potential pollutants and
contaminants, and addressing the quality of the indoor
environment can improve employee and client health. Salon
professions should be vigilant of possible symptoms from
various environmental issues, such as sick building syndrome,
indoor air and water contaminates, and chemical hazards. To
prevent exposure to harmful pollutants, salon air and water
quality should be maintained, with a primary focus on identifying and reducing possible sources of pollution. Maintaining
an adequate HVAC system is integral to the process. The
presence of flammable chemicals and potentially hazardous
materials in the salon environment requires that a fire safety
plan and protocols for handling dangerous substances be in
place. Maintaining a clean, safe environment for employees
and clients will ensure a pleasant experience for all.
Phone: 800 / 707-5644 • FAX: 916 / 878-5497
7
TESt questions
#P5051 environmental issues
This is an open book test. Please record your responses on the Answer Sheet.
A passing grade of at least 75% must be achieved in order to receive credit for this course.
Accreditation: Paragon CET courses meet the requirement for continuing education as set forth
by the North Carolina Board of Cosmetic Art Examiners.
Designation of Credit: Paragon CET designates this continuing education activity for 1 CE hour.
This 1 CE Hour course expires October 31, 2017.
1. A familiar term for an indoor air quality
problem is contaminated building syndrome.
A) True
B) False
4. A micro-organism commonly found in whirlpools
and baths is Pseudomonas aeruginosa.
A) True
B) False
2. According to an international study, the most
common volatile organic compound, a major
source of indoor air pollution in salons and
spas, is formaldehyde.
A) True
B) False
5. To ensure a successful fire safety program, the
fire marshal should inspect the facility annually.
A) True
B) False
3. Salon professionals can decrease their exposure
to volatile organic compounds by following
certain practices, such as good ventilation of
the areas, closing the packages of the beauty
products when not in use, and selecting safer
beauty products without strong odors.
A) True
B) False
Be sure to transfer your answers to the Answer Sheet/Evaluation located between pages 28–29.
DO NOT send these test pages to Paragon CET. Retain them for your records.
PLEASE NOTE: Your postmark or facsimile date will be used as your test completion date.
8
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___________________________________________________________________
#P6011 OSHA Regulations
Course #P6011 — 1 CE HOUR
OSHA Regulations
Faculty
Paragon CET Staff
Division Planner
Leah Pineschi Alberto, licensed cosmetologist and instructor of cosmetology, has been educating students in Northern
pedicure practices.
Learning Objectives
1. Explain the history of Occupational Safety
and Health Administration (OSHA).
2. Describe the purpose of the Bloodborne
Pathogens Standard.
3. Discuss the impact of OSHA regulations on
employee health, including risk management
and safety issues.
4. Review hazardous materials and waste
management, including the process of
handling blood and chemical spills.
5. Identify important ergonomic and latex
allergy issues in the salon setting.
6. Discuss legal issues and employee safety.
course.
Audience
Accreditation
for 1 CE hour.
About the Sponsor
Course Objective
The purpose of this course is to supply information that will
allow salon professionals to more easily comply with the broad
spectrum of rules covered by OSHA regulations.
Phone: 800-707-5644 • Fax: 916-878-5497
Phone: 800 / 707-5644 • FAX: 916 / 878-5497
9
#P6011 OSHA Regulations ___________________________________________________________________
INTRODUCTION
BLOODBORNE PATHOGENS
In 1970, Congress established the Occupational Safety and
Health Administration (OSHA). OSHA has defined its mission as assuring that working men and women are provided
with safe, healthful working conditions. The agency fulfills its
mission by applying and enforcing standards developed under
the Act. It also provides information, education, training,
and assistance to employers so they can maintain safe and
healthful workplaces [1].
The purpose of the Bloodborne Pathogens Standard, published by OSHA in final form in 1991, is to limit occupational exposure to blood, bodily fluids, and other potentially
infectious materials, because any exposure could result in
bloodborne pathogen transmission. These standards apply
to all employees who could be “reasonably anticipated to
face contact with potentially infectious materials while
performing their normal job duties” [3]. Some of the most
common bloodborne pathogens include hepatitis C, human
immunodeficiency virus (HIV), and hepatitis B.
At one time, OSHA compliance was considered an issue only
important to and applicable for industry. Because salons do
not use heavy equipment or have issues regarding noise levels
or high-level chemical spills, people assumed that they were
safe. Employee injuries were documented, and business went
on as usual. However, OSHA now mandates that salons and
spas have written safety compliance plans, specific to their
company and location, that address the safety standards for
their industry.
HISTORY OF OSHA
OSHA was created through the enactment of the William
Steiger Occupational Safety and Health Act (OSH Act),
was signed by President Nixon on December 29, 1970,
and became effective on April 28, 1971. OSHA creates
and enforces safety and health regulations to ensure that
employees work in environments that are free from recognized hazards.
Q The OSH Act created three federal agencies: OSHA, within
1 the Department of Labor; the Occupational Safety and
Health Review Commission; and the National Institute
for Occupational Safety and Health (NIOSH), within the
Department of Health and Human Services. The OSH Act
covers only the private sector [2].
OSHA’s duties include writing standards, inspecting workplaces for compliance with standards, and prosecuting violations. The review commission is responsible for resolving
disputes between OSHA and violators of the OSH Act (usually employers). NIOSH conducts research on occupational
hazards and makes recommendations for standards [2]. OSHA
is continually pushing for improved safety in all categories
of the workplace.
10
The standard requires employers to implement an exposure
control plan that mandates Universal Precautions (treating all body fluids as if infectious). The plan stresses hand
hygiene, recommends the use of Personal Protective Equipment (PPE), sets forth processes to minimize blood exposure
and splashing, ensures appropriate packaging of specimens,
and regulates waste [3]. Under the standard, the employer
must evaluate potential for contact to infectious materials
and provide protection to any employees that may be exposed
to these materials, including training, vaccination, and PPE.
Copies of the complete Bloodborne Pathogens Standards
can be obtained at https://www.osha.gov/SLTC/bloodbornepathogens/standards.html or by contacting OSHA at (800)
321-OSHA.
RECORDING AND REPORTING
INJURIES AND ILLNESSES
In 2002, OSHA revised the rule addressing the recording
and reporting of occupational injuries and illnesses. The
goal of this revision was to simplify the overall recordkeeping for employers, generate more accurate information about
occupational injuries, and better protect employee privacy
[4]. Any records involving bloodborne pathogen exposure,
treatment, and laboratory testing must be retained and
recorded on the OSHA 300 Log.
Code 29 CFR 1904 in the Code of Federal Regulations
(CFR) addresses record keeping. One of the most confusing
parts of record keeping is determining if an injury or illness
is recordable based on first aid or medical treatment. The
revised standard sets new definitions of medical treatment
and first aid to simplify recording decisions. An injury or
illness is considered work-related if an event or exposure in
the work environment caused or contributed to the condition or significantly aggravated a pre-existing condition. All
reportable injuries must be reported on the OSHA 300 Log,
OSHA form 301, or an equivalent form [4]. Complete and
in-depth information on recordable and reportable injuries
and illnesses may be found by visiting http://www.osha.gov.
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___________________________________________________________________ #P6011 OSHA Regulations
SAFETY/RISK MANAGEMENT
All employee injuries and illnesses must be assessed with
regard to safety and the possibility that a safe workplace has
somehow been compromised. When evaluating any employee
injury, the safety issues that might affect the outcome, such
as chemical exposure, glove use, ergonomics, and even air
quality issues, should be examined to make certain no overall
safety issues exist. Any safety issues should be documented
and reported to prove that the issues have been addressed
and that no hazards are being neglected. Avoiding the perception that OSHA regulations are being ignored can be
accomplished by careful documentation.
ROLE OF MANAGEMENT
The management staff of any salon or like facility is the first
line of defense. They will know the employees, what has to be
done, and that their example will be emulated. A concerned
attitude, use of necessary protective equipment, and safe work
habits by supervisory and management staff will encourage
employee participation [5].
A supervisor is generally the first one on the scene after an
incident is reported and will be the one to do the initial
investigation. This supervisor’s commitment to safety and
accident prevention is a key factor whether the incident
involves an employee or patient injury. Supervisors will also
be the first to spot and prevent unsafe lifting, failure to wear
PPE, and disregard for safety information. The time to correct
these lapses is at the time the lapse occurs. Consistency, fair
play, and discipline, when necessary, are fundamental aspects
of employee safety.
CONTROLLING COSTS
A commitment by supervisor and managerial staff to control
costs is another factor in a successful program. Commitment
must be not only to direct cost reduction, such as medical
and compensation, but also in indirect cost reduction, such as
new employee training, equipment down time, and accident
investigation time by the supervisor [5].
WORKERS’ COMPENSATION
One of the factors that will complicate any employee injury
is workers’ compensation. Each state has its own set of laws;
however, prompt reporting of treated injuries and an accurate
OSHA accident log will help to lessen any conflicts. Employees must understand that prompt reporting of work-related
injuries will lead to effective treatment and lower overall costs
to the facility. The salon manager should also be familiar with
the workers’ compensation laws in their own state. It is wise
to have the handbook available for reference.
VIOLENCE IN THE WORKPLACE
Violence in the workplace is an issue that is increasingly
receiving public attention. An estimated 2 million workers
are injured each year during a workplace assault. While a
majority of these injuries are nonfatal, the U.S. Bureau of
Labor Statistics reported that of the 4,383 fatalities in the
workplace in 2012, 767 workers were fatally injured by assault
and/or violent attack [6; 12].
When evaluating an organization as a safe workplace,
employee education and documentation of that education is
essential. OSHA’s quest is to provide a safe workplace for all
employees. An employee health risk management program
that is organized well can assist a facility in meeting OSHA
requirements with ease.
MATERIAL SAFETY DATA SHEETS
(MSDS) AND HAZARDOUS WASTE
The Hazard Communication Standard, also known as
the Right-to-Know Law, is referenced by Code 29 CFR
1910.1200 [7]. The purpose of the standard is to ensure
that chemical hazards in the workplace are identified and
evaluated and that information concerning these hazards is
communicated to employers and employees.
Cosmetologists may be exposed to high concentrations of
several chemical compounds that are used in products for
hair, facial, skin, nail, and body treatments. Products may
contain any of several volatile organic compounds (VOCs),
methacrylates, phthalates, and formaldehyde. The Hazard
Communication Standard seeks to inform employees about
hazards from workplace chemicals and ways that employees
can monitor their exposure to hazardous chemicals and
protect their health. This transfer of information is to be
accomplished by means of a comprehensive hazard communication program, which includes container labeling and
other forms of warning [8; 9].
The standard is comprised of several major categories: hazard Q
determination, Material Safety Data Sheets (MSDS) that 2
list exposure dangers, employee training, the written program, and trade secrets. OSHA requires that the workplace
evaluate chemicals, label them, maintain MSDS, train the
employees with documentation, and have a written hazard
communication program. In addition, the U.S. Food and
Drug Administration requires that ingredients of cosmetics
and beauty products, including permanent hair solutions and
tints, appear on the labels.
Phone: 800 / 707-5644 • FAX: 916 / 878-5497
11
Q One way to determine if a chemical is hazardous is by con3 sulting one of the following lists [3]:
• OSHA Toxic and Hazardous Substances
• American Conference of Governmental
Industrial Hygienists
• National Toxicology Program Annual
Report on Carcinogens
• International Agency for Research on
Cancer Monographs
If a chemical is encountered that is not found in one of these
lists, it is the responsibility of the employer to search other
scientific literature to determine if the chemical is hazardous.
Every chemical in the facility must have an MSDS sheet,
and the sheets must be updated on a regular basis and readily available to employees. Training and documentation of
training must be provided and take place at the time of initial
assignment or whenever a new, potentially dangerous chemical is introduced into the workplace. Not only do employees
have a legal right to know about chemical hazards, but the
employer must also provide protection for the employees,
eye wash stations, and monitoring of exposure.
Hazardous waste products fall under two general categories:
pathological waste and infectious waste. Infectious waste is
any waste that may contain pathogens capable of causing an
infectious disease. Pathological waste is any human tissues,
organs, and/or body parts, other than teeth, and is generally not found in the field of cosmetology. All pathological
waste should be considered infectious waste [3]. Hazardous
waste must be disposed of properly, as designated by state or
local laws.
CHEMICAL AND BLOOD SPILLS
Part of the salon’s responsibilities for workplace safety rests
with that facility’s ability to have a plan in place for spills of
all kinds. Blood and chemical spills, such as formaldehyde
or any other harmful chemical (e.g., chemicals found in
hair, nail, and skin products), both contain the potential for
employee injury. Salon professionals must take precautions
for chemical spills, regardless of how minor. Spill kits for
both chemical and blood spills should be placed strategically
around the facility. All personnel must be trained in the use
of the spill kits, and training must be documented. Policies
should be in place that cover spill cleanup, protective equipment, handling solid or liquid spills, and the storage and
handling of any chemicals [3].
12
ERGONOMICS
Ergonomics is defined as the science of designing the workplace to accommodate the worker. When establishing an
ergonomics program, breaking down the program into four
main components makes the program more valuable:
•
•
•
•
Worksite analysis
Hazard prevention and control
Medical management
Training and education
Although no standards exist to universally regulate ergonomics in the salon industry, OSHA has established a protocol for
developing industry and task-specific ergonomic guidelines,
which can be found on OSHA’s website at http://www.osha.
gov [10]. This protocol was created to “establish a fair and
transparent process for developing industry and task specific
guidelines that will assist employers and employees in recognizing and controlling potential ergonomic hazards” [10]. As
of 2014, no specific ergonomic standards had been established
for salon professionals. However, it is possible that OSHA
will publish a standard in the future.
Special attention should be paid to maintain ergonomically
correct posture and ergonomically friendly work areas and
to reduce wear and tear caused by repetition and incorrect
tool handling.
LATEX ALLERGY AND
THE USE OF GLOVES
When evaluating the overall safety plan for the salon and
compliance with the employee safety regulations that address
PPE, latex allergy can be an important factor. An employer
must provide safety equipment as an effective barrier to hazardous materials that can be worn by the employee without
causing discomfort or adverse effects. Some populations with
high risk of developing a latex allergy include those with
a history of allergies and anyone who frequently comes in
contact with latex products. Because of the use of hazardous
chemicals in salon professions, there is a high potential of
the use disposable gloves, including latex gloves; therefore,
there is a high potential for latex allergy.
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Changing to a non-latex glove to eliminate reactions may
not work. Some non-latex gloves may still contain chemical
sensitizers. Gloves labeled hypoallergenic do not necessarily
eliminate allergic reactions. The use of hypoallergenic gloves
may minimize the likelihood of an allergic reaction but will
not eliminate the possibility of a reaction. As the employer
is responsible to provide gloves that can be worn safely, all
measures must be taken to find the kind of glove that can be
worn safely by the employee without exposing them to the
external hazards of harmful material or the internal hazards
of a reaction to the equipment providing protection.
TRAINING AND EDUCATION
Throughout the OSHA standards, employee training and
education are paramount. The standards themselves are very
specific about the training and education of employees. The
following items must be considered:
• Designation of a person responsible
for conducting training
• A specific format for the training program
• Elements of the training program
• Procedures to train new employees
at the time of their initial assignment
When OSHA visits a facility, they expect the facility to be
able to produce a written program addressing all of the safety
aspects, including fire safety, hazard communication, disaster
plans, and many other areas. In addition, they will expect to
see proof of education, such as lesson plans, inservice dates,
sign-in sheets, and education evaluation. The Bloodborne
Pathogens Standard requires employee education to happen
immediately upon hire. Documentation must reflect this.
LEGAL ISSUES
In today’s litigious society, any facility is at risk for lawsuits. If
an employee is injured on the job and that employee is able
to show that a lack of safety equipment or training or unsafe
conditions caused the injury, the facility is at risk for litigation. Lack of proper treatment of the injury and continuing
unsafe conditions would also be factors.
If a lawyer investigates an incident, he or she will expect to Q
examine the multitude of documentation available, includ- 4
ing incident reports, medical records that include treatment
of the employee, and training and education records. Safety
conditions that could have caused the injury, any perceived
unsafe conditions that exist, the safety committee minutes
that show how the facility has addressed the condition, and
further actions to correct the condition will also be reviewed.
Knowing what the standards prescribe for the facility and
carrying out proper documentation for all programs, whether
evaluating written plans, the education program, or follow-up
of existing conditions, will be the best protection possible.
The standards should be read carefully, and training seminars
and any other resources available to help keep the facility in
compliance should be considered.
SURVEYS, COMPLIANCE,
AND DOCUMENTATION
CONSULTATION
OSHA requires that every employer furnish employees with Q
employment and a place of employment that are free from 5
recognized hazards that cause, or are likely to cause, death
or serious physical harm. To avoid citations, employers must
comply with standards. This can be done by an internal
safety staff or by an outside private consultant. Free consultations are available to small businesses with no more than
250 employees at one site and no more than 500 employees
total at all sites.
Requests for assistance may be done in person, over the
phone, or in writing. The consultation will include an
opening conference and an inspection to examine building
structure, air and noise monitoring, PPE, job training, the
current safety and health programs, and current injury and
illness records as well as the communication procedures for
safety policies and procedures [11].
RECORDS REVIEW
A records review is an examination of the injury and illness
records to determine whether there will be a comprehensive
inspection of the workplace. The compliance officer reviews
the OSHA 300 Log and employment data in order to calculate the lost-time injury rate. This figure is compared to the
national average, and if the facility rate is lower, the officer
may not conduct a comprehensive safety inspection. A short
tour may be conducted to determine compliance with the
hazard communication standard and to ensure the presence
of an effective safety and health management program [3].
Phone: 800 / 707-5644 • FAX: 916 / 878-5497
13
RESOURCES
Read and understand the regulations and take advantage of
all the resources available. The most important resource is
the 29 CFR 1910, General Industry Standards. There are also
many free resources, such as the free OSHA consultations.
Access the provided websites for more information and
updated standards. Keep informed about changes in regulations or standards.
Centers for Disease Control and Prevention
http://www.cdc.gov
(800) CDC-INFO or (800) 311-3435
NIOSH Information Line
http://www.cdc.gov/niosh
(800) 356-4674
OSHA
http://www.osha.gov
(800) 321-OSHA
14
www.ParagonCET.com
TESt questions
#P6011 oSHA regulations
Designation of Credit: Paragon CET designates this continuing education activity for 1 CE hour.
1. The Occupational Safety and Health Act created
the National Institute for Occupational Safety
and Health.
A) True
B) False
4. An area a lawyer might investigate in connection
with an employee incident could be safety
conditions.
A) True
B) False
2. The U.S. Food and Drug Administration requires
that ingredients of cosmetics and beauty products,
including permanent hair solutions and tints,
appear on the labels.
A) True
B) False
5. OSHA provides free consultations to small
businesses with no more than 50 total employees.
A) True
B) False
3. One way to determine if a chemical is hazardous
is by consulting a list such as the National
Toxicology Program Annual Report on
Carcinogens.
A) True
B) False
Phone: 800 / 707-5644 • FAX: 916 / 878-5497
15
#P2011
Chemical Makeup of Hair, Skin, and Nails
________________________________________________
Course #P2011 — 2 CE HOURS
Chemical Makeup of
Hair, Skin, and Nails
Faculty
Paragon CET Staff
Division Planner
Leah Pineschi Alberto, licensed cosmetologist and instructor
of cosmetology, has been educating students in Northern
pedicure practices.
Course Objective
The purpose of this course is to provide salon professionals
with a review of the chemical makeup of the hair, skin, and
nails.
Learning Objectives
1. Define pH and how it affects hair, skin,
and nails.
2. Outline the chemical and anatomic makeup
of hair, skin, and nails.
3. Describe chemicals commonly encountered
in the salon setting.
4. Discuss conditions and disorders that can affect
the quality of hair, skin, and nails, including
considerations for children and the elderly.
course.
Audience
Accreditation
for 2 CE hours.
About the Sponsor
16
Phone: 800-707-5644 • Fax: 916-878-5497
www.ParagonCET.com
_______________________________________________ #P2011 Chemical Makeup of Hair, Skin, and Nails
INTRODUCTION
In order to offer safe and effective services to the public,
cosmetology professionals must be aware of the chemical
makeup, growth, and structure of hair, skin, and nails. Salon
professionals’ basic knowledge and their commitment to
increased understanding will translate into client satisfaction.
ACIDS AND BASES
Understanding the potential hydrogen (pH) scale is essential
to the discussion of the chemical makeup of the hair, skin,
and nails. The pH scale measures the acidity, or excess of
hydrogen ions (H+), and the base or alkalinity, defined as
an excess of hydroxide ions (OH-). On the pH scale, values
between 1 and 7 are considered acidic, and values between
7 and 14 are base or alkaline. For example, vinegar has a low
pH (2.4) and is acidic, tasting sour, bitter, or sharp. Chlorine
and ammonia both have high pH (11.7 and 12, respectively)
and are extremely alkaline. Distilled water is usually between
a 6 and 7 on the pH scale, which is considered essentially
neutral (neither acidic nor alkaline). If substances are combined, the pH of the resulting compound will be different
than the original portions.
Each change of one number up or down on the pH scale is
exponential. A pH of 9 is ten times more alkaline than a pH
of 8. A pH increase of two whole numbers is equal to 100-fold
change in alkalinity. Therefore, a small change on the pH
scale indicates a large actual change in pH [2].
THE PH OF HAIR
The pH of hair ranges between 4.5 and 5.5. When selecting products for use on the hair, it is important to consider
the condition of the hair and the pH of the product. The
higher the pH, the more alkaline or harsh the product may
be. In the case of shampoo, a higher pH may be selected to
remove buildup, but this in turn can strip hair of necessary
oils, resulting in over-stimulation of the sebaceous oil glands
in the scalp and worsening of oily hair. Highly porous hair,
often a result of overprocessing, is dry and brittle (lacking
necessary oils) and will require a shampoo with a lower pH
and therefore less alkalinity [2].
THE PH OF THE SKIN
Normal skin surface pH is between 4 and 6.5 in healthy
people, though it varies among the different areas of the
skin. Newborn infants are born with a higher skin surface pH
compared to adults, but this normalizes within 3 days of birth.
Similar to the action of alkaline products on the hair, the pH
of products used on the skin must be chosen thoughtfully [3].
The skin is protected from bacterial and fungal infections and
surface contaminants by the acid mantle. The acid mantle
is a thin, film-like barrier on the outermost layer of the skin.
The acid mantle contains lactic acid, amino acids from sweat,
free fatty acids from sebum (an oily substance secreted by
sebaceous glands via the hair follicles), and amino acids and
pyrrolidine carboxylic acid from the cornification process of
skin [3]. Cleansing the skin with alkaline soaps or detergents
can disturb the acid mantle.
THE PH OF NAILS
Nails are essentially hardened skin cells [4]. They are susceptible to both bacterial and fungal infection when the pH
changes as a result of exposure, age, and certain medications.
CHEMICAL AND ANATOMIC MAKEUP
SKIN
Skin is the largest organ of the body and acts as a barrier
against the environment, pathogens, and dehydration. The
skin has seven functions [13]:
•
•
•
•
•
•
•
Sensation
Hydration
Absorption
Regulation
Protection
Excretion
Respiration
Sensations, or feelings, allow you to react to temperature,
pain, and pressure and to recognize touch. Some areas of the
skin are more sensitive (e.g., fingertips) than others. Skin also
allows the body to retain and absorb water and excretes perspiration and oils. These functions can cool the body, allow
a person to remain hydrated, and maintain suppleness. The
skin serves as an important form of protection as it guards
against the elements and from bacteria and fungi [2]. Finally,
skin provides for expression and body image [13]. Skin plays
a vital role in self-esteem and social communication. Skin
characteristics have an impact on how an individual communicates, both verbally and nonverbally, and how the other
person reacts to that individual. It also provides significant
social cues regarding health and vitality.
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17
#P2011 Chemical Makeup of Hair, Skin, and Nails ________________________________________________
This illustration shows the basic structure of the skin.
Source: National Institute of Arthritis and Musculoskeletal and Skin Diseases
Q Human skin is composed of two main layers: the epidermis
1 (outer layer) and the dermis (inner layer) (Image 1). The
epidermis is divided into five layers of cells. They are, in order
Q
2 from the outermost inward:
• Stratum corneum: This layer is composed of dead
keratinized cells and is constantly being sloughed
off and renewed from below. It also contains the
acid mantle, an oily layer with reduced pH.
• Stratum lucidum: Also known as the clear layer, this
layer is found in areas where the epidermis is thicker,
like the palms of the hands and the soles of the feet.
It lies directly below the stratum corneum.
• Stratum granulosum: This layer is actually composed
of 1 to 5 sub-layers and is believed to help with
keratin formation.
• Stratum spinosum: Often referred to as the “prickly
layer,” cells in this layer begin to flatten as they are
migrating toward the skin surface. The stratum
spinosum acts as a stabilizing support to the skin.
• Stratum germinativum or basale: The deepest layer
of the epidermis is the stratum germinativum. It is
composed of a single layer of constantly dividing cells
that form new cells. Melanin, which determines skin
color and protects the sensitive dermis from ultraviolet (UV) light, is produced in this layer as well.
The dermis is the thickest layer of the skin, varying in thickness from 0.2–4 mm. The reticular dermis anchors the skin
to the body and contains sweat glands, hair follicles, nerves,
and blood vessels. The dermis also contains the sebaceous
glands, which secrete sebum and lubricate the skin. The
major proteins found in the dermis are collagen and elastin.
18
Image 1
Collagen gives skin its tensile strength, while elastin provides
the skin with elastic recoil. This characteristic prevents
the skin from being permanently reshaped. The dermis is
divided into two areas: the papillary dermis, which contains
capillaries for blood flow, and the reticular layer, which is
comprised of thick collagen fibers. The dermis also contains
the receptors that sense pain and pressure.
Beneath the dermis lies subcutaneous tissue, which attaches
the skin to the underlying structures. Subcutaneous tissue
contains fat, connective tissue, blood vessels, lymphatics,
and nerve endings [13].
NAILS AND NAIL EXTENSIONS
The nail is made of keratin, a waterproof and durable protein,
and grows in a similar way to hair. Nail growth begins with
the matrix, a layer that produces the keratin cells that are
pushed outward from the base of the nail. The shape and
size of the matrix also influences the shape and thickness of
the nail [1]. The cells multiply and push upward and harden
into three layers: the cuticle, cortex, and medulla. Nail
growth is effected by hormones, exercise, nutrition, and an
individual’s overall health. On average, nails grow 1/10 to
1/8 inch per month in adults; in younger people nail growth
can be faster because of more rapid cell reproduction. The
thumb nail grows slowest, while the middle finger grows
fastest. Toenails are harder and thicker than fingernails and
grow more slowly [2].
Artificial nails or nail extensions can be applied over a plastic
tip or directly on the nail when nails are too thin or weak
to grow to the length that a client desires. There are three
general systems to create artificial nails:
• Powder and liquid acrylic
• Wraps and no-light gels
• Light-cured gels
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In addition, fabric wraps (made of silk, linen, paper, or fiberglass) may be added to nails to strengthen weak nails or help
a cracked nail grow out.
HAIR AND SCALP
The main purpose of hair is to protect the body from heat,
cold, and injury. The root of the hair is located below the
surface of the skin, enclosed within the follicle; the hair shaft
is the exposed portion. The hair root includes the follicle,
bulb, papilla, arrector pili muscle, and sebaceous glands.
Numerous factors affect the quality of hair growth, including
an unhealthy scalp.
Follicle Structure
Q The hair follicle is a tube-like pocket in the skin that encases
3 the hair root (Image 2). It is created when cells in the basal
layer of the epidermis travel down to the lower layer to seek
nourishment. The structure of the follicle or root sheath is
similar to a sleeve in the skin from which the hair will grow.
A sebaceous gland is attached to the follicle and is the source
of sebum, which lubricates the hair during growth. The follicle extends from the epidermis through the dermis. The hair
bulb is the lowest area of the follicle and receives nutrients
from the dermal papilla. The arrector pili muscle is a small
muscle near the base of the follicle that reacts to responds to
emotional stresses or cold to create the sensation of “goose
bumps” [2]. There are no hair follicles on the palms of the
hands or the soles of the feet.
Keratinization
Growing hair is made up of keratin. As these protein cells
mature, they become fibrous and die in a process called keratinization. When this process is over, the cells that form the
hair strand are no longer alive [1].
Physical Properties
Q Hair texture includes three classifications: coarse, medium, or
4 fine. The texture of hair is related to the thickness or diameter of the hair strand. Coarse hair has the largest diameter,
while fine hair has the smallest. Coarse hair is stronger and
is therefore more resistant to lighteners, coloring, and other
chemical processes, including relaxing or waving solutions.
Hair density refers to the number of hairs per square inch of
scalp. The average hair density is 2,200 hairs per square inch.
However, naturally blonde hair is more dense, and naturally
red hair is less dense. People with the same hair texture may
have different hair density and vice versa.
The porosity of hair refers to the ability of the hair to absorb
moisture. Low porosity results in resistance to chemical treatment; high porosity may result in over processing.
Hair elasticity refers to the stretchiness of the hair or the
ability of hair to stretch and return to its original form without breaking. Hair with low elasticity is brittle and, unlike
normal hair, fails to stretch without breaking.
This illustration shows normal follicle structure
(also referred to as a pilosebaceous unit) in the skin.
Source: National Institute of Arthritis
and Musculoskeletal and Skin Diseases
Image 2
Dryness of the hair and scalp can be related to inactive sebaceous glands, excessive shampooing, or weather (winter or dry
climates). Conversely, overactive sebaceous glands can cause
oily hair and scalp. Poor diet, lack of exercise, and incorrect
hygiene can aggravate both dryness and oiliness, as can
medical conditions and prescription and non-prescription
medications [2].
CHEMICALS COMMONLY
ENCOUNTERED IN SALONS
Cosmetologists and beauty professionals must be aware of
all the inherent risks when mixing or using any products or
combinations of products on the skin, hair, or nails.
NAILS
Nail salon workers continuously come into contact with
nail care products and solvents, some of which can cause
lasting health effects. It has been suggested that nail salon
workers have significantly higher exposure to dangerous
chemicals than the average person. While research on nail
salon workers is limited, studies provide reason for concern
for this vulnerable population.
According to the Federal Food, Drug, and Cosmetic Act,
nail care products are considered cosmetics and are regulated
under the same law as makeup. Nail products for use both
in the home and in the salon are regulated by the U.S. Food
and Drug Administration.
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19
Methyl Methacrylate (MMA) Monomers
Artificial nails are composed primarily of acrylic polymers and
are made by reacting together acrylic monomers with acrylic
polymers. When the reaction is completed, traces of the
monomer are likely to remain in the polymer. For example,
traces of methyl methacrylate (MMA) monomers remain
after artificial nails are formed. The polymers themselves are
typically quite safe, but traces of the reactive monomers can
result in an adverse reaction in sensitive individuals, including redness, swelling, and pain in the nail bed. Today, ethyl
methacrylate monomer is commonly used in the creation of
acrylic nails, although MMA monomer may still be found
in some artificial nail products. In the early 1970s, the FDA
received a number of complaints of injury associated with
the use of artificial nails containing MMA. Among these
injuries were reports of fingernail damage and deformity, as
well as contact dermatitis. Unlike MMA monomers, methyl
methacrylate polymers were not associated with these injuries. Based on its investigations of the injuries and discussions
with medical experts in the field of dermatology, the agency
chose to remove from the market products containing 100%
MMA monomer. The FDA has declared MMA “poisonous
and deleterious” and considers its use in artificial nail products
inappropriate [5; 6]. In 2004, the Florida Legislature voted
to ban MMA in salons. Thirty-eight states now prohibit the
use of products with MMA monomers, and in Florida, fines
and/or jail time are likely if MMA is found in your salon [6].
HAIR
Permanent Waving
Permanent waving makes physical and chemical changes
to the makeup of hair. The process of permanent waving of
hair has remained generally the same since the 1930s. Usually, the hair is wrapped onto rods, and a lotion containing
ammonium thioglycolate is applied, changing the protein
structure in the hair. This is referred to as an alkaline perm.
When the solution is applied, the cuticle of the hair opens
and is penetrated to the cortex, breaking the salt bonds. Other
types of substances may be used for this purpose, including
glycerol monothioglycolate (“acid perm”), a mixture of acid
and alkaline (“exothermic perm”), or neutral lotions. After
a neutralizer is applied to close the structure again, the hair
takes the shape of the rod. Conditioners are also used to
decrease damage to the hair. An alkaline perm is generally
used for hair that will be less likely to respond to the curling,
including coarse, thick, or resistant types. Acid and neutral
perms are useful for clients with damaged hair and fragile
hair types [2].
20
Hair Coloring and Bleaching
Four types of hair color will fit the desires of most clients:
temporary color, semi-permanent color, demi-permanent
color, and permanent color. Temporary hair coloring coats
the cuticle of the hair shaft and remains visible until the
next shampoo. Temporary color can only be used to attain a
darker color. Semi-permanent coloring contains a low level
of hydrogen peroxide and partially penetrates the cuticle of
the hair shaft. This color typically remains for 4 to 5 shampoos. Demi-permanent coloring penetrates deeper through
the cuticle to the cortex through the use of an alkaline
agent, such as ethanolamine or sodium carbonate. Because
it penetrates deeper, it lasts longer, usually between 20 and
28 shampoos. Finally, permanent hair coloring lasts until
natural hair grows out or until the coloring fades. These
coloring products contain a developer or an oxidizing agent
and an alkalizing agent, usually ammonia. Ammonia allows
color to enter the hair shaft by swelling the cuticle to the
point at which it can best be penetrated.
Hair bleaching or lightening is achieved through oxidation of
the melanin in hair and is considered a type of permanent hair
coloring. In this process, hydrogen peroxide is mixed with an
alkaline product (e.g., ammonia), which reacts with melanin
in the hair and removes the color. Most bleaches should be
kept away from the skin to prevent burns, but there are gentle
oil or cream lighteners that can be applied directly to the
scalp. Oil lighteners are very mild and can be used on the
face and body as well. Strong lighteners, containing alkaline
mixed with hydrogen peroxide, can irritate the scalp and are
therefore used most often for highlighting [1].
Chemical Hair Relaxing
Hair relaxing, or lanthionization, reforms or relaxes hair with
excessive curl or wave to a straight position. The process is
similar to that used for permanent waving, but the absence
of the curling rods changes the end result. There are two
types of chemical relaxers: sodium hydroxide and ammonium
thioglycolate. Sodium hydroxide relaxers (also referred to as
lye relaxers) have 2% to 3% sodium hydroxide in a cream
base; lithium hydroxide, potassium hydroxide, calcium
hydroxide, and guanidine hydroxide are also available and
are slightly milder. The pH for this type ranges from 11.5 to
14 [1]. Ammonium thioglycolate relaxers contain 4% to 6%
thioglycolate acid and 1% ammonium hydroxide; the pH
range is 8.8 to 9.5. The relaxer is applied to the roots of the
hair, where it alters the hair shaft’s structure. Some relaxers
require a protective base (e.g., petroleum jelly) be placed
on the scalp prior to the procedure to prevent burning or
irritation. After the relaxing phase is completed, neutralizer is applied to stop the relaxing process and balance the
pH. Neutralizers, usually either hydrogen peroxide, sodium
perborate, or sodium bromate, are known as fixatives or
stabilizers. These bonding agents can cause the hair to be
fragile, and hair can be significantly damaged by excessive
application of relaxers.
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SKIN-CARE PRODUCTS
Skin-care products often contain combinations of methyl,
propyl, and ethyl parabens. Common ingredients in this
group include glycerine, propylene glycol, sorbitol, and hyaluronic acid. Propylene glycol is a petroleum-based humectant used to retain water and is used in the manufacture of
many skin-care products. Synthetic colors, usually labeled
as FD&C or D&C followed by a number, may be toxic to
sensitive individuals. They are coal-tar based additives and
known cancer-causing agents. Triethanolamine (TEA) and
diethanolamine (DEA) are common ingredients used to
adjust pH balances. These are very toxic and are associated
with eye problems and skin dryness. The simple ingredient
“fragrance” can include a variety of chemicals including
phthalates, a substance known to cause cancer and birth
defects in lab animals.
CONDITIONS AND DISORDERS
CONDITIONS AND DISORDERS
OF THE HAIR AND SCALP
Dandruff
Dandruff, or pityriasis, is a medical condition characterized by
excessive shedding of dead skin cells from the scalp. Dandruff
is a result of the fungus Malassezia. Malassezia is present on all
skin and is only problematic when the cell growth increases
to an abnormal level, interfering with natural cell renewal [7].
Dandruff may be accompanied by inflammation and redness
and should be treated with mild antifungal shampoos containing pyrithione zinc, selenium sulfide, or ketoconazole.
Consultation with a doctor and topical steroids may be
required [2].
Alopecia
Alopecia is the technical term for any abnormal hair loss.
The most common types are androgenic alopecia, alopecia
areata, and postpartum alopecia. Alopecia usually is the result
of hormonal, age-related, or genetic changes. Androgenic
alopecia is often referred to as male-pattern baldness. This
type of alopecia is genetically inherited and usually starts
at about 35 years of age in both men and women. Alopecia
areata is characterized by sudden onset of hair loss, often in
patches, resulting from an autoimmune response. In people
with alopecia areata, white blood cells attack the hair follicles, preventing hair growth. Males and females of all races
can be affected, and onset is usually in childhood. Postpartum
alopecia affects women shortly after the birth of a child and
is temporary, usually lasting less than one year.
A pattern of incomplete hair loss on the scalp
of a person with trichotillomania.
Source: Wikimedia Commons
Image 3
Trichotillomania
Trichotillomania is a disorder characterized by the noncosmetic pulling of hair, resulting in significant hair loss
(Image 3). Trichotillomania is commonly associated with
considerable distress and is a diagnosable mental disorder.
The majority of individuals start pulling hair during childhood or adolescence, though hair pulling can begin at any
age. While most adults with trichotillomania are women, hair
pulling may be about as common in young boys as it is in girls
[8]. Adults most commonly pull from the scalp, eyelashes,
eyebrows, beard, and pubic area. Children may also pull hair
from other people or from pets. Individuals with trichotillomania often engage in other damaging body-focused behaviors, such as skin-picking or nail-biting. Trichotillomania also
has been viewed as a form of obsessive compulsive disorder
because of the repetitive and seemingly compulsive nature
the action. Treatment may include cognitive-behavioral
therapy and medications prescribed by a doctor.
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21
Infestations
Parasites like head lice obtain their nutrients by attaching
to another organism (a “host”). Head lice are transferred
from one person to another through close contact or sharing grooming equipment (Image 4). Treatment includes
lice-killing shampoo and removal and sterilization of bed
linens, grooming equipment, and clothing. Another potential infestation is scabies, caused by the itch mite Sarcoptes
scabiei (Image 5). These mites burrow into the skin and
produce intense itching (especially at night) and a pimplelike rash. An extended period of direct skin-to-skin contact
is usually required to transmit scabies; however, transmission
by infected bed linens is possible because the mites can live
up to 48 hours off of the host [9; 12].
Actual size of the three lice forms compared to a penny.
Source: Centers for Disease Control
and Prevention
Image 4
CONDITIONS AFFECTING THE NAILS
Diseases, disorders, and conditions of the nail are called onychosis. These diseases require referral to a doctor and careful
handling by the cosmetology professional. No services should
be provided when disease is present.
Onychomycosis, tinea unguium, or unguis is a fungal infection of the nail (Image 6 and Image 7). This fungal infection appears as a thickened, yellow, and brittle nail bed,
but it is usually not painful. Some clients will lose the nail
entirely. Treatment of onychomycosis involves prescription
antifungal medications. Other possible infections include
paronychia (bacterial infection of the skin around the nail)
and onychoptosis (periodic nail loss). Each of these disorders
requires treatment by a doctor.
Onychomycosis, or tinea unguium, is a fungal infection
involving the nail bed. Note the deformation of the
nail giving them a thickened, cracked, and irregular
appearance.
This photograph depicts the pimple-like rash on the
webbing of the fingers due to an infestation of the
human itch mite, commonly known as scabies.
Source: Centers for Disease Control
and Prevention
22
Source: CDC/Dr. Libero Ajello
Image 6
Image 5
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Folliculitis occurs when bacteria infects the hair follicles.
Symptoms include a rash, itching, redness, and pimple-like
bumps. In extreme cases, there will be damage to the hair and
follicles. Most of the time, the infection will clear up on its
own, but persistent rashes may require antibiotics.
Impetigo is an infection usually caused by staphylococcal or
streptococcal bacteria. It causes red sores or blisters that can
break open, ooze, and develop a yellow-brown crust. Impetigo
is highly contagious and can be spread to others through close
contact or by sharing items like towels and toys. Antibiotic
treatment is usually required.
Fungal Infections
This infant’s left thumb had become infected causing
the tip to become red, along with disruption of the nail
bed, producing a discolored, yellow, highly misshapen
nail, all due to what was determined to be a Candida
albicans fungal infection caused by thumb sucking.
Source: CDC/Dr. Libero Ajello
Like bacteria, fungi exist on the healthy skin’s surface,
especially in moist areas of the body. However, fungi can
become harmful if they begin to overgrow and invade the
skin. Common fungal skin infections include candidiasis
and tinea infections.
Image 7
Q Other nail diseases and conditions do not require medical
5 intervention but can be irritating irregularities that interfere
with the client receiving nail treatments [1]. Nails can be
overly thick or thin, ridged, furrowed, concave, or ingrown.
In these cases, the provision of service depends upon the
condition of the nail and presence of infection. Clients may
also have hangnails, bruised nails (dark red or purple blood
clots under the nail plate), white spots on nails, overgrown
cuticles, and bitten or split nails.
CONDITIONS AND DISORDERS OF THE SKIN
As discussed, the skin is a protective barrier and constantly
comes into contact with pathogens that cause a variety of
diseases. In some cases, the skin can become infected, which
can threaten overall health and should be a consideration
for cosmetologists. Skin infection can result from bacterial,
fungal, or viral sources.
Bacterial Infections
Common bacterial infections include cellulitis, folliculitis,
and impetigo. Cellulitis is often caused by Streptococcus or
Staphylococcus aureus bacterial infections, animal bites, or
wounds exposed to contaminated water. Clients with cellulitis will have skin inflammation and tenderness. Treatment
includes antibiotics and the application of cold compresses
to the infection site.
A close-up of a ringworm lesion caused by the fungus
Trichophyton verrucosum.
Source: CDC/Dr. Lucille K. Georg
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Image 8
23
A shingles rash on a man’s forehead.
Source: CDC
The right index finger of a patient with an allergic
response to a dermatophytic fungal infection known
as ringworm.
Source: CDC
Image 9
Candidiasis is an overgrowth of the fungus Candida albicans.
Commonly referred to as a yeast infection, it can affect the
mouth, nails, and/or genitals. It can result in white patches,
redness, itchiness, and pain, depending on the area affected.
Treatment with prescription creams and/or mouthwashes
may be necessary.
A tinea infection causes red, itchy, scaly, ring-like blotches
on the affected area. This infection is often referred to as
ringworm, jock itch, or athlete’s foot, depending on the area
affected (Image 8 and Image 9). Treatment is with antifungal
medications and steroids to reduce inflammation in more serious cases. Another type, tinea versicolor, typically affects the
torso and causes a series of lighter or darker blotches on the
skin that will not tan. Antifungal medications and applying
dandruff shampoo to the skin are two methods of treating
this fungal skin infection [10].
24
Image 10
Viral Infections
Viral infections of the skin are particularly concerning
because they have no known cure. As such, treatment for
viral conditions focuses on relieving symptoms and diminishing outbreaks. Common viral infections include herpes
simplex and herpes zoster (shingles).
Herpes can develop on many parts of the body, but most commonly affects the mouth, lips, and/or genitals. Oral herpes, or
cold sores, appear as small, itchy blisters around the mouth
or on the lips or gums. Antiviral drugs and topical creams
are used to shorten outbreaks and lessen pain and itching.
Shingles is caused by the reactivation of the chickenpox
virus, mainly in older adults. It is characterized by a blistering rash, skin sensitivity, and severe pain and/or burning
(Image 10). Usually, the rash occurs on only one side of the
body. Individuals with shingles cannot spread shingles but
can transmit chickenpox [11].
Urticaria (Hives)
Urticaria, or hives, occur as a rash or welts and are often
itchy, burning, or stinging. They can appear anywhere on the
body and can signal a serious allergic reaction, especially if
accompanied by difficulty breathing. Hives may be caused by
a reaction to medications, such as aspirin or penicillin; foods,
such as eggs, nuts, and shellfish; food additives; temperature
extremes; or infections.
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Asymmetry
A melanoma that is irregular in shape.
Source: National Cancer Institute
This illustration shows models of three types of acne
lesions: the microcomedo; the open comedo, or
blackhead; and the closed comedo, or whitehead.
Source: National Institute of Arthritis
and Musculoskeletal and Skin Diseases
Image 12
Border
Image 11
Other Skin Conditions
Psoriasis is an autoimmune disorder that causes the abnormal
build-up of skin cells, resulting in thick, dry, scaly patches of
rough skin. Psoriasis is chronic but not contagious.
Dermatitis is a general term used to describe inflammatory
disorders of the skin. Types of dermatitis include eczema
and seborrheic dermatitis (often associated with dandruff).
Although these disorders are generally harmless, they can
cause discomfort and self-consciousness.
Acne is a chronic inflammatory disorder of the sebaceous
oil glands. Depending on the type of inflammation, people
with acne may have blackheads, whiteheads, cysts, and/or
scarring (Image 11). In severe cases, oral medications may
be used to clear up breakouts.
A melanoma with a border that is uneven, ragged, or notched.
Source: Skin Cancer Foundation
Image 13
Color
Skin Cancer
Skin cancer is a constant concern. More than 3.5 million
cases of nonmelanoma skin cancer are diagnosed each year,
making it the most common cancer in the United States [14].
Exposure to UV radiation, primarily sun exposure, has been
the most significant factor associated with the three primary
types of skin cancers. Sources of UV radiation include the
sun, sunlamps, sunbeds, and other types of tanning devices.
A melanoma with coloring of different shades of brown,
black, or tan.
Image 14
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25
Chickenpox may also affect children, although less so as a
result of widespread vaccination. Chickenpox is characterized
by an itchy rash of blisters all over the body and can lead
to serious complications such as pneumonia, brain damage,
or death.
Diameter
Warts develop in some children. These skin growths are
caused by contact with the contagious human papillomavirus
and can spread from person-to-person or through contact
with toys and other objects. Treatments include freezing,
surgery, lasers, and chemicals.
A melanoma with a diameter that is greater than 6 mm.
Image 15
Skin cancers are categorized as either melanoma or nonmelanoma types. Nonmelanoma skin cancers vary greatly in
appearance and can be pearly, waxy, or translucent bumps
(papules), or scaly, shiny, gray-to-red patches. Melanomas can
also vary in color, shape, and size and can resemble moles or
freckles. Generally, melanomas can be differentiated from
noncancerous moles because they have at least one of the
following features [15; 16]:
•
•
•
•
•
Asymmetry
Border irregularity
Color variations
Diameter of 6 mm or greater
Evolving size, shape, surface, shades of color,
or symptoms (such as itching or tenderness)
Coxsackievirus infection, or hand, foot, and mouth disease,
usually occurs in children younger than 10 years of age. The
illness starts with a fever, then progresses to painful mouth
sores and a non-itchy rash with blisters. It spreads through
coughing, sneezing, and used diapers. Treatment includes
non-aspirin pain relievers to control the fever.
Scarlet fever is a rash caused by a Streptococcus infection,
usually strep throat. Symptoms include sore throat, fever,
headache, bright red rash (especially in the armpits and
groin), abdominal pain, and swollen neck glands. After 7 to
14 days, the rash will slough off. Scarlet fever is very contagious, but good hand washing can reduce its spread.
Skin Disorders in the Elderly
As we age, our skin undergoes a number of changes influenced
by lifestyle, diet, heredity, and smoking. UV light exposure
from the sun is the main cause of skin damage. Skin begins
to stretch, sag, and wrinkle as elastin is lost. Aging skin
can be rough and dry and may begin to show both benign
and pre-cancerous growths. Thinning skin and prescription
medications can increase the appearance of age-spots on the
face, hands, and forearms. Some diseases, including shingles,
occur more frequently in older adults.
These characteristics are often grouped together and referred
to as the ABCDE rule (Images 12, 13, 14, and 15).
SUMMARY
Skin Disorders in Children
Children are commonly affected by allergies and skin infections and are especially sensitive to exposure to extremes
of temperature. “Fifth disease,” a contagious viral rash, primarily affects children. It is usually a mild illness that lasts
approximately 2 weeks. Treatment includes rest, fluids, and
non-aspirin pain relievers.
Knowledge regarding the physical and chemical structures
of hair, nails, and skin is essential for all salon professionals.
This section has provided an overview of healthy hair, nails,
and skin, and disorders and conditions that can affect these
structures. An understanding of the variety of beauty and
health products used in cosmetology will help to improve
client satisfaction and salon safety.
26
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TESt questions
#P2011 CHEMICAL MAKEUP OF HAIR, SKIN, AND NAILS
Designation of Credit: Paragon CET designates this continuing education activity for 2 CE hours.
1. The two layers of the skin are the epidermis
and dermis.
A) True
B) False
4. Coarse hair has the largest diameter, while fine
hair has the smallest.
A) True
B) False
2. Melanin is produced in the stratum lucidum.
A) True
B) False
5. Bruised nails are characterized by the presence
of a dark red or purple blood clot under the
nail plate.
A) True
B) False
3. There are no hair follicles on the palms of the
hands.
A) True
B) False
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27
#P424Course
Communicable
Diseases ________________________________________________________________
#P424 — 4 CE HOURS
Communicable Diseases
Faculty
Paragon CET Staff
Division Planner
Leah Pineschi Alberto, licensed cosmetologist and instructor
of cosmetology, has been educating students in Northern
pedicure practices.
Audience
This course is designed for all cosmetologists, estheticians,
and nail technicians.
Accreditation
for 4 CE hours.
About the Sponsor
28
Course Objective
The purpose of this course is to provide salon professionals
with the knowledge necessary to provide the best services
to their clients.
Learning Objectives
1. Outline the important issues related to bacterial
diseases that salon professionals may encounter,
including tuberculosis, mycobacterial infections,
and staph.
2. Describe the signs and symptoms of parasitic
infestations and potential treatment options.
3. Discuss viral diseases that may be encountered
and/or transmitted in the salon environment.
course.
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________________________________________________________________ #P424 Communicable Diseases
INTRODUCTION
Diseases are considered communicable if they spread from
one person to another or from an animal to a person. Most
diseases spread due to direct contact with an infected person
or his/her blood, but some diseases may be spread by sharing implements or through the air or contaminated water.
Because salon professionals work very closely with their
clients, they are at risk for both contracting and spreading communicable diseases. It is our responsibility as salon
professionals to protect our clients and ourselves to the best
of our abilities. This course will review the most common
communicable diseases, with a special focus on diseases often
encountered in the salon or spa environment.
TUBERCULOSIS
HISTORICAL BACKGROUND
Tuberculosis (TB), also historically called the “white plague”
and “consumption,” is a disease that has plagued the citizens
of nearly every nation in the world for centuries. It can affect
any organ in the body, although the lungs remain the primary
site of infection. The disease is caused by a group of similar
bacilli, most commonly Mycobacterium tuberculosis, which is
often abbreviated as M. tuberculosis or MTB.
Evidence of TB dating back 6,500 years has been found in
archaeological digs. There are signs of the organism in the
remains of mummified Egyptians and mention of it in ancient
Chinese and Sanskrit written records. During the 16th to
the 19th centuries, TB was epidemic in Europe, causing the
death of as many as one in four persons.
IMPACT OF TB
It has been estimated that 2 billion people, one-third of the
world’s population, have become infected with M. tuberculosis and are therefore at risk for developing the disease
within their lifetime. In 2013, an estimated 9 million people
developed TB and 1.5 million died from the disease [3]. TB
is the leading cause of death in people who are infected with
human immunodeficiency virus (HIV) or acquired immune
deficiency syndrome (AIDS); even among healthy people,
5% to 15% will develop some form of tuberculosis in their
life [4].
Fortunately, TB is less common in the United States than
in many other countries. In 2013, a total of 9,582 TB cases
were reported in the United States, continuing the decrease
in incidence rates for 20 straight years [5]. California, Florida,
New York, and Texas each had more than 500 cases in 2012.
Combined, these four states account for 49.9% of all cases
in the United States [6].
Conditions that may trigger new cases of TB include [6]:
• Increased poverty, injection drug use,
and homelessness
• Increased numbers of residents in longterm care facilities
• Foreign-born persons originating from
countries where TB is endemic
• Immunocompromised individuals,
particularly those with HIV/AIDS
• Failure to complete TB drug treatments
People born outside the United States and racial/ethnic
minority populations are more likely to develop TB [6].
Starting in Northern Europe more than 500 years ago, the
disease spread steadily across the continent but did not move
into Russia until the late 1800s. New Guinea, the last place
left uninfected, developed TB for the first time in the 1940s.
In 2013, foreign-born citizens of the United States had a
TB rate 13 times higher than those who were born in the
United States [1]. Five countries of origin account for more
than 50% of immigrant TB cases: Mexico, the Philippines,
India, Vietnam, and China [6].
In the 1950s, two major developments greatly advanced the
treatment and control of TB. First, the discovery of the drug
isoniazid provided the first highly effective, inexpensive, and
safe treatment able to regularly produce a clinical cure. Second, the use of multiple drugs was shown to make treatments
work better and to reduce the risk of transmitting the disease.
TB is also more common among people living in overcrowded
housing with poor sanitation. One report stated that as many
as 18% of persons living in homeless shelters test positive
for TB [8]. Prison inmates and migrant farm workers are also
at increased risk for TB due to crowded housing conditions.
Fortunately, and in part as the result of current treatment
and public health control measures, the incidence of TB
decreased by almost 42% between 1993 and 2011 [1]. However, strains of the disease that are resistant to available
treatments have developed, and it is still important to be
aware of the disease and its possible transmission [1].
HOW TB SPREADS
TB is spread through the air from one person to another. Q
The TB bacteria are put into the air when a person with 1
TB disease of the lungs or throat coughs, sneezes, speaks,
or sings. People nearby may breathe in these bacteria and
become infected [9].
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29
#P424 Communicable Diseases ________________________________________________________________
Compared to other communicable diseases, it is not easy to
get TB. On average, a person is exposed to the bacteria for
two months before getting sick. However, there have been
reports of infection occurring in much less time. In one
well-reported incident, a passenger on an airline was very ill
with TB and coughed throughout the entire flight. Later, it
was learned that fellow passengers on the plane had become
infected with TB [10].
TB is not spread by [9]:
•
•
•
•
•
Shaking someone’s hand
Sharing food or drink
Touching bed linens or toilet seats
Sharing toothbrushes
Kissing
TYPES OF INFECTIONS
Not everyone infected with TB bacteria becomes sick. As a
result, two TB-related conditions exist: latent TB infection
and TB disease [9].
Latent TB Infection
TB bacteria can live in the body without making you sick;
this is called latent TB infection. In most people who breathe
in TB bacteria and become infected, the body is able to fight
the bacteria to stop them from growing. People with latent
TB infection do not feel sick and do not have any symptoms.
They also are not infectious and cannot spread TB bacteria
to others. However, if TB bacteria become active in the
body and multiply, the person will go from having latent TB
infection to being sick with TB disease [9].
TB Disease
TB bacteria become active (begin to multiply) if the immune
system cannot stop them from growing [9]. People with TB
disease are sick and are able to spread the bacteria to people
they spend time with every day.
Many people who have latent TB infection never develop TB
disease. Some people develop TB disease soon after becoming
infected (within weeks) before their immune system can fight
the TB bacteria. Other people may get sick years later, when
their immune system becomes weak for another reason [9].
SIGNS AND SYMPTOMS
The early symptoms of active TB disease are often missed
at first because they are so subtle. Because of this, people
frequently have difficulty pinpointing exactly when they
got sick. Some individuals without obvious symptoms are
diagnosed based on a routine chest x-ray. For those who
do have symptoms, the most common manifestations are a
gradual, mild fever, discomfort, cough, loss of appetite, and
weight loss.
30
The cough associated with TB is generally dry at first, then
later individuals begin coughing up white phlegm. With
severe forms of the disease, a person may begin to cough up
blood due to lung damage.
Chest pain, usually with deep breaths, may also develop. If
there is extensive lung destruction, individuals will have
shortness of breath, which eventually leads to respiratory
failure and death.
DIAGNOSIS
In most cases, a physical examination by a doctor will not
be enough to diagnose TB. Chest x-ray is the best way to see
early signs of TB, as it is nearly always abnormal in people
with active pulmonary TB. In addition, there are two kinds
of tests that are used to detect TB bacteria in the body: the
TB skin test (TST) and TB blood tests. These tests can be
given by a healthcare provider or local health department. A
positive reaction to either of the tests means that additional
testing is necessary to see if the person has latent TB infection or TB disease [9].
TREATMENT FOR LATENT TB INFECTION
If an individual has latent TB infection but not TB disease,
treatment may be necessary to keep the infection from progressing to TB disease. Treatment of latent TB infection is
essential to controlling and eliminating TB in the United
States. The decision about taking treatment for latent TB
infection will be based on your chances of developing TB
disease [9]. The preventive treatment of choice for adults
with latent TB infection is isoniazid for 6 or 9 months [11].
TREATMENT FOR TB DISEASE
TB disease can be treated by taking several drugs, usually for
6 to 9 months. It is very important to finish the medicine
and take the drugs exactly as prescribed. If the drugs are
stopped too soon, the TB can come back. If the drugs are
taken incorrectly, the bacteria that are still alive may become
resistant to those drugs, making the disease harder and more
expensive to treat [9].
MYCOBACTERIUM FORTUITUM
Mycobacterium fortuitum is a nontuberculous mycobacterium,
which is a bacterium that can cause lung disease resembling
tuberculosis, enlarged lymph nodes, skin disease, or infection
that spreads to the bloodstream and other parts of the body
[31]. M. fortuitum is naturally found in water and soil [32].
It is uncommon for this condition to cause lung disease, but
M. fortuitum can cause local skin disease, inflammation of
the bone, joint infections, and eye disease after trauma [31].
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During a pedicure, the legs are scrubbed and massaged,
making them vulnerable to any bacteria that may be present. Improper disinfection techniques can allow bacteria,
including M. fortuitum, to live and thrive in the basin of
the pedicure tubs. Serious outbreaks of this disease linked
to pedicure tubs have been widely reported and resulted in
a renewed emphasis on sanitation and sterilization in salons
and spas.
The bacteria grow very quickly. Because it is found naturally in tap water, the salon and pedicure tub environment
promotes its growth. The bacteria flourish in the warm
environment of the water pipes of a salon and feed on the
debris that typically accumulates in a hair salon (e.g., hair,
skin, and nail debris). It often forms dense layers of cells and
proteins called biofilms, which can be very hard to remove
[32]. The bacteria can grow and accumulate for a very long
time, becoming more difficult to eradicate.
M. fortuitum enter the skin and cause bumps on the lower
portion of the leg (exposed to the bacteria during a pedicure),
which eventually leads to painful boils and even skin ulcers.
Skin boils usually start out looking like a spider bite that
gradually grows in size and eventually produces pus [33]. Scar
tissue is left after the boils have either gone away on their
own or been removed through surgery.
Infections such as M. fortuitum are relatively rare [33]. If a
salon’s whirlpool foot spas are cleaned and disinfected properly and in accordance with your state’s regulations, the risk
of these infections is very small [33].
Q Clients should be advised to never receive a pedicure within
2 24 hours of shaving their legs or if they have any open sores
or cuts on their feet or legs [33]. If an infection does develop,
a doctor should be seen immediately. It is important that the
doctor know about any exposures to whirlpool foot spas. The
doctor will take a small biopsy of a boil to test for mycobacterial culture [33].
Typical treatment may include local wound care for the
lesions and antibiotics. In more severe cases, surgery may be
required. There is no exact duration of therapy, but treatment is commonly given for a period of 6 months. Treatment is not considered complete until all lesions have been
eliminated [34].
STAPH INFECTION
Staphylococcus bacteria, also known as “staph,” are among
the most common bacteria and can be found on doorknobs,
countertops, and other hard surfaces [35]. About 1 out of
every 3 people have staph bacteria on their skin or in their
nose. It does not cause any problems for most people who
have it on their skin, but it can sometimes cause serious
infections such as skin or wound infections, pneumonia, or
infections of the blood [36].
Staphylococcal infections can spread easily through contact
with pus from an infected wound, skin-to-skin contact with
an infected person, or contact with objects such as towels and
unsanitized equipment (e.g., foot spas) used by an infected
person. It is important to note that some people may have
Staphylococcus aureus on their hands or other parts of the
body and not know it. This is called being a “carrier.” If a
salon professional is a carrier and does not follow appropriate
precautions, he or she could transmit the bacteria to a client,
where it can cause disease. This is particularly dangerous if
the client has an open cut or is bleeding. An open wound
is the ideal entry for bacteria and can result in a systemic
infection or a skin infection.
There are steps that clients and salon professionals can
take to prevent the spread of staphylococcal infections.
First, clients should be instructed to refrain from any hair
removal on the legs, arms, and hands within 24 hours of
receiving a manicure or pedicure. If a client has any broken
skin (including cuts or nicks) and is scheduled to receive a
treatment including touching, massaging, or immersing the
area, the appointment should be rescheduled for a time after
the area has healed [37]. Cosmetologists, estheticians, and
nail technicians should wear gloves and should not perform
procedures if they have a skin infection. Each client should
receive a clean towel, and all implements should be cleaned
according to the established standards after each use.
Antibiotics are given to kill staph if an infection develops.
Some staph bacteria are resistant, meaning they cannot be
killed by the usual antibiotics. Methicillin-resistant S. aureus,
or MRSA, is resistant to the antibiotics that are often used
to treat these infections [36]. Treatment of MRSA and other
resistant infections involves the use of alternative antibiotic
drugs and cleansers, usually over a long period of time.
DERMATOPHYTES
Dermatophytes are fungi that cause skin, hair, and nail Q
infections. Infections caused by these fungi are also some- 3
times known as “ringworm” or “tinea.” Despite the name
“ringworm,” this infection is not caused by a worm, but by
a type of fungus. Dermatophytes can live on moist areas of
the skin, on environmental surfaces, and on household items
such as clothing, towels, and bedding. Anyone can get a
dermatophyte infection, including animals [38].
There are many types of infections caused by this fungus.
The infections are generally identified by its location on the
body. Some common dermatophyte infections include [38]:
• Tinea barbae: Ringworm of the bearded
parts of the face and neck
• Tinea capitis: Ringworm of the scalp
• Tinea corporis: Ringworm of the body
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31
• Tinea cruris: Ringworm of the groin, skin folds,
inner thighs, or buttocks, also known as jock itch
• Tinea faciei: Ringworm of the face (other than
bearded parts)
• Tinea pedis: Ringworm of the feet, also known
as athlete’s foot
• Tinea unguium/onychomycosis: Ringworm of
the toenail or fingernail
There are many different species of dermatophytes that can
cause infection in humans. Some species spread from person
to person (Trichophyton rubrum and Trichophyton tonsurans)
and other species spread to people from animals like cats and
dogs (Microsporum canis) [38].
SYMPTOMS
As noted, dermatophyte infections can affect the skin on
almost any area of the body, such as the scalp, legs, arms,
feet, groin, and nails. These infections are usually itchy.
Redness, scaling, cracking of the skin, or a ring-shaped rash
may occur. If the infection involves the scalp or beard, hair
may fall out. Infected nails become discolored, thick, and
may possibly crumble. More serious infections may lead to
an abscess or cellulitis [38].
Dermatophyte infections are usually spread through direct
contact with an infected person or animal. Clothing, bedding,
towels, and equipment can also become contaminated and
spread the infection. Symptoms typically appear between 4
and 14 days following exposure [38].
DIAGNOSIS
Doctors may diagnose dermatophyte infections based on
symptoms and a physical examination. To confirm the
diagnosis, the doctor may take scrapings of affected skin or
clippings of affected nails. These can be examined under
a microscope and may be sent to a laboratory for a fungal
culture [38].
TREATMENT
The particular medication and duration of treatment depends
on the location of the dermatophyte infection. Scalp infections usually require treatment with an oral antifungal medication. Infections of other areas of the skin can be treated
with topical antifungal medications. Nail infections can be
challenging to treat and may be treated with oral and/or topical antifungal medications. Courses of treatment may range
from 2 to 6 weeks or more, depending on the severity of the
infection and the doctor’s recommendations [38].
32
HEAD LICE
The head louse, or Pediculus humanus capitis, is a parasitic
insect that can be found on the head, eyebrows, and eyelashes. Head lice feed on human blood several times per
day and live close to the human scalp. Although they are
uncomfortable, head lice are not known to spread disease [39].
Head lice are found worldwide. In the United States, infestation with head lice is most common among preschool
children attending child care, elementary schoolchildren,
and the household members of infested children. Although
reliable data on how many people in the United States get
head lice each year are not available, an estimated 6 million
to 12 million infestations occur each year among children 3
to 11 years of age [39]. In the United States, infestation with
head lice is much less common among African Americans
than among persons of other races, possibly because the claws
of the of the head louse are better adapted for grasping the
shape and width of the hair shaft of other races [39].
Head lice move by crawling; they cannot hop or fly. Head
lice are spread by direct contact with the hair of an infested
person. Anyone who comes in head-to-head contact with
someone who already has head lice is at greatest risk. Spread
by contact with clothing (such as hats, scarves, coats) or
other personal items (such as combs, brushes, or towels)
used by an infested person is uncommon. Personal hygiene
or cleanliness in the home or school has nothing to do with
getting head lice [39].
SYMPTOMS
The signs and symptoms of head lice infestation include [39]:
• Tickling feeling of something moving in the hair
• Itching, caused by an allergic reaction to the
bites of the head louse
• Irritability and difficulty sleeping (because head
lice are most active in the dark)
• Sores on the head caused by scratching, which
can become infected with bacteria found on the
person’s skin
Nits are lice eggs laid by the adult female head louse at
the base of the hair shaft nearest the scalp. Nits are firmly
attached to the hair shaft and are oval-shaped and very small
(about the size of a knot in thread) and hard to see. Nits often
appear yellow or white, although live nits sometimes appear
to be the same color as the hair of the infested person. Nits
are often confused with dandruff, scabs, or hair spray droplets.
They usually take about 8 to 9 days to hatch. Eggs that are
likely to hatch are usually located no more than ¼ inch from
the base of the hair shaft. Nits located further than ¼ inch
from the base of hair shaft may very well be already hatched,
non-viable nits, or empty nits or casings. This is difficult to
distinguish with the naked eye [39].
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Head lice and head lice nits are found almost exclusively
on the scalp, particularly around and behind the ears and
near the neckline at the back of the head. Head lice or head
lice nits sometimes are found on the eyelashes or eyebrows
but this is uncommon. Head lice hold tightly to hair with
hook-like claws at the end of each of their six legs. Head
lice nits are cemented firmly to the hair shaft and can be
difficult to remove even after the nymphs hatch and empty
casings remain [39].
Head lice and nits soon perish if separated from their human
host. Adult head lice can live only a day or so off the human
head without blood for feeding. Nymphs (young head lice)
can live only for several hours without feeding on a human.
Nits generally die within one week away from their human
host and cannot hatch at a temperature lower than that close
to the human scalp. For these reasons, the risk of transmission
of head lice from a wig or other hairpiece is extremely small,
particularly if the wig or hairpiece has not been worn within
the preceding 48 hours by someone who is actively infested
with live head lice [39].
TREATMENT
Treatment for head lice is recommended for persons diagnosed with an active infestation. All household members and
other close contacts should be checked; those persons with
evidence of an active infestation should be treated. Some
experts believe prophylactic treatment is prudent for persons
who share the same bed with actively infested individuals.
All infested persons (household members and close contacts)
and their bedmates should be treated at the same time [39].
Some medicines that kill lice have an ovicidal effect (kill
eggs). For pediculicides that are only weakly ovicidal or not
ovicidal, routine retreatment is recommended. For those that
are more strongly ovicidal, retreatment is recommended only
if live (crawling) lice are still present several days after treatment (depending on the recommendation for each medication). To be most effective, retreatment should occur after
all eggs have hatched but before new eggs are produced [39].
When treating head lice, supplemental measures can be
combined with recommended medicine (pharmacologic
treatment); however, such additional (non-pharmacologic)
measures generally are not required to eliminate a head lice
infestation. For example, hats, scarves, pillow cases, bedding,
clothing, and towels worn or used by the infested person
in the two-day period just before treatment is started can
be machine washed and dried using the hot water and hot
air cycles because lice and eggs are killed by exposure for 5
minutes to temperatures greater than 53.5°C (128.3°F). Items
that cannot be laundered may be dry cleaned or sealed in a
plastic bag for two weeks. Items such as hats, grooming aids,
and towels that come in contact with the hair of an infested
person should not be shared. Vacuuming furniture and floors
can remove an infested person’s hairs that might have viable
nits attached [39].
Over-the-counter or prescription medication requires these
treatment steps [39]:
• Before applying treatment, it may be helpful to
remove clothing that can become wet or stained
during treatment.
• Apply lice medicine, also called pediculicide,
according to the instructions contained in the
box or printed on the label.
• If the infested person has very long hair (longer
than shoulder length), it may be necessary to use
a second bottle.
• Pay special attention to instructions on the label or
in the box regarding how long the medication should
be left on the hair and how it should be washed out.
There are several considerations when completing lice treatment [39]:
• Do not use a combination shampoo/conditioner
or conditioner before using lice medicine. Do not
re-wash the hair for 1 to 2 days after the lice medicine
is removed.
• Have the infested person put on clean clothing after
treatment.
• If a few live lice are still found 8 to 12 hours after
treatment but are moving more slowly than before,
do not retreat. The medicine may take longer to kill
all the lice.
• Comb dead and any remaining live lice out of the
hair using a fine-toothed nit comb.
• If, after 8 to 12 hours of treatment, no dead lice are
found and lice seem as active as before, the medicine
may not be working.
• Do not retreat until speaking with a healthcare
provider; a different pediculicide may be necessary.
If the healthcare provider recommends a different
pediculicide, carefully follow the treatment instructions contained in the box or printed on the label.
Nit combs, often found in lice medicine packages, should
be used to comb nits and lice from the hair shaft. Many flea
combs made for cats and dogs are also effective [39].
After each treatment, checking the hair and combing with
a nit comb to remove nits and lice every 2 to 3 days may
decrease the chance of self-reinfestation. Continue to check
for 2 to 3 weeks to be sure all lice and nits are gone. Nit
removal is not needed when treating with spinosad topical
suspension [39].
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33
SCABIES
Scabies is an infestation of the skin by the human itch mite
(Sarcoptes scabiei var. hominis). The microscopic scabies mite
burrows into the upper layer of the skin, where it lives and
lays its eggs. The most common symptoms of scabies are
intense itching and a pimple-like skin rash. The scabies mite
usually is spread by direct, prolonged, skin-to-skin contact
with a person who has scabies [40]. Casual contact (e.g., a
hand shake, quick hug) is not usually enough to transmit
the parasites.
Scabies is found worldwide and affects people of all races and
social classes. Scabies can spread rapidly in crowded conditions where close body and skin contact is frequent. Institutions such as nursing homes, extended-care facilities, prisons,
and salons are often sites of scabies outbreaks. Child-care
facilities are also common sites of scabies infestations [40].
PEOPLE AT RISK
As noted, certain places are associated with higher rates
of scabies, usually because skin-to-skin contact, which is
required for transmission of the disease, is more likely. People
who frequent these locations are more likely to develop the
disease. This includes children, mothers of young children,
and residents of prisons, nursing homes, assisted-living residences, and extended-care facilities [41]. Scabies may also be
transmitted sexually. However, it is important to remember
that anyone can get scabies [41]. The risk of contracting
scabies may also be increased in people with compromised
or weak immune systems [41].
SYMPTOMS
Q The most common signs and symptoms of scabies are intense
4 itching (pruritus)—especially at night—and a pimple-like
(papular), itchy rash. The itching and rash each may affect
much of the body or be limited to common sites, such as the
wrist, elbow, armpit, webbing between the fingers, nipple,
penis, waist, belt-line, and/or buttocks. The rash also can
include tiny blisters (vesicles) and scales. Scratching the rash
can cause skin sores; sometimes these sores become infected
by bacteria [40].
Tiny burrows may be seen on the skin; these are caused by
the female scabies mite tunneling just beneath the surface
of the skin. These burrows appear as tiny raised and crooked
grayish-white or skin-colored lines on the skin surface.
Because mites are often few in number (usually only 10 to 15
mites per person), these burrows may be difficult to find. They
are found most often in the webbing between the fingers; in
the skin folds on the wrist, elbow, or knee; and on the penis,
breast, or shoulder blades [40].
34
DIAGNOSIS
Diagnosis of a scabies infestation usually is made based on
the customary appearance and distribution of the rash and
the presence of burrows. Whenever possible, the diagnosis
of scabies should be confirmed by identifying the mite, mite
eggs, or mite fecal matter (scybala). This can be done by
carefully removing a mite from the end of its burrow using
the tip of a needle or by obtaining skin scraping to examine
under a microscope. It is important to remember that a person can still be infested even if mites, eggs, or fecal matter
cannot be found [40].
TREATMENT
Products used to treat scabies are called scabicides because
they kill scabies mites; some also kill eggs. Scabicides to treat
human scabies are available only with a doctor’s prescription.
No “over-the-counter” (non-prescription) products have
been tested and approved for humans [40].
When treating adults and older children, scabicide cream
or lotion is applied to all areas of the body from the neck
down to the feet and toes. When treating infants and young
children, the cream or lotion is also applied to the head and
neck. The medication should be left on the body for the
recommended time before it is washed off, and clean clothes
should be worn after treatment [40].
In addition to the infested person, treatment is recommended
for household members and sexual contacts, particularly
those who have had prolonged skin-to-skin contact with the
infested person. All persons should be treated at the same
time in order to prevent reinfestation. Retreatment may be
necessary if itching continues more than 2 to 4 weeks after
treatment or if new burrows or rash continue to appear [40].
HEPATITIS
Hepatitis is inflammation of the liver that may be caused
by exposure to toxic chemicals, autoimmune disease, or
infection. The viral infections most associated with hepatic
inflammation include hepatitis A, B, C, D, and E; the most
common types are hepatitis A, B, and C [12].
Viral hepatitis is the leading cause of liver cancer and the
most common reason for liver transplantation. An estimated
4.4 million Americans are living with chronic hepatitis, but
most do not know they are infected [12].
THE LIVER
The liver is one of the largest organs in the body. The healthy
adult liver weighs about 2.5 to 4 pounds and is in in the right
upper quadrant of the abdomen. The liver helps digest food,
store energy, and remove poisons [13]. Inflammation of the
liver can cause many problems, especially as a result of a
build-up of toxins in the body.
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SIGNS AND SYMPTOMS
Some people with viral hepatitis have no signs of the infection. Symptoms, if they do appear, can include [14]:
• Jaundice, which is when the skin and whites
of the eyes turn yellow
• Low-grade fever
• Headache
• Muscle aches
• Tiredness
• Loss of appetite
• Nausea
• Vomiting
• Diarrhea
• Dark-colored urine and pale bowel movements
• Stomach pain
DIAGNOSIS AND TESTING
Any individual with symptoms of hepatitis or who believes
he/she has been exposed to hepatitis should see a doctor [14].
All people with a history of using injectable drugs (even
once) or who received a blood transfusion or organ transplant
before 1992 should be tested for hepatitis.
Diagnosis of hepatitis is based on questions about one’s health
history, a physical exam, and blood tests. These blood tests
look for parts of the virus or antibodies the body makes in
response to the virus [14].
HEPATITIS A
Hepatitis A is transmitted via the fecal-oral route. After the
virus is ingested, it is transported from the intestines to the
liver, where it invades the hepatocytes (the main cells in
the liver). The virus uses the hepatocytes for viral replication and is then released into the bloodstream and excreted
in the stool. Hepatitis A is usually spread when the virus is
taken in by mouth from contact with objects, food, or drinks
contaminated by the feces of an infected person. A person
can get hepatitis A through [15]:
• Person-to-person contact
• An infected person not washing his or her hands
properly after going to the bathroom and touching
other objects or food
• A parent or caregiver not properly washing his
or her hands after changing diapers or cleaning
up the stool of an infected person
• Sex or sexual contact with an infected person
(not limited to anal-oral contact)
• Contaminated food or water
Hepatitis A can also be spread by eating or drinking food
or water contaminated with the virus. This is more likely
to occur in countries where hepatitis A is common and in
areas where there are poor sanitary conditions or poor sewage disposal, including Mexico, Cuba, and most countries of
Africa, South America, and Asia [15]. The food and drinks
most likely to be contaminated are fruits, vegetables, shellfish,
ice, and water [16].
Although anyone can get hepatitis A, in the United States,
certain groups of people are at higher risk, such as those
who [16]:
• Travel to or live in countries where hepatitis A
is common
• Are men who have sexual contact with other men
• Use illegal drugs, whether injected or not
• Have clotting-factor disorders, such as hemophilia
• Live with someone who has hepatitis A
• Have oral-anal sexual contact with someone who
has hepatitis A
By law, diagnosed cases of hepatitis A must be reported to
the local health authorities, who in turn report the incidence
to the Centers for Disease Control and Prevention (CDC).
In 2012, only 3,000 new cases were reported in the United
States [17]. The World Health Organization estimates the
annual worldwide incidence to be 1.4 million per year [40].
Treatment and Prevention
There are no special treatments for hepatitis A. Most people
with hepatitis A will feel sick for a few months before they
begin to feel better, but some will need to be hospitalized.
During this time, doctors usually recommend rest, adequate
nutrition, and fluids [16].
Frequent handwashing with soap and warm water after using
the bathroom, changing a diaper, or before preparing food
can help prevent the spread of hepatitis A [16]. However,
the best way to prevent hepatitis A is through vaccination.
Hepatitis A vaccination is recommended for [16]:
• All children at 1 year of age
• Travelers to countries that have high
rates of hepatitis A
• Men who have sexual contact with other men
• Users of illegal drugs
• People with chronic (lifelong) liver diseases,
such as hepatitis B or hepatitis C
• People who are treated with clotting-factor
concentrates
• People who work with hepatitis A-infected
animals or in a hepatitis A research laboratory
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35
HEPATITIS B
Hepatitis B virus is a bloodborne pathogen that is typically
acquired through contact with contaminated blood, during
childbirth, or through sexual interaction. Sexual contact
and use of contaminated needles for drug injection are the
primary risk factors [18]. Hepatitis B does not transfer across
the placenta, but transmission can occur when an infant is
exposed to the blood of an infected mother at the time of
delivery. Tattoos, ear and body piercing, acupuncture, and
blood transfusions received prior to 1980 are also risk factors.
Approximately 10% to 20% of people infected with hepatitis
B will develop chronic disease. This occurs most often in
infants, children, and people with immune-compromising
conditions, such as HIV. Chronic hepatitis B infection is the
leading cause of liver failure and liver cancer in the world [19].
Treatment of acute hepatitis B infection is primarily supportive. Control of nausea and vomiting, maintenance of
fluid and electrolyte balance, avoidance of hepatotoxic
medications and alcohol, and extended periods of rest are
the typical therapies.
Transmission
Hepatitis B is spread when blood, semen, or other body fluid
infected with the virus enters the body of a person who is not
infected. People can become infected with the virus during
activities such as [20]:
• Birth (spread from an infected mother to her
baby during birth)
• Sex with an infected partner
• Sharing needles, syringes, or other drug-injection
equipment
• Sharing items such as razors or toothbrushes
with an infected person
• Direct contact with the blood or open sores
of an infected person
• Exposure to blood from sharp instruments
Among adults in the United States, nearly two-thirds of acute
hepatitis B cases are acquired through sexual contact. In fact,
hepatitis B is 50 to 100 times more infectious than HIV and
can be passed through the exchange of body fluids, such as
semen, vaginal fluids, and blood [20]. One European study
has linked hepatitis B transmission to salon and spa services,
particularly manicures and shaving [21]. The level of risk at
salons and spas requires further research [22].
Unlike hepatitis A, hepatitis B is not spread routinely
through food or water or through sharing eating utensils,
breastfeeding, hugging, kissing, holding hands, coughing,
or sneezing.
36
Although anyone can get Hepatitis B, some people are at
greater risk, such as those who [20]:
•
•
•
•
•
•
•
•
•
•
Have sex with an infected person
Have multiple sex partners
Have a sexually transmitted disease
Are men who have sexual contact with other men
Inject drugs or share needles, syringes, or other
drug equipment
Live with a person who has chronic hepatitis B
Are infants born to infected mothers
Are exposed to blood on the job
Are hemodialysis patients
Travel to countries with moderate-to-high rates
of hepatitis B
Hepatitis B virus can survive outside the body at least seven
days [20]. During that time, the virus can still cause infection
if it enters the body of a person who is not infected. All blood
spills—including those that have already dried—should be
cleaned and disinfected. Gloves should always be used when
cleaning up any blood [20].
There is no medication available to treat acute hepatitis B.
People with chronic hepatitis B infection should seek the
care or consultation of a doctor. They should be monitored
regularly for signs of liver disease and evaluated for possible
treatment. Several medications have been approved for
hepatitis B treatment, and new drugs are in development.
However, not every person with chronic hepatitis B needs
to be on medication, and the drugs may cause side effects in
some people [20].
As with hepatitis A, the best way to prevent hepatitis B is
by getting the vaccine. The hepatitis B vaccine is safe and
effective and is usually given as 3 to 4 shots over a 6-month
period. Hepatitis B vaccination is recommended for [20]:
• All infants, starting with the first dose of
hepatitis B vaccine at birth
• All children and adolescents younger than 19
years of age who have not been vaccinated
• People whose sex partners have hepatitis B
• Sexually active persons who are not in a longterm, mutually monogamous relationship
• Persons seeking evaluation or treatment for
a sexually transmitted disease
• Men who have sexual contact with other men
• People who share needles, syringes, or other
drug-injection equipment
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• People who have close household contact with
someone infected with the hepatitis B virus
• Residents and staff of facilities for developmentally
disabled persons
• Travelers to regions with moderate or high rates
of hepatitis B
• People with chronic liver disease
• People with HIV infection
• Anyone who wishes to be protected from
hepatitis B infection
HEPATITIS C
Hepatitis C virus is the leading cause of end-stage liver
disease and the leading reason for liver transplantation in
the United States [23; 24]. An estimated 50% to 90% of
persons who acquired HIV through injection drug use also
have hepatitis C [25].
Hepatitis C occurs throughout the world, though some areas
are more affected than others. The World Health Organization estimates that 10% of the population of the Middle East,
Africa, and Eastern Europe are infected with hepatitis C. In
the United States, 1.8% of the population (approximately
3.2 million people) carries the virus [26].
In the United States, there is a higher death rate from hepatitis C infection than from HIV infection [27]. Between 1999
and 2007, approximately 75% of people who died as a result
of hepatitis C were born between 1945 and 1964. Many of
these “baby boomers” acquired hepatitis during adolescence
or young adulthood through experimentation with injection
or inhaled drugs [27]. So, it is recommended that all adults
born between 1945 and 1965 be tested for hepatitis C infection, even if they have no other risk factors [28].
Approximately 70% to 80% of people with acute hepatitis
C do not have any symptoms [26]. Some people can have
mild-to-severe symptoms soon after being infected. If symptoms occur, the average time is 6 to 7 weeks after exposure,
but this can range from 2 weeks to 6 months. However, as
noted, many people infected with hepatitis C never develop
symptoms [26].
Transmission
Like hepatitis B, hepatitis C is considered a bloodborne
pathogen. The most common source of infection is exposure
through transfusion, use of injectable drugs, and occupational
injury with a contaminated sharp object. Transmission from
mother to infant is uncommon but can occur if the infant
is exposed to contaminated blood during birth [29]. Before
1992, when widespread screening of the blood supply began
in the United States, hepatitis C was also commonly spread
through blood transfusions and organ transplants.
Less commonly, a person can also get hepatitis C virus infection through sexual contact with a person infected with
hepatitis C or sharing personal care items that may have
come in contact with another person’s blood, such as razors
or toothbrushes [26]. The risk of transmission from sexual
contact is believed to be low. The risk increases for those
who have multiple sex partners, have a sexually transmitted
disease, engage in rough sex, or are infected with HIV [26].
HCV is present in menstrual blood; therefore, intercourse
during the menstrual period is considered to be higher risk
than intercourse when menstrual blood is not present.
Snorting cocaine has been associated with hepatitis C transmission, probably from sharing nasal straws contaminated
with blood. History of tattoo is considered a risk factor for
HCV infection, although no cases of transmission have been
linked to licensed, commercial tattoo parlors [23]. However,
body art is becoming increasingly popular in the United
States, and unregulated tattooing and piercing are known to
occur in prisons and other informal or unregulated settings
[26]. Unregulated tattooing and piercing often does not
follow good infection control practices and may be a risk;
however, it is unclear how common these practices are in
the United States [30]. As with hepatitis B, there is a risk of
hepatitis C transmission in the salon/spa setting when nonsingle use items, such as nail files, nail brushes, finger bowls,
foot basins, buffers, razors, clippers, and scissors, are used [22].
Acute hepatitis C infection can clear on its own without
treatment in about 25% of people [26]. However, treatment
does reduce the risk that acute hepatitis C will become a
chronic infection. Several medications available to treat
acute and chronic hepatitis C, including new treatments
that appear to be more effective and have fewer side effects
than previous options.
People with chronic hepatitis C should be monitored regularly by an experienced doctor. They should avoid alcohol
because it can cause additional liver damage. If liver damage
is present, a person should check with his or her doctor about
getting vaccinated against hepatitis A and B. There is no
vaccine available to prevent hepatitis C [26].
People should not be excluded from work, school, play, child
care, or other settings because they have hepatitis C. There
is no evidence that people can get hepatitis C from service
providers without blood-to-blood contact [26].
Phone: 800 / 707-5644 • FAX: 916 / 878-5497
37
INFLUENZA
Influenza, or the flu, is a viral communicable disease. A brief
definition for influenza is “respiratory illness with fever.”
Uncomplicated influenza is characterized by an abrupt onset
of [42]:
• Constitutional symptoms: Fever, chills, aches,
headache, severe and persistent fatigue, eye pain,
light sensitivity, and burning in the chest
• Respiratory symptoms: Nonproductive cough,
sore throat, and runny nose
Initially, there are more constitutional than respiratory symptoms. Many people use the term “stomach flu” to describe
illnesses with nausea, vomiting, or diarrhea. These symptoms
can be caused by many different viruses, bacteria, or even
parasites. While vomiting, diarrhea, and being nauseous or
“sick to your stomach” can sometimes be related to the flu—
more commonly in children than adults—these problems are
rarely the main symptoms of influenza. The flu is a respiratory
disease and not a stomach or intestinal disease [43].
Children may also experience any of the accompanying
effects of fever, such as listlessness, irritability, no appetite,
and convulsions. In addition, ear infection, nausea, vomiting, and diarrhea are frequently reported in children with
influenza [44]. Elderly individuals may exhibit confusion in
addition to other symptoms.
An individual with influenza usually appears feverish and
fatigued with hot, moist skin, a flushed face, and red, watery
eyes. More than half of people infected with the influenza
virus will have nasal discharge with obstruction and redness
around the nose. Younger individuals may have enlarged
lymph nodes [45].
The beginning of the flu is so abrupt that many people
can pinpoint the hour in which they became ill. This is an
important feature that helps distinguish influenza from other
diseases with flu-like symptoms. The fever is generally 101
to 102 degrees F, although children may run higher fevers.
Most people with the flu complain of body aches, often in
the back muscles. These symptoms usually last from 2 to 3
days and may continue for as long as 5 days [42].
Treatment
Antiviral drugs are a treatment option for persons with the
flu. Studies show that flu antiviral drugs work best for treatment when they are started within two days of getting sick.
However, starting them later can still be helpful, especially
if the sick person has a high-risk health condition or is very
sick from the flu. When used for treatment, antiviral drugs
can lessen symptoms and shorten the time you are sick by 1 or
2 days. They also can prevent serious flu complications, like
pneumonia. For people with a high-risk medical condition,
38
treatment with an antiviral drug can mean the difference
between having milder illness instead of very serious illness
that could result in a hospital stay [7].
Antiviral drugs are considered a second line of defense to treat
the flu; the flu vaccine is the first and best way to prevent
influenza. Flu vaccines cause antibodies to develop in the
body about two weeks after vaccination. These antibodies
provide protection against infection with the viruses that are
in the vaccine. The Centers for Disease Control and Prevention recommend that almost everyone 6 months of age and
older should get a flu vaccine every season, ideally in October
but at any time in the flu season (usually October through
March) [50]. People with severe, life-threatening allergies
to flu vaccine or any ingredient in the vaccine should not
be vaccinated.
HERPES
Herpes is an infection caused by a common virus called Q
herpes simplex. Herpes is spread through direct, skin-to-skin 5
contact with an infected person. Often, the contact occurs
during kissing or vaginal, anal, or oral sex. Herpes virus may
be shed from the skin even without blisters or sores, so it
may be transmitted even when the skin looks normal. It is
especially easy to contract the virus if there is direct contact
with sores, but it is also possible to become infected if no sores
are present on an infected partner [46]. It is estimated that
80% of adults in the United States have the herpes virus [48].
There are several types of herpes simplex virus. Type 2 most
often causes genital sores, and type 1 most often appears as
cold sores (also referred to as fever blisters) on the mouth or
infections of the skin [47]. Even though herpes virus type 1
mainly affects the mouth area, it can be transmitted to other
parts of the body, including the fingers and the eye. It can also
infect the genital area, just as HSV-2 can infect the face [48].
TRANSMISSION
Cold sores are contagious at all stages. However, they are the
most contagious when they break open and fluid comes out.
Cold sores can spread to other people through kissing. They
can also spread through sharing things that touch the lips
and skin around them, such as drinking glasses, towels, or
utensils [48]. It is important to note that an individual with
oral herpes can transmit the virus to a partner’s genitals if
oral sex is performed, particularly during an outbreak.
SIGNS AND SYMPTOMS
Some people do not notice any symptoms at all or have such
mild signs that they do not suspect they have an infection.
This is one reason why herpes is so widespread. In most cases,
symptoms appear 2 to 20 days (average 4 to 7 days) after
contact with an infected person. Clusters of blister-like sores
appear at the site where the virus first entered the body [47].
www.ParagonCET.com
Oral cold sores occur outside the mouth—on the lips, chin,
or cheeks or in the nostrils. When they do occur inside the
mouth, it is usually on the gums or the roof of the mouth
[49]. These sores may itch, burn, or be extremely painful. A
person also may experience other symptoms, such as swollen
glands, general muscle aches, fever, or a burning sensation.
The sores usually last for 10 to 14 days and then heal completely, without scarring. The healing marks the end of the
active phase of herpes [47].
The herpes virus remains in the body and becomes inactive
after the sores have healed. While in the inactive stage, the
herpes virus can remain in nerve tissue for long periods of
time without causing any symptoms. However, because the
virus continues to live in the nerve tissue, periodic outbreaks
are common, particularly if an individual is stressed or sick.
Recurrences are usually preceded by a tingling feeling where
the cold sore will appear [47].
TREATMENT
There is no cure for the herpes simplex virus; it is always
in the body after it is contracted, and outbreaks cannot be
totally prevented. However, individuals can cut down how
often outbreaks appear and how long they last each time [48].
One way of limiting outbreaks or the duration of cold sores is
with prescription antiviral medications, which are available
as pills or ointments. These are most effective if used before
the blisters form, as soon as tingling develops. Examples of
common antiviral medications include acyclovir, penciclovir,
valacyclovir, and famciclovir. Antiviral medications limit the
virus’s ability to grow and allow the body to fight it faster [48].
PREVENTION
The only way to prevent herpes is to avoid being exposed
to the virus. It is best to avoid contact while symptoms are
present [47]. To prevent infecting other people, people with
oral herpes should wash their hands before touching other
people, particularly when cold sores are present, and should
avoid sharing towels, utensils, or razors with others [48].
as they spread from the head to the rest of the body. When
the rash appears, a person’s fever may spike to more than
104° Fahrenheit. After a few days, the fever subsides and
the rash fades [51].
About three out of 10 people who get measles will develop
one or more complications including pneumonia, ear infections, or diarrhea [51]. Measles can be serious in all age
groups. However, children younger than 5 years of age and
adults older than 20 years of age are more likely to suffer from
measles complications [51].
Treatment
The treatment of measles is mainly supportive—meaning
there is no medication to cure the disease. People who
develop measles may take over-the-counter pain medications to control aches or fever. Rest, plenty of fluids, and a
humidifier are also recommended to help ease the symptoms
of the disease.
As with many other viral diseases, the best treatment is
prevention, and measles is highly preventable by vaccination. In the decade before 1963, when an effective vaccine
became available, nearly all children got measles by the time
they were 15 years old. It is estimated 3 to 4 million people
in the United States were infected each year. Also each year
an estimated 400 to 500 people died, 48,000 were hospitalized, and 4,000 suffered encephalitis (swelling of the brain)
from measles [51].
Measles can be prevented with the MMR (measles, mumps,
and rubella) vaccine. One dose of MMR vaccine is about
93% effective at preventing measles if exposed to the virus,
and two doses are about 97% effective [51]. Children receive
one dose at 12 to 15 months of age and a second dose at 4 to
6 years of age (usually when starting kindergarten). Teenagers
and adults who do not have evidence of immunity against
measles and who wish to be protected should get two doses
of MMR vaccine separated by at least 28 days [51].
CONCLUSION
Measles
Measles is a highly contagious respiratory disease caused by a
virus. Measles starts with a fever, runny nose, cough, red eyes,
and sore throat, and two or three days after symptoms begin,
tiny white spots (Koplik spots) may appear inside the mouth.
Three to five days after symptoms begin, a rash breaks out.
It usually begins as flat red spots that appear on the face at
the hairline and spread downward to the neck, trunk, arms,
legs, and feet. Small raised bumps may also appear on top
of the flat red spots. The spots may become joined together
Due to their easy spread, communicable diseases can be a
prevalent and serious problem in a salon setting. Education
provides the opportunity to ensure that salon professionals
have the information necessary to prevent the spread of communicable diseases. The threat of spreading communicable
diseases can be alleviated by ensuring all proper prevention
protocols are being followed. Maintaining a clean, safe
environment for employees and clients will ensure a pleasant
experience for both client and salon professional.
Phone: 800 / 707-5644 • FAX: 916 / 878-5497
39
TESt questions
#P424 COMMUNICABLE DISEASES
Accreditation: Paragon CET courses meet the requirement for continuing education as set forth by
the North Carolina Board of Cosmetic Art Examiners.
Designation of Credit: Paragon CET designates this continuing education activity for 4 CE Hours.
This 4 CE Hour course expires February 28, 2018.
1. Tuberculosis is spread through the air from one
person to another.
A) True
B) False
4. The most common signs and symptoms of
scabies are intense itching—especially at night—
and a pimple-like rash.
A) True
B) False
2. In order to prevent Mycobacterium fortuitum
infections, clients should be advised to shave
their legs within 24 hours before receiving a
pedicure.
A) True
B) False
5. Herpes virus cannot be spread from the skin
unless a blister or sore is present.
A) True
B) False
3. Despite the name, “ringworm” is caused by a
type of fungus, not a worm.
A) True
B) False
40
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Information
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NCSP15
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Profession:
Complete by mail
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Contact us
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MI
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You may complete all or any combination of these courses for a maximum
payment of $13.99 (or pay the individual course price, whichever is less).
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Course #
Special Offer expires
September 30, 2016
Course Title / CE Hours
Individual Price
P5051
Environmental Issues / 1 CE Hour
$5
P6011
OSHA Regulations / 1 CE Hour
$5
P2011
Chemical Makeup of Hair, Skin, and Nails / 2 CE Hours
$8
P424
Communicable Diseases / 4 CE Hours
$16
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NCSP15
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Please note the following:
• A passing grade of at least 75% must be achieved on the course test in order to receive credit.
• Darken only one circle per question. A = True, B = False
• Use pen or pencil; please refrain from using markers.
#P5051 environmental issues
#P6011 OSHA Regulations
Please refer to page 8 for test questions.
AB
1. ❍ ❍
2. ❍ ❍
3. ❍ ❍
4. ❍ ❍
5. ❍ ❍
AB
1. ❍ ❍
2. ❍ ❍
3. ❍ ❍
4. ❍ ❍
5. ❍ ❍
#P2011 chemical makeup of hair, skin, & nails
#P424 communicable diseases
AB
1. ❍ ❍
2. ❍ ❍
3. ❍ ❍
4. ❍ ❍
5. ❍ ❍
AB
1. ❍ ❍
2. ❍ ❍
3. ❍ ❍
4. ❍ ❍
5. ❍ ❍
Evaluation: Do you have any comments or suggestions?
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Vol. 5
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NCSP15
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