SECTION 435:40-1-4.1. Infection control standards

(a)   Purpose. These standards have been developed for electrology students, licensed practicing electrologists, and approved electrology instructors in Oklahoma. These standards emphasize the need to consider all patient/clients as potentially infectious, minimize the risk of exposure to blood or body fluids, reduce the risk of transmitting infection or disease from patient/client to patient/client, practitioner to patient/client, and patient/client to practitioner.

(b)   Description. Electrology is a superficially invasive procedure, which does not generate splashes or sprays of blood and body fluids. It is NOT necessary to wear masks, eye protection, a face shield, or gowns while practicing electrolysis. Electrolysis needles can become contaminated with blood, serum, or other material because of the insertion of the needles into the hair follicle and skin. All needles must be either single-use, pre-sterilized, disposable needles OR be properly sterilized in an autoclave or dry heat sterilizer according to the standards that follow. Any critical instrument re-used between patient/clients must be sterilized and monitored, for effectiveness, according to these standards. Each instrument or piece of equipment must be properly disposed of, disinfected, or sterilized depending on its use and contamination. Cleaning of surfaces, instruments, and equipment must precede appropriate disinfection or sterilization. During the treatment, a new pair of non-sterile, medical grade, disposable exam gloves must be worn by the electrologist to reduce the risk of transmitting disease or infection between the practitioner and the patient/client.

(c)   Blood-borne pathogens.

(1)   The three blood-borne pathogens of great concern to healthcare workers who could be at risk to blood and body fluids containing visible blood are Hepatitis B virus (HBV), Hepatitis C virus (HCV), and HIV/AIDS.

(2)   HIV/AIDS is a threat to healthcare workers, but not as much as Hepatitis B.

(3)   Practitioners and electrology students should be vaccinated against HBV.

(4)   Risks among health care professionals vary during the training and working career, but are often highest during the training period. For this reason, vaccination should begin before starting training and be completed during training. If the student refuses to be vaccinated, they must sign a waiver before beginning training.

(5)   The immunization regimen consists of three doses of vaccine. The first dose is provided initially, followed at one month and six months.

(6)   Students and non-immunized practicing electrologists should contact their personal physician or the City/County Health Department for appropriate immunization against hepatitis B.

(d)   Standards for hand washing. Hand washing is one of the most important procedures for preventing the transmission of infections. Hand washing accomplishes a physical removal of microorganisms and a chemical inactivation of residual microorganisms on the surface of the skin. Fingers are thought to be the most important part of the hand in terms of the transfer and spread of pathogenic micro flora. Hand washing products can become contaminated or support the growth of microorganisms. Liquid products should be stored in closed containers and dispensed from either disposable containers or containers that are washed and dried thoroughly before refilling.

(1)   A sink with hot and cold running water is located in each treatment room

(2)   Hands are cleansed with use of plain liquid soap and water or degermed by hand sanitizers using 60% - 70 % alcohol-based hand rubs (if hands are not visibly soiled):

(A)   Before and after treatment of each patient/client

(B)   Before donning gloves and immediately after gloves are removed

(3)   Hands are thoroughly washed with liquid soap and water:

(A)   When visibly soiled

(B)   Immediately if accidental bare-handed contact with blood, body fluids, secretions, excretions, non-intact skin, mucous membranes or contaminated equipment occurs.

(4)   Hand washing technique with liquid soap and water includes:

(A)   Use of plain soap and water

(B)   A vigorous rubbing together of all surfaces of lathered hands, especially between fingers and fingernail areas, for 15 to 30 seconds

(C)   A thorough rinsing under a stream of water

(D)   Hands are dried thoroughly with a clean disposable paper towel

(E)   Faucets are turned off with the paper towel

(F)   Paper towel is disposed of in the appropriate covered receptacle in the treatment room.

(5)   Hand washing technique using 60% to 70% alcohol-based antiseptic hand rubs includes:

(A)   Apply product label-recommended amount of alcohol gel or rinse to the palm of one hand

(B)   Vigorously rub hands together covering all surfaces of hands, especially between fingers and fingernail areas, between 15 to 25 seconds until the alcohol dries.

(e)   Standards for use of gloves.

(1)   Each patient/client must be treated with fresh unused gloves. Determine patient/client allergies before wearing latex gloves. Several conditions have been connected to latex sensitivity, including such allergic reactions as asthma, eczema, hay fever, allergies to cosmetic powders or foods, and frequency or duration of glove use/exposure. Non-sterile gloves are appropriate for electrology procedures and should be worn when hands are likely to become contaminated with potentially infective material such as blood, all body fluids, secretions, excretions, non-intact skin, and mucous membranes.

(2)   The consistent wearing of gloves will decrease the risk of potential exposure. Wearing gloves will also protect the patient/client from potential exposure to the microbial flora of the electrologist, including blood-borne organisms should there be cuts, scrapes, or micro-lesions on the electrologist's hands. When gloves are worn, hand washing is recommended after removal because gloves may become perforated during use and bacteria can multiply rapidly on gloved hands. Gloves that are torn or knowingly perforated during a treatment should be removed immediately and hands washed before donning fresh gloves.

(3)   Wearing latex powder-free, reduced protein content gloves will reduce the risk of a latex allergy. When wearing latex gloves, do not use oil-based hand creams or lotions, which causes glove deterioration, unless they have been shown to reduce latex-related problems and maintain glove barrier protection. If the electrologist or patient/client is allergic to latex, there are other non-latex glove materials available such as vinyl.

(4)   Washing gloves while treating the same patient/client is not recommended. This can cause "wicking", the enhanced penetration of liquids through microscopic holes in the gloves. Deterioration of the glove material can also occur with the use of disinfecting agents or oils. Wearing gloves will not guarantee protection as gloves may have micro tears.

(5)   Use a fresh pair of non-sterile, medical grade, disposable exam gloves during the treatment of each patient/client. Gloves are disposed of in an appropriate receptacle in the treatment room.

(6)   Wash hands in accordance with the above hand washing standards before putting on gloves and immediately after gloves are removed.

(f)   Standards for patient/client health history. A complete past and current health history is obtained from each patient/client before treatment. The general health status of the patient/client may be a factor in susceptibility to infection and normal healing. It will also have an affect on the outcome of the treatment plan due to any hormonal disorders or disease states. Professional interpretations require careful observation and good judgment. The patient/client's health status should be updated and evaluated on an on-going basis and referred to an appropriate physician as indicated.

(g)   Standards for patient/client skin preparation.

(1)   Treatment should be delayed if actual or potential signs or symptoms of infection are present. The practitioner should refer to the appropriate physician when the health history or skin assessment indicates

(2)   Before treatment, the treatment area should be thoroughly cleansed to remove makeup or grime if present and reduce the bacterial count on the skin.

(3)   Wipe the treatment area with an antiseptic skin preparation.

(4)   After treatment, the treatment area should be wiped with an appropriate product, taking into consideration the patient/client's skin type and any skin allergies.

(5)   Patient/clients are instructed on appropriate post-treatment care to promote healing.

(h)   Standards for cleaning and sterilization of instruments/items.

(1)   Coordinating the cleaning, sterilization, and disinfection of instruments/items to maintain asepsis technique is required. Precautions should be taken to avoid puncture injuries from instruments.

(2)   All instruments that will penetrate tissue should be either pre-sterilized disposable or thoroughly cleaned and then sterilized before reuse to reduce the risk of transmission of infection and disease.

(3)   The endodontic dry heat sterilizer (glass bead sterilizer) is no longer cleared to market by the Food and Drug Administration (FDA). The endodontic dry heat sterilizer should not be used in the practice of electrology.

(4)   Some high-level disinfectants, including glutaraldehyde-based germicides, are not recommended as an applicable method of sterilization of instruments and items, based on their toxicity level, instability, and impracticality. Sterilization with liquid chemical germicides is not capable of being biologically monitored. If a medical device is heat-stable, the proper method of reprocessing is by using a heat-based method such as a steam autoclave or dry heat oven.

(5)   Carbon rollers are porous and cannot be sterilized or disinfected, therefore, they should not be used.

(6)   Cleaning is the basic first step for all decontamination. Cleaning physically removes debris and reduces the number of microorganisms present. Cleaning is the removal of organic material or soil from objects and is usually done by using protein-dissolving enzyme detergent and water. Generally, cleaning is designed to remove rather than kill microorganisms. Technology has provided cleaning products and devices that are especially appropriate for the cleaning of instruments used in electrology. A meticulous physical cleaning is always done before sterilization or disinfection. For sterilization or disinfection, refer to the manufacturers' instructions for exposure times and conditions as well as recommendations for rinsing and subsequent handling of processed items.

(7)   Low-level and intermediate-level disinfectants used in the practice of electrology should be registered with the Environmental Protection Agency (EPA), whereas high-level disinfectants/liquid chemical sterilants are cleared by the FDA for use in sterilizing or disinfecting medical and dental instruments. Disinfectants are to be used according to the manufacturer's instructions.

(8)   An intermediate-level disinfectant is capable of killing M. tuberculosis var. bovis, but not bacterial spores. It will also inactivate organisms such as most vegetative bacteria and fungi as well as viruses such as hepatitis B virus (HBV) and HIV. Examples of intermediate-level disinfectants include alcohols (70 to 90% ethanol or isopropanol), chlorine compounds, and certain phenolic or iodophor preparations.

(9)   A high-level disinfectant inactivates some, but not necessarily all, bacterial spores. It will kill M. tuberculosis var. bovis, bacteria, fungi, and viruses. High-level disinfection is the minimum treatment recommended by the CDC guidelines for reprocessing of semi-critical instruments or devices. Examples of high-level disinfectants include glutaraldehyde-, chlorine dioxide-, hydrogen-peroxide, orthophthaldehyde-, and peracetic acid-based formulations.

(10)   Chlorine solutions in concentrations of 0.05 to 0.5% free chlorine are generally considered intermediate-level disinfectants for specific site disinfection. Solutions of 0.5% (household bleach contains approximately 5% sodium hypochlorite) have broad-spectrum germicidal activity, and exhibit sporicidal activity, are tuberculocidal, inactivate vegetative bacteria, and are fungicidal and virucidal. Klein and Deforest (1965) reported that all 25 viruses were inactivated in 10 minutes by as little as 0.02% available chlorine. Bleach solutions used to process tips for epilator needle holder are freshly made by mixing one tablespoon household bleach to one quart tap water. Discard bleach solution after each use.

(11)   Critical items.

(A)   Instruments

(i)   Needles

(I)   Single-use, pre-sterilized, disposable

(II)   Pre-sterilized, re-useable

(ii)   Forceps

(B)   Processing

(i)   Single-use and re-useable needles

(I)   Stored in a manner that will maintain sterile condition, away from wetness or humidity extremes.

(II)   Not to be recapped, bent, or manipulated by hand prior to disposal to avoid accidental puncture injury.

(III)   Place in a sharps container immediately after use, or when opened and found damaged, or when not used before expiration date.

(IV)   When the sharps container is full, it is to be sealed securely and disposed of properly as specified by state and local health regulations as an item of regulated medical waste. According to the Oklahoma Dept. of Labor's OSHA division, sharps containers can be disposed of in the regular trash only after being filled with cement. They recommend a more practical solution of taking them to a local hospital or clinic that will include it with their regular biohazard waste materials to be picked up by a biohazard waste company. They may charge a small fee for this service.

(ii)   Forceps and re-useable needles

(I)   Forceps are cleaned and then sterilized before their initial use.

(II)   Used critical items are placed in an ultrasonic unit, empty covered container or a holding container, which holds either a liquid detergent solution or protein-dissolving enzyme detergent, following manufacturer's instructions for dilution.

(III)   The holding container is held under warm running water to rinse off detergent and debris, then drained.

(IV)   Forceps and re-useable needles are then placed in the basket of an ultrasonic unit using transfer forceps. If a protein-dissolving enzyme detergent was not used in the holding container, it must be used now in the ultrasonic unit for proper cleaning, following manufacturer's instructions for dilution and immersion time.

(V)   Basket is removed from ultrasonic unit, rinsed under running water and drained. Forceps are dried with disposable paper towels. Needles are drained and air-dried on disposable paper towels.

(VI)   Forceps and needles are packaged individually or in small multiples for the sterilization process. If sterilized in multiples, any instruments not used whose package has been opened must be resterilized.

(VII)   Place packaged instruments in an autoclave or dry heat sterilizer using a chemical indicator on each package or one with each individual load. This only indicates items have been exposed to a sterilization process, it does not guarantee sterility. Biological indicators are used no less than once a month (per sterilizer) according to manufacturer's instructions to ensure proper mechanical function. Lab reports are filed in a permanent Sterility Assurance file to be kept in your office records.

(VIII)   Autoclaves and dry heat sterilizers are loaded, operated and maintained according to manufacturer's instructions. Sterilizers must have visible physical indicators (thermometers, timers).

(IX)   Cleaned, dried and packaged instruments are sterilized by either dry heat at 340 degrees F (170 C) for 1 hour; 320 degrees F (160 C) for 2 hours or by following directions by the manufacturer of the unit or by autoclave (steam under pressure) for 15-20 minutes at 250 degrees F (121 C); 15 psi (pounds per square inch). The above temperature and exposure times for dry heat sterilizers and autoclaves relate only to the time of exposure after attainment of the specific temperature and do not include a penetration or heat-up lag time. Exposure time does not include drying and cool-down time. Follow the manufacturer's instructions for the unit you have if times and temperatures differ from those given above.

(12)   Semi-critical items.

(A)   Instruments

(i)   Tips for epilator needle holders

(ii)   Anaphoresis/cataphoresis rollers

(B)   Processing

(i)   Tips for epilator needle holders

(I)   Must be processed before initial use and after use between each patient/client. Tips that are contaminated (e.g. dropping or touching unsterilesurface) must be reprocessed before use.

(II)   Follow same processing directions described earlier for re-useable critical items concerning holding container and ultrasonic cleaning.

(III)   Package tips individually or in small multiples for sterilization in an auto-clave or disinfect by submersing in a fresh solution of an intermediate- level disinfectant for 10 minutes or follow manufacturer's directions. Dry the tips with disposable paper towels.

(IV)   Store tips in a clean, dry, covered container to prevent contamination.

(ii)   Anaphoresis/cataphoresis rollers.

(I)   Must be processed before initial use and after use between each patient/ client.

(II)   Rollers are cleaned, dried and disinfected in the same manner as tips.

(13)   Non-critical Items.

(A)   Instruments/Items

(i)   Indifferent electrodes

(ii)   Needle cords

(B)   Processing

(i)   These items are cleaned, dried and subjected to a low-level disinfection after each treatment.

(ii)   Low-level disinfectants are capable of inactivating most bacteria, some Viruses and fungi, but not bacterial spores or M. tuberculosis var. bovis. Examples are quaternary ammonium compounds and certain iodophors or phenolics.

(i)   Standards for environmental control and housekeeping.

(1)   A variety of microorganisms are normal contaminants of environmental surfaces, most of which are non-pathogens. Conscientious sanitation and disinfection techniques control cross-infection.

(2)   Hospital-grade disinfectants registered with the Environmental Protection Agency (EPA) should be used for environmental surface cleaning. Product labels give the EPA registration number and should give adequate safety and precautionary information. Manufacturer's instructions on the use of the product should be followed. Information on specific manufacturer label claims and the classification of disinfectants can be obtained by writing the Anti Microbial Division, EPA 751 OC, Office of Pesticides Programs, 401 M Street SW, Washington, DC 20460. http://www.epa.gov/.

(3)   Adequate levels of safety for surfaces of medical equipment (non-critical surfaces) may be achieved by simple washing or scrubbing with detergent and warm water or, depending on the equipment surface and the nature and degree of contamination, cleaning followed by an application of an intermediate- to low-level chemical germicide. Follow manufacturer's instructions for application and exposure times of disinfectant products.

(4)   Cleaning schedules and methods vary according to the type of surface to be cleaned and the amount and type of soil present. Items on countertops should be maintained in a sanitary manner. Sinks and toilet facilities should be clean at all times. Environmental surfaces in the treatment room should be cleaned on a regular basis. Equipment surfaces, doorknobs, telephones, and treatment tables should be cleaned on a regular basis. Protective barrier film or appropriate disinfectants should be used on surfaces touched during the treatment. Treatment tables should be covered with either cloth or paper drapes and changed after each patient/client. Floors and carpets should be vacuumed and cleaned regularly. Walls, blinds and curtains should be cleaned when visibly soiled.

(j)   Standards for potential exposures to blood-borne pathogens.

(1)   Health care workers who have percutaneous or mucous membrane exposure to blood and other body fluids are at risk for infection, including HBV, HCV AND HIV infection. The Centers for Disease Control and Prevention (CDC) concludes in a continuing study that, while HIV infection is a real risk to health care workers, the risk is low and can be minimized by taking appropriate precautions.

(2)   Identified risk factors for HIV and HCV transmission are almost identical to those for HBV transmission. Despite the similarities in modes of transmission, the risk of HBV infection in health care settings far exceeds that for HIV or HCV infection.

(3)   The following steps are to be taken when a puncture injury has occurred:

(A)   Remove and discard gloves.

(B)   Milk the puncture site to expel blood. Clean the wound vigorously with one-half teaspoon of soap and water for 10 to 15 seconds, using friction.

(C)   Immediate contact is made to practitioner's personal physician for appropriate consultation, and for necessary post-exposure strategies.

(D)   Documentation of the exposure is made including: date, route of expo-sure, circumstance under which exposure occurred, name of source patient/client, HIV and/or hepatitis status of source patient/client, status of practitioner's testing, follow-up testing and any necessary post-exposure prophylaxis.

[Source: Added at 21 Ok Reg 1056, eff 5-14-04; Amended at 31 Ok Reg 1979, eff 9-12-14]