Section 1.3: Levels of Infection Control

Section 1.3: Levels of Infection Control

Infection control is divided into three distinct levels: cleaning (also known as sanitation), disinfection, and sterilization. Each level serves a specific purpose in maintaining public health and safety within the salon and spa environment. As an esthetician, you must know the differences between these levels, the required contact times, and the state regulations governing their implementation. Failing to apply the correct level of infection control to tools and equipment is one of the most common causes of state board citation fines.

Level 1: Cleaning (Sanitation)

Cleaning is the lowest level of infection control. It is defined as a physical process using soap or detergent and warm water to remove visible dirt, debris, and many disease-causing germs from tools, equipment, and surfaces.

• Mechanism: Cleaning does not kill pathogens. Instead, it mechanically reduces the number of microbes on a surface, making it safer to handle.
• Application: Cleaning is the mandatory first step before disinfection or sterilization. If a tool has organic matter (like sebum, makeup, or skin cells) left on it, the chemical disinfectant cannot make direct contact with the surface, rendering the disinfection process useless.
• Examples: Washing hands with soap and water, scrubbing tweezers with a brush and warm soapy water, and wiping down a facial bed with a cleaning detergent.

Level 2: Disinfection

Disinfection is the second level of infection control and is the standard requirement for most non-porous esthetics tools. It is a chemical process that destroys most harmful pathogens (including bacteria, viruses, and fungi) on non-porous surfaces, but it does not destroy bacterial spores.

• EPA Registration: All disinfectants used in a California salon or spa must be registered with the Environmental Protection Agency (EPA) as hospital-grade disinfectants.
• Submersion Rule: Under California Board rules, all multi-use tools must be completely submerged in a wet disinfectant container. The container must be large enough to allow all parts of the tools to be completely covered by the liquid.
• Wet Contact Time: For a disinfectant to be fully effective, tools must remain completely submerged in the solution for the EPA-approved contact time. For most liquid disinfectants, this is exactly 10 minutes. Wiping a tool down with a disinfectant wipe does not meet this requirement unless the surface remains visibly wet for the entire contact time specified on the label.

Exam Trap: Liquid disinfectants must be changed daily, or sooner if the solution becomes cloudy or contaminated with debris.

Level 3: Sterilization

Sterilization is the third and highest level of infection control. It is a process that completely destroys all microbial life, including highly resistant bacterial spores.

• Application: Sterilization is required for critical tools that penetrate the skin or make contact with broken skin or bodily fluids (e.g., extraction lancets or microdermabrasion tips).
• Autoclaves: The most common method of sterilization in a spa is the steam autoclave. Autoclaves use steam under pressure to achieve temperatures high enough to kill all microorganisms.
• Board Rules for Autoclaves: The California Board of Barbering and Cosmetology has strict requirements for salons that use autoclaves:
  1. Spore Testing: Autoclaves must undergo weekly spore testing (also called biological monitoring) by an independent laboratory to verify they are functioning properly and actually killing spores.
  2. Logbooks: The salon must maintain a detailed logbook documenting the date and results of each spore test, as well as the date, time, temperature, and pressure of each sterilization cycle.
  3. Record Keeping: Spore test results and autoclave logs must be kept on the salon premises for at least 12 months and made available to inspectors upon request.

The UV "Sterilizer" Myth

A common misconception and exam trap revolves around Ultraviolet (UV) light cabinets. Many salons refer to these boxes as "UV sterilizers."

Board Reality: UV light cabinets cannot sterilize tools. They do not reach the temperatures or pressures required to destroy bacterial spores. Under California regulations, UV cabinets may only be used as dry, clean storage containers for tools that have already been cleaned and disinfected. Storing dirty tools in a UV cabinet is a major health violation.

Single-Use vs. Multi-Use Items

Infection control protocols differ based on whether an item is single-use or multi-use:

• Multi-Use (Disinfectable) Items: Items constructed of hard, non-porous materials such as metal, glass, or plastic. These items can be cleaned and disinfected repeatedly. Examples include tweezers, comedone extractors, metal spatulas, and glass high-frequency electrodes.
• Single-Use (Disposable) Items: Items made of porous materials that cannot be properly cleaned and disinfected because they absorb liquids or skin cells. These items must be discarded immediately after a single client use. Examples include cotton pads, sponges, wooden wax spatulas, paper towels, and emery boards.