4.2 Disinfectant Solutions & Instrument Reprocessing (K.A.R. 28-24-10 and 28-24-11)

Quick Answer: After each service, every nonelectrical instrument is (1) cleaned, (2) rinsed with potable water, and (3) disinfected (K.A.R. 28-24-10). You either totally immerse it in an EPA-registered disinfectant according to the manufacturer's instructions and then rinse, or totally immerse it in bleach solution for 10 minutes and then rinse. Keep the solution prepared, available and covered at all times, and change it daily, or sooner if visibly cloudy or dirty. Keep the SDS and the manufacturer's labeled container on hand. Soiled instruments wait in a labeled, covered container. Disinfected instruments are stored in a labeled, clean, enclosed cabinet, drawer or covered container used only for clean instruments.

Choosing a Disinfectant

Kansas requires an EPA-registered product that is bactericidal, virucidal and fungicidal (K.A.R. 28-24-1(g)). Check the label for:

• an EPA registration number;
• claims covering bacteria, viruses and fungi;
• the dilution for a concentrate and the contact time: how long the item stays fully submerged, or how long a surface stays visibly wet;
• use directions for immersion (implements) versus sprays or wipes (surfaces, and shears).

Common salon formulations include quaternary ammonium compounds (quats), phenolic disinfectants, accelerated hydrogen peroxide products and chlorine bleach. Any of them is acceptable in Kansas if it meets the definition and you follow its label. Phenolics have a high pH and can irritate skin and damage some plastics and rubber. Read the SDS and wear gloves when mixing any concentrate.

Solutions and Formulations: The Basic Chemistry

• A concentrate is diluted with water to a use solution. Measure both with a measuring cup (Board checklist), because guessing produces a solution that is too weak or dangerously strong.
• Contact time is the period the product must stay in contact to kill the organisms on its label. For immersion, the whole instrument, hinge and jaws included, stays completely submerged for that time.
• Organic load such as hair, skin, nail dust, oils and blood uses up or blocks the disinfectant. That is why instruments are cleaned first, and why Kansas requires changing the solution daily, or more often if it is visibly cloudy or dirty (K.A.R. 28-24-10(b)). The fine schedule charges $250 for a first failure to change it, and $250 for having no disinfectant or no approved disinfectant.

Reprocessing Nonelectrical Instruments (K.A.R. 28-24-10)

After each service, as applicable:

1. Clean each nonelectrical instrument or piece of equipment with soap or detergent and water, scrubbing hinges and serrations with a clean brush to remove all visible debris.
2. Rinse with potable water.
3. Disinfect using one of these methods:
   • for instruments other than shears and makeup brushes: (i) totally immerse in a disinfectant following the manufacturer's instructions, then rinse with potable water; or (ii) totally immerse in bleach solution for 10 minutes, then rinse with potable water;
   • for shears: a concentrate, spray, wipe or foam disinfectant per the label;
   • for makeup brushes: a concentrate, spray or foam disinfectant per the label.

Nail implements such as nippers, pushers, clippers, tweezers, metal nail files, rasps and curettes use the total immersion methods. Many salons dry the instrument after rinsing and before storage so it isn't put away wet. The regulation's required steps are clean, rinse, disinfect, rinse.

Keeping Solutions and Records Ready

• (b) The disinfectant or bleach solution must be prepared, available for use and covered at all times. You cannot mix it only when an inspector walks in. The inspection checklist asks for a solution prepared at the time of inspection, in covered containers large enough to fully immerse instruments.
• (c) For each disinfectant, the Safety Data Sheet (SDS) and the manufacturer-labeled container, with enough product for safe services, must be available at all times and given to the Board on request.

Storing Used and Clean Instruments

Dropped implement: it is no longer clean. Pick it up, put it in the used-instrument container (or discard it if single-use), clean your hands, and take a clean replacement from the clean container. Wiping it with a towel or spraying it and continuing is not acceptable.

Electrical Instruments (K.A.R. 28-24-11)

Electrical equipment, such as an e-file handpiece or a paraffin unit's surfaces, cannot be immersed. After each service:

1. Remove all debris from the electrical instrument; and
2. Completely saturate the part that touched the consumer with bleach solution or a disinfectant used according to the manufacturer's instructions.

Store disinfected electrical instruments in a clean area: on a stand or hook, or on a clean towel covered by a clean towel, or in a labeled, clean, closed container or drawer reserved for clean instruments.

E-file bits and mandrels: clean and disinfect each metal bit and mandrel after each use on a consumer, then store it in a clean, closed and labeled container until next use (K.A.R. 28-24-11(d)). Sanding bands are single-use and are thrown away right after use (K.A.R. 28-24-8(c)).

Towel warmers: at the end of each day, remove all towels, launder them before reuse, and disinfect the warmer daily per the manufacturer (K.A.R. 28-24-11(c)).

Exam Trap: "Wiping Off" Blood

If an exam item has a technician wipe blood off nippers with a cotton pad and drop them straight into the disinfectant, the procedure is wrong. Wiping is not cleaning. Contaminated instruments must be cleaned with soap or detergent and water, rinsed, then disinfected, and the Kansas blood exposure steps apply (section 5.1).