2.3 Standard Precautions, PPE & Blood Exposure Incidents

1. Why This Matters on Both Exams

General Theory domain I(D), Standard Precautions for exposure incidents (first aid kit, blood-spill disinfection and disposal), and Written Practical domain 1(C), first aid and exposure incident procedures, both test this material. Waxing, extractions and exfoliation can all break skin, so a blood exposure is a routine risk, not a rare emergency.

2. Standard Precautions

The CDC's Universal Precautions (1985–1987) required workers to treat blood and certain body fluids as infectious. In 1996 the CDC folded them into Standard Precautions. Under Standard Precautions, all blood, body fluids, secretions and excretions except sweat, plus non-intact skin and mucous membranes, are treated as potentially infectious for every client, whatever their known health status.

You cannot tell who carries hepatitis B, hepatitis C or HIV by looking. Many carriers have no symptoms. That is why the protective steps are the same for every client, and why an esthetician never skips gloves on the grounds that a client is "low risk."

3. Personal Protective Equipment and Hand Hygiene

Gloves. Minnesota requires gloves for extractions, waxing and hair removal, skin-penetrating tools, non-intact skin, a practitioner's own non-intact hand skin, mixing or touching disinfectant, and whenever the manufacturer's directions call for them (Minn. R. 2105.0375, subp. 7, item O).

Glove rules: wash hands and wrists before putting gloves on; change them if they tear or touch a non-disinfected surface, object or third person; discard them after every service; never wash or reuse single-use gloves. Remove gloves by peeling the first from the wrist so it turns inside out, holding it in the gloved hand, then sliding clean fingers under the second cuff and peeling it over the first. Wash your hands afterward.

Handwashing. Minnesota requires thorough handwashing with soap and water, dried with a single-service towel or air dryer, before every service. A hand rub with at least 60 percent alcohol may be used instead only when hands are free of lotion, product or visible soil. Gloves and hand wipes never replace handwashing (subp. 2). A good technique lathers for at least 20 seconds and covers palms, backs of hands, between fingers, thumbs, fingertips and wrists, then uses the towel to turn off the faucet.

Other PPE. Safety glasses protect against splashes when mixing disinfectant concentrate or pouring peel solutions. A clean smock or apron protects clothing and clients, and it must never hold tools in its pockets (subp. 7, item L).

4. Minnesota's Blood and Body Fluid Exposure Procedure

When an unexpected cut or abrasion exposes blood or body fluid, or blood appears because of a service, stop the service and follow Minn. R. 2105.0375, subp. 5:

Some training programs teach "double-bagging" in a biohazard bag. That is a safe extra step, but the Minnesota rule itself requires a sealed plastic bag. Choose the answer that matches the rule. Lancets and extraction needles, which only advanced practice estheticians use, always go into a sharps container (subp. 13).

Client versus practitioner injury. When a client bleeds during extractions or waxing, you are protecting yourself and preventing contamination of your tools and products. When you nick your own finger, you must also protect the client: cover the wound with a glove or finger cot before continuing, and keep contaminated products out of the service.

5. OSHA's Bloodborne Pathogens Standard

OSHA's Bloodborne Pathogens Standard (29 CFR 1910.1030) applies to employers whose employees have occupational exposure to blood. Key requirements:

• a written exposure control plan;
• engineering and work-practice controls, such as sharps containers and handwashing;
• PPE supplied at no cost;
• the hepatitis B vaccine offered free to exposed employees within 10 working days of initial assignment;
• post-exposure evaluation and follow-up; and
• annual training.

Hepatitis B can survive in dried blood on surfaces for at least seven days, which is why prompt surface disinfection matters.

6. Applying the Procedure: A Waxing Scenario

During a bikini wax, pinpoint bleeding appears at several follicles, a common and expected event with coarse terminal hair.

1. Stop and tell the client calmly what you are doing.
2. You are already gloved for waxing; confirm the gloves are intact or change them.
3. Press sterile gauze or clean cotton over the area. If it is practical, rinse with water, then apply an antiseptic and cover any true break with a sterile bandage.
4. Place the bloody cotton, gauze and wax strips in a plastic bag, seal it and discard it.
5. Remove any tool that touched blood. Clean and disinfect the bed surface or any other surface the blood contacted. Wash your hands.
6. Clean and disinfect the tools under subp. 4 (full immersion in an EPA-registered hospital disinfectant) before reuse.

Treatment-room emergencies other than blood exposure, such as chemical burns, eye splashes, fainting and allergic reactions, are covered in section 2.5.