2.3 Blood Exposure Procedures: Missouri Rule & NIC Practical Standard

Nail services put sharp and abrasive tools close to living skin at the nail folds, the hyponychium, and the soles of the feet. When skin breaks, blood can carry bloodborne pathogens — disease-causing microorganisms such as hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV). You cannot tell by looking who carries them. That is why the profession uses Standard Precautions: treat all blood and body fluids as potentially infectious, every time.

Missouri's Rule: Two Procedures

Rule 20 CSR 2085-11.020(2)(F) begins, "If a cut is sustained or a blood spill should occur, the following steps must be followed." It then gives one list for an injury to the licensee, apprentice, student, or salesperson, and another for an injury to the patron.

Details Examiners and Inspectors Notice

• Stopping comes first in both lists. Never finish a coat of polish or a fill before you handle the cut.
• No contact with the wound. Styptic and antiseptic are applied with a single-use applicator such as a cotton-tipped swab, and the swab is then discarded. A solid styptic pencil touches the wound directly, so it cannot meet this requirement. Missouri's barber sanitation rule separately bans styptic pencils.
• Gloves protect both people. In the patron procedure, gloves go on before you touch anything. Missouri's disease-control provision also requires gloves any time you have open wounds, dermatitis, or other non-intact skin on your hands.
• Covered waste. Blood-soiled cotton, gauze, wipes, gloves, and single-use files go into a covered waste receptacle. Many employer exposure-control plans and textbooks also call for sealing blood-soiled disposables in a plastic bag first, and some call for double-bagging. Follow your salon's written plan and local waste rules.

The NIC Practical Examination Standard

The seventh core section of the NIC Nail Technology Practical is the Blood Exposure Procedure, examined individually. You demonstrate the response to a minor cut to your own index finger during a service. The cut does not require stopping the service, and no work area or client has been contaminated. Examiners score whether:

1. blood exposure supplies and materials are labeled in English;
2. you remove the materials from the first aid kit;
3. the supplies and materials are visibly clean;
4. you wear gloves;
5. you clean the injured area with antiseptic;
6. you cover the injury with a dressing that is absorbent and secured;
7. you dispose of all contaminated supplies.

Because the scenario says nothing was contaminated, the scored tasks focus on the wound itself. In a real salon, if blood reaches the table or an implement, you also complete the cleaning and disinfection steps Missouri's rule lists.

A Rehearsable Practical Sequence

1. Stop, and tell the examiner you will perform the blood exposure procedure.
2. Remove your first aid kit supplies onto a clean surface: gloves, antiseptic, single-use applicators, and an adhesive bandage or gauze with tape.
3. Put on gloves.
4. Apply antiseptic to the injured area with a single-use applicator.
5. Cover the injury with an absorbent dressing and secure it.
6. Discard the applicator, wrappers, and any contaminated supplies — and your gloves, if they are contaminated — in the trash container.
7. Put on a fresh glove before resuming, as Missouri's rule requires for a hand injury.

Handling Blood-Contaminated Implements and Surfaces

For blood spills, many salons choose a disinfectant whose label lists effectiveness against HBV and HIV. The EPA label, not habit, sets the contact time.

Employee Protections

If you are an employee with occupational exposure to blood, the federal OSHA Bloodborne Pathogens Standard (29 CFR 1910.1030) requires your employer to have a written exposure control plan and to offer the hepatitis B vaccine series at no cost within 10 working days of initial assignment. After an exposure incident, the employer must provide a confidential medical evaluation. Report any exposure right away. Section 2.4 covers OSHA's other salon safety requirements.

When a Cut Is More Than Minor

End the service and refer the client (or yourself) for medical care when bleeding does not stop with light pressure, the cut is deep, or the person has a bleeding disorder or takes anticoagulant medication and the wound keeps oozing. Record the incident and the steps you took in the client or salon record.

Scenario: A Slip During a Pedicure

While nipping a hangnail on a client's great toe, a technician breaks the skin at the lateral nail fold, and a drop of blood appears.

1. The technician stops the service and calmly explains why.
2. She puts on gloves from her station kit.
3. She cleanses the area, applies antiseptic with a cotton-tipped applicator, and dabs liquid styptic with a fresh applicator. Neither the bottle nor its nozzle touches the toe.
4. She covers the area with an adhesive bandage and checks the client's comfort.
5. She wipes the foot rest and cart with an EPA-registered disinfectant and places the nippers in the "to be disinfected" container.
6. She discards the applicators and gloves in the covered trash and washes her hands with an antimicrobial cleanser before continuing on the other foot.