3.2 Decontamination Levels: Cleaning, Disinfection & Sterilization

The Three Levels of Decontamination

Infection control in the esthetics profession relies on a stringent hierarchy of decontamination procedures. The terms cleaning, sanitizing, disinfecting, and sterilizing are often used interchangeably by the general public, but in a professional clinical setting, they have very specific, legally defined meanings. The state board requires estheticians to perfectly execute the three levels of decontamination to maintain a safe environment.

Level 1: Cleaning (Sanitization)

Cleaning is a mechanical process (scrubbing) using soap and water or detergent and water to remove all visible dirt, debris, and many disease-causing germs from tools, implements, and equipment. This process is sometimes referred to as sanitization, which means a chemical process for reducing the number of disease-causing germs on cleaned surfaces to a safe level.

Cleaning is the absolute prerequisite for all other decontamination steps. You cannot disinfect or sterilize a tool that has not been thoroughly cleaned first. If organic matter (like skin cells, sebum, or blood) is left on a tool, it will interfere with the chemical action of the disinfectant, rendering it ineffective.

There are three main ways to clean tools or implements:

1. Washing with soap and warm water, and then scrubbing them with a clean and properly disinfected nail brush.
2. Using an ultrasonic unit.
3. Using a cleaning solvent (e.g., on metal bits for electric files).

Level 2: Disinfection

Disinfection is a chemical process that uses specific products to destroy most, but not necessarily all, harmful organisms on environmental surfaces. Disinfectants used in salons, spas, and medical facilities must be registered with the Environmental Protection Agency (EPA).

Disinfection is effective in eliminating most microorganisms, but it is not effective against bacterial spores. In the salon setting, disinfection is the standard process for all non-porous (hard) surfaces, tools, and implements that do not penetrate the skin.

EPA-Registered Disinfectants

To be compliant with state board regulations, an esthetician must use an EPA-registered disinfectant. The label will display an EPA registration number, which certifies that the product has been tested and is effective against specific pathogens.

Disinfectants used in esthetics must be:

• Bactericidal: Capable of destroying bacteria.
• Virucidal: Capable of destroying viruses.
• Fungicidal: Capable of destroying fungi.

Tennessee escalates the requirement specifically for blood contact. Rule 0440-02-.13(2)(b) requires that tools and implements which have come into contact with blood or body fluids be cleaned in soap and water and disinfected by complete immersion in an EPA registered, hospital grade, bactericidal, virucidal, fungicidal disinfectant effective against HIV-1 and Hepatitis B Virus, mixed and used according to the manufacturer's direction. For everything else, Rule 0440-02-.13(2)(a) requires an EPA registered bactericidal, virucidal, fungicidal product used per the manufacturer's directions — hospital grade is not the everyday baseline.

Contact Time

One of the most critical aspects of disinfection is contact time (or efficacy time). This is the amount of time the surface must stay moist with the disinfectant in order for the chemical to be effective. If the label specifies a 10-minute contact time, leaving the implement in the solution for only 5 minutes means the item is not legally or safely disinfected. Always set a timer.

Note where that number comes from. Tennessee does not set a fixed immersion time. Rule 0440-02-.13(2) requires the disinfectant to be mixed and used according to the manufacturer's directions, so the label — not the state rule and not salon tradition — establishes both the dilution and the contact time. Ten minutes is common for quaternary ammonium products; it is not a Tennessee legal minimum.

Types of Disinfectants

Estheticians work with several categories of chemical disinfectants, each with specific handling requirements.

Quaternary Ammonium Compounds (Quats)

"Quats" are disinfectants that are very effective when used properly in the salon. The most advanced type of these formulations is called multiple quats. They usually disinfect implements in 10 minutes. They are highly effective, odorless, and fast-acting. However, prolonged exposure can cause tools to rust or damage plastics, so implements should be removed promptly after the specified contact time, rinsed, and dried.

Phenolic Disinfectants

Phenolics are powerful tuberculocidal disinfectants derived from carbolic acid (phenol) chemistry — not, despite a persistent salon-textbook claim, a form of formaldehyde. They have a very high pH, can cause damage to the skin and eyes, damage plastic and rubber, and cause certain metals to rust. Some phenolic compounds carry serious toxicity and environmental concerns. Because of their toxicity and environmental impact, their use is increasingly restricted, and they should only be used when explicitly required by state regulations.

Sodium Hypochlorite (Bleach)

Household bleach, strictly defined as 5.25 percent sodium hypochlorite, is an effective disinfectant and has been used extensively as a disinfectant in the salon. Bleach must have an EPA registration number and contain at least 5% sodium hypochlorite. It is corrosive to metals and plastics and can cause skin irritation and eye damage. Bleach solutions must be mixed fresh every 24 hours or when the solution has been contaminated.

Safety Precautions for Disinfectants

Disinfectants are hazardous chemicals. Always adhere to the following safety protocols:

• Always wear gloves and safety glasses when mixing or handling disinfectants.
• Always add disinfectant to water, not water to disinfectant, to prevent foaming and splashing.
• Use tongs, gloves, or a draining basket to remove implements from disinfectants.
• Keep disinfectants out of reach of children.
• Carefully follow the manufacturer’s instructions for mixing, usage, and disposal.

Level 3: Sterilization

Sterilization is the highest level of decontamination. It is the process that completely destroys all microbial life, including the highly resistant bacterial spores.

Sterilization is required for any tool that pierces the skin or comes into contact with blood or bodily fluids (e.g., lancets, comedone extractors, electrolysis needles).

Autoclaves

The most effective method of sterilization in the esthetics setting is the use of an autoclave. An autoclave is a piece of equipment that uses heat and pressurized steam to sterilize non-porous metal tools. The high pressure allows the steam to reach temperatures higher than the boiling point of water, which is necessary to penetrate the protective coating of bacterial spores.

Regular testing of the autoclave is required to ensure it is functioning correctly. Spore tests (biological indicators) are run periodically and sent to a laboratory to verify that the equipment is successfully destroying all spores.

Dry Heat Sterilization

Dry heat sterilization is another method, but it requires much higher temperatures and longer exposure times than autoclaves. It is less common in modern spas due to the extended time required and the potential for damaging delicate instruments.

Summary of the Decontamination Process

By rigorously following these decontamination protocols, estheticians ensure the health and safety of every client who enters their treatment room.