2.3 The Communicable Disease Rule, Towels & Safe Product Handling
Key Takeaways
- Rule 0440-02-.12(1) bars serving any patron with definite open sores, symptoms of infectious or contagious skin disease, or parasitic infestation without written permission from a physician.
- A licensee who knowingly has a communicable infectious or contagious disease or parasitic infestation may not give service in a shop or school.
- A separate clean towel must be provided for every patron, and headrests must be covered with a separate clean towel or paper for each patron.
- Re-dipping a previously used towel into hot water and using it on a patron is expressly prohibited by Rule 0440-02-.13(6)(c).
- Creams and semi-solid products must be removed from containers with a clean spatula that is disinfected or disposed of immediately after use.
The Rule That Says No
Estheticians are taught to be accommodating. Tennessee law is not. Rule 0440-02-.12 places a hard stop in front of two situations, and it applies whether or not the client insists.
(1) No patron with definite open sores, exhibiting symptoms of infectious or contagious disease or disorders of the skin, or parasitic infestations will be served in a shop or school unless written permission from a physician has been secured.
(2) No cosmetologist, manicurist, aesthetician, shampoo/manicurist, instructor or natural hair stylist who knowingly has an infectious or contagious disease or parasitic infestation in a communicable stage shall give service in a school or shop.
Read paragraph (1) carefully, because the exception is the tested part. Tennessee does not simply say "refuse service." It says the service is barred unless written permission from a physician has been secured. A client with a physician's written clearance may be served. A client who says "my dermatologist said it's fine" may not — the rule requires the permission in writing.
Paragraph (2) runs the other direction and catches the esthetician. If you knowingly have a contagious condition in a communicable stage — an active cold sore on your own lip, conjunctivitis, a confirmed scabies infestation — you may not give service. "Knowingly" is doing real work here; the rule does not require you to diagnose yourself, but once you know, you stop.
What triggers the rule in a treatment room
| Presentation | Action |
|---|---|
| Active herpes simplex lesion (cold sore) on or near the lip | No service to the area; physician's written permission required to proceed |
| Weeping, crusted or bleeding lesion of unknown origin | No service; refer to a physician |
| Impetigo — honey-coloured crusting, highly contagious | No service; refer |
| Tinea (ringworm), tinea versicolor with active scaling | No service; refer |
| Suspected scabies or pediculosis | No service; refer |
| Open acne excoriations the client has picked raw | Treat around them or reschedule; these are definite open sores |
| Healed, closed, non-inflamed post-acne marks | Service is fine; these are not open sores |
Document the refusal in the client record with the date, what you observed, and the referral you made. That note is your defence if the client later complains, and it is also the professional path: you are not diagnosing, you are declining and referring.
Before You Touch Anyone
Rule 0440-02-.13(1) sets two conditions that must be satisfied before work begins on any patron:
- Washing hands with soap and water, and
- Placing around the patron's neck a clean cape.
This is the rule that makes hand hygiene a legal obligation in Tennessee rather than a best practice, and it specifies soap and water — hand sanitiser is an adjunct, not a substitute, for the pre-service wash. The cape requirement applies to every discipline, aesthetics included; in a facial context the clean cape works together with a clean headband and clean draping over the treatment couch.
Towels and Linens
Rule 0440-02-.13(6) has three parts, and every one of them is examinable.
- (a) A separate, clean towel shall be provided for each patron. Not a fresh corner of the same towel. Not a towel that only touched the client's shoulder.
- (b) Headrests shall be covered with a separate, clean towel or paper for each patron. In a facial room this is the paper or towel over the headrest of the reclining facial table.
- (c) The practice of dipping a towel previously used for any purpose into a container of hot water and using the towel on a patron is prohibited.
Part (c) is the one that catches working estheticians. The hot-towel step in a facial feels harmless — the water is hot, so surely it is clean. Tennessee rejects that reasoning outright. Once a towel has been used for any purpose, re-heating it in a water bath does not restore it. This is why Rule 0440-02-.07(2)(k) requires an electric hot towel cabin: clean, laundered towels go into the cabin, and used towels go into the covered and labeled soiled-towel container.
Storage closes the loop: clean towels live in the enclosed and labeled storage area required by Rule 0440-02-.07(2)(c), and soiled towels go directly into the covered and labeled container required by 0440-02-.07(2)(d).
Powders, Lotions and Creams
Rule 0440-02-.13(8) governs how product leaves its container:
- (a) Powders and lotions must be applied with a clean applicator and the applicator disposed of immediately after each use.
- (b) Creams and other semi-solid substances must be removed from their containers with a clean spatula (or similar device), which is disinfected or disposed of immediately after use.
This is Tennessee's codified anti-double-dipping rule, and it is broader than most students assume. It is not enough to avoid dipping a used spatula. The rule requires that the spatula be disinfected or disposed of immediately after use — so the working habit is: one spatula, one withdrawal, one disposal. If you need more product mid-treatment, you take a new spatula.
The same logic governs wax. A wax applicator that has touched skin never re-enters the pot; once it does, the pot is contaminated and the wax must be discarded.
Combs, Instruments and Surfaces
Even in a skin care shop, several general provisions apply:
- Rule 0440-02-.13(7)(b): No operator shall carry combs or other instruments in the pockets of clothing. Tweezers clipped into a smock pocket are a violation.
- Rule 0440-02-.13(10): All equipment, shampoo basins, furnishings and work surfaces must be kept in good repair, and disinfected after each service.
- Rule 0440-02-.13(11): All disposable blades used in razors, safety razors and razor heads must be replaced with a new blade for each patron.
- Rule 0440-02-.13(9): After exposure to blood or bodily fluids, the licensee shall immediately wash hands with soap and water and use hand sanitizer or antiseptic.
- Rule 0440-02-.13(2)(c): A licensee shall maintain a supply of antiseptic and/or liquid or spray styptic for use if a patron's skin is accidentally broken during a service. Note the form: liquid or spray. A shared styptic pencil applied to broken skin cross-contaminates and has no place in a professional treatment room.
A regular client arrives with an active, weeping cold sore at the corner of the mouth and asks for her usual facial. Under Rule 0440-02-.12(1), what may the esthetician do?
During a facial an esthetician re-heats the towel she used earlier in the service by dipping it in a bowl of very hot water, then applies it to the client's face. Which rule does this break?
How does Rule 0440-02-.13(8)(b) require creams and other semi-solid products to be removed from their containers?
Which two things must happen before a Tennessee licensee commences work on any patron, under Rule 0440-02-.13(1)?