ENH505 Lecture 6 2024 PDF

Personal Service Settings 2 Reminder! NO CLASS – OCT 31st, this is a work week for your assignment! Types of Disinfectants The type of disinfectant you need to use depends on the type of services you provide and if the tools you are using are considered semi-critical or non-critical. Remem...

Personal Service Settings 2 Reminder! NO CLASS – OCT 31st, this is a work week for your assignment! Types of Disinfectants The type of disinfectant you need to use depends on the type of services you provide and if the tools you are using are considered semi-critical or non-critical. Remember! Critical tools require sterilization There are three levels of disinfection: 1. High-level disinfection 2. Intermediate-level disinfection 3. Low-level disinfection High-Level Disinfectant A high level disinfectant is used for semi-critical items. High-level disinfectants kill all types of germs (except large numbers of bacterial spores). The label may say “high-level disinfectant” or “sterilant”. Examples include: Chlorine beach (1 part bleach, 9 parts water) ≥ 6% Hydrogen peroxide. 2% Hydrogen Peroxide (enhanced action formulation) Remember: re-usable critical items MUST be sterilized Intermediate-Level Disinfectant An intermediate-level disinfectant is used for non-critical items that may accidentally touch broken skin or mucous membranes, or break the skin. Intermediate-level disinfectants kill most types of germs, but not bacterial spores. The label may say “general disinfectant”, “limited disinfectant” or “hospital disinfectant”. Examples include: Chlorine bleach (1 part bleach, 49 parts water) 70-90% ethyl or isopropyl alcohol Low-Level Disinfectant A low-level disinfectant is used for work surfaces and non-critical items that do not directly touch the client or only touch hair or intact skin. It can kill some types of germs but not mycobacteria or bacterial spores. The label may say “general disinfectant”, “limited disinfectant” or “hospital disinfectant”. Examples include: Chlorine bleach (1 part bleach, 499 parts water) Quaternary ammonium (e.g. ‘barbicide’) 0.5% hydrogen peroxide (enhanced action formula). Disinfectants and Contact Time How well a disinfectant works depends on contact time. What is contact time? Contact time is the length of time that the surface of a piece of equipment or tool stays wet with a disinfectant. *Some disinfectants, such as chlorine bleach and alcohol do not have instructions because contact time depends on how strong you mix the solution. Chlorine Bleach Chlorine bleach solution – Contact time is 10 minutes. Low-level – Mix 1/2 tsp of bleach to 1L of water (100ppm). Intermediate-level – Mix 4 tsp of bleach to 1L of water (1000ppm). High level – Mix 7 tbsp of bleach to 1L of water (5000ppm). Quick Tips about Disinfectants ✓ Check expiry dates. ✓ Follow (if provided) instructions for contact time and proper dilution of disinfectant. ✓ Follow safety data sheet for choosing the right PPE. ✓ Products must have drug identification number (DIN) or a natural product number (NPN) issued by Health Canada. ✓ PSS operators should contact local public health unit before choosing a new disinfectant product or if they are unsure which product to use. Disinfectants Types Summary Level of Disinfectant Examples of disinfectant agent Low-Level Chlorine bleach solution 100ppm (1/2 tsp of bleach to 1L of water) Quaternary Ammonium (e.g. Barbicide) 0.5% hydrogen peroxide (enhanced action formulation) Intermediate-Level Chlorine bleach solution 1,000ppm (4 tsp of bleach to 1L of water) 70-90% ethyl or isopropyl alcohol 0.5% hydrogen peroxide (enhanced action formulation) High-Level Chlorine bleach solution 5,000ppm (7 tbsp of bleach to 1L of water) 2% hydrogen peroxide (enhanced action formulation) 6% hydrogen peroxide 0.55% ortho-phthaladehyde Steam Sterilizer The best sterilizer for heat-resistant tools and equipment is a steam sterilizer. Steam sterilizers work best when you follow the instructions for: Temperature and pressure Cycle length and size of the load Packaging ✓ Every new steam sterilizer must have a printout or a display that provides details of time, temperature and pressure reached for each cycle. Unacceptable methods of reprocessing The following are not to be used for sterilizing tools and equipment: Dishwashers or microwave ovens Boiling Ultraviolet light or irradiation Glass bead sterilizers Pressure cookers Flash sterilization Chemiclaves (has serious health risks) Glutaraldehyde (has serious health risks) Sterilization – Packaging Tools and Equipment Tools and equipment must be packaged before sterilizing. ✓ Items must be clean and dry before packaging. Any moisture that remains after sterilization can lead to the items not being properly sterilized. Sterilization – Packaging Tips Use paper-plastic peel pouches. Make sure the pouch material can be used with the type of sterilizer you use. Contact the manufacturer for more information. Mark the date of sterilization on the package or pouch using a permanent, soft-tipped marker. Do not write on the sealed area on the pouch. Be careful not to damage the packaging when writing on the package or pouch. Only open sterilized items in pouches and packages when it is about to be used. Sterilization – Operator Requirements To make sure tools and equipment are properly sterilized, operators must follow manufacturers’ instructions for the sterilizer. This includes how to: Install and operate the unit. Clean and maintain the unit. Package and load items. Check for proper temperatures, pressure and time requirements. Document any maintenance or repairs done. Make sure monitoring methods are in place (e.g. mechanical, chemical and biological monitors). Document results. Monitoring the Sterilization Process For items to be properly sterilized, you must monitor the sterilization process with these three indicators: 1) Mechanical indicators, 2) Biological (spore tests) indicators and 3) Chemical indicators For each batch of items, all three indicators must be documented with the date and signature of the worker. Mechanical (Physical) Monitoring Mechanical monitoring checks to see if conditions (e.g. time, temperature and pressure) for sterilization were met in the sterilizer during the cycle. The following information printed out or displayed by the sterilizer must include: The length of time that the sterilization temperature was maintained (not the total cycle time). The actual temperature during the sterilization phase The actual pressure reached and maintained during the sterilization process. This information must match manufacturers’ requirements. Chemical Monitoring Chemical monitoring checks that the package or area inside the sterilizer has been through the complete cycle. This includes external chemical indicators (strip outside of packaging) and internal chemical indicators (item placed inside packaging) that changes in appearance (e.g. colour). This change will tell you if the sterilization process was completed. Biological Monitoring (Spore Testing) Biological monitoring checks the ability of the sterilizer to kill microorganisms Must be done once every two weeks. It is best to test daily. A bacteria spore testing device is placed inside the container that holds the pouches. After cycle is complete, the spore test is to be sent to a service provider that checks to see if bacterial spores are present or not. If the test results comes back negative (i.e. no spore growth), the sterilizer is working properly. If the test results comes back positive (i.e. spore growth found), the sterilizer has failed and is not working properly. What if my unit fails the biological monitoring (spore test)? There are 5 important steps to complete if you receive a positive spore test. 1. STOP use of any tools or equipment that was sterilized since the last negative (passed) spore test. 2. Find all equipment and instruments that were used since that last negative spore test. 3. Find out the potential risks to clients. What if my unit fails the biological monitoring (spore test)? 4. Repeat the biological monitoring test. If test is negative, re-sterilize any equipment and instruments that were sterilized since the last negative spore test. If repeat test is positive, stop using the sterilizer and find out if repair and/or maintenance is needed. 5. If the sterilizer requires repair and/or maintenance, the sterilizer must be re-tested with mechanical, chemical and biological monitors for at least three fully loaded consecutive cycles before use. What if my unit fails mechanical or chemical monitoring? When the mechanical monitor or chemical indicator fails, this means the sterilizer is not working properly. Do not use the equipment and instruments in that load. The equipment and instruments must be cleaned, repackaged and re-sterilized. Find another way to sterilize or use another procedure that doesn’t spread diseases. See if sterilizer repair or maintenance is needed. Conduct a spore test. Storage of Sterilized Items Once items are properly sterilized, the sterile packages must be stored in a clean, dry and dust-free area away from any dirty work area. ✓ When storing sterile packages in containers, make sure the container is labelled as “sterile”. ✓ Do not store other items that are used a lot with these sterile packages as this can damage the package. If you have purchased a pre-sterilized, single-use item, make sure to check the expiry date. Expired items are to be removed and not used. Single-use Tools and Equipment Some sterile tools and equipment and instruments are made to be single-use (one time use). These items cannot be properly cleaned, disinfected or sterilized to be used again, therefore, these items must be thrown out after they are used. Examples: dermal punch tools for piercing, acupuncture needles, tattoo needles Clean Service Areas Keeping the service area clean is important to prevent infections ✓ Personal items such as food, drinks, medications, hygiene items are not allowed where piercing supplies are stored, or where services are provided. ✓ No smoking or vaping is allowed in the service area Common Infections and Concerns: Hairdressing and Barbering This includes all services involving a person’s hair, head, or face. Examples include shaving, cutting, colouring, styling, hair extensions, and scalp or hair treatments The infection risk in hairdressing and barbering is low, however, services involving a razor and scissors can cut the client’s skin and spread harmful germs. Service Bacterial Infections Viral Infections Cause Hairdressing/Barbering Serratia macesecens and Hepatitis B and C Improperly cleaned Staphylococcus aureus and disinfected hair and barbering tools (razors, scissors) Single use items Single use items must only be used one time and thrown out right away. Follow manufacturers instructions and your PHI’s direction to properly use and discard single use items. This includes: straight edge razor, neck strip, gloves, dispensed products, etc. Straight razors with permanently attached blades are not allowed to be used. Note: sharps must be discarded into an approved sharps container. Approved sharps container Example of an approved Approved sharps containers are sharps container yellow or red in colour, puncture resistant, closable, leak proof and labelled. Sharps containers must be sealed up when ¾ full and must be taken by a licensed biomedical waste company for disposal. Sanitary strips and towels If a re-usable cape is used on clients during service, a sanitary strip or towel must be used as a barrier between the cape and the clients skin. This includes single use neck strips, wraps and towels. Items labeled as single use by manufacturer must only be used once and thrown out. These items cannot be re-used between clients. Re-usable towels can only be used on one client, and must be laundered between clients. Store all used towels in a sanitary manner, such as a hamper. Multi use Items Multi-use items can be re-used if properly cleaned and disinfected. Follow manufacturer’s and PHI’s instructions. These items must first be cleaned using soap and warm water, to remove any residue. After cleaning, disinfect items using low, intermediate or high level disinfectant depending on the use of the item. Your salon or barber shop may have tools that are classified as non-critical, semi-critical and critical. Hair and Barber Tools Tools that do not come in contact with broken skin can be cleaned and disinfected using low level disinfectant. Examples include: Combs, brushes, hair rollers and clips, hair clipper guards, etc. Equipment that may pierce skin or come in direct contact with non-intact skin must be cleaned and disinfected using intermediate level disinfectant Examples include: Scissors, razor handles, hair clipper blades, crochet hooks, etc. Equipment that has accidentally pierced the skin must be cleaned and disinfected using high level disinfectant. Record Keeping There are many records that must be kept on-site for 1 year, and available if asked by your PHI up to 2 years. These records include: Client records Disinfection and sterilization records Maintenance records on devices used for reprocessing tools and equipment Records about invasive procedures and after-care information for clients Records related to accidental exposures to blood or body fluids Day-to-day Operation The work area should be clean, organized, and well lit. Single-use items must be used once and then discarded. Multi-use tools must be cleaned and disinfected between clients. Disinfected tools must be stored in a clean, covered container when not in use. Single-use (disposable) items are not allowed to be saved for future use on the same client. Protecting staff and clients Staff: It is strongly recommended for staff to be vaccinated against Hepatitis B and annual influenza Staff must not come to work ill to prevent infecting other workers and clients Use gloves if coming in contact with non-intact skin and chemicals Clients: Before providing any type of service, make sure the client is in good health and is visibly free from skin infections near the service area This can include illness, lesions, wounds, infection, rashes, breaks in skin, etc. Common Infections: Manicure and Pedicure Fungal Bacterial Viral Infections Cause Infections - Nail fungus - Mycobacterium - HIV - Contaminated (Aspergillus) - Staphylococcus - Hepatitis B equipment - Hepatitis C - Environment - Unclean hands touching treatment area Single-use items Single-use items must be used only ONCE then thrown away or discarded into an approved sharps container. Examples of single-use items: Emery boards Foam or sponge core buffer blocks Foam nail files Pumice stones Wooden cuticle pushers Sand bands Foam toe separators Slippers Credo blade Approved sharps container Sharps such as razor blades and pedicure blades (credo blades) are used only once then discarded into an approved sharps container immediately after use. Approved sharps containers are yellow or red in colour, puncture resistant, closable, leak proof and labelled. Sharps containers must be sealed up when ¾ full and must be taken by a licensed biomedical waste company for disposal. Multi use Items All reusable nail service tools must be cleaned and disinfected with an intermediate or high level disinfectant between clients. Examples of reusable items: - Nail clippers - cuticle nippers - glass/diamond nail files - foot paddles Do not use low level disinfectant such as barbicide to disinfect reusable tools. UV light sterilizers are not approved for sterilization. These units may be used to store cleaned and disinfected instruments. Foot Baths If not properly cleaned, foot baths can transmit bacteria, viruses, and fungi. Foot Baths Foot baths MUST be cleaned and disinfected after each client. After each use: 1. Drain the foot bath completely. 2. Wash the basin with detergent and water, use a brush to remove dirt. Rinse with water. 3. Refill foot bath with lukewarm water just above the jets. 4. Add a disinfectant approved by the manufacturer to the water. If using 5% household chlorine bleach, add 3 tablespoons of bleach for each gallon of water in the foot bath. 5. Activate jets and flush for at least 10 minutes. 6. Drain the foot spa and wipe dry. Foot Baths At the end of each day (8 steps) 1. Remove the screen from the foot bath basin. Remove the drain plug. Clean the screen and drain plug with detergent and a brush. 2. Soak the screen and drain plug for 10 minutes in a solution of 1 teaspoons of 5% household bleach for each cup of lukewarm water. 3. Replace screen and drain plug. 4. Refill foot bath with water just above the jets. Add 2 or 3 tablespoons of detergent, turn on the jets for 5 minutes, drain and rinse. Foot Baths 5. Refill foot bath with lukewarm water just above the jets. 6. Add a disinfectant approved by the spa manufacturer to the water in the foot bath. If using 5% household chlorine bleach, add 6 tablespoons (1/4 cup) of bleach for each gallon of water in the foot spa. 7. Activate jets for 10 minutes. 8. Drain the foot bath and wipe dry. Foot Baths Do not use oil-based products in the foot bath or on the client’s feet or legs before they use the foot bath. Oil will build up in the recirculation lines and give bacteria a breeding ground. You cannot mix chlorine bleach with ammonia products. The combination produces toxic chlorine gas. Record Keeping There are many records that must be kept on-site for 1 year, and available up to 2 years after. These records include: Client records Disinfection and sterilization records Maintenance records on devices used for reprocessing tools and equipment Records about invasive procedures and after-care information for clients Records related to accidental exposures to blood or body fluids How do infections happen? Infections can happen from: The improper cleaning and disinfecting of reusable equipment (piercing device, piercing tools). Improper use of single-use piercing items. Using non-sterile earrings. Unclean skin at the piercing site. Unclean hands touching the piercing area.  Common Infections: Ear Piercing Bacterial Viral Infections Cause Infections Mycobacterium HIV Contaminated equipment Pseudomonas Hepatitis B Environment Hepatitis C Unclean hands touching piercing area Did you know? Infections of the ear lobe are harder to treat because immune cells generally do not circulate in this area. Example of a pseudomonas aeruginosa infection. Image: Journal of American Medical Association Ear Piercing Since piercing the ear involves breaking through the skin, there are important things you must do to prevent the spread of infections and prevent exposure to blood and body fluids. 6 steps to protecting from infections Hand Hygiene Piercing Clean education service and client areas after-care Preventing infections Clean and Cleaning disinfect the ear reusable before tools piercing Sharps Disposal Hand Hygiene Clean hands are important! Before and after each client, or during a break in service, you MUST wash your hands with soap and water or use a hand sanitizer if hands are not visibly dirty. Single use, disposable gloves must be worn on both hands during ear piercing. Gloves must be changed between clients, or breaks in service. Steps to safe ear lobe piercing using an ear piercing device 1. Clean hands before and after each client. ✓ Use hand sanitizer (70-90% alcohol) if your hands are not visibly dirty; or wash your hands with soap and water if your hands are visibly dirty. 2. Check that the client’s skin is free from any cuts, rashes or visible infections. ✓ Do not provide service if there are visible skin conditions and advise the client to seek medical attention. Never offer to treat any skin conditions. Steps to safe ear lobe piercing using an ear piercing device 3. Wear single-use, disposable gloves on both hands during the procedure. Change gloves between clients, or during breaks in service (e.g. leaving the station) of the same client. 4. Clean the front and back of the ear Approved Skin Antiseptics povidone-iodine solution lobe with an approved skin antiseptic. isopropyl alcohol 70-90% 5. Mark the ear lobe with an aseptic ethyl alcohol 70-90% chlorhexidine 0.5% with 70% technique to prevent contamination alcohol benzalkonium chloride 0-0.13% of the marking pen. If using a chlorhexidine gluconate 2-4% (not for use on mucous membranes) reusable pen, then clean the front and back of the ear lobe with an approved skin antiseptic. Steps to safe ear lobe piercing using an ear piercing device 6. Load the ear piercing device without touching either the sterile jewelry or the stud-holding sterile cartridge. Do not spray the sterile jewelry with antiseptic before piercing. 7. Pierce the ear lobe with the sterile jewelry. 8. Discard all disposable parts (i.e. cartridges/adaptors and leftover jewelry in opened packages). 9. Remove gloves and clean hands. Steps to safe ear lobe piercing using an ear piercing device 10. Explain after-care instructions to the client and provide them with written information. 11. Clean and disinfect the ear piercing device with an intermediate to high level disinfectant between clients. 12. Store the ear piercing equipment in a clean enclosed container to prevent contamination and avoid touching the device unless hands are washed and single-use disposable gloves are worn. Sharps Disposal Example of an approved Dermal punches, needles or sharps container sharp tools should be immediately discarded after use to prevent injury. All sharps must be discarded in an approved sharps container.  Types of Ear Piercing Devices There are two types of ear piercing devices; one with no disposable parts and one with some disposable parts. Devices with NO disposable parts must be fully sterilized between clients. If these guns cannot be sterilized, they must not be used. Image: CIPHI Ontario  Types of Ear Piercing Devices Devices with SOME sterile disposable parts must be cleaned and disinfected with an intermediate to high level disinfectant after use. A sterile earring is included in the disposable cartridge. Any disposable parts (cartridges) must Image: CIPHI Ontario be thrown away after use.  Ear cartilage piercing If using a dermal punch (biopsy) tool or a needle to pierce ear lobes or cartilage, it must be purchased as a sterile, single- use, disposable items. Dermal punch tools and needles cannot be re-used and must be disposed of in an approved sharps container after use. Clients must be given verbal and written ear piercing aftercare instructions. After Care Information for Clients Review after care information with clients to reduce the chance of infection. Information should include: ✓ Instructions for proper cleaning and dressing of service site, including potential infection symptoms ✓ Normal bathing and showering are allowed but otherwise keep the pierced area dry ✓ Only touch jewelry with clean hands ✓ If there is redness, pain or swelling that lasts longer than 24 hours, instruct clients to NOT remove the jewelry and see a doctor. Record Keeping There are many records that must be kept on-site for 1 year, and available if asked by your PHI up to 2 years. These records include: Client records Disinfection and sterilization records Maintenance records on devices used for reprocessing tools and equipment Records about invasive procedures and after-care information for clients Records related to accidental exposures to blood or body fluids Types of Services Tattooing involves inserting needles into the skin and injecting dyes or inks to create permanent designs. Since tattooing breaks the skin surface, it is possible for the client and the worker to become infected with a bacteria or blood borne disease. Types of Services Micropigmentation involves inserting needles or making small cuts on the skin surface to create permanent or semi- permanent make-up on a person’s skin. Since this service also uses a needle to insert pigment under the skin, it is possible for the client or worker to become infected with a bacteria or blood borne disease. Types of services Microblading is a semi-permanent form of eyebrow micropigmentation done using a pen-sized blade with a tip made up of several tiny needles/blades. The pigment is applied to the skin and then pushed under the skin using the microblade. Infections with microblading can happen when germs get under the skin. It is possible for the client or worker to become infected with a bacteria or blood borne disease. Types of Services Microneedling is done using a motorized pen-style device or a manual roller-style device with many needles mounted to its surface. These needles are used to create tiny holes in the skin. It is used to treat scars or stretch marks, but may also be used to deliver cosmetic products into the skin. Infections can happen when germs get under the skin. It is possible for the client or worker to become infected with a bacteria or blood borne disease. Types of Services Laser tattoo removal This service involves using a laser to break down tattoo ink particles. With laser tattoo removal, the skin layer is damaged and can be burned, can blister, or scab over. This can lead to infections. Protecting workers and clients Clean hands are important! Before and after each client, or during a break in service, you MUST wash your hands with soap and water or use a hand sanitizer if hands are not visibly dirty. Single use, disposable gloves must be worn on both hands during invasive procedures. Gloves must be changed between clients, or breaks in service. Protecting workers and clients The work area should be clean, organized, and well lit. Single-use items must be used once and then discarded. Do not save and use for future use on same client. Multi-use tools must be cleaned, disinfected and/or sterilized between clients. Disinfected tools must be stored in a clean, covered container when not in use. Sterilized tools should remain in a sterile pouch until time of use. Protecting workers and clients It is strongly recommended for staff to be vaccinated against Hepatitis B and annual influenza Staff must not come to work ill to prevent infecting other workers and clients Wear gloves and use a “no-touch technique” to avoid direct contact with sterile site Protecting workers and clients Preparing the skin before tattoo or micropigmentation: Do not tattoo within 15 cm (six inches) of inflamed or infected skin, or skin with a rash Clean skin with an approved antiseptic before starting. Use soap and water to clean the area first if it is visibly soiled (see next slide for a list of approved skin antiseptics) If a topical anesthetic is used, clean the area with a skin antiseptic before applying the anesthetic If you need to remove hair, use a single-use disposable razor If a soap and water solution is used for lubrication, make it fresh each time Only use stencil-transfer solutions if using a stencil. Approved Skin Antiseptics The following are approved skin antiseptics for cleaning service area before procedure: povidone-iodine solution isopropyl alcohol 70 - 90% ethyl alcohol 70 - 90% (by volume) chlorhexidine gluconate 2 – 4% (do not use around the eyes, inner ear or on mucous membranes) chlorhexidine 0.5% with 70% alcohol benzalkonium chloride 0 – 0.13% Protecting workers and clients Tattoo and micropigmentation services can spread infections by: Touching client with unclean hands Contaminated (dirty) tools, environment and products (e.g. double dipping inks or lubricating products) Re-using single use tools (e.g. ink caps, razors) Improper cleaning and disinfecting of re-usable tools and equipment (e.g. grips, tubes, clamps) Servicing unclean or infected skin areas Improper after care instructions  Service Bacterial Infections Viral Infections Cause Tattooing Mycobacterium, or HIV, Hepatitis B Tap water used in ink, Staphylococcus and C contaminated Also: Fungal (e.g. Candida) equipment, environment, unclean hands touching treatment area, clients own bacteria on skin Microblading and Mycobacterium, or HIV, Hepatitis B Contaminated Micropigmentation Staphylococcus and C equipment or pigments, Also: Fungal (e.g. Candida) unclean hands touching treatment area, clients own bacteria on skin Infections are more easily spread when the service breaks the skin surface. This allow for germs to enter the skin and can lead to localized skin infections or a more serious bloodstream infection. Inks that have been contaminated with bacteria can cause lung disease, joint infections and other organ infections.  The human immunodeficiency virus (HIV) can live in a liquid at room temperature for up to 15 days! It can also survive in pigmented solutions (e.g., tattoo inks). As a result, tattooing machines, along with the tattoo needles, can spread blood-borne diseases. Single use items Single use items used during or after invasive procedures must be sterile and discarded after each client. Sterile items should be safely stored and opened in front of the client. Single-use items should be used wherever possible. Materials used for dressings (e.g., for tattoo aftercare) are to be kept in a cleanable rigid container with a tight-fitting lid to prevent contamination. Remember to check expiry dates on products before using! Examples of Single Use Items Bandages to cover tattoos Cups and liquids used for rinsing between colours Disposable ink caps Elastic bands used on equipment or instruments Lubricant applicators Plastic sheaths (used to cover the tattoo machine, cords, power supply, bottles) Purchased pre-packaged sterile needles Razors Rinsing cups Single-use needle bars Single-use PPE (gloves, masks, gowns, eye protection) Stencils Swabs used to apply skin antiseptic Water mixed with tattoo inks Wipes, tissues, and dental bibs used during procedure Sharps Disposal Example of an approved Single-use sharps must be sharps container discarded in an approved sharps container. Needles or sharp tools should be immediately discarded after use to prevent injury. All sharps must be discarded in an approved sharps container. Re-usable items Re-usable items must be cleaned, and disinfected and/or sterilized between each client. Re-usable critical items (that pierce the skin) MUST be sterilized between each client. Examples of Reusable Tool and Equipment Critical Semi-critical (or Non-critical, Non-critical, Low-Level (requires Items That Intermediate-Level Disinfection sterilization) Hold/Contact Critical Disinfection (if Items) , High Level uncovered) Disinfectant Reusable Microblade Clip cord * Rigid containers ink caps handles Contact screws * used to hold dirty (e.g., metal Service trays * equipment until ink caps) Spray bottles * reprocessing (at Tattoo Tattoo machine and end of day) needles, controls* Scissors used to cut grips, tubes Tube clamp * bandages and tips *If covered with a single-use disposable sheath/cover during use theses items can be reprocessed as a Non-critical item with a Low-Level Disinfection, with the covers being discarded immediately after each use. (if the equipment cannot readily be cleaned and disinfected or sterilized and is not introduced into the body or into body cavities). Re-usable items There are also other items that may be used in service areas that need to be cleaned and disinfected, or protected from contamination with germs. These include: Towels or sheets: Must be changed and laundered between clients. The covered area (e.g. chair) must be cleaned and disinfected with a low-level disinfectant at the end of each day. Lubricants, antiseptics, and styptic products: Must be dispensed in a sanitary manner using single-use tools (e.g. sticks, spatulas) to prevent the product from being contaminated  Disinfectant Level Summary for types of tools and equipment Equipment/Instrument Risk Examples Disinfectant Level Classification Critical item Reusable ink caps (e.g., metal Sterilization ink caps) Tattoo grips, tubes and tips Semi-critical item High-level disinfection (sterilization is preferred) Non-critical items: meant to only Clip cord Intermediate-level touch skin but may accidentally touch Contact screws disinfection broken skin or break the skin and Service trays touch mucous membranes. Spray bottles Tattoo machine and controls Tube clamp Non-critical items: does not directly Scissors used to cut bandages Low-level disinfection touch the client, touches only hair or Rigid containers used to hold non-broken skin. dirty equipment until reprocessing (at end of day) Sterilizers Sterilizers used in personal service settings must meet the standards made by Health Canada and the CSA Group. When buying a sterilizer, check to see if it is licensed for sale by Health Canada by checking the Medical Devices Active License Listing. The preferred sterilizer for heat-resistant equipment and instruments is steam sterilization. Client After-Care Instructions After the tattoo service is provided, the tattooed area shall be covered with a single use dressing intended to cover wounds (sterile gauze or a clean dressing intended for wound care) ointment may also be applied to help prevent infection. Verbal or written instructions may include: Only touching the tattooed area with clean hands The expected healing time of the site Advice on how to deal with minor redness, pain, or swelling Explaining the signs and symptoms of infection A recommendation to see a doctor within 24 hours if there are any signs of an infection after the procedure