Spa Infections and Prevention

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Spa Infections and Prevention

• Dr. Wendy Smeltzer
• BSc, MD, CCFP, FCFP
• Santé Spa
• Calgary, AB and Victoria, BC

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Overview

• Chain of infection
• Infection risks in spa
• Classification of spa services
• Appropriate cleaning according to classification
• General precautions for spa

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Why is this important?

• Protect the spa worker
• Protect the spa guest
• Promote the spa industry generally

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The Chain of Infection
Agent (germ)
Reservoir (where germs are found)
Host (susceptible person)
Portal of Entry (way germs get in)
Portal of Exit (way germs get out)
Means of Transmission (way germs travel)
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Infectious agents (Germs)

• Bacteria Staph. aureus (boils), Streptococcus
  (impetigo), Pseudomonas(folliculitis)
• Viruses Hepatitis B and C, HIV, HPV(warts),
  HSV (coldsores)
• Fungi Tinea pedis (athletes foot), other Tinea,
  Candida (paronychia)
• Other parasites scabies, lice

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Reservoir (hiding place)

• People
• The environment (water, air, organic matter)
• Contaminated product

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Transmission germs move around

• Direct or indirect contamination
• Contaminated objects
• Droplet spread
• Airborne spread

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Portal of entry (Where germs get in)

• Any opportunity where first level of defense is
  breached (breaks in the skin, abrasion, cut)
• Aerosols (breathe it)

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Work surfaces

• Can act as a reservoir of infectious agents
• Moisture/warmth contribute ( ie.footbaths)
• Survival times of organisms not precisely known
  HIV in hours, Hep B in years!

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Procedures

• Contaminated implements
• Contaminated equipment
• Skin contaminants
• Blood and body fluids do not have to be visible
  to transmit infection!!

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People

• Staff
• Guests
• Resident vs Transient Flora

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Transmission of infection from a spa treatment

• Vehicle born contaminated items such as
  implements, linens
• Direct exposure walking surfaces
• Direct contact skin to skin contact

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Types of infections

• Facials folliculitis, impetigo, coldsores
• Pedicures- plantar warts, athletes foot
• Manicures- paronychia, nail fungus
• Massage- scabies, ringworm
• Waxing bacterial and viral infections
• Potential for Hepatitis B and C and HIV if any
  blood exposure

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Prevention of Infections

• Important to know the level of disinfection
  required for the procedure performed!

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Classification of Procedures(Spaulding)

• Critical
• Semi-critical
• Non-critical

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Critical Classification

• Items that penetrate the skin or mucous membranes
• Examples needles, surgical instruments
• Appropriate cleaning method Sterilization

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Semi-critical

• Items that come into contact with mucous
  membranes and skin that may not be intact
• Example nippers, extractors
• Appropriate cleaning method Intermediate to
  high level disinfection, sterilization

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Non-critical

• Items that come in contact but never penetrate
  intact skin
• Examples make up brushes
• Appropriate cleaning method Low level
  disinfection

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Cleaning

• Important first step!
• The physical removal of organic matter or debris
  from objects
• Will remove some organisms but does not kill
  those remaining behind on the object

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Low level disinfectants

• Will kill some bacteria, viruses and fungi but
  not effective against all
• QUATS (quaternary ammonium cmpds)
• - Barbicide, Zephiran, Fulltrol Plus, A456N
• Phenols
• -Dettol, Lysol

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Intermediate level disinfectants

• Destroy most bacteria, viruses and fungi except
  TB and spores
• Level varies widely among products and situation
• Alcohols 70 Ethanol, Isopropanol
• Halogens - Bleach (110 dilution X 10min)
• Some phenols and iodophors
  - Sanikleen, Surgikleen

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High level disinfectants

• Kills all bacteria, viruses and fungi but not
  spores
• Glutaraldehyde 2
• Hydrogen Peroxide 6
• Peracetic Acid 1

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Sterilization

• Destruction of all forms of microbial life
• Autoclave (steam under pressure)
• Dry heat
• Liquid chemical sterilants
  (exposure time critical)
  
• Chemical Vapour , Chemi-clave
• (ethylene oxide)

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Glass bead, ultraviolet methods and boiling in
water are not capable of sterilizing implements
and instruments!

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3 Principles for Success with Disinfection

• Choose the correct product for level of
  disinfection needed
• Use correct protocol
• Regular compliance

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Disinfectant Products

• Regulated as drugs in Canada (purpose of disease
  prevention and health preservation)
• DIN number ensures product is effective
• MSDS material safety data sheet

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General practices of spa workers

• Handwashing guidelines
• Bloodborne pathogen precautions
  (Universal precautions)

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Hands are the most common vehicle for
transmission of infection!

• 80 of common infections
• spread by hands

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Handwashing is still the most important method to
prevent transmission of infections!
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Poor Compliance

• General population
• -95 say they wash hands
• -67 actually do
• Health care workers
• -range 5 to 81
• -overall avge 40

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Poor technique!

• No soap (water only not enough!)
• Inadequate time (9.5 sec vs 15-20 sec)
  Twinkle, twinkle little star
• Not entire hand surface
• Not rinsing well (10 sec needed)
• Not drying completely
• Handling taps

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Alcohol based waterless agents

• Improved compliance
• Many advantages
• No water needed
• Fast to use
• Less skin irritation
• Do not promote resistance

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CDC Hand Hygiene Recommendations October 2002

• Wash hands when hands are visibly dirty or
  contaminated
• If hands not visibly soiled, use an alcohol-based
  hand rub for routinely decontaminating hands.
  Alternatively can wash hands with an
  antimicrobial soap and water.

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Other recommendations

• Provide workers with hand lotions or creams to
  minimize risk of irritant dermatitis
• Natural nail tips less than ¼ inch long
• No artificial nails or extensions in high risk
  situations
• No recommendation regarding wearing rings

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Blood-borne pathogens precautions(Universal
Precautions)

• Consider all clients as being potentially
  infected with blood-borne pathogens
• Canada Hepatitis C 10 in 1000
• Hepatitis B 5 in 1000
• HIV 1.5 in 1000

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Gloves

• Wear gloves when contact with blood, mucous
  membranes and non-intact skin
• Wear gloves if worker has dermatitis or skin
  lesions
• Latex generally better than vinyl but both are
  effective
• Important to decontaminate hands before and after
  glove use

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Attention to hygiene in the work environment
benefits both staff and guests and builds public
confidence in the spa industry!
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Questions?