Ontario Protocol for Personal Service Workers

Infection Control Program

In accordance with the Mandatory Health Programs and Services Guidelines

Ministry of Health

Public Health Branch

January 1998

  1. Introduction
  2. Glossary
  3. General Guidelines for Equipment, Instruments and Supplies
  4. General Guidelines for Cleaning, Disinfecting and Sterilizing Equipment and the Premises
    1. Introduction
    2. Cleaning
    3. General
    4. Cleaning Work Surfaces
    5. Cleaning of Instruments
    6. Disinfection
    7. Sterilization
    8. Exemption
    9. Disposal of Equipment and Waste
    10. Record Keeping
  5. Health and Personal Hygiene
    1. Health of the Personal Services Worker (P5W)
    2. Health of the Client
  6. Response Procedures for Accidental Exposure to Blood and Body Fluids
    1. Causes of Accidental Exposure
    2. Procedure
  7. Guidelines for Specific Personal Services
    1. Manicuring and Nail Treatments
      1. Additional Requirements to the General Guidelines
      2. Nail Fungus and Nail Mould
    2. Electrolysis
      1. Additional Requirements to the General Guidelines
    3. Tattooing and Micropigmentation
      1. Additional Requirements to the General Guidelines Before Tattooing
      2. Additional Requirements to the General Guidelines After Tattooing
    4. Body Piercing
      1. Additional Requirements to the General Guidelines
    5. Ear Piercing
      1. Choice of Ear Piercing Methods
      2. Additional Requirements to the General Guidelines
    6. Appendices
      1. Preparing Household Bleach Solutions
      2. Hand Washing Procedures
      3. Universal Precautions
      4. Routine Inspections Required for Personal Services
    7. Tables
      1. Recommended Care for Equipment used in Personal Service Premises
      2. Temperature and Time Combinations for Autoclaves
    8. References

    Ministry of Health Infection Control in Personal Services Settings Protocol


    This protocol has been developed for personal service workers (PSWs) to minimize the risk of contracting blood-borne infections for both clients and PSW's during the delivery of personal services. Percutaneous or mucus membrane exposure to blood or body f1uids can lead to infection with blood-borne pathogens including hepatitis B, hepatitis C, human immunodeficiency virus (HIV) and other human retroviruses. For this reason, infection control precautions must be taken in every personal service occupation where blood or body fluid contact is possible Both the client and the operator can be at risk of being infected with blood-borne pathogens. It is important to recognize that blood and body fluids do not have to be visible on the instrument or needle to result in infection.
    This protocol applies to any facility or person offering services where there is a risk of exposure to blood, such as, but not limited to: hairdressing and barber shops, tattoo and body piercing studios, electrolysis, and aesthetic clinics. The following guidelines comprise general recommendations for all personal service facilities and equipment. Requirements specific to each area of practice are presented in summarized formats following the general guidelines.
    Statutory Basis
    This is the protocol named in requirement No. 5 under the Infection Control Program of the Mandatory Health Programs and Services Guidelines, December 1997, published by the Minister of Health as authorized by Section 7 of the Health Protection and Promotion Act, Revised Statutes of Ontario, l990.

    Under the above-mentioned act, each health unit must ensure that the following guidelines are in place, and the recommendations contained in it are followed.

    2.0 GLOSSARY

    The following definitions apply throughout this protocol:

    Acquired Immunodeficiency Syndrome (AIDS)
    A broad spectrum of disease caused by HIV ranging from asymptomatic infection to advanced clinical disease, which is characterized by acquired immunosuppression.
    A chemical agent intended for disinfection of the skin. An antiseptic can inhibit the growth of micro-organisms or destroy these (e.g., 70% alcohol).
    Includes a single-use, disposable spatula or a similar device.
    Blood-borne Infections
    Infections spread through contaminated blood or other bodily fluids, including semen, vaginal secretions or saliva (e.g., HIV, HBV, HCV infections)
    The physical removal of organic matter or debris from objects, usually done by using water, detergent and friction. The process removes micro-organisms primarily by mechanical action but does not kill those remaining on the object.
    The presence of an infectious agent on the body surface or on clothes, instruments or dressings or other inanimate articles or substances including water.
    The spread of infectious agents from a contaminated body surface or instruments, water, food and any other inanimate articles to those that are free of them.
    The intermediate measure that kills or destroys most disease-producing micro-organisms, except spores.
    Hepatitis B infection (HBV)
    An infection of the liver caused by the hepatitis B virus.
    Hepatitis C infection (HCV)
    An infection of the liver caused by the hepatitis C virus.
    Human immunodeficiency virus (HIV)
    The virus that causes AIDS.
    Entry into and multiplication of infectious micro-organisms within the body.
    Infection control
    The process of minimizing the risks of spreading infection while providing personal services.
    Infectious disease agent
    Micro-organisms such as viruses, bacteria, fungi which are capable of producing disease. (Also referred to as "pathogens".)
    Infectious waste
    All waste which is known to be, or could potentially be contaminated with disease-causing bacteria, and/or viruses, and which presents a recognized infectious hazard to individuals who handle it without using appropriate precautions.
    An appliance, apparatus or tool used during the process of carrying out personal services.
    Mucous membrane
    The elastic tissue which lines the cavities connected to the skin, such as eyes, mouth, urethra.
    Entry into the body through injection into the bloodstream, skin, muscle or other tissues.
    Personal service worker (PSW)
    A person who operates or practices in a business offering personal care procedures which may lead to exposure to blood, serum or other body fluids.
    Accidental or intentional break through the skin or other body tissue.
    The destruction of all forms of microbial life including bacterial spores, usually achieved by using heat and steam under pressure.


    Operational Requirements for Equipment. Instruments and Supplies

    1. The work site shall be appropriate to the personal service activity. Work surtace(s) including counter tops, trays, or other surfaces used by the PSW to place instruments and supplies upon during a personal service, shall have a smooth and impervious finish, and shall be cleaned and disinfected with a low to intermediate level disinfectant after each client.
    2. The work area(s) shall be well lit to facilitate cleaning and prevention of injuries.
    3. A sink with hot and cold running water shall be provided for cleaning of equipment and hand washing. Soap, preferably liquid-type, and single-use hand towels must be provided for hand washing.
    4. The equipment and instruments used shall be of durable construction, maintained in good repair, and maintained in a clean and sanitary condition.
    5. When a protective cover is used around a client's neck, a sanitary neck strip or towel shall be used to keep the protective cover from coming into direct contact with the client's neck. The neck strip or towel shall be discarded or laundered after each use.
    6. After each client, every sheet and towel used shall be discarded or deposited in a receptacle (reserved for that purpose) and laundered prior to re-use.
    7. Clean linen shall be stored in a manner that protects it from contamination.
    8. When only a portion of a cosmetic preparation or other substance (i.e., cream, lotion or powder) is used on a client, the portion to be used shall be removed from the container in such a way that the remaining portion is not contaminated (i.e., with a clean disposable wooden blade).
    9. All equipment, instruments and supplies intended for single service use and those that cannot be disinfected or sterilized adequately shall be disposable. These items must not be used on more than one person and must be discarded after being used.
    10. Equipment, instruments and supplies which are, or may come in direct contact with the client shall be thoroughly cleaned, and disinfected or sterilized after each use according to the classification as shown in Table I.


    1. Introduction

      The rationale for cleaning, disinfecting and sterilizing equipment can be understood more readily if client contact equipment is divided into three general categories (critical, semi-critical and non-critical) based on potential risk of infection involved in their use. Critical items are those which penetrate skin or mucous membranes and enter sterile body tissues; semi-critical items are those which come into contact with mucous membranes or which may potentially break skin and non-critical items are those which touch only intact skin or the client environment.

      The following table gives some guidance regarding expectations for care of equipment based on its classification.

      Table I: Recommended Care for Equipment used in Personal Service Premises
      Classification Definition and Method to be Used
      Critical Items that penetrate the skin or mucous membranes and thereby enter the tissues or other normally sterile areas of the body. Examples: needles, probes, filaments, scalpels, razors, piercing gun. Thorough cleaning followed by sterilization is required. Note: Some equipment must be supplied sterile and discarded following use; it cannot be adequately cleaned, e.g., needles.
      Semi-critical Items that come into contact with mucous membranes, those that may potentially penetrate body surfaces, or objects that are used to handle sterile items. Examples: nippers, scissors, forceps or tweezers, probe, needle holder, clippers. Thorough cleaning followed by sterilization if possible; at a minimum, disinfection with 1:10 household bleach solution or another approved high level disinfectant.
      Non-critical Items that come in contact but do not penetrate intact skin, or those that do not ordinarily touch the client. Examples: work surfaces, client chairs or benches, equipment trays, head rests, combs, tanning beds, chairs, counter tops, light handles. Thorough cleaning followed by disinfection with low to intermediate level disinfectant.
      Source: Modified from Alberta Health: Health Standards and Guidelines tor Personal Services, 1995>
    2. Cleaning
      • General
        • In addition to the cleaning/disinfection required after each client, all work surfaces shall be washed with detergent and disinfected with an environmental disinfectant at the end of each working day and when they become visibly soiled.
        • All gowns, drapes, wraps and cloths used in treatment shall be clean, in good repair and shall not be re-used without having been adequately cleaned. Paper coverings shall be disposed of after each client.
        • Materials used for cleaning equipment, such as nylon brushes and pads, should be disinfected after each cleaning session by soaking in a freshly prepared 1:100 household bleach solution (see Appendix I) or other approved environmental disinfectants. When not in use, they should be stored dry.
        • Any other dirty articles, which do not require sterilization, should be placed in the cleaning area to be cleaned as soon as possible. They should be kept separate from the instruments that require sterilization to minimize handling of contaminated articles.
      • Cleaning Work Surfaces Contaminated with Blood or any other Body Fluid
        • Surfaces such as benches, chairs or floors that have become contaminated with blood or other body fluids should be cleaned as soon as possible using a soap and water solution.
        • The surface should then be disinfected with a freshly prepared 1:10 bleach solution and left for a minimum of 5 minutes or 1:100 bleach solution for 30 minutes before wiping dry.
        • Cloths used for wiping up blood or other body fluids should be disposed by placing them in a sealed plastic bag to be placed in regular garbage.
      • Cleaning of Instruments

        After completing a procedure on a client, the following steps must be carried out:
        • Thick, heavy duty, non-disposable rubber gloves should be worn to ensure safety when washing contaminated instruments. Care must be taken at all times to prevent any penetration of the skin or splashing of mucous membranes (such as eyes) during the cleaning process.
        • Dirty instruments should be moved to the cleaning area of the premises for cleaning.
        • If elastic bands are used on clamps or machine heads, the elastic bands are to be removed and disposed of before the clamps are cleaned and sterilized.
        • All used. disposable, sharp instruments should be placed into a regulation "sharps" container immediately after use.
        • All used re-useable instruments should be placed immediately after completing the treatment into a puncture resistant container with a lid and filled with water or a detergent. This container should be labelled "dirty instruments for sterilizing" and only be used for this purpose.
        • Prior to disinfection or sterilization, instruments should be thoroughly washed using water and a detergent either with a brush or an ultrasonic cleaning device.

        The ultrasonic cleaning device may be used if sharps or other intricate items are being cleaned. Ultrasonic cleaners must be operated with the lid on to prevent any microorganisms present in the cleaning solution from becoming airborne and contaminating surfaces in the premises. They must be operated and maintained according to the manufacturer's directions.

        Note: Ultrasonic cleaners do not sterilize or disinfect instruments. However, they do provide a very safe and effective means of cleaning instruments prior to sterilization.

    3. Disinfection

      Disinfection, which is an intermediate level between cleaning and sterilization, ensures the destruction of most vegetative pathogens using chemicals or pasteurization. The level of disinfection achieved depends principally on contact time, temperature, type of chemical germicide and the nature of the microbial contamination.

      Disinfectants may be categorized as: high level disinfectants such as glutaraldehyde, intermediate level disinfectants such as alcohols, phenol or hypochlorite and low level disinfectants such as quartemary ammonium compounds. Disinfectants may destroy bacteria, fungi, viruses and some spores.

      While many environmental disinfectants are appropriate for disinfection, a dilute solution of household bleach is inexpensive and extremely effective. The bleach (5.25% available chlorine) should be diluted to a 1:100 (for intermediate level disinfection) or 1:10 (for high level disinfection) dilutions (see Appendix I) and made fresh daily to preserve the strength.


      • Disinfection must be applied following thorough cleaning to any client contact surface which may have become contaminated with body fluids (i.e., client chair. treatment surface or any surface upon which equipment contaminated with bodv fluids is placed).
      • Items which would normally touch mucous membranes or which inadvertently come into contact with blood or sterile body tissues must be, at a minimum, disinfected between uses. If possible, sterilization is always preferable.
      • Instruments which inadvertently contact body fluids, such as scissors which accidentally nip flesh during a haircut or clippers or nippers which nip the nail bed during a manicure must be cleaned and disinfected appropriately. These instruments must be cleaned with soap and water and a brush and then disinfected (with a recognized disinfectant such as 1:10 household bleach, 70% isopropyi alcohol, or 6% hydrogen peroxide) by immersing for 10 minutes and then allowing to air dry.

        Note: Instruments must not be stored in disinfectant.
    4. Sterilization

      Sterilization is based on the time-temperature exposure using steam under pressure in an autoclave or using a dry heat sterilizer. Heating of the instruments occurs by both steam penetration and heat conduction. The sterilization is dependent on the temperature, pressure, the duration of exposure to steam, packaging of the material and size of the load. It is important that the autoclave chamber be loaded correctly so that steam can circulate and penetrate. Regular maintenance is also very important.

      • Manufacturers' instructions regarding packaging, temperature, pressure and time requirements should be followed. The following are some examples of manufacturers' requirements:

        Table II: Temperature and Time Combinations for Autoclaves
        134-138° (273-281°) 3 minutes
        126-129° (259-264°) 10 minutes
        121-124° (250-255°) 15 minutes
        115-118° (239-245°) 30 minutes
        Source: City of Toronto Department of Public Health: Skin Piercing - Personal Service Workers: Tattoo, Micropigmenuiion, Electrolysis, Body Piercing, 1995
      • For those premises performing procedures in which instruments are expected to contact blood or sterile tissues, equipment must be sterilized using an autoclave which uses heat and steam under pressure or a dry heat sterilizer.
      • While there are effective means of achieving chemical sterilization (i.e.. using Cidex. Glutarex. Omnicide, Sonacide. BM28 Plus which all contain 2% glutaraldehyde), chemical sterilants are not recommended for personal service worker applications because of issues concerning toxicity, disposal, ventilation, and the necessity of long contact times required to achieve sterilization.
      • Requirements
        • A commercially approved autoclave which sterilizes using heat and steam under pressure or a dry heat sterilizer is required in all personal service premises where skin penetration is a feature of the service (e.g., electrolysis, tattoo, micropigmentation).
        • All instruments which normally touch blood or sterile tissues must be sterilized prior to use and sterilized between clients. All needles, metal instruments or other equipment which pierce skin or come into contact with body substances shall be in sterile condition, either supplied sterile as single-use disposable or sterilized in a steam autoclave or a dry heat sterilizer according to manufacturers' instructions for the correct time and temperature.
        • Following sterilization, instruments must be stored in such a way as to protect them from contamination. The best means of avoiding contamination is the use of single-use, sterile, disposable supplies whenever possible.
        • To provide the highest assurance of sterility, critical items should be disposable. In addition, disposable items significantly reduce the cost of staff-time spent on sterilizing items.
        • Critical items (see Table I) shall be:
          • purchased sterile and disposed of after a single use, i.e., needles, probes, razors or
          • (if this is not possible, is acceptable but not advocated) sterilized between use.
        • Equipment which will not be used immediately after sterilization should be packaged to maintain sterility in storage. Appropriate autoclavable packaging is available from suppliers.
        • New reusable instruments should be sterilized before initial use.
        • Autoclaves and dry heat sterilizers should be serviced on a regular basis and their operation monitored routinely as follows:
          • Every load should be packaged with temperature sensitive tape, which indicates by colour change that an adequate temperature has been reached.
          • In addition, the autoclave or dry heat sterilizer must be challenged, at a minimum monthly, with a commercially available preparation of heat resistant spores (Bacillus stearothermophilus}. The spore strips must be sent to a laboratory after exposure in the autoclave to ensure that the bacteria are no longer able to grow: this means the autoclave is operating properly.
          • A log of the monitoring information for each load should be maintained including temperature, pressure, cycle length and test results.

          Note: Domestic pressure cookers, glass-bead sterilisers, microwaves, ultraviolet light, boiling water and dry-heat, domestic ovens are NOT approved means of sterilizing equipment.

      • Exemption

        Premises where there is only ear piercing are exempt from requiring an autoclave or a dry heat sterilizer as long as the following requirements are met:
        • Sterile, prepackage studs on an integrated platform are used in the piercing gun
        • After each client, the gun is fully disassembled, cleaned with soap and water and a brush and disinfected by soaking in a recognized disinfectant (i.e., alcohol, bleach, hydrogen peroxide) for a period which exceeds 10 minutes. The gun is then stored dry in a clean case between uses.
    5. Disposal of Equipment and Waste
      • Place a container labelled "dirty instruments for sterilizing" in the work area for the collection of these instruments.
      • All waste material and other garbage shall be placed in covered receptacles and disposed of in a sealed bag at the end of each day.
      • All used "sharps" (needles, razors or any other sharp piece of equipment capable of puncturing skin) shall be placed in an impervious container labelled "biohazard" and shall be taken by a licensed biomedical waste disposal company for incineration.
      • Used sharps must not be placed in the municipal garbage. Alternatively, some drug stores and health departments may be willing to make arrangements to dispose of small amounts of biomedical waste.
    6. Record Keeping
      • All owners of personal services premises shall keep client records for skin invasive procedures. The records should include:
        • date of procedure
        • client name, address and telephone number
        • procedure carried out
        • any relevant comments.
      • Records must be kept for a minimum of one year.


    1. Health of the Personal Services Worker (PSW)
      • The PSW shall ensure that their own health does not in any way endanger the health of the client's. For this reason a high standard of personal hygiene is necessary. Hands must be washed well for 10-15 seconds with soap and water before and after each client (see Appendix II). All cuts and wounds must be washed and dressed immediately with a waterproof dressing.
      • The PSW must wear clean, washable clothing while working and must refrain from eating, smoking or drinking while working.
      • During any procedure, good infection prevention practices and universal precautions shall be followed to prevent contamination of disinfected or sterilized equipment through contact with work surfaces, clothing or hands (see Appendix III).
      • Care should be taken to prevent puncture wounds and abrasions to the PSW from needles, razors or glassware. Should such an incident occur, wash the wound well encouraging it to bleed freely, dress the wound, consult a physician immediately and document any such incident in the records.
      • Immunization to protect against hepatitis B is strongly recommended for all PSWs. This vaccine is available from family doctors.
      • If used, impervious, single-use gloves must be changed between clients and between breaks in treatment of the same client. Impervious gloves must be worn for invasive procedures like tattooing, piercing or electrolysis.
    2. Health of the Client
      • The PSW must ensure any part of the body to be treated is clean and free from any cuts, wounds, rash or visible skin disease.
      • For invasive procedures, the area to be treated must be cleaned before treatment with an alcohol-impregnated swab or other recognized skin antiseptic. If the area is to be marked or stencilled, this must be done prior to disinfection.
      • If a client's skin is punctured accidentally with non-sterile equipment, wash the wound well encouraging it to bleed freely, dress the wound and document any such incident in the records. The client should be advised to consult a physician.


    1. Causes of Accidental Exposure

      Exposure to blood and body fluids presents the risk of infection from blood-borne pathogens such as hepatitis B virus (HBV), hepatitis C virus (HCV), or HIV. The following could result in exposure to blood-borne pathogens:
      • a needle stick or cut from a used needle or sharp object contaminated withblood/body fluid
      • a splash of blood/body fluid onto broken skin (open cut. wound, dermatitis)
      • a splash of blood/body fluid onto mucous membrane (eyes, nose. mouth).
    2. Procedure

      If an accidental exposure occurs, the following procedures should be followed:
      • Wash the exposed skin surface with water and soap or a germicidal hand-washing solution. If the area is bleeding, allow it to bleed freely. After cleaning the wound, apply a skin antiseptic and cover with a sterile dressing or band-aid. If there has been a splash on to the mucous membrane, flush the area thoroughly with water.
      • The person exposed should immediately contact the family doctor for assessment of the need to receive post-exposure prophylaxis and to determine if the individual has completed a series of hepatitis B vaccine.
      • A record of the incident should be kept by the owner of the premises including:
        • name, address and phone number of the client, name of PSW
        • date of injury
        • circumstances surrounding the injury
        • action taken.
      • Records should be kept for a period of one year.


    1. Manicuring and Nail Treatments

      • Additional Requirements to the General Guidelines
        • Great care must be taken to avoid piercing the client's skin, especially when cutting cuticles or filing the nails.
        • Disposable instruments are to be discarded after use on each client.

      • Nail Fungus and Nail Mould
        • Clients' nails should be carefully examined prior to providing nail services. While not blood-borne infections, nail fungus and mould are surprisingly common and are often seen in the salon. Nail fungus usually appears as a discoloration in the nail that spreads toward the cuticle. Nail mould can be identified in the early stages as a yellow-green spot that becomes darker with time.
        • Nail services shall not be provided for a client who has this type of discoloration on his or her nails. Clients with this condition should be advised to see their doctor for appropriate treatment.
    2. Electrolysis - Additional Requirements to the General Guidelines
      • Any sterilized instruments or needles accidentally touched or contaminated in any other way, either before or during a treatment, shall be replaced with a sterile instrument or needle.
      • Care shall be taken when inspecting needles for defects, such as damaged or blunt points. They must be supplied packaged and sterilized prior to use and should only be visually inspected.
      • Needles must never be tested for sharpness on the operator's skin before use.
      • It is required that only single-use, sterile needles are used as this minimizes the risk of infections.

        Saving needles for re-use on the same client poses an occupational risk. There may be confusion leading to their use on more than one client. There is no need to use reusable electrolysis needles, as disposable needles are inexpensive and are readily available.

        The heat produced by the current passing through an electrolysis needle will not cause the needle to become hot enough to be sterilized. The temperature is only likely to reach 70-80°C and the period that the current passes through the needle is too short (1-2 seconds only) for sterilization to occur.
      • The removable tip of the epilator needle/probe holder is not an invasive instrument, however, it may become contaminated with blood, serum or other material on the skin and should be cleaned and disinfected before re-use. The removable tip of the epilator needle/probe holder should be removed after each treatment and cleaned with soap and water or detergent, rinsed, dried and disinfected by submersion in 70% isopropyi alcohol or other approved high level disinfectant for 10 minutes and allowed to air-dry.
      • The portion of the epilator cord which comes into contact with the client's treated skin should be wiped with a detergent-germicide between clients, as should the magnifying lamp, the client eye shields and the rod held by the client during the procedure.
      • A laser device using light energy is not an invasive apparatus itself, however, instruments used in assessing a client or during treatment (e.g., forceps, hand pieces, distant gauges and caps) might touch the skin and/or become contaminated with blood, serum or other material on the skin. These instruments should be cleaned and disinfected after each client.
    3. Tattooing and Micropigmentation
      • Additional Requirements to the General Guidelines Before Tattooing
        • To prevent surfaces from being contaminated in the event that an item has to be handled or adjusted while tattooing is in progress:
          • Spray-bottles and ink bottles should be covered with single-use plastic bags, so that only the nozzles are exposed.
          • Any surfaces which may need to be touched, for example light fittings and power pack controls, should be covered with cling film. This should be changed between clients if touched while serving a previous client.
          • The required number of single-use, disposable ink caps should be placed into stainless steel ink cap trays and inks should be dispensed into ink caps. The stainless steel caps should be sterilized. Alternatively, inks may be dispensed onto a single-use, disposable tray. Any leftover ink must be discarded with its container after each client.
          • Water used for rinsing between colors should be placed in disposable cups and the water and cups disposed after each client.
          • Tissues or wipes to be used during tattoo procedures should be stored where they cannot become contaminated. Enough wipes to be used on one client should be kept in the working area and any not used should be immediately discarded after each client.
          • Hands should be washed thoroughly and disposable impervious gloves worn.

        • Any sterile instruments accidently touched or contaminated in any other way should be replaced immediately, either before or during a treatment, with another sterile instrument or needle.

        • Needles must never be tested for sharpness on the operator's skin.

        • A tattoo should not be carried out within six inches of an inflamed, infected area of skin or skin with a rash.

        • The client's skin may be covered with lubricating jelly. It is important that the jelly be removed from the original container using clean, single-use applicator. If extra jelly is required on the client, a new spatula should be used each time. Because of the high risk of cross-contamination of the pump outlet, self-dispensing pumps for lubricating jelly should be used only to dispense onto a clean single-use applicator. Under no circumstances should petroleum jelly be removed from the container using gloves or bare fingers.

        • Only single-use, disposable needles may be used. The estimated number of needles needed for one day's work should be soldered on to the rods with lead-free solder in advance of the day's work if the implanter type tattoo machine is being used. If the stylus-type machine is to be used, sterile, pre-packed, disposable needles and stylus tips or caps should be supplied.

        • Parts of the tattooing instrument which cannot be sterilized (frame, motor and cord clip) should be protected with impervious single use, disposable covers or at a minimum, wiped thoroughly with disinfectant between each client.

        • The rods or needle bar and needles should be treated ultrasonically to remove flux residue, dust and any organic matter. The rods and needles should then be sterilized in an autoclave. The tubes and kidney dishes must be similarly cleaned and sterilized (or provided sterile for single use).

      • Additional Requirements to the General Guidelines After Tattooing
        • The tattoo must be covered with a clean and preferably sterile, non-stick dressing.

        • Any tool touched with gloved hands must be considered contaminated and must also be disinfected between clients.

        • Needle bars and tubes must be disengaged from the machine and placed in the ultrasonic cleaner. The tube may then be packaged for sterilization. The needle bars must then be disassembled (clip and dispose of old needle), rebuilt and re-cleaned in the ultrasonic cleaner; they may be packaged for sterilization.

        • Cleaned needle bars, needles and tubes can then be sterilized in an autoclave.

        • Pigment capsules with remaining dyes must be disposed of in a lined garbage container.

        • Any leftover jelly must be discarded. It may not be returned to the original container and must not be used on another client.

        • Any stencil used on a client must be discarded. Because of the high risk of cross-contamination with blood, it is important that stencils are not re-used on other clients.

        • Working surfaces, such as chairs and tables, must be cleaned and disinfected with a low level disinfectant between clients.
    4. Body Piercing - Additional Requirements to the General Guidelines
      • Needles must be pre-packed, pre-sterilized, single-use and be disposed of after use in an approved sharps box. Should needles be prepared by the operator, they must be filed down, cleaned in an ultrasonic cleaner and, sterilized in peel-away packs in an autoclave prior to use.
      • A no-touch technique (using sterile forceps) should be used to reduce the risk of skin or soft tissue infection.
      • If the piercing site is to be marked, it should be done with an indelible ink before the skin is cleansed. The skin should the be cleansed with 70% isopropyi alcohol or 10% povidone iodine (Betadyne). A surface anesthetic may be applied using a sterile disposable swab.
      • Ear piercing guns are not suitable for use on parts of the body other than the lobe of the ear. Body piercing guns are inaccurate, non-sterile and should not be used.
      • The operator should not use a piercing stud when piercing any part of the body other than the lobe of the ear. A captive bead ring or nostril screw should be used instead.
      • Clients should be given verbal and written information regarding body piercing after-care:
      • normal bathing and showering is permitted but otherwise keep the pierced area dry
      • clean hands before touching jewelry
      • turn jewelry when wound is not dry
      • do not closely cover wound - allow access to air
      • the expected healing time of the wound should be discussed with the client
      • describe possible complications and their signs and symptoms and the indicators of each
      • advise on how to deal with slight redness, pain or swelling with recommendations to consult a family physician if the problem does not improve within 24 hours
      • advise not to remove the jewelry from an apparently infected piercing but to seek medical advice.

    5. Following piercing, all non-disposable equipment should be washed with soap and water or detergent in an ultrasonic cleaner and, following rinsing, be sterilized in an approved steam autoclave or a dry heat sterilizer.
  8. Ear Piercing
    • Choice of Ear Piercing Methods
      • An ear piercing system designed in such a way that contamination of the gun does not occur is highly recommended. In these systems, a pre-sterilized capsule containing the studs and butterflies is inserted into the gun. No contact occurs between the gun and the ear, and the capsule is discarded after the studs are inserted. Guns which have disposable cartridges to hold studs are recommended as they further reduce the risk of transmission of blood-borne diseases. Where methods of ear piercing using a trocar and cannula or needle and cork are used, all articles that penetrate the skin (i.e., needle, cork) must be disposed of or cleaned and sterilized (i.e., forceps) in strict accordance with the sterilization procedures outlined under the General Guidelines (Section 3).
  9. Additional Requirements to the General Guidelines
    • All ear piercing guns must be thoroughly cleaned and disinfected, especially the stud holders, to minimize the risk of spreading infection. Clean guns should always be stored in a clean, covered container when not in use.
    • Only studs that have been taken from a sealed package should be used. Strict care must be taken when handling ear piercing equipment, so as not to contaminate sterile ear studs.
    • Any stud packets that have been opened previously or where the pack is split must not be used for piercing. The contents of these packs are no longer sterile and may cause infection if used for this purpose. They can, however, be sold in the same way other studs and earrings are sold.
    • Sterile studs must not be handled with bare hands. The PSW must be familiar with the correct loading procedures for the gun to be used. All guns should be capable of being loaded without the need to touch the studs or the stud holding devices on the gun. If forceps are used, they must be sterilized prior to use.
    • Disposable cartridges - used in some guns for holding of studs - must be disposed of after use on each client.
    • The personal services premises should have a sink with hot and cold running water for hand washing and cleaning of equipment.


  1. Preparing a 1:100 Household Bleach Solution (for intermediate level disinfection)

    • 50 mL (1/4 cup) household bleach + 4000 mL (16 cups) water, or
    • 5 mL (1 tsp) household bleach + 500 mL (2 cups) water
    This standard solution should be used for disinfecting non-critical items and surfaces.
    This standard solution should be mixed daily to preserve the strength.

  2. Preparing a 1:10 Household Bleach Solution (for high level disinfection)

    • 500 mL (1 cup) household bleach + 2250 mL (9 cups) water, or
    • 125 mL (1/4 cup) household bleach + 1125 mL (2 1/4 cups)
    This strong bleach/water solution should be used to decontaminate areas and surfaces following contact with body substances. Such situations include:
    • blood contaminated items and work surfaces
    • all semi-critical items not sterilized.
    This strong solution should be mixed daily to preserve the strength.

APPENDIX II - Hand-Washing Procedures

The best way to stop diseases from spreading is to wash hands before attending to any new clients and after finishing with each client. The following steps should be followed to make sure hands are free of infectious disease agents:
  1. Wet hands with warm running water.
  2. Apply liquid soap and lather well. Rub hands vigorously for 10-15 seconds as they are being washed.
  3. Wash all surfaces including: backs of hands, wrists, between fingers and under nails.
  4. Rinse hands well. Leave the water running.
  5. Dry hands with a single-use towel.
  6. Turn off the water using the same towel, or with a paper towel, not bare hands.

Note: When hands are washed frequently, it is important to dry them gently and thoroughly to avoid chapping. Chapped skin breaks open, allowing bacteria to enter. Hence, if hands are washed frequently, hand lotion should be applied as needed to keep the skin soft and reduce chapping.

APPENDIX III - Universal Precautions

In 1987, the United States Centers for Disease Control and Prevention (CDC) and Laboratory Center for Disease Control in Canada (LCDC) published guidelines on how to prevent the transmission of HIV to health care workers, including PSWs. The guidelines outline work practices to prevent parenteral, mucus membrane and non-intact skin exposure to blood-borne pathogens.

PSWs need to consider all clients as being potentially infected with blood-borne pathogens. The universal precautions approach, which treats all clients as potentially infectious, varies from the traditional approach which advised precautions only when an infection was known to exist.

Universal precautions pertain primarily to preventing transmission of blood-borne pathogens from exposure to blood/body fluids according to the level of risk shown below:

Universal precautions are not meant to prevent transmission of microbes that are not blood-borne such as pathogens contained in skin pimples. Hands are the most common vehicle of transmission. Therefore, hand washing is still the most important infection prevention measure (see Appendix II).

PSWs who may be potentially exposed to blood and body fluids should strictly follow universal precautions to minimize the risk of exposure to blood-bome pathogens. The following elements of universal precautions are very important:

1. Hand-washing
Wash hands before and after each client contact, after contact with contaminated articles, after removing gloves and after inadvertent exposure to blood or body fluids. Gloves are not a substitute for hand-washing.
2. Gloves
Wear gloves as a skin barrier when contact with blood/body fluids or mucous membranes is likely. The glove type should be appropriate for the procedures being performed. Both latex and non-latex (e.g., vinyl, nitrile, etc.) gloves are effective barriers but latex generally provides a better fit.
3. Protective Clothing
Wear gowns or aprons during procedures where street clothing is likely to become soiled. Soiled gowns or aprons should be changed after each client.
4. Proper Handling of Sharps to Avoid Needlestick Injuries
Avoid recapping, breaking, bending or otherwise manipulating needles, filaments or other sharp devices during personal service procedures, when cleaning instruments and when disposing of used sharps. Easily accessible puncture resistant sharps containers shall be utilized for all sharps disposal.

Note: PSWs who have dermatitis or skin lesions should refrain from direct client care and from handling client equipment until the condition is healed, unless appropriate barriers can be worn.

PSWs who are pregnant are not at greater risk of contracting HIV or other blood-bome infections, but should strictly follow universal precautions to minimize the risk.

APPENDIX IV - Routine Inspections Required for Personal Services

Personal Service Setting or Service Provided Number of Inspections Required Annually*
Body Piercing. Micropigmentation. Tattooing at least one routine inspection
Ear Piercing at least one routine inspection
Electrolysis at least one routine inspection
Manicure, Pedicure at least one routine inspection
Hairdressing, Barber shop at least one routine inspection
* Routine- Inspections should be separated by at least four months


  1. Ontario Ministry of Health. Mandatory' Health Programs and Sen'ices Guidelines. Toronto. Ontario: Queen's Printer for Ontario, December 1997; 47.
  2. Benenson AS. Control of Communicable Diseases Manual. American Public Health Association, 1995, pg 534-5.
  3. Fauci AS, Clifford-Lane H. Human Immunodeficiency Virus (HIV) diseases: AIDS and related disorders, in: Hamson's Principles of Internal Medicine 13'1' Edition. New York: McGraw-Hill Inc., 1994, pg 1567.
  4. Health and Welfare Canada, Health Services and Promotion Branch. Infection Control Guidelines, 1988.
  5. Alberta Health. Health Standards and Guidelines for Personal Services, 1995.
  6. Dychdala GR. Chlorine and Chlorine compounds, in: Block SS, Disinfection. Sterilization, and Preservation 4th Edition, Philadelphia: Lea and Febiger, 1991, pg 146 and 1012.
  7. Cremieux A, Fleurette J. Methods of Testing Disinfectants, in: Block SS, Disinfection, Sterilization, and Preservation 4'1' Edition, Philadelphia: Lea and Febiger, 1991, pg 146 and 1012.
  8. Favero MS. Chemical Disinfection of Medical and Surgical Materials, in: Block SS. ED. Disinfection, Sterilization and Preservation 3rd Edition, Philadelphia: Lea and Febiger, 1983, pg 469-92.
  9. Health Canada. Recommendations for Prevention of HIV Transmission of Human Immunodeficiency Virus, Hepatitis B virus and other Blood borne Pathogens in Health Care Settings. Canada Diseases Weekly Report 1988; 117-124.
  10. City of Toronto Public Health Department. Skin Piercing - Personal Service Workers: Tattoo, Micro pigmentation. Electrolysis, Body Piercing, 1995.
  11. Australia, Victorian Government of Human Services, Public Health Division. Standards of Practice for Beauty Treatment and Electrolysis, 1996. Health (Infectious Diseases) Regulations 1990.
  12. Australia, Victorian Government of Human Services, Infectious Diseases Unit. Standards of Practice for Hairdressing, 1996. Health (Infectious Diseases) Regulation 1990.
  13. Australia, Victorian Government of Human Services, Infectious Diseases Unit. Standards of Practice for Tattooing and Body Piercing, 1996. Health (Infectious Diseases) Regulation 1990.

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