1453 n. hwy. us #1, unit 32 ormond beach, fl 32174 1-888 ... · chapter 7 cosmetologist sanitation,...

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1453 N. Hwy. US #1, Unit 32Ormond Beach, FL 321741-888-857-6920 (toll free)

Fax (386) 615-1812

Dear Colleague:

Over the years one of the biggest complaints we have had from licensees is that they want courses tailored justto their profession. We listened to your concerns and this year we have printed 3 different course books; onebook for cosmetologists, one for nail technicians, and one for estheticians. You are receiving a course bookfor your profession. If you have more than one license you may receive more than one book, but you onlyneed to complete one course book.

This book contains 16 hours of material and will meet all your continuing education requirements. We havesome brand new courses this year that we think you will find interesting and have updated all the staterequired courses with new material.

As always we are determined to set the standard in quality continuing education at a guaranteed low price. Wewill accept all competitors price specials or coupons if their price is lower than mine. Simply enclose theircoupon with your test and pay that amount, no questions asked. We simply will not be undersold.

Just a reminder, our web site allows you to check your answers and print out your certificate of completioninstantly. Our website address is www.elitecme.com. You may also complete your test by mail, fax or phone.

Why go anywhere else for your continuing education? Please call us toll free if you have any questions.

Sincerely,

Annette MowlPresident

Course approved by the Board of Cosmetology. Provider Number 0001553

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The Board of Cosmetology’s records indicate that your license will expire on October 31st. Therefore, you are required to complete 16 hours of continuing education prior to renewing your license. Be sure to complete your education through an approved provider. All approved providers receive a state number. Our provider number is 0001553.

This course contains everything you need to meet the Board of Cosmetology’s continuing education requirements. Chapter 1~HIV/AIDS (2 hours), Chapter 2~Chemical Makeup & Conditions of Hair (2 hours), Chapter 3~Florida Statutes &

Administrative Code (2 hours), Chapter 4~Workers Compensation (1 hours), Chapter 5~(OSHA) Education & Salon Safety (1 hour), Chapter 6~ Environmental Issues (1 hour), Chapter 7~ Cosmetologist Sanitation, Sterilization & Safety: New Risks(3 hours),Chapter 8~Cosmetology:Retail Sales (2 hours) and Chapter 9~Dealing With Difficult People (2 hours). Carefullyreview the information contained in these chapters.

After reading the information, you must complete the final exam on pages 62 - 64 marking your answers on the answer sheet on page 65. Fill out all information on the answer sheet (be sure to fill in your license number) and include payment for $17.50 payable to Elite CME. You can then mail in your course using the envelope provided or for faster service you can fill in your credit card number and fax your test to us at (386)615-1812. As long as you receive a 75% or better on your exam you will be issued a certificate of completion and we will notify the Board of Cosmetology that you have completed your continuing education. Don’t forget our website at www.elitecme.com is also an easy way for you to complete your education.

Yes, we electronically report your hours to the Board within 24 hours of receiving your test.

The Board of Cosmetology sends out their license renewal notices approximately 90 days before your license expires. If you have moved and do not receive a renewal notice, you should call the board at 1(850)487-1395. It is important to remember that completing your continuing education does not renew your license. Renewing your license is done through the Board, not your continuing education provider.

No, continuing education is done through private board approved providers.

In lieu of the renewal notice that was mailed to each licensee, send a copy of your license, a request to change the address (if applicable) and the appropriate fee made payable to Department of Business and Professional Regulation (DBPR) and mail it to DBPR 1940 N. Monroe Street Tallahassee, FL 32399. You may also contact the board by phone to renew at 850- 487-1395, or go to www.myfloridalicense.com to renew by internet.

No problem, we are here to help you. Call us toll free 1(888)857-6920.

Complete your test by mail, internet, fax, or phone.New course material.

COMPLETING YOUR CONTINUING EDUCATION IS EASY!!Carefully Read the Information Below.

Why am I receiving this course?

How do I complete this course?

How do I get my test graded and do I get a certificate of completion?

Do you report my hours to the Board of Cosmetology?

When does the state send out notices of license renewal?

Does the State or the Board of Cosmetology offer a continuing education course?

I did not receive a license renewal notice from the Board of Cosmetology. How do I renew my license? Reminder, renewal notices are mailed in late July.

I still have questions.

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Chapter 1 HIV/AIDS (2 credit hours)......................................................................................................Page 1

Chapter 2 Cosmetology: Chemical Makeup and Conditions of Hair(2 credit hours)......................................................................................................Page 7

Chapter 3 Florida Statutes & Adminstrative Law(2 credit hours).......................................................................................................Page 16

Chapter 4 Worker’s Compensation(1 credit hour)........................................................................................................Page 24

Chapter 5 (OSHA) Education & Salon Safety(1 credit hour)........................................................................................................Page 29

Chapter 6 Environmental Issues(1 credit hour)........................................................................................................5

Chapter 7 Cosmetologist Sanitation, Sterilization and Safety: New Risks(3 credit hours).......................................................................................................Page 39

Chapter 8 Salon Professional: Retail Sales(2 credit hours).......................................................................................................Page 50

Chapter 9 Dealing With Difficult People and Situations(2 credit hours).......................................................................................................Page 56

Final Examination Questions......................................................................................................Page 62

Final Examination Answer Sheet............................................................................................... Page 65

Course Evaluation........................................................................................................................Page 66

All Rights Reserved. Materials may not be reproduced without the expressed written permission or consent of Elite CME Inc.. The materials presented inthis course are meant to provide the consumer with general information on the topics covered. The information provided was prepared by professionals withpractical knowledge in the areas covered. It is not meant to provide medical, legal or professional services advice. If necessary, it is recommended that youconsult a medical, legal or professional services expert licensed in the State of Florida.

Elite CME 16 Hour Continuing Education Course

for the Cosmetologists

CHAPTER 1HIV / AIDS

(2 Credit Hours)

We try are best to change our information so that you don't end up read-ing the same information every two years. This year's HIV course hassome of the same basic information, but we have also done a snapshot ofhow the disease began and how quickly it became an epidemic. In addi-tion, this year we have added a section about how HIV research is help-ing solve other medical conditions and how you should deal withHIV/Aids employees. We hope you find it informative.

Learning Objectives:Define HIV and AidsList the Risk factors for HIVDescribe how research helps solve other medical conditionsDescribe how you should deal with HIV infected employees

INTRODUCTIONAIDS (acquired immunodeficiency syndrome) was first reported in theUnited States in 1981 and has since become a major worldwide epidem-ic. AIDS is caused by HIV (human immunodeficiency virus). By killingor damaging cells of the body's immune system, HIV progressivelydestroys the body's ability to fight infections and certain cancers. Peoplediagnosed with AIDS may get life-threatening diseases called opportunis-tic infections, which are caused by microbes such as viruses or bacteriathat usually do not make healthy people sick.

More than 900,000 cases of AIDS have been reported in the UnitedStates since 1981. As many as 950,000 Americans may be infected withHIV, one-quarter of who are unaware of their infection. The epidemic isgrowing most rapidly among minority populations and is a leading killerof African-American males ages 25 to 44. According to the Centers forDisease Control and Prevention (CDC), AIDS affects nearly seven timesmore African Americans and three times more Hispanics than whites. Inrecent years, an increasing number of African-American women and chil-dren are being affected by HIV/AIDS. In 2003, two-thirds of U.S. AIDScases in both women and children were among African-Americans.

TRANSMISSIONHIV is spread most commonly by having unprotected sex with an infect-ed partner.

Risky behaviorHIV can infect anyone who practices risky behaviors such as

• Sharing drug needles or syringes • Having sexual contact• Having sexual contact with someone whose HIV status is

unknown

Infected bloodHIV also is spread through contact with infected blood. Before donatedblood was screened for evidence of HIV infection and before heat-treat-ing techniques to destroy HIV in blood products were introduced, HIVwas transmitted through transfusions of contaminated blood or bloodcomponents. Today, because of blood screening and heat treatment, therisk of getting HIV from such transfusions is extremely small.

Contaminated needlesHIV is frequently spread among injection drug users by the sharing ofneedles or syringes contaminated with very small quantities of bloodfrom someone infected with the virus.

It is rare, however, for a patient to give HIV to a health care worker orvice-versa by accidental sticks with contaminated needles or other med-ical instruments.

Mother to child Women can transmit HIV to their babies during pregnancy or birth.Approximately one-quarter to one-third of all untreated pregnant women

infected with HIV will pass the infection to their babies. HIV also can bespread to babies through the breast milk of mothers infected with thevirus. If the mother takes certain drugs during pregnancy, she can signifi-cantly reduce the chances that her baby will get infected with HIV. Ifhealth care providers treat HIV-infected pregnant women and delivertheir babies by cesarean section, the chances of the baby being infectedcan be reduced to a rate of 1 percent. HIV infection of newborns hasbeen almost eradicated in the United States due to appropriate treatment.

A study sponsored by the National Institute of Allergy and InfectiousDiseases (NIAID) in Uganda found a highly effective and safe drug forpreventing transmission of HIV from an infected mother to her newborn.Independent studies have also confirmed this finding. This regimen ismore affordable and practical than any other examined to date. Resultsfrom the study show that a single oral dose of the antiretroviral drugnevirapine (NVP) given to an HIV-infected woman in labor and anotherto her baby within 3 days of birth reduces the transmission rate of HIVby half compared with a similar short course of AZT (Azidothymidine).For more information on preventing transmission from mother to child,go to http://aidsinfo.nih.gov/guidelines.

SalivaAlthough researchers have found HIV in the saliva of infected people,there is no evidence that the virus is spread by contact with saliva.Laboratory studies reveal that saliva has natural properties that limit thepower of HIV to infect, and the amount of virus in saliva appears to bevery low. Research studies of people infected with HIV have found noevidence that the virus is spread to others through saliva by kissing. Thelining of the mouth, however, can be infected by HIV, and instances ofHIV transmission through oral intercourse have been reported.

Scientists have found no evidence that HIV is spread through sweat,tears, urine, or feces.

Casual contactStudies of families of HIV-infected people have shown clearly that HIVis not spread through casual contact such as the sharing of food utensils,towels and bedding, swimming pools, telephones, or toilet seats.

HIV is not spread by biting insects such as mosquitoes or bedbugs.

Sexually transmitted infectionsIf you have a sexually transmitted infection (STI) such as syphilis, geni-tal herpes, Chlamydia infection, gonorrhea, or bacterial vaginosisappears, you may be more susceptible to getting HIV infection duringsex with infected partners.

EARLY SYMPTOMS OF HIV INFECTIONMany people do not have any symptoms when they first become infectedwith HIV. They may, however, have a flu-like illness within a month ortwo after exposure to the virus. This illness may include:

• Fever • Headache • Tiredness • Enlarged lymph nodes (glands of the immune system easily

felt in the neck and groin)

These symptoms usually disappear within a week to a month and areoften mistaken for those of another viral infection. During this period,people are very infectious, and HIV is present in large quantities in geni-tal fluids.

More persistent or severe symptoms may not appear for 10 years or moreafter HIV first enters the body in adults, or within 2 years in childrenborn with HIV infection. This period of "asymptomatic" infection variesgreatly in each individual. Some people may begin to have symptomswithin a few months, while others may be symptom-free for more than10 years.

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Even during the asymptomatic period, the virus is actively multiplying,infecting, and killing cells of the immune system. The virus can also hidewithin infected cells and lay dormant. The most obvious effect of HIVinfection is a decline in the number of CD4 positive T (CD4+) cellsfound in the blood the immune system's key infection fighters. The virusslowly disables or destroys these cells without causing symptoms.

As the immune system worsens, a variety of complications start to takeover. For many people, the first signs of infection are large lymph nodesor "swollen glands" that may be enlarged for more than 3 months. Othersymptoms often experienced months to years before the onset of AIDSinclude:

• Lack of energy • Weight loss • Frequent fevers and sweats • Persistent or frequent yeast infections (oral or vaginal) • Persistent skin rashes or flaky skin • Pelvic inflammatory disease in women that does not respond

to treatment • Short-term memory loss

Some people develop frequent and severe herpes infections that causemouth, genital, or anal sores, or a painful nerve disease called shingles.Children may grow slowly or be sick a lot.

WHAT IS AIDS?The term AIDS applies to the most advanced stages of HIV infection.CDC developed official criteria for the definition of AIDS and is respon-sible for tracking the spread of AIDS in the United States.

CDC's definition of AIDS includes all HIV-infected people who havefewer than 200 CD4+ T cells per cubic millimeter of blood. (Healthyadults usually have CD4+ T-cell counts of 1,000 or more.) In addition,the definition includes 26 clinical conditions that affect people withadvanced HIV disease. Most of these conditions are opportunistic infec-tions that generally do not affect healthy people. In people with AIDS,these infections are often severe and sometimes fatal because theimmune system is so ravaged by HIV that the body cannot fight off cer-tain bacteria, viruses, fungi, parasites, and other microbes.

Symptoms of opportunistic infections common in people with AIDSinclude

• Coughing and shortness of breath • Seizures and lack of coordination • Difficult or painful swallowing • Mental symptoms such as confusion and forgetfulness • Severe and persistent diarrhea • Fever • Vision loss • Nausea, abdominal cramps, and vomiting • Weight loss and extreme fatigue • Severe headaches • Coma

Children with AIDS may get the same opportunistic infections as doadults with the disease. In addition, they also have severe forms of thetypically common childhood bacterial infections, such as conjunctivitis(pink eye), ear infections, and tonsillitis.

People with AIDS are also particularly prone to developing various can-cers, especially those caused by viruses such as Kaposi's sarcoma andcervical cancer, or cancers of the immune system known as lymphomas.These cancers are usually more aggressive and difficult to treat in peoplewith AIDS. Signs of Kaposi's sarcoma in light-skinned people are roundbrown, reddish, or purple spots that develop in the skin or in the mouth.In dark-skinned people, the spots are more pigmented.

During the course of HIV infection, most people experience a gradualdecline in the number of CD4+ T cells, although some may have abrupt

and dramatic drops in their CD4+ T-cell counts. A person with CD4+ Tcells above 200 may experience some of the early symptoms of HIV dis-ease. Others may have no symptoms even though their CD4+ T cellcount is below 200.

Many people are so debilitated by the symptoms of AIDS that they can-not hold a steady job nor do household chores. Other people with AIDSmay experience phases of intense life-threatening illness followed byphases in which they function normally.

A small number of people first infected with HIV 10 or more years agohave not developed symptoms of AIDS. Scientists are trying to determinewhat factors may account for their lack of progression to AIDS, such as:

• Whether their immune systems have particular characteristics • Whether they were infected with a less aggressive strain of the

virus • If their genes may protect them from the effects of HIV

Scientists hope that understanding the body's natural method of control-ling infection may lead to ideas for protective HIV vaccines and use ofvaccines to prevent the disease from progressing.

DIAGNOSISBecause early HIV infection often causes no symptoms, your health careprovider usually can diagnose it by testing your blood for the presence ofantibodies (disease-fighting proteins) to HIV. HIV antibodies generallydo not reach noticeable levels in the blood for 1 to 3 months followinginfection. It may take the antibodies as long as 6 months to be producedin quantities large enough to show up in standard blood tests. Hence, todetermine whether you have been recently infected (acute infection),your health care provider can screen you for the presence of HIV geneticmaterial. Direct screening of HIV is extremely critical in order to preventtransmission of HIV from recently infected individuals.

If you have been exposed to the virus, you should get an HIV test assoon as you are likely to develop antibodies to the virus-within 6 weeksto 12 months after possible exposure to the virus. By getting tested early,if infected, you can discuss with your health care provider when youshould start treatment to help your immune system combat HIV and helpprevent the emergence of certain opportunistic infections (see section ontreatment below). Early testing also alerts you to avoid high-risk behav-iors that could spread the virus to others.

Most health care providers can do HIV testing and will usually offer youcounseling at the same time. Of course, you can be tested anonymouslyat many sites if you are concerned about confidentiality.

Health care providers diagnose HIV infection by using two differenttypes of antibody tests: ELISA and Western Blot. If you are highly likelyto be infected with HIV but have been tested negative for both tests, yourhealth care provider may request additional tests. You also may be told torepeat antibody testing at a later date, when antibodies to HIV are morelikely to have developed.

Babies born to mothers infected with HIV may or may not be infectedwith the virus, but all carry their mothers' antibodies to HIV for severalmonths. If these babies lack symptoms, a doctor cannot make a definitivediagnosis of HIV infection using standard antibody. Health careproviders are using new technologies to detect HIV to more accuratelydetermine HIV infection in infants between ages 3 months and 15months. They are evaluating a number of blood tests to determine whichones are best for diagnosing HIV infection in babies younger than 3months.

TREATMENTWhen AIDS first surfaced in the United States, there were no medicinesto combat the underlying immune deficiency and few treatments existedfor the opportunistic diseases that resulted. Researchers, however, have

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developed drugs to fight both HIV infection and its associated infectionsand cancers.

HIV InfectionThe Food and Drug Administration (FDA) has approved a number ofdrugs for treating HIV infection. The first group of drugs used to treatHIV infection, called nucleoside reverse transcriptase (RT) inhibitors,interrupts an early stage of the virus making copies of itself. These drugsmay slow the spread of HIV in the body and delay the start of oppor-tunistic infections. This class of drugs, called nucleoside analogs,includes

• AZT (Azidothymidine) • ddC (zalcitabine) • ddI (dideoxyinosine) • d4T (stavudine) • 3TC (lamivudine) • Abacavir (ziagen) • Tenofovir (viread)

Health care providers can prescribe non-nucleoside reverse transcriptaseinhibitors (NNRTIs), such as

• Delavridine (Rescriptor) • Nevirapine (Viramune) • Efravirenz (Sustiva) (in combination with other antiretroviral

drugs)

FDA also has approved a second class of drugs for treating HIV infec-tion. These drugs, called protease inhibitors, interrupt the virus frommaking copies of itself at a later step in its life cycle. They include:

• Ritonavir (Norvir) • Saquinivir (Invirase) • Indinavir (Crixivan) • Amprenivir (Agenerase) • Nelfinavir (Viracept) • Lopinavir (Kaletra) • Atazanavir (Reyataz) • Fosamprenavir (Lexiva)

FDA also has introduced a third new class of drugs, known at fusioninhibitors, to treat HIV infection. Fuzeon (enfuvirtide or T-20), the firstapproved fusion inhibitor, works by interfering with HIV-1's ability toenter into cells by blocking the merging of the virus with the cell mem-branes. This inhibition blocks HIV's ability to enter and infect the humanimmune cells. Fuzeon is designed for use in combination with other anti-HIV treatment. It reduces the level of HIV infection in the blood andmay be active against HIV that has become resistant to current antiviraltreatment schedules.

Because HIV can become resistant to any of these drugs, health careproviders must use a combination treatment to effectively suppress thevirus. When multiple drugs (three or more) are used in combination, it isreferred to as highly active antiretroviral therapy, or HAART, and can beused by people who are newly infected with HIV as well as people withAIDS.

Researchers have credited HAART as being a major factor in significant-ly reducing the number of deaths from AIDS in this country. WhileHAART is not a cure for AIDS, it has greatly improved the health ofmany people with AIDS and it reduces the amount of virus circulating inthe blood to nearly undetectable levels. Researchers, however, haveshown that HIV remains present in hiding places, such as the lymphnodes, brain, testes, and retina of the eye, even in people who have beentreated.

Side effects Despite the beneficial effects of HAART, there are side effects associatedwith the use of antiviral drugs that can be severe. Some of the nucleosideRT inhibitors may cause a decrease of red or white blood cells, especially

when taken in the later stages of the disease. Some may also causeinflammation of the pancreas and painful nerve damage. There have beenreports of complications and other severe reactions, including death, tosome of the antiretroviral nucleoside analogs when used alone or in com-bination. Therefore, health care experts recommend that you be routinelyseen and followed by your health care provider if you are on antiretrovi-ral therapy.

The most common side effects associated with protease inhibitorsinclude nausea, diarrhea, and other gastrointestinal symptoms. In addi-tion, protease inhibitors can interact with other drugs resulting in seriousside effects. Fuzeon may also cause severe allergic reactions such aspneumonia, trouble breathing, chills and fever, skin rash, blood in urine,vomiting, and low blood pressure. Local skin reactions are also possiblesince it is given as an injection underneath the skin.

If you are taking HIV drugs, you should contact your health careprovider immediately if you have any of these symptoms.

Opportunistic infectionsA number of available drugs help treat opportunistic infections. Thesedrugs include

• Foscarnet and ganciclovir to treat CMV (cytomegalovirus) eye infections

• Fluconazole to treat yeast and other fungal infections • TMP/SMX (trimethoprim/sulfamethoxazole) or pentamidine

to treat PCP (Pneumocystis carinii pneumonia)

CancersHealth care providers use radiation, chemotherapy, or injections of alphainterferon-a genetically engineered protein that occurs naturally in thehuman body-to treat Kaposi's sarcoma or other cancers associated withHIV infection.

PREVENTIONBecause no vaccine for HIV is available, the only way to prevent infec-tion by the virus is to avoid behaviors that put you at risk of infection,such as sharing needles and having unprotected sex.

Many people infected with HIV have no symptoms. Therefore, there isno way of knowing with certainty whether your sexual partner is infectedunless he or she has repeatedly tested negative for the virus and has notengaged in any risky behavior.

Although some laboratory evidence shows that spermicides can kill HIV,researchers have not found that these products can prevent you from get-ting HIV.

TWENTY YEARS OF HIV/AIDS:SNAPSHOTS OF AN EPIDEMIC

This snapshot gives you an idea of how quickly HIV/Aids became anepidemic.

1981 - Unexplained cases of enlarged lymph nodes among men are observed and studied by physicians and researchers in New York City.

US Total Cases reported: 159

1982 - In addition to cases in men, cases of AIDS are reported in hemo-philiacs and in a few women, infants and recipients of blood transfusions. Transmission of an infectious agent through blood and sexual contact is strongly suspected.

The Centers for Disease Control and Prevention establishes the term acquired immunodeficiency syndrome (AIDS) and identi-fies four "risk factors". Unprotected sex, intravenous drug use, Haitian origin, and hemophilia A

US Total Cases reported: 771 Deaths: 618

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1983 - A major outbreak of AIDS among men and women in central Africa.

The CDC warns bloodbanks of a possible problem with the US Blood supply. AIDS cases have now been reported in 33 countries.

US Cases reported: 2,807 Deaths: 2,118

1984 - Dr. Robert Gallo of the U.S. National Cancer Institute announces that his lab has isolated the virus believed to cause AIDS. He calls it human T-cell lymphatic virus type III (HTLV- III).

Total Cases reported: 7,239 Deaths: 5,596

1985 - The federal government licenses an HIV antibody test, and screening of the U.S. blood supply begins.

Ryan White, a 13-year-old hemophiliac with AIDS, is barred from school in Indiana.

US Total Cases reported: 15,527 Deaths: 12,529

1986 - In the first comprehensive report on AIDS, the Institute of Medicine states that $2 billion is needed annually for AIDS research and care.


1987 - Researchers realize that virtually all cases of HIV infection ultimately lead to full blown AIDS, but only after a long incuba-tion period.

1988 - The federal government mails an educational pamphlet, "understanding AIDS," to 107 million homes nationwide.


1989 - The NIH funds 17 community based AIDS clinical research units as part of a federally sponsored research program.


1990 - Surveillance data indicate that while black and latina women constitute just 19% of all U.S. women, they represent 72% of U.S. women diagnosed with AIDS.

Nearly twice as many Americans have now died from AIDS as in the Vietnam War.

Ryan White dies of AIDS.


1991- The CDC reports that one million Americans are infected with HIV.

Ervin "Magic" Johnson announces that he is infected with HIV.


1992 - President Clinton establishes a new White House Office of National AIDS Policy.


1993 - AIDS patients start to show signs of resistance to AZT.Arthur Ashe dies of AIDS


1994 - Drs. David Ho and George Shaw show that following initial infection, HIV replicates in the body continuously, producing billions of copies each day.


1995 - AIDS deaths reach an all time high.The New York Times reports that AIDS has become the leading cause of death among all Americans ages 25 to 44.

1996 - For the time in the U.S., a larger proportion of AIDS cases occur among African Americans (41%) than among whites (38%).


1997 - AIDS patients continue to live longer thanks to the new anti-HIVtherapies, dubbed drug "cocktails," and AIDS deaths in the U.S. decline by 42%.


1998 - Early hope that combination therapy might affect a clinical cure for AIDS fades.


1999 - Experts estimate that at least half of all new HIV infections in the U.S. (and worldwide) occur among young people under the age of 25.


2000 - UNAIDS reports that 3.1 million people are now living with HIV/AIDS, over 13 million children have lost one or both parents to AIDS and nearly 22 million people have died of AIDS-related causes since the epidemic began.


2001 - New study shows that 14% of individuals newly infected with HIV in the U.S. already exhibit resistance to at least one antiviral drug.

U.S. Secretary of State Colin Powell reaffirms the position that HIV/AIDS constitutes a national security threat.

2001- 2006 - Many believe that HIV/AIDS are a thing of the past because you do not hear much about it in the news media anymore. Nothing could be further from the truth. Below is a chart that shows while the number of deaths has leveled off, the shear number of people living with AIDS is growing.

How does HIV research help with the cure of other diseases?Many ask how does HIV/AIDS affect me and why is research so impor-tant. The fact is, HIV/AIDS research is helping solve many other medicalmysteries.

Treatments for several types of cancer have grown directly out of AIDSresearch. One promising experimental therapy for advanced cancer ishigh dose chemotherapy followed by a bone marrow transplant. But theprofound immune suppression necessary for a successful transplant often

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leads to devastating, even fatal, infections. New drugs to treat and pre-vent these infections have come directly from AIDS targeted research.

Treatments for other cancers are also emerging from AIDS research.Several natural body hormones called growth factors promote the activityof HIV. Many of these hormones also accelerate the growth and spreadof cancer cells. Blocking the activity of these hormones is a strategy firstused experimentally to treat kaposi's sarcoma, a cancer found in patientswith HIV/AIDS. Now it is also being tested in bladder, vulva, and breastcancers and has shown some exciting recent success in treating coloncancer. In addition, small proteins and drugs that can block the growth ofnew blood vessels (which is critical to the survival of tumor cells) wereoriginally developed to treat Kaposi's sarcoma, but are now being testedin many other cancers as well.

Are other treatments for major diseases likely to emerge from AIDSresearch any time soon?Absolutely, AIDS research is helping to improve treatments forAlzheimer's disease and heart disease. Alzheimer's disease is a progres-sive, global dementia whose cause is unknown. Profound dementia iscommonly seen in the late stages of AIDS as well, so drugs that are suc-cessful in lessening nerve damage and dementia in AIDS, for example,may benefit patients with Alzheimer's. The characteristic plaques that fillthe brain cells of an Alzheimer's patient are formed partly by enzymescalled proteases, so scientists are now investigating the use of proteaseinhibitors to treat this debilitating dementia. Many HIV positive childrenand adults also suffer heart attacks and strokes because HIV appears toaffect small blood vessels in the heart and the brain, which makes themvulnerable to spasm, blood clots, and early atherosclerosis. The smallarteries of a two-year-old child with AIDS often resemble those of a 50year-old man. In HIV infection, a process of programmed cell deathinjures the cells that line the small blood vessels of the heart. Similardamage occurs in HIV-negative people with atherosclerosis. Discoveringa way to block this process may benefit not only those with AIDS, but amuch broader population as well.

How does the study of HIV/AIDS help in the treatment of other dis-eases? HIV/AIDS therapies may be critical in the treatment of other diseases.For example, lamivudine and adefovir can help patients with hepatitis Bthat have no other options. In addition, protease inhibitors are beingdeveloped to combat infections, such as hepatitis C, influenza, and mostrecently, SARS is based on a concept similar to that of an anti-HIV entryinhibitor called enfuvirtide, or fuzeon, which was approved for use in2003. A modified version of another AIDS drug called cidofovir, used totreat CMV eye infections in AIDS, is now being developed to treat andpossibly prevent smallpox infection. AIDS drugs have been used to elim-inate diseases in plants. Two of them, adefoir and tenofovir, can eradicatethe banana streak virus, which infects a substantial proportion of theworld's banana harvest.

Since HIV is a virus that attacks the immune system, what doesAIDS research teach us about autoimmune disorders or immune-based therapies for other diseases?HIV-positive people often develop autoimmune problems, such as psoria-sis or blood abnormalities associated with lupus. For these autoimmunediseases, treatments developed for AIDS should also apply when thesame conditions occur spontaneously. Certain hormones that modify thefunction of immune cells are now being tested as treatments for AIDS.Some of the most recent include IL-12 and TNF ( tumor necrosis factor)alpha inhibitors, which may also boost the immune systems of cancerpatients.

WORKPLACE ACCOMMODATIONS FOR EMPLOYEES WITHHIV/AIDSPeople living with HIV infection and AIDS can be productive workersfor many years in the best of circumstances, the challenges associated

with HIV can be significant. In addition to complex medical and legalconcerns, AIDS raises difficult emotional issues such as fear, stigma,death, and dying.

HIV/AIDS is an increasingly important issue in workplaces throughoutthe country.Two-thirds of large businesses and one in 10 small businesseshave already encountered an employee with HIV infection or AIDS.More than 75 percent of all AIDS cases occur among people between theages of 25 and 44, the same group comprising the bulk of the U.S. work-force.

Employment Provisions Under the Americans with Disabilities Act of1990The Americans with Disabilities Act (ADA) prohibits discriminationagainst all people with disabilities or perceived disabilities, includingpeople with HIV infection and AIDS. A detailed explanation of the ADAis beyond the scope of this publication but can be found at www.ada.gov.

Similar legal requirements have been in place for employers covered bythe Rehabilitation Act and by certain State and municipal ordinancescovering disability discrimination in employment.

The employment provisions of the ADA also require employers to pro-vide "reasonable accommodations" for employees with disabilities.Reasonable accommodations are changes or adjustments in the job orwork environment that permit individuals with disabilities to perform theessential functions of a job. The term "reasonable accommodation" is alegal term that refers to certain changes and adjustments in the work-place. An employer may choose to go beyond the ADA and provide anaccommodation that would not be required under the law. For example,removing an essential function from an employee's job description andproviding HIV education for all employees are not examples of reason-able accommodations. Similarly, while allowing an employee to workpart-time is a type of reasonable accommodation, continuing to pay thatemployee a full-time salary is not required by the law. The ADA estab-lishes a baseline, a floor, not a ceiling.

Specific Legal Boundaries of Reasonable AccommodationEmployers and employees trying to determine appropriate accommoda-tions should be aware of the specific legal boundaries of "reasonableaccommodation." Many of the employers profiled in these case studiesprovided assistance and accommodations that went above and beyondwhat the law would require. As a general rule of thumb, given that theADA governs many of the actions in this area, employers should consid-er the ADA implications of any decisions involving an employee withHIV infection or AIDS. This includes any decisions about disclosing anemployee's HIV Status.

The ADA has strict rules about maintaining confidentiality of suchinformation, and employers should ensure that they do not violate theserules. As awareness of the ADA and its employment provisions increases,more and more employees are stepping forward to disclose their HIV sta-tus to their employers, managers, coworkers, and friends. Disclosureoften takes courage and is unlikely to happen without an environment inwhich the disclosure will be met with cooperation and support. Becauseof the stigma still associated with HIV, this disclosure (especially in theworkplace setting) too often does not occur until a crisis forces the issueout into the open. By this time an otherwise manageable situation canbecome a crisis, and everyone loses, the HIV positive employee, theemployer, the manager, coworkers, and the worksite.

Many employers believe that encouraging disclosure may not be desir-able because it creates certain obligations that might not have otherwiseexisted. An environment that discourages or is hostile to disclosure, how-ever, may present altogether different problems, legal and otherwise, justas a company experiences similar problems when it does not encourageemployees with harassment complaints to come forward.

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Most human resource professionals agree that providing an environmentwhere complaints or situations (such as the existence of a disability andthe need for an accommodation) can be discussed and remedied withoutthe fear of retaliation is a sound policy for both overall productivity andlegal reasons.

There Is No Simple Formula for Accommodation of Employees WithHIV Infection or AIDSThe dual goals of accommodation are to ensure that work assignmentsare accomplished and that the individual with HIV infection or AIDScontinues working as long as possible. Accommodation is a process ofongoing problem solving between an employee with HIV infection orAIDS and his or her supervisor. Because the manifestations of HIVinfection and AIDS are different in different people, accommodation isnot a one-time alteration of a job or physical structure. Just as each per-son with HIV infection and AIDS experiences the disease differently,each person will also require different accommodations. An accommoda-tion that is effective for an earlier phase of HIV infection may not beeffective for a later phase; an accommodation is an ongoing processrequiring ongoing evaluation, in part because the manifestations ofHIV infection and AIDS change over time, and in part because someattempted accommodations may not work for either the employer or theemployee.

Effective accommodation does not require lowering the expectations ofthe employee. Rather, it requires ongoing negotiation and creative prob-lem solving to determine alternative means of accomplishing workassignments. This negotiation process may result in different outcomes insimilar circumstances. For example, one employee might convert from afull-time job to part time.

Providing Accommodation to Employees With HIV Infection orAIDS Is a Team Effort With Impact on a Company's Workforce,Managers, and PoliciesBecause of the fear and stigma still associated with HIV/AIDS, accom-modating people with HIV infection and AIDS affects virtually everyonein the workplace. A fearful work environment is not a productive workenvironment. In the process of providing accommodation of employeeswith HIV infection or AIDS, an employer might consider addressingcoworker attitudes. In order to dispel unwarranted fears and to ensurecooperation in the accommodation process, managers need accurateinformation about HIV infection and AIDS. Confronting AIDS alsoinvolves confronting grief. Coworkers and managers in these profilesresponded constructively in a supportive environment where emotionalresponses to HIV could be addressed. Leadership is an important part ofeffective accommodation. A message from the manager about how anemployee with HIV infection or AIDS will be treated is critical becauseit sets a clear standard.

The Benefits of Accommodating Employees With HIV Infection andAIDS Balance the CostsCompanies that effectively manage HIV/AIDS grow stronger. How acompany treats one employee with a chronic illness is a clear indicatorand a signal of the standard it will use in managing other employees.Witnessing support, accommodation, and respect for a coworker with aterminal illness strengthens worker morale, loyalty, and productivity.Coworkers and supervisors share a deeply human connection. Employershave the satisfaction of knowing they are making a contribution to thedignity and well-being of one of their own employees. Sometimes com-panies directly benefit financially from accommodations as well. Oneemployee, working on commission based pay, wanted to reduce the pres-sure caused by his income depending directly on his daily sales. Hisaccommodation included converting from commission based pay to afixed salary. When his sales were high, this arrangementbenefited the company since it kept the commissions he would havereceived.

Companies benefit when employees who become ill can help train otheremployees to share and eventually assume some of their responsibilities.The expertise of a knowledgeable and experienced employee is thuspassed on to a new employee. This may also give ill employees somepeace of mind knowing their responsibilities are being taken care of intheir absence.

Employees Who Fully Disclosed Their HIV Status in the WorkplaceFelt Relieved and StrengthenedBeing an employee with HIV/AIDS, as one interviewee described it, is"not for cowards." The employee must manage the overwhelming emo-tions of facing a terminal and often stigmatizing illness while still contin-uing to be a productive worker. People with HIV infection and AIDS arechallenged to manage and plan for an ever changing set of ailments,health care needs, and financial demands all while maintaining motiva-tion and self-esteem.

HIV-positive employees must decide whom to inform about their healthstatus, how much information to reveal, and when to reveal it. The stig-ma still associated with HIV/AIDS makes such decisions all the moredifficult. Fear of rejection, regrettably, is a fear based in reality.

The decision to disclose HIV status is the prerogative of the HIV-positiveindividual. It is illegal for an employer to ask a current or prospectiveemployee about HIV status. Nonetheless, the HIV-positive employeemay have to disclose some health information to managers or supervisorsin order to seek an accommodation. Accommodations can be made with-out the supervisor's knowing that the individual is HIV-positive or hasAIDS; the supervisor may know only that the individual is ill.

Disclosure of one's HIV status can take place in many settings. Someemployees have chosen to disclose it in letters to colleagues or workgroups; others do so in face-to face meetings with individuals or groups.

Intensive workplace AIDS education may precede or follow a disclosure.Employees may inform managers of their health condition but requestthat the information be kept confidential; and by law, the employer mustcomply with that request.

Over time, however, if coworkers unaware of these circumstancesbecome suspicious of perceived preferential treatment, they may becomeresentful and spend considerable time, energy, and effort trying to figureout "what's wrong." Rumors may circulate. When the performance oftheir work groups is called into question by superiors, managers may findthemselves unable to adequately explain the situation. In such circum-stances, the employee may be uncomfortable as well, knowing thatrumors are circulating and feeling the unwanted attention from others. Atthat point, it may be helpful for the manager to discuss with theemployee what, if anything, he or she wants to do to address the situa-tion. The decision to disclose rests with the employee, but the employeemay be willing to risk disclosure if the manager is not forcing the indi-vidual to disclose but, instead, offers support for whatever decision ismade.

Finally, many employees with HIV/AIDS believe that continuing to workis critical to their mental and physical health and survival. Work can pro-vide a sense of purpose, financial support, productiveness, continuity,involvement, peer support, and the opportunity to focus on somethingother than one's illness. In our culture and society, a person's work andprofession often hold deep ethical, economic, and personal significance.The importance of work and the workplace context for people with HIVinfection and AIDS should not be underestimated. Indeed, for some,keeping a job may mean keeping the "will to live."

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CHAPTER 2COSMETOLOGY

CHEMICAL MAKEUP AND CONDITIONS OF HAIR(2 Credit Hours)

Learning Objectives:Describe the basic anatomy and chemical composition of hair Describe how the pH scale pertains to hair careList and compare the three main types of hair color.Explain the significance of Material Safety Data Sheets Identify ingredients in common hair care products that may be problematic to clientsAssociate common symptoms with conditions and diseases of the hair and scalp

Introduction:This chapter will review the chemical composition of the hair and dis-cuss various conditions that you are likely to encounter in your clients.Understanding the composition and nature of hair is the first step in pro-tecting your clients from possible harm that a variety of products cancause.

Structure of hairLike other mammals, humans are covered by hair. Human body hair,however, is much finer than that of our nonhuman brothers and sisters,and is concentrated primarily on our heads, underarms, and genitalregions. Most men, and some women, also have hair on their faces.Each hair grows from an individual follicle that is adjacent to a seba-ceous gland. Sebaceous glands produce sebum, which moisturizes skinand hair and is a barrier to toxins. Sebum also manufactures the body'svitamin D, triggered by exposure to the sun.

Hair is outgrowth of skin but has no sense of feeling due to the lack ofnerve endings. It is made up of the protein keratin (also found in skinand nails). Keratin protein is formed by the joining of amino acids. Thefact that the acids join at some places along the protein chain makes ker-atin relatively resistant to change. The chemical make up of hair alsocontains carbon, hydrogen, nitrogen, sulfur, and oxygen. Hair protectsthe body from heat loss and ultraviolet rays. Hair follicles extend downinto the dermis (skin layer). A nerve ending surrounds the bulb of eachhair follicle. Glands secrete an oily substance directly onto the hair folli-cle, lubricating the hair shaft.

Hair is composed of cells arranged in three layers: the cuticle, the cortex,and the medulla. The cuticle is the outside layer composed of transpar-ent, scale like cells. Chemicals raise these scales so solutions such aschemical relaxers, hair color, or permanent wave solutions can enter.The cortex is the inner layer of cells that give hair its strength. It is com-posed of numerous parallel fibers of hard keratin. These fibers are twist-ed around one another like a rope. This layer gives hair its color. Themedulla is the innermost layer and is composed of round cells. If youhave very fine hair, medulla cells may be absent.

Hair's inner cortex is composed of spindle-shaped cells and an outersheath, called the cuticle. Within each cortical cell are the many fibrils,running parallel to the fibre axis, and between the fibrils is a softer mate-rial called the matrix. It grows from a hair follicle.

This is a cross section of a hair fairly close to the surface. You can tellwhere it's been cut because there's a bit of sebaceous gland (SbG) next toit. The cortex and medulla of the hair are both present. Some short, curlywool hairs lack a medulla. The outer epithelial root sheath (ORS) is acontinuation of the epidermis down into the follicle.

The cuticle is responsible for much of the mechanical strength of the hairfibre. It consists of scale-shaped layers. Human hair typically has 6-8layers of cuticle. Wool has only one, and other animal hair may havemany more layers. Hair responds to its environment, and to its mechani-cal and chemical history. For example, hair which is wetted, styled andthen dried, acquires a temporary 'set', which can hold it in style. Thisstyle is lost when the hair gets wet again. For more permanent styling,chemical treatments (perms) break and re-form the disulphide links with-in the hair structure.

In people of European descent, blond hair and black hair are at the finerend of the scale, while red hair is the coarsest. The hair of people ofAsian descent is typically coarser than the hair of other groups. Hair witha round cross-section will fall straight, as opposed to curly hair, whichhas a flat cross-section. The cross-sectional shape of human hair is typi-cally round in people of Asian descent, round to oval in Europeandescent, and nearly flat in African peoples; it is that flatness whichallows African hair to attain its frizzly form. In contrast, hair that has around cross section will be straight. A strand of straight round cross-sec-tion hair that has been flattened, for example, with an edge of a coin, willcurl up into a micro-afro.

The speed of growth is roughly 11 cm/yr = 0.3 mm/day = 3 nm/s. Cellsat the base of the hair follicle divide and grow extremely rapidly. A sin-gle strand of human hair can hold approximately 100 g (3.5 oz) ofweight, although this will vary greatly with thickness. Wet hair, however,is very fragile.

Pathology of hairThe term "pathology" refers to the study of disease, including its natureand origins, as well as its effect on the structure and function of the body.A closely related subject is etiology, which investigates the causes or rea-sons for disease. This chapter reviews diseases and other common condi-tions of the hair and scalp, which are all part of the integumentary sys-tem. The information presented in the following section will help youdevelop workplace guidelines for recognizing potential health risks, todetermine when and how to proceed with service-or if you should pro-ceed at all. This information is not meant to be used for self-diagnosisor as a substitute for consultation with a health care provider. If you haveany questions or concerns regarding the conditions or diseases describedbelow, consult a health care provider.

Disorders of the hair and scalpThe condition and appearance of the hair and scalp are influenced bymany factors, including physical health, nutrition, blood circulation,emotional state, function of the endocrine glands, and medications con-sumed. Common disorders of the hair and scalp include vegetable andanimal parasitic infections, staphylococci infections, which cause furun-cles (boils), and the following conditions, which may affect the hair folli-cle and/or sebaceous glands.

Alopecia is the formal term for any abnormal hair loss. It should not beconfused with natural hair loss, which occurs when the hair has grown toits full length, falls out, and is replaced by a new hair. Alopecia senilis ishair loss associated with old age, alopecia prematura may occur any timebefore middle age, and is characterized by slow thinning over time.Alopecia areata is relatively sudden, patchy hair loss, including the spot-ty baldness that is associated with anemia and typhoid fever, amongother conditions. Tension alopecia is caused by tight braiding or hairstyles that pull the hair's roots.

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Canities is the formal term for gray hair, which is caused by the loss ofpigment. Acquired canites is usually associated with aging, while con-genital canites, a condition existing at birth, includes albinism.

Dandruff (or pityriasis) is a condition in which small white flakes orscales appear on the scalp and hair. Excessive dandruff can lead to bald-ness, if the condition is severe and neglected. Dandruff may be due tomicrobial infection, poor circulation, nerve stimulation, or diet, and maybe associated with specific shampoos, or insufficient rinsing of sham-poos. Pityriasis capitis simplex, or dry type dandruff is characterized byan itchy scalp and white scales scattered throughout the hair. Pityriasissteatoides, a greasy or waxy type of dandruff, is characterized by a scalyskin surface mixed with sebum, and may include bleeding or oozing ofthe sebum when scales tear off. Refer the client to a physician for med-ical attention. Dandruff is considered contagious and may spreadthrough the common use of brushes, hair clips, or styling implements.

Fragilitas crinium is the formal term for brittle hair, which may includesplit ends. Conditioners may improve hair flexibility.

Hair loss occurs naturally as part of hair growth and regeneration. Inwomen, childbirth, stress, crash dieting, emotional stress and shock cancause greater than normal hair loss, though it is usually temporary. Someolder women experience female-pattern hair loss with thinning of thecrown and hairline.

Drugs used in cancer chemotherapy frequently cause a temporary loss ofhair, noticeable on the head and eyebrows, because they kill all rapidlydividing cells, not just the cancerous ones. Other diseases and traumascan cause temporary or permanent loss of hair, generally or in patches.

Hirsutism (or hypertrichosis) is excess hair on the body. Genetic back-ground and age can impact how much hair a woman has on the cheeks,upper lip, arms and legs. There are a variety of methods to cope withunwanted hair, such as tweezing, waxing, shaving, bleaching, depilato-ries and electrolysis. Electrolysis is the only permanent hair-removalmethod, and is typically among the most expensive and time-consumingmeans of removal.

Monilethrix is the formal term for beaded hair, which breaks between thenodes or beads. Hair and scalp treatments may prove helpful.

Tinea capitis (ringworm) is a fungal infection that forms a scaly, ring-likelesion on the scalp. It is highly contagious.

Trichoptilosis is the formal term for split ends.

Trichorrhexis nodosa, or knotted hair, is characterized by dry, brittle hairwith nodular swellings along the length of the hair shaft. Hair breakseasily, but the condition may be remedied somewhat by conditioners.Changes in the hair during pregnancyWomen may experience changes in their hair during pregnancy. In mostcases, these changes are temporary and will return to their original condi-tion after the birth. Hirsutism, or excessive hair growth, can appear onthe face and/or chest due to hormonal changes experienced during preg-nancy. Within six months after giving birth, this condition generally dis-sipates. Telogen effluvium refers to excessive hair loss that occurs with-in five months after pregnancy. This condition does not cause permanenthair loss or baldness, typically returning to normal after six to twelveweeks.

Hair color changeHair color change is probably one of the most obvious signs of aging.Hair color is caused by a pigment (melanin) produced by hair follicles.With aging, the follicle produces less melanin. Graying often begins inthe 30's, although this varies widely. Graying usually begins at the tem-ples and extends to the top of the scalp. Hair becomes progressivelylighter, eventually turning white.

Many people have some gray scalp hair by the time they are in their 40's.Body and facial hair also turn gray, but usually later than scalp hair. Thehair in the armpit, chest, and pubic area may gray less or not at all.Graying is genetically determined. Gray hair tends to occur earlier inCaucasians and later in Asian races. Nutritional supplements, vitamins,and other products will not stop or decrease the rate of graying.

Chemical induced hair color changes There have been reports of blonde hair, as well as darker hair, turninggreen after prolonged exposure to chlorine in swimming pools. Usually,the problem is associated with concentrations of copper dissolved in thepool water, which can chemically interact with chlorine. High levels ofcopper in tap water can also turn hair green.

Chronic smoking has been associated with premature gray hair becausetoxic substances in tobacco smoke are able to block melanocyte cell pig-ment producing activity. Heavy smokers with white or gray hair maydevelop a yellow hair color due, most likely to prolonged exposure to airladen with tar from cigarette smoke. The tar may chemically react with,and preferentially adhere to, the hair fiber.

Hair thickness changes and hair lossHair is a protein strand that grows through an opening (follicle) in theskin. A single hair has a normal life of about 4 or 5 years. That hair thenfalls out and is replaced with a new hair. Hair loss usually developsgradually and may be patchy or diffuse (all over). Roughly 100 hairs arelost from your head every day. The average scalp contains about 100,000hairs.Hair grows about an inch every couple of months. Each hair grows for 2to 6 years, remains at that length for a short period, then falls out. A newhair soon begins growing in its place. At any one time, about 85% of thehair on your head is in the growing phase and 15% is not. Each individ-ual hair survives for an average of 4-1/2 years, during which time itgrows about half an inch a month. Usually in its 5th year, the hair fallsout and is replaced within 6 months by a new one.

Genetic baldness is caused by the body's failure to produce new hairs andnot by excessive hair loss. The amount of hair you have on your bodyand head is determined by your genes. Almost everyone experiencessome hair loss with aging, and the rate of hair growth slows. Many hairfollicles stop producing new hairs altogether. The hair strands becomesmaller and have less pigment, with thick, coarse hair of a young adulteventually becoming thin, fine, light-colored hair. Both men and women tend to lose hair thickness and amount as they age.Inherited or "pattern baldness" affects many more men than women.About a quarter of men begin to show signs of baldness by the time theyare 30 years old, and about two-thirds of men have significant baldnessby age 60. Men develop a typical pattern of baldness associated with themale hormone testosterone (male-pattern baldness). Hair may be lost atthe temples or at the top of the head.

Each hair sits in a cavity in the skin called a follicle. Baldness in menoccurs when the follicle shrinks over time, resulting in shorter and finerhair. The end result is a very small follicle with no hair inside.Ordinarily, hair should grow back. However, in men who are balding, thefollicle fails to grow a new hair. Why this occurs is not well understood,but it is related to your genes and male sex hormones. Even though thefollicles are small, they remain alive, suggesting the possibility of newgrowth.Male pattern baldness is the most common type of hair loss in men. Itusually follows a typical pattern of receding hairline and hair thinning onthe crown, and is caused by hormones and genetic predisposition.Ultimately, one may have only a horseshoe ring of hair around the sides.In addition to genes, male-pattern baldness seems to require the presenceof the male hormone testosterone . Men who do not produce testosterone(because of genetic abnormalities or castration) do not develop this pat-tern of baldness.

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Women may also develop a typical pattern of hair loss as they age(female-pattern baldness ). In female pattern baldness, the hair becomesless dense all over and the scalp may become visible. Female-patternbaldness is a pattern of hair loss (alopecia) caused by hormones, agingand genetics. Unlike male-pattern baldness, female-pattern baldness is anover-all thinning which maintains the normal hairline. Body and facialhair are also lost, but the hairs that remain may become coarser. Somewomen may notice a loss of body hair, but may find that they havecoarse facial hair, especially on the chin and around the lips.

Baldness is not usually caused by a disease, but is related to aging,heredity, and testosterone. In addition to the common male and femalepatterns from a combination of these factors, other possible causes ofhair loss, especially if in an unusual pattern, include:

• Hormonal changes (for example, thyroid disease , childbirth, oruse of the birth control pill)

• A serious illness (like a tumor of the ovary or adrenal glands) or fever

• Medication such as cancer chemotherapy • Excessive shampooing and blow-drying • Emotional or physical stress • Nervous habits such as continual hair pulling or scalp rubbing • Burns or radiation therapy • Alopecia areata -- bald patches that develop on the scalp,

beard, and, possibly, eyebrows. Eyelashes may fall out as well. This is thought to be an immune disorder.

• Tinea capitis (ringworm of the scalp)

What is pH? PH is a unit of measurement; just as degrees measure temperature andinches measure distance, pH numbers measure the amount of acid oralkali in water based solution. All solutions that contain water and prod-ucts that dissolve in water have an acidic or alkaline nature. Acidic andbasic are two extremes that describe chemicals, just like hot and cold aretwo extremes that describe temperature. Mixing acids and bases can can-cel out their extreme effects, much like mixing hot and cold water caneven out the water temperature. A substance that is neither acidic norbasic is neutral.

The pH scale measures how acidic or basic a substance is. It ranges from0 to 14. A pH of 7 is neutral. A pH less than 7 is acidic, and a pH greaterthan 7 is basic. The pH scale is logarithmic, which means each step ornumber increase by multiples of 10. Each whole pH value below 7 is tentimes more acidic than the next higher value. For example, a pH of 4 isten times more acidic than a pH of 5 and 100 times (10 times 10) moreacidic than a pH of 6. The same holds true for pH values above 7, eachof which is ten times more alkaline (another way to say basic) than thenext lower whole value. For example, a pH of 10 is ten times more alka-line than a pH of 9. If you using a product that is pH 6 or only one num-ber away from acid balanced it is actually 10 times less acidic, which is ahuge difference. One number variation in pH will greatly affect the acid-ity or alkalinity of your cosmetic preparations.

Pure water is neutral, with a pH of 7.0. When chemicals are mixed withwater, the mixture can become either acidic or basic. Vinegar and lemonjuice are acidic substances, while laundry detergents and ammonia arebasic. Chemicals that are very basic or very acidic are called "reactive."These chemicals can cause severe burns. Automobile battery acid is anacidic chemical that is reactive, and household drain cleaners often con-tain lye, a very alkaline chemical that is reactive.

pH of hairHow does the pH scale pertain to hair? On the pH scale, hair falls onaverage between 4.5 and 5.5. This measurement is not the pH of theactual hair, but of the protective film of oily acidic secretions whichcoats and lubricates the surface of the skin, hair and nails. This combina-tion of oils and water-soluble materials is referred to as our acid mantle,which is produced by the skin. Products with a pH of 4.5 to 5.5 are com-patible with the natural biology of the hair and scalp. These productsmaintain a mildly acidic environment that closely resembles the environ-ment of our acid mantle. We call these products " acid balanced."

The scalp's oils keep the hair lubricated and shiny. The scalp's aciditykeeps the fiber compact and strong. Part of the reason long hair tends tobe weaker at the ends and dull in appearance is that less of the acid man-tle reaches these ends. If, for example, the average pH on the surface ofthe scalp is measured at 4.8, the pH of the hair at further distances fromthe scalp will increase, showing that less of the acid mantle reaches theends of longer hair.

When high pH products, such as alkaline permanent waves or tints, comein contact with the hair, the solution is absorbed through the cuticle layerinto the inner layer of the hair called the cortex. The high pH causes thecortex layer to swell. This swelling forces the rigid cuticle layers to bestretched. At this point, the hair is in a very delicate condition and vul-nerable to excess stretching and breaking. This condition is necessaryfor permanent waves to successfully curl the hair and for tints to depositcolor molecules into the cortex for lasting color. Therefore, a high pH isessential for some chemical services to work properly.

pH and hair care productsShampoos, conditioners, hair colors, and tints all require the proper com-bination of ingredients and appropriate pH, which plays a crucial role inthe success of almost all salon services. Without the correct pH, perma-nent wave solutions could not create curls or waves, and color moleculesfrom tints would not deposit themselves into the cortex. Continuous useof shampoos and reconditioners with a high pH, however, can damageand dry out the hair.

Shampoo is the most common chemical applied to the hair and thereforeit especially important that it be acid-balanced. Do not confuse pH bal-anced and acid balanced. pH balanced means the pH is balanced at acertain number, but not necessarily at 4.5 to 5.5. Acid balanced meansthat it is balanced at the appropriate acidic level. Repeated use withshampoo of high pH could make the hair feel dry, dull, and less manage-able. There are three basic reasons for using acid-balanced shampoosand conditioners.

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The natural pH environment of a healthy hair and scalp is 4.5 to 5.5.Using acid balanced products keep the hair and scalp within this naturalrange. The acid mantle protects hair and skin from drying out andbecoming brittle and dull. Acid balanced products create and environ-ment that resembles the environment of our natural acid mantle. Also,the hair is structurally compact at a mildly acidic pH value. Swelling isminimized.

How many times have you heard marketing promotions touting theirproduct as "acid or pH balanced?" We have been told that a low pH isgood for our hair while a high pH is less desirable. This is true whenpertaining to products like shampoo and reconditioners, but there aresome services such as permanent waves and tints that rely on high pHchemicals.

Some products do not have the pH number listed on their labels. If youwant to find out the pH of any product you are using, you can use pHtest paper or nitrazine paper. Just dip the paper into the solution. Aproduct with a 4.5 pH or below will not change the paper from its origi-nal yellow shade. A higher pH will change the color to dark blue (4.6 to7.4) and any product with a pH over 7.5 will turn the paper purple.

Permanent waves and pHAlkaline waves have a pH of approximately 8.5 to 9.5. The high alkalin-ity softens and swells the hair fibers, making it easier for the chemicalsof the wave to penetrate the hair structure. Because of the high alkalini-ty, cautious and skillful use of the perm is essential to prevent damage tothe hair structure. There are pH normalizing conditioners that are madeto return hair to its natural pH after chemical services. It is a good idea touse one after giving an alkaline permanent wave.

When high alkaline solutions are used, such as tints and bleaching solu-tions, they will change the pH of the hair and skin. In this situation, aswith alkaline permanent waves, this is desirable. The important thing isto neutralize any extra alkalinity and bring the pH back to 4.5 to 5.5.This minimizes the swelling and strengthens the hair.

pH products work together to assure successful results and beautiful hair.Acid balanced shampoos protect the hair during cleansing. Conditionersand reconditioners that are acid balanced help return hair to its naturalmildly acidic state. Some products need to be alkaline to work properlysuch as permanent waves and tints. To control damage that might occurfrom these services finish with products that have a pH lower than 5.5.

You use chemicals and products everyday. It is important to know whatthese products do to the hair and why. pH is more than a number. It is ameasuring tool, a way for us to select and control products and services.Knowledge of pH enables you to leave the hair and skin in a natural andhealthy condition.

Hair colorPeople have been coloring their hair for thousands of years using plantsand minerals. Some of these natural agents contain pigments (e.g., henna,black walnut shells) and others contain natural bleaching agents or causereactions that change the color of hair (e.g., vinegar). Natural pigmentsgenerally work by coating the hair shaft with color. Some natural col-orants last through several shampoos, but they aren't necessarily safer ormore gentle than modern formulations. It's difficult to get consistentresults using natural colorants, plus some people are allergic to the ingre-dients.

Haircoloring is the result of a series of chemical reactions between themolecules in hair, pigments, as well as peroxide and ammonia, if present.Hair is mainly keratin. Its natural color depends on the ratio and quanti-ties of two proteins, eumelanin and phaeomelanin. Eumelanin is respon-sible for brown to black hair shades while phaeomelanin is responsiblefor golden blond, ginger, and red colors. The absence of either type ofmelanin produces white/gray hair.

Bleach is used to lighten hair. The bleach reacts with the melanin in hair,removing the color in an irreversible chemical reaction. The bleach oxi-dizes the melanin molecule. The melanin is still present, but the oxidizedmolecule is colorless. However, bleached hair tends to have a pale yel-low tint. The yellow color is the natural color of keratin, the structuralprotein in hair. Also, bleach reacts more readily with the dark eumelaninpigment than with the phaeomelanin, so some gold or red residual colormay remain after lightening. Hydrogen peroxide is one of the most com-mon lightening agents. The peroxide is used in an alkaline solution,which opens the hair shaft to allow the peroxide to react with themelanin.

Hair dye1

Hair dye products may be divided into three categories, i.e., permanent,semi-permanent and temporary hair colors. Semi-permanent and tempo-rary hair coloring products are solutions (on rare occasions dry powders)of various coal-tar, i.e. synthetic organic, dyes which deposit and adhereto the hair shaft to a greater or lesser extent. Temporary hair colors mustbe reapplied after each shampooing. The vehicle may consist of water,organic solvents, gums, surfactants and conditioning agents. The coal-tardyes are either listed and certified colors additives or dyes for whichapproval has not been sought. The dyes may not be non-permitted metal-lic salts or vegetable substances.

Temporary or semi-permanent hair colors deposit acidic dyes onto theoutside of the hair shaft or allow small pigment molecules to slip insidethe hair shaft, typically using a small amount of peroxide. In some cases,a collection of several colorant molecules enter the hair to form a largercomplex inside the hair shaft. Shampooing will eventually dislodge tem-porary hair color. These products don't contain ammonia, meaning thehair shaft isn't opened up during processing and the hair's natural color isretained once the product washes out.

Permanent hair colorPermanent hair colors are the most popular hair dye products. They maybe further divided into oxidation hair dyes and progressive hair dyes.Oxidation hair dye products consist of (1) a solution of dye intermedi-ates, e.g., p-phenylenediamine, which form hair dyes on chemical reac-tion, and preformed dyes, e.g., 2-nitro-p-phenylenediamine, whichalready are dyes and are added to achieve the intended shades, in anaqueous, ammoniacal vehicle containing soap, detergents and condition-ing agents; and, (2) a solution of hydrogen peroxide, usually 6%, inwater or a cream lotion.

The outer layer of the hair shaft, its cuticle, must be opened before per-manent color can be deposited into the hair. Once the cuticle is open, thedye reacts with the inner portion of the hair, the cortex, to deposit orremove the color. Most permanent hair colors use a two-step process(usually occurring simultaneously) which first removes the original colorof the hair and then deposits a new color. It's essentially the same processas lightening, except a colorant is then bonded within the hair shaft.

Ammonia is the alkaline chemical that opens the cuticle and allows thehair color to penetrate the cortex of the hair. It also acts as a catalystwhen the permanent hair color comes together with the peroxide.Peroxide is used as the developer or oxidizing agent. The developerremoves pre-existing color. Peroxide breaks chemical bonds in hair,releasing sulfur, which accounts for the characteristic odor of haircolor.As the melanin is decolorized, a new permanent color is bonded to thehair cortex. Various types of alcohols and conditioners may also be pres-ent in hair color. The conditioners close the cuticle after coloring to sealin and protect the new color.

The ammoniacal dye solution and the hydrogen peroxide solution, oftencalled the developer, are mixed shortly before application to the hair. Theapplied mixture causes the hair to swell and the dye intermediates (andpreformed dyes) penetrate the hair shaft to some extent before they have

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fully reacted with each other and the hydrogen peroxide and formed thehair dye.

A hair dye product containing a non-approved coal-tar color (but not anon-approved metallic or vegetable dye) which is known to causeadverse reactions under conditions of use cannot be considered adulterat-ed if the label bears the caution statement provided in section 601(a) ofthe FD&C Act and offers adequate directions for preliminary patch test-ing by consumers for skin sensitivity. The caution statement reads as fol-lows:

Caution - This product contains ingredients which may cause skin irritation on certain individuals and a preliminary test according to accompanying directions should first be made. This product must not be used for dyeing the eyelashes or eyebrows; to do may cause blindness.

If the label of a coal-tar color-containing hair dye product does not bearthe caution statement of section 601(a) and the patch testing directions, itmay be subject to regulatory action if it is determined to be harmfulunder customary conditions of use.

Several coal-tar hair dye ingredients have been found to cause cancer inlaboratory animals. In the case of 4-methoxy-m-phenylenediamine (4-MMPD, 2,4-diaminoanisole) which had also been demonstrated inhuman and animal studies to penetrate the skin, the agency consideredthe risk associated with its use in hair dyes a "material fact" whichshould be made known to consumers. The regulation requiring a labelwarning on hair dye products containing 4-MMPD published in October1979 was to become effective April 16, 1980. The regulation requiredthat hair dyes containing 4-MMPD bear the following warning:

Warning - Contains an ingredient that can penetrate your skin and has been determined to cause cancer in laboratory animals.

Some hair dyes manufacturers held that the potential risk was too smallto be considered "material" and challenged the validity of the regulationin court. The agency decided to reconsider its earlier position, enteredinto a consent agreement with hair dye manufacturers, and stayed theeffectiveness of the regulation until completion of an assessment of thecarcinogenic risk of 4-MMPD in accordance with scientifically acceptedprocedures.

In addition to 4-MMPD, the following other hair dye ingredients havebeen reported to cause cancer in at least one animal species in lifetimefeeding studies: 4-chloro-m-phenylenediamine, 2,4-toluenediamine, 2-nitro-p-phenylenediamine and 4-amino-2-nitrophenol. They were alsofound to penetrate human and animal skin.

Hair dye reactions As with hair relaxers, some consumers have reported hair loss, burning,redness, and irritation from hair dyes. Allergic reactions to dyes includeitching, swelling of the face, and even difficulty breathing.

Coal tar hair dye ingredients are known to cause allergic reactions insome people. Synthetic organic chemicals, including hair dyes and othercolor additives, were originally manufactured from coal tar, but todaymanufacturers primarily use materials derived from petroleum. The useof the term "coal tar" continues because historically that language hasbeen incorporated into the law and regulations.

The law does not require that coal tar hair dyes be approved by FDA, asis required for other uses of color additives. In addition, the law does notallow FDA to take action against coal tar hair dyes that are shown to beharmful, if the product is labeled with the prescribed caution statementindicating that the product may cause irritation in certain individuals, thata patch test for skin sensitivity should be done, and that the product mustnot be used for dyeing the eyelashes or eyebrows. The patch test involvesputting a dab of hair dye behind the ear or inside the elbow, leaving itthere for two days, and looking for itching, burning, redness, or otherreactions.

The problem is that people can become sensitized--that is, develop anallergy--to these ingredients. They may do the patch test once, and thenuse the product for 10 years" before having an allergic reaction. To guardagainst this, a patch test must be used every time. Many variables, likewhat chemicals are already in your hair and what your natural color is,affect what color the hair will turn out.

Hair color and cancerAs indicated above, over the years, some studies have indicated a possi-ble link between hair dye use and cancer, while others have not. InFebruary 1994, FDA and the American Cancer Society released an epi-demiologic study involving 573,000 women. Researchers found thatwomen who had ever used permanent hair dyes showed decreased risk ofall fatal cancers combined and also of urinary system cancers. The studyalso revealed that women who had ever used permanent hair dyesshowed no increased risk of any type of hematopoietic cancer (cancer ofthe body's blood-forming systems).

This research, published in the Journal of the National Cancer Institute,did suggest that prolonged use (20 years or more of constant use) ofblack hair dye may slightly increase the occurrence of non-Hodgkin'slymphoma and multiple myeloma, but these cases represented a smallfraction of hair dye users. This study followed previous NCI studies thatraised concern about the use of hair dyes and higher rates of non-Hodgkin's lymphoma.

In another study, published in the October 5, 1994, issue of the Journal ofthe National Cancer Institute, researchers from Brigham and Women'sHospital in Boston followed 99,000 women and found no greater risk ofcancers of the blood or lymph systems among women who had ever usedpermanent hair dyes.

Then in 1998, scientists at the University of California at San Franciscoquestioned 2,544 people about their use of hair-color products. Afterintegrating the results of this study with those of animal and other epi-demiologic studies, they concluded that there was little convincing evi-dence linking non-Hodgkin's lymphoma with normal use of hair-colorproducts in humans. The study was published in the December 1998issue of the American Journal of Public Health.

It is still common to hear that the use of permanent or semi permanenthair color products, particularly black and dark brown colors, is associat-ed with increased incidence of human cancer including non-Hodgkin'slymphoma, multiple myeloma, and Hodgkin's disease. Obviously, forindividuals at risk or recovering from cancer, recognizing the linksbetween personal care products and one's health can be vital to prevent-ing continued exposure to possible carcinogens like diethanolamine, con-tained in many shampoos and other products. According to a 2004 studyby the Environmental Working Group (EWG), 93 percent of shampoospossibly contain harmful impurities linked to cancer or other health prob-lems. Additionally, EWG found that 69 percent of hair-dye products maypose cancer risks.

Health and hair care ingredients:In pursuit of cleanliness and beauty, we buy approximately $20 billionworth of personal care products every year. More than 5,000 ingredientsare allowed for use in personal care products. Unfortunately, many ingre-dients are linked to damaging effects on human health. Many are identi-fied by government agencies as hazardous, but many others remainuntested. Unlike the pharmaceutical industry, the government does notrequire safety testing for these products before they go to market. Someingredients with known health hazards are very common in personal careproducts, both conventional products and alternative ones.

To avoid potentially harmful ingredients, consult the list below, compiledwith information from the Environmental Working Group (EWG) and theWashington Toxics Coalition. You can also visit EWG's Skin Deepreport, (http://www.ewg.org/reports/skindeep2/), an online searchable

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database of potentially toxic chemicals in personal care products, includ-ing phthalates, which are often not listed on labels. The database alsooffers brand-specific information and what the group considers saferalternatives.2

In regard to the safety of hair products,3 do not under-estimate theimportance of a patch test before trying any hair color products, even ifthey are semi-permanent or temporary hair dyes. The best way is to testfor allergic reaction is to apply the product to a quarter-sized spot behindthe ear or neck several days prior to actually using the product on yourscalp.

Predisposition TestFederal Law mandated under the Pure Food, Drug and Cosmetic Act of1938 provides that a skin test designed to determine an individual's over-sensitivity to certain chemicals be performed on all clients 24 hours priorto the application of the chemicals. Hypersensitivity to chemical prod-ucts can only be determined by administering a patch or predispositiontest. Allergies may appear suddenly and without warning even if theclient has successfully used a product for years.

NOTE: Before the application of any chemicals, a thorough analysis ofhair must be done to determine the presence of metallic salts.

Client ProtectionTechnician's hands must be washed with soap and warm water before the operation begins.

Drape the client appropriately:a. Skin of the client's neck must be protected from the re-usable

drape by a neck strip.b. Drape must be snug at the neckline and extend over the back of

the chair to protect the client's clothing and the chair.c. Two towels must be used to protect the client from solutions

which may drip during the service. One must be under the drape and one must be on top of the drape.

NOTE: It is always important to read and follow manufacturer's direc-tions for any chemical service. Because of the variance in productsavailable for use, in actual practice, the manufacturer's directions takeprecedence.

Select an area on the back of the neck below the ear lobe to apply the chemical.

NOTE: Manufacturer's directions may indicate a different area on thebody for the application of the chemical; be guided by the manufacturer'sdirections.

Cleansinga. Cleanse a quarter size area behind client's ear or in the inner

portion of the elbow.Water on a sanitary cotton ball or swab should be used for cleansing.

b. Area should air dry.Application

a. Product for P.D. test must be mixed in correct proportions according to manufacturer's directions.

b. Product must be applied to test area with a sterile cotton swab.c. Sufficient amount of product must be applied to be effective

for testing.d. Area must be left uncovered and undisturbed for 24 hours. Do

not wash off.e. After 24 hours the test area must be examined. If any sign of

swelling, burning, itching, redness, or inflammation occurs, theclient may be allergic to the product tested and unable to receive an aniline derivative application. (This would be a posi-tive reaction.)

NOTE: Only if the reaction is NEGATIVE (no reaction) may the producttested be used.

NOTE: Chemical burns may occur if solution saturated cotton is left onthe skin.

In case of chemical burnsa. Wash away the chemical with large amounts of water for at

least 5 minutes.b. Remove the victim's clothing from the affected area to prevent

further skin contact.c. Consult the product MSDS for additional first aid information.

Material Safety Data Sheets (MSDS)Hazardous substances are used in this industry on a regular basis and thelicensee is responsible for knowing and obeying the laws of all regulato-ry agencies they may encounter in their careers. The Material SafetyData Sheet (MSDS) is the primary source of information describing thehazardous properties of each chemical product used in the profession. Itcontains information on potential health hazards, proper handling of thechemicals and disposal methods, as well as, emergency first-aid proce-dures. The MSDS is the tool that will help hair, skin, and nail care pro-fessionals work safely in their environment.

The Federal OSHA Hazard Communication Standard requires thatschools and salons develop and maintain a list of hazardous chemicalspresent in the work place. Hazardous chemicals may include such prod-ucts as alcohol, permanent wave solutions, hair straightening solutions,etc. Schools and anyone employing cosmetology licensees are requiredby law to collect and maintain a file on MSDS for the chemicals used inthe establishment.

Manufacturers and distributors of products are, by law, charged with pro-viding an MSDS sheet for each of their products free of charge. Schoolsare responsible under the Hazard Communication Standard to train andfamiliarize both their staff and students about hazardous chemicals pres-ent in their facilities. An MSDS should be requested each time productscontaining hazardous substances are purchased or acquired. These filesshould be updated regularly. MSDS can be requested directly from themanufacturer or distributor of these products.

The MSDS should be reviewed in order to find out all necessary healthand safety information about the product before using it. This will helpindividuals make educated decisions about the products they use in theirprofession for their own personal safety, as well as the health and safetyof their clients.

Regardless of your current health, it's important to know the ingredientsin your personal care items. Shampoo and styling products contain vari-ous combinations of parabens, phthalates, fragrance and coal tar colors,which are associated with some risk, so read ingredient labels carefully.Because labels are often difficult to decipher and not all ingredients arenecessarily disclosed, finding safer personal care products can be a chal-lenge. Remember it is also the amount, not just the presence, of an ingre-dient that determines risk.

Women with hair loss or other hair and scalp disorders should notassume hair products are safe. Trying a different hair color or highlightsto create the illusion of thicker hair using hair dyes may actually furtherhair loss or aggravate existing hair and scalp disorders. This is becausemost professional hair color products contain loads of harsh chemicalssuch as peroxide, ammonia and p-phenylenediamine that can cause seri-ous damage to the hair and scalp and increase hair loss.

Danger to eyesWhether applying hair chemicals at home or in a hair salon, consumersand beauticians should be careful to keep them away from the eyes. FDAhas received reports of injuries from hair relaxers and hair dye acciden-

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tally getting into eyes. The use of permanent eyelash and eyebrow tintingand dyeing has been known to cause serious eye injuries and even blind-ness. There are no color additives approved by FDA for dyeing or tintingeyelashes and eyebrows.

Hair care ingredientsThe following ingredients hold some risk or are associated with negativereactions in some individuals:

Ammonia, used in hair dyes and bleaches, can irritate the eyes and skinand can be toxic when inhaled.

Bronopol may break down in products into formaldehyde and also causethe formation of carcinogenic nitrosamines, compounds shown to causecancer in laboratory animals, under certain conditions. Bronopol is oftenlisted as 2-bromo-2-nitropropane-1,3-diol.

Diethanolamine (DEA), widely used in shampoos as an emulsifier orfoaming agent, is a suspected carcinogen, and its compounds and deriva-tives include triethanolamine (TEA), and monoethanolamine (MEA), allof which can be contaminated with nitrosamines, Contamination is morelikely if the product also contains Bronopol (see above). DEA, TEA,and MEA are hormone disruptors that are also known to combine withnitrates to form cancer-causing nitrosamines. If a product containsnitrites, which are used as a preservative or present as a contaminant notlisted on labels, chemical reactions between nitrites and these substancesmay occur during the manufacturing process and while products arestored in their containers. This reaction leads to the formation ofnitrosamines. Most nitrosamines, including those formed from DEA orTEA, are carcinogenic. There is no way to know which products containnitrosamines because government does not require manufacturers to dis-close this information on the label.

A 1997 study by the U.S. National Toxicology Program found that thesecompounds themselves might also be carcinogenic. Repeated skin appli-cation of DEA was found to cause liver and kidney damage in animals.The study also discovered that when absorbed through the skin, DEAaccumulated in organs. TEA may also cause contact dermatitis in someindividuals.

FD&C colors (or coal tar colors) are used extensively as coloring agentsor coloring additives in personal care products. Coal tar colours havebeen found to cause cancer in animals and many people experience aller-gic reactions to them, such as skin irritation and contact dermatitis. Theyare listed as FD&C or D&C, followed by a color and a number, forexample: FD&C Red No. 6, or D&C Green No. 6. FD&C Blue 1 and FD&C Green 3 are carcinogenic, and impurities in other colors -- D&C Red33, FD&C Yellow 5 and FD&C Yellow 6 -- have been shown to causecancer when when applied to the skin. Some artificial coal tar colors con-tain heavy metal impurities, including arsenic and lead, which are car-cinogenic.

The law does not require that coal tar hair dyes be approved by FDA, asis required for other uses of color additives. In addition, the law does notallow FDA to take action against coal tar hair dyes that are shown to beharmful, if the product is labeled with the following caution statement:

"Caution-This product contains ingredients which may cause skin irritation on certain individuals and a preliminary test according to accompanying directions should first be made. This product must not be used for dyeing the eyelashes or eyebrows; to do so may cause blindness."

Fragrance: Synthetic fragrances are the most common ingredients foundin personal care products. In 1989 the US National Institute ofOccupational Safety and Health evaluated 2,983 fragrance chemicals forhealth effects. They identified 884 of them as toxic substances.The term"fragrance" on a label can indicate the presence of up to 4,000 separateingredients. A common shampoo and conditioner ingredient, fragrancecan include possible skin irritants and allergens. The FDA does not

require companies to disclose the ingredients listed as "fragrance" whichmany include phthalates, chemicals that have been found to produce can-cer of the liver and birth defects in lab animals.

Fragrance is a known trigger of asthma, and fragrances more often causeallergic contact dermatitis than any other ingredient; including wateryeyes and respiratory tract irritation. Other negative symptoms reported tothe FDA have included headaches, dizziness, rashes, skin discoloration,violent coughing and vomiting, and allergic skin irritation. Clinicalobservations by medical doctors have shown that exposure to fragrancescan affect the central nervous system, causing depression, hyperactivity,irritability, and other behavioral changes. Many of the compounds in fra-grance are suspected or proven carcinogens.

Hydrogen peroxide is an irritant included in oxidation dyes, which con-tain a combination of hydrogen peroxide, dye and ammonia,Lead acetate is the active ingredient in progressive dyes, which containup to ten times the lead level allowed in house paint. Lead is a neurotox-in, affecting the brain and nervous system, and is a known carcinogenand hormone disruptor. It is readily absorbed through the skin and accu-mulates in the bones. It causes neurological damage and behavior abnor-malities, and large accumulations can result in leg cramps, muscle weak-ness, numbness and depression.

Nonylphenols (nonoxynol or nonylphenol ethoxylate) are surfactants(substances that reduces the surface tension of liquids, making it easierfor them to disperse) used for their detergent properties. This substance isfound in some shampoos and hair color, resulting when certain chemicalscommonly found in these products break down. These chemicals can actas hormone disrupters, potentially threatening reproductive capacity.They are of such concern that many European countries are phasing themout. Some manufacturers have voluntarily discontinued their use.

Parabens, an ingredient in many relaxers, are preservatives with antibac-terial properties. Widely used in all kinds of personal care products,paraben is usually preceded by the prefixes methyl-, ethyl-, butyl-,propyl, or isobutyl. Parabens, which are included in some conditioners,can cause allergic reactions or contact dermatitis in some people.(Preservatives are one of the leading causes of contact dermatitis.) TheU.S. Food and Drug Administration (FDA) also warns consumers to usecaution when using relaxers, as chemicals may accidentally enter theeyes.

Additionally, parabens, according to research published in a 2004 issueof the Journal of Applied Toxicology, have been found in breast tumors.An accompanying article suggested that adolescents and close relativesof breast-cancer patients may be at an increased risk due to continuedexposure. Parabens can affect the endocrine system (the glands that pro-duce hormones).

Peroxide is a possible carcinogen used in hair-coloring products that canirritate the skin of hands and scalp and damage hair and eyes.

Phenylenediamine (p-Phenylenediamine or PPD), found in many hairdyes, is linked with skin irritations, respiratory disorders and cancers, andis banned in Europe. Also called oxidation dyes, amino dyes para dyes,or peroxide dyes, PPDcan cause eczema, bronchial asthma, gastritis, skinirritation and even death. It is also a carcinogen and can react with otherchemicals to cause photosensitivity.

Next to peroxide and ammonia, it is p-phenylenediamine that causes themost concerns among people regarding hair color. To make the situationmore confusing for the general public, there are plenty of synonyms forthis chemical which makes it quite difficult for the consumer to discern ifthis chemical is present in a particular hair product or not.

Synonyms or components of p-Phenylenediamine: Paraphenylenediamine Para-aminoaniline (p-aminoaniline)

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PPD PPDA1,4-Benzenediamine Orsin™ 1,4-Penylenediamine Ursol™ D Rodol™ D Paradiaminobenzene

Appropriate recommendations on use concentrations, restrictions andwarnings for such application are critical as after active sensitizationthere may be extensive cross reactivity to other commonly encounteredchemical substances to which the consumer may be exposed. Theseinclude other hair colouring agents, textile dyes, drugs and rubber chemi-cals. The US Food and Drug Administration proposed legislation that wouldhave required warning labels on products, advising that this ingredientcan penetrate skin and has been determined to cause cancer in lab ani-mals. If passed, beauty salons would have had to post warnings for theircustomers. Cosmetic industry lobbyists defeated the proposal.

Phthalates are found in many products from plastics to shampoo.Phthalates are widely used in hair products (sprays and shampoos) toenhance fragrances, as solvents, and to denature alcohol. The oily textureof phthalates helps lotions penetrate skin. These hormone-disruptingchemicals are suspected of contaminating breast milk and causing dam-age to the kidneys, liver, lungs and reproductive organs. Recent producttests found the chemical in every fragrance tested in the United States.

Manufacturers are not required to list phthalates on product labels, sothey are difficult to avoid. Phthalates in DEHP, DHP, and DBP5 are notidentified on cosmetic labels when they are in fragrance. Since, phtha-lates often "hide" behind the term "fragrance;" choose products labeled"fragrance-free" or that are scented exclusively with pure botanical oressential oils.

One type of phthalate, diethyl phthalate (DEP) is commonly found in fra-grances and other personal care products. A study published inEnvironmental Health Perspectives (December 2002) found that DEP isdamaging to the DNA of sperm in adult men at current levels of expo-sure. DNA damage to sperm can lead to infertility and may also belinked to miscarriages, birth defects, infertility and cancer in offspring.DEP is the phthalate found in the highest levels in humans.

Polyethylene and polyethylene glycol (PEG ingredients), which arefound in hair straighteners, are safe in themselves but can be contaminat-ed with 1,4- dioxane, which produced liver cancer in rodents in NationalCancer Institute (NCI) studies.

Polysorbate compounds 60 and 80 are emulsifiers, used in lotions andcreams, that can also become contaminated with the carcinogen 1,4-diox-ane. Dioxane readily penetrates the skin. While dioxane can be removedfrom products easily and economically by vacuum stripping during themanufacturing process, there is no way to determine which products haveundergone this process. Labels are not required to list this information.

Polyvinylpyrrolidone (PVP), widely used in hair-care products, especial-ly sprays, has been found to stay in the body for months. In rats it con-tributed to tumor development.

Propylene glycol, a humectant, or moisture-attracting ingredient, foundpersonal care products, can irritate the skin in sensitive individuals.

Propylene glycol is recognized as a neurotoxin by the National Institutefor Occupational Health and Safety in the U.S. It is known to cause con-tact dermatitis, kidney damage and liver abnormalities. It is widely usedas a moisture-carrying ingredient in place of glycerine because it ischeaper and more readily absorbed through the skin. The

Material Safety Data Sheet for propylene glycol warns workers handlingthis chemical to avoid skin contact.

Sodium hydroxide is an active ingredient in lye relaxers that can causeskin irritation, burns and necrosis as well as breathing difficulty wheninhaled. Although "no lye" relaxers do not contain sodium hydroxide andresult in less skin irritation than lye products, they too can burn the scalpif used incorrectly.

Sodium lauryl sulfate (sodium laureth sulfate, SLS) are used as latheringagents, and are present in 90% of commercial shampoos. This chemicalis a known skin irritant and appears to increase allergic response to othertoxins and allergens, according to the Cosmetics Ingredient Review(CIR), a panel of cosmetics-industry experts established to safety-testingredients (cir-safety.org). After a review of over 250 existing SLS stud-ies, the CIR concluded that SLS is not cancer-causing. However, Somedoctors are not convinced and recommend avoiding SLS.

The U.S. government has also warned manufacturers of unacceptablelevels of dioxane formation in some products containing SLS. 1,4-Dioxane or para-dioxane is also commonly referred as simply 'dioxane'.However, 1,4-dioxane should not be confused with dioxin (or dioxins),which are a different class of chemical compounds. While dioxane canbe removed from products easily and economically by vacuum strippingduring the manufacturing process, there is no way to determine whichproducts have undergone this process. Labels are not required to list thisinformation.

Using caution with relaxers and dyes4

According to the Food and Drug Administration's Office of Cosmeticsand Colors, hair straighteners and hair dyes are among its top consumercomplaint areas. Complaints range from hair breakage to symptoms war-ranting an emergency room visit. Reporting such complaints is voluntary,and the reported problem is often due to incorrect use of a product ratherthan the product itself. FDA encourages consumers to understand therisks that come with using hair chemicals, and to take a proactiveapproach in ensuring their proper use. The agency doesn't have authorityunder the Federal Food, Drug, and Cosmetic Act to require premarketapproval for cosmetics, but it can take action when safety issues surface.

The role of the FDAWhen consumers notify the FDA of problems with personal care prod-ucts, the agency evaluates evidence on a case-by-case basis and deter-mines if follow-up is needed. The FDA looks for patterns of complaintsor unusual or severe reactions. The agency may conduct an investigation,and if the evidence supports regulatory action, the FDA may requestremoval of an item from the market.

Take the example of two popular hair relaxer products by World RioCorp.--the Rio Naturalizer System (Neutral Formula) and the RioNaturalizer System with Color Enhancer (Black/Licorice). After receiv-ing complaints about these products in November and December of1994, the FDA warned the public against using them. Consumers com-plained of hair loss, scalp irritation, and discolored hair.

In December 1994, the World Rio Corp., Inc. of Los Angeles, Calif.,announced that it stopped sales and shipments of the product. But reportsindicated that the company continued to take orders, and the CaliforniaDepartment of Health also stepped in to stop sales. In January of 1995,the U.S. Attorney's Office in Los Angeles filed a seizure action againstthese products on behalf of FDA. By then, the agency had received morethan 3,000 complaints about the Rio products.

Although most relaxers are alkaline, this product was formulated to beacidic. In the resulting consent decree of condemnation and permanentinjunction, FDA alleged that the products were potentially harmful orinjurious when used as intended, that they were more acidic thandeclared in the labeling, and that the labeling described the products as

14

"chemical free" when "allegedly they contained ingredients commonlyunderstood to be 'chemicals.'"

Safer straighteningFDA has received complaints about scalp irritation and hair breakagerelated to both lye and "no lye" relaxers. Some consumers falsely assumethat compared to lye relaxers, "no lye" relaxers take all the worry out ofstraightening.

People may think because it says 'no lye' that it's not caustic, but bothtypes of relaxers contain ingredients that work by breaking chemicalbonds of the hair, and both can burn the scalp if used incorrectly. Lyerelaxers contain sodium hydroxide as the active ingredient. With "no lye"relaxers, calcium hydroxide and guanidine carbonate are mixed to pro-duce guanidine hydroxide.

Research has shown that this combination in "no lye" relaxers results inless scalp irritation than lye relaxers, but the same safety rules apply forboth. They should be used properly, left on no longer than the prescribedtime, carefully washed out with neutralizing shampoo, and followed upwith regular conditioning. For those who opt to straighten their own hair,it's wise to enlist help simply because not being able to see and reach thetop and back of the head makes proper application of the chemical andthorough rinsing more of a challenge.

Some stylists recommend applying a layer of petroleum jelly on the scalpbefore applying a relaxer because it creates a protective barrier betweenthe chemical and the skin. Scratching, brushing, and combing can makethe scalp more susceptible to chemical damage and should be avoidedright before using a relaxer. Parents should be especially cautious whenapplying chemicals to children's hair and should keep relaxers out ofchildren's reach. There have been reports of small children ingestingstraightening chemicals and suffering injuries that include burns to theface, tongue, and esophagus.

How often to relax hair is a personal decision. Relaxing at intervals ofsix to eight weeks is common, and the frequency depends on the rate of aperson's hair growth. Some professionals feel that straightening every sixweeks is too frequent, as relaxers can cause hair breakage in the longterm, with blow drying and curling doing further damage.

Consumers should be aware that applying more than one type of chemi-cal treatment, such as coloring hair one week and then relaxing it thenext, can increase the risk of hair damage. The only color recommendedfor relaxed hair is semi-permanent because it has no ammonia and lessperoxide, compared with permanent color.

The FDA encourages voluntary reporting of adverse reactions to hairproducts to the FDA, Center for Food Safety and Applied Nutrition,Office of Cosmetics and Colors.

ENDNOTES1 http://www.cfsan.fda.gov/~dms/cos-hdye.html2 http://www.ewg.org/reports/skindeep2/3 http://www.womenshair.info/articles/article6.htm

4 http://www.fda.gov/fdac/features/2001/101_hair.html By Michelle Meadows U.S. Food and Drug Administration FDA Consumer magazine January-February 2001

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CHAPTER 3FLORIDA STATUTES AND ADMINISTRATIVE CODE

(2 Credit Hours)Learning Objectives:

Be able to list and describe your legal responsibilities accord-ing to the Florida Cosmetology Practice Act and Florida Administrative CodeKnow your duties and Responsibilities under Florida Law

IntroductionTwo primary areas of law pertaining to the practice of cosmetology in theState of Florida are:

The Florida Cosmetology Practice Act: Chapter 477 of the Florida Statutes1

Chapter 61G5 of the Florida Administrative Code2

The following pages simplify excerpts of these documents, clarifying theregulations that address you as a cosmetologist, and explaining your legalresponsibilities and obligations.

Other sections or chapters of the Florida Statutes [FS] and FloridaAdministrative Code [FAC] that apply to the practice of cosmetology(such as Chapter 456: Health Professions and Occupations; or Chapter120: Administrative Procedure Act; among others) are not addressed inthis chapter. Text in full for the Laws of Florida may be found athttp://www.state.fl.us/dbpr/pro/cosmo/cos_codes.shtml. Please referdirectly to the Laws of Florida to determine the effective date of a creat-ing act or a particular amendment.

477.011 Short titleThis act will be referred to as the Florida Cosmetology Act, or the Act.The following chapter discusses the Act, covering these topics:

• Purpose of the Act• Definitions used in the Act • Hair braiding, hair wrapping, and body wrapping • Exemptions and qualifications for practice• The Board of Cosmetology• Rulemaking• Legal and investigative services• Registration, licensing, license renewal, and status• Continuing education and examinations• Schools of cosmetology and salons• Fees, services, prohibited acts, and penalties• Disciplinary and civil proceedings• Licensing and graduates of Florida School for the Deaf and

the Blind

477.012 PurposeThe Legislative deems it necessary in the interest of public health to reg-ulate the practice of cosmetology in this state. However, restrictions shallbe imposed only to the extent necessary to protect the public from signif-icant and discernible danger to health and not in a manner which willunreasonably affect the competitive market. Further, consumer protectionfor both health and economic matters shall be afforded the public throughlegal remedies provided in this act

477.013 DefinitionsThe Act uses the following definitions:"Board" means The Board of Cosmetology"Department" means the Department of Business and ProfessionalRegulation

"Cosmetologist" means a person who is legally licensed to practice cos-metology in Florida

"Cosmetology" means treatments to the head, face, and scalp, includinghair shampooing, cutting, arranging, coloring, permanent waving, andrelaxing; hair removal, including wax treatments; manicure and pedicureof the nails; and skin care treatments, performed with compensation, orpayment, for purposes of appearance (aesthetics), rather than medicalreasons"Specialist" means a person holding a specialty registration in one ormore of the following specialty services:

Manicuring the nails, including any treatment or affixing to the nails (including cutting, polishing, tinting, coloring, cleansing, adding, or extending) and massage of the hands, with the exception of nails affixed with only a simple adhesive

Pedicuring (including shaping, polishing, tinting, or cleansing) thenails of the feet, including any treatment, massage, or beautification of the feet

Facials, including any treatment and massage of the face, skin, and scalp, using oils, creams, lotions, or other preparations, and skin careservices

"Shampooing" means the washing or treatment of the scalp and hair withsoap and water, special preparations, hair tonics, or other applications "Specialty salon" means any place of business where at least one ofthese specialties (manicuring, pedicuring, facials, and/or shampooing)occurs

"Hair braiding" means weaving or interweaving natural human hair forcompensation; It does not include cutting, coloring, permanent waving,relaxing, removing, chemical or other treatment of hair, or the use of hairextensions or wefts

"Hair wrapping" means the wrapping of manufactured materials aroundhair for compensation; It does not include cutting, coloring, permanentwaving, relaxing, removing, removing, weaving, chemically treating,braiding, using hair extensions, or performing any other service definedas cosmetology

"Photography studio salon" means a place of business where cosmeticand hair-related services (with the exceptions of shampooing, coloring,permanent waving, relaxing, removal of hair or any other service definedas cosmetology) are performed only to prepare a model or client for aphotographic session

"Body wrapping" means a treatment using herbal wraps for the purposeof cleansing or beautifying the skin that does not include:

The application of oils, lotions, or other fluids (with the exception of fluids contained in presoaked wrapping materials)

Manipulation of superficial body tissue (other than that which occurs with compression during normal use of wrapping materials)

"Skin care services" means treatment of the skin (other than the head,face, and scalp) using an implement, such as a sponge, brush, or cloth (orhands, in the case of a chemical peel), to apply or remove skin treatmentmaterials. Skin care services must be performed by a licensed cosmetol-ogist or facial specialist at a licensed cosmetology or specialty salon.Skin care services may not include any massage or manipulation of thesuperficial body tissues.

477.0132 Hair braiding, hair wrapping, and body wrapping regis-trationIndividuals who are only responsible for hair braiding must:

- register with the Department of Health;- pay a registration fee; and- take a 2-day 16-hour course including (5 hours) Board-

approved HIV/AIDS and communicable disease education,

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What You Should Know About...

Florida Statutes: Chapter 477 THE FLORIDA COSMETOLOGY PRACTICE ACT

Sections: 477.011 - 477.031

(5 hours) sanitation and sterilization, (4 hours) disorders anddiseases of the scalp, and (2 hours) laws regarding hair braiding.

Individuals who are only responsible for hair wrapping must:- register with the Department of Health;- pay a registration fee; and- take a 1-day 6-hour board-approved course of HIV/AIDS and

communicable disease education, sanitation and sterilization,disorders and diseases of the scalp, and laws regarding hairwrapping

Unless specifically licensed or exempted under this chapter, individualswho are only responsible for body wrapping must:

- register with the Department of Health;- pay a registration fee; and- take a 2-day 12-hour board-approved course of HIV/AIDS and

communicable disease education; sanitation and sterilization; disorders and diseases of the scalp; and laws regarding body wrapping

Hair braiding, hair wrapping, and body wrapping do not have to takeplace in a cosmetology or specialty salon. If they take place outside of acosmetology or specialty salon, hair braiding, hair wrapping, and bodywrapping must be performed using disposable implements or implementssanitized in a disinfectant approved for hospital use or by theEnvironmental Protection Agency.

A person can legally practice hair braiding, hair wrapping, or body wrap-ping once he or she has submitted an application for registration thatincludes proof of:

- successful completion of the education requirements- payment of fees

477.0135 ExemptionsThis chapter does not apply to:

- People commissioned by the U.S. armed forces as medical or surgical officers,

- People authorized by Florida law to practice medicine, surgery,osteopathic medicine, chiropractic medicine, massage; naturopathy, or podiatric medicine

- Registered nurses - Barbers licensed by the state- People employed as cosmetologists who serve inmates,

patients, or military personnel in federal, state, or local institu-tions, hospitals, or military bases

- People who apply cosmetics (without compensation) for the purpose of selling cosmetic products

- People who are only responsible for shampooing (which doesnot require a license)

- People working in a licensed barbershop who are only responsible for cutting, trimming, polishing, or cleaning the fingernails

- A photography studio salon, except:The hair-related services of the photography studio salon must be performed under supervision of a licensed cosmetologist employed by the salon, and

The salon must use disposable hair-related implements or a wetor dry sanitizing system approved by the Environmental Protection Agency

- A license is not required of any individual providing makeup, special effects, or cosmetology services to an actor, stunt per-son, musician, extra or other talent during a production recog-nized by the Office of Film and Entertainment as a qualified production as defined in s.288.1254(2). Such services are not required to be performed in a licensed salon.

- A license is not required of any individual providing makeup orspecial effects services in a theme park or entertainment com-plex to an actor, stunt person, musician, extra or other talent or providing makeup or special effects services to the general public. The term "theme park or entertainment complex" has the same meaning as in s.509.013(9).

477.015 Board of CosmetologyThe Board of Cosmetology exists within the Department of Business andProfessional Regulation. Members of the Board will:

- Be appointed by the Governor - Be confirmed by the Senate- Be responsible for carrying out the regulations discussed in the

Cosmetology Practice Act- Total 7 individuals, each a resident of the state for at least 5

continuous years:5 of the 7 Board members must be licensed cosmetologists with a minimum of 5 years of practice

2 of the 7 Board members will be laypersons (without special knowledge or training in cosmetology)

The Governor can fill any vacancies on the Board (for the remainder ofunexpired terms) at any time.

Board members must remain on the board, even after a term has expired,until a replacement member is appointed and qualified to serve.

No Board member can serve more than two consecutive terms, regardlessof whether the terms were partly or fully served.

Each Board member will take the constitutional oath of office, file withthe Department of State, and receive a certificate of appointment beforeassuming any duties as a Board member

The Board will elect one member as chair and one member as vice-chairin the month of January

The Board will hold at least one annual meeting, and hold other meetingwhen the chair deems it necessary.

At least four members of the Board are required for a quorum (the num-ber of votes required to adopt a rule)

Board members will receive $50 for each day spent conducting Boardbusiness (to a maximum amount of $2000 per year) and reimbursementfor daily travel expenses associated with attending Board meetings

Each Board member is responsible to the Governor for carrying out allthe duties required of them by their position as Board member

In case of complaints or question of wrongdoing, the Governor willinvestigate the actions of the Board or specific members, and remove anyBoard members responsible for neglect of duty, incompetence, unprofes-sional or dishonorable conduct.

The Board has the authority to adopt rules based on the provisions in thischapter.

The Board may by rule adopt any restrictions established by a regulationof the United States Food and Drug Administration related to the use of acosmetic product or any substance used in the practice of cosmetology ifthe board finds that the product or substance poses a risk to the health,safety, and welfare of clients or persons providing cosmetology services.

447.017 Legal ServicesThe Department shall provide all legal services needed to carry out theprovisions of this act.

477.018 Investigative servicesThe Department of Business and Professional Regulation will provide allinvestigative services required by the Board or the Department to carryout the provisions of the Cosmetology Act.

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477.019 Cosmetologists; qualifications; licensure; supervised prac-tice; license renewal; endorsement; continuing educationTo qualify for licensing as a cosmetologist, a person must:

- Apply to the department for licensing- Be eligible to take the licensing exam for cosmetology by:

Being at least 16 years old or have a high school diploma

Paying the application fee (which is not refundable) and the examination fee (which is refundable if the individual is ineligible for licensing)

- Have been authorized to practice cosmetology in another state or country for a period of at least one year, and not able to qualify for licensing by endorsement, or

- Have received at least 1,200 hours of training, including completion of cosmetology services at:

A licensed school of cosmetology

A cosmetology program within the public school system

The Cosmetology Division of the Florida School for the Deafand the Blind, with provisions meeting the specifications of this chapter

A government-operated cosmetology program in the state of Florida

The Board will establish rules and procedures for certifying an individ-ual's qualification to take the required exam after completing a minimumof 1,000 school hours. If the person does not pass the examination, he orshe will not qualify to take the exam again until he or she has completed1,200 hours of training.

Once an applicant receives a passing grade on the exam and pays the ini-tial licensing fee, the department will issue a license to practice cosme-tology.

After the first licensing exam, pending the results, graduates of licensedcosmetology schools, or programs that are certified by the Department ofEducation, may legally practice cosmetology in a licensed cosmetologysalon.

Graduates who fail the first exam may continue to practice under thesupervision of a licensed cosmetologist in a licensed cosmetology salon,if the graduate applies to take the next available exam, until he or shereceives the results of that exam.

A graduate may not continue to practice cosmetology if he or she failsthe exam twice.

Renewal of license registration will follow Board rules:That specify procedures for licensing by endorsement (for practi-tioners who have a current active license in another state and who have qualifications similar to those required by the State of Florida)

Regarding continuing education (to ensure public safety by requir-ing updated training of licensees), not to exceed 16 hours every two-year licensing renewal period for licensees and registered spe-cialists. Continuing education courses must address the following topics and their significance to the practice of cosmetology:

- HIV/AIDS/Communicable disease - Occupational Safety and Health Administration regulations- Workers' compensation issues- Environmental issues- State and federal laws and rules regarding cosmetologists,

cosmetology, salons, specialists, specialty salons, booth renters, and/or chemical makeup relating to hair, skin, and nails

Individuals who are only responsible for hair braiding, hair wrap-ping, or body wrapping are exempt from these continuing education requirements.

The Board may require any licensee in violation of a continuing educa-tion requirement to take a course, or a course and examination, up to atotal of 48 credit hours, in addition to any other penalties required.

Qualifications and renewal of specialty registration:An individual is qualified for registration as specialist in one or morespecialty practices who:

- Is at least 16 years of age or has received a high school diploma- Has received a certificate of completion in a specialty from one of

the following: A school licensed under s 477.023, or chapter 1005 or the equivalent authority in another state

A specialty program within the public school system

A specialty program within the Cosmetology Division of the Florida School for the Deaf and the Blind, provided minimum curriculum requirements are met

- Applies to the department in writing using department forms- Pays the initial registration fee for one or more of the specialty

practices within cosmetology- Renews registration according to board rules- Has been authorized to practice cosmetology in another state with

similar or more stringent standards for specialty areas of cosmetol-ogy and follows board-specified procedures for registration

- Submits an application showing proof of completion of educationalrequirements and payment of applicable fees, and pending issuanceof registration, practices under the supervision of a registered specialist in a licensed specialty or cosmetology salon.

Inactive status:A cosmetologist's license that has become inactive can be reactivated,according to rules developed by the Board, with an application to thedepartment and payment of a reactivation fee or renewal fee not toexceed $50.

Graduates of Florida School for the Deaf and the Blind will be licensedupon graduation. Licensing or other application fees for graduates willbe provided by the Department.

The Board will specify rules regarding competency examinations for cos-metology, including:

- Areas of competency - Grading criteria - Relative weight of each grading area- Score required for a passing grade

The Board will insure that the exam measures both competency andknowledge of legal requirements. The board may offer a written clinicalexamination, a performance examination, or both, in addition to a writtentheory examination. The board may use professional testing services todevelop the examinations.

The Board will:Ensure that examinations comply with state and federal equal opportuni-ty guidelines

Ensure that examinations will be administered at least once a year

Develop rules for the reexamination of applicants who have previouslyfailed the examinations

Ensure that examinations are conducted with appropriate confidentialityof scores; the applicant will be known only by a number until the exami-nations is completed and graded. Once the grade is accurately recorded,it will be filed with the secretary of the department, and kept on file forreference and inspection for a period of at least two years following theexamination.

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477.0201 Specialty registration; qualifications; registration renewal;endorsementAny person is qualified for registration as a specialist in any one or moreof the specialty practices within the practice of cosmetology under thischapter who: Is at least 16 years of age or has received a high school diploma.

Has received a certificate of completion in a specialty pursuant to s.477.013(6) from one of the following:

A school licensed pursuant to s. 477.023.

A school licensed pursuant to chapter 1005 or the equivalent licensing authority of another state.

A specialty program within the public school system.

A specialty division within the Cosmetology Division of the Florida School for the Deaf and the Blind, provided the train-ing programs comply with minimum curriculum requirements established by the Board.

A person desiring to be registered as a specialist shall apply to theDepartment in writing, using forms prepared and furnished by theDepartment.

Upon paying the initial registration fee, the department shall register theapplicant to practice one or more of the specialty practices within thepractice of cosmetology.

Renewal of registration shall be accomplished pursuant to rules adoptedby the Board.

The Board will adopt rules specifying procedures for the registration ofspecialty practitioners desiring to be registered in this state who havebeen registered or licensed and are practicing in states which have regis-tering or licensing standards substantially similar to, equivalent to, ormore stringent than the standards of this state.

Pending issuance of registration, a person is eligible to practice as a spe-cialist upon submission of a registration application that includes proofof successful completion of the education requirements and payment ofthe applicable fees required by this chapter, provided such practice isunder the supervision of a registered specialist in a licensed specialty orcosmetology salon.

477.0212 Inactive statusA cosmetology license that has become inactive may be reactivated,under s. 477.019, upon application to the Department.

The Board will develop rules relating to the renewal of inactive licenses.The Board will set a fee not exceeding $50 for the reactivation of aninactive license or renewal of an inactive license.

477.025 Cosmetology salons; specialty salons; requisites; licensure;inspection; mobile cosmetology salonsCosmetology salons or specialty salons must by licensed by theDepartment (except as indicated in subsection 11).

The Board will develop rules regarding the application and licensingprocess, operation of salons and their facilities, personnel, and safety andsanitation requirements.

Any entity wanting to operate a cosmetology or specialty salon in thestate will submit an application form (provided by the Department),including the application fee and any relevant information required bythe Department to process the application.

Once the application is received, the Department may investigate the pro-posed cosmetology or specialty salon.

Applicants who fail to meet all the requirements will be denied in writ-ing, and receive a list of the unmet requirements.

Applicants who failed to meet the requirements and are denied licensuremay reapply.

When a proposed cosmetology or specialty salon is expected to meet allthe requirements for licensure, the department will grant the license,according to conditions it considers proper, upon payment of the originallicensing fee.

A license for operation of a cosmetology or specialty salon may not betransferred from the name of the original licensee to another person. Alicense for operation may be transferred from one location to another,with approval by the Department.

Renewal of license registration for cosmetology or specialty salons willfollow rules developed by the Board. The Board will also develop rulesgoverning penalties for delinquent renewal, and fees or associated penal-ties.

The Board will develop rules regarding inspection of cosmetology andspecialty salons.

The Board will develop rules regarding the licensing, operation, andinspection of mobile cosmetology salons, including their facilities, per-sonnel, and requirements for safety and sanitation.

Mobile salons must follow all licensing and operating requirements spec-ified in this chapter, chapter 455, and any rules of the Board orDepartment that apply to cosmetology salons that are not mobile, unlessthey conflict with the rules addressed in this subsection.

A mobile cosmetology salon must have a permanent business address, belocated within an inspection area, where the employees at the mobilesalon can receive correspondence from the Department. TheDepartment will keep all records of appointments, itineraries, employees'license numbers, and vehicle identification numbers of the mobile salon,at the local Department office, for verification purposes by Departmentpersonnel.

Before the beginning of each month, each mobile salon license-holderwill file an itinerary with the Board, listing the dates, operating hours,and locations of the mobile salon, so periodic inspections may be sched-uled.

The Board will establish fees for mobile cosmetology salons that are nohigher than those for traditional salons.

Mobile cosmetology salons must operate according to the laws and regu-lations of businesses in the area, including the Americans withDisabilities Act (providing access to individuals with disabilities) andOSHA (Occupational Safety and Health Administration) requirements.

Facilities licensed under part II or III of chapter 400, as well as cosmetol-ogists licensed according to 477.019, who may provide salon servicesexclusively to residents of the facility, are exempt from the provisions ofthis section,.

477.026 Fees; dispositionThe board will set the following fees:Cosmetologists: Original licensing, license renewal, and delinquent renewal = no morethan $25Endorsement application, examination, and reexamination = no morethan $50Cosmetology and specialty salons:License application, original licensing, license renewal, and delinquentrenewal = no more than $50

All fees collected by the department according to this chapter will bepaid into the Professional Regulation Trust Fund, created within theDepartment, according to statutes 215.37 and 455.219. The legislaturemay use any excess money from this fund for the General Revenue Fund.

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477.0263 Cosmetology services to be performed in licensed salon;exceptionCosmetology services must be performed by licensed cosmetologists inlicensed salons, with these exceptions:

Cosmetologist services can be performed by a licensed cosmetolo-gist in a nursing home, hospital, or residence (when the client is too ill to go to a salon). In these cases, arrangements must be madethrough a licensed salon, according to rules established by the Board.

A person with a valid cosmetology license in any state, or who is authorized to practice cosmetology in any country or other area under U.S. jurisdiction may perform cosmetology services in alocation other than a licensed salon if the services are associated with:

- The motion picture, fashion photography, theatrical, or tele- vision industry (Also see legislative Update at the end of this Chapter)

- A photography studio salon- A manufacturer trade show demonstration- An educational seminar

477.0265 Prohibited actsThe following acts are prohibited by law:

-Practicing cosmetology or a specialty without an active cosmetologylicense or registration as a specialist

-Owning or operating, in full or in part, a cosmetology orspecialty salon:

Which is not licensed according to this chapterIn which a person who is not licensed or registered as a cos-metologist or specialist is permitted to provide cosmetology or specialty services

-Purposely or repeatedly violating this chapter or any rules devel-oped by the Board

-Permitting an employee to provide cosmetology or specialty serviceswithout a valid, active license as a cosmetologist or registrationas a specialist.

-Obtaining or attempting to obtain a license or registration in exchange for money (other than payment of the required fee) or other items of value, or by fraud.

-Using or attempting to use a suspended or revoked license or regis-tration to practice cosmetology or a specialty.

-Advertising or implying that skin care or body wrapping servicesare associated with the practice of massage therapy.

- In the practice of cosmetology, use or possess a cosmetic productcontaining a liquid nail monomer containing and trace of methyl methacrylate (MMA).

Individuals violating any provision of this section are guilty of a misde-meanor of the second degree.

477.028 Disciplinary proceedingsThe Board has the authority to revoke or suspend a cosmetologist'slicense or a specialist's registration, and to reprimand, censure, denyfuture licensure, or discipline a cosmetologist or a specialist who:

-Can be proven to have obtained a license or registration by fraud ormisrepresentation

-Can be proven guilty of fraud, deceit, gross negligence, incompe-tency, or misconduct in the practice or instruction of cosmetology or a specialty

-Can be proven guilty of aiding, assisting, procuring, or advising an unlicensed person to practice as a cosmetologist

The Board has the authority to revoke or suspend the license of a cosme-tology or specialty salon, to deny future licensure, or reprimand, censure,or discipline the owner of a salon that:

-Can be proven to have obtained a license or registration by fraud ormisrepresentation

-Can be proven guilty of fraud, deceit, gross negligence, incompe-tency, or misconduct in the practice or instruction of cosmetology ora specialty

Disciplinary proceedings will be conducted according to the provisionsof chapter 120.

The Department will not issue or renew a license of certificate of regis-tration to any person or salon that has been assessed a fine, interest, orcosts related to investigation to an investigation or prosecution until theperson or salon has paid the charges in full, complied with the require-ments, or satisfied all conditions of the final order.

477.029 PenaltyIt is illegal for any person to:

Claim that he or she is a cosmetologist, specialist, hair wrapper, hair braider, or body wrapper, unless he or she is appropriately licensed, registered, or authorized, according to this chapter.

Operate a cosmetology salon that is not licensed according to this chapter.

Permit an employee to provide cosmetology or specialty services unless they are appropriately licensed, registered, or authorized, according to this chapter.

Present a license that belongs to someone else.

Provide false or forged evidence to the department in the course ofobtaining a license, according to this chapter.

Impersonate a license holder with the same or a different name.

Use or attempt to use a license that has been revoked.

Violate any part of statutes 455.227(1), 477.0265, or 477.028.

Violate or refuse to follow any rule, final order of the Board or Department, part of this chapter, or chapter 455.

A person who violates any part of this section will be subject to one ormore of the following penalties, determined by the Board:

Revoked or suspended license or registration

Reprimand or censure

An administrative fine of no more than $500 for each offense

Probation, for a period of time and subject to conditions determinedby the Board

Refusal to certify the applicant for licensing

477.031 Civil proceedingsAs part of another action or criminal prosecution, the Department mayfile a proceeding, in the name of the state, to issue a restraining order,injunction, or writ of mandamus against a person currently or formerly inviolation of any part of this chapter or regulations of the Department.

Administrative Rules Governing the Profession61G5-18.00015 Cosmetologist and Compensation DefinedA cosmetologist is a person who is licensed to perform the mechanical orchemical treatment of the head, face, and scalp, for aesthetic rather thanmedical purposes, for compensation , including, but not limited to hairshampooing, hair cutting, hair arranging, hair braiding, hair coloring, per-manent waving, and hair relaxing.

A cosmetologist may also perform non-invasive hair removals includingwax treatments but not electrolysis.

For the purposes of this act:"Compensation" is defined as the payment of money or its equivalent,the receipt or delivery of property, or the performance of a service, or thereceipt or delivery of anything of value in exchange for cosmetologyservices.

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"Medical purposes" is defined as any form of bodily intrusion into theorifices, skin, muscles, or any other tissues of the body.

61G5-20.0015 Performance of Cosmetology or Specialty ServicesOutside a Licensed SalonCosmetology or specialty services may be performed by a licensed cos-metologist or specialist in a location other than a licensed salon, includ-ing a hospital, nursing home, residence, or similar facility. When aclient, for reasons of ill health, is unable to go to a licensed salon. Thefollowing procedure shall be followed:

Arrangements shall be made through a licensed salon

Information, including the name of the client and the address atwhich the services are to be performed, should be recorded in theappointment book

The appointment book should remain at the salon and be made available, upon request, to any investigator or inspector of the Department

When cosmetology or specialty services are performed in a locationother than a licensed salon, these services may lawfully be performedonly upon clients, residents, or patients, who for reasons of ill health areunable to visit a licensed salon. Such services are not to be performedupon employees, persons who do not reside in the facility, or any othernon-qualified persons.

Cosmetology services may only be performed in a photography stu-dio salon subject to the following requirements:Only hair-arranging services and the application of cosmetic productsmay be performed in a photography studio salon. Such services mayonly be performed for the purpose of preparing a model or client of thephotography studio for a photographic session. Shampooing the hair, haircutting, hair coloring, permanent waving of the hair, hair relaxing,removing of hair, manicuring, pedicuring, and the performance of anyother service defined as cosmetology may not be performed in a photog-raphy studio salon.All hair-arranging services and applications of cosmetic products to beperformed in the photography studio salon shall be performed by alicensed Florida cosmetologist or under the supervision of a licensed cos-metologist employed by the salon. "Under the supervision of a licensedcosmetologist" means that an individual who then holds a current, activeFlorida license as a cosmetologist must be physically present at the pho-tography studio salon at all times when hair-arranging services or appli-cations of cosmetic products are being performed.When performing hair-arranging services, the photography studio salonmust use either disposable hair-arranging implements or a wet or dry san-itizing system approved by the Environmental Protection Agency

61G5-20.00175 Fashion PhotographyFor purposes of Section 477.0263(3), F.S., fashion photography isdefined to mean the photographing of one or more human subjects orprofessional models, for commercial purposes, where the subject ormodel receives remuneration, compensation, or wages for being photo-graphed. Fashion photography shall not include instances in which thesubject pays a photographer a fee to be photographed, or instances inwhich the photographs are made for the personal use and enjoyment ofthe subject rather than for commercial purposes.

61G5-20.002 Salon RequirementsPrior to opening a salon, the owner must:

Submit an application on forms provided by the Department ofBusiness and Professional Regulation; and Pay the required registra-tion fee (as outlined in the fee schedule in Rule 61G5-24.005); andMeet the safety and sanitary requirements, as listed below. Theserequirements shall continue in full force and effect for the life of thesalon:

Ventilation and cleanliness: Each salon shall be kept well ventilated.

The walls, ceilings, furniture and equipment shall be kept clean and free from dust.

Hair must not be allowed to accumulate on the floor of the salon.

Hair must be deposited in a closed container.

Each salon which provides services for the extending or sculp-turing of nails shall provide such services in a separate area that is adequately ventilated, for the safe dispersion of all fumes resulting from the services.

Toilet and lavatory facilities: Each salon shall provide (either on the premises, or in the same building as, and within 300 feet of, the salon) adequate toilet and lavatory facilities.

To be adequate, such facilities shall have at least one toilet and one sink with running water.

Such facilities shall be equipped with toilet tissue, soap dis-penser with soap or other hand cleaning material, sanitary towels or other hand-drying device, such as a wall-mounted electric blow dryer, and waste receptacle.

Such facilities and all of the foregoing fixtures and compo-nents shall be kept clean, in good repair, well lighted, and ade-quately ventilated, to remove objectionable odors.

Location of salon:A salon or specialty salon may be located at a place of resi-dence. Salon facilities must be separated from the living quar-ters by a permanent wall construction. A separate entrance must be provided, to allow entry to the salon from other than from the living quarters. Toilet and lavatory facilities must comply with the regulations above and must have an entrance from the salon other than through the living quarters.

Animals:No animals or pets are allowed in a salon, with the excep-tion of fish kept in closed aquariums, or trained animals used to assist the hearing impaired, visually impaired, or the physically disabled.

Shampoo bowls: Each salon must have shampoo bowls equipped with hot and cold running water, located in the area where cosmetology services are being performed.

A specialty salon that exclusively provides specialty services (as defined in Section 477.013(6), F.S.) need not have a sham-poo bowl, but must have a sink or lavatory equipped with hot and cold running water, on the premises of the salon.

Each salon must follow these regulations:Linens:

Each salon must keep clean linens in a closed, dustproof cabi-net.

All soiled linens must be kept in a closed receptacle.

Soiled linens may be kept in open containers if the area is entirely separated from the area in which cosmetology servic-es are rendered to the public.

Containers: Salons must use containers for waving lotions and other preparations in a manner that prevents contamination of the unused portion. All creams must be removed from containers using spatulas.

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Sterilization and disinfectionThe use of a brush, comb, or other article with more than one patron and without disinfection is prohibited.

Each salon is required to have sufficient combs, brushes, and implements to allow for adequate disinfecting practices. Combs or other instruments must not be carried in pockets.

SanitizersAll salons must be equipped with and utilize wet sanitizers with hospital level disinfectant or an EPA-approved disin-fectant.

A wet sanitizer is any receptacle containing a disinfectant solution that is large enough to allow for complete immersion of the articles. A cover must be provided.

Mix and use all disinfectants according to the manufacturer's directions.

Use effective and approved disinfecting methods for salons:

First, clean articles with soap and water;

Remove hair from combs and brushes;

Wipe cutting edges with a hospital level or EPA-approved disinfectant

Completely immerse implements and metallic instruments in a hospital level or EPA-approved disinfectant solution. For purposes of this rule, a "hospital level disinfectant or EPA approved disinfectant" means the following:

For all combs, brushes, metallic instruments, instru-ments with a cutting edge, and implements that have not come into contact with blood or body fluids, a disinfectant that indicates on its label that it has been registered with the EPA as a hospital grade bacterial, virucidal, and fungicidal disinfectant;

For all combs, brushes, metallic instruments with a cutting edge, and implements that have come into contact with blood or body fluids, a disinfectant that indicates on its label that it has been registered with the EPA as a tuberculocidal disinfectant.

Storage:After cleaning and disinfecting, articles must be stored in a clean, closed cabinet or container until used. Undisinfected articles such as pens, pencils, money, paper, mail, etc., must not be kept in the same container or cabinet. For the purpose of recharging, rechargeable clippers may be stored in an area other than in a closed cabinet or container, provided such area is clean and provided the cutting edges of such clippers have been disinfected.

Ultra-violet irradiation may be used for the storage of articles and instruments, after they have been cleaned and disinfected.

No cosmetology or specialty salon may be operated in the same licensedspace allocation with any other business that adversely affects the sanita-tion of the salon, or in the same licensed space allocation with a schoolteaching cosmetology, or a specialty licensed under Chapter 477, or inany other location, space, or environment that adversely affects the sani-tation of the salon.

In order to control the required space and maintain proper sanitation, atany point where a salon adjoins another business, school, or other loca-tion, space, or environment, permanent walls must separate the salonfrom the other business, school, location, space, or environment, andthere must be separate and distinctly marked entrances for each. For pur-poses of this rule, "permanent wall" means a vertical continuous structure

of wood, plaster, masonry, or other similar building material that is phys-ically connected to a salon's floor and ceiling, and serves to delineate andprotect the salon.

The full salon must contain a minimum of 200 square feet of floor space.No more than two (2) cosmetologists or specialists may be employed in asalon with only the minimum required floor space. A specialty salonoffering only one of the regulated specialties must have a minimum of100 square feet used in the performance of the specialty service, andmust meet all sanitation requirements stated in this section. No more thanone specialist or cosmetologist may be employed in a specialty salonwith only the minimum required floor space. An additional 50 square feetis required for each additional specialist or cosmetologist employed.

61G5-20.003 InspectionsThe Department of Business and Professional Regulation may inspect aproposed salon to determine that all requirements have been met. Eachlicensed salon should be inspected at least annually by the Department.No person should, for any reason, inhibit or interfere with an authorizedrepresentative of the Department performing these inspections.

61G5-20.004 Display of DocumentsAll holders of a cosmetology or specialty salon license should display (ina conspicuous place within the salon and clearly visible to the generalpublic entering the salon) the following documents:

The current salon license

A legible copy of the most recent inspection sheet for the salon.

All holders of a cosmetology or specialty salon license should requireand ensure that all individuals engaged in the practice of cosmetology,any specialty, hair braiding, hair wrapping, or body wrapping, display atthe individual's work station (at all times when the individual is perform-ing cosmetology) a current license or registration of all specialty, hairbraiding, hair wrapping, or body wrapping services.

61G5-20.005 Salon License RenewalAll salon licenses should be renewed on or before November 30 of eachbiennial (even-numbered) year:

By meeting all the current requirements for salon licensure (as expressed in Rule Chapter 61G5-20), and

By paying the renewal fee (specified in Rule 61G5-24.009)

A salon license is delinquent if not renewed by the November 30 renewaldate. To renew a delinquent license, a licensee shall pay the delinquentfee (as outlined in Rule 61G5-24.009), in addition to the biennial renewalfee. A delinquent salon license shall expire at the end of the biennium inwhich it becomes delinquent.

After a salon license has expired at the end of the biennium, the follow-ing must be filed with the Board:

A new salon license application,

The delinquent fee (as outlined in Rule 61G5-24.009), and

All fees (as outlined in Rule 61G5-24.005)

Until such new license is issued for and received by the salon, all cosme-tology and specialty services shall cease.

61G5-20.006 Transfer of Ownership or Location of a SalonNo salon license may be transferred from the name of one licensee toanother. A salon license may be transferred from one location to anotheronly by filing a new application and fee, and obtaining departmentalapproval (pursuant to the requirements of Rule 61G5-20.002), prior totransferring the license.

61G5-20.007 Communicable DiseaseNo person engaged in the practice of cosmetology or a specialty in asalon may proceed with any service for a person having a visible disease,

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pediculosis, or open sores suggesting a communicable disease, until suchperson furnishes a statement, signed by a physician licensed to practicein the State of Florida, stating that the disease or condition is not in aninfectious, contagious, or communicable stage.

No cosmetologist or person registered to practice any specialty inFlorida, who has a visible disease, pediculosis, or open sores suggestinga communicable disease, may engage in the practice of cosmetology orany specialty, until such cosmetologist or registrant obtains a statement,signed by a physician licensed to practice in the State of Florida, statingthat the disease or condition is not in an infectious, contagious, or com-municable stage.

61G5-20.008 Employment of Applicants for Licensure as aCosmetologist Prior to Licensure; Employment of Applicants forRegistration as a Specialist Prior to RegistrationHolders of a cosmetology salon license who permit an applicant forlicensure to work as a cosmetologist in their salon, pursuant to Rule61G5-18.0055, must:

First obtain from the applicant a copy of the completed appli-cation for licensure by examination submitted to the Department by the applicant, and a copy of the notification by the Department to the applicant that he or she has been sched-uled to take the licensure examination. The cosmetology salon license holder shall not permit an applicant to practice cosme-tology or perform cosmetology services in the salon until after the date of the licensure examination as indicated on the noti-fication from the Department.

Upon learning or in any way becoming aware that an applicant who isperforming cosmetology services in their salon has either failed to takethe first licensure examination as scheduled by the Department, or hasfailed to achieve a passing grade on the first licensure examination takenby the applicant:

Immediately cease to permit the applicant to further perform cosmetology services until the applicant provides to the cos-metology salon license holder a copy of the completed appli-cation for reexamination submitted to the Department by the applicant for the next available licensure examination immedi-ately following the licensure examination which the applicant failed to take or pass.

Upon learning or in any way becoming aware that an applicant who isperforming cosmetology services in their salon has either failed to takethe next available licensure examination immediately following the licen-sure examination which the applicant failed to pass:

Immediately cease to permit the applicant to further perform cosmetology services until the applicant provides to the cos-metology salon license holder proof of having been issued a cosmetology license by the Department.

Ensure that all cosmetology services performed in the salon by the applicant are performed in accordance with the conditions as set forth in Rule 61G5-18.0055.

Display in a conspicuous place at the cosmetology salon location inwhich the applicant performs cosmetology services:

A copy of the completed application for licensure by examina-tion submitted to the Department by the applicant, and

A copy of the completed application for reexamination sub-mitted to the Department by the applicant if such reexamina-tion is required under Rule 61G5-18.0055.

Holders of a cosmetology or specialty salon license who wish to permitan applicant for registration as a specialist to perform specialty servicesin their salon (pursuant to Rule 61G5-29.004), or who wish to permitapplicants for registration as a hair braider or hair wrapper to performhair braiding or hair wrapping services in their salon must:

Prior to permitting an applicant to perform any specialty serv-ices, hair braiding, or hair wrapping services in their salon, obtain from the applicant a copy of the completed application for registration submitted to the Department by the applicant;

Upon learning or in any way becoming aware that an appli-cant who is performing specialty services in their salon pur-suant to Rule 61G5-29.004, or performing hair braiding or hair wrapping services in their salon pursuant to Rule 61G5-31.006, has been notified that his or her application is incom-plete, or has been determined by the Board to be not qualified for registration as a specialist, shall immediately cease to per-mit the applicant to further perform specialty services;

Ensure that all specialty services performed in the salon by theapplicant are performed in accordance with the conditions as set forth in Rule 61G5-29.004, and all other applicable laws and Rules of the Board;

Ensure that all hair braiding and hair wrapping services per-formed by the applicant in the salon are performed in accor-dance with all applicable laws and Rules of the Board;

Display in a conspicuous place at the cosmetology or specialty salon location in which the applicant performs specialty serv-ices, hair braiding, or hair wrapping services, a copy of the completed application for registration as a specialist, hair braider, or hair wrapper submitted to the Department by the applicant.

ENDNOTES

1 Current version can be viewed at http://www.flsenate.gov/Statutes2 Current version can be viewed at http://fac.dos.state.fl.us/faconline/chapter64.pdf

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CHAPTER 4WORKER'S COMPENSATION

(1 Credit Hour)Learning Objectives:

Define Worker's CompensationKnow the history of Worker's CompensationBe able to define the benefits available to you

Workers' Compensation, A Brief HistorySimply defined, workers' compensation recompenses, gives something toa worker, one who performs labor for another, for services rendered orfor injuries. This simple definition is taken in part from Webster's NinthNew Collegiate Dictionary and in studying this subject closely, we findthis definition extremely accurate. Workers' compensation is not "insur-ance", rather, it is social insurance, much the same as unemploymentcompensation and social security. It is however, the oldest form of socialinsurance.

Insurance, as defined, is coverage by contract whereby one party under-takes to indemnify or guarantee another against loss by a specified con-tingency or peril. The very word "Insurance" comes from the Latin wordfor "Security". The word "Policy" comes from the Italian language mean-ing "Promise". The first evidence of insurance appeared in China around3000 BC when merchants would divide their cargo into several ships,protecting their investments and dividing any losses among themselves.This system was continued forward and in 1750 BC the Babyloniansdevised a system where the merchant would borrow money to finance hisshipment of goods. He paid the lender an additional sum of money and inexchange for this additional sum, the lender agreed to cancel the loanshould the shipment be lost or stolen. This system was recorded in theCode of Hammurabi around 1750 BC. The Romans are credited withdeveloping life and health insurance through guilds or clubs around 600AD.

Under the various workers' compensation systems, insurance is pur-chased or provided by employers through individual insurance compa-nies, funds, or self insurance plans to provide the worker with the indem-nity and medical benefits required by the laws or acts of the variousstates or provinces. The Jones Act, Harbor worker's, Longshoremen'sAct, the Federal Workers' Compensation act, are all under governmentalregulation and administration but the purpose of these laws are all thesame, to compensate the injured worker for loss of wages and medicalbenefits. All are meant to be self-executing and are constantly changing,but they are still there, protecting not only the worker, but the employeras well and have been for many years.

Moving through history, very little is found regarding workers' compen-sation, although other forms of protection against the liability of oneagainst another come to light and the term known as "insurance"becomes popular. Common law was the avenue for claims against anoth-er. Under liability, the "duty" and "breach of duty" of one to and againstanother was the rule to follow. It wasn't until the early 18th century thatthe "respondeat superior" doctrine under "Old English" law came intobeing. Under this doctrine, the master (employer) was held to be liablefor damages to a third person caused by a servant's (employee) act oromission while the servant was acting within the course and scope ofemployment. Not many workers were protected under this doctrineunless they were injured by a fellow worker. Overall, it was still anotherstep in the right direction.

The Modern Birth in EuropeGermany took the lead in the protection of injured workers in 1838 bypassing legislation protecting railroad employees and passengers in theevent of accidents. Further changes were made in 1854 when a law waspassed requiring certain classes of employers to contribute to sicknessfunds and in 1876 a "Voluntary Insurance Act" was passed, which failedin actual operation. Bismarck introduced a Compulsory Plan in 1881,

which was enacted in stages and finalized in 1884 and is the model forour present system.

"Workingmen's" Compensation bloomed in England in 1880 whenthe English Parliament passed the "Employer's Liability Act."Industrialization swept across Europe like a storm in the 1800's. InEngland, under English Common Law, the injured worker had only onerecourse and that was to sue the employer. It was virtually the same sys-tem that existed in Germany who, for many years, had been closelyallied with England in many business ventures.

Enter the Legal ProfessionBarristers, solicitors and others with legal knowledge and training cameforward in increasingly large numbers from 1850 forward and represent-ed the injured workers on a contingency or percentage of what theycould collect basis. Although the burden of proof was on the worker aswell as other legal expenses, the courts became backlogged and the gen-eral public suffered from this unfair and inefficient system as crowdeddockets and few judges delayed other civil actions. In the midst of thischaos and confusion, it was noticed that the worker was beginning toprevail in these actions and with the growing legal profession's assistancewere tying up attaching machinery, buildings and property of theemployers through liens and attachments.

In 1897, England repealed the employer's liability act of 1880 andreplaced it with a "workmen's" compensation act. Meanwhile, the stormthat swept through Europe during this period of industrialization reachedthe shores of the United States fueled by the aftermath of the Civil Warfrom 1861-1865.

Into the 20th CenturyThe northern states in this great conflict geared up for the war throughthe building of factories to produce various armaments with the iron andsteel industries taking the lead. However, it was the garment industry inthe New York/New Jersey area that brought attention to the plight of theinjured worker. Previously making uniforms for the soldiers of theUnion, this industry converted rapidly to the manufacturing of clothingfor civilian wear after the war ended. These "sweatshops" paying verylittle yet demanding high production, became the target for the earliestlitigation on behalf of injured workers who were usually paid nothing ifthey were injured on the job. Safety was nearly non-existent.

Through the 1880's to the turn of the century, the legal profession in theUnited States was also growing and the increase of lawsuits had the sameeffect on the judicial system in the United States that it had in Englandand Germany. First, the crowded dockets, second, few judges to handlethe cases and third, and most important to the worker, judgments wererendered in favor of the worker at a steadily increasing rate. By 1908, theworkers were winning in nearly 15% of all cases. The American conceptof "workmen's" compensation was now based on that of Germany andEngland's philosophy, that industry is responsible for the costs of injuriesinherent in industrial occupations.

The first "workmen's" compensation law passed in the United States wasthe Federal Employer's Liability act. Covering certain FederalGovernment employees engaged in hazardous occupational duties as wellas employees of common carriers engaged in interstate and foreign com-merce. It was adopted in 1908 at the urging of President TheodoreRoosevelt. He pointed out to congress that "the burden of an accident fellupon the helpless man, his wife and children" and that this was "an out-rage". So it was that the Federal Government took the lead in providingworkers with protection in the event of on the job injuries in the UnitedStates.

Not Quite ReadyPrior to 1908, there was an attempt by several states to do something forat least some workers. These attempts were in the form of legislation ofemployer liability acts. These acts were based on the theory that the

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employee must bear his own economic loss from an industrial accidentunless he could show that some other person was directly responsible,because of a negligent act or omission, for the occurrence of the acci-dent. These acts brought some of the workers into the same arena of liti-gation as a common stranger and the employer's liability was limited tohis own negligence or at most, for the liability of someone for whom hewas directly responsible, under the doctrine of Respondeat Superior.Georgia passed their act in 1855 and by 1907, 26 states had passedemployer liability acts.

None of these state acts embodied an actual compensation principle andmost simply said, "prove it" and sue. In 1902 the state of Maryland cameclose, passing an act that provided for a cooperative accident insurancefund. Benefits were provided only for fatal accidents and the law wasruled unconstitutional 3 years later. In 1908, Massachusetts passed an actauthorizing establishment of private plans for compensation upon theapproval of the state board of conciliation and arbitration. This act fadedinto obscurity soon after passage. New York adopted a workmen's com-pensation act which was compulsory for certain hazardous jobs andoptional for others.

One year later in 1911, the Court of Appeal of New York in the Ives v.South Buffalo Railway Company case ruled the act unconstitutional onthe grounds of deprivation of property without due process of law. Thestate of New York had been a controversial stage for "workmen's" com-pensation since 1898, when the Social Reform Club of New York drafteda bill to take before the state legislature that proposed compensation forcertain types of industrial accidents. Labor unions, strangely enough,were the main opposition mainly because they feared that state control ofworker's benefits would reduce the popularity of unions as well as theworker's loyalty. It essentially never got off the drawing board.

"Workmen's" Compensation was on the move; the Federal Governmenttook the first solid step with the Federal Employer's Liability Act, nowthe states took their turn.

The Great Trade OffThe individual states moved a little slower and the year 1911 is most sig-nificant in the history of workers' compensation in America. Wisconsinwas the first state to adopt a "workmen's" compensation law that was toremain under debate for many weeks. The employers lobbied the statelegislator for what is now known as the "great trade-off". Through thislegislation, the employer agreed to provide medical and indemnity (wagereplacement) benefits and the injured employee agreed to give up his/herright to sue the employer. It was clear that the growing success of litiga-tion was beginning to be felt by the business community. This same year,1911, ten more states enacted "workmen's" compensation laws. Fourmore states adopted laws in 1912, and eight more passed laws in 1913.By 1948, all the states had at least some form of "workman's" compensa-tion in effect including Alaska and Hawaii. Although they did not acquirestatehood until 1959, they had taken the step to adopt legislation in 1915when they were territories. Today, in addition to the 50 states, workers'compensation laws are in effect in the District of Columbia, Puerto Rico,Virgin Islands, the Navajo Nation, the Dominion of Canada, and 12Canadian Provinces. Workers' compensation has become the exclusiveremedy for the injured worker. It also protects employers from damagesuits filed by the injured worker as well as provides employers with abasis for calculating production costs.

The Florida ExperienceFlorida moved slowly in enacting a workers' compensation law primarilybecause Florida had a smaller work force, virtually no manufacturing andno major problems until the "Great Depression" of the 1930's. Floridaindustry was limited and consisted primarily of phosphate mining, agri-cultural harvesting of fruits and vegetables, tobacco, cattle and logging.In addition, there was a steady movement of people, mostly unemployed,moving down from the north, seeking their fortune as well as Florida

sunshine. Florida started an aggressive campaign to attract business tothe warmer, more economical climate in mid-depression and the 1935legislature meeting in regular session and Governor David Sholtz, whowas considered to be a "liberal" and full of "new ideas" recognized thenecessity for this legislation. A "workmen's" compensation law was nec-essary to meet the demands and requirements of the increased and indus-trial employment in the state and as an inducement and invitation toother industries to move to and operate in Florida. Prospective employersknew that they would be open to lawsuits from workers injured on thejob. Most states had adopted legislation entering into the "tradeoff" andnow it was Florida's turn. Employers who had been in Florida for manyyears saw these new residents bring an increase in accidents and injuries.Lawsuits were on the rise and workers demanded protection. PresidentFranklin D. Roosevelt's "New Deal" brought many reforms including"workmen's" compensation.

This new law was signed May 23,1935 as House Bill 29 and becameeffective July 1,1935. Florida made the headlines across the country sev-eral months later on Labor Day, September 1, 1935, when the mostvicious hurricane ever to hit North America came ashore and devastatedthe Keys and coastal areas. The loss of life was in the hundreds withhundreds more missing. Two records were set that day. The barometerrecorded a low of 26.35 inches of Mercury and winds blew in excess of250 miles per hour.

The New Act provided for creation of a new Florida IndustrialCommission which began actual operations in June 1935. The commis-sion consisted of three members, two of them appointed by the governorto serve during the governor's term of office and the third member to beappointed by the governor to serve a four-year term and be chairman ofthe commission.

The Florida Industrial Commission's first chairman was Wendall C.Heaton and he received a salary of $4,200.00 yearly. The Commissionwas responsible for administering the provisions of the workmen's com-pensation law, making studies and investigations with respect to safetyprovisions and the causes of injuries in employment. They were author-ized to make rules and regulations dealing with workmen's compensa-tion. The cost of administering the law was borne by a tax on workmen'scompensation insurance premiums and upon self-insurers. It is interest-ing to note that this method of financing the cost of administering thelaw still exists today.

The way the law was structured regarding benefits to the injured workeris extremely interesting. Initially, no compensation was allowed for thefirst fourteen days of the disability. Compensation for disability was notto exceed $18.00 per week nor be less than $4.00 per week; provided,however, that if the employee's wages were less then $4.00 per week heshall receive his full weekly wage. Compensation for disability was paidat the rate of 50%, 55%, and 60% of the employee's average weeklyearnings, dependent upon the number of dependents of the employee.Medical treatment was furnished at a cost not to exceed $250.00, exceptin surgical cases in which the maximum expense to the employer was$500.00. Under no circumstances would compensation be paid for morethen 350 weeks nor would the total amount paid exceed $5,000.00. Theemployments not included under the act were domestic servants, agricul-ture and horticultural farm labor.

In the first year of the Florida Industrial Commission, 10,977 cases on"workmen's" compensation were reported by Florida's 67 counties. Ofthese, 2,983 were reported in Dade county and 1,985 were reported inDuval County. Benefits paid were approximately $290,434.00.

By 1937, approximately 40,380 cases were handled by the Commission,providing benefits of $963,711.00 to injured employees in compensationand medical treatment. This figure also includes the costs of funerals inthe recorded 89 fatalities.

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Between 1935 and 1978 few major changes were made in Florida'sworkman's compensation system. The first medical fee schedule wasadopted in 1938 during the regular legislative session. The special dis-ability trust fund was established in 1955. Also referred to as the "secondinjury fund", the purpose of the fund is to encourage employers to hireworkers with disabilities. The same year, the rehabilitation and medicalservices section within the Bureau of Workman's' Compensation wasestablished. In 1960, Florida enacted their own coding and descriptionsystem. By 1978 Florida adopted, for the first time, a conversion indexlinking Florida's fee schedule to the Florida Medical Association relativevalue coding system which was fully adopted and completed by 1981.

A Major OverhaulIn 1978, major changes in the state workmen's compensation systemwere underway in the state legislature, the first major change since 1935.The law had basically been a "fixed benefit" system, with workers paidon the basis of the severity and type of injury related to a fixed scheduleof benefits. Those who were able to or even returned to work receivedlump sum payments while those who could not work were limited to theschedules. This system was replaced by the "wage loss concept" underthe new compensation act. Now called workers' compensation instead of"workmen's" compensation, effective August 1, 1979, and this new actwas to apply to all claims for injury arising out of accidents occurring onor after august 1,1979. The industrial relations commission was abol-ished on October 1, 1979. After September 30,1979, appeals from ordersof deputy commissioners (eventually called Judges of CompensationClaims 10 years later in 1989) were to be heard by the First DistrictCourt of Appeal (1st DCA). The Bureau of Workmen's Compensationunder the Department Of Commerce was expanded and replaced by theDivision of Workers' Compensation under the newly created DepartmentOf Labor And Employment Security, which was vested with extensivepowers.

This major reform actually reduced premiums for employers from 1978through 1982 nearly 23%. They were to be the last reductions for over adecade as the wage loss concept proved not to be the answer to loweringcosts.

In 1980, House Bill 1677, as amended by the Florida Senate and passedby the State House of Representatives, was the major legislative cleanupeffort. The year of 1981 saw the revised bill for the Workers'Compensation Act. This bill essentially deleted obsolete provisions relat-ing to the Industrial Relations Commission and Deputy Commissionersof Industrial Claims. The Workers' Compensation act of 1986 incorporat-ed pre-1979 and post-1979 concepts, definitions and directions.

By 1988 another major "clean up" effort was the talk of the stateLegislators. Consequently, new reforms were adopted in 1989, followedby major changes in the benefit structure during the 1990 session. Also,in 1990, the Bureau Of Workers' Compensation Fraud was established inthe Department Of Insurance to combat fraud within the system and theBureau Of Safety within the Division Of Workers' Compensation wasupgraded to full division status to fill the needs of customers for safetyinspections and program establishment. The Workers' CompensationDrug Free Workplace Program was added to the law this same year rec-ognizing the role that drugs and alcohol played in accidents on the job.

TodayWe have seen wage loss come in 1979 and go in the 1993 reform,replaced by impairment income and supplemental benefits. The closingyears of the 20th Century brought many changes especially as litigationand medical care continued to be a problem not only in Florida but on anational level as well. The 1993 reform act introduced our system toManaged Health Care Arrangements (MCA's). The Employee'sAssistance Office (EAO), designed to prevent litigation through educa-tion, information, and the Early Intervention Program and to resolve dis-putes quickly and effectively, became a reality. In addition, the Employer

Help Line, known today as the Customer Information and Services, wasestablished to assist employers and other customers with their questionsand problems. In the 1993 Reform Act the emphasis was, and still istoday, placed on reemployment, getting the injured worker back to workas soon as able, therefore reducing costs and increasing productivity.

In 2003, our law again underwent a major reform, with changes to thePermanent Total, Impairment Income and Death Benefit structures, con-struction industry exemptions, compliance enforcement, medical servic-es, as well as examination and investigation of carrier and claim handlingentities.

The Division of Workers' Compensation through reorganization contin-ues to emphasize education and information both externally and internal-ly to all customers the Division serves. Through outreach programs,workshops, conferences, seminars, brochures, pamphlets and other mate-rials, the Division's customers will better understand and take a pro-active role in improving the system.

The Future…We are just a few years into 21st Century and have already seen sweep-ing changes with the abolishment of the Department of Labor andEmployment Security, the Division of Safety and the Special DisabilityTrust Fund. The Agency for Health Care Administration was elevated tofull Department status in 2001 and received the Medical Services portionof the Division of Workers' Compensation in February 2001with perma-nent transfer effective July 1, 2002. The Reemployment section trans-ferred to Department of Education, Division of Vocational Rehabilitationwith the remainder of the Division moving to Department of Insurancealso effective July 1, 2002. Department of Insurance and Department ofBanking and Finance merged into the new Department of FinancialServices effective January 1, 2003.

Yes, there will be changes as we progress into this new century, butworkers' compensation is still here for the citizens of Florida.

History of Workers' Compensation Timeline10th Century B.C. Kings and Temples and Book of Genesis, first possi-ble indication of a form of "workman's" compensation 1855 United States, Georgia passes Employer Liability Act in the state

legislature. 26 other states pass similar acts between 1855-1907.These acts were simply permission to sue the employer if employ-ee proved a negligent act or omission.

1861-1865 United States Civil War, Industrialization in the North for the war effort. When the war ends, factories convert from manufactur-ing uniforms to regular clothing. Birth of the infamous "sweatshops".

1880 England, Parliament passes "Employer's Liability Act". 1884 Germany passes "Industry Compensation Act". 1897 England repeals "Employer's Liability Act" and replaces with a

"Working Man's Compensation Act". 1898 New York, the New York Social Club drafts a bill for "Partial

Compensation for Workers". No action taken by state legislature. Largest opponent is labor unions.

1901 Maryland passes legislation for a "Cooperative Accident Insurance Fund".

1905 Maryland Act ruled "unconstitutional" by state Supreme Court. 1908 Massachusetts passes legislation establishing private plans for com-

pensation. Never signed by the governor and passed into obscurity.1908 Federal Employer's Liability Act passed by the U.S. Congress at the

urging of President Theodore Roosevelt. This is the first "work-man's" compensation Law in the United States.

1910 New York, legislature passes a partial "workman's" compensation act.

1911 New York Court of Appeals rules that the act is "unconstitutional". 1911 New York, Triangle Shirtwaist Company Fire in New York City,

over 146 workers jump to their deaths to escape fire in 10-story

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building. Exits were blocked, many law suits. Entire nation shocked at this tragedy. New York City immediately adopts first safety codes.

1911 Wisconsin becomes first state in the union to adopt a true "work-man's" compensation law. Called the "Great Trade Off"; employers provide coverage, employees give up right to sue.

1911 Triangle Shirt Waist Company Fire in New York City, Workers,mostly female immigrants trapped in 10 story building, 146 jumpto their deaths. Major safety reforms sweep New York and the country.

1912 Four more states pass laws. 1913 Eight more states adopt legislation. 1915 Alaska and Hawaii pass "workman's" compensation laws even

though they are only territories. 1935 Florida passes "Workman's" Compensation Law". 1938 First Medical and Surgical Fee Schedule 1948 All states in the union have "Workman's" Compensation Laws. 1955 Special Disability Trust Fund created. 1955 Rehabilitation and Medical Services Section established in the

Bureau of "Workman's" Compensation 1979 Florida, first major reform since 1935. "Workman's" Compensation

now called "Workers" Compensation; many sweeping changes; wage loss concept adopted replacing fixed benefit system. Division of Workers' Compensation established within the new Department of Labor and Employment Security

1990 Florida, additional reform, Bureau of Workers' Compensation Fraud established in Department of Insurance, Division of Fraud

1990 Florida, Drug-Free Workplace added to law, first in the United States.

1990 Bureau of Safety in the Division of Workers' Compensation upgraded to full division status within the Department of Labor and Employment Security. 1993 Florida, Major Reform Act, WageLoss eliminated, new Impairment Income and SupplementalBenefits, Managed Care, Chiropractic care limits, EmployeeAssistance and Ombudsman Office created along with otherchanges.

1999 Special Disability Trust Fund abolished by Legislation. Division ofSafety also abolished effective July 1, 2000.

2000 Department of Labor and Employment and Employment Security abolishment begins with various Divisions including Jobs and Benefits and Unemployment Compensation renamed and trans-ferred to other State Agencies.

2002 Abolishment of the Department of Labor and Employment Security completed through Legislation. Agency for Health CareAdministration (AHCA) receives Medical Services section of Division of Worker' Compensation Bureau of Rehabilitation andMedical Services. Rehabilitation portion transferred to Department of Education. Remainder of Division transferred to Department of Insurance effective July 1, 2002.

2003 Department of Insurance and Department of Banking and Finance merge into one new agency, the Department of Financial Services effective January 1, 2003.

2003 Major Reform Act, changes to Permanent Total Disability,Permanent Total Supplement, Permanent Partial Benefits, Practice Parameters and Protocols mandatory in medical care, changes to Independent Medical Examinations, Attorney Fee Award structure, Compliance, Exemptions, elimination of Supplemental Benefitsand other Legislative changes.

Frequently asked questions regarding workers compensationQ: How long after an accident do I have to report it to my employer?A: You should report it as soon as possible but no later than thirty (30)days or your claim may be denied.

Reference: Section 440.185 , Florida Statutes

Q: When should my employer report the injury to their insurancecompany?A: Your employer should report the injury as soon as possible, but nolater than seven (7) days after their knowledge. The insurance companymust send you an informational brochure within three (3) days afterreceiving notice from your employer. The brochure will explain yourrights and responsibilities, as well as provide additional informationabout the workers' compensation law. A copy of the brochure can beviewed on this website under "Publications".


Q: My employer will not report my injury to the insurance company.What can I do?A: You have the right to report the injury to their insurance company.However, if you need assistance, contact the Employee Assistance Office(EAO) at (800) 342-1741 or e-mail [email protected]


Q: What kind of medical treatment can I get?A: The medical provider, authorized by your employer or the insurancecompany, will provide the necessary medical care, treatment and pre-scriptions related to your injury.

Reference: Section 440.13(2) , Florida Statutes

Q: Do I have to pay any of my medical bills?A: No, all authorized medical bills should be submitted by the medicalprovider to your employer's insurance company for payment.


Q: Will I be paid if I lose time from work?A: Under Florida law, you are not paid for the first seven days of disabil-ity. However, if you lose time because your disability extends to over 21days, you may be paid for the first seven days by the insurance company.


Q: How much will I be paid? A: In most cases, your benefit check, which is paid bi-weekly, will be 662/3 percent of your average weekly wage. If you were injured beforeOctober 1, 2003, this amount is calculated by using wages earned duringthe 91-day period immediately preceding the date of your injury, not toexceed the state limit. If you worked less than 90% of the 91 day period,the wages of a similar employee in the same employment who hasworked the whole of the 91-day period or your full-time weekly wagemay be used. If you were injured on or after October 1, 2003 , your aver-age weekly wage is calculated using wages earned 13 weeks prior toyour injury, not counting the week in which you were injured.In addition, if you worked less than 75% of the 13 week period, a similaremployee in the same employment who has worked 75% of the 13-weekperiod or your full time weekly wage shall be used.

Reference: Section 440.02(28) & 440.14 , Florida Statutes

Q: Do I have to pay income tax on this money? A: No. However, if you go back to work on light or limited duty and arestill under the care of the authorized doctor, you will pay taxes on anywages earned while working. For additional information on Income Tax,you may want to visit the Internal Revenue Service website at:www.irs.gov

Q: When will I get my first check?A: You should receive the first check within 21 days after reporting yourinjury to your employer.


Q: If I'm only temporarily disabled, how long can I get these checks?A: You can receive Temporary Total, Temporary Partial Disability pay-ments or a combination of the two benefits during the continuance ofyour disability for no more than a maximum of 104 weeks.


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Q: Can I receive social security benefits and workers' compensationbenefits at the same time?A: Yes. However an offset, or reduction in your workers' compensationcheck may be applied because the law states that the two combined maynot exceed 80 percent of your average weekly wage earned prior to yourinjury. For further information on Social Security, you may contact theSocial Security Administration at (800) 772-1213 or visit their website atwww.ssa.gov .


Q: Can I receive unemployment compensation and workers' com-pensation benefits at the same time? A: No, not if you are receiving temporary total or permanent total dis-ability benefits as you must be medically able and available for work toqualify for unemployment. For additional information on Unemploy-ment Compensation, you may want to utilize the UnemploymentCompensation website at: www.floridajobs.org.

Reference: Section 440.15(10), Florida Statutes

Q: What can I do if I am not receiving my benefit check?A: Call the insurance company and ask for the adjuster or claims repre-sentative. If you still have questions and don't understand why the checkshave stopped, call the EAO at (800)342-1741 or e-mail [email protected].


Q: If I am unable to return to work until my doctor releases me,does my employer have to hold my job for me? A: No, there is no provision in the law that requires your employer tohold the job open for you.

Q: Can my employer fire me if I am unable to work because of aninjury and am receiving workers' compensation benefits?A: No, it is against the law to fire you because you have filed or attempt-ed to file a workers' compensation claim.


Q: If I am unable to return to the type of work I did before I wasinjured, what can I do?A: The law provides, at no cost to you, reemployment services to helpyou return to work. Services include vocational counseling, transferableskills analysis, job-seeking skills, job placement, on-the-job training, andformal retraining. To find out more about this program, you may contactthe Department of Education, Division of Vocational Rehabilitation,Bureau of Rehabilitation and Reemployment Services at (850) 245-3470or visit their website at: www.rehabworks.org/


Q: My employer and the insurance company have denied my claimfor workers' compensation benefits. Do I need legal representation toget my benefits? What should I do?A: It is your decision whether or not to hire an attorney. However, theEAO can assist you and attempt to resolve the dispute. If unable toresolve, the EAO can further assist you in completing and filing aPetition for Benefits. This service is provided at no cost to you. For assis-tance call: (800) 342-1741 or e-mail [email protected] . For the locationof the nearest EAO, click on: www.fldfs.com/WC/dist_offices.html .

Reference: Section 440.191 & 440.192 , Florida Statutes

Q: What is the time limit for filing a Petition for Benefits? A: In general, there is a two (2) year period to file a Petition.However, it depends on the type of issue in dispute. You may call theEAO at (800) 342-1741 or e-mail [email protected] for specific informa-tion.


Q: Is there a period of time after which my claim is no longer open?A. If you were injured on or after January 1, 1994 , the claim is closedone (1) year from the date of your last medical treatment or payment ofcompensation. This period of time is referred to as the Statute ofLimitations. If you were injured before January 1, 1994 , the period istwo (2) years.


Q: Can I get a settlement from my claim? A: Settlements may be made under certain circumstances and are volun-tary; not automatic or mandatory.

Q: If I settle my claim for medical benefits with the insurance com-pany and my condition gets worse later, who pays for my futuremedical care, surgeries, etc?A: You are responsible for your future medical needs after your claim formedical benefits is settled.

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CHAPTER 5(OSHA) EDUCATION AND SALON SAFETY

(1 Credit Hour)Learning Objectives:

Describe a Material Safety Data Sheet (MSDS)Know the purpose of an MSDSKnow how to safely work with chemicalsBe aware of how workplace injuries can occur

OSHA and YouOSHA has not formulated any rules and regulations that deal specificallywith the Cosmetology industry. While no specific rules exist, individualsengaged in the practice of cosmetology are expected to abide by basicrules contained within the Code of Federal Regulations (29 CFR) thatdeal with workplace safety and health. These rules describe the responsi-bilities of employers and employees in dealing with hazardous chemicals,personal protective devices, proper ventilation, prevention from overexposure to dusts, and overall health and safety plans.

One regulation that indirectly impacts the cosmetology profession isplaced on the manufacturers of many of the products that you may use inyour business. The federal government requires that product manufactur-ers make available to customers Material Safety Data Sheets (MSDS).Each MSDS must contain basic information on the each product manu-factured. There is no standard format for an MSDS but one must containthe following:

Identity of chemicals that may present physical or chemical hazardsPhysical hazards, i.e. volatility, evaporation rate and interac-tion with other chemicalsHealth hazards, i.e. possible physical side effects of product usagePrimary routes of entry into the bodyPermissible exposure limitsCarcinogen (cancer causing) hazard of the chemicalPrecautions and handling proceduresControl and protection measuresEmergency and first aid proceduresStorage and disposal information

Your local product supplier is required by federal law to provide youwith an MSDS for each product you purchase from them. It is the legalresponsibility of salon owners to collect MSDS for each product that youuse in your business and to make them available for reference. The fol-lowing is a sample of OSHA form 174 (MSDS) Sheet: (on next page)

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Material Safety Data Sheet U.S. Department of LaborMay be used to comply with OSHA's Hazard CommunicationStandard, 29 CFR 1910 1200. Standard must be consulted forspecific requirements.

Occupational Safety and Health Administration(Non-Mandatory Form)Form ApprovedOMB No. 1218-0072

IDENTITY (as Used on Label and List) Note: Blank spaces are not permitted. If any item is not applicable or no information is available, the space must be marked to indicate that.

Section IManufacturer's name Emergency Telephone NumberAddress (Number, Street, City, State and ZIP Code) Telephone Number for Information

Date PreparedSignature of Preparer (optional)

Section II-Hazardous Ingredients/Identity InformationHazardous Components (Specific Chemical Identity, CommonName(s)) OSHA PEL ACGIH TLV

Other LimitsRecommended % (optional)

Section III-Physical/Chemical CharacteristicsBoiling Point Specific Gravity (H20 = 1)Vapor Pressure (mm Hg) Melting PointVapor Density (AIR = 1) Evaporation Rate (Butyl Acetate = 1)Solubility in WaterAppearance and OdorSection IV-Fire and Explosion Hazard DataFlash Point (Method Used) Flammable Limits LEL UELExtinguishing Media

Special Fire Fighting Procedures

Unusual Fire and Explosion Hazards

(Reproduce locally) OSHA 174 Sept. 1985

LabelsEach container of a hazardous substance must have a label attached to it.The label must be in English and state the product name, risk and safetyphrases. The label may also state the ingredient's chemical name.

If a hazardous substance is transferred from one container into a secondcontainer, and the substance is not entirely used immediately, you mustensure that the second container is properly labeled. Chemicals must notbe decanted into a food or beverage container.

If the contents of a container are unknown, it should be labeled:CAUTION DO NOT USE UNKNOWN SUBSTANCE

Store all unknown substances in isolation until its contents can be identi-fied and properly labeled. If the substance can not be identified, disposeof it. You should contact the Environmental Protection Agency for adviceon disposal requirements.

Working with Hazardous ChemicalsThe issue of most concern to salon professionals is chemical exposure inthe workplace. According to National Institute for Occupational Safetyand Health (NIOSH), the chemicals used in a hair salon can cause arange of allergies and lung problems, from hairspray induced coughs torashes caused by certain chemicals in hair dye. Dyes and bleaches cancause dermatitis, or skin rashes, among some salon professionals.

Dermatitis (a general term meaning inflammation of the skin) There aretwo types of dermatitis. Irritant contact dermatitis results from contactwith irritant substances, such as water and detergents in shampoo.Allergic contact dermatitis occurs when a person develops an allergicresponse to a chemical.

Asthma (a respiratory disease, which narrows the air passages and resultsin breathing difficulties) Chemicals used in the hairdressing, nail andbeauty industry may aggravate pre-existing asthma or cause occupationalasthma.

Hazardous substances can enter the body through the skin, by inhalationor by swallowing. Acute health effects, such as eye and throat irritation,may occur almost immediately. Chronic health effects, such as allergiccontact dermatitis, take some time to develop.

The likelihood of a hazardous substance causing health effects dependson a number of factors, including:

• the toxicity of the substance • the amount of substance that workers are exposed to • the length of exposure • the frequency of exposure • the route of entry into the body, e.g. skin absorption, inhala-

tion or ingestion. Here are a few tips to avoid exposure to haz-ardous chemicals:

Substitution• Replace a substance with an alternative product that contains a

less hazardous substance. Health information found in an MSDS may assist in the selection of a less hazardous sub-stance.

• Replace pressurized aerosol containers, with pump sprays, e.g. pressurized wrap catalyst, hairsprays.

Redesign• Make sure there is good ventilation so that exposure to air

borne contaminants can be prevented or minimized, e.g. local exhaust ventilation.

• Protect against eye splash by installing splash shields in areas where chemicals are mixed.

Administrative controls• Make sure MSDSs are available for all chemicals used in the

salon. • Make sure workers are provided with suitable information,

training and supervision on the safe use of chemicals and PPE (personal protective equipment).

• Store chemicals away from energy sources, such as fuse boxes, naked flames, heat and intense light sources.

• Store flammable chemicals in a cool place in a securely locked fireproof cabinet.

• Make sure chemicals are out of reach for children. • Make sure procedures are in place for the clean up of spills

using a suitable absorbent material. Refer to the MSDS. • Clean up chemical spills promptly. • Make sure that spilled chemicals and equipment used for

chemical clean up are disposed of appropriately. Contact the Environmental Protection Agency for further advice.

• Purchase chemicals in ready-to-use packages rather than trans-ferring from large containers.

• Do not eat, drink or smoke in areas that contain chemicals. • Wash hands with a pH neutral soap or barrier cream before

eating, drinking or smoking.Personal protective equipment

• Provide gloves, glasses, aprons and respiratory protection as required by your hazardous substances risk assessment. Guidance can be found in the MSDS.

• Provide workers with training on the fit, maintenance and use of personal protective equipment.

• Make sure workers apply barrier creams on exposed skin areas if bothered by skin irritation.

• Make sure workers cover broken skin with a waterproof dress-ing.

• Make sure workers wear eye protection and covered shoes to protect against chemical splashes

• Other control measures apply specifically to each industry. Nail IndustryBoth ethyl methacrylate (EMA) and methyl methacrylate (MMA) havebeen used as an ingredient in artificial nail products. These chemicals canexist as a monomer (nail liquid) and polymer (nail powder).

MMA monomer (nail liquid) is considered too dangerous for use in thebeauty industry as it causes too many adverse health effects. Theseinclude:

• allergic contact dermatitis • permanent loss of the nail plate • loss of sensation in the fingertips

These health problems do not apply to the use of MMA polymer (nailpowder). EMA is also considered a safer alternative to MMA monomer,as it is less likely to cause allergic reactions and damage nail plates.

Checklist to identify whether a product contains MMA monomer• Is MMA listed as an ingredient on the MSDS and label? • Does the product have an unusually strong or strange odor

that does not smell like other acrylic liquids? • Does the product seem to set much harder and feel less flexi-

ble than other products? • Are the nail extensions extremely hard and very difficult to

file, even with coarse abrasives? • Do the nail extensions not soak off in solvents designed to

remove acrylics? Specific control measures - nail industry

• Do not use products containing liquid methyl methacrylate (MMA) monomer.

• Provide a transparent screen between the nails being clipped and the eyes of the worker and client to reduce the risk of eye injury.

• Make sure low/no odor nail products are used with good ven-tilation. Vapors from these products can build up in the salon without being noticed.

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• Make sure workers use dispenser bottles with small openings (only large enough for an application brush to enter) and pres-sure sensitive stoppers to reduce the amount of evaporation of nail liquid.

• Make sure workers use only the required amount of nail liquidand pour it into a closed dispenser bottle.

• Make sure workers close product containers immediately after use.

• Make sure workers use a dappen dish with a hole in the lid for volatile chemicals. Put a small marble over the hole to prevent evaporation.

• Make sure workers do not clean dirty brushes on table towel, use absorbent paper towel.

• Dispose of paper towel and other waste materials in a sealed bin. Remove waste from bin several times a day to minimize exposure to vapors.

• Make sure workers do not smoke or allow clients to smoke while working, as many products are highly flammable.

• Make sure oil burners are not used near nail products. • Make sure workers wear dust masks when filing acrylic nails

for protection against dust. (Note: dust masks do not provide protection against chemical vapors.)

• Make sure workers wear eye protection where there is a risk of chemical splashes to the eye or nail clippings, acrylic dusts and acrylic shards entering the eye.

• Wear safety goggles or glasses over contact lenses or replace contact lenses with prescriptive safety glasses with side pro-tection.

Manual tasksThe manual tasks performed in the hairdressing, nail and beauty industrycan be physically demanding and are responsible for the majority ofmusculoskeletal disorders. Disorders can include lower back pain, neckand shoulder pain, tendonitis of the shoulder or wrist, leg discomfort andcarpal tunnel syndrome.How do manual task injuries occur?Injuries from manual tasks result from ongoing wear and tear to thejoints, ligaments, tendons, muscles and discs. Although uncommon,injuries can be caused by a one-off overload situation.Over a period of time, damage can gradually build up through:

• holding fixed positions for a prolonged time • performing repetitive movements that are fast and/or involve a

lot of muscular effort If insufficient breaks are taken, muscle fatigue can lead to inflammationand tissue damage. Injury is more likely to occur when this happensrepeatedly.What are the risk factors?Risk factors are part of the demands of a job that affect the worker andcan contribute to injury. These are set out in the table below.Common manual task risk factors in the nail and beauty industry

Design controlsRedesign the work area

• Provide adequate lighting for the task to decrease bending of the back or neck.

• Make sure there is enough room for easy movement around furniture and work areas.

• Provide non-slip surfaces that are comfortable for standing, e.g. cork.

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Risk Factor Contribution to Injury

Examples of WorkProblems

Working postures Awkward posturesrequire greater muscu-lar effort and lead togreater fatigue, partic-ularly when holding aposition for a longtime.Awkward posturesoccur when joints areworking away fromthe normal position.

• back bent or twisted • neck bent forward or

twisted shouldersraised e.g. applying color

• upper arms held out to the sides and away from the body e.g. massage, cutting hair

• wrist bent or twisted,stabilizing hand when filing nails

Repetition andduration

Continually repeatinga movement, particu-larly with a forcefulexertion, increases therisk of injury.

Long durations ofawkward postures orrepetitive work arealso a risk.

• rolling hair• applying color• filing nails• prolonged sitting or

standing• prolonged bending or

leaninge.g. electrolysis

Work area design The work area designand layout mayrequire workers tobend or reach to per-form tasks.

• equipment and materials not located close to the workercausing workers tobend, reach or twist

• non-adjustable chairsand benches

• work surfaces too high or too low

• poor lighting • hard, slippery floors • work surfaces too

wide or narrow • leaning or supporting

elbows or arms on work surfaces

Use of tools Poor design andexcessive use of handtools contributes todisorders of the wrist,elbow and shoulder.

• working with heavy tools

• difficult or awkward hand grips

• vibrating tools eg. electric nail files and drills

Load handling Supporting a weightwhile holding armsaway from the bodyincreases stress to theback and shoulders.

• working with heavy tools eg. holding a blow dryer away from the body

• holding a body part while waxing

• carrying heavy boxes of product to storage

Individual factors

For new, young, older,pregnant and inexperi-enced workers, therisk of injury isincreased. The type ofclothes people wearcan also have animpact.

• lack of training in specific tasks

• no period of physical adjustment provided

• wearing shoes with an elevated heel

Work organization

Continuous work of asimilar nature, poorequipment mainte-nance and inadequaterest breaks can resultin fatigue and lead toinjury.

• too little task variation • inadequate rest breaks • insufficient staff to

cope with peak periods

• Provide adjustable tables. • Place required work items within reach and close to waist

height. • Provide trolleys with castors to reduce carrying. • Provide padding on table for nail work to protect elbows and

underside of arms from nerve damage, e.g. a towel. • Make sure the work surface for nail work is wide enough so

that you do not bump knees with your client or have to stretch to reach client's hands.

• Provide access to chairs in lunchroom or office so workers can rest from prolonged standing.

Select well designed tools• Discuss the selection and purchase of new tools and

equipment with staff prior to purchase. • Make sure that tools are as light as possible.

Redesign work methods• Work as close as possible to the client to reduce bending and

reaching.

Administrative controls• Make sure workers alternate tasks so that different muscles

are used, e.g. variation in artificial nail filing techniques. • Manage the number of bookings per worker, particularly those

involving demanding tasks• Make sure workers take short breaks frequently to give wrists,

shoulders or back a rest. • Make sure workers alternate between sitting and standing

when performing tasks• Make sure all tools are maintained so they do not need extra

effort to use. • Train workers to do tasks so that problem working postures

are avoided or kept to a minimum.

BACK INJURIES AND THE WORKPLACEBack disorders can develop gradually as a result of microtrauma broughtabout by repetitive activity over time or can be the product of a singletraumatic event. Because of the slow and progressive onset of this inter-nal injury, the condition is often ignored until the symptoms becomeacute, often resulting in disabling injury. Acute back injuries can be theimmediate result of improper lifting techniques and/or lifting loads thatare too heavy for the back to support. While the acute injury may seemto be caused by a single well-defined incident, the real cause is often acombined interaction of the observed stressor coupled with years ofweakening of the musculoskeletal support mechanism by repetitivemicro-trauma. Injuries can arise in muscle, ligament, vertebrae, anddiscs, either singly or in combination.

Although back injuries account for no work-related deaths, they doaccount for a significant amount of human suffering, loss of productivity,and economic burden on compensation systems. Back disorders are oneof the leading causes of disability for people in their working years andafflict over 600,000 employees each year with a cost of about $50 billionannually in 1991 according to NIOSH. The frequency and economicimpact of back injuries and disorders on the work force are expected toincrease over the next several decades as the average age of the workforce increases and medical costs go up.

I. BACK DISORDERS. A. FACTORS ASSOCIATED WITH BACK DISORDERS.

Back disorders result from exceeding the capability of the muscles, tendons, discs, or the cumulative effect of several contributors:

• Reaching while lifting. • Poor posture--how one sits or stands. • Stressful living and working activities--staying in

one position for too long.

• Bad body mechanics--how one lifts, pushes, pulls, or carries objects.

• Poor physical condition-losing the strength and endurance to perform physical tasks without strain.

• Poor design of job or work station. • Repetitive lifting of awkward items, equipment, or

(in health-care facilities) patients. • Twisting while lifting. • Bending while lifting. • Maintaining bent postures. • Heavy lifting. • Fatigue. • Poor footing such as slippery floors, or constrained

posture. • Lifting with forceful movement. • Vibration, such as with lift truck drivers, delivery

drivers, etc. B. SIGNS AND SYMPTOMS. Signs and symptoms

include pain when attempting to assume normal posture, decreased mobility, and pain when standing or rising from a seated position.

Noise and vibration The main risk to health from noise exposure, other than permanent lossof hearing, is stress and fatigue. Noise levels of most equipment, such ashair dryers and radios, in the health and beauty industry are generally nothigh enough to cause hearing loss. However, some workers and clientsmay find the noise levels annoying.If a worker has used a personal security alarm in an emergency situation,he or she should be tested by an audiologist or ear, nose or throat special-ist to establish whether or not hearing damage has occurred.Equipment, such as hand held hair dryers, body massagers and electricnail files and drills emit vibration. Workers who use this equipment are atrisk of developing Raynaud's disease and/or carpal tunnel syndrome Theonset of these conditions depends on:

• type of equipment used • length of use • postures that equipment is used in

Employers should consult with workers and take steps to minimize riskfrom exposure to noise and vibration at work.

Control measuresSubstitution

• Replace existing equipment with equipment that emits a lower level of noise and vibration.

Redesign• Rearrange the layout of the workplace to separate noisy work

activities from less noisy activities. • Install sound absorbing material on ceiling and walls to reduce

the sound level.

Administrative controls• Adopt a "buy quiet" policy for all new equipment. • Make sure all equipment is maintained and in a good condition. • Make sure workers vary working postures regularly to

minimize exposure to vibration, e.g. alternate the equipment between hands.

• Provide workers with training and information about noise and vibration.

FIRE SAFETY AND PREVENTIONLimiting the DamageSalons should be equipped with sprinklers and fire detection equipment.The fire detection system should be connected to a central station moni-tor. Linens need to be stored away from other combustibles in noncom-bustible or fire-retardant containers.

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What employers should do to protect workers from fire hazardsEmployers should train workers about fire hazards in the workplace andabout what to do in a fire emergency. Employers should train employeeson how to escape a possible fire.

What does OSHA require for emergency fire exits?Every workplace must have enough exits suitably located to enableeveryone to get out of the facility quickly. Considerations include thetype of structure, the number of persons exposed, the fire protectionavailable, the type of industry involved, and the height and type of con-struction of the building or structure.

In addition, fire doors must not be blocked or locked when employeesare inside. Delayed opening of fire doors, however, is permitted when anapproved alarm system is integrated into the fire door design. Exit routesfrom buildings must be free of obstructions and properly marked withexit signs.

Develop an emergency action/fire prevention planNot every employer is required by OSHA to have an emergency actionplan but establishing one for your particular workplace is a good rule tofollow.

The rules for fixed extinguishing systemsFixed extinguishing systems throughout the workplace are among themost reliable fire fighting tools. These systems detect fires, sound analarm, and send water to the fire and heat. To meet OSHA standardsemployers who have these systems must:

• Substitute (temporarily) a fire watch of trained employees to respond to fire emergencies when a fire suppression system is out of service.

• Ensure that the watch is included in the fire prevention plan and the emergency action plan.

• Post signs for systems that use agents (e.g., carbon dioxide, Halon 1211, etc.) posing a serious health hazard.

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CHAPTER 6ENVIRONMENTAL ISSUES

(1 Credit Hour)Learning Objectives

Define OzoneLearn about Ozone dangersDescribe other methods to control indoor pollution

Introduction and PurposeOver the years one of the most common questions we have fromlicensees is what air cleaner should I use in my salon and are ozone aircleaners the best option to help with salon odors and pollutants. Belowwe have summarized the findings from the US Environmental ProtectionAgency regarding ozone generators.

Ozone Generators Ozone generators that are sold as air cleaners intentionally produce thegas ozone. Often the vendors of ozone generators make statements anddistribute material that lead the public to believe that these devices arealways safe and effective in controlling indoor air pollution. For almost acentury, health professionals have refuted these claims (Sawyer, et. al1913; Salls, 1927; Boeniger, 1995; American Lung Association, 1997;Al-Ahmady, 1997). The purpose of this document is to provide accurateinformation regarding the use of ozone-generating devices in indooroccupied spaces. This information is based on the most credible scientificevidence currently available.

Some vendors suggest that these devices have been approved by the fed-eral government for use in occupied spaces. To the contrary, NO agencyof the federal government has approved these devices for use in occupiedspaces. Because of these claims, and because ozone can cause healthproblems at high concentrations, several federal government agencieshave worked in consultation with the U.S. Environmental ProtectionAgency to produce this public information document.

What is Ozone?Ozone is a molecule composed of three atoms of oxygen. Two atoms ofoxygen form the basic oxygen molecule--the oxygen we breathe that isessential to life. The third oxygen atom can detach from the ozone mole-cule, and re-attach to molecules of other substances, thereby alteringtheir chemical composition. It is this ability to react with other sub-stances that forms the basis of manufacturers' claims.

How is Ozone Harmful?The same chemical properties that allow high concentrations of ozone toreact with organic material outside the body give it the ability to reactwith similar organic material that makes up the body, and potentiallycause harmful health consequences. When inhaled, ozone can damagethe lungs (see - "Ozone and Your Health" www.epa.gov/airnow/brochure.html). Relatively low amounts can cause chest pain, coughing, shortnessof breath, and, throat irritation. Ozone may also worsen chronic respira-tory diseases such as asthma and compromise the ability of the body tofight respiratory infections. People vary widely in their susceptibility toozone. Healthy people, as well as those with respiratory difficulty, canexperience breathing problems when exposed to ozone. Exercise duringexposure to ozone causes a greater amount of ozone to be inhaled, andincreases the risk of harmful respiratory effects. Recovery from theharmful effects can occur following short-term exposure to low levels ofozone, but health effects may become more damaging and recovery lesscertain at higher levels or from longer exposures (US EPA, 1996a,1996b).

Manufacturers and vendors of ozone devices often use misleading termsto describe ozone. Terms such as "energized oxygen" or "pure air" sug-gest that ozone is a healthy kind of oxygen. Ozone is a toxic gas withvastly different chemical and toxicological properties from oxygen.Several federal agencies have established health standards or recommen-dations to limit human exposure to ozone. These exposure limits aresummarized in Table 1.

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EPA's Final Non-attainment Designations for 8-Hour OzoneOn April 15, 2004 EPA designated as "non-attainment" areasthroughout the country that exceeded the health-based standards for8-hour ozone. The designations process plays an important role inletting the public know whether air quality in a given area ishealthy. Once designations take effect, they also become an impor-tant component of state, tribal and local governments' efforts tocontrol ground-level ozone. http://www.epa.gov/ozonedesignations/

Table 1. Ozone Heath Effects and StandardsHealth Effects Risk Factors Health Standards*Potential risk ofexperiencing:

Decreases in lungfunction

Aggravation of asth-ma

Throat irritation andcough

Chest pain andshortness of breath

Inflammation oflung tissue

Higher susceptibilityto respiratory infec-tion

Factors expected toincrease risk andseverity of healtheffects are:

Increase in ozone airconcentration

Greater duration ofexposure for somehealth effects

Activities that raisethe breathing rate(e.g., exercise)

Certain pre-existinglung diseases (e.g.,asthma)

The Food and DrugAdministration(FDA) requiresozone output ofindoor medicaldevices to be nomore than 0.05 ppm.

The OccupationalSafety and HealthAdministration(OSHA) requiresthat workers not beexposed to an aver-age concentration ofmore than 0.10 ppmfor 8 hours.

The NationalInstitute ofOccupationalSafety and Health(NIOSH) recom-mends an upperlimit of 0.10 ppm,not to be exceededat any time.

EPA's NationalAmbient Air QualityStandard for ozoneis a maximum 8hour average out-door concentrationof 0.08 ppm (see -the Clean Air Act -www.epa.gov/air/caa/title1.html#ib)

(* ppm = parts per million)

Is There Such a Thing as "Good Ozone" and "Bad Ozone"?The phrase "good up high - bad nearby" has been used by the U.S. Environmental Protection Agency (EPA) to make the distinction betweenozone in the upper and lower atmosphere. Ozone in the upper atmos-phere--referred to as "stratospheric ozone"--helps filter out damagingultraviolet radiation from the sun. Though ozone in the stratosphere isprotective, ozone in the atmosphere - which is the air we breathe - can beharmful to the respiratory system. Harmful levels of ozone can be pro-duced by the interaction of sunlight with certain chemicals emitted to theenvironment (e.g., automobile emissions and chemical emissions ofindustrial plants). These harmful concentrations of ozone in the atmos-phere are often accompanied by high concentrations of other pollutants,including nitrogen dioxide, fine particles, and hydrocarbons. Whetherpure or mixed with other chemicals, ozone can be harmful to health.

Are Ozone Generators Effective in Controlling Indoor Air Pollution?Available scientific evidence shows that at concentrations that do notexceed public health standards, ozone has little potential to removeindoor air contaminants.

Some manufacturers or vendors suggest that ozone will render almostevery chemical contaminant harmless by producing a chemical reactionwhose only by-products are carbon dioxide, oxygen and water. This ismisleading.

• First, a review of scientific research shows that, for many of the chemicals commonly found in indoor environments, the reaction process with ozone may take months or years (Boeniger, 1995). For all practical purposes, ozone does not react at all with such chemicals. And contrary to specific claims by some vendors, ozone generators are not effective in removing carbon monoxide (Salls, 1927; Shaughnessy et al., 1994) or formaldehyde (Esswein and Boeniger, 1994).

•Second, for many of the chemicals with which ozone does readily react, the reaction can form a variety of harmful or irritating by-products (Weschler et al., 1992a, 1992b, 1996; Zhang and Lioy, 1994). For example, in a laboratory experiment that mixed ozone with chemicals from new carpet, ozone reduced many of these chemicals, including those which can produce new carpet odor. However, in the process, the reaction produced a variety of aldehydes, and the total concentration of organic chemicals in the air increased rather than decreased after the introduction of ozone (Weschler, et. al.,1992b). In addition to aldehydes, ozone may also increaseindoor concentrations of formic acid (Zhang and Lioy, 1994), both of which can irritate the lungs if produced in sufficient amounts. Some of the potential by-products produced by ozone's reactions with other chemicals are themselves very reactive and capable of producing irritating and corrosive by-products (Weschler and Shields, 1996, 1997a, 1997b).

•Third, ozone does not remove particles (e.g., dust and pollen) from the air, including the particles that cause most allergies. However, some ozone generators are manufactured with an "ion generator" or "ionizer" in the same unit. An ionizer is a device that disperses negatively (and/or positively) charged

ions into the air. These ions attach to particles in the air giving them a negative (or positive) charge so that the particles may attach to nearby surfaces such as walls or furniture, or attach to one another and settle out of the air. In recent experiments, ionizers were found to be less effective in removing particles of dust, tobacco smoke, pollen or fungal spores than either high efficiency particle filters or electrostatic precipitators. (Shaughnessy et al., 1994; Pierce, et al., 1996). However, it is apparent from other experiments that the effectiveness of par-ticle air cleaners, including electrostatic precipitators, ion gen-erators, or pleated filters varies widely (U.S. EPA, 1995).

There is evidence to show that at concentrations that do not exceedpublic health standards, ozone is not effective at removing manyodor-causing chemicals.

• In an experiment designed to produce formaldehyde concern-trations representative of an embalming studio, where formaldehyde is the main odor producer, ozone showed no effect in reducing formaldehyde concentration (Esswein and Boeniger, 1994). Other experiments suggest that body odor may be masked by the smell of ozone but is not removed by ozone (Witheridge and Yaglou, 1939). Ozone is not consid-ered useful for odor removal in building ventilation systems (ASHRAE, 1989).

• While there are few scientific studies to support the claim that ozone effectively removes odors, it is plausible that some odorous chemicals will react with ozone. For example, in some experiments, ozone appeared to react readily with cer-tain chemicals, including some chemicals that contribute to the smell of new carpet (Weschler, 1992b; Zhang and Lioy, 1994). Ozone is also believed to react with acrolein, one of the many odorous and irritating chemicals found in secondhand tobacco smoke (US EPA, 1995).

If used at concentrations that do not exceed public health standards,ozone applied to indoor air does not effectively remove viruses, bac-teria, mold, or other biological pollutants.

• Some data suggest that low levels of ozone may reduce airborne concentrations and inhibit the growth of some biologi-cal organisms while ozone is present, but ozone concentra-tons would have to be 5 - 10 times higher than public health standards allow before the ozone could decontaminate the air sufficiently to prevent survival and regeneration of the organ-isms once the ozone is removed (Dyas, et al.,1983; Foarde et al., 1997).

• Even at high concentrations, ozone may have no effect on bio-logical contaminants embedded in porous material such as duct lining or ceiling tiles (Foarde et al, 1997). In other words, ozone produced by ozone generators may inhibit the growth of some biological agents while it is present, but it is unlikely to fully decontaminate the air unless concentrations are high enough to be a health concern if people are present. Even with high levels of ozone, contaminants embedded in porous mate-rial may not be affected at all.

If I Follow Manufacturers' Directions, Can I be Harmed?Results of some controlled studies show that concentrations of ozoneconsiderably higher than these standards are possible even when a userfollows the manufacturer's operating instructions.

There are many brands and models of ozone generators on the market.They vary in the amount of ozone they can produce. In many circum-stances, the use of an ozone generator may not result in ozone concentra-tions that exceed public health standards. But many factors affect theindoor concentration of ozone so that under some conditions ozone con-centrations may exceed public health standards.

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You can order the Office of Air Quality Planning and Standard's"Good Up High Bad Nearby", EPA publication number EPA-451/K-03-001, June 2003 and "Ozone and Your Health"[www.epa.gov/airnow/brochure.html] EPA publication numberEPA-452/F-99-003, September 1999 from:

U.S. Environmental Protection AgencyNational Center for Environmental Publications (NSCEP)P.O. Box 42419Cincinnati, OH 424191-800-490-9198/(513) 489-8695 (fax)

• In one study (Shaughnessy and Oatman, 1991), a large ozone generator recommended by the manufacturer for spaces "up to 3,000 square feet," was placed in a 350 square foot room and run at a high setting. The ozone in the room quickly reached concentrations that were exceptionally high--0.50 to 0.80 ppm which is 5-10 times higher than public health limits.

• In an EPA study, several different devices were placed in a home environment, in various rooms, with doors alternately opened and closed, and with the central ventilation system fan alternately turned on and off. The results showed that some ozone generators, when run at a high setting with interior doors closed, would frequently produce concentrations of 0.20 - 0.30 ppm. A powerful unit set on high with the interior doors opened achieved values of 0.12 to 0.20 ppm in adjacent rooms. When units were not run on high, and interior doors were open, concentrations generally did not exceed public health standards (US EPA, 1995).

• The concentrations reported above were adjusted to exclude that portion of the ozone concentration brought in from the outdoors. Indoor concentrations of ozone brought in from outside are typically 0.01- 0.02 ppm, but could be as high as 0.03 - 0.05 ppm (Hayes, 1991; U.S. EPA, 1996b; Weschler et al., 1989, 1996; Zhang and Lioy; 1994). If the outdoor portion of ozone were included in the indoor concentrations reported above, the concentrations inside would have been correspond-ingly higher, increasing the risk of excessive ozone exposure.

• None of the studies reported above involved the simultaneous use of more than one device. The simultaneous use of multiple devices increases the total ozone output and therefore greatly increases the risk of excessive ozone exposure.

Why is it Difficult to Control Ozone Exposure with an OzoneGenerator?The actual concentration of ozone produced by an ozone generatordepends on many factors. Concentrations will be higher if a more power-ful device or more than one device is used, if a device is placed in asmall space rather than a large space, if interior doors are closed ratherthan open and, if the room has fewer rather than more materials and fur-nishings that adsorb or react with ozone and, provided that outdoor con-centrations of ozone are low, if there is less rather than more outdoor airventilation.

The proximity of a person to the ozone generating device can also affectone's exposure. The concentration is highest at the point where the ozoneexits from the device, and generally decreases as one moves furtheraway.

Manufacturers and vendors advise users to size the device properly to thespace or spaces in which it is used. Unfortunately, some manufacturers'recommendations about appropriate sizes for particular spaces have notbeen sufficiently precise to guarantee that ozone concentrations will notexceed public health limits. Further, some literature distributed by ven-dors suggests that users err on the side of operating a more powerfulmachine than would normally be appropriate for the intended space, therationale being that the user may move in the future, or may want to usethe machine in a larger space later on. Using a more powerful machineincreases the risk of excessive ozone exposure.

Ozone generators typically provide a control setting by which the ozoneoutput can be adjusted. The ozone output of these devices is usually notproportional to the control setting. That is, a setting at medium does notnecessarily generate an ozone level that is halfway between the levels atlow and high. The relationship between the control setting and the outputvaries considerably among devices, although most appear to elevate theozone output much more than one would expect as the control setting isincreased from low to high. In experiments to date, the

high setting in some devices generated 10 times the level obtained at themedium setting (US EPA, 1995). Manufacturer's instructions on somedevices link the control setting to room size and thus indicate what set-ting is appropriate for different room sizes. However, room size is onlyone factor affecting ozone levels in the room.

In addition to adjusting the control setting to the size of the room, usershave sometimes been advised to lower the ozone setting if they can smellthe ozone. Unfortunately, the ability to detect ozone by smell varies con-siderably from person to person, and one's ability to smell ozone rapidlydeteriorates in the presence of ozone. While the smell of ozone may indi-cate that the concentration is too high, lack of odor does not guaranteethat levels are safe.

At least one manufacturer is offering units with an ozone sensor thatturns the ozone generator on and off with the intent of maintaining ozoneconcentrations in the space below health standards. EPA is currentlyevaluating the effectiveness and reliability of these sensors, and plans toconduct further research to improve society's understanding of ozonechemistry indoors. EPA will report its findings as the results of thisresearch become available.

Can Ozone be Used in Unoccupied Spaces?Ozone has been extensively used for water purification, but ozone chem-istry in water is not the same as ozone chemistry in air. High concentra-tions of ozone in air, when people are not present, are sometimes used tohelp decontaminate an unoccupied space from certain chemical or bio-logical contaminants or odors (e.g., fire restoration). However, little isknown about the chemical by-products left behind by these processes(Dunston and Spivak, 1997). While high concentrations of ozone in airmay sometimes be appropriate in these circumstances, conditions shouldbe sufficiently controlled to insure that no person or pet becomesexposed. Ozone can adversely affect indoor plants, and damage materialssuch as rubber, electrical wire coatings, and fabrics and art work contain-ing susceptible dyes and pigments (U.S. EPA, 1996a).

What Other Methods Can Be Used to Control Indoor Air Pollution?The three most common approaches to reducing indoor air pollution, inorder of effectiveness, are:

1. Source Control: Eliminate or control the sources of pollution; 2.Ventilation: Dilute and exhaust pollutants through outdoor air

ventilation, and 3.Air Cleaning: Remove pollutants through proven air cleaning

methods.

Of the three, the first approach -- source control -- is the most effective.This involves minimizing the use of products and materials that causeindoor pollution, employing good hygiene practices to minimize biological contaminants (including the control of humidity and moisture,and occasional cleaning and disinfection of wet or moist surfaces), andusing good housekeeping practices to control particles.

The second approach -- outdoor air ventilation -- is also effective andcommonly employed. Ventilation methods include installing an exhaustfan close to the source of contaminants, increasing outdoor air flows inmechanical ventilation systems, and opening windows, especially whenpollutant sources are in use.

The third approach -- air cleaning -- is not generally regarded as suffi-cient in itself, but is sometimes used to supplement source control andventilation. Air filters, electronic particle air cleaners and ionizers areoften used to remove airborne particles, and gas adsorbing material issometimes used to remove gaseous contaminants when source controland ventilation are inadequate.

ConclusionsWhether in its pure form or mixed with other chemicals, ozone can beharmful to health.

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When inhaled, ozone can damage the lungs. Relatively low amounts ofozone can cause chest pain, coughing, shortness of breath and, throat irri-tation. It may also worsen chronic respiratory diseases such as asthma aswell as compromise the ability of the body to fight respiratory infections.

Some studies show that ozone concentrations produced by ozone genera-tors can exceed health standards even when one follows manufacturer'sinstructions.

Many factors affect ozone concentrations including the amount of ozoneproduced by the machine(s), the size of the indoor space, the amount ofmaterial in the room with which ozone reacts, the outdoor ozone concen-tration, and the amount of ventilation. These factors make it difficult tocontrol the ozone concentration in all circumstances.

Available scientific evidence shows that, at concentrations that do notexceed public health standards, ozone is generally ineffective in control-ling indoor air pollution.

The concentration of ozone would have to greatly exceed health stan-dards to be effective in removing most indoor air contaminants. In theprocess of reacting with chemicals indoors, ozone can produce otherchemicals that themselves can be irritating and corrosive.

RecommendationThe public is advised to use proven methods of controlling indoor airpollution. These methods include eliminating or controlling pollutantsources, increasing outdoor air ventilation, and using proven methods ofair cleaning.

SOURCES & BIBLIOGRAPHY• The Inside Story: A Guide to Indoor Air Quality, EPA Document Number EPA 402-K-93-

007. U.S. EPA, U.S. CPSC. April 1995. • Indoor Air Facts No. 7.- Residential Air Cleaners, EPA Document Number EPA 20A-4-001.

U.S. EPA. February 1990. • Residential Air Cleaning Devices: A Summary of Available Information, EPA Document

Number EPA 402-K-96-001. U.S. EPA. February 1990.• Indoor Air Pollution: An Introduction for Health Professionals, EPA Document Number EPA

402-R-94-007. American Lung Association, EPA, CPSC, American Medical Association. • "Health Canada Advises the Public About Air Cleaners Designed to Intentionally Generate

Ozone (Ozone Generators)", Health Canada, Canada 1999-19, February 5, 1999.www.hc-sc.gc.ca/english/protection/warnings/1999/99_62e.htm

• U.S. EPA's Indoor Air Quality Information Clearinghouse (IAQ INFO), PO Box 37133, Washington D.C. 20013-7133;by phone (800) 438-4318.

• California Department of Health Services, Indoor Air Quality Program, 850 Marina Bay Parkway, Suite G365/EHL, Richmond, CA 94804. DHS-IAQ Program Assistance Line: (510) 620-2874, Fax: (510) 620-2825

• Federal Trade Commission , Consumer Response Center,(202) 326-3128.• U.S. Consumer Product Safety Commission, Washington D.C. 20207; or call Consumer

Hotline, English/Spanish: (800) 638-2772, Hearing/Speech Impaired: (800) 6388270.• The Association of Home Appliance Manufacturers (AHAM) has developed an American

National Standards Institute (ANSI)-approved standard for portable air cleaners (ANSI/AHAM Standard AC-1-1988). This standard may be useful in estimating the effec-tiveness of portable air cleaners. Under this standard, room air cleaner effectiveness is rated by a clean air delivery rate (CADR) for each of three particle types in indoor air: tobacco smoke, dust, and pollen.

• Only a limited number of air cleaners have been certified under this program at the present time. A complete listing of all current AHAM-certified room air cleaners and their CADRs can be obtained from CADR

• Association of Home Appliance Manufacturers (AHAM) 1111 19th Street, NW, Suite 402Washington, DC 20036(202) 872-5955www.aham.org

• AHAM also provides information on air cleaners on their AHAM-certified Clean Air Delivery Rate site at www.cadr.org

• American Lung Association Fact Sheet - Air Cleaning Devices: Types of Air Cleaning Processes

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CHAPTER 7COSMETOLOGIST SANITATION, STERILIZATION,

AND SAFETY: NEW RISKS(3 Credit Hours)

Learning ObjectivesExplain the difference between pathogenic and nonpathogenic bacteriaIdentify the primary forms of pathogenic microorganisms and explain their relationship to diseaseList infections caused by common viruses, bacteria, and fungusthat may exist in a salon or spaExplain the significance of avian flu to the cosmetologistContrast disinfectants and antiseptics and explain the signifi-cance of those differencesList the steps necessary to properly sanitize hands, and to disinfect, handle, and store tools appropriatelyList special infection control responsibilities for cosmetologistsList infection control responsibilities according to universal sanitation precautionsContrast sanitation and sterilization and explain the signifi-cance of those differencesExplain the risks of antibiotic resistanceExplain the signficance of Material Safety Data Sheets (MSDS)

The Significance of Sterilization in Spas and SalonsLate in the year 2000, a mysterious outbreak of bacterial infections inWatsonville, California baffled health professionals for many weeks.Painful sores appeared on the skin of more than 140 women who werefound to have visited the same beauty salon. The infections were diffi-cult to treat, even with the use of antibiotics. After some weeks, investi-gators in the health department determined that these women had beeninfected with bacteria in the course of receiving a spa pedicure. Thesalon was shut down after testing indicated high levels of tuberculosis-related bacteria in all of the salon's footbaths. Dangerous bacteria hadbuilt up on the suction screens of the footbaths, which had not been prop-erly cleaned. While the boils and skin ulcers eventually healed, the infec-tions left deep purple scars on the legs of more than 100 women.1

Soon after the Watsonville discovery, a 20/20 investigation revealedsalons in Phoenix, Boston, and Houston were also guilty of unsanitaryconditions, with many testing positive for potentially harmful bacteria.Other examples followed: Investigations in California noted potentiallyharmful conditions in 16 out of 18 examined salons; an undercoverinspection in Philadelphia found technicians reusing unclean instruments;and in Westminster, Colorado, a jury awarded $3 million dollars to awoman who contracted herpes from a nail technician using unsterilizedtools.2

Unfortunately, the message is still not out. As recently as August 2005,nine salons in California were named in a lawsuit over pedicure-relatedinfections.3 Of even greater concern is a death in Texas, resulting from apedicure-related infection. The following information is excerpted fromthe Dallas/Fort Worth Channel 8 report, published at WFAA.com, andcan be found in full at http://www.wfaa.com/sharedcontent/dws/wfaa/bwatson/stories/wfaa060222_mo_mrsadeath.537e22dd.html:

Family believes pedicure led to woman's death: 02:26 PM CST on Thursday, February 23, 2006By BRAD WATSON / WFAA-TVSomething as simple as a pedicure is said to have been the cause of Kimberly Jackson's death. A MRSA staph bacteria that's sometimes found in nail salons is very aggressive. Usually it causes open sores that take strong antibiotics over weeks or even months to knock down. However, in some cases MRSA can lead to death and the family of

the Fort Worth woman said that's what happened in this case. Her husband, David Jackson of Fort Worth, said he still can't believe his wife is gone, and the cause of her death only adds to the agony. "Something so stupid like a pedicure took her life," Jackson said. The death certificate signed by the JPS Health Center doctor who treated her showed Jackson died from a heart attack due to a staph infection on her foot that infected her blood. "She couldn't get it healed no matter what she was doing, and the antibiotics just wouldn't stop it," Jackson said. MRSA is an aggressive bacteria resistant to common antibiotics and is sometimes found in the water of salon foot spas that are not disinfected properly. The doctor put Jackson on a cocktail of strong oral and intravenous antibiotics. "It got pretty big and she got pretty scared she was going to lose her foot," Mathis said. But on Feb. 12 the 46-year-old woman lost her life. The Texas Department of Licensing and Regulation that oversees nail salons said it will be investigating Jackson's death.

Until licensees and salon owners follow the necessary disinfection proce-dures without fail, news stories and media attention will undoubtedlycontinue to highlight such disturbing cases, putting the health of clients,the reputation of the industry, and your business at risk. This chapter willaddress these health risks with information you can use to protect your-self, you clients, and coworkers.

Bird FluA new threat of which you should be aware is "bird flu" or avian influen-za:

What is avian influenza?4

Avian influenza, or "bird flu", is a contagious disease of animals causedby viruses that normally infect only birds and, less commonly, pigs.Avian influenza viruses are highly species-specific, but have, on rareoccasions, crossed the species barrier to infect humans.

In domestic poultry, infection with avian influenza viruses causes twomain forms of disease, distinguished by low and high extremes of viru-lence. The so-called "low pathogenic" form commonly causes only mildsymptoms (ruffled feathers, a drop in egg production) and may easily goundetected. The highly pathogenic form is far more dramatic. It spreadsvery rapidly through poultry flocks, causes disease affecting multipleinternal organs, and has a mortality that can approach 100%, often within48 hours.

What is special about the current outbreaks in poultry?The current outbreaks of highly pathogenic avian influenza, which beganin South-east Asia in mid-2003, are the largest and most severe onrecord. Never before in the history of this disease have so many countriesbeen simultaneously affected, resulting in the loss of so many birds.

The causative agent, the H5N1 virus, has proved to be especially tena-cious. Despite the death or destruction of an estimated 150 million birds,the virus is now considered endemic in many parts of Indonesia and VietNam and in some parts of Cambodia, China, Thailand, and possibly alsothe Lao People's Democratic Republic. Control of the disease in poultryis expected to take several years.

The H5N1 virus is also of particular concern for human health, asexplained below.

Which countries have been affected by outbreaks in poultry?From mid-December 2003 through early February 2004, poultry out-breaks caused by the H5N1 virus were reported in eight Asian nations(listed in order of reporting): the Republic of Korea, Viet Nam, Japan,Thailand, Cambodia, Lao People's Democratic Republic, Indonesia, and

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China. Most of these countries had never before experienced an outbreakof highly pathogenic avian influenza in their histories.

In early August 2004, Malaysia reported its first outbreak of H5N1 inpoultry, becoming the ninth Asian nation affected. Russia reported itsfirst H5N1 outbreak in poultry in late July 2005, followed by reports ofdisease in adjacent parts of Kazakhstan in early August. Deaths of wildbirds from highly pathogenic H5N1 were reported in both countries.Almost simultaneously, Mongolia reported the detection of H5N1 in deadmigratory birds. In October 2005, H5N1 was confirmed in poultry inTurkey. Outbreaks in wild and domestic birds are under investigationelsewhere.

Japan, the Republic of Korea, and Malaysia have announced control oftheir poultry outbreaks and are now considered free of the disease. In theother affected areas, outbreaks are continuing with varying degrees ofseverity.

What are the implications for human health?The widespread persistence of H5N1 in poultry populations poses twomain risks for human health.

The first is the risk of direct infection when the virus passes from poultryto humans, resulting in very severe disease. Of the few avian influenzaviruses that have crossed the species barrier to infect humans, H5N1 hascaused the largest number of cases of severe disease and death inhumans. Unlike normal seasonal influenza, where infection causes onlymild respiratory symptoms in most people, the disease caused by H5N1follows an unusually aggressive clinical course, with rapid deteriorationand high fatality. Primary viral pneumonia and multi-organ failure arecommon. In the present outbreak, more than half of those infected withthe virus have died. Most cases have occurred in previously healthy chil-dren and young adults.

A second risk, of even greater concern, is that the virus - if given enoughopportunities - will change into a form that is highly infectious forhumans and spreads easily from person to person. Such a change couldmark the start of a global outbreak (a pandemic).

Where have human cases occurred?In the current outbreak, laboratory-confirmed human cases have beenreported in four countries: Cambodia, Indonesia, Thailand, and Vietnam.

Hong Kong has experienced two outbreaks in the past. In 1997, in thefirst recorded instance of human infection with H5N1, the virus infected18 people and killed 6 of them. In early 2003, the virus caused two infec-tions, with one death, in a Hong Kong family with a recent travel historyto southern China.

How do people become infected?Direct contact with infected poultry, or surfaces and objects contaminatedby their feces, is presently considered the main route of human infection.To date, most human cases have occurred in rural or periurban areaswhere many households keep small poultry flocks, which often roamfreely, sometimes entering homes or sharing outdoor areas where chil-dren play. As infected birds shed large quantities of virus in their faeces,opportunities for exposure to infected droppings or to environments con-taminated by the virus are abundant under such conditions. Moreover,because many households in Asia depend on poultry for income andfood, many families sell or slaughter and consume birds when signs ofillness appear in a flock, and this practice has proved difficult to change.Exposure is considered most likely during slaughter, defeathering,butchering, and preparation of poultry for cooking. There is no evidencethat properly cooked poultry or eggs can be a source of infection.

Does the virus spread easily from birds to humans?No. Though more than 100 human cases have occurred in the currentoutbreak, this is a small number compared with the huge number of birdsaffected and the numerous associated opportunities for human exposure,

especially in areas where backyard flocks are common. It is not presentlyunderstood why some people, and not others, become infected followingsimilar exposures.

What about the pandemic risk?A pandemic can start when three conditions have been met: a newinfluenza virus subtype emerges; it infects humans, causing serious ill-ness; and it spreads easily and sustainably among humans. The H5N1virus amply meets the first two conditions: it is a new virus for humans(H5N1 viruses have never circulated widely among people), and it hasinfected more than 100 humans, killing over half of them. No one willhave immunity should an H5N1-like virus emerge.

All prerequisites for the start of a pandemic have therefore been met saveone: the establishment of efficient and sustained human-to-human trans-mission of the virus. The risk that the H5N1 virus will acquire this abilitywill persist as long as opportunities for human infections occur. Theseopportunities, in turn, will persist as long as the virus continues to circu-late in birds, and this situation could endure for some years to come.

How serious is the current pandemic risk?The risk of pandemic influenza is serious. With the H5N1 virus nowfirmly entrenched in large parts of Asia, the risk that more human caseswill occur will persist. Each additional human case gives the virus anopportunity to improve its transmissibility in humans, and thus developinto a pandemic strain. The recent spread of the virus to poultry and wildbirds in new areas further broadens opportunities for human cases tooccur. While neither the timing nor the severity of the next pandemic canbe predicted, the probability that a pandemic will occur has increased.

Preventing the flu: what you can do5

General flu prevention tips: • Wash your hands to wash away the flu virus• Cover your mouth when you sneeze or cough• Get a flu shot to boost your overall immunity• Stay home if you are sick

Viruses are hardy organisms. They can live for up to 48 hours on the sur-faces of toys, shopping car handles, coffeemakers, doorknobs, computerkeyboards, and other hard surfaces.

It can take up to a week for that virus that infected you to produce symp-toms. Even if you're not showing symptoms, you can infect others, sowash your hands regularly with hot water and soap.

TravelPublic Health Agencies have issued advisories for people traveling toareas that have experienced bird flu problems. The list of countriesincludes Thailand, China, Cambodia, Vietnam, South Korea, Japan,Indonesia and Laos.

The agencies note that while there's been no evidence of the illness beingspread through food, travelers to those countries should not consumeundercooked poultry, raw eggs or lightly cooked egg products (such asrunny eggs).

The agencies also suggest people traveling to those countries pay extraattention to personal hygiene: wash your hands thoroughly and often -especially if you touched eggs or undercooked poultry and egg products.

The agency further warns people to avoid contact with live poultry - andto stay away from poultry farms or markets where live birds are sold.

If you visited a farm overseas:Make sure that clothing and footwear worn on the farm are free from soiland manure before returning to the United States. Wash your clothes anddisinfect your footwear.

Your Responsibilities as a CosmetologistAs a cosmetologist, you have responsibilities to the state and your pro-

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fession to learn and use appropriate precautionary measures and cleaningprocedures. You must follow these procedures to protect both you andyour clients, reduce the incidence of bacterial, viral, and fungal infection,and prevent the spread of disease. You, your instruments, and work sta-tion must be kept as clean as possible; meaning no short cuts, or omis-sions, of any precautionary measures discussed in this chapter.Violations can result in legal penalization, as well as infection.

This chapter will review these subjects:1. The biology of pathogens, how they function, reproduce, and

infect2. Universal sanitation and sterilization precautions3. Regulations that apply to cosmetology4. The difference between decontamination, sanitation, and

disinfection5. How to effectively disinfect tools and surfaces in your

environment, and sanitize hands6. Sanitary procedures for facial services

Microorganisms and Infectious AgentsMicroorganisms are tiny living particles (organisms) with many differentcharacteristics. They live in our air, water, and earth, and are foundeverywhere on the planet. Some microorganisms are associated withinfection or disease; others are harmless or even helpful. Bacteria, virus-es, and parasites are three major categories of microorganisms that youencounter every day.

BacteriaBacteria are tiny one-celled vegetable microorganisms (plants) that canonly be seen with a microscope. The most plentiful organisms on theearth, bacteria are found virtually everywhere around us, existing in dust,dirt, and decay, our skin and body tissues, the air we breathe, and thewater we drink. Bacteria produce slimy fluids or waxy coatings, whichmoisten them and help them survive in inhospitable environments.Fimbri, hairlike tendrils that anchor the bacteria to an object, make bacte-ria "sticky," requiring one to use some degree of pressure when scrub-bing, to break the hold of these tenacious fibers.

Bacteria exist in one of two modes: an active, vegetative, mode, and aninactive, spore-forming mode. In the active stage, bacteria grow andmultiply at an astonishing speed. Reproducing through binary fission (aprocess in which one bacteria splits into two), bacteria produce millionsof copies within hours. Bacteria are only able to reproduce when theenvironment meets their specific needs in temperature and degree ofmoisture. They require a warm, damp, usually dark, and often dirty envi-ronment that provides a supply of food adequate to sustain the bacteriaand provide fuel for reproduction. If conditions are not favorable forreproduction, the bacteria will move into a spore-forming stage, produc-ing spores with tough outer surfaces that are almost impervious to wind,heat, cold, harsh cleaners, or disinfectants. These characteristics helpspores survive for long periods between reproductive phases.

While there are hundreds of different kinds of bacteria, they are primarilysorted into one of two types, according to the danger they pose to us.Potentially harmful bacteria are called pathogenic; harmless or beneficialbacteria are called nonpathogenic. The great majority (about 70%) ofbacteria are nonpathogenic. Called saprophytes, these organisms do notproduce disease and carry out necessary functions, such as decomposingdead matter, for example. Nonpathogenic bacteria also exist in the humandigestive tract, and in the mouth and intestines, where they facilitatedigestion by breaking down food.

A much smaller minority (about 30%) of organisms are pathogenicorganisms, also called microbes or germs. These are harmful, and pro-duce disease when they invade animal or plant life. Pathogenic bacteriacommonly exist in the salon environment. Bacterial infection occurswhen a body is exposed to and cannot successfully fight off bacterial

invasion. General infections typically begin as local infections, whichmay start as a boil or pimple accompanied by pus (a compilation of bac-teria, decayed tissue, waste, and blood cells) that is often associated withinfection. Bacterial toxins, from local infections, can spread to differentparts of the body through the bloodstream, increasing the likelihood ofgeneral infection.

Pathogenic bacteria are distinguished by their characteristic shapes:Bacilli are rod-shaped, and the most common bacteria, causing diseasessuch as influenza, tetanus, and diptheria. Spirilla are spiral-shaped bacte-ria, and cocci are round bacteria that produce pus. Cocci rarely move ontheir own, but are usually transported through the air in dust particles orother substances. Bacilli and spirilla are both capable of self-movement(motility), using hairlike projections (flagella or cilia) to propel them-selves.

VirusesViruses are infectious biological entities that are very small-much smallerthan bacteria-and cause disease by entering a healthy cell, maturing, andreproducing. Unlike bacteria, viruses do not survive for any length oftime without the protection of a living cell. Viruses are dangerousbecause their replication inside the cell eventually causes the death ofthat cell. They are parasites; taking the cell's nutrients, and destroying thecell in the process. The cell is then used to breed hundreds, thousandsand even millions of new mature infectious viruses that leave to infectother cells. Viruses cause diseases like hepatitis, influenza, and measles,and are the source of colds, chicken pox, cold sores and genital herpes,mononucleosis, hepatitis, and HIV/AIDS.

Viruses are a particular concern in salons because of their potentialseverity and the way they spread. Viruses occupy the surfaces of objectsyou touch, including door handles, coffee mugs, and scissors; they can beinhaled on tiny dust particles, or travel on the minute amount of salivaexpelled in a cough. Viral infections can be transmitted from one personto another through casual contact with an infected individual or contactwith what he or she touched. Both hand-to-surface and hand-to-handcontact are both highly effective methods for transferring virus particlesfrom one individual to another.

Plant ParasitesPlant parasites, such as fungus or mold, mildew, and yeasts are multi-cel-lular organisms that are as prevalent as bacteria, and consume both liveand dead tissue to survive. Fungi usually prefer a damp environment,but can also survive in a warm, dry climate. They reproduce and spreada number of different ways, and can invade the human body easily,requiring no break in the skin.

Ringworm and athlete's foot are two common contagious diseases thatare spread by fungi. Another is favus, which affects the scalp.Cosmetologists should not serve any individual with signs of any fungalinfection. If you have a fungal infection, do not work, and seek treatmentimmediately. If you think a client has ringworm, identified by a ring-shaped, circular pattern on the skin, or athlete's foot, do not provide serv-ice to the individual, as it is highly contagious. Tell the individual to con-sult a physician for treatment.

Precautions with Plant ParasitesFungal infections can be stubborn. They often affect the skin, but alsocan cause severe respiratory infections. More common versions of fun-gal infection are those caused by yeast (including nail fungus, athletesfoot, and jock itch) and ringworm. Both over-the-counter and prescrip-tion treatments are available for relief from the unpleasant, itchy symp-toms of common yeast infections.

Plant parasites, like fungus and mold, are contagious, with fungus a sig-nificant communicable risk between clients and technicians givenimproper sanitation techniques at a salon. Nail fungus appears as discol-oration of the nail plate (on either the fingernails or toenails), initially

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white, but growing darker over time. Clients with nail fungus should bereferred to a physician for treatment.

Animal ParasitesAnimal parasites may be single-cell (protozoans) like amoebas or malar-ia, or multi-cell, like mites or lice. Protozoans consume both plant andanimal tissue, and are found in blood and body fluids, water, and food.Multi-cell animals, like lice and mites, can hide in the hair and burrowunder the skin. Be aware of the signs of scabies, identified by bite markson the skin, Rocky Mountain spotted fever, or typhus, which is caused byrickettsia, animal parasites carried by fleas, lice, and tics that are evensmaller than bacteria.

For any individual with a visible communicable disease, like pediculosis(head lice), open sores, or marks suggesting scabies, it is recommendedthat the person furnish a statement signed by a physician that the diseaseor condition is not in an infectious, contagious or communicable stage.The same is true if the nail technician has symptoms or indications of avisible disease, lice, or open sores; he or she should not return to workuntil obtaining a statement signed by a physician stating that the diseaseor condition is not in an infectious, contagious, or communicable stage. If lice (which infect both head and pubic hair), small, white eggs, or nits,are found in the hair, the cosmetologist should provide a shampoo treat-ment to kill the infestation, but no other services. After the lice are nolonger present, other services may be offered.

Modes of Contamination and TransmissionDiseases are communicable or contagious when they move from oneindividual to another. Working with the public means encounteringpotentially dangerous pathogens and opportunistic organisms everyday.Always assume your clients, co-workers, and environment could be car-rying illness, and use proper infection control procedures every day.

Humans have some level of immunity against infection, but our level ofprotection varies with age, health, and a range of other factors. Skin isour first line of defense; when there are no cuts or scrapes, skin is excel-lent protection against pathogens. In the vast majority of cases, bacteria,fungi, and viruses enter the body through the portals of the nose, andmouth, small tears or openings in the skin, and to a lesser extent, the eyesand ears. Once inside the body, the pathogen reproduces rapidly, at a ratethat can overwhelm the immune system, resulting in disease.

Transmission may occur through direct or indirect contact. Germs mayspread from one individual to another through direct contact-holdinghands or kissing, for example-or indirectly-inhaling contaminateddroplets in the air (airborne transmission), or touching a contaminatedsurface and then touching one's nose, eyes, or a mucous membrane. Tryto avoid touching your face during the day, and always wash your handsbetween clients.

Yeast, scabies, lice and many other skin infections do not require an opensore or mucosal surface to infect. Athlete's foot, for example, contami-nates through indirect transmission: When someone with athlete's footwalks barefoot on a wet bathroom floor, the person leaves spores behindthat will stick to the foot of anyone else walking barefoot on that floor,infecting the individual, even if he or she has no cuts or openings on thefeet. Fungi, like athlete's foot, will survive for some time on a damp orwet floor. Shower stalls and soaking baths that retain small amounts ofwater must be thoroughly cleaned and disinfected with the appropriatedisinfectant.

The primary modes of travel for common contagions are:• Unclean hands• Unclean implements• Open sores• Pus• Mouth and nose discharge• Shared cups or towels

• Coughing or sneezing• Spitting

Pathogenic bacteria can also enter the body through:• A break in the skin, including pimples, scratches, or cuts• The nose and the mouth, during breathing• The mouth, during eating and drinking

Humans are excellent sources of contamination because we are constant-ly leaving organic particles behind, wherever we go; a mixture of deadskin cells, with viral, bacterial, and fungal particles, along with othermicroorganisms that consume skin cells or use us to travel to an appro-priate host. Every time you touch something, you deposit some of thisorganic matter on another surface. Simple actions, like touching aclient's hair, brushing some of your hair out of your eyes with your hand,or touching a spray bottle can move microorganisms from one item toanother, from you to your client, or your client to you.

Dirty instruments and poor sanitation at salons or spas also puts clients atrisk for diseases such as athlete's foot and hepatitis B and C. Manyhealth care resources recommend no shaving of the legs before or theday of a salon footbath, as "scrapes and nicks can make you more sus-ceptible to infection."6 They also suggest that cosmetologists push backcuticles instead of cutting them.

Individuals who are susceptible to infection, due to a compromised pro-tection system or some failure in their ability to resist invasion, are alsothe targets of opportunistic microorganisms. In contrast to pathogens,opportunistic organisms do not cause initial illness, but will infect anindividual once pathogenic organisms have already weakened its immunesystem. Opportunistic organisms cling to the skin and the hair, and existin the bodies, of healthy people.

Microbes also contaminate ventilation systems; to discourage theirgrowth, vents, filters, humidifiers, and dehumidifiers should be cleanedand maintained regularly. Investigate any mildewy or musty odors,which are a good indication of microbe growth. Germs in a ventilationsystem easily spread throughout a salon, landing on people, surfaces, andimplements, whenever the blower or fan turns on.

Germs not only float through the air, settling constantly on salon sur-faces, such as sinks and countertops, they can also "hitchhike" on humanskin, hair, and clothing, contaminating anything with which they comeinto contact. Pathogenic and opportunistic microorganisms are able tothrive in a salon or spas warm, moist places; like the drain of the sham-poo sink, the footbaths, hot and cold water handles and tap, etc.Implements like scissors, files, brushes, or nippers can be major sourcesof contamination because they often contain organic matter, an optimumgrowth environment for pathogenic and opportunistic microorganisms.

Some of the most dangerous areas in a salon or spa are the places con-taminated tools or equipment are kept, including the table and the trashcans in which you deposit dirty implements. Microbes can also exist onseemingly unlikely products, like bars of soap, for example. Becausegerms and other microorganism have been shown to thrive on bar soapsalons should use liquid soap that can be dispensed from a container foreach customer. In addition, soaking solutions, lotions, and creams, whichinitially are uncontaminated, may lose preservatives that keep them safefrom pathogenic or opportunistic microbes from growing in them.Changes in color, texture, appearance, or odor can be signs of contamina-tion.

Fighting infection may be a matter of staying home when you are sick.Just as you should avoid working with contagious clients, you should notgo to work if you have infection, such as a bad cold or flu. Cover yourmouth and nose to control pathogens escaping through sneezes andcoughs. Avoid causing wounds; if your client's skin is dry or fragile, tears and breaks can occur easily. Use abrasive instruments with careand a gentle touch, especially around sensitive skin.

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Decontaminating Your EnvironmentYou have a responsibility to control exposure to pathogens by decontami-nating your environment and tools. Remember that pathogens collectanytime an object or surface is exposed to air. Doorknobs, handles, thetelephone, money, cabinets, the cash register-all are surfaces touched bycoworkers and clients that may harbor harmful pathogens, so all must bedecontaminated to some degree. Cleaning is only the first step of theprocess. The following sections review the meaning of sanitation, sterili-zation, and disinfection, terms that are commonly used interchangeably,but have very different meanings and require different procedures.

SanitationSanitation is the lowest level of decontamination. Sanitation will reducegerms on a surface, but will not kill all organisms. Sanitation provides aminimum level of cleanliness, protecting public health by preventing thespread of some, but not all, bacteria and fungi. Instruments that are sani-tized are not sterile. Countertops and workstations should also be sani-tized, wiped down with soap and water; this process should not be con-fused with, and does not replace, disinfection, which requires and appro-priate disinfectant. Remember that soap and water will kill most of thebacteria on your hands, workstation, or chair, but will not kill all the bac-teria or fungal spores.

The term sanitation is most often used in reference to cleaning the hands.Hand washing is absolutely essential to controlling bacteria and the mosteffective way to prevent the spread of infectious agents from one personto another. Hands cannot be sterilized, because it is impossible toremove all microorganisms from the surface of the skin; water and soap,in fact, are not sterile, and can introduce new bacteria and infectiousagents. (Even anti-bacterial soaps will not remove all the organisms onyour hands.)

Your hands are populated by both resident and transient organisms.Resident organisms are a normal part of your skin's environment; theirnatural habitat. They grow and multiply in an oxygen environment, andrarely cause infection, or harm the individual who is their host. Theseorganisms cannot be removed easily by hand-washing. Sanitation con-trols minimize exposure to transient organisms. These organisms, like E.coli and salmonella, cause dangerous infections in humans. In contrastto resident organisms, transient organisms cannot live long on the surfaceof our skin. They function poorly in an oxygen environment, usually sur-viving less than 24 hours. These organisms can be removed easilythrough the process of hand-washing, using friction, soap, and water.

Effective Hand-WashingTo wash hands in way that removes transient organisms requires soap,water, and friction. Soap need not be anti-bacterial, as it is no moreeffective against pathogens than traditional soaps. Friction is perhaps themost crucial component, as it is friction that typically removes the tran-sient organisms. The entire procedure should take at least 10 to 20 sec-onds and be repeated after each client.

1. Wet hands with running water2. Apply soap in the middle of the wet hands; use an FDA listed,

antimicrobial liquid hand soap.3. Lather well4. Use vigorous friction by rubbing the hands together; pay

attention to nail beds and the webs between the fingers and thumbs

5. Rinse hands thoroughly with water (leave the water running)6. Dry hands with a paper towel7. Turn water off, using a paper towel

Cleaning Agents for HandsCleaning agents assist in the process of removing substances from sur-faces. Soaps and detergents are two common cleaning agents that areoften confused for one-another, but are composed of very different ingre-dients and have different cleaning properties. Soaps are the product of a

chemical reaction, formed by vegetable oil reacting with lye, for exam-ple, and the addition of chemicals that add a desirable smell or quality tothe soap, such as glycerine, to make it milder. While soap does not killmicroorganisms, soap and water will help remove them from surfaces.

Detergents are manufactured for the express purpose of cleaning specificsubstances off of specific items, and are created using chemicals that canbe very harsh to skin. In contrast to detergents that do not leave aresidue or require rinsing, soaps leave a coating or residue on the body;typically one designed to make skin smoother or more attractive. Soapsalso remove less fat from the skin than detergents, which have a dryingquality and may strip the skin. Be sure to use the appropriate cleaningagent for the job. Different cleaning and disinfecting agents have manydifferent properties. Always read the ingredients, instructions, and rec-ommendations for use on the item's label.

Sterilization and Disinfection"Sterile" means free from all germs; sterilization is the most effectivelevel of decontamination, involving the removal of all bacterial life froma surface. This is the level of decontamination required for tools and sur-faces in hospital surgeries, Hospitals use steam autoclaves to heat instru-ments to a very high temperature, but this is an impractical method forsalon sterilization. Some businesses choose to boil instruments, but mostcosmetology salons sterilize instruments with the use of disinfectants.

Disinfection is the process of killing specific microorganisms, bacteria orgerms, using physical or chemical processes. Disinfectants are chemicalagents that destroy organisms on contaminated instruments or surfaces.Disinfectants can be dangerous and must be used with caution. They areeffective at destroying bacteria on equipment and implements but shouldnot be used on the skin. In a salon atmosphere, disinfectants must beable to kill viruses, fungus, and dangerous bacteria.

Disinfectants may be used in ultrasonic cabinets if desired. These clean-ers use high-frequency sound waves to form bubbles that clean instru-ments. Ultrasonic cleaners, however, are only effective when used withan appropriate disinfectant. Ultraviolet Sanitizers should not be used todisinfect tools, as they are ineffective against viruses and do not clean thecrevices of instruments. Bead sterilizers are also ineffective in sterilizingor disinfecting implements.

A critical part of sterilization is effectively storing the sterilized itemswithout recontaminating them. Touching sterilized instruments withbare hands, placing them on a surface that is not sterile, or storing in anunsterile compartment will contaminate the instrument, and requireresterilization. After cleaning and disinfecting instruments, place them ina clean, dry storage container until ready for use. Ultraviolet electricalsanitizers may be used as a dry storage container. Do not keep articlessuch as pens, pencils, money, paper, mail etc. in the same container assterilized or unsterilized instruments. Disposable instruments may be apractical alternative, especially for instruments or objects, such as nee-dles, that can easily penetrate the skin.

DisinfectantsControlling bacteria in a salon requires some degree of effort, vigilance,and good sense. In choosing a disinfectant, always look for the EPAregistration number (awarded by the Environmental Protection Agency)to ensure you are using an approved disinfectant. This number indicates alevel of safety for specific kinds of disinfection, killing bacteria includingstaphylococcus, salmonella, and pseudomonas. Salons and spas must usenot only EPA-approved disinfectants, but those with an EPA rating ofhospital-level (tuberculocidal) quality. These disinfectants are especiallyeffective for salon use and are capable of killing viruses, dangerous bac-teria, and fungus.

Disinfectants can be hazardous if prepared or used incorrectly. Consultthe manufacturer's Material Safety Data Sheets (MSDS) for informationon preparing the solution, and read precautions regarding chemicals list-

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ed on the label to determine what, if any, safety hazards they pose. Toensure safety, use an appropriate ratio of concentration in the solution,and clean only approved items, according to label instructions. Weargloves and safety glasses, as indicated, when mixing and using solutions.

Sanitation and disinfection are often misunderstood or confused.Sanitizing refers to cleaning of all visible residue or debris. This must befollowed with disinfection, which refers to the use of chemicals todestroy germs on non-living surfaces. Salon or spa disinfectants includeEPA-registered disinfectant products, 10% bleach, or 70% or higher iso-propyl or ethyl alcohol.

Do not confuse disinfectants, which destroy harmful microorganisms,with antiseptics, products designed to slow the growth of microorgan-isms. Antiseptics do not kill microorganisms and should not be confusedwith disinfectants or used for salon disinfection. Antiseptics may be safe-ly applied to the skin and used as sanitizers.

Household disinfectants, commonly used to clean offices and homes,may be used to clean floors, doorknobs, walls, etc., as directed on thecontainer label, but should not be used in place of a hospital grade salondisinfectant, which is required to sterilize instruments.

Bleach can be used as an effective disinfectant, but it is not a cleaningagent and should only be applied to clean surfaces. Bleach must be usedwith caution because it can release toxic fumes when mixed with certainsubstances. Bleach is far too harsh to be used to disinfect tools, as it maydamage them. Bleach may be safely used in the laundry.

Do not use alcohol as a disinfectant. Alcohol was used as a disinfectantfor many years, due to a widely-held misconception that it could be usedfor sterilization purposes. Not only is alcohol a poor disinfectant, it isalso highly flammable, creating a potential fire hazard.

Formalin and formalin tablets are not accepted disinfectants and shouldnot be used in a salon. Both release formaldehyde, a toxic cancer-causinggas that is highly irritating to the eyes, nose, lungs, and throat. Long-termexposure to formaldehyde may damage the respiratory track, causingbronchitis or other respiratory conditions

Quaternary ammonium compounds ("quats") are the most widely useddisinfectants in nail salons and schools, but they do not kill tuberculosisbacteria. Quats are safe and work quickly; most instruments can be dis-infected in 15-20 minutes with a quat solution. Do not leave instrumentsin a solution for an extended period of time, as the instruments may bedamaged by rust or erosion of their cutting edges. New super quatsdestroy bacteria quickly and can disinfect your instruments in an evenshorter time (10-15 minutes). Once instruments have been submerged forthe recommended time interval, remove them from the solution and placethem in closed cabinet or drawer.. Quats can also be used to clean sur-face areas that come in contact with food.

Phenolic disinfectants ("phenols") are excellent disinfectants with fewlimitations. They kill a broad range of germs, including resistantmicrobes like tuberculosis. Their disadvantages include their relativeexpense, danger to the skin, and potential reactions with some types ofrubber and plastics used on implements, causing tools to soften and cor-rode. Concentrated or undiluted phenol disinfectants can cause severeburns to the skin and eyes, and are toxic if swallowed. Even diluted phe-nols can irritate the eyes and skin. If phenol disinfectants are used in thesalon, they must be kept safely out of children's reach, be clearly labeled,and be used strictly according to manufacturer's instructions.

Disinfection Techniques for Non-Electrical and ElectricalInstruments and Equipment

1. Disinfection of non-electrical instrumentsDeciding to dispose or not to dispose of non-electrical instru-ments and equipment:

Before attempting to disinfect an implement, determine if the tool is porous or non-porous, and whether it is single-use or multi-use itemPorous items are made of absorbent material such as wood and cloth. This category includes the majority of nail files, orangewood sticks, and buffer blocks. Porous items that are damaged in cleaning or disinfection procedures are single-use items. They should be disposed of in the garbage after one use.Any porous item that is contaminated by the following: blood, body fluid, broken skin, infections, or any other unhealthy conditions cannot be disinfected. It must be disposed of in the garbage. Non-porous items are constructed of hard materials, including metal, glass, or hard plastic, such as scissors, combs, nippers, drill bits, and metal or fiberglass-backed nail files. All non-porous tools can be disinfected, even if they come into contact with blood or infectious conditions. These are all multi-use items. Clean off all visible debris, then completely immerse non-porous tools for 10 minutes in an EPA-registered disinfectant, 10% bleach, or 70% or higher isopropyl or ethyl alcohol.Towels, chamois, buffing bits, and similar items can be cleaned in a washing machine with regular detergent at the end of each day. Instruments, including brushes, which are not designed to touch skin, and are used in waterless products such as nail polish, acrylic monomer and powder, or light-cured gels, do not spread germs and do not need to be disinfected. If you are not sure that a file or tool can be safely cleaned, disinfected, and used again, don't take the risk. When in doubt, throw it out.

a. Scrub each implement with a clean brush in a solution of soapand water to remove all organic matter.

b. Rinse implements thoroughly in clean water.c. Pat the implements dry with a clean towel (paper or cloth) to

prevent the dilution of the disinfection solution.d. Totally immerse in an EPA registered disinfectant with demon-

strated bactericidal, viricidal and fungicidal capabilities accord-ing to manufacturer's directions.

e. Implements must be removed by either gloved hands or clean tongs to prevent contamination of the solution.

f. Implements should then be rinsed with clean water again and patted dry. At this point in the disinfection process pointed or sharp edged implements should be oiled to prevent rusting and maintain the cutting edge.

g. Store implements in a clean, covered container until they are used, to prevent contamination.

2. Disinfection of electrical instrumentsa. Removable Parts

1. Scrub each removable part with a clean brush in a solution of soap and water to remove all organic matter.

2. Rinse removable part thoroughly in clean water.3. Pat the removable part dry with a clean towel (paper or

cloth) to prevent dilution of the disinfection solution.4. Totally immerse in an EPA registered disinfectant with

demonstrated bactericidal, viricidal, and fungicidal capabili-ties according to manufacturer's directions.

5. Removable parts must be removed by either gloved hands orclean tongs to prevent contamination of the solution.

6. Removable parts should then be rinsed with clean water again and patted dry. At this point in the disinfection processpointed or sharp edged non-removable parts should be oiled to prevent rusting and maintain the cutting edge.

7. Store removable parts in a clean, covered container until they are used, to prevent contamination.

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b. All non-removable parts must be disinfected according to manufacturer's directions.1. Remove all foreign matter from the clippers, vibrators, or

other electrical instruments.2. Commercially prepared disinfectant sprays are available that

meet State requirements for use on non-removable parts which cannot be immersed in a disinfectant container.

3. The container for disinfecting implements must be clean andlarge enough to thoroughly immerse (completely cover) all implements.

4. The disinfectant container must be properly labeled as to its contents ("quats," etc.). The container must be covered to help prevent evaporation as well as product contamination from airborne bacteria.

5. The disinfectant solution must be changed at least weekly or whenever visibly cloudy or dirty. If it becomes contaminated(visibly cloudy or dirty) in less than a week, it must be changed.

6. If the technician is unable to immediately attend to used implements, used implements must be placed into a covered,properly labeled receptacle until such time as disinfection can be accomplished.

NOTE: All disinfectant solutions used must be EPA regis-tered and possess bactericidal, fungicidal, and viricidal capabilities. You will find this information printed on the label if it is an EPA registered disinfectant.

Sanitary Maintenance Area ProceduresPurpose: To maintain previously disinfected implements in a sanitarycondition while serving the client.

There are two acceptable sanitary maintenance areas ("S.M.A.'s"); one orthe other must be used to maintain sanitary conditions in the individualwork areas, to ensure the client and technician's maximum protection.

Dry sanitary maintenance area1. Use a clean paper towel to maintain a sanitary work area.2. Place previously disinfected implements to be used on this paper

towel.3. Place the towel and implements on a clean working surface and

begin the client service.4. Implements to be re-used must be wiped free of lotions, creams, or

organic matter prior to returning them to the sanitary maintenance area.

5. At the conclusion of the service the implements must be properly disinfected before re-use, and the paper towel must be disposed of. A sanitary cloth towel may be used in place of paper but should not be confused with the normal table set-up. A separate towel is required.

Universal Sanitation Precautionary MeasuresFor sanitation procedures not addressed specifically by your state, followthe universal sanitation and sterilization checklist below, including thesteps for salon or spa sanitation and laundry. Never take short-cuts oromit necessary steps in your personal hygiene practices or use of sanitiz-ers, disinfectants, gloves, or goggles, to maintain salon or spa cleanlinessand provide a safe environment for you, your clients, and coworkers.While some requirements are not the sole responsibility of cosmetolo-gists, you should be aware of risks associated with other spa or salonservices:

1. Walls, ceilings, floors, and equipment must be free from dust 2. Clean floors, sinks, and toilets with commercial products that

kill germs 3. Working area must be well lighted, heated, and ventilated4. Plumbing must be installed properly and provide both hot and

cold water

5. You must have one operational sink and toilet. Toilet tissue and waste receptacles must be provided

6. Hand cleaning with antimicrobial liquid soap, sanitary towels or a hand-drying blower must be provided

7. Premises must be kept free from rodents, vermin, or other animals

8. A drinking fountain with paper cups should be provided9. Clean doorknobs, especially in restrooms

10. Clean linens should be kept in dustproof cabinet11. Soiled linens should be kept in closed receptacles12. Sanitary towel/neck strips need to be provided for every patron13. Keep your nail services in a separate area of the salon14. Hair needs to be removed from the floor and placed in a closed

container15. Do not allow pets or animals in a salon, except those trained to

assist impaired or disabled individuals16. All personnel should wear clean uniforms17. Do not treat any inflammatory disease or condition of skin,

scalp, face or hands18. Gloves need to be worn during manicuring, waxing, facials,

shampoos, pedicuring, tweezing and any service where you may come in contact with any blood or body fluids

19. Always use clean cotton balls, sponges, or tissues when applying any cosmetics or skin creams

20. Do not place items, such as combs, bobby pins, tools etc, in your mouth

21. Do not place combs or other instruments in pockets22. The use of any article on more than one patron without being

disinfected is prohibited23. Avoid touching your client's face or eye area unless necessary

to the service24. Dust and filings carry pathogens, so be sure to clean your work

area after every client25. Make-up should never be shared26. Capes should not touch clients' skin27. Place all disinfected implements in a covered container. Each

container should be labeled with cosmetologist's or nail tech's name, especially for booth licensees.

28. Never use the same towel on more than one client29. Discard all disposable materials after use with one client30. Tools should be cleaned after every use and stored only with

other cleaned instruments31. Sanitize your work area with a disinfectant32. Always wash hands after using the restroom33. Always use a hospital level disinfectant on salon or spa

implements34. Disinfecting products should be available at all times to clean

scissors, razors, clippers, etc.35. Have a first-aid kit available in case of a blood spill. The kit

should include adhesive bandages, gauze, antiseptic, and dis-posable latex gloves.

36. All products used directly on patrons should be labeled, be clean and be in closed containers.

37. Cotton should be in a storage area or covered container so hair does not contaminate.

38. All paraffin wax that has come in contact with a client's skin should be disposed after each use. Used wax should never be re-used.

39. Head rests of chairs should be cleaned with a hospital grade EPA registered disinfectant.

Steps for Sanitation Between Clients1. After concluding service with the client, discard disposable

materials in a closed waste receptacle. Empty waste receptacle daily.

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2. Spray the table with disinfectant.3. Disinfect metal equipment or tools with an EPA-registered dis-

infectant and store them in a clean, closed, and clearly labeled container after use with each client.

Other TipsHave at least two complete sets of implements; on busy days, one set can be disinfecting while you work.For regular clients, you may want to keep their single-use implements in a separate closed container labeled with their name and only use these implements on that customer.Use a dusk mask and safety goggles when appropriate.Keep caps on all products to reduce the amount of vapor that escapes into the air.

LaundrySoiled linens may harbor pathogens, but rarely transmit dis-ease. Handle used linens as little as possible to avoid contami-nation All soiled linen should be bagged or placed in containers at thelocation where it was used and should not be sorted or rinsed in the location of use.Gloves and other appropriate protective apparel should be wornby employees sorting soiled linen. Commercial laundry facilities often use water temperatures of at least 160°F and 50-150 ppm of chlorine bleach to remove significant quantities of microorganisms from contaminated linen. In the salon, normal washing and drying cycles including"hot" cycles are adequate to ensure client safety (studies sug-gest that satisfactory reduction of microbial contamination can be achieved at water temperatures lower than 160°F if laundry chemicals suitable for low-temperature washing are used at proper concentrations). Follow instructions by the manufactur-ers of the machine and the detergent or wash additive should be followed closely. Handle clean linen in ways that ensure cleanliness, and store ina closed cabinet or closet.

The Problem of Antibiotic Resistance7

OverviewThe triumph of antibiotics over disease-causing bacteria is one of modernmedicine's greatest success stories. Since these drugs first became widelyused in the World War II era, they have saved countless lives and bluntedserious complications of many feared diseases and infections. After morethan 50 years of widespread use, however, many antibiotics don't packthe same punch they once did.

Over time, some bacteria have developed ways to outwit the effects ofantibiotics. Widespread use of antibiotics is thought to have spurred evo-lutionary changes in bacteria that allow them to survive these powerfuldrugs. While antibiotic resistance benefits the microbes, it presentshumans with two big problems: it makes it more difficult to purge infec-tions from the body; and it heightens the risk of acquiring infections in ahospital.

Diseases such as tuberculosis, gonorrhea, malaria, and childhood earinfections are now more difficult to treat than they were decades ago.Drug resistance is an especially difficult problem for hospitals becausethey harbor critically ill patients who are more vulnerable to infectionsthan the general population and therefore require more antibiotics. Heavyuse of antibiotics in these patients hastens the mutations in bacteria thatbring about drug resistance. Unfortunately, this worsens the problem byproducing bacteria with greater ability to survive even our strongestantibiotics. These even stronger drug-resistant bacteria continue to preyon vulnerable hospital patients.

To help curb this problem, the Centers for Disease Control andPrevention (CDC) provides hospitals with prevention strategies and edu-

cational materials to reduce antimicrobial resistance in health care set-tings. According to CDC statistics

• Nearly two million patients in the United States get an infection in the hospital each year

• Of those patients, about 90,000 die each year as a result of their infection-up from 13,300 patient deaths in 1992

• More than 70 percent of the bacteria that cause hospital-acquired infections are resistant to at least one of the drugs most commonly used to treat them

• Persons infected with drug-resistant organisms are more likely to have longer hospital stays and require treatment with secondor third choice drugs that may be less effective, more toxic, and more expensive

In short, antimicrobial resistance is driving up health care costs, increas-ing the severity of disease, and increasing the death rates from certaininfections.

Environment Forces Evolutionary ChangeA key factor in the development of antibiotic resistance is the ability ofinfectious organisms to adapt quickly to new environmental conditions.Bacteria are single-celled creatures that, compared with higher life forms,have small numbers of genes. Therefore, even a single random genemutation can greatly affect their ability to cause disease. And becausemost microbes reproduce by dividing every few hours, bacteria canevolve rapidly. A mutation that helps a microbe survive exposure to anantibiotic drug will quickly become dominant throughout the microbialpopulation. Microbes also often acquire genes, including those that codefor resistance, from each other.

The advantage microbes gain from their innate adaptability is augmentedby the widespread and sometimes inappropriate use of antibiotics. Aphysician, wishing to placate an insistent patient ill with a cold or otherviral condition, sometimes inappropriately prescribes antibiotics. Alsowhen a patient does not finish taking a prescription for antibiotics, drug-resistant microbes not killed in the first days of treatment can proliferate.Hospitals also provide a fertile environment for drug-resistant germs asclose contact among sick patients and extensive use of antibiotics forcebacteria to develop resistance. Another controversial practice that somebelieve promotes drug resistance is adding antibiotics to agriculturalfeed.

A Growing ProblemFor all these reasons, antibiotic resistance has been a problem for nearlyas long as we've been using antibiotics. Not long after the introduction ofpenicillin, a bacterium known as Staphylococcus aureus began develop-ing penicillin-resistant strains. Today, antibiotic-resistant strains of S.aureus bacteria as well as various enterococci-bacteria that colonize theintestines-are common and pose a global health problem in hospitals.More and more hospital-acquired infections are resistant to the mostpowerful antibiotics available, methicillin and vancomycin. These drugsare reserved to treat only the most intractable infections in order to slowdevelopment of resistance to them.

There are several signs that the problem is increasing: • In 2003, epidemiologists reported in The New England Journal

of Medicine that 5 to 10 percent of patients admitted to hospi-tals acquire an infection during their stay, and that the risk for ahospital-acquired infection has risen steadily in recent decades.

• Strains of S. aureus resistant to methicillin are endemic in hos-pitals and are increasing in non-hospital settings such as locker rooms. Since September 2000, outbreaks of methicillin-resist-ant S. aureus infections have been reported among high school football players and wrestlers in California, Indiana, and Pennsylvania, according to the CDC.

• The first S. aureus infections resistant to vancomycin emerged in the United States in 2002, presenting physicians and patients

46

with a serious problem. In July 2002, the CDC reported that a Michigan patient with diabetes, vascular disease, and chronic kidney failure had developed the first S. aureus infection com-pletely resistant to vancomycin. A similar case was reported in Pennsylvania in September 2002.

• Increasing reliance on vancomycin has led to the emergence of vancomycin-resistant enterococci infections. Prior to 1989, no U.S. hospital had reported any vancomycin resistant enterococ-ci, but over the next decade, such microbes have become com-mon in U.S. hospitals, according to CDC.

• A 2003 study in The New England Journal of Medicine found that the incidence of blood and tissue infections known as sep-sis almost tripled from 1979 to 2000.

NIAID Research8

Antimicrobial Advances and ActivitiesNIAID-funded research grants and activities are yielding results that willhelp public health officials hold the line in our fight against drug-resist-ant microbes. For example:

• NIAID-funded researchers at the University of California Berkeley have documented the mechanics of how E. coli bacte-ria use pumps in the thin space between their membranes to expel antibiotic drugs. Their results, reported in the Journal of Bacteriology, serve as a model for how these molecular pumps work in bacteria responsible for hospital-acquired infections.

• NIAID grantees at the Washington University School of Medicine in St. Louis have uncovered new information about how bacteria that cause urinary tract infections manufacture hair-like fibers to cling to the lining of the bladder. Their find-ings could lead to new drugs that would treat urinary tract infections by blocking formation of these protein fibers. Approximately half of all women experience urinary tract infections, and 20 to 40 percent of those will develop recurrent infections. The results were reported in the journal Cell.

• An NIAID-funded project at The Institute for Genomic Research recently discovered that small pieces of DNA that canjump between chromosomes or organisms helped a strain of E. faecalis bacteria develop resistance to vancomycin. The researchers found that these "mobile elements" of DNA appear to contain a newly identified vancomycin resistance segment carrying vancomycin resistance genes. These results were pub-lished in the journal Science.

Partnerships and Interagency CollaborationsIn addition to sponsoring research, NIAID co-chairs the Federal govern-ment's Interagency Task Force on Antimicrobial Resistance. This taskforce is made up of representatives from NIAID, CDC, the Food andDrug Administration, the Agency for Healthcare Research and Quality,the Department of Agriculture, the Department of Defense, theDepartment of Veterans Affairs, the Environmental Protection Agency,the Center for Medicaid and Medicare Services, and the HealthResources and Services Administration. The Task Force is working onimplementing an antimicrobial resistance action plan that reflects a broadconsensus of theses agencies with input from a variety of constituentsand collaborators. The plan is available online at http://www.cdc.gov/dru-gresistance/actionplan/index.htm.

NIAID also co-sponsors the Annual Conference on AntimicrobialResistance with the Infectious Disease Society of America and other gov-ernment and not-for-profit agencies. The conference updates attendees onthe science, prevention, and control of antimicrobial resistance and pro-vides a forum for discussion of new methods of treatment and control.

Related Information:9Other federal agencies are involved in combating the problem of drug-resistant microbes. See the links below for more information.

• Centers for Disease Control and Prevention

http://www.cdc.gov/drugresistance/community/ • Food and Drug Administration

http://www.fda.gov/oc/opacom/hottopics/anti_resist.html • National Library of Medicine Medline database

http://www.nlm.nih.gov/medlineplus/antibiotics.html • Public Health Action Plan to Combat Antimicrobial Resistance

http://www.cdc.gov/drugresistance/actionplan/index.htm

NIAID is a component of the National Institutes of Health (NIH), whichis an agency of the Department of Health and Human Services. NIAIDsupports basic and applied research to prevent, diagnose, and treat infec-tious and immune-mediated illnesses, including HIV/AIDS and othersexually transmitted diseases, illness from potential agents of bioterror-ism, tuberculosis, malaria, autoimmune disorders, asthma and allergies.

Prepared by:Office of Communications and Public LiaisonNational Institute of Allergy and Infectious DiseasesNational Institutes of HealthBethesda, MD 20892

U.S. Department of Health and Human Services

Table of Antibacterials 10

Non-residue-producing antibacterialsResidue-producing antibacterials

APUA: Alliance for the Prudent Use of Antibiotics

Antibacterial agent information sheet• What is an antibacterial and how are antibacterials classified? • What are some common antibacterials? • How common are antibacterials in consumer products? • Is the use of antibacterial agents regulated in the US? • What is the difference between bacteriostats, sanitizers, disin-

fectants and sterilizers? • How beneficial are antibacterials?

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Substance Group Substancealcohols ethanol

isopropanolaldehydes glutaraldehyde

formaldehydehalogen-releasing compounds chlorine compounds

iodine compoundsperoxides hydrogen peroxide

ozoneperacetic acid

gaseous substances ethylene oxideformaldehyde

Substance Group Substanceanilides triclocarbanbiguanides chlorhexidine

alexidinepolymeric biguanides

bisphenols triclosanhexachlorophene

halophenols PCMX (p-chloro-m-xylenol)

heavy metals silver compoundsmercury compounds

phenols and cresols phenolcresol

quaternary ammonium compounds

cetrimidebenzalkonium chloridecetylpyridinium chloride

• Are antibacterial agents safe? • Do antibacterials create resistant bacteria? • Can the widespread use of antibacterial agents lead to more

resistant bacteria? • Are there other concerns about the use of antibacterial agents? • Are there other effective cleaning methods to prevent disease

spread? • When are antibacterials useful?

What is an antibacterial and how are antibacterials classified?In its broadest definition, an antibacterial is an agent that interferes withthe growth and reproduction of bacteria. While antibiotics and antibacte-rials both attack bacteria, these terms have evolved over the years tomean two different things. Antibacterials are now most commonlydescribed as agents used to disinfect surfaces and eliminate potentiallyharmful bacteria. Unlike antibiotics, they are not used as medicines forhumans or animals, but are found in products such as soaps, detergents,health and skincare products and household cleaners.

What are some common antibacterials?Antibacterials may be divided into two groups according to their speedof action and residue production: The first group contains those that actrapidly to destroy bacteria, but quickly disappear (by evaporation orbreakdown) and leave no active residue behind (referred to as non-residue-producing). Examples of this type are the alcohols, chlorine, per-oxides, and aldehydes. The second group consists mostly of newer com-pounds that leave long-acting residues on the surface to be disinfectedand thus have a prolonged action (referred to as residue-producing).Common examples of this group are triclosan, triclocarban, and benza-lkonium chloride.

How common are antibacterials in consumer products?All products that claim to kill bacteria and/or viruses have some kind ofantibacterial agent. Alcohols, chlorine and peroxides have been used formany decades in health-care and cleaning products. Within the past twodecades, the residue-producing antibacterials, once used almost exclu-sively in health care institutions, have been added to increasing numbersof household products, particularly soaps and cleaning agents. A recentsurvey reported that 76% of liquid soaps from 10 states in the US con-tained triclosan and approximately 30% of bar soaps contained triclocar-ban. Many cleaning compounds contain quaternary ammonium com-pounds. Because these compounds have very long chemical names, theyare often not easily recognized as antibacterial agents on packaginglabels. More recently, triclosan has been bonded into the surface of manydifferent products with which humans come into contact, such as plastickitchen tools, cutting boards, highchairs, toys, bedding and other fabrics.

Is the use of antibacterial agents regulated in the US?Whether or not an antibacterial agent is regulated depends upon itsintended use and its effectiveness. The US Food and DrugAdministration (FDA) regulates antibacterial soaps and antibacterial sub-stances that will either be used on the body or in processed food, includ-ing food wrappers and agents added to water involved in food process-ing.

If a substance is not intended for use on or in the body, it is registered bythe US Environmental Protection Agency (EPA) under the Federal Insecticide, Fungicide, and Rodenticide Act. Substances are registeredeither as public health or as non-public health antimicrobial agents.

What is the difference between bacteriostats, sanitizers, disinfectantsand sterilizers?The EPA classifies public health antimicrobials as bacteriostats, sanitiz-ers, disinfectants and sterilizers based on how effective they are indestroying microorganisms. Bacteriostats inhibit bacterial growth in inan-imate environments. Sanitizers are substances that kill a certain percent-

age of test microorganisms in a given time span. Disinfectants destroy orirreversibly inactivate all test microorganisms, but not necessarily theirspores. Sterilizers destroy all forms of bacteria, fungi, and other microor-ganisms and their spores.

Disinfectants can be further categorized as broad or limited spectrumagents. A broad-spectrum disinfectant destroys both gram-negative andgram-positive bacteria. A limited-spectrum disinfectant must clearlyspecify the specific microorganisms against which it works.

How beneficial are antibacterials?Antibacterials are definitely effective in killing bacteria, however, thereis considerable controversy surrounding their health benefits. The non-residue producing agents have been used for many years and continue tobe effective agents for controlling disease organisms in a wide variety ofhealthcare and domestic settings. When used under strict guidelines ofapplication, the residue-producing agents have proven effective at con-trolling bacterial and fungal infection in clinical settings such as hospi-tals, nursing homes, neonatal nurseries and other health care facilitieswhere there may be a high risk of infection.

A certain few consumer products have demonstrated effectiveness forspecific conditions: antibacterial toothpaste helps control periodontal(gum) disease; antibacterial deodorants suppress odor-causing bacteria,and antidandruff shampoos help control dandruff. However, to date, thereis no evidence to support claims that antibacterials provide additionalhealth benefits when used by the general consumer.

Are antibacterial agents safe?When used as directed for external surfaces, antibacterial agents are con-sidered to be relatively non-toxic. However, some may cause skin andeye irritation, and all have the potential for doing harm if not stored orused properly. Furthermore, evaluations of risk are based on singleagents, and do not consider the effects of multiple uses or multiple com-pounds. Recently, triclosan has been reported in surface waters, sewagetreatment plants, the bile of fish, and breast milk, but the significance ofthese findings is presently unknown.

Do antibacterials create resistant bacteria?Because of their rapid killing effect, the non-residue producing antibac-terial agents are not believed to create resistant bacteria. Resistanceresults from long-term use at low-level concentrations, a condition thatoccurs when consumer use residue-producing agents such as triclosanand triclocarban. Until recently, it was accepted that these agents did notaffect a specific process in bacteria, and because of this, it was unlikelythat resistant bacteria could emerge. However, recent laboratory evidenceindicates that triclosan inhibits a specific step in the formation of bacteri-al lipids involved in the cell wall structure. Additional experiments foundthat some bacteria can combat triclosan and other biocides with exportsystems that could also pump out antibiotics. It was demonstrated thatthese triclosan-resistant mutants were also resistant to several antibiotics,specifically chloramphenicol, ampicillin, tetracycline and ciprofloxacin.

Resistance to antibacterials has been found where these agents are usedcontinuously (as in the hospital and food industry); however, at the pres-ent time, this modest increase in resistance has not yet created a clinicalproblem.

Can the widespread use of antibacterial agents lead to more resistantbacteria?Many scientists feel that this is a potential danger, but others argue thatthe laboratory conditions used in the research studies do not represent the"real world." So far, studies of antibacterial use in home products such assoap, deodorant and toothpaste have not shown any detectable develop-ment of resistance. However, such products have only been in use for arelatively short period of time and studies of their effects are stillextremely limited.

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Are there other concerns about the use of antibacterial agents?Yes, experts believe that the use of these agents creates a false sense ofsecurity that may cause individuals to become lax in their hygiene habits.Antibacterial use should not be considered an alternative to normalhygiene, except where normal hygiene practices are impossible.

It should always be remembered that most bacteria are harmless and inmany cases, even beneficial. Very few bacteria actually cause disease.Antibacterials are not discriminating and an all-out attack on bacteria ingeneral is unjustified. Constant use of disinfecting agents tends to disruptthe normal bacteria that act as barriers against invading pathogens. Thismay cause shifts in bacterial populations and create a "space" for disease-causing bacteria to enter and establish infection.

In addition, some scientists have gathered evidence showing that overlyhygienic homes during early childhood may be linked to the appearanceof allergies later in life. In this "hygiene hypothesis," allergies developbecause the childhood immune system fails to mature properly due tolack of contact with immune-stimulating bacteria. This hypothesisremains controversial and requires further research for validation.

Are there other effective cleaning methods to prevent disease spread?For most purposes, washing with regular soap and rinsing with runningwater, followed by thorough drying is still considered the most importantway of preventing disease transmission. This is especially important afterusing the toilet, changing a diaper, emptying a diaper pail, cleaning thetoilet, or after handling raw meat or poultry. Several common traditionalagents are effective against a wide range of disease-causing organisms.These include 70% solutions of ethyl or isopropyl alcohol, householdbleach and hydrogen peroxide. Unlike triclosan and other long-actingagents, these products destroy multiple cells components at once ratherthan attacking a specific bacterial process.

When are antibacterials useful?While there is no evidence that the routine use of antibacterials confer ahealth benefit, they are useful where the level of sanitation is critical andadditional precautions need to be taken to prevent spread of disease.Thus, they are important in hospitals, day care centers and healthcarefacilities and other environments with high concentrations of infectiousbacteria. In the home environment, they may be needed for the nursingcare of sick individuals with specific infections, or for those whoseimmune systems have been weakened by chronic disease, chemotherapyor transplants. Under these circumstances, antibacterials should be usedaccording to protocol, preferably under the guidance of a health care pro-fessional.

Handwashing is one of the most important means of preventing thespread of infection.

--US Centers for Disease Control & PreventionHandwashing--rubbing your hands together with soap and water--reducesthe spread of germs from one person to the next. According to the USCenters for Disease Control and Prevention, handwashing is one of themost important means of preventing the spread of infection.

If you track when you wash your hands you may find it is not as often asyou think. A recent survey found that 94% of Americans say that theyalways wash their hands after going to the bathroom but observations inpublic restrooms show that only 68% of adults did so.

Why should you wash?Germs are so small that you cannot see them. A few of them can causeillnesses like diarrhea and colds as well as more serious, and life-threat-ening, diseases.

Washing your hands correctly, greatly reduces the chances of spreadinggerms. Disease-causing germs can enter your body when your unwashedhands touch your nose, mouth, and open wounds. Some of those germsmay have changed to protect themselves against an antibiotic, which iscalled antibiotic resistance.

While your health care providers have a professional responsibility towash their hands, it is important that everyone make handwashing a per-sonal priority.

When should you wash?Before you...

• Prepare or eat food • Treat a cut or wound or tend to someone who is sick • Insert or remove contact lenses

After you... • Use the bathroom • Handle uncooked foods, particularly raw meat, poultry or fish • Change a diaper • Blow your nose, cough or sneeze • Play with or touch a pet, especially reptiles and exotic animals • Handle garbage • Tend to someone who is sick or injured

How should you wash?How you wash your hands is just as important as when you wash them,especially when it comes to eliminating germs. Just rinsing them quicklyis not enough. When you wash your hands:

• Use soap and warm, running water • Wash all surfaces thoroughly, including wrists, palms, back of

hands, fingers and under the fingernails • Rub hands together for at least 10-15 seconds • When drying, use a clean or disposable towel if possible, and

pat your skin rather than rubbing to avoid chapping and crack-ing

• Apply hand lotion after washing to soothe your skin and help prevent drying

ENDNOTES1 Sims, Amy C. "Dangers Lurk in Dirty Salons," Friday, May 4, 2002, in Fox Life, a feature

of foxnews.com Copyright 2004 ComStock, Inc Fox News Network LLC See: http://www.foxnews.com/story/0,2933,53589,00.html

2 Getting Nailed, Investigation Uncovers Unsanitary Conditions at Nail Salons, June 8, 2001, Homepage 20/20 feature ABC News. See: http://more.abcnews.go.com/sections/2020/2020/2020_010517_nails.html

3 California Nail Salons Being Sued, Wednesday August 24, 2005: see www.nailsmag.com/feature.aspx?fid=88&ft+2

4 reproduced from the World Health Organization's website; see www.cbc.ca/news/background/avianflu/who_faqs.html

5 CBC News Indepth: Avian Flu, see: www.cbc.ca/news/background/avianflu/index.html6 HealthScout: www.healthscout.com/printer/416/524859/main.htm copyright 2005

ScoutNews LLC7 www.niaid.nih.gov/factsheets/antimicro.htm8 Other research projects-at NIH or funded by other components of NIH-are seeking new,

molecular-level knowledge on the interactions of microbes and human cells as well as the tricks microbes use to outwit antibiotics. Another avenue of research is sleuthing the genomes of drug-resistant bacteria for vulnerabilities that could be attacked with new or existing drugs.

9 News releases, fact sheets and other NIAID-related materials are available on the NIAID Web site at http://www.niaid.nih.gov.

10 Adapted with permission from Disinfectants in Consumer Products, Health Council of the Netherlands, No. 2001/05E, 2001.

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CHAPTER 8SALON PROFESSIONALS: RETAIL SALES

(2 Credit Hours)Learning Objectives:

Distinguish between hard-sell techniques and more contempo-rary approaches to retail salesCalculate an average ticket amountDefine and discuss the term "cosmeceuticals"Explain how the FDA distinguishes between cosmetics and drugsDiscuss the use of a survey or questionnaire to learn about clients needs and preferencesList some places to learn about new products and research resultsDiscuss the principles behind selling with integrity

IntroductionThis chapter is intended for cosmetologists, stylists, and nail technicianswho are either independent contractors or employees of a salon, spa, orsimilar business. In either case, you are probably encouraged to sellretail products, either of your own choosing or that of a manager orowner. In some cases, you may set prices for these items; in other cases,they are set for you, perhaps at manufacturer-recommended prices. Youare likely encouraged to sell retail, but you may resent or avoid thisaspect of your job. This chapter will discuss why some individuals arereluctant to sell retail items associated with their services, and discussways to address or overcome this discomfort, and reap the substantialrewards.

Industry trendsA number of recent research studies show the following numbers regard-ing personal care and beauty aids:

The U.S. dominates the world with 22% of the $103 billion global Cosmetics & Toiletries market; that means $21 billion dollars per year in the U. S. alone.1

$5.5 of that 21 billion is in Skin Care, alone. The Skin Care market is projected to increase by 30% and reach $7.2 billion by 2005.

Your clients are purchasing these products. That's a given.

Yet, according to the Green Book, which reports industry data for thecategory of "cosmetic/beauty aids," an average spa/salon visit is associat-ed with a "$25 service ticket and a $3.25 retail ticket."2

So where are your clients buying these products?

It doesn't seem to add up. Especially when you consider that the typical35 year-old client is likely to use a couple, or more, of the followingproducts: makeup, a cleanser, toner, moisturizer, scrub, and/or mask.For example, most people use at least two hair products: shampoo andconditioner. One study estimated the average number of products clientsused on just their hair was four.3

If you are an employee receiving commissions on retail sales, you knowit financially behooves you to sell retail products. Retail sales can rescueyour bottom line. You also know it makes points with the owner or man-ager of your establishment. Business specialists consider a 30% service-to-retail ratio necessary for a spa to stay in the black. That means that aspa that makes $1000 for the day should make a minimum of $300 fromretail. Ideally, a spa should earn about half of its revenues from retailsales.

Results from an ongoing on-line poll on The National CosmetologyAssociation web site shows nothing but room for improvement. Inresponse to the following question, "What percentage of your salon'stotal revenue comes from retail sales?" The great majority, over one-halfof all respondents (51%), stated a percentage between 1 and 10%; 40%

of respondents stated a percentage between 11 and 20%; and only 17%stated a percentage of over 20%.4 Clearly, these results suggest a cosme-tologist or technician may be missing out on a tremendous opportunityfor increased sales, if he or she does not offer products for clients to pur-chase when they visit.

Selling what the client needs: informationThese professionals are missing out on the fact that clients want and needhome care routines and products that work. They will purchase personalcare products somewhere, and clients do need assistance and informationto find the right products.

Recent research results, released November 2005,5 confirmed whatmany cosmetologists already know: that women in the United States donot understand their own skincare needs, but often think they do.Eighty-eight percent (88%) of the women surveyed thought they knewwhich skincare products were appropriate for their skin type, but only8% were able to correctly answer a few basic questions about skin andskincare products.

Survey responses were consistent across age, educational levels, andincome. Respondents did not know what ingredients were useful oreffective in anti-aging products, what products could be used to reduceinflammation, fine lines and wrinkles around the eyes, or lighten darkspots on the skin. Women were consistently mistaken about their ownskin type; over one-half of the women surveyed wrongly believed theyhad sensitive skin.

The study concluded that most products are recommended or purchasedbased on a skin self-analysis, which is often incorrect, meaning themajority of women are not buying the right products. Survey respondentswere spending an average of $28 dollars per month ($336 per year) onskincare products alone, and were using inappropriate products, wastingmoney and potentially complicating their original skin problem. Only36% of respondents see a doctor or esthetician for a skincare problem.More are likely to try to treat the problem themselves by buying a prod-uct at a drug or department store, while forty-one percent (41%) seek theadvice of family and friends.

What is true for skincare products is true for hair care products, nail careproducts, and a variety of other items clients typically purchase for theirbeauty and personal care needs; consumers know little about the ingredi-ents in their shampoos, nail care, or skin products. While you are not adoctor, you do have experience and expertise that the typical client doesnot have. Use your information as an edge to help your client's appear-ance and confidence. Your clients are going to buy beauty and personalcare products and services, but your honest and informed guidance canmake all the difference in their appearance and mood.

Providing needed services, products, and information: telling,instead of sellingYou may not consider yourself a salesperson; perhaps the word has unap-pealing connotations to you. It is likely that you got into cosmetologyfor many reasons, but not for sales reasons. You probably would find ituseful to be able to sell additional products or services than you do now,but you do not want to take the chance of alienating clients. But what ifyou could sell retail items without ethical difficulties, even comfortably,happily, and confident that you are providing real customer care?

Rather than consider yourself a salesperson, start to think of yourself as aconsultant, advisor, or holistic service provider. Remember that the worldis made up of clients and service providers. Everyone sells something,be it their labor, their talent, or their knowledge. Do not fall into the trapthat some technicians do: afraid to sell, afraid the client will perceivethem as pushy, intrusive, or money-hungry. You can increase retail saleswithout compromising on your integrity, by selling your expertise andmaking client care the bedrock of your business.

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Providing additional products and services should not diminish yourstature, but, instead, enhance your image as a professional. Realize thatselling is a skill that requires information and education, and realize thateveryone who interacts with the client can recommend or sell appropriatepersonal care items. As a spa or salon professional, you have a signifi-cant interest in the health, beauty, and well-being of your clients. Youwant to help them feel more relaxed and better about themselves. Takethis responsibility seriously. Encourage clients to purchase products andservices only when they are to their best benefit. Take the professionalresponsibility to recommend products and services that are ideal for yourclient.

You have the opportunity to tell your clients what you really think, inyour expert opinion, and clients have the opportunity to learn about theproducts and services they use. There is a big difference between per-suading the client to have an extra treatment, or buy an extra product,solely to make money, and recommending a really effective beauty regi-men that the client will love. Few women, for example, use any sun pro-tection outside of seasonal use, while sun damage is possible year-round.6 Why not let clients know that they should be protecting them-selves all year long, and help them choose the best products for theirunique needs?

This chapter should give you some hints on how to sell appropriate prod-ucts to clients and provide assistance to them without compromising yourintegrity, values, or professional principles. If you are enthusiastic abouta product, selling may simply be a matter of telling the client about yourfavorite products-those you really believe in-and why. No matter whatyour role, you will find a few strategies will increase the amount you areeasily able to sell, and need not be distasteful.

The internal battle: your own reservationsFeelings of discomfort in recommending products and services can betroubling and should be addressed directly. What is making you uncom-fortable? Is it a lack of knowledge, or lack of assertiveness or confi-dence? Could it be guilt that you are recommending something based onthe salon owner's demands, rather than your own opinions about a prod-uct? Are you afraid the client will see your additional suggestions astransparent or phony, seeing you as money-hungry rather than helpful?

People sometimes talk themselves out of being good retailers because ofguilt. Conduct some self-analysis: what are your motives? There isnothing incompatible or unseemly about discussing products and treat-ments that you know will be good for your client. If it is appropriate torecommend a product for the client to use in-between salon or spa visits,make the decision to promote products that you think have real value,those in which you have confidence.

Do you think you are influencing them to buy products they cannotafford? Research suggests customers rarely have problems spendingmoney on products they feel work and have value.7 If someone comes toyou for a service or treatment, and you provide it, are you taking advan-tage of them? No. As long as you put their interests and needs beforeyour own, you are providing client care that is a rightful part of theirsalon or spa experience. You are not there to persuade, only to tell.

Customers will spend their money on personal care products, regardlessof you, but, if they associate their happy purchase with your care andattention, they will come to trust and depend on your opinions.Remember, you are not there to manipulate or force the client to do any-thing he or she does not want. The client is in control of his or herfinances. You are simply educating them about products and services.You may tell clients what is best for them, but they will make the finaldecision.

Convey a sense of pride and ownership in the products you use and rec-ommend. You should have first-hand, real evidence of product results.Do treatments with the product consistently meet or exceed your

expectations? Have you acquainted yourself with competing productsand new active ingredients? Do you keep an open mind and learn thefacts about different techniques and products in the field? Providing theprofessional, valuable, and important information your clients deserve isan essential and important adjunct to your services. Help them develop acustomized regimen to meet their specific needs.

If, after all this soul-searching, the thought of retail or other sales stillseems distasteful, consider the following: Anecdotal evidence suggeststhat some estheticians or spa technicians do not sell much retail becausethey think there is something disingenuous or unclean about it, like sell-ing stolen merchandise or used cars. If you think retail sales are some-how dishonest or insincere, you may be thinking of long, outdated "hard-sell" strategies. Contemporary sales approaches typically focus on thequality of relationship between the service provider and client. You can,and in fact should, have integrity in this role. This means that your bondis built on honesty and the real value you serve in the client's life."Retail sales" need not be a derogatory term.

Have integrityNo part of what you are doing should be dishonest, or deceive or manip-ulate the client into spending money. Always be professional, ethical,and truthful. If you are resistant or uncomfortable discussing services,products, or treatments, consider these guidelines, and confirm that youare acting according to them; if you fear you are misrepresenting your-self or the product, or are taking advantage of the client in some way.

Only recommend additional resources, such as products and services, with the client's best interests at heart Remember that it is unethical to speak falsely about a product, service, or treatment.

You have the choice to be motivated by selfishness, or to act with integri-ty. Choose to live and work according to an ethical code that emphasizesthe best welfare for your client. Be honest and provide input that willhelp them find the best products and treatments for their needs. Youshould be committed to your client's good health and welfare ahead ofyour profits. If you are concerned about your client's well being, it willshow. Clients will come to trust you and learn to depend on your opin-ions.

Making retail a priorityOnce you have decided you want to make more of your retail opportuni-ties, you can move on to the next step; taking better advantage of sellingopportunities.

To assess your sales success in retail, calculate the following: Learn to measure an average ticket amount. Add up your total servicesales for a week and then divide it by the number of clients you haveseen. Do the same to determine your total retail sales: Total up retailsales for a week and divide it by the number of clients seen. You canalso work out how much you make per hour: Take your total retail andservice sales amounts and divide them by the total number of hours youhave worked, giving you the amount you make per hour.8

Keep track of your service sales and retail sales over each week and seeyour profits increase.

You can spend lots of money buying books that discuss marketing strate-gies and salesmanship techniques, and there are many types of softwareprograms to help you keep detailed information about each client's pref-erences and purchases, but many steps toward better retailing can betaken without great expense, every day. The first step is making a com-mitment to that objective. You must choose to make retailing a priorityevery day. Consider it an essential part of your business to recommendproducts for clients to use everyday at home.

Part of getting to know your client knows when and how to share infor-mation. Put yourself in your client's place and consider how you wouldlike to be advised about a type of treatment or product that could easily

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and effectively be used on a daily or weekly basis, rather than those usedduring professional treatment at the spa or salon. You may be ambiva-lent or averse to approaching the topic, especially if you work in a spa,where one of your objectives is to maintain a relaxing, stress-free envi-ronment for your client. Do not avoid discussing the subject of productsor treatments out of politeness, not wanting to offend, or a fear of beingintrusive, if your client seems receptive, but do try to be sensitive to yourclient's moods and steer away from the topic if your client appears dis-tracted or distressed.

Making time and space for retailPart of retail success is creating an environment that lends itself to sell-ing. Committing yourself to retail means building time into your servic-es to consider and talk about products. Some spas, for example, offerfacial services that last just under an hour. This practice, (called "hotbedding" because the chair or table is still warm from the previous client)leaves little time to discuss retail choices with the client. By makingtreatment time periods include time to discuss products and look aroundat the end of the session, you immediately facilitate sales and avoid theimpression or feeling that you are rushing through the session.

Take the time to conduct a needs-assessment with clients. This can takethe form of a small questionnaire asking about a client's physical com-plaints and their needs and expectations for treatment. New clients, orthose who have been away for a while, should be scheduled for a longersession in order to have enough time to conduct a brief verbal or writteninterview and analysis of the client's needs at the beginning of the ses-sion. It is crucial that you build in time to develop rapport with the clientand learn what their needs and expectations are, not only for the visit, butover the long-term.

One of the most logical times to discuss the benefits of a treatment orproduct is at the end of the service, when they see the results of yourskills and expertise. Clients naturally want to maintain the look that youhave achieved. Do review products, at the end, that can be used for aneffective home-care regimen. While the client cannot get a spa facialevery day, she or he can make sure that no more damage is done to theskin in between facials. Do not leave all discussion to the very end of thesession, however, when you may be rushed. Changing the way youapproach the client regarding a recommendation, and taking the time tolisten to your client's needs makes all the difference in the world.

Choosing productsIn deciding what brands or items to carry, do the following:

• Carry professional products, only. Do not try to compete with drug stores or supermarkets. Limit your line of products. You'll find that four very strong lines sell better than 8 or 9 brands you feel less certain about. Realize that different lines have different strengths and present a variety.

• Only sell products you believe in. Maintain your integrity and don't compromise. If you are less than thrilled about a prod-uct your salon carries, talk to the owner about it. Rather than saying anything negative in front of the client, however, sim-ply move on to another product you really believe in.

• Learn as much as possible about each item, especially infor-mation about active ingredients.

Salon products vary enormously in their quality. Most product lines arebuilt around a few exceptional products, with the remainder being aver-age.9 It behooves the salon to carry a good variety of product lines toaddress the needs of all clients. A cosmetologist or salon should never bea slave to a manufacturer. Professionals should be more concerned aboutwhat is good for the client than what is good for the manufacturer, salon,or spa.

Be knowledgeable and informativeMore than anything else, information is the key to selling retail products.Learning about them is an important part of your responsibilities, as

training is closely linked to success. Some salons assign responsibilityfor retail sales to one individual-a professional "closer" - who takes careof the client after the technician's job is done. This does a disservice tothe technician, who misses the opportunity to use his or her knowledgeof the client's needs and preferences.

It is the technician who spends time with the client and develops a rap-port with him or her, and it makes sense that the client's home care regi-men is developed in collaboration with the person with whom he or shehas spent time. It is useful, however, to store preferences and productinformation in a general computer file that everyone can access. Then,when the client runs out of the product or products he or she is using athome, and the technician is not there, someone else can look up thespecifics of the items purchased and routine involved.

Professionals deserve the opportunity to recommend products based onthe best and latest information and products available. Over the pastdecade, cosmetics have far surpassed the effectiveness of traditional per-sonal care items. A new class of products, called "cosmeceuticals," hasemerged that includes vitamins, fermentation products, algae derivatives,and other extracts.10 Nutritional supplements and even foods are poten-tial skin care ingredients.

While marketing hype is regulated to some extent; meaning there arespecific limitations on the claims made by formulators, consumers areoften confused by the competing claims they hear. In fact, marketingresearch suggests that consumer preferences are largely related to smelland/or the appearance of packaging. They do not know what is real andwhat is hype.

There is a great deal of information out there, for those who know howto find it. Ingredient suppliers and formulators generate clinical data toprove their claims, and companies commonly use consumer panels to testtheir products before putting them in the market. Formulas are used withmany different groups to determine effectiveness with various skin andhair types, and this data is published in research studies and reprinted inmagazines and trade journals.

Cosmetics guidelines are not as rigorous as those for pharmaceuticalproducts, or "drugs." If a cosmetics manufacturer claims a product"cures, prevents, mitigates disease," or otherwise "affects the structure orfunction of the human body,"11 the U.S. Food and Drug Administration(FDA) considers it a drug, not a cosmetic item. Companies can make adrug claim only after the FDA confirms that efficacy claims are based onthe proven effect of the active ingredient.

Cosmetics, on the other hand, have some "wiggle room" in their defini-tion; cosmetic products can claim to enhance beauty and sex appeal, eventhough these are very difficult characteristics to quantify or measure sci-entifically. This gray area between drugs and cosmetics is monitored bythe FDA, which investigates product claims to distinguish one from theother. However, this area of overlap is complicated. Some cosmeticingredients actually result in temporary changes in the structure andfunction of the skin. By definition these would by considered drugclaims, but, in fact, they are still considered cosmetics.

Cosmetic claims are reviewed by the National Advertising Division ofthe Council of Better Business Bureaus (NAD). The NAD reviews ques-tionable claims brought to their attention by unhappy consumers or com-panies in competition with the company making the claim. NAD willdetermine if claims are substantiated by real evidence. If the claim can-not be substantiated, it must be amended to reflect real research results,or it must be discontinued or withdrawn. With all the products currentlyavailable, there is no need for cookie-cutter analyses and treatment.Each client should have her or his own unique problem-solving solution.

While pampering is an important part of the spa or salon experience,clients need not be disappointed by poor outcomes. The art and science

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of personal care and beauty products has reached an advanced level that,diagnosed and treated properly, clients should be able to see real results.If you are not getting the expected outcome, consult a colleague and veri-fy that you have diagnosed the problem correctly.

Here are some examples of the kind of information you can communi-cate to clients:

• Many clients express an interest in purchasing "natural" prod-ucts because of health concerns, so many manufacturers use the term "natural" to promote a product. Truly natural prod-ucts, however, are made with natural preservatives, which have a much shorter shelf-life than most commercial products.Products using natural preservatives may last two to three years unopened, but, once opened, need to be kept in the refrigerator. Even then, they may last only six to nine months.Compare this with commercial products that have a shelf-life of seven years for unopened products, and three to four years for opened items.12

• Educate your clients about changes that happen to products over the course of a year. Clients may complain about a prod-uct that worked for a while, but no longer seems to. Inform them that changes in product performance after a few months may result from climate change (dryness or humidity affects hair products as well as hair), and explain that products that are right for you during one season are not always the best during another. Hormonal changes, over a month or year, may also affect how a product works.

• New anti-aging formulas typically contain sunscreens to mini-mize the damaging effects of ultraviolet radiation on the skin. Some of these effective formulas also contain retinol or other active ingredients to reduce the appearance of lines, combined with anti-irritants, such as vitamins and panthenol. Some of these ingredients, however, do not preserve well enough to be useful after sitting on a shelf for over a year. Sunscreen's active ingredients, like avobenzone and octyl methoxycinnamate, and vitamins, like retinol, vitamin E, and beta-carotene, are not very stable, so products will need to be replaced more frequently. Shea lipids, which are used to provide a physical structure for lipstick and other cosmetics, also have "minor bioactivity," or "cell renewal" properties that can protect the skin from environmental degradation and screen out the sun's rays.13

• Antioxidants can prevent damage to DNA, collagen, elastin, and lipids within the skin that lead to wrinkles. While nothing reverses the aging process, the use of antioxidants in correctly designed formulas can actually slow the skin's aging process.

Be confident Having confidence is a matter of two main factors:

Knowing your customerNot fearing resistance

Knowing your customerThe better you know your customer, the easier it is to recommend itemsthat meet your client's needs. Do not fall into the trap of pre-judging aclient's needs, fears, desires, or intentions. It does a disservice to bothyou and your client. If you want to really know your clients, and want toincrease client satisfaction with you and your place of business, ASKQUESTIONS. A needs-assessment or client survey can be a real eye-opener, refreshing and reorienting your approach to customers and cus-tomer service.

Needs-assessments and client surveys are a way for you to measureclient satisfaction and see where you're coming up short. It can suggestinspiring and innovative ways to improve service and increase profits.Surveys or questionnaires need not be complicated, and should not

be very long. In all cases, survey forms should be filled out and deposit-ed in a designated location privately and anonymously by the client.

Questions should focus on client needs, but can cover a wide range oftopics. You may want to ask the client if they require any services you donot currently provide; products they would like you to keep in stock;preferences in music, available beverages, and reading materials; orchanges they would make, if they could, to improve the salon. Be sure toput a very general question at the end asking for any other comments,suggestions, or complaints they may want to communicate.

Your clients are your best information resource, so make use of them toincrease client satisfaction, customer retention, and profits. Encouragingfeedback from the client is usually well-received. Clients like to knowyou are listening to them, and care about their answers. Be sure to thankclients for their honesty and assistance in filling out the form. Somesalons or spas reward clients for filling out a brief survey giving them,for example, a discount on their purchases that day. Confirm that eachclient is only able to fill out one form.

There is also a great deal of consumer or industry information availablein the form of professional survey results, which are published by a rangeof companies and industries. Research is conducted on virtually everytopic and can be extremely useful to the salon or spa professional. Someof this data finds its way into trade journals and magazines, and is avail-able for free, while others may charge anywhere from a modest to exor-bitant fee to purchase data findings and conclusions.

One recent study, for example, conducted by Intelligent Spas, publishedresearch results from a broad-ranging survey about consumer preferencesreleased in August of 2005. The report, entitled "Female Versus MaleSpa Consumers: Survey of Behaviors, Expectations, Preferences andPredictions,"14 presents results from over 370 respondents. As its titlesuggests, it investigated differences between men and women relating tospa visits, including patterns of use, reasons for visits, treatments experi-enced, how the consumer knew about the spa, and how much time wasspent there. It also discussed expectations and needs related to producttypes, treatment choices, and preferences by one gender or the other fortreatment type, as well as decision-making factors used by the client inchoosing a spa.

This particular study and many others like it are a direct line of commu-nication between clients and industry professionals. Learning aboutbehaviors, expectations, and preferences of consumers in general, andyour clients, in particular, can help predict trends and understand therationale behind customer decision-making.

Do not fear resistanceObjections are a natural response and should not worry you. Many peo-ple resist change or are reluctant to try something new. Whatever theclient's qualifications or objections, listen to them carefully. Do not disre-gard the comments or disagree with the client. Instead, consider objec-tions the way clients let you know about their issues or concerns, andinterpret them as a roadmap of information that points the way to theright products.

If you encounter resistance to your recommendations for products oradditional services, they will likely be caused by factors relating to oneof the following:

Financial constraints: If clients pay a substantial amount of money for services, but are unwilling to do so with products, you may want to point out the increased value that the client will get from these products at a marginally higher price. Remember that some clients do not hold their own purse-strings, while others claim poverty when they have adequate funds. Do not try to figure out the financial situation of your client. Simply speak truthfully and let them act.

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Time constraints: Clients may tell you they do not have time for the daily or weekly regimen you are suggesting. Remind them that tending to the problem only during salon visits may not be the most effective way to address the issue or problem. Listen carefully to their objections or concerns, and empathize without attempting to persuade or convince them of anything, but do be honest telling them that the time they spend on the regimen will be rewarded with real results. Uncertain value or questionable benefits: provide specific, sensory information about how the product will benefit them. Tell clients what they can reasonably expect from the new experience; give them specific information and a time-frame for product benefits to result. With excellent one-use products, provide a free sample to prove your point.

Even when the client leaves without purchasing an item you have recom-mended, they may think it over, and return sometime later to purchase it.Get used to objections and don't let them ruffle you. They often precedesales.

Best practices: inventory and pricingThe amount of inventory you stock and the amount of money you chargefor each item are critical factors you will need to decide for yourself.Each varies according to many factors, including the size of the salon orspa, the services you offer, the type of individuals you serve, and theamount of business you have over the short and long term. Some deci-sions are fairly self-evident. For example, you will need to stock moreinventory during your high season, and order replacements, as necessary,as the season wanes.

If you are to err on the side of too much or too little inventory, haveextra; being caught short-handed is a lousy way to miss out on a sale; itdisappoints customers and shows inefficiency in your place of business.Industry experts typically suggest buying extra products, especiallytrendy or hot-selling items, as they can be given away with certain serv-ices, if necessary, as a bonus that your customer will appreciate andremember. You may also want to provide a complimentary service withthe sale of multiple items, speeding slow-moving products off yourshelves.

The better you know your customers, the better you will be able to pre-dict the amount and type of business you will get throughout the year. Itis useful to look through a previous year or year's receipts to see whatand how much of various services and products sold each month. Notethe timing of increases and/or decreases in sales. A great deal of businesssoftware can help you put this information into a computer and analyze itas an additional support.

Manufacturers and distributors often provide a suggested retail price thatallows a business to make up to a 50% profit on each item sold. Mostmanufacturers suggest a price that makes a reasonable to generous profitfor salons distributing the item. Given a hefty mark-up, the salon or spacan also discount a product and still make a profit. Salons or spas mayalso charge an additional fee, beyond the suggested retail price, if theychoose to.

Some salon or spa owners set retail prices at the suggested level to keeppricing comparable across the industry, but offer special deals periodical-ly to move inventory or appeal to customers; For example, offering a dis-count when products are purchased with a specific service or in quantity.

Many industries establish tiered pricing schemes, in which differentitems are priced at 2 or 3 different levels, giving the customer products ina continuum of low, mid and high end pricing, and appealing to a widervariety of customers. While there is always someone who likes to savemoney and does not really feel there is a great variation in quality basedon price, there will also always be the customer who likes to try the bestitems around, or appreciates the qualities of an expensive, but effective

item, and will pay a step higher prices for them. Every once in a while,this type of client tries an upgrade of his or her usual product. If theylike it, they will be back for more.

Retail prices are often developed according to a price curve. For exam-ple, a manufacturer will set different prices for a product according to itsquality of results. Start with the highest quality and prices and adjustthese downward as necessary. If the customer considers the price toohigh, you should always have a less expensive alternative to suggest.Losing the trust of a good client is not worth the risk of an inflated oroverly high price.

Pay attention to client feedback, especially from repeat customers.Asking about the performance of the product you sold them is veryimportant, and the answers can help you determine pricing points.Someone who loves a lotion you recommend will turn into a lifelongpurchaser of that product, while a person who feels "duped" by a highprice may never tell you unless you ask.

Other strategies for moving products from your shelves more quickly areto offer a percentage discount on services with the purchase of an item,or the reverse, or offer something free with a purchase. Sample packetsare great "freebies" that sell the product by offering the opportunity touse an item risk-free. You can also sell sample packets of as many ofyour products as possible.

Best practices: presentation/displayDifferent types of displays affect people differently. Visual consumers aremost susceptible or influenced by what they see, auditory individuals,according to what they hear, and kinesthetic individuals, by what theysense or feel. Purchasing decisions are influenced by all the senses, butare most directly tied to visual cues. Research suggests as much as 78%of purchasing decisions are based on visual influences. Colors are alsosaid to influence purchasing behavior. According to one source, impulsepurchases may be influenced by red-orange, black, and royal blue, andbudget shoppers are more likely to respond to pink, teal, and light anddark blue.24

There are a number of optimum display stations outside of your immedi-ate area where products can be displayed. Some effective locations arewithin the first few yards of the salon entrance or the main area clientsare ushered into or sit. Even if space is very limited, place items at eyelevel near the reception desk or counter, especially if it is an area thatclients must pass a number of times each visit.

Most people scan a visual display from top left to lower right, as onewould read the English language in a book, although individuals of dif-ferent cultures may scan differently. Put the best selling items at eye-level and the slowest moving items just below, to draw attention to thatarea.

Products should typically be grouped or organized by type, for example,all skin moisturizers or hair products together. Poorly organized ormessy displays discourage purchases.

Always have a good stock of popular items on the shelves as well assome in storage, but keep the shelf-life of products in mind. While manyproducts are packaged to withstand a wide range of temperatures withoutill-effects, some inventory may be affected by extreme cold or heat.Keep items stored at room temperature to avoid changes in texture, con-sistency, or appearance of products

Once you have chosen the best products to distribute, keep them stockedconsistently so that regular customers will be able to depend on it.Clients who see different products every time they visit the salon or spawill begin to questions your commitment or lack of commitment to aproduct line or item. If you see your moisturizer get discontinued, youbegin to wonder why the salon is no longer getting the product back in.

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One rule of thumb is to create displays that use more than a dozen of theproduct, as this seems to convey to clients that the item is in greatdemand. If you have a plentiful amount of an item, it looks like you arewell-stocked for frequent or rapid sales. Managers typically suggest dis-playing no fewer than 3-6 products in a row. Less than three in a displayand shelves look empty, conveying a negative message about your com-mitment or enthusiasm for a product. If possible, stack items at least 4deep and place a mirror behind items to emphasize them.

If you have only two or three of an item, perhaps for aesthetic reasons orlack of presentation space, you will be too easily wiped out of visibleinventory. Anecdotal evidence and marketing research suggest that a sin-gle bottle on a shelf fares poorly. Nobody seems to want to buy the lastof anything, either feeling that it has been on the shelf too long or some-thing is wrong with it.

Effective use of showcases for product display is very important.Showcases present products in a more user-friendly form than shelves.Make up, for example, does not sell as well if it is in boxes, drawers, oron a high shelf. Shoppers need to see a combination of merchandise,both for testing and purchasing purposes. Have a tester rack for clients,and keep it well stocked with moisturizer, tissues, alcohol, and a mirror,to encourage testing. Testers should be plentiful, clean, organized, andneat.

Wrap and present products purchased by the consumer in attractive bagsand packaging, with brightly colored tissue paper, or foil packaging.Think of how stores like Victoria's Secret make every purchase look likea fancy gift that the client gets to unwrap.

ENDNOTES1 The Green Guide issue 31 (November 1, 1996)

http://www.thegreenguide.com/issue.mhtml?i=31h 2 Melinda M. Minton, Minton Business Solutions;

http://spas.about.com/library/weekly//aa120201a.htm3 Retail Selling Can Save Your Bottom Line, Melinda M. Minton, Minton Business

Solutions http://spas.about.com/library/weekly/aa120201a.htm 4 http://www.ncacares.org/instapoll/archive.cfm?PollID=94&TemplateName=Homepage

&PollDS=nca&returnPage=/index.cfm Date: 11/14/20055 Society of Dermatology SkinCare Specialists (SDSS), Ridgewood, NJ. Survey results at

http://www.spatrade.com/news/index.phtml?act=read&id=3876 Society of Dermatology SkinCare Specialists (SDSS), Ridgewood, NJ. Survey results at

http://www.spatrade.com/news/index.phtml?act=read&id=3877 "Consumers Look For Value, Not Always Price," Small Store Survival; Success Strategies

for Retailers, Arthur Andersen LLP, John Wiley & Sons, Inc. 1997.8 Retail Selling Can Save Your Bottom Line, Melinda M. Minton, Minton Business

Solutions http://spas.about.com/library/weekly/aa120201a.htm9 Salon Sense Magazine, see http://www.isnow.com/hair/partners/pub/salonsense/0903retail

success.html10 http://pubs.acs.org/cen/coverstory/8218/8218age.html11 http://pubs.acs.org/cen/coverstory/8218/8217age.html12 www.dermaorganics.com13 http://pubs.acs.org/cen/coverstory/8218/8218age.html14 http://www.spatrade.com/news/index/phtml?act+read&id=367

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CHAPTER 9DEALING WITH DIFFICULT PEOPLE AND SITUATIONS

(2 Credit Hours)Learning Objectives:Describe the physiological reactions that produce the "fight or flight"response.

Explain the relationship between stress and illness.Define and give examples of very aggressive and very passive behavior. List some characteristics of active listening and explain its purpose.

IntroductionYou have probably worked with at least one or two "difficult" individualsin your career. It could be a coworker, manager, or client-anyone whomakes your life more complicated or stressful by creating and includingyou in situations you would like to avoid. Difficult people tend to con-tribute to a negative atmosphere. They may have poor work habits orsocial skills. Difficult people are likely to complain when their businessis too busy, and/or too slow. They may be petty and gossipy, startrumors, or repeat unhelpful comments.

Difficult people may talk too much, be loud, rude, and/or physicallyimposing. They may be verbally or physically abusive. They may besulky, or give you "the silent treatment." They may be bullies or nags.They may be constant whiners, or pathological liars. Difficult peoplemake your life difficult. While spas and salons are supposed to offer a lit-tle sanctuary from the daily grind, they may have just the opposite effecton cosmetologists or technicians who are plagued by a difficult personal-ity at work-a client who always raises your blood pressure, perhaps, or amanager who won't stay out of your business.

Difficult people encourage "burnout" in those around them. We may feelmanipulated by them. They make us lose our temper, slow downprogress, and prevent us from getting things done. They may make usfeel guilty, anxious, or upset. In many cases, working with someone youdon't get along with is not only a difficult and stressful experience, butone that negatively affects productivity. Coworkers who are not happy intheir positions can "bleed" discontent onto their clients or coworkers.Even if you try to hide dissatisfaction or frustration from your superiors,coworkers, and clients, this kind of stress can build up, and it is possibleto sense the negative energy in your environment, as well as be affectedby it.

Every day we encounter difficulties and negative responses in others.What should we do when confronted by difficult people who are a painto deal or work with? You may try to reason with the person, ignore thebehavior, or respond in kind-someone launches into you; you launchback. But this brings you no closer to a solution, and may make the situ-ation worse. Ignoring the person contributes to lowered morale, in gen-eral, as difficult people tend to make everyone a little more on edge.Additionally, you may feel resentful that the individual causes you dis-tress and uses up your time and energy. Irritation and frustration canmount, until tempers explode.

What if you could respond in a way that effectively diffuses the angerand directly addresses the dilemma? It is possible to change the way youdeal with difficult situations and behaviors, to bring out the best in peo-ple and effectively address difficult people and situations. This chaptershould help you:

• examine the "challenging" behaviors you encounter • understand something about people act as they do• analyze how you react to them• learn ways to prevent and address difficult situations

Understanding behavior I: habitual responses; emotion vs. logicBefore you can address the problem of difficult people and behaviors,

you must be able to observe and identify your own actions and moods,realistically and objectively. Answer these questions to assess howstrongly you are affected by a particular difficult person, and to whatdegree this individual negatively influences your behavior:

Talking or working with this individual drains my energy.When I know I have to have contact with this person, my mood takes a turn for the worse.I tense up around this person.I would be very relieved if I knew I did not have to encounter this person any more.I plan ways to avoid this person.This person seems to bring out the worst in me. I do not like how I act around him/her.

If you answered yes to these questions, you are having strong emotionalreactions to this individual and are likely experiencing a significantamount of stress related to him/her. Tension or stress may manifestitself, over time, in physical symptoms like stomach aches or headaches,and stress-related behavior, including impatience, anger, sadness, andoverreaction. In some people, long-term reactions to stress may includedepression. Stress over long periods of time can run you down and even-tually take its toll on your health.

Learning techniques to handle difficult people or address difficult behav-ior involves a number of steps. The first step is learning to identify yourown emotional responses in a difficult interaction, and know this abouthuman emotions and behavior: Much of how we think and act is a matterof habit, or repeated patterns of behavior, including the way we deal withdifficult people or situations. If our habits are negative, our results tendto be negative, too. The challenge is to express the negative emotionsyou feel in useful, positive ways.

Most people are unable to behave logically under stress because theyreact automatically, without thinking. Confronted with difficulty, thebody tends to respond with the "fight or flight" response1 ; the heartbeats more rapidly, and perspiration increases. This reaction, called"acute stress response" is an evolutionary reaction to threatening situa-tions. It causes us (and other vertebrates) to react in one of two ways, toeither address the danger (fight) or run away (flight).

During the acute stress response, the sympathetic nervous system triggersthe release of epinephrine and norepinephrine from the medulla and adre-nal glands. These speed up the heart rate and breathing, and constrictblood vessels in certain parts of the body, while opening blood vessels inthe muscles. The muscles tighten, or tense, as the brain, lungs and heartwork harder ,preparing the individual for either fight or escape.Adrenalin surges, making the person alert and aware, and physicallyready for what comes next.

Humans commonly respond angrily to difficult situations because of thisphysiological response. Instead of responding with a thoughtful reaction,from the left side of the brain (the problem-solving, logical part), wereact with the right side of the brain-emotional, irrational, and withoutlogic. You can control this reaction by developing your awareness, iden-tifying your physical reaction to stress and the associated emotionalresponse. This insight allows you to begin controlling your responses ina difficult interaction, rather than having your responses control you.

Think about how you react when someone drives dangerously near you,cutting you off, for example. Most people respond angrily to a threatlike this. How do you react? Does the anger fade quickly? Are youlikely to say a few choice words about bad drivers to your passenger?Will you swear at the individual? Even follow him just so you can givehim a piece of your mind? Do you find a way to stay irritated for awhile, or, does this one moment pass easily, with you realizing that youfelt personally threatened and, perhaps, even fearful for a moment? Some people's attitudes are easily influenced. They may be "moody" -upone day or hour and down the next, with little or no idea why, reacting

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blindly or emotionally without analyzing their reactions or resultingbehavior. Do you react automatically to the people around you? Doessomeone else's bad mood tend to "rub off" on you? If you are the kindof person who chooses to remain upset long after a near-collision, youcan't continue to blame the other driver. Realize that your responses todifficult people or situations are entirely your own decision and com-pletely under your control. If you choose to replay the incident in yourmind and "refuel" your anger, you are wasting a great deal of energy onevents in the past that cannot be changed.

Next time you feel emotion and logic at odds with one another, pullingyou in opposite directions, focus your attention on your physical andemotional reactions. When you are able to pause, instead of blindlyreacting, you will begin to gain control over your moods, and choosehow you react. While it may not be possible to do in all cases, it is a sim-ple, but profound step towards controlling your moods, rather than beingcontrolled by them.

Like us, other people's difficult behavior may be steeped in habitual pat-terns. We all develop responses to other people's words and actions thatcan automatically take over if we let them. By interrupting our own neg-ative repeated strategies, it is possible to break the pattern, allowing theinteraction to shift from one of frustration to the beginnings of a solution.

Difficult people are seeking particular things in response to their behav-ior. You may be unable to see the benefits they reap because they are notthings you desire. Difficult people, for example, may not only want toget their way; they may get some satisfaction from "pushing your but-tons" or making you lose your temper. Difficult people may feed into orencourage our own difficult nature. Instead of playing into their behav-ior by contributing to or escalating the conflict, learn to switch off yourdefense mechanism when confronted with negative actions or words.Practice the following:

1. recognize your automatic reaction2. take deep measured breaths and focus on your breathing until

you feel the physiological response dissipating

Learn to refrain from pointless arguments or accusations that exacerbatethe difficult situation. This gives you an opportunity to respond in a waythat is productive and brings about a good or better outcome. By recog-nizing and not reacting to or adding to conflict, you will no longer beheld hostage by your moods and automatic reactions, and difficult peoplewill not seem so difficult. Once you learn some strategies for dealingwith problem behaviors, you will be able to take charge of the interactionor situation and promote a more peaceful environment.

Learning to deal with difficult behaviors in others requires you to man-age your part of the interaction effectively. While events may occurbeyond your control, your response is still within your control, and youare entirely responsible for your own reactions.

Principles of conflict resolution (getting along with others)Working in harmony with other individuals can be a matter of establish-ing and implementing a number of principles to help you control yourown words and actions and create the foundation for a peaceful, or atleast, less stressful, work environment. While there are many differentphilosophies of conflict resolution, many stress the same guiding princi-ples. The following guide, drawn from Zen Buddhist teachings,2includes many of these common principles. Notice how many are direct-ed at changes in one's own thinking and behavior:

• Take responsibility for our vulnerabilities and emotional trig-gers in relationships with others.

• Investigate our own responsibility in the conflict before speak-ing with another.

• Practice non-stubbornness by holding an open heart, a willing-ness to understand, and a desire to reconcile differences.

• Have face-to-face resolution of the conflict with the other per-son or people involved.

• Use anger in a constructive and respectful way, allowing it to teach and transform us for the better, avoiding the "poison" of envy and comparing ourselves to others.

• Separate the behavior from the person, seeing the situation as an opportunity.

Perhaps the core principles of conflict resolution or dealing with difficultpeople are to maintain respectful relationships and try to resolve issueswithout emotion. The first part of this chapter introduced the importanceof observing your emotions and learning to stop yourself from automati-cally reacting without thinking. The next part discusses some principlesof respectful communication.

Like the principles above, these ways of thinking revolve around chang-ing you and the way you respond to difficult people. This is because, asmuch as we try, we cannot change other people. The most effectivechanges are those we implement internally, changing ourselves. Bychanging the way you respond to difficult people, you change the type ofinteraction that results. By shifting the focus to yourself and your ownbehavior, you have the means by which to change the nature of the inter-action from negative to positive.

Principle 1: Stop trying to change other peopleTrying to change the difficult person does not resolve any problems andtypically leaves you even more frustrated and angry. So, instead of try-ing to change the difficult person, to make them less difficult, accept thatperson as he/she is, with faults, like you. Simply by choosing to acceptpeople as they are, we create a less stressful environment. Think of howeasily people telling others how they should change leads to heightenedconflict, and accept that you no longer have to try to control or influenceother people's thoughts and behavior-the realization that it is not yourmission to convince everyone that you are right. Leave that burdenbehind, and accept that you have no responsibility for changing minds.

Principle 2: No blame-gamePeople grow accustomed to blaming others or themselves when things gowrong, rather than looking for ways to fix the problem without focusingon blame. Blame does little or nothing to resolve a difficult situation.Learning to address negative energy or attitudes around you withoutblame is an integral part of dealing with difficult people. This meansrelaxing your judgment of people and assuming the best of those aroundyou, giving them the benefit of the doubt.

Principle 3: It's not about youA necessary aspect of this strategy is learning to depersonalize communi-cation and behavior. It is the realization that, in most cases, the difficul-ties you encounter are not at all about you. When a person ignores you,or speaks unfairly to you, how do you handle it? Do you feel angry atthe person, assume their words to you were malicious and intentional?As you go through the day, do negative feelings about the person persist?Do you hate others because you think they hate you? This kind of think-ing perpetuates negative behavior on both sides and gets you no closer toa solution.

Negative behaviors or responses often come from our own feelings ofinsecurity. Learn to listen to others without forming these presumptuousattitudes that revolve around your ego. Realize, when you are talking toa difficult person, that you already have a bias against them, and that youmay be predisposed to interpreting his/her comments negatively or in ajudgmental way. In so many cases, a perceived snub has nothing to dowith you. Perhaps the person you were speaking to had a long day, or ispreoccupied with some recent bad news. By learning not to interpret theinteraction as a personal affront, we give the person the benefit of thedoubt.

Principle 4: Treat people wellPractice treating difficult people with as much kindness and patience asyou can. If you are respectful toward them, you may find their behavior

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loosens up, or bothers you less. Remember that anyone can be some-one's difficult person at some point; even you, given the right (or wrong)circumstances.

Principle 5: Don't waste your time and energy on things you cannotchange (like the past)Many people are unable to let go of the anger or frustration associatedwith a source of negative stress. Practice mentally "throwing the prob-lem away" by putting an end to rumination or "replay" of the situation inyour head. Do not occupy your time repeating the story, or endlesslycomplaining to other people. Use this energy for more productive pur-suits.

Choose to focus your energy on the present and future, rather than wasteit on past events that cannot be changed. Many people find the "SerenityPrayer," by Reinhold Niebuhr, a good reminder about wasted emotionalenergy:

God grant me the serenity, To accept the things I cannot change,

The courage to change the things I can, And the wisdom to know the difference.

Understanding behavior II: communicating needs: assertiveness,aggression, and passivity Much of a person's ability to deal usefully with emotions like anger andfrustration is associated with his or her style of behavior or degree ofassertiveness. Assertiveness refers to the spectrum or range of behaviorbetween passivity, at one end, and aggression, at the other. It may be oneof the first things you notice about another person's behavior.

Individuals respond to difficult situations with different degrees ofassertiveness. Stress tends to pull at people emotionally, making themeither more or less passive or aggressive than is usual for them. Assertivepeople differ from passive and aggressive people in their ability toacknowledge and state their own needs, and respect the needs of others.Passive or aggressive individuals are typically unable to do so.

Characteristics associated with aggressive or passive/aggressive tenden-cies:• I often yell back when someone yells at me.• When someone tries to boss me around, I frequently do the opposite of

what he/she asks.• I often take my time "just to show" someone, when he/she tries to boss

me around.• I often make threats that I really don't intend to carry out.• When I'm feeling insecure and jealous, I'll often pick a fight with some

one rather than tell him/her directly what's on my mind.• Starting arguments with someone when he/she disagrees with me is

something I often do.• Slamming doors is something I often do when I get mad at someone.• I'll often do something on purpose to annoy someone, and then apolo-

gize when he/she accuses me of it.• I will often break a "rule" someone has made just to spite him/her.• When someone makes me do something that I don't like, I often make

a point of getting even later.• I often won't do what someone asks me to do if he/she asks in a nasty

way.

AggressionAggressive, or domineering, thinking focuses on meeting one's ownneeds at the expense of others'. Aggressive individuals often ignore theimpact of their behavior on others; it is an "I win, you lose," position,incorporating a variety of aggressive methods of control, including dis-honesty. Judging, criticizing, out-talking, or being loud and intimidatingcan all be used to dominate other individuals.

Being aggressive often involves a belief system that puts the aggressor'sstandards and needs above others. Aggressive people may think they are

the only ones that have a corner on the "truth" of the situation. They maybe very stringent about following their rules, but not those of others'.Aggressive individuals do not consider other people's wishes and havelittle respect for others' needs and rights. Things may have to go theirway or no way at all.

Aggressive people may have had backgrounds in which domineeringbehavior was encouraged or rewarded. While they may appear very con-fident, they often have poor self-esteem, and may be unable to acceptblame. Unlike passive manipulators, aggressive individuals tend to beobvious in their attempts to push people around. A "bully," for example,is one type of aggressive personality that typically uses some form ofobvious mental, physical, or monetary coercion to force others to do asthey wish.

Another type of aggressive or dominating personality is the "con-man"who uses deception or subterfuge, often relying on verbal skills to per-suade others to do what they want. Con-men differ from other aggressivemanipulators in their ease and ability to lie, and lack of concern forspeaking falsely. The terms sociopath and psychopath refer to twoextreme forms of con-men behavior, individuals who have little regardfor others' welfare, and engage in extreme behavior to get what theywant, with few or no signs of guilt.

Dominant or aggressive behavior may also manifest itself in judgmentalcontrol, a "holier than thou" or "know it all" attitude that keeps othersoff-balance. The judgmental person thinks he or she is morally and/orintellectually right, or has "the truth" on his/her side, and implies that theperson with which they are in conflict is not as intelligent, or as good aperson, in some way. This kind of manipulation is dishonest in that judg-mental people claim they are doing the right thing, while their real moti-vation is to control the situation and get their way.

While aggression allows the difficult individual to get his/her way in onesense, aggressive manipulation works against the difficult individualbecause other people learn to fear or resent, and distance themselves,from the difficult person. Like passive individuals, aggressive peoplemay have poor social skills and little trust in others. They may feel sus-picious, angry, and wounded by others' reactions to them.

PassivityPassive or nonassertive thinking focuses on meeting others peoples'needs, at your own expense. It is a "You win, I lose" proposition.Passive people typically allow others to control them, but are also capa-ble of manipulating or controlling others. Individuals who tend towardpassive behavior in times of stress are likely to feel angry and victimizedor taken advantage of. They may feel frustrated, feeling they never gettheir way, and have little control over their lives. They may be sulky orwithdrawn, thinking that no one listens to what they say, anyway. Theymay have little confidence in themselves, and be reluctant to acceptchange.

Indirect passive manipulators may use subtle or devious means to gettheir way, including sabotage, sarcasm, "playing the martyr," or the"silent treatment." They may be inclined to use passive/aggressive meas-ures, spreading rumors, making fun of others, or talking behind others'backs. They may hide their feelings, pretending that everything is finewhile they are actually seething inside. Sometimes a person can go fromone extreme to the other; a person who is typically nonassertive willbecome aggressive. This may happen because small amounts of resent-ment build up until "the last straw," when they lose their temper.

Passive manipulation may also be subconscious, and include withdrawal,feeling depressed or "down," and a disinclination to communicate orcooperate. Passive personalities may be overly dependent on others,hypersensitive to criticism, and lacking in social skills. Passive behaviorcan be frustrating to more motivated, efficient workers, who may feelthey're carrying "dead weight," at the place of employment.

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Characteristics of assertive behavior and communicationAssertive thinking and behavior balances an active concern for one's ownwelfare and goals with those of others. It comes from a genuine wish andattempt to find "win-win," long-term solutions to recurring problems, asopposed to superficial or temporary, stop-gap measures that ignore theunderlying cause of the problem. Assertive communicators face difficultsituations squarely, while nonassertive people tend to avoid directlyaddressing the root of the problem.

The assertive approach utilizes the individual's respect for him/herself,treating the other person in an understanding and kind way, yet focusedand firm enough to accomplish the win-win solution. While the ultimateobjective of the assertive approach is finding immediate and lasting solu-tions to problems,3 assertive communicators endeavor to de-escalateconflict and improve communication, bringing people closer together.Assertiveness tends to be the most effective response to nonassertive,aggressive, or manipulative behavior, but learning to act assertively typi-cally requires some degree of training and skill, whereas nonassertiveand aggressive responses, by contrast, are emotional and automatic.

Assertive communicators tend to be more emotionally open and honestabout their feelings and thoughts. They tend to act kindly and diplomati-cally throughout the difficult situation, and speak and act in respectfulways. Assertive communicators are more likely to express care or con-cern for another person, to compliment or commend him or her, even inthe midst of a difficult situation.

The following statements describe characteristics typically associatedwith assertive behavior and communication:4• Confronting someone with a problem as it comes up is seldom a

problem for me.• Telling someone that he/she is taking advantage of me is not difficult

for me to do. • If someone is annoying me, I do not find it difficult to express my

annoyance to him/her.• Saying "NO" to someone when I would like to say "NO" is easy for

me to do.• I am able to ask someone to do me a favor without any difficulty.• I do not have difficulty telling someone my true feelings.• Challenging someone's beliefs is something I can do with little

difficulty.• In general, I am very direct in expressing my anger to someone.• I do not have trouble saying something that might hurt someone's

feelings when I feel he/she has injured me.• Expressing criticism to someone is not a problem for me.• I can express a differing point-of-view to someone without much

difficulty.• I often let someone know when I disapprove of his/her behavior.• In general, I am not afraid to assert myself with someone.• I do not give someone the "silent treatment" when I'm mad at him/her. • Instead, I just tell him/her what has angered me.

Honest, but kind Assertive communicators use words with great care because they knowwords can hurt people deeply, causing great pain. Choosing to speakkindly and carefully does not mean that you cannot voice your opinionsor disagree with the difficult person. It means you do not use words toattack or undermine. During a difficult encounter, speak the truth, but tellit in a way that is supportive-building up self-esteem rather than tearingit down. Always bring attention to a sensitive issue in private, to avoid anaudience, and try to discuss problem behavior without indicting the per-son behaving that way.

Assertive communicators are honest, diplomatic, and diligent about keep-ing their word. They back up their words with action because they knowthat if you do not follow up your promises or statements with the speci-fied actions or behaviors, people will begin to doubt what you say.

Words can bond people in close relationships or rip them apart.Assertive communicators realize their power and use them carefully.Poorly or angrily chosen words, once spoken, have an impact that cannever be taken back. Thoughtless words can get back to the personthey're about, wounding him/her deeply, making him/her feel surroundedby false friends. When you are speaking about another person, considerthe following: Would that person be wounded by your words if theywere repeated by someone else, out of context, without you around todefend yourself? Even after an apology, there is some residue of hurt oranger from wounding words.

Positive intention; high expectations and giving the benefit of thedoubtAssertive communicators are compassionate and nonjudgmental. Theyrealize they cannot know all the experiences that made the difficult per-son what he or she is today. Instead of judging or blaming the difficultperson, the assertive communicator is sensitive to the needs of the diffi-cult individual, and treats him or her compassionately.

Assertive communicators know that much of our ability to know and getalong with others is dependent on healthy self-esteem. We all travel withan "Achilles' heel," some weakness or sensitivity that is particularly acuteto us. Sometimes what we react to in others' is the weaknesses we identi-fy in ourselves. Difficult situations can be emotional and confusing.Unless you specifically state your good intent, there is a possibility thatyour words and behavior will be misunderstood or misinterpreted.Showing your positive intent through words and actions can be likeknowing the magic words to make the situation easier.

In this important dimension of assertive communication, the speakeridentifies a positive intention behind the difficult behavior, and treats thedifficult person with a positive, charitable manner. This means acknowl-edging that the difficult individual does not mean to be difficult; that heor she is operating out of goodwill, and toward positive objectives.

Difficult people may feel victimized by the world around them. Theymay feel that no one is on their side and everyone is against them.Showing your positive intent is showing the caring emotions that are thecontext for what you are saying. Showing your positive intention lets thedifficult person know where, emotionally, you are coming from. Whenyou state you positive intent toward the person, you give them positivefeedback; the individual may expect to hear accusatory language, insteadhe hears concern and interest.

Stating positive intentions can be as simple as learning to say, "I'm sorrythat you're having a problem. How can I help?" Expressing concernimmediately reduces anxiety and conflict and increases goodwill. Thedifficult person feels you are not against him or her. Holding thesethoughts about the difficult person will influence the way you speak andact to the person, avoiding an accusatory language or tone. In stating orconfirming that you understand the difficult person has good intentions,you develop a bond of goodwill, confirming that you are both on thesame "team," and your intentions are understood

Giving someone the benefit of the doubt is one of the most powerfultools for bringing out the best in people at their worst. People both riseand fall to the level of others' expectations. Have you noticed, oncesomeone has a negative opinion of you, you may feel that it is impossibleto redeem yourself in their eyes? When a difficult person behaves in adifficult way, you may be tempted to think, "That's why everyone has aproblem with you." It is easy to let your preconceived notions about thedifficult person allow you to make the assumption that a behavior is root-ed in negative intention. But even behavior that appears negative cancome from good intent.

We tend to associate difficult people with negative feelings and reactions.We can reinforce those notions about them, or we can assume the best,even if it is wrong. Assuming the best has a positive effect on difficult

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people. Instead of criticizing the person or telling them why they arewrong (making them defensive), you minimize their apprehensive, pro-tective defense mechanisms. As they learn to disassociate you with neg-ative words and actions, they will stop seeing you as the enemy, and bemore receptive to what you say.

Difficult people want to be heard and understoodMost people want two things from a verbal interaction. They want toknow that they have been heard, and they want to know that what hasbeen heard has been understood. Arguments often erupt in a situationwhere two or more people are trying to be heard and understood at thesame time. For effective communication to result, one person must bethe listener, open to hearing and understanding what is said.

Feelings of anger associated with the difficult situation are commonly thecombination of two things: the original reason for unhappiness or dis-tress, and the associated frustration and feelings of helplessness becauseno one is listening to, understanding, or helping you solve the problem.Listening to what the person has to say has an immediate diffusing effecton hostility by addressing one of the sources of anger. In fact, a kind,understanding word is sometimes all that is needed to cool emotionaloverreactions and promote good will.

Difficult people often feel their good intentions are being misunderstood,that they are not being heard and understood. Learning good listeningskills and behavior, asking important questions, and providing appropri-ate feedback ensures that the difficult person feels heard and understood.In fact, by listening attentively, you can even prevent difficult peoplefrom becoming difficult, as taking the time to listen increases feelings ofcooperation and understanding.

Understanding is both an emotional and intellectual process. In a difficultsituation, you must convince the difficult individual that you are under-standing on both levels. We do this by our appearance and behavior, thequestions we ask, and feedback we give. Most people focus on the wayyou say things as much or more than what you say. Your intentions arenot nearly as relevant as your behavior. Both should have the same mes-sage

When someone is venting their frustrations or complaining, demonstratethat you are paying attention to their emotions and words. Pay attentionto nonverbal signs of communication and seek clarification if you sus-pect that you and the other person aren't "on the same page." Fatigue,disability, language difficulties, and cultural issues are some of the manyfactors that complicate communication between two people. Some peoplehave an initial period of difficulty speaking their mind; they may feelrude, awkward, or not want to express disagreement with you. As yougrow more familiar with one another, your interactions will likelybecome more natural and comfortable.

Listening skillsAssertive communication requires good listening skills. Assertive com-municators listen carefully, responding with sympathy and targeted ques-tions that get at the heart of the issue. They pay close attention to whatthe individual is staying instead of wandering off on their own thoughts,or thinking ahead to how they will respond. Active listeners have anopen mind and are able to consider other people's points of view.

Being a good listener means that you:• Don't tune out• Don't interrupt• Are open-minded - don't already have your mind made up • Maintain good listening behavior (like eye contact - don't look

down or around room)• Ask questions to clarify and provide feedback

Do you tune out? Sometimes we don't hear what people say because we are bored or pre-occupied; the mind wanders off on its own little journey, thinking its own

thoughts. While the person is speaking, we are contemplating manythings, including what we will say when it is time to respond. You mayhave poor listening skills, in general, or the tendency to tune out the dif-ficult person because you associate him/her with something unpleasant.

Do you interrupt? Interrupting individuals before they are finished speaking should be dis-

couraged. Try not to rush the difficult person, read his or her mind, oranticipate what he or she is about to say. Let them make their statementat their own pace. Do not try to hurry the discussion along, or solve theproblem before you've heard all the pertinent details.

In some cases, listening may not be a useful use of your time. Difficultpeople who complain constantly sometimes try to draw others into theirdrama. In this case, keeping the interaction as short as possible. For dif-ficult people who talk a great deal and listen too little, you may have tointerrupt to be heard at all.

If someone raises their voice to you, will not let others speak, or com-plains without end, it may be necessary to kindly but firmly interrupt theindividual and redirect the conversation. The interruption must beunemotional, without anger or blame. Speak respectfully to the individ-ual, using his or her name to get their attention, for example, "Excuseme, John." Aggressive people are likely to raise their voices, in an effortto speak over you; escalating the conflict. Continue to politely repeatthis until the difficult person finally stops speaking and turns his/herattention to you.

Do you listen with an open mind?Some people are not willing to entertain the prospect of changing theiropinion, no matter what they hear. Do you consider what the difficultperson is saying without predisposition or bias?

Do you show good listening behavior?Is your tone of voice and body language saying the same thing as yourwords? Are you making eye contact and nodding or commenting toshow your interest? Do your questions further understanding of the dif-ficulty? How do you look and act? Are you tapping your foot, or are youreyes darting around the room? Are you thinking about how you're goingto respond to the individual? Not only your words, but your body lan-guage and manner of speaking (volume and tone of your voice) shouldconvey interest and concern.

Do you ask the right questions and provide appropriate and support-ive feedback?Do you use the principles of active listening, paraphrasing and askingquestions when you need clarification and to show you are interested andlistening to what is being said?

At some point, the individual may stop talking or start to repeat whathe/she has already said. At that point you provide feedback, consistingof a statement of positive intent, then feedback or clarification of whatthey just said. If you think you understand what the person said, brieflysummarize what you heard using some of the same terms the difficultperson used. By using the same words they used, you convey that youhave been listening intently and understood the meaning they intended.Do not replay the whole conversation; simply the main points. Note anystatements in which the difficult individual mentioned his or her feelingsas much as you emphasize what happened in the sequence of events.

Finding a solution to a problem often requires learning more informationor different information than the difficult person is giving you. Clear upconfusion with specific questions that will help you understand the diffi-culty. Asking questions also communicates to the difficult person thatyou are interested in finding a solution for the problem. Clarification(questions) should be phrased in an even-handed unemotional tone.Avoid sounding accusatory or phrasing questions in a blaming way.

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Difficult people may speak in vague generalities, or provide little of sub-stance in what they say, Ask brief questions that clarify the factual detailsuntil you and others begin to have an understanding of the difficult situa-tion, and why the difficult person feels about the subject the way they do.There are usually rationale reasons at the root of every action or behav-ior. Ask questions until you understand the motivation behind the diffi-cult behavior.

Most clarification questions begin with "who," "what," "where," "when,"and "how." Use them to fill in any information gaps left by the speaker.Asking questions that fill in the blanks helps the difficult person pullhimself out of the difficult situation and also makes him feel his difficultsituation is being addressed seriously and respectfully.

Your focus in asking questions should be: • to clarify the meaning of the situation for the difficult person• to clarify their intention in regard to the interaction• to clarify the criteria for a solution or way to ease their distress

Asking the difficult person to explain his or her reasoning can be veryuseful. Ask the difficult person what rationale or criteria are leadinghim/her to the problematic conclusion or decision. After learning thesecriteria, summarize them to the person and confirm that these are the rea-sons or rationale behind their position. If you sense defensiveness,acknowledge good intent and confirm that you understand what they aretrying to accomplish.

After clarifying any questions you have about the difficult situation, sum-marize what you've heard, answering these questions:

• What is the problem?• Who is involved?• When it happened?• Where it happened?• How it happened?

By doing this, you demonstrate to the listener that you are working tounderstand his point, and you provide the individual with the opportunityto fill in any gaps, if either you or the other person missed an importantdetail. When you are done summarizing, ask the individual if youunderstand him correctly. And confirm that you understand.

ENDNOTES1 http://en.wikipedia.org/wiki/Fight-or-flight_response2 Sangha at Clouds in Water Zen Center. See http://www.cloudsinwater.org/

GuidelinesForCommunication.htm3 http://front.csulb.edu/tstevens/assertion_training.htm#What%20is%20

Nonassertive, %20Aggressive,%20and%20Assertive%20Thinking%20and%20Behavior? Or http://www.csulb.edu/~tstevens/

4 Adapted from Assertiveness Inventory Scale; Authors: K. Daniel O'Leary and Alison D. Curley; see http://www.psychology.sunysb.edu/marital-/downloads/aggression.htm

SOURCES & BIBLIOGRAPHY• Brinkman, Rick and Rick Kirschner, Dealing with People You Can't Stand,

McGraw-Hill, Inc., 2002.• Cava, Roberta, Dealing with Difficult People, Firefly Books, 2004.• Crowe, Sandra A., Since Strangling Isn't an Option, A Perigee Book, Berkeley

Publishing Group (a division of Penguin Putnam Inc.), New York, 1999.• Losoncy, Lew, Salon Psychology, Matrix University Press, 1988.• Toropov, Brandon, Complete Idiot's Guide to Getting Along with Difficult

People, Alpha Books, Macmillan General Reference, A Simon & Schuster Macmillan Company, New York.

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Final Examination Test QuestionsChoose True or False for questions 1 thru 65 and mark your answer onthe Final Examination Sheet found on page 65.

1. AIDS was first reported in the United States in 1991.

True False

2. Scientists have found no evidence that HIV is spread through sweat, tears, urine, or feces.

True False

3. Severe symptoms may not appear for 10 years or more after HIV first enters the body in adults.

True False

4. In 1981, 159 cases of HIV/AIDS had been reported and by 1991 that number had grown to 206,563 and 156,143 deaths.

True False

5. HIV/AIDS research has not provided any help in finding treat-ments for other diseases.

True False

6. The Americans with Disabilities Act prohibits discrimination against all people with disabilities or perceived disabilities, including people with HIV infections and AIDS.

True False

7. Rarely are people living with HIV/AIDS productive workers.

True False

8. More than 75% of all AIDS cases occur among people betweenthe ages of 25 and 44.

True False

9. If an employee discloses to employer that they have HIV/AIDSthe employer is allowed to tell the rest of the coworkers in the salon without the permission of the infected employee.

True False

10. Nearly 1/4 of large businesses and 1 in 20 small businesses have already encountered an employee with HIV infection or AIDS.

True False

11. Sebaceous glands produce sebum, which moisturizes skin and hair and is a barrier to toxins.

True False

12. Hair is composed of cells arranged in three layers, the cuticle, the cortex, and the medulla.

True False

13. Fragilitas crinium is the formal term for any abnormal hair loss.

True False

14. On the pH scale, healthy hair falls on average between 7.5 and 8.5.

True False

15. A high pH is essential for some chemical services to work properly.

True False

16. Allergic reactions to dyes include itching, swelling of the face, and even difficulty breathing.

True False

17. The Material Safety Data Sheet (MSDS) is the primary source of information describing the hazardous properties of each chemical product used in the profession.

True False

18. A "specialty salon" means any place of business where at least one of these specialties (manicuring, pedicuring, facials , and /or shampooing) occurs.

True False

19. At least 3 members of the cosmetology board must be licensed cosmetologists with a minimum of 5 years practice.

True False

20. A license for operation of a cosmetology or specialty salon may be transferred from the name of the original licensee to another person without approval by the Department.

True False

21. Salons cannot be located in a residence under any circum-stances.

True False

22. Pets are allowed in a salon so long as they are kept on a leash or are caged.

True False

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23. All salons must be equipped with and utilize wet sanitizers with an alcohol base disinfectant.

True False

24. No cosmetology or specialty salon may be operated in the same licensed space allocation with any other business that adversely affects the sanitation of the salon, or in the same licensed space allocation with a school teaching cosmetology or a specialty license.

True False

25. England took the lead in the protection of injured workers in 1838 by passing legislation protecting railroad employees and passengers in the event of accidents.

True False

26. The first "workmen's" compensation law passed in the United States was the Federal Employer's liability act.

True False

27. By 1830 the US had 26 states that had passed employer liabili-ty acts.

True False

28. Florida was the first state to adopt a workmen's compensation law.

True False

29. You do not have the right to report your injury to your employ-er's worker's compensation insurance company.

True False

30. Usually you do not receive your first worker's compensation check until 3 months after reporting your injury.

True False

31. Dermatitis is a general term meaning inflammation of the skin.

True False

32. Your local product supplier is required by federal law to pro-vide you with an MSDS for each product you purchase from them.

True False

33. Every employer is required by OSHA to have an emergency action plan.

True False

34. Ozone is a molecule composed of 6 atoms of oxygen.

True False

35. Several ozone generators have been approved by the federal government.

True False

36. Manufacturers and vendors of ozone devices often use mislead-ing terms to describe ozone.

True False

37. The concentration of ozone is highest where it exits the devise and generally decreases as one moves further away.

True False

38. Ozone generators usually do not have a control setting by which the ozone output can be adjusted.

True False

39. The ability to detect ozone by smell varies considerably from person to person, and one's ability to smell ozone rapidly dete-riorates in the presence of ozone.

True False

40. Bacteria are found virtually everywhere around us, existing in dust, dirt, and decay, our skin and body tissues, the air we breathe, and the water we drink.

True False

41. Potentially harmful bacteria are called nonpathogenic.

True False

42. Viruses are a particular concern in salons because of their potential severity and the way they spread.

True False

43. Ringworm and athlete's foot are two common contagious dis-eases that are spread by animal parasites.

True False

44. One of the primary modes of travel for common contagions is unclean hands.

True False

45. Many health care resources recommend no shaving of the legs before or the day of a salon footbath as scrapes and nicks can make you more susceptible to infection.

True False

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46. Touching sterilized instruments with bare hands, placing them on a surface that is not sterile, or storing in an unsterile com-partment will contaminate the instrument, and require resteril-ization.

True False

47. Salons and spas may use any EPA-approved disinfectants. They are not required to be hospital-level (tuberculocidal) quality.

True False

48. Head rests of chairs should be cleaned with a hospital grade EPA registered disinfectant.

True False

49. Diseases such as tuburculosis, gonorrhea, malaria, and child-hood ear infections are now easier to treat than they were decades ago.

True False

50. Antibiotic resistance has been a problem for nearly as long as we've been using antibiotics.

True False

51. Antibacterials may be divided into two groups according to their speed of action and residue production.

True False

52. Research suggests that most products are recommended or pur-chased based on a skin self-analysis, which is often incorrect.

True False

53. People sometimes talk themselves out of being good retailers because of pride.

True False

54. You should have first-hand, real evidence of product results.

True False

55. You should be committed to your own profits ahead of your client's good health and welfare.

True False

56. More than anything else, communication is the key to selling retail products.

True False

57. A new class of products, called "cosmeceuticals," has emerged that includes vitamins, fermentation products, algae deriva-tives, and other extracts.

True False

58. Companies can make a cosmetic claim only after the FDA con-firms that efficacy claims are based on the proven effectivenessof the active ingredient.

True False

59. Cosmetic products can claim to enhance beauty and sex appeal,even though these are very difficult characteristics to quantify or measure scientifically.

True False

60. The "acute stress response" is an evolutionary reaction to threatening situations.

True False

61. Blame is the best way to resolve a difficult situation.

True False

62. Learning to depersonalize communication and behavior means the realization that, in most cases, the difficulties you encounter are all about you.

True False

63. Negative behaviors or responses often come from our own feelings of insecurity.

True False

64. Assertiveness refers to the spectrum or range of behavior between passivity, at one end, and aggression, at the other.

True False

65. Passive thinking focuses on meeting one's own needs at the expense of others.

True False

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COURSE EVALUATION

This is the attendee's evaluation of the continuing education course (any comments will be appreciated).

(circle one - 1 being the Worst 10 being the Best)

I would rate this course..........................................................1 2 3 4 5 6 7 8 9 10

The content of this course met my expectations....................1 2 3 4 5 6 7 8 9 10

The course material was presented in a clear,concise and well organized format......................................................1 2 3 4 5 6 7 8 9 10

I would recommend this course.............................................YES NO

The material presented met the course’s stated objective......YES NO

I found this course affordable.................................................YES NO

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Did You Remember:

1) to clearly print your name and address on the answer sheet?2) to fill out your license number on the answer sheet?3) to include your payment or credit card information?4) a $10.00 fee will be added for all returned checks.

Thank you for choosing Elite CME for your continuing education.

Elite CME, Inc1453 N. Hwy, US #1, Unit 32

Ormond Beach, FL 32174Toll Free # ~ 1(888)857-6920

Fax # ~ 1(386)615-1812

Elite CME’s continuing education courses are approved by the Board of CosmetologyOur Provider Number is 0001553.