COVID-19 INDUSTRY GUIDANCE:

Expanded Personal Care Services

July 2, 2020

All guidance should be implemented only with county health officer approval following their review of local epidemiological data including cases per 100,000 population, rate of test positivity, and local preparedness to support a health care surge, vulnerable populations, contact tracing, and testing.

Overview

On March 19, 2020, the State Public Health Officer and Director of the California Department of Public Health issued an order requiring most Californians to stay at home to disrupt the spread of COVID-19 among the population.

The impact of COVID-19 on the health of Californians is not yet fully known. Reported illness ranges from very mild (some people have no symptoms) to severe illness that may result in death. Certain groups, including people aged 65 or older and those with serious underlying medical conditions, such as heart or lung disease or diabetes, are at higher risk of hospitalization and serious complications. Transmission is most likely when people are in close contact or in a poorly ventilated area with an infected person, even if that person does not have any symptoms or has not yet developed symptoms.

Precise information about the number and rates of COVID-19 by industry or occupational groups, including among critical infrastructure workers, is not available at this time. There have been multiple outbreaks in a range of workplaces, indicating that workers are at risk of acquiring or transmitting COVID-19 infection. Examples of these workplaces include hospitals, long-term care facilities, prisons, food production, warehouses, meat processing plants, and grocery stores.

As stay-at-home orders are modified, it is essential that all possible steps be taken to ensure the safety of workers and the public.
Key prevention practices include:

  • physical distancing to the maximum extent possible,

  • use of face coverings by workers (where respiratory protection is not required) and customers/clients,

  • frequent handwashing and regular cleaning and disinfection,

  • training workers on these and other elements of the COVID-19 prevention plan.
    In addition, it will be critical to have in place appropriate processes to identify new cases of illness in workplaces and, when they are identified, to intervene quickly and work with public health authorities to halt the spread of the virus.

Purpose

This document provides guidance for expanded personal care services, which includes personal care that requires touching a client’s face, e.g. facials, electrolysis, and waxing. This guidance applies to esthetic, skin care, cosmetology, electrology, nail services, body art professionals, tattoo parlors, and piercing shops, and massage therapy (in non-healthcare settings). This guidance is intended to support a safe, clean environment for workers and customers. Establishment license holders must acknowledge that renters or lessees should only resume operations when they are ready and able to implement the necessary safety measures to provide for their safety and that of their customers.

The guidance is not intended to revoke or repeal any worker rights, either statutory, regulatory, or collectively bargained and is not exhaustive, as it does not include county health orders, nor is it a substitute for any existing safety and health-related regulatory requirements such as those of Cal/OSHA or the California Board of Barbering and Cosmetology.1 Stay current on changes to public health guidance and state/local orders, as the COVID-19 situation continues. Cal/OSHA has more comprehensive guidance on their Cal/OSHA General Guidelines on Protecting Workers from COVID-19 webpage. CDC has additional requirements in their guidance for businesses and employers.

Required Use of Face Coverings

On June 18, CDPH issued Guidance on the Use of Face Coverings, which broadly
requires the use of face coverings for both members of the public and workers in all
public and workplace settings where there is a high risk of exposure.

People in California must wear face coverings when they are engaged in work,
whether at the workplace or performing work off-site, when:

  • Interacting in-person with any member of the public;

  • Working in any space visited by members of the public, regardless of whether anyone from the public is present at the time;

  • Working in any space where food is prepared or packaged for sale or distribution to others;

  • Working in or walking through common areas, such as hallways, stairways, elevators, and parking facilities;

  • In any room or enclosed area where other people (except for members of the person’s own household or residence) are present when unable to physically distance; or,

  • Driving or operating any public transportation or paratransit vehicle, taxi, or private car service or ride-sharing vehicle when passengers are present. When no passengers are present, face coverings are strongly recommended.

Complete details, including all requirements and exemptions to these rules, can be found in the guidance. Face coverings are strongly encouraged in other
circumstances, and employers can implement additional face covering
requirements in fulfilling their obligation to provide workers with a safe and healthful workplace. Employers should provide face coverings to workers or reimburse workers for the reasonable cost of obtaining them.

Employers should develop an accommodation policy for any worker who meets oneof the exemptions from wearing a face covering. If a worker who would otherwise be required to wear a face covering because of frequent contact with others cannot wear one due to a medical condition, they should be provided with a non-restrictive alternative, such as a face shield with a drape attached to the bottom edge, if feasible, and if the medical condition permits it.

Businesses that are open to the public should be cognizant of the exemptions to wearing face coverings in the CDPH Face Covering Guidance and may not exclude any member of the public for not wearing a face covering if that person is complying with the guidance. Businesses will need to develop policies for handling these exemptions among customers, clients, visitors, and workers.

Workplace Specific Plan

  • Establish a written, workplace-specific COVID-19 prevention plan at every
    location, perform a comprehensive risk assessment of all work areas and work tasks, and designate a person at each facility to implement the plan.

  • Incorporate the CDPH Face Covering Guidance into the Workplace Specific Plan and include a policy for handling exemptions.

  • Identify contact information for the local health department where the facility is located for communicating information about COVID-19 outbreaks among workers or customers.

  • Train and communicate with workers and worker representatives on the plan and make the plan available to workers and their representatives.

  • Regularly evaluate the workplace for compliance with the plan and document and correct deficiencies identified.

  • Investigate any COVID-19 illness and determine if any work-related factors could have contributed to risk of infection. Update the plan as needed to prevent further cases.

  • Implement the necessary processes and protocols when a workplace has an outbreak, in accordance with CDPH guidelines.

  • Identify close contacts (within six feet for 15 minutes or more) of an infected worker and take steps to isolate COVID-19 positive worker(s) and close contacts.

  • Adhere to the guidelines below. Failure to do so could result in workplace illnesses that may cause operations to be temporarily closed or limited.

Individual Control Measures and Screening

  • Provide temperature and/or symptom screenings for all workers at the
    beginning of their shift and any vendors or contractors entering the establishment. Make sure the temperature/symptom screener avoids close contact with workers to the extent possible.

  • If requiring self-screening at home, which is an appropriate alternative to providing it at the establishment, ensure that screening was performed prior to the worker leaving the home for their shift and follows CDC guidelines, as described in the Topics for Worker Training section above.

  • Encourage workers and customers who are sick or exhibiting symptoms of COVID-19 to stay home.

  • Employers must provide and ensure workers use all required protective equipment, including eye protection, gloves, and face shields where necessary.

  • Employers should consider where disposable glove use may be helpful to supplement frequent handwashing or use of hand sanitizer; examples are for workers who are screening others for symptoms or handling commonly touched items. Workers should wear gloves when handling items contaminated by body fluids.

  • Disposable gloves should be worn for services that require them. Wearing gloves should be done in conjunction with regular hand washing and is not a substitute for regular hand washing.

  • Contact customers before visits to confirm appointments and ask if they or someone in their household is exhibiting any COVID-19 symptoms. If the customer answers in the affirmative, reschedule the appointment. Such communication can be done via phone, app, email, or text to remind customers that they should only come to the facility for their appointment if they do not pose a health risk to other customers or workers. In order to implement pre-screening protocols and ensure physical distancing protocols, consider suspending walk-in appointment availability.

  • Tell customers that no additional friends or family will be permitted in the facility, except for a parent or guardian accompanying a minor.

  • Customers should be temperature and/or symptom screened upon arrival. Be prepared to cancel or reschedule customers who indicate they have any signs of illness.

  • Display a set of guidelines for customers that are to be a condition of entry. The guidelines must include instructions to wear face coverings, use hand sanitizer, maintain physical distance from other customers, and they should communicate changes to service offerings. The guidelines should be posted in clearly visible locations, including at entrances, include pictograms, and be made available digitally (e.g. through email).

Cleaning and Disinfecting Protocols

  • Ensure that coworkers, fellow tenants, booth renters, and/or staff have coordinated and put a plan in place for cleaning and disinfection at the beginning and end of each shift and in between customers. Perform thorough cleaning in high traffic areas, such as reception areas, and areas of ingress and egress including stairways, stairwells, and handrails.

  • Frequently disinfect commonly used surfaces including credit card terminals, counters, reception area seating, door handles, light switches, phones, toilets, and handwashing facilities.

  • Evaluate existing hygiene and sanitation protocols and cleaning processes and update where necessary. Use hospital grade, Environmental Protection Agency (EPA)-approved products to clean and disinfect anything the client came in contact with, including treatment tables, face cradles, stools, bolsters, door knobs, side tables, chairs, etc. Follow the product manufacturer’s recommendations for contact time. Use
    disinfectants labeled to be effective against emerging viral pathogens, diluted household bleach solutions (5 tablespoons per gallon of water), or alcohol solutions with at least 70% alcohol that are appropriate for the surface. Provide workers training on the chemical hazards, manufacturer’s directions for use, ventilation requirements, and Cal/OSHA requirements for safe use. Workers using cleaners or disinfectants should wear gloves and other protective equipment as required by the product. Follow the asthma-safer cleaning methods recommended by the California Department of Public Health and ensure proper ventilation.

  • Since porous surfaces such as chair seats cannot be easily disinfected, consider covering with a plastic or disposable liner and cleaning or disposing of the liner after each customer.

  • All appliances at work stations and in treatment rooms should be properly disinfected between each customer.

    • For non-porous implements, such as tweezers or scissors, clean the item with hot, soapy water to remove any physical debris. Rinse and dry the implement completely. Follow by immersing the implement in an EPA-registered liquid disinfectant that is labeled as a bactericide, fungicide, and virucide for the full contact time as stated by the manufacturer’s directions. Items should be removed at the end of contact time, rinsed, and dried with a clean paper towel.

    • For electrical implements such as magnifying LED lamps, hot towel warmers, and esthetic devices, clean the implement with a spray or wipe to remove any physical debris. Follow with an EPA-registered disinfectant spray or wipe for the full contact time as noted by the manufacturer’s directions. Use caution when using a spray and be sure your device is unplugged and do not spray into the motor. For electronics such as tablets, touch screens, keyboards, remote controls, and ATM machines, remove visible contamination if present. Follow the manufacturer’s instructions for all cleaning and disinfection products. Consider use of wipeable covers for electronics. If no manufacturer guidance is available, consider the use of alcohol-based wipes or sprays containing at least 60% alcohol to disinfect touch screens. Dry surfaces thoroughly to avoid pooling of liquids.

  • To minimize the risk of Legionnaires’ disease and other diseases associated with water, take steps to ensure that all water systems (e.g., drinking fountains) are safe to use after a prolonged facility shutdown.

  • Where linens are used, even if the customer does not get under them, the linens should still be removed and the bed or table properly disinfected. Treatment tables must be covered with either clean treatment table paper, a clean towel, or a clean sheet after each use.

  • Workers should wear disposable gloves when removing used linens, towels, and other draping, including blankets and client draping for each treatment. Do not shake the dirty laundry. Place used linens in a lined, lidded receptacle positioned outside the treatment space, if possible, to minimize the possibility of dispersing virus in the air. Dirty linens should not be used again until properly laundered either by a commercial laundering service or a laundering process which includes immersion in water of at least 160 degrees Fahrenheit for at least 25 minutes. Store all clean linens in a clean, covered place.

  • Where possible, do not clean floors by sweeping or other methods that can disperse pathogens into the air. Use a vacuum with a HEPA filter wherever possible.

  • Workers should consider changing their own clothes after each customer or wearing scrubs or a clean, launderable or disposable smock, if available.

  • Consider removing items (e.g., throw pillows, fabric-lined chairs, seat cushions) with surfaces that cannot be cleaned properly. Have a hard-surfaced, non-porous chair or large hard-surfaced or plastic basket for clients to put their clothes on or in.

  • Amenities, including magazines, art books, coffee, water, self-serve stations (unless touchless), and other items for customers, must be removed from reception areas to help reduce touch points and customer interactions. Do not allow food or beverages to be at stations or in treatment rooms.

  • Thoroughly clean any product display areas, including all shelving and
    display cases. Remove and discard any open “test” products and
    discontinue this practice to help reduce contamination. Add signage to this area to let customers know it is cleaned and disinfected daily.

  • Encourage the use of credit cards and contactless payment systems. If electronic or card payment is not possible, customers should come with exact cash payment or check.

  • Consider upgrading to touchless faucets, soap and paper towel dispensers, and adding touchless, automatic hand sanitizer dispensers. Ensure soap dispensers and paper towel dispensers are regularly filled.

  • Equip reception areas and workstations with proper sanitation products, including hand sanitizer and sanitizing wipes.

  • Provide time for workers to implement cleaning practices during their shift. Cleaning assignments should be assigned during working hours as part of the worker’s job duties.

  • Workers should avoid sharing phones, tablets, laptops, desks, pens, and other work supplies, wherever possible. Never share PPE.

  • Discontinue the use of shared food and beverage equipment in break rooms (including shared coffee brewers).

  • Consider opening treatment room windows, if feasible and within security protocols. Consider installing portable high-efficiency air cleaners, upgrading the building’s air filters to the highest efficiency possible, and making other modifications to increase the quantity of outside air and ventilation in all working areas.

  • In addition to the above cleaning and disinfecting protocols cosmetology, barbering, and electrology businesses must follow the existing California Board of Barbering and Cosmetology rules. Additional rules may also apply for businesses at the local, county-level.

Physical Distancing Guidelines

  • Implement measures to ensure physical distancing of at least six feet between and among workers and customers, except while providing the services that require close contact. This can include use of physical partitions or visual cues (e.g., floor markings, colored tape, or signs to indicate to where workers and/or customers should stand).

  • Maintain at least six feet of physical distance between each work station area, and/or use impermeable barriers between work stations to protect customers from each other and workers.

  • Stagger appointments to reduce reception congestion and ensure adequate time for proper cleaning and disinfection between each customer visit. Consider servicing fewer customers each day or expanding operating hours to allow for more time between customers and suspending walk-in appointments.

  • If possible, implement virtual check-in technology to ensure that workers are notified when a customer arrives. Ask customers to wait outside or in their cars rather than congregating in reception areas. Reception areas should only have one customer at a time or the area should be modified to support adequate physical distancing, including removing chairs and sofas or spacing them further apart.

  • Take measures at reception desks or other areas where physical distancing cannot be maintained to minimize exposure between workers and customers, such as Plexiglas or other barriers.

  • Consider offering workers who request modified duties options that minimize their contact with customers and other workers (e.g., managing inventory or managing administrative needs through telework).

  • Require workers to avoid handshakes, fist bumps, hugs, or similar greetings that break physical distance.

  • Discourage workers from congregating in high traffic areas, such as bathrooms, hallways, or credit card terminals.

  • Close breakrooms, use barriers, or increase distance between tables/chairs to separate workers and discourage congregating during breaks. Where possible, create outdoor break areas with shade covers and seating that ensures physical distancing.

  • Adjust any staff meetings to ensure physical distancing. Hold meetings over the phone or via webinar for workers wherever possible.

Additional Considerations for Esthetic, Skin Care, and Cosmetology Services

  • Workers should wear a face shield for eye protection (with a face covering) when they are providing clients treatment on facial or neck areas that do not enable the client to wear a face covering.

  • Disposable gloves should be worn throughout the entire esthetic service and while performing cleaning and disinfection of all implements and surfaces after each client session.

  • Before leaving the treatment room, remove and dispose of gloves, apply proper hand sanitizer or wash hands with soap and water, and use a previously readied disposable barrier, such as a paper towel or sanitizer wipe, to open and close the treatment room door while leaving the room.

  • Single use applicators must be used and disposed of immediately after use in a lined trash bin. The trash bin should have a lid and should be lined with a disposable plastic bag.

Additional Considerations for Electrology Services

  • Electrologists must use disposable gloves during the client’s entire treatment. Electrologists should wear a face shield for eye protection (with a face covering) when they are providing clients treatment on facial or neck areas that do not enable the client to wear a face covering.

  • Clients having any other areas treated should be required to wear a face covering throughout the service, if able to wear one per the CDPH Face Covering Guidance.

  • Tweezers, rollers, and needle holder caps should be properly cleaned and sterilized between each client. This could include the use of an autoclave or placing the items in a sealed pouch and sterilizing them in a dry heat
    sterilizer. The pouch should not be reopened until the next client’s
    treatment session begins.

  • Where possible, use disposable probes that do not require a probe tip or cap, which will reduce exposure points. If not using disposable probe tips or caps, the removable tip or cap of the epilator needle/probe holder must be cleaned and disinfected after each client.

  • Needles used for electrolysis must be single-use, disposable, prepackaged, and sterile and disposed of in an approved sharps container immediately after use. Sharps containers must be discarded in accordance with biomedical waste regulation.

  • Heat produced by the electrical current passing through an electrolysis needle is not sufficient to sterilize it.

  • Ultrasonic cleaning units, forceps, and all containers, including their removable parts, must be cleaned and disinfected between each client according to the manufacturer’s instructions.