Barbershops
and Infection Risk
There
are three compelling reasons that a jail barbershop may be a focal point for
infection within the facility: First,
from a public health standpoint, there are several communicable diseases of the skin and blood
… to a lesser degree … that are of concern in barbering and hair styling. Secondly, in most jails,
inmates with little or no training in infection control practices do the
haircutting. And thirdly, barbering
tools may be reused without appropriate disinfection, creating an opportunity
for the transmission of bacterial, viral, fungal, or parasitic organisms.
Communicable
Diseases of Concern
The disease
of primary importance in a barbering operation is ringworm; a condition caused
by several species of fungi that is easily transmitted by direct contact, or by
contact with contaminated equipment and towels.
Infestations of head lice known as pediculosis are also spread in the
same way.
Other
diseases of the scalp that are spread in a similar manner include staphylococcal
and other bacterial and yeast infections.
Of these infectious diseases, methycillin
resistant Staphylococcus aureus or MRSA seems to be of greatest concern. Recently published reports from the
One of the
significant problems associated with conditions of the scalp is that they are
not often reported and mostly treated through self-medication. Therefore, a general outbreak among all
inmates is a possibility. In addition,
since the organisms that cause these diseases know no boundaries, correctional
personnel can become infected and carry the infection to their families.
More
recently, the potential spread of viral bloodborne
diseases such as Hepatitis B, C and HIV have been added to the list of risk in
barbering and beauty operations. For instance, the infection
most prevalent in many jails is not MRSA, but the bloodborne
viral diseases such as Hepatitis B and C; with the greatest prevalence being that
of Hepatitis C. These bloodborne diseases are transmitted by direct
contact with an infected individual. A
simple nick caused by a clipper or razor can be the means for their spread.
Finally,
believe it or not, dander and hair clippings can be a source of allergens for
certain atopic (sensitized) individuals and manifest itself by causing a wide
variety of symptoms including eczema and localized or generalized hives and skin
rashes; itching, watery or puffy eyes; respiratory conditions such as nasal
discharges and sneezing, just to mention just a few.
Considering
the potential risk of spreading diseases through barbering, it is therefore
prudent to review your jail’s haircutting operations and take a serious look at
the infection control practices.
The
Jailhouse Barbershop
Ideally,
all barbering and beauty operations should be supervised by licensed
professionals in a committed facility where proper cleaning, disinfection and
personal hygiene is possible. These
facilities should comply with applicable state and local codes. However the
reality of hair cutting and styling, particularly in jails is often left to
unsupervised inmates and performed in inmate living areas; consisting of a
chair or overturned trash container in the day room, a sheet for a drape and a
tool box or cardboard container with the clippers and a comb. If this is the case, a few things can be done
to minimize the risks of disease.
First, hire
a recognized barber or beautician to design a hair cutting and styling program
to meet the needs of your facility. You
provide the security input; they will design the disease prevention. The best
source for these professionals is to either contact a barber or beauty school
or an inspector from the state health agency.
These individuals are well-trained in public health and have extensive
knowledge of applicable codes. They also
have extensive experience in the various methods of cleaning, disinfecting and
personal hygiene. An additional resource
is state sanitarians who oversee the environmental health and safety of
institutions. Most can provide the necessary
resources to make the barbering and beauty operations of your institution safe.
Second,
designate an area for barbering and hair styling that is easily cleanable, with
running water, and has adequate ventilation and lighting. If an area cannot be designated for these
purposes, a portable kit that includes means for cleaning, disinfection and
personal hygiene can be designed and safely used. Control measures require the use of clean,
disinfected instruments and equipment on each inmate; particularly those first
entering the institution. Towels and
drapes should be used only once and instruments such as clippers, combs and
razors should be thoroughly cleaned and disinfected after each use. In addition, personal cleanliness on the part
of the barber or beautician is also an essential control measure. These individuals should wear clean clothing
and wash their hands frequently (also consider the use of hand sanitizers).
Finally,
Inmate barbers who are infected with an organism that is
readily transmitted to others during barbering activities should not work until
they are no longer contagious. Examples
of conditions that can be transmitted during haircutting include purulent
conjunctivitis (pink eye), varicella-zoster
virus (VZV) infections including herpes, shingles and chicken
pox; respiratory illnesses such as colds, influenza, and tuberculosis,
bacterial skin infection such as impetigo or cutaneous
abcesses, pimples and lesions including methicillin-resistant staphylococcus infection (MRSA), and ectoparasites such as scabies and lice. Hepatitis B, Hepatitis C, and HIV are not
transmitted during routine barbering activities and should NOT preclude
employment as a barber.
Most importantly however, is training of inmate barbers
in infection control practices. All
inmates who are to serve as barbers should receive training on disease associated
with barbering and their prevention.
They should undergo post-education testing, and be observed periodically
to ensure adherence with infection control practices and procedures.
Basic
Infection Control Practices
Taking it one step further, the following is a list of minimal
infection control practices relating to barbering and hair styling that should
be included in each jail’s policy and procedure manual: