NÁVRH REŽIMOVÝCH A ORGANIZAČNÍCH OPATŘENÍ PRO PROVOZ SLUŽEB KADEŘNICTVÍ, VČETNĚ KADEŘNICKÝCH SALÓNŮ.

Hlavnímu hygienikovi ČR:


Dobrý den,
jménem kadeřnického cechu Esthete author z.s., registrovaného hospodářskou komorou, se vás do-voluji oslovit při řešení hygienických předpisů pro provoz kadeřnických pracovišť v rámci opětov-ného vstupu do režimu 4. stupně dle tabulky PES.


Tento návrh se zakládá na reálné studii, která je podložená a popsaná v několika případech, které se staly během první vlny pandemie na území USA, zveřejněné Centrem pro kontrolu a prevenci ne-mocí – Americké ministerstvo zdravotnictví a sociálních služeb.

Studie popisuje případy, kdy covid – pozitivní kadeřníci prováděli služby. V důsledku pečlivé ochrany a dodržování bezpečnostních předpisů však nedošlo k žádnému přenosu cov-19 na klienta.

Jeden z důležitých postřehů:
Kadeřník provádí službu, kdy klienti jsou obráceni od kadeřníka, zákazník sedí na kadeřnickém křesle a jeho obličej směřuje přímo do zrcadla, přičemž kadeřník se pohybuje v 95 % - tech služby za zákazníkem (za jeho zády) a po jeho stranách asi metr od klienta, což má omezený vliv na přenos infekce. Toto platí i pro mytí vlasů, barvení vlasů a další jiné úkony. Můžeme říct, že přímému kon-taktu obličej-obličej dochází asi v 5 % - tech celkové služby, a to zejména při úpravě ofiny. Pak bych také zdůraznil, že používané nástroje, především fény a žehličky jsou vybaveny ionizačními tryskami a při jejich používání dochází k částečné dezinfekci pracovního prostředí.


Jako poslední je důležité vnímat kadeřnickou službu jako službu relaxačního typu, kde člověk není fyzicky namáhán a díky tomu minimalizuje kontaminaci prostředí v bezprostředním styku s klien-tem bez vlivu rychlého a hlubokého dýchání.
Tento prostor, ve kterém se nachází jak klient, tak i poskytovatel služby – kadeřník, by měl být dle našeho názoru 16 m2, a to z důvodů dodržování vzájemných rozestupů mezi pracovními místy - 2 m na každou stranu.
Výsledky této studie lze použít k informování o politice veřejného zdraví během pandemie COVID-19. Pravidlo vyžadující použití krycích vrstev na obličej pravděpodobně přispělo k zabránění pře-nosu SARS-CoV-2 během kontaktních interakcí mezi stylisty a klienty v salonu.

Důsledné a správné používání roušek na obličeji je důležitý nástroj pro minimalizaci šíření SARS-CoV-2 od presymptomatických, asymptomatických a symptomatických osob. CDC doporučuje zá-sady na pracovišti, které se týkají především používání obličejových masek/roušek jak pro zaměstnance, tak i pro klienty a mimo to i každodenní sledování známek a příznaků COVID-19 na zaměstnancích. Použití roušek a dodržení předepsaných zásad je tedy dostačujícím způsobem k zabránění přenosu infekce COVID-19 při kadeřnické praxi.

Jan Pešan
Prezident spolku Esthete author z.s.
tel. 776 706 067
email: info@estheteauthor.com

 

STUDIE

Absence of Apparent Transmission of SARS-CoV-2 from Two Stylists After Exposure at a Hair Salon with a Universal Face Covering Po-licy — Springfield, Missouri, May 2020

Weekly / July 17, 2020 / 69(28);930-932

On July 14, 2020, this report was posted online as an MMWR Early Release.

M. Joshua Hendrix, MD1; Charles Walde, MD2; Kendra Findley, MS3; Robin Trotman, DO4 (View author affiliations)
View suggested citation

Summary

What is already known about this topic?
Consistent and correct use of cloth face coverings is recommended to reduce the spread of SARS-CoV-2.

What is added by this report?
Among 139 clients exposed to two symptomatic hair stylists with confirmed COVID-19 while both the stylists and the clients wore face masks, no symptomatic secondary cases were reported; among 67 clients tested for SARS-CoV-2, all test results were negative. Adherence to the community’s and company’s face-covering policy likely mitigated spread of SARS-CoV-2.
What are the implications for public health practice?

As stay-at-home orders are lifted, professional and social interactions in the community will present more opportunities for spread of SARS-CoV-2. Broader implementation of face covering policies could mitigate the spread of infection in the general population.
On May 12, 2020 (day 0), a hair stylist at salon A in Springfield, Missouri (stylist A), developed re-spiratory symptoms and continued working with clients until day 8, when the stylist received a po-sitive test result for SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19). A second hair stylist (stylist B), who had been exposed to stylist A, developed respiratory symptoms on May 15, 2020 (day 3), and worked with clients at salon A until day 8 before seeking testing for SARS-CoV-2, which returned a positive result on day 10. A total of 139 clients were directly servi-ced by stylists A and B from the time they developed symptoms until they took leave from work. Stylists A and B and the 139 clients followed the City of Springfield ordinance* and salon A policy recommending the use of face coverings (i.e., surgical masks, N95 respirators,† or cloth face cove-rings) for both stylists and clients during their interactions. Other stylists at salon A who worked closely with stylists A and B were identified, quarantined, and monitored daily for 14 days after their last exposure to stylists A or B. None of these stylists reported COVID-19 symptoms. After stylist B received a positive test result on day 10, salon A closed for 3 days to disinfect frequently touched and contaminated areas. After public health contact tracings and 2 weeks of follow-up, no COVID-19 symptoms were identified among the 139 exposed clients or their secondary contacts. The citywide ordinance and company policy might have played a role in preventing spread of SARS-CoV-2 during these exposures. These findings support the role of source control in preven-ting transmission and can inform the development of public health policy during the COVID-19 pandemic. As stay-at-home orders are lifted, professional and social interactions in the community will present more opportunities for spread of SARS-CoV-2. Broader implementation of masking policies could mitigate the spread of infection in the general population.

Stylist A worked from day 0 to day 8 with COVID-19 symptoms before receiving a diagnosis of COVID-19 by polymerase chain reaction (PCR) testing. Although self-isolation was recommended after testing on day 6, stylist A continued to work until the test returned a positive result, at which time stylist A was excluded from work by salon A. On day 3, after working with stylist A, stylist B developed respiratory symptoms. During Stylist A’s symptomatic period, the two stylists interacted while neither was masked during intervals between clients. Stylist B worked from day 3 to day 8 while symptomatic before self-isolating and seeking PCR testing, which returned a positive result for SARS-CoV-2 on day 10. Stylist A worked with clients for 8 days while symptomatic, as did sty-list B for 5 days. During all interactions with clients at salon A, stylist A wore a double-layered cot-ton face covering, and stylist B wore a double-layered cotton face covering or a surgical mask.

The Greene County Health Department (Missouri) conducted contact tracing for all 139 exposed clients back to the dates that stylists A and B first developed symptoms. The 139 clients were moni-tored after their last exposure at salon A. Clients were asked to self-quarantine for 14 days and were called or sent daily text messages to inquire about any symptoms; none reported signs or symptoms of COVID-19. Testing was offered to all clients 5 days after exposure, or as soon as possible for those exposed >5 days before contact tracing began. Overall, 67 (48.2%) clients volunteered to be tested, and 72 (51.8%) refused; all 67 nasopharyngeal swab specimens tested negative for SARS-CoV-2 by PCR. Telephone interviews were attempted 1 month after initial contact tracings to coll-ect supplementary information. Among the 139 exposed clients, the Greene County Health Depart-ment interviewed 104 (74.8%) persons.

Among the 139 clients, the mean age was 52 years (range = 21–93 years); 79 clients (56.8%) were male (Table 1). Salon appointments ranged from 15 to 45 minutes in length (median = 15 minutes; mean = 19.5 minutes). Among the 104 interviewed clients, 102 (98.1%) reported wearing face coverings for their entire appointment, and two (1.9%) reported wearing face coverings part of the time (Table 2). Types of face covering used by clients varied; 49 (47.1%) wore cloth face cove-rings, 48 (46.1%) wore surgical masks, five (4.8%) wore N95 respirators, and two (1.9%) did not know what kind of face covering they wore. Overall, 101 (97.1%) interviewed clients reported that their stylist wore a face covering for the entire appointment; three did not know. When asked about the type of face coverings worn by the stylists, 64 (61.5%) reported that their stylist wore a cloth face covering (39; 37.5%) or surgical mask (25; 24.0%); 40 (38.5%) clients did not know or re-member the type of face covering worn by stylists. When asked whether they had experienced re-spiratory symptoms in the 90 days preceding their appointment, 87 (83.7%) clients reported that they had not. Of those who did report previous symptoms, none reported testing for or diagnosis of COVID-19.

Six close contacts of stylists A and B outside of salon A were identified: four of stylist A and two of stylist B. All four of stylist A’s contacts later developed symptoms and had positive PCR test results for SARS-CoV-2. These contacts were stylist A’s cohabitating husband and her daughter, son-in-law, and their roommate, all of whom lived together in another household. None of stylist B’s con-tacts became symptomatic.

DISCUSSION
SARS-CoV-2 is spread mainly between persons in close proximity to one another (i.e., within 6 feet), and the more closely a person interacts with an infected person and the longer the interaction, the higher the risk for transmission (1). At salon A in Springfield, Missouri, two stylists with CO-VID-19 symptoms worked closely with 139 clients before receiving diagnoses of COVID-19, and none of their clients developed COVID-19 symptoms. Both stylists A and B, and 98% of the inter-viewed clients followed posted company policy and the Springfield city ordinance requiring face coverings by employees and clients in businesses providing personal care services. The citywide ordinance reduced maximum building waiting area seating to 25% of normal capacity and recom-mended the use of face coverings at indoor and outdoor public places where physical distancing was not possible. Both company and city policies were likely important factors in preventing the spread of SARS-CoV-2 during these interactions between clients and stylists. These results support the use of face coverings in places open to the public, especially when social distancing is not pos-sible, to reduce spread of SARS-CoV-2.

Although SARS-CoV-2 is spread largely through respiratory droplets when an ill person coughs or sneezes (1), data suggest that viral shedding starts during the 2-to-3-day period before symptom on-set, when viral loads are at their highest (2). Although the rate of transmission of SARS-CoV-2 from presymptomatic patients (those who have not yet developed symptoms) and asymptomatic persons (those who do not develop symptoms) is unclear, these persons likely contribute to the spread of SARS-CoV-2 (3). With the potential for presymptomatic and asymptomatic transmission, widespread adoption of policies requiring face coverings in public settings should be considered to reduce the impact and magnitude of additional waves of COVID-19.
Previous studies show that both surgical masks and homemade cloth face coverings can reduce the aerosolization of virus into the air and onto surfaces (4,5). Although no studies have examined SARS-CoV-2 transmission directly, data from previous epidemics (6,7) support the use of universal face coverings as a policy to reduce the spread of SARS-CoV-2, as does observational data for CO-VID-19 in an analysis of 194 countries that found a negative association between duration of a face mask or respirator policy and per-capita coronavirus-related mortality; in countries that did not re-commend face masks and respirators, the per-capita coronavirus-related mortality increased each week by 54.3% after the index case, compared with 8.0% in those countries with masking policies (CT Leffler, Virginia Commonwealth University, unpublished data, 2020).§ Similar outcomes have been observed for other respiratory virus outbreaks, including the 2002–04 outbreak of Severe Acute Respiratory Syndrome (SARS) (6) and the 2007–08 influenza season (7). A systematic re-view on the efficacy of face coverings against respiratory viruses analyzed 19 randomized trials and concluded that use of face masks and respirators appeared to be protective in both health care and community settings (8).

The findings in this report are subject to at least four limitations. First, whereas the health depart-ment monitored all exposed clients for signs and symptoms of COVID-19, and no clients developed symptoms, only a subset was tested; thus, asymptomatic clients could have been missed. Similarly, with a viral incubation period of 2–14 days, any COVID-19 PCR tests obtained from clients too early in their course of infection could return false-negative results. To help mitigate this possibility, all exposed clients were offered testing on day 5 and were contacted daily to monitor for symptoms until day 14. Second, although the health department obtained supplementary data, no information was collected regarding underlying medical conditions or use of other personal protective measures, such as gloves and hand hygiene, which could have influenced risk for infection. Third, viral shed-ding is at its highest during the 2 to 3 days before symptom onset; any clients who interacted with the stylists before they became symptomatic were not recruited for contact tracing. Finally, the mode of interaction between stylist and client might have limited the potential for exposure to the virus. Services at salon A were limited to haircuts, facial hair trimmings, and perms. Most stylists cut hair while clients are facing away from them, which might have also limited transmission.

The results of this study can be used to inform public health policy during the COVID-19 pande-mic. A policy mandating the use of face coverings was likely a contributing factor in preventing transmission of SARS-CoV-2 during the close-contact interactions between stylists and clients in salon A. Consistent and correct use of face coverings, when appropriate, is an important tool for mi-nimizing spread of SARS-CoV-2 from presymptomatic, asymptomatic, and symptomatic persons. CDC recommends workplace policies regarding use of face coverings for employees and clients in addition to daily monitoring of signs and symptoms of employees, procedures for screening em-ployees who arrive with or develop symptoms at work, and posted messages to inform and educate employees and clients (https://www.cdc.gov/coronavirus/2019-ncov/community/organizati-ons/businesses-employers.html).

ACKNOWLEDGMENTS
Alina Ainyette, Megan Rippee-Brooks, Jodi Caruthers.
Corresponding author: Robin Trotman, robintrotman@sbcglobal.net.

1 Washington University School of Medicine, St. Louis, Missouri; 2University of Kansas Medical Center, Kansas City, Missouri; 3 Springfield-Greene County Health Department, Springfield, Mis-souri; 4CoxHealth Infection Prevention Services, Springfield, Missouri.

All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. Robin Trotman reports personal fees from Merck outside the published work. No other potential conflicts of interest were disclosed.

Springfield, Missouri, city ordinance went into effect May 6, 2020, restricted seating in waiting areas to 25% of normal capacity and recommended social distancing and use of face coverings for employees and clients when social distancing was not or could not be followed. https://www.sprin-gfieldmo.gov/5140/Masks-and-Face-Coveringsexternal icon.
† Particulate-filtering facepiece respirators that filter ≥95% of airborne particles (https://www.cdc.gov/niosh/npptl/topics/respirators/disp_part/n95list1.html).
§ https://doi.org/10.1101/2020.05.22.20109231external icon.

REFERENCES
1. CDC. Clinical questions about COVID-19: questions and answers. Atlanta, GA: US Department of Health and Human Services, CDC; 2020. https://www.cdc.gov/coronavirus/2019-ncov/hcp/faq.html
2. He X, Lau EHY, Wu P, et al. Temporal dynamics in viral shedding and transmissibility of COVID-19. Nat Med 2020;26:672–5. CrossRefexternal icon PubMedexternal icon
3. Oran DP, Topol EJ. Prevalence of asymptomatic SARS-CoV-2 infection: a narrative review. Ann Intern Med 2020;M20–3012. CrossRefexternal icon PubMedexternal icon
4. Konda A, Prakash A, Moss GA, Schmoldt M, Grant GD, Guha S. Aerosol filtration efficiency of common fabrics used in respiratory cloth masks. ACS Nano 2020;14:6339–47. CrossRefexternal icon PubMedexternal icon
5. MacIntyre CR, Seale H, Dung TC, et al. A cluster randomised trial of cloth masks compared with medical masks in healthcare workers. BMJ Open 2015;5:e006577. CrossRefexternal icon PubMedexternal icon
6. Lau JT, Tsui H, Lau M, Yang X. SARS transmission, risk factors, and prevention in Hong Kong. Emerg Infect Dis 2004;10:587–92. CrossRefexternal icon PubMedexternal icon
7. Aiello AE, Perez V, Coulborn RM, Davis BM, Uddin M, Monto AS. Facemasks, hand hygiene, and influenza among young adults: a randomized intervention trial. PLoS One 2012;7:e29744. CrossRefexternal icon Pub-Medexternal icon
8. MacIntyre CR, Chughtai AA. A rapid systematic review of the efficacy of face masks and respirators against coronaviruses and other respiratory transmissible viruses for the community, healthcare workers and sick patients. Int J Nurs Stud 2020;108:103629. CrossRefexternal icon PubMedexternal icon