Biosafety in HOF: antisepsis, sterile field and PPE

Infection after filler is one of the hardest complications to manage in HOF. It can appear days or months later, sometimes as a nodule, and may be linked to a biofilm, a layer of bacteria attached to the product that resists ordinary treatment. Prevention depends on a set of simple precautions repeated in every procedure: biosafety.

This guide gathers the pillars of biosafety in the HOF office at a review level: hand hygiene, protective equipment, antisepsis, sterile field, materials, sharps and surfaces. The waste plan (PGRSS) and the health authority requirements for opening the clinic are on their own pages, PGRSS in the HOF clinic and ANVISA RDCs for the HOF clinic.

Why does biosafety weigh so much in injectable procedures?

Every injection crosses the skin barrier. In aesthetic procedures there are a few aggravating factors:

• Product that stays in the tissue. Fillers and biostimulators stay for months. A bacterium carried in with the product finds a surface where it can settle.
• Multiple punctures. Skin boosters, toxin and some fillers involve several entry points in the same session.
• Areas near the mouth and nose. Perioral skin and mucosa have abundant flora.
• Late infection mistaken for something else. An inflammatory nodule months later may be infection, a reaction to the product or a granuloma. Investigation is harder when the origin is uncertain.

Infection and biofilm have their own guide in infection and biofilm after filler.

What are the pillars of biosafety in the office?

Hand hygiene: when to do it?

The World Health Organization describes five moments for hand hygiene in care: before touching the patient, before a clean or aseptic procedure, after risk of exposure to body fluids, after touching the patient and after touching surfaces near the patient. In the HOF office, this translates into cleaning your hands when receiving the patient, before putting on gloves for the procedure, after taking them off and after handling the chair, the phone or the patient record.

Gloves do not replace hand hygiene. Gloves must be changed when they touch something outside the field, such as the phone, the chair or the patient's hair.

How to prepare the patient's skin?

Skin preparation usually follows a logical sequence:

1. Complete removal of makeup and sunscreen. Residue hinders the action of the antiseptic and can be carried into the skin.
2. Cleaning the area.
3. Antisepsis with an antiseptic suitable for facial skin, respecting the action time and drying time indicated by the manufacturer. Antiseptics such as chlorhexidine in alcohol solution and 70% alcohol are the most cited in the literature on injectable procedures; the choice considers the area, because near the eyes some antiseptics call for special care.
4. Do not touch the prepared area with a bare hand, non-sterile gauze or hair.
5. Repeat the antisepsis if the area is touched or if the procedure is long and involves several areas.

If there is topical anesthetic, it must be removed completely before antisepsis, because the cream also interferes with preparation. In areas near the mouth, asking the patient not to touch their face and not to lick their lips during the procedure makes a difference.

What is aseptic technique in practice?

Asepsis is the set of measures that prevents contamination. In an injectable procedure, it comes down to one rule: what enters the patient's tissue cannot touch anything that is not sterile. This applies to the needle, the cannula, the product and the parts of the syringe that connect to the instrument.

• Set up the tray only at the moment of use, on a clean, disinfected surface, with a drape.
• Open sterile packaging without touching the contents.
• Change the needle or cannula if it touches something outside the field.
• Use a new needle or cannula for each patient; single-use materials are not reprocessed.
• Avoid excessive talking over the open field and wear a mask during the procedure.

How to handle vials and products?

Toxin storage has a guide in botulinum toxin storage, and lot recording in traceability of injectables.

Sharps and biological exposure accidents

NR-32, the Brazilian occupational standard on safety and health in health services, prohibits recapping and manual disconnection of needles and requires sharps to be discarded in a dedicated, rigid, puncture-resistant container placed near the place of use. The same standard covers vaccination of workers, including the hepatitis B vaccine.

Cleaning surfaces and the environment

• Clean and disinfect the chair, headrest, counter and equipment between patients.
• Use the disinfectant and contact time indicated by the manufacturer, compatible with the surface material.
• Keep the clean area (preparation) and the disposal area separate.
• Reusable instruments go through cleaning and sterilization in a validated process, with records.

What do the regulations say?

Among the most cited regulations for services that perform injectable aesthetic procedures in Brazil are:

Enforcement belongs to the health authority of the municipality, state or Federal District, which may have its own requirements. Professional councils also have rules on the practice of each profession. Confirm with the local health authority and with your council what applies to your type of service. The licensing part is in health license for the HOF clinic.

How to explain it to the patient?

Patients notice biosafety and associate it with care. Explaining what you are doing also helps them cooperate.

And in Harmy?

Biosafety checklist before each procedure

1. Hands cleaned and appropriate PPE.
2. Photos taken before antisepsis, with the phone outside the field.
3. Makeup, sunscreen and topical anesthetic completely removed.
4. Skin cleaned and prepared with antiseptic, respecting time and drying.
5. Active lesion in the area ruled out.
6. Tray set up at the moment, with sterile, single-use material.
7. Lot and expiry of the products recorded.
8. Sharps container within reach and no recapping.
9. Surfaces cleaned and disinfected between patients.

To turn this list into a room routine, see the HOF procedure room checklist.