What precautions should be taken while working in a hair salon?

Summary

The following is a short summary of evidence sources that provide high quality information from three rapid reviews, two national guidance's, one provincial guidance, two municipal guidance’s and one single study on what precautions can be taken in a hair salon while providing services to clients.  For additional information about each of the sources, see the Table below.

The Government of Alberta (June, 2020) and Toronto Public Health (October, 2020) guidance states that hairstylists/ barbers must be screened for symptoms before entering premises, and both clients and staff must always wear face coverings when providing or receiving services [6,7,8]. The Centers for Disease Control and Prevention (CDC), Toronto Public Health and the Government of Alberta all state that to protect themselves and others, staff should: 1) disinfect products, tools, and workstations between each client; 2) use single-use supplies where possible; 3) launder reusable fabric after each use; 4) install Plexiglas barriers between workspaces; and 5) frequently wash hands with soap and water for at least 20 seconds [5,6,7].  
 
There is limited evidence and conflicting guidance on the use of hair dryers in salons. Guidance from the CDC, COVID-19 Employer Information for Beauty Salon and Barbershop Employers (November, 2020), states that the use of personal fans and blow dryers are discouraged as they have the potential to spread airborne respiratory droplets that may contain the virus [4]. However, the Government of Alberta and Toronto Public Health state that hairdryers can be used only when both staff and clients are wearing a face covering [6,7,8]. A single study, Absence of Apparent Transmission of SARS-CoV-2 from Two Stylist After Exposure at a Hair Salon with a Universal Face Covering Policy (July, 2020), describes that masking in salon settings is effective at preventing transmission, yet this is still an area of research and the results of a single study are not conclusive due to their quality of evidence [9]. 
 
An absence of high-quality evidence relating to the risks associated with COVID-19 in salon settings and to effective prevention measures is a limitation of this review. Consideration of the evidence relating to heating, ventilation and air conditioning (HVAC) systems may provide information regarding the spread of COVID-19 as a result of hairdryers. Three rapid reviews state that it is unknown if HVAC systems influence the spread of the SARS-CoV-2 viral particles [1,2,3]. The Canadian Agency for Drugs and Technologies in Health describe in its Heating, Ventilation, and Air Conditioning Systems in Public Spaces (September, 2020) rapid review that the larger the SARS-CoV-2 droplet is, the more susceptible the virus is to gravity, which could make it infectious to others through close contact or surface contact [1,3]. The authors of the three rapid reviews note that SARS-CoV-2 viral particles remain in the air for at least 1 hour and on surfaces for up to a few days, but have not demonstrated the virus would be capable of infecting susceptible hosts in this manner [1,2,3]. A combination of ventilation and air purification, or better air exchange, may aid in the prevention of transmission by diluting the concentration of SARS-CoV-2 [1,2].  
 
As of January 14, 2021, the City of Toronto, Peel Region, York Region and North Bay Parry Sound District are in stay-at-home order, therefore, under provincial orders, personal service settings including hair salons, barber shops, nail salons and tattoo parlours must be closed (10,11).  

Evidence

What‘s Trending on Social Media and Media

In June 2020, CTV News in Kitchener, ON released an article on what to expect when hair salons reopen. It was stated that the stylists will no longer offer clients a blow dry in order to help prevent the spread of germs, even when staff and clients wear facemasks. 

iHeart Radio released a segment on seven tips to stay safe at the salon during COVID-19 (June, 2020). A few tips are to: 1) wear a face covering; 2) operate by appointment-only to reduce capacity; and 3) clean and disinfect the workstations between every appointment. 
  

Organizational Scan

The Region of Halton released guidance for operators of personal service settings (September, 2020) to ensure employee and client safety. It was noted that client and service provider must wear a face covering, disinfect workstations and equipment thoroughly between clients, and limit the use of the hair dryer, especially near the face. 
 
Niagara Region Public Health released a summary checklist of required measures to reduce the spread of COVID-19 (June, 2020) while providing services. This checklist states that hair dryers should only be used if all clients and staff in the work area are wearing a face covering. 

Review of Evidence

Resource	Type/Source of Evidence	Last Updated
Heating, Ventilation, and Air Conditioning Systems in Public Spaces — CADTH: Canadian Agency for Drugs and Technologies in Health	Rapid Review	This review states that the evidence about SARS-CoV-2 and modes of its transmission is evolving.   Studies have found the presence of RNA in air samples, but have not conclusively proved that this route of transmission would be capable of infecting suspectable hosts.   Large droplets and aerosols are influenced by air currents, HVAC systems may influence the spread of the virus, but are more likely to benefit as they would dilute the concentration of SARS-CoV-2.   A combination of ventilation and air purification may aid in prevention of the spread of SARS-CoV-2.  Last Updated: September 21, 2020
Transmission of SARS-CoV-2 virus through Heating, Ventilation, and Air Conditioning (HVAC) systems in hospitals or non-hospital settings — Alberta Health Services	Rapid Review	Alberta Health Services states that there is no clear evidence of transmission of SARS-CoV-2 associated with HVAC systems in hospitals or health care facilities, although it is mechanically possible.   Studies that have identified the presence of viral RNA in procedure generated aerosols have not demonstrated viable virus that would be capable of infecting susceptible host.  Rooms with higher air exchanges tend to have less viral RNA detected in the air.   Last Updated: June 4, 2020
Can Air-Conditioning Systems Contribute to the Spread of SARS/MERS/COVID-19 Infection? — Chirico et al.	Rapid Review	This review found that the few COVID-19 investigations available do not provide sufficient evidence that HVAC systems can play a significant role in the indoor outbreaks reported.  Demonstration of the contamination in HVAC systems by SARS-CoV-2 viral particles is currently lacking.   Limited experimental studies in a laboratory-controlled environment demonstrated that aerosolized SARS-CoV-2 particles remained suspended in the air for at least 3 hours, viable in air for at least 1 hour, and on surfaces for up to a few days.   Last Updated: August 19, 2020
COVID-19 Employer Information for Beauty Salon and Barbershop Employers — CDC: Centers for Disease Control and Prevention	National Guidance	The CDC states that to protect staff and clients the use of personal fans and blow dryers are discouraged as they have the potential to spread any airborne respiratory droplets that may contain the virus that causes COVID-19.   The HVAC system in most non-medical buildings play only a small role in infectious disease transmission.  Last Updated: November 11, 2020
What Beauty Salon and Barbershop Employees Need to Know about COVID-19 — CDC: Centers for Disease Control and Prevention	National Guidance	The CDC states that exposure may occur through close contact, touch or handling contaminated surfaces or frequently touched items and then touching face, mouth, nose, or eyes.   Staff can help protect themselves and others by cleaning and disinfecting items or areas between each client, use single-use tools and supplies where possible, launder reusable fabric supplies after each user, and wash hands with soap and water for at least 20 seconds.  Last Updated: November 11, 2020
Guidance for Hair Salons and Barbershops — Government of Alberta	Provincial Guidance	This guidance states that hairstylists should avoid sharing products or tools between workstations.   If sharing is required, clean and disinfect products and tools between users.   Hairstylists should also only use equipment that can be cleaned and disinfected, or disposed of, between clients.   At this time, blow-drying hair is not recommended unless both the stylist and client wear masks.  Last Updated: June 17, 2020
Hair Salons and Barber Shops: COVID-19 Prevention Checklist — Toronto Public Health	Municipal Guidance	This guidance states face coverings must always be worn by staff and clients while indoors and when providing/ receiving services, even when physical distancing or plexiglass/barriers are used.    Used towels must be placed in a laundry bin, and disposable plastic must be discarded in a garbage bin immediately after use.   Hairdryers can be used only when staff and clients are wearing a face covering.  Last Updated: October 20, 2020
Barber and Hair Salon Services in Long-Term Care and Retirement Home Settings — Toronto Public Health	Municipal Guidance	Toronto Public Health notes that hairstylists/ barbers must be screened before entering premises and must always wear a medical mask when indoors, and for the duration of providing personal services to clients. If a client is unable to wear a mask/ face covering when providing services to a client, the stylist/barber is instructed to use a medical mask and eye protection. However, hairdryers are to be used only when stylists and clients are both wearing a mask.  Last Updated: August 17, 2020
Absence of Apparent Transmission of SARS-CoV-2 from Two Stylist After Exposure at a Hair Salon with a Universal Face Covering Policy — Hendrix et al.	Single Study	This study found two stylists in Missouri, USA, with COVID-19 symptoms, who worked closely with 139 clients before receiving diagnoses of COVID-19, that none of their clients developed COVID-19 symptoms.   Among 67 clients tested for COVID-19, all test results were negative.   As a result, the citywide ordinance reduced maximum building waiting area seating to 25% of normal capacity and recommended the use of face coverings by employees and clients at indoor and outdoor public places where physical distancing was not possible.   Last Updated: July 16, 2020
COVID-19 Guidance: Personal Service Settings — City of Toronto	Provincial Guidance	A province-wide declaration of emergency and stay-at-home order was placed into effect on January 14, 2021.  Under provincial orders, personal service settings including hair salons, barber shops, nail salons and tattoo parlours must close.  Last Updated: January 13, 2021
COVID-19 public health measures and restrictions — Ontario Government	Provincial Guidance	As of January 14, 2021, a stay-at-home order is in effect for all of Ontario.  Last Updated: January 11, 2021
COVID-19 Public Health Guidelines: Personal Service Settings — Halton Region	Organizational Scan	Last Updated: September 8, 2020
COVID-19 Guidance for Personal Service Settings — Niagara Region Public Health	Organizational Scan	Last Updated: May 31, 2020
Disclaimer: The summaries provided are distillations of reviews that have synthesized many individual studies. As such, summarized information may not always be applicable to every context. Each piece of evidence is hyperlinked to the original source.