​About this fact sheet

Colonic lavage, also called colonic irrigation, is a skin penetration procedure under the Public Health Regulation 2022 (the Regulation) and businesses must implement infection control practices to prevent infections spreading from one person to another.

Colonic lavage treatments can spread viral, bacterial, or fungal infections from one client to another through contaminated equipment and surfaces. The procedure can cause other injuries to clients if it is not performed correctly. These can include trauma to the colon, such as ulceration or perforation; and worsen chronic bowel disease such as diverticulitis, Crohn’s disease or haemorrhoids; and thermal shock or scalding.

Businesses can find the rules for skin penetration procedures in the Regulation.

Business construction

The business should be designed and constructed so that it can be easily and correctly cleaned (see fact sheet Skin penetration business design and construction.) Contact the local council to ensure all local rules have been met.

• The colonic treatment system must meet the requirements of the local council and the local water and sewerage authority.
• All toilets or wastewater disposal devices must be connected to the sewer.
• All colonic irrigation systems must have a registered backflow prevention device installed by an accredited plumber and undergo annual testing.
• Water is to meet the requirements of the NSW Health Guidelines. Town water supply should be used, where available.
• If a filtration/disinfection system is installed, it must be maintained in line with the manufacturer’s specification.
• The water used in the treatment must be regulated so it is as close as possible to body temperature to prevent thermal shock and scalding.
• Controls for the colonic systems should be located so clients cannot alter settings once the procedure commences.
• Pumps, other pressure-enhancing devices or suction facilities should not be on the client side of the tank. Mechanisms for regulating water temperature should be installed at the mains and the tank.
• It is recommended that a toilet be provided in each treatment room for both a closed and open system. However:
• For a closed system a toilet for client use must be installed near the room in which the procedure is carried out.
• For an open system a toilet for client use must be in the immediate vicinity of the treatment room.

Equipment

Colonic irrigation equipment is a medical device. It should have an Australian Register of Therapeutic Goods (ARTG) inclusion number (listing or registration).

• All equipment needs to be in good working order, be cleaned and dried after use and be kept in a clean and dry condition.
• All articles that penetrate the skin must be sterile before use.
• Sterilisation must be carried out in a steam-under pressure bench top autoclave in line with AS/NZS 4815:2006 Office-based health care facilities - Reprocessing of reusable medical and surgical instruments and equipment, and maintenance of the associated environment (see fact sheet How to clean and sterilise reusable equipment and instruments).
• Equipment that is difficult to clean and sterilise should be single-use.
• Articles that are used in a skin penetration procedure but do not penetrate the skin, must be correctly cleaned and kept in a clean condition.
• Clean towels and linen must be used for each new client. Linen should be washed in detergent and hot water. If an impervious cover is used (such as plastic), it must be cleaned and disinfected before it is used for each new client.
• Catheters and speculum must be sterile, and it is recommended that they are single-use only. All equipment should be listed on the Register of Therapeutic Goods and have an ARTG number.
• Reusable tubing is difficult to clean and sterilise. It can be difficult to completely remove air from tubing and if air remains in the tubing, the tubing will not be effectively sterilised and therefore must be single-use.

Business hygiene

• The business is to be kept in a clean condition.
• Treatment areas such as benches must be cleaned between each client and/or a clean covering placed over the treatment surface.
• The business should have documented cleaning and maintenance procedures for the fixtures, fittings and equipment, and staff are trained in these procedures.
• All waste should be tightly bagged and disposed of daily.
• Sterile packaging should be opened just prior to starting the treatment.
• Sterile parts of equipment that will penetrate the skin should not be touched with bare hands. If handling sterile equipment is necessary, a pre-packed sterile alcohol swab, a sterile dry swab, or sterile single-use gloves should be used.
• To prevent cross contamination, all liquids and creams must be decanted into single-use containers, and a single-use applicator must be used for each person undergoing the procedure (no double dipping).
• Hospital grade disinfectants must be used in colonic irrigation businesses for the treatment bed, the external irrigation system and ensuite facilities due to the high risk of faecal contamination.

Personal hygiene for practitioners

• The person performing a colonic lavage procedure must wear a clean impermeable gown or apron and single-use gloves.
• Cuts or wounds should be covered with a sealed waterproof bandage.
• Hands should be washed:
• before and after attending to a client
• before and after a procedure
• after exposure to a body substance
• after touching a client’s surroundings
• after the removal of gloves.
• See Hand Hygiene Australia for additional information on how to wash your hands.

Other requirements

• The business must be registered with the local council, meet all necessary planning and building standards, and have all necessary approvals before opening.
• Clinical/biohazard waste must be disposed of by an approved waste contractor. Contact your local council for details.
• Water temperature should be adjusted to the same level as normal body temperature to prevent thermal shock or scalding. The temperature of the water delivery should be 34 to 40°C and should never exceed 40°C (normal body temperature is 37.6°C).
• If a thermostatic mixing valve is used to mix hot and cold water, it must be approved by NSW Health and installed and maintained in accordance with the Regulation.

Fees and penalties

Further action may be taken if a business fails to comply with the Regulation. This may include:

• An Improvement Notice or Prohibition Order accompanied by an administration fee ranging from $285 to $295.
• Penalty notices ranging from $110 to $1100 for an individual and $220 to $2200 for a corporation. Maximum penalties are higher for prosecutions and may include a daily penalty.
• If a Prohibition order is issued, the business must display a copy at or near the entrance to the business where it is clearly visible to customers.
• Prohibition Order reinspections attract a fee of $255 per hour with a minimum charge of 30 minutes and a maximum charge of 2 hours.

Further advice

• Contact your local council.
• Contact your local Public Health Unit by calling 1300 066 055.