About this fact sheet

This fact sheet has been developed by NSW Health to assist colonic lavage practitioners and operators of colonic lavage clinics to adopt good infection control practices. Good infection control will prevent the spread of disease, as well as enable colonic lavage practitioners and operators to meet the requirements of the Public Health Regulation, 2012.

Procedures that involve skin penetration carry a greater risk of spreading disease because microorganisms (germs) can easily enter the body when the skin barrier is broken. Colonic lavage is an invasive procedure. If strict hygienic procedures are not followed, a variety of bacterial and viral diseases can be spread from one client to another or even to many others causing an outbreak of disease.

Premises - registration, construction and materials

• All premises that carry out skin penetration procedures, including colonic lavage, must be registered with the local council. Notification forms are available from the Public health legislation.
• The construction of the premises should meet with local council requirements.
• The finish on all surfaces within the premises should be made of materials that are easily cleaned.
• Adequate lighting should be provided.
• Potable good quality water must be used which meets the requirements of the Australian Drinking Water Guidelines. Town water supply should be used, where available. If a filtration/disinfection system is installed, it must be maintained in accordance with the manufacturers specification.
• It is recommended that the water used in the treatment is regulated so it is as close as possible to body temperature to prevent thermal shock and scalding.
• 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 Public Health Regulation 2012.
• The installation of 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 physical air gap from the water supply that meets the specifications of the local water authority. This is to prevent backflow into the potable supply.
• Premises must be properly equipped with:
1. a hand wash basin that has a supply of clean, warm, potable water (The hand wash basin should be located in the treatment area).
2. a separate sink that has a supply of clean, warm water for cleaning equipment (A cleaning area should be provided and the dirty area should be separated from the clean area)
3. liquid soap (or an alcohol based hand cleaner)
4. single-use towels or an automatic hand dryer
5. disposable gloves, clean linen and gowns or aprons that are appropriate for the skin procedures carried out at the premises
6. a waste disposal bin
7. a toilet for client use only that is, in the case of a procedure using a closed system, located in close proximity to the room in which the procedure is carried out. In the case of a procedure using an open system, this toilet should be located in the immediate vicinity of the room in which the procedure is being carried out.
8. preferably, a toilet should be provided in each treatment room.

Equipment

• Any equipment at the premises must be in good working order, be cleaned and dried after use and be kept in a clean and dry condition.
• Reusable articles that penetrate the skin must be sterilised at the premises using a bench-top steriliser that complies with AS 2182-1998 Sterilisers - Steam - Bench top.
• (There must be at least one person present at the time the steriliser is used who is adequately trained in the operation of the bench-top steriliser).
• Equipment must be thoroughly cleaned (i.e. via scrubbing, using an instrument washer, and/or ultra-sonic cleaner) before processing through a bench-top steriliser (see How to Sterilise your instruments and comply with the Public Health Regulation 2012).
• All instruments must be wrapped and packaged prior to processing through a bench-top steriliser. This will maintain sterility and permit aseptic removal of the contents of the pack at the time of use. An exception to this requirement is if items are used immediately after processing through a bench-top steriliser.
• The bench-top steriliser must have a print out facility to record the cycle parameters (i.e. temp, pressure, time), otherwise a Class 4, 5 or 6 chemical indicator must be used in one instrument package (in every load) or there must be direct observation and recording of cycle parameters.
• Where on-site technical support is not available to achieve calibration or validation, a Class 5 or 6 indicator must be placed in every instrument package (in every load) or a process challenge device must be used in every load.
• Sterilisation must be carried out in accordance 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.
• Equipment that is difficult to clean and sterilise, such as colonic lavage tubing should only be used once and then disposed immediately after use (single-use only).
• Clinical/biohazard waste containing blood or bodily fluids must be disposed into a clinical waste bin and then collected by a licensed waste contractor (see you local council) .
• Articles that are used in a skin penetration procedure but do not penetrate the skin must be cleaned and kept in a clean condition.
• Towels or other types of linen used for covering or protection during the procedure must be clean at the start of each treatment. Linen should be washed in detergent and hot water.

Hygiene procedures

• The premises must be kept in a clean and hygienic condition at all times.
• Treatment areas such as benches should be cleaned between each client and/or a clean covering placed over the treatment surface .
• Sterile packaging should be opened just prior to starting the treatment.
• Sterile parts of the equipment that will penetrate the skin should not be handled.
• (If handling sterile equipment is necessary, a sterile insertion tube, a fresh 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).

Personal hygiene for practitioners

• Single use gloves and a clean gown made of an impermeable material must be worn by the practitioner during a skin penetration procedure .
• Hands should be washed
  • before and after attending a client
  • before and after a procedure
  • after exposure to a body substance
  • after touching a clients surroundings
  • after the removal of gloves.
• See Hand Hygiene Australia for additional information on how to wash your hands.
• Cuts or wounds should be covered with a sealed waterproof bandage.

Other requirements

• Sterilisation records must be kept for 12 months showing (a) the time and date when each article was sterilised and (b) the length of time that the article was sterilised and the temperature and pressure levels of the bench-top steriliser.
• Clinical/biohazard waste must be disposed by an approved waste contractor. Contact your local council for details.

Fees and penalties for non-compliance

• Failure to comply with the Public Health Act 2010 and the Public Health Regulation, 2012 can result in the issue of a penalty infringement notice. Penalties range from $110 - $1100 for an individual and $220 - $2200 for a corporation. Maximum penalties are higher for prosecutions and may include a daily penalty.
• Administration fees ranging from $250 - $270 are charged if an improvement notice or prohibition order is required to be issued.
• Reinspection of the premises in relation to a prohibition order incurs a fee to the occupier of the premises of $250 per hour with a minimum charge of half an hour and a maximum charge of 2 hours (excluding time spent travelling).

Further information

• Skin penetration industry
• Public health legislation

In NSW, you can call 1300 066 055 to talk to your local public health unit​.​​​​​