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Nail salon syndrome is quite common.I have seen pts who developed fungal nails or tinea pedis after a pedicure.I even had a young lady who went for a pedicure and developed onycholysis.I have not seen too many studies on it,however,I am familiar with an article written on it.
Patient of mine was given a session at a pedicure salon for her birthday. 20 years type 1 (poorly controlled) - both neuro and vasc status compromised. Technician 'buffed' off medial heel with pulmice stone until bleeding - lesion rapidly progressed to an infected ulcer. I'm still managing her wound 4 months post. Silly thing is she new the risks of accessing a place like this, however she did not want to upset her daughter by rejecting the 'gift'.
Are we really pretending that our patients are totally proof against cross infection with all the uglies lurking around in our treatment rooms? And if you don't have any in your room ..how are you achieving that?
Regards Phill
I read a lot about surface to surface contact, but I am looking into airborne contamination. A number of people have concerns but there seems to be little action. I am interested in your concerns as I have some answers.
Alan
Alan,
I have had subjective concerns about the airborne particles generated by use of pod drills...bacteria, viruses and protein particles, all of which can/may impact on the health of us and our patients....many pods just don't use drills and blame their slackness on these issues and tell themslves that doing a less complete job is OK because of this stuff. Everyone make their own choice and has their own reasons, more or less valid ones...
For years I have used HEPA room filters...which may be purely placebo... but the living result feels better. There are also some Italian podiatry suckers (Cattani Dental co. I think )that look a little like a Dalek that would probably help but nobody brings them to Australia...I tried a few years ago. What do you know?
Regards Phill
I think point made about 'salon syndrome' was mainly about cross infection due to unclean and non-sterile instruments. I share your concerns over airborne particles in practice, the potential for cross infection, and especially their effect on the practitioner's health. I too use a room filter, dust extract drill and a 'dust' face mask, but the accumilation on surfaces in the room demonstrates you can't remove it all. I am interested in ideas on how to improve things.
Since buying a new (2nd hand) Autoclave I have been looking at what is meant when we use the term sterile.
The Health and Safety Executive state that,
autoclaving, effectively 100% kill;
incineration, effectively 100% kill;
chemical disinfectant [state which] used according to manufacturers instructions and under conditions similar to those used by the manufacturer when validating the disinfectant against the host micro-organism. Under these circumstances it is acceptable to rely on validation data provided by the manufacturer e.g. the log reduction in viability may be stated by the manufacturer or there may be an alternative statement of effectiveness;
chemical disinfectant [state which] used under non-standard conditions that do not conform with the manufacturer's instructions, or non-standard heat treatments etc. In these circumstances it will be necessary to undertake measurements to validate the procedure. This will enable the actual percentage kill, log reduction in viability, or similar to be stated.
The CDCP Centre for Disease Control and Prevention, Atlanta, states that a 12 log reducion in microbe/pathogen load is the highest reduction feasible, ref: Esty JR, Meyer KF. The heat resistance of spores of B. botulinus and allied anaerobes, XI. J Infect Dis 1992;31:650-63.
Does anyone have a refference or know the typical log reduction of a clinical non vacuum autoclave. The HSE state Effectively 100% but is a 6 log reduction in load Efectively 100%.
A 1 log reduction in the microbial/pathogen load, usualy expressed as CFU/ml (colony forming units eg 1 bacteria), reduces by 10 times so 1million become 100,000.In a 6 log reduction 1 million (1000,000) become 1 ie 99.9999% reduction. Is this Efectivelly 100%?
What log reduction would you consider acceptable for podiatry/chiropody but not podiatric surgery.
What would be a typical load in CFU/ml for an autoclave in clinical practice?
What we do with surfaces and liquid treatments is also about contact times....a substance may well be effective against a good range of bugs...but over 10-15 minutes etc....I tend to spray the old alcohol with pink additive around and leave it in place a bit to extend the time....not as good as alcohol taken internally but it can't hurt.
Cam,
What evidence is there that pedicurists are any worse than podiatrists when it comes to infections folowing pedicures? There was precious little evidence in that article of any kind.
Too many podiatrists are threatened by pedicurists because they have no greater skills or knowledge than pedicurists. They ought to be worried.
Greg:While it is true that some podiatrists are stupidly in competition with pedicurists,and that some podiatrists are rather incompetent,to say that "Too many podiatrists....have no greater knowledge or skill than pedicurists" is nonsense on stilts.Podiatrists have to go to college,med school,sit for boards,etc.Again,it is true that a few members of this profession are not that great and elitist as well.However ,I cannot swallow an asinine comment like the one made by yourself(with all due respect,I may add).
Last edited by John Spina : 30th October 2005 at 04:50 AM.
Reason: punctuation error
Before this blows up into an international incident .... John is talking about the situation and educational requirements in the USA and Greg is talking about the situation and educational requirements in New Zealand ....worlds apart in the context of this discussion.
John, I wish you were right. But in England, Australia and New Zealand many Podiatrists trained a long time ago and have done nothing to keep up, advance thier skills or knowledge. They spend their days cutting peoples toenails and chipping off corns and calluses. I can't see a great difference between them and well trained pedicurists.Nothing elitist about it, just the sad truth.
Greg:I see what you see right here in America!I have a colleague who is not sure what needle you use for a heel spur injection.Another banana(sorry,he is) will do nothing except cut toenails as he is afraid he will be sued if he does a thing above and beyond that.So I see my share of flotsam and jetsam right here.I myself am no Dr.Welby.I am,however,competent.My point is there are some lemons,but there are also some fine podiatrists here and elsewhere.I do appreciate your opinion.Indeed,many pods need to hear it.I just said what I said because I do enjoy what I do,and I simply do not like to see this profession criticized.thank you for a spirited discussion.
John
Just to help this Thread on a little bit, are we back to Supply and Demand again? What is it really about here? Should it be what the customer wants or what the Podiatrists wants?
If he/she is prepared to put their hand in their pocket and pay for nail, corn or callus cutting that is what they will get from me!
If on the other hand they are prepared to pay for expensive, sometimes in their eyes, what they don't want or need, that's how it will be in the private sector!
Who is more important the Patient or the Podiatrist?
Just maybe the Patient might want a Chiropodist, whose grades have just been removed from our NHS. so they cannot have him/her? In a free market place this should resolve itself but here in the UK. the NHS. is just about the only Nationalised institution/industry left. But don't worry the Government is working on it!
Regards,
Colin.
PS. Now there is a thought Greg, how about trained Pedicurists for the NHS? But would they work for such low wages?
Mycobacterium fortuitum complex are rapidly-growing nontuberculous mycobacteria found ubiquitously in the environment including, water, soil, dust, and biofilms. M fortuitum has been reported to cause skin and soft-tissue infections in association with nail salon footbath use during pedicures. Four cases of M fortuitum complex furunculosis are reported that occurred after pedicures in the Cincinnati, Ohio/Northern Kentucky area. Dermatologists and clinicians should consider mycobacterial infections from the M fortuitum complex when patients present with nonhealing furuncles on the lower legs and should inquire about recent pedicures. Early recognition and institution of appropriate therapy are critical. Public health measures should be explored to protect against such infections, given the recent popularity of the nail care industry.
The only real way we are going to stand tall on the subject of nail salon infections is to gather our own log of nail infections/foot infections from pedicures. Please participate in the NAILSALONINFECTIONSURVEY.com site. The site is password protected for doctors. Email for the user name/ password. Nail techs, pedicurists can complete the second non password protected survey and consumers who may never report these issues may report to the third survey. The Journal of Dermatology article Mar 2006 reports 4 cases to the board of cosmetology in Ohio/Kentucky recently. Unfortunately, not all cases are reported or even seen by physicians.
I would urge all Pods, MDs, DOs, NP and others to complete this survey. The same is true of all consumers and nail techs and international pedicurists. Boards of cosmetology are sometimes hampered by politics, lack of medical oversight, and a tremendous issue of language barrier when a high percentage of US salons are now serviced by recent arrivals from non-english speaking counties. When I testified before the board of Cosmetology in Tennnessee in 2002 most of the violators were Asian and brought there own interpreters. THey were cited for issues like attempting taking each others test or no certificate to operate. None of the violators acknowledged to the board why they were being cited even with the interpreters.
My book, Death by Pedicure discusses this in detail.
If you want to do something about this. Take the survey NAILSALONINFECTIONSURVEY.com and then call find out about your state's board of cosmetology in your state. It will surprize you. Call them and get a rule book so you can see if your state uses callus cutters or what constitutes sanitiation in a nail salon. Inspect your own practices as well. There are good nail techs and there are good pods. There is also the opposite spectrum of both. Learn to identify both. My book, which will be sold wholesale to pods in quantity for resale in your offices, will help your patient population to know how to select the good ones.. See Justfortoenails.com for when the book is released.
Bob Spalding
Last edited by Admin : 14th April 2006 at 08:55 AM.
Reason: made link clickable and link to book thread
KSL Utah are reporting: How Safe Are Pedicures?
May 1st, 2006 @ 10:06pm
Quote:
They're cheap, fast, and popping up all over the place. But are they safe?
"Should women be afraid?"
"Oh, I wouldn't allow a family member or a friend to put their foot in a bath like this."
Before you make your next pedicure appointment, see what our investigation uncovered. We found so much contamination, it would be enough to shut down a hospital. What about a nail salon?
With a growing number of shops promising fast service at a great price, we stopped in for some pedicures.
Summer toes are the hot thing. Twenty dollars; done in an hour.
Maybe:
"My toenails just turned yellow and started crumbling."
Penny Webster: "Green. Your two big toes actually turned green. Green. My two big toes were green and the rest of my toes turned white."
There's Penny Webster's infected toes and fingernails.
"They started to feel peculiar. I was pushing on it and I took a hold of it, went like that, and the whole thing came off."
And Lee Anne Edwards:
"It just looked awful."
Her $20 pedicure:
"I only had this much toe nail left that was even normal."
Now $900 to fight an infection.
Dr. Mark Moritz/St. Mark's Hospital: "I've seen a big increase, yeah."
Dr. Mark Moritz is a podiatrist at St. Mark's Hospital.
Dr. Moritz: "Somebody could potentially die from something like this. And that's what's very scary. They may not know where it came from."
We listened to doctors who say nail salons are putting more women at serious risk for infections. You'll be amazed at what we found. A surprising number of salons violate regulations. That you're being exposed to outrageous levels of bacteria. And,it's up to you to protect yourself.
We sent women into five salons we chose at random. All had recently passed a county health inspection. We collected water samples from jetted pedicure tubs.
We delivered the samples to a lab. The testing started. Bacteria began to grow, and grow.
While we waited, we analyzed 70 health inspections. Inspectors cited safety problems at more than half the salons they went in to.
Pedicure tools not disinfected between clients, dirty floors, clippers with old nail shavings left on them. Dirty files getting reused.
Dr. Moritz: "This is awful."
Our water tests uncovered another hazard.
Dr. Moritz: "I wouldn't let my mother, my sister, my friend go to a facility that had this kind of bacteria count."
Ten different forms of bacteria, in four of the five pedicure basins we tested. They include staph, klebsiella, pseudomonas known to cause: tissue damage, gangrene. In fact, doctors say they have amputated toes, removed nails, from exactly such infections.
Dr. Moritz: "It indicates to me that many people have used the same bath without a cleaning in between it."
Our tests found bacteria colonies 11-hundred times greater than what's considered safe.
The doctor considers three very dangerous. But: 34-thousand bacteria colonies:
"This would say to me that somebody needs to be shut down."
At the Salt Lake Valley health department, inspectors say they won't shut them down.
"Buyer beware."
And you're on your own.
They don't test for contamination. There are no standards for pedicure water. You should ask questions if it seems dirty:
Diane Keay/ Salt Lake Valley Health Dept.: "I wouldn't just turn around and leave. I would tell them why I am turning around and leaving."
We didn't name the salons we tested -- they were chosen at random, to find out how widespread the problem is. Again, four out of five had contamination.
To show you how serious it is: KSL radio's Suzanne Viehweg had a pedicure, then a blood infection ran up her leg. Worst case scenario: a foot amputation. But, two months of treatment appear to be working.
Because of our investigation, the Salt Lake Valley Health Department issued new guidelines for consumers tonight.
I think point made about 'salon syndrome' was mainly about cross infection due to unclean and non-sterile instruments. I share your concerns over airborne particles in practice, the potential for cross infection, and especially their effect on the practitioner's health. I too use a room filter, dust extract drill and a 'dust' face mask, but the accumilation on surfaces in the room demonstrates you can't remove it all. I am interested in ideas on how to improve things.
I have been looking at the collection efficiency of collecting at the source (a collection stool just below the foot for general work, and an over the foot hood for use with drills). Anything collected is passed through a HEPA filter so that air recirculated is free of all sub micron particles. Even if the collection efficiency is only 30-50%, continually recirculating the room air will reduce all particles over a period of time. This principle is used in electronics, pharmaceutical manufacturing, and fine engineering, so why not in Podiatrists rooms?
Alan
Our local news here in Toronto has been running a "consumer health alert" warning of "dirty" nail salons. It's definitely good to see them reporting on such matters. Click here for video clip
__________________
Edward Yip
York Foot And And Ankle Clinic
15423 Yonge St
Aurora, ON, Canada
L4G 1P1
905-713-2546
Our local news here in Toronto has been running a "consumer health alert" warning of "dirty" nail salons.
Now there has been some media coverage in Australia:
The Sydney Morning Herald are reporting: Warnings over nail salons health risk
Quote:
NAIL salon patrons are contracting fungal and bacterial infections because of poor hygiene, experts warn.
They are also exposing themselves to more serious risks, such as hepatitis C and HIV.
Australian Podiatry Association (APA) NSW vice-president Brenden Brown said there had been a boom in nail salons offering quick and inexpensive manicures. But many had poor hygiene standards, such as inadequate cleaning or sterilising of equipment.
"They are using the same instrument from person to person - it's scary," Mr Brown said.
Fungal infections such as tinea and candida albicans were the most typical health problems resulting from unhygienic nail treatments, he said. And, while the chance of becoming infected with hepatitis C or HIV from a nail salon was slim, it was still a "definite possibility".
Each week, Mr Brown's podiatry practice treats between three and five patients who have contracted fungal or bacterial infections at salons. Permanent damage to the nail can result and there could be more serious implications for those with weak immune systems or diabetes.
He expressed concern about the practice of foot soaking, which podiatrists stopped doing 15 years ago because of the risk of spreading bacterial infections such as staphylococcus. An American woman died this year after contracting a staph infection at a Texas nail salon.
Last year, consumer monitor Choice conducted a "shadow shop" of 53 Sydney nail salons, examining hygiene standards, the quality of service and prices. Researchers found more than one-third of salons to be unsatisfactory.
"They weren't cleaned up properly between clients, they were covered with dust, sometimes even pieces of skin," Choice spokesman Christopher Zinn said. Poor ventilation and the smell of hazardous chemicals were also listed as concerns.
Nail salons are not regulated in NSW, although they must register with the local council. However, many councils investigate only if a complaint has been made, Choice said.
The NSW Department of Health has a list of guidelines for nail technicians, but these are only recommendations.
Choice, the Australian Professional Fingernail Association and APA NSW have all expressed concern about the lack of regulation of nail salons. They say health authorities should carry out regular inspections.
The Australian Professional Fingernail Association receives up to 15 complaints about nail salon hygiene and quality each month.
Spokeswoman Vittoria Hall said customers should ensure the nail technician is fully qualified and holds a certificate I or II in nail technology from a registered institution.
She said salons should clean each implement with a sanitisation product between customers. In cases where blood was drawn, the implement should be sterilised in an autoclave or soaked in solution for up to 24 hours.
"If the salon staff pick up implements from somewhere else and they look dirty, if there is dust on the table or the implements, if the towel isn't clean, the customer should walk out," Ms Hall said.
Staff at salons approached by The Sun-Herald said that they maintained a high level of cleanliness and hygiene.
Rosie Tran, from Rosies Nails in Neutral Bay, said she had a certificate II in nail technology, but not all manicurists shared her level of qualification. "We clean straight away after we use equipment and we have got a special machine to sterilise tools," Ms Tran said.
Jenny Tran, from USA Nails in Potts Point, said all equipment was cleaned between customers and the salon also had an autoclave which sterilised scissors for cutting cuticles.
Here is another:
Nasty Nails? Woman claims infection from nail salon
Quote:
It was almost like clockwork. Every two weeks after work, Renata Brown stopped in for a manicure. Now she's got a different routine, one that includes gauze, sterile pads and antibiotics.
It started in January when she says she went to a local nail salon to get her nails done.
Yes, I can confirm this trend. Many people think pedicurists can cure all their foot disesaes... I hear it every day in my office... then they wonder about the difference.
Mycobacterium bolletii/Mycobacterium massiliense furunculosis associated with pedicure footbaths: a report of 3 cases.
Wertman R, Miller M, Groben P, Morrell DS, Culton DA. Arch Dermatol. 2011 Apr;147(4):454-8.
Quote:
BACKGROUND:
Mycobacterium bolletii and Mycobacterium massiliense are recently described species of nontuberculous mycobacteria. Footbaths preceding pedicures at nail salons have been implicated as reservoirs of infection with nontuberculous mycobacteria. To our knowledge, this case series represents the first documented outbreak of M bolletii/M massiliense furunculosis, identified by heat-shock protein 65 gene, hsp65, sequencing, occurring in immunocompetent patrons of a North Carolina nail salon.
OBSERVATIONS:
We describe 3 cases of lower extremity furunculosis caused by M bolletii/M massiliense associated with pedicure footbaths from the same North Carolina nail salon. Lesions developed within 1 month of the salon visit and were characterized by erythematous, indurated papules and plaques. Histologic examination revealed suppurative granulomatous dermatitis. Mycobacterium bolletii/M massiliense was identified by sequencing the 16S ribosomal RNA (rRNA) and hsp65 genes. All 3 patients responded to different combinations of clarithromycin, doxycycline hydrochloride, azithromycin, and moxifloxacin hydrochloride for complete lesion resolution.
CONCLUSIONS:
Clinicians should elicit a history of pedicure footbaths and maintain a high level of suspicion when faced with skin lesions of the lower extremities that are culture negative or are refractory to conventional antibiotic therapy. Accurate identification and discrimination of M massiliense and M bolletii is difficult and requires sequencing of multiple gene targets beyond their identical 16S rRNA sequences.
That is shocking. I have a nail business and infection control is paramount - wash, fluid, ultrasonic and then autoclave. If it can't be autoclaved it is thrown away (eg nail files). For pedicures we use disposable liners for the spa.
Also in the UK client consultation forms are kept and all medical problems notes. In the case of diabetes, epilepsy, heart problems and many more conditions you are not allowed to perform the service - not even allowed to just apply nail polish.
Regarding pedicures, toe nail cutting and callus reduction is included. Callus is treated with an AHA acid treatment. So it makes you wonder what the point of becoming an FHP is. I am half way through my training and wish I hadnt bothered really. Incidentally depending on whether they are basic or luxury, pedicures can cost from £12 to £30.
There is no excuse for lack of hygene in any treatment whether if be by a pedicurist, FHP or podiatrist.
Would you suggest to some of your patients that they visit a beautician because a FHP doesn't necessarily offer pampering either, or for any other reason?
Rise of pedicures and risks of infection
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