February 3 2009 - Features
Pedicure Troubles Still Bubbling
By Trina Kleist
The news stories out of California are a sickening déjà vu: People show up at their doctors’ offices with ugly, pus-filled sores all over their lower legs. The sores are traced back to a pedicure service weeks or months before the appearance of pimply bumps that turn purplish, then seep and spread.
Victims take antibiotics for months. Summer fun and fashion bring misery, as women agonize over how to hide weeping sores and nasty scars. They contemplate plastic surgery and million dollar lawsuits.
Investigators find it was all preventable, caused by bacteria in improperly cleaned — or uncleaned — pedicure foot spas.
The first major outbreak infected at least 110 people in 2,000 in a high-volume, discount salon in Watsonville, Calif.
Now, it’s happening again. In late 2004, infections cropped up in nearby San Jose. By March, the count was more than 140 victims. By then, another outbreak appeared in nearby Contra Costa County, with at least six victims.
More cases are popping up all over North America. Spa manufacturers, industry leaders, and state boards are responding with educational efforts and new regulations.
As awareness spreads, salons owners and nail technicians are also taking steps to improve cleanliness. But if you feel confident that your establishment is not one of “those” salons, think again. Even among technicians who are aware of the problem and have sanitation procedures in place, many are mistaken about the right way to clean their pedicure spas.
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To Be Confident, Double-Check Your Procedures
If you think you are already doing a good job cleaning your pedicure foot spas, protect yourself by reviewing your procedures again. Even at pricey salons with great reputations, nail technicians often don’t understand how to clean their spas properly.
1. Check your state regulations for cleaning procedures. California’s regulations are becoming a model for other states, and include the following elements:
• A four-step cleaning after every client:
- Drain the tub, and remove all debris.
- Wash down the tub with water and soap or detergent. Make sure your cleaner has a surfactant to get rid of the oily film that can hide bacteria.
- Use an EPA-registered, low-level, hospital-grade disinfectant according to the manufacturer’s instructions. The product must be in the tub at least 10 minutes to disinfect. Less time will not work.
- Dry the tub with a clean towel.
• Nightly cleaning according to manufacturer’s instructions. Remove, wash and disinfect any screens or cover plates for 10 minutes.
• Additional cleaning every week or two weeks with bleach, according to manufacturer’s instructions or your state’s regulations.
• A cleaning log for daily and weekly cleanings (required in California, and a back-up in case of a lawsuit).
Remember that it is not enough to spray on a disinfectant. It must be in the water and in contact with the tub and equipment for 10 minutes to kill bacteria. Click here for detailed foot spa cleaning guidelines. The guidelines can also be found in the issue of FEET that accompanied your March 2005 NAILS.
2. Use the right amount of cleaner. Read the label of both your soap or detergent, and your disinfectant. Make sure you are using the products the way the manufacturer says on the labels. They may not clean properly otherwise. Make sure you are using the right amount of disinfectant. Take time to do the math, and don’t skimp on product to save money.
3. Check for EPA approval. Check your cleaning products to make sure they are registered with the EPA. The product should kill bacteria, fungus, and viruses — some states specifically require this. (The suffix “-cide” means “kills,” as in “bactericide.”) Products that are labeled with the EPA have been tested to make sure they kill bad bugs. The product must be used according to the instructions.
4. No leg-shaving before pedicures. Most of the people who have gotten infections from pedicure spas had shaved their legs shortly before the service. Shaving can leave nicks in the skin that you can’t see, but are big enough for bacteria to get inside. Suggest to your clients that they not shave their legs within 24 hours before their service. Cosmetology boards in California and Ohio are already advising technicians to do this.
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Puzzling Differences Between Events
Differences among the three outbreaks are puzzling scientists who study epidemics and public health officials who try to prevent them.
In the Watsonville case, all the victims had gone to a single salon.
In the recent events, people with infections had patronized at least 34 salons in two San Francisco Bay Area counties. Three San Jose salons have been linked to the bulk of the infections. In the Watsonville case, all the victims were infected by the same bug: Mycobacterium fortuitum, a common critter that lives in dirt, dust, and city water supplies everywhere.
In the Bay Area events, there are several bad guys. Most of the infections seem to be caused by a Mycobacterium cousin, M. chelonae. Other Mycobacterium relations and streptococcus have also been found to cause the painful boils on patrons’ legs.
But all those germs are common. Why have these large outbreaks occurred — so far — only in two areas that are an hour’s drive apart? “These bacteria lie in water all over the country. If it’s happening in large clusters (in San Jose), it does make you wonder what’s going on, ”muses Kevin Winthrop, a medical doctor and epidemiologist who studied the Watsonville case for the U.S. Centers for Disease Control.
Surfactants and Confusion
Foot spa cleanliness was clearly a key factor in the Watsonville infections. But its role in the Bay Area shows cleanliness needs something more — a surfactant cleaner.
Massage oil, lotion, perfume, and other products used in pedicures create a film that clings to the walls and pipes of a pedicure spa. Human skin has natural oil that adds to the goo. A surfactant is a kind of detergent that breaks up that oily film.
The surfactant must clean that oily film first. Without it, the disinfectant used in the next step cannot work right, Arizona-based sanitation expert Nancy King warns.
Pedicure throne manufacturer Amerispa LLC spent four years developing a product that cleans and disinfects in one step. It includes a surfactant.
Similar products from other companies are on the way, says Amerispa vice president Jim Casteel, based in Rancho Cordova, Calif.
On top of that, salon owners and nail technicians often are confused about proper cleaning procedures. The owner of one of the three salons most often linked to the San Jose infections says her staff had been cleaning the foot spas properly.
“We sanitize and disinfect the foot baths just like we were instructed,” Kathy Nguyen of Kathy Nails told television station KTVU shortly after the story broke.
But King, who has reviewed Nguyen’s procedures, says they were not correct.
“People don’t know what to do or how to do it,” says King, who is executive director of the Foundation for Safety in Cosmetology. “Many of the salon owners involved in these latest outbreaks thought they were correctly following the rules.”
Technicians mistakenly think they can clean without disinfecting. Or they may disinfect without cleaning. They may spray on a disinfectant without circulating it with water through the unit. Or, they may have the disinfectant in the water for less than 10 minutes. None of these procedures is right.
Even some state inspectors have reportedly given faulty information about cleaning procedures, sources say.
“Unfortunately, in the legal world, you’re responsible for what you should have known. And the responsibility falls on the salon owner. Their question is, how could I have known?” King says.