An outbreak of bacterial infections linked to pedicure foot spas poses new mysteries for public health detectives. It also shows there is still a lot of confusion among nail technicians and salon owners about proper cleaning procedures. To protect yourself, do your homework!
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.