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!
Infections Popping Up All Over
Because most infection cases have been in California, many nail technicians think “it can’t happen here.” But that’s a trap. It can and it is. An investigation by NAILS uncovered documented reports of pedicure related infections in seven American states, on top of the outbreaks in the Bay Area and Watsonville. (See sidebar, “It’s Happening Everywhere.”)
Those cases involved different bacteria, but all of the culprit germs live in city water and ordinary dirt and dust everywhere.
“There are probably small outbreaks elsewhere … but we don’t really know,” researcher Winthropsays. After the Watsonville outbreak, the California Department of Public Health started a reporting program.
Doctors in each county are being asked to report the cases they see among their patients. This will help public health officials figure out what is behind the outbreaks.
Another trap is thinking that the risk of infection lies only with high volume, discount salons where time pressures and low prices tempt operators to cut corners.
“It could happen in any salon,” warns Fort Worth, Texas, podiatrist Dennis Arnold, founder of the International Pedicure Association.
That’s because confusion about proper sanitation appears to be widespread.
In March, Amerispa hosted free seminars on the subject in San Jose. Seminar leaders polled guests about what they knew of proper cleaning.
“Out of 30 people we asked at each class, not one got it right on the time element,” Amerispa’s Casteel recalls. “You put [the disinfectant] in wet and leave it in for 10 minutes. It’s impossible to do it in two or three minutes.”
Client Reactions Are Mixed
Television coverage of the infections has left many pedicure patrons wary. Susan Reeves lives between the San Jose and Contra Costa outbreaks in Fremont, Calif.
“I stopped going to those places,” says Reeves, a stay-at-home mom who had followed the Watsonville event. She liked getting pampered for $9. “But I saw they were cutting my toenails with an instrument they’d get out of a drawer, and then throw it back in to use on the next person. I thought that was gross.”
More women are apparently coming to that conclusion, at least for now. Overall business in the San Jose area is down, state cosmetology board members say. Salons up to 30 miles away are feeling the effects, says Alex Nimh, a disinfectant distributor for Amerispa who is based in the area. Some of the shops that were implicated in the infections have shut down for lack of business, Nimh reports.
Others struggle to hang on, trying to cover costly leases with 30% or 40% of their usual traffic. Other establishments have picked up the customers from those places, Nimh says.
Sanitation practices may be improving in remaining salons, he speculates. “People are ordering more chemicals to clean the machines, ”Nimh says. “It means, one, they’re starting to comply with the law [regarding sanitation], or two, they’ve got an increase in customers. I think it’s a combination of the two.”
Smart salon owners, Nimh adds, are using their sanitation procedures as a marketing tool. “Word-of-mouth is a key motivator,” Nimh says. “A client says, ‘This salon is doing such-and-such to keep me safe,’ and she tells her friends.”
Of Vietnamese descent, Nimh is able to explain to Vietnamese salon owners in their own language that the cost of disinfectant is smaller than the cost of losing their business. But some salon owners stubbornly refuse to disinfect properly.
"The main reason they say they don’t do what they need to be doing is time. It’s the worst excuse, because you have to take the time, ”Nimh says.
But with prices so low and competition so high, they see no way out. “Paying for the chemicals and all that is such a cost at the end of the day that they can’t afford to do it, ”Nimh says. “I teach them, ‘You have to raise prices and explain to your customers why you’re raising prices. They’ll thank you for it.’”
The Watsonville case prompted deep changes in the pedicure industry. Throne manufacturers found ways to circulate foot tub water without pipes, which are harder to clean. Health officials and industry leaders found better ways to clean the spas that do have pipes, still the majority in service. New cleaning regulations became law in California.
Now, a major focus for work is improving communication with Asian nail salon owners, who make up an estimated 42% of the industry nationally.
Amerispa is passing out DVDs showing proper cleaning and disinfecting procedures in both English and Vietnamese. They’re working on Vietnamese translations of their instructions. Spanish instructions could come later.
European Touch, based in Milwaukee, wrote thorough cleaning instructions several years ago. “We are working on having instruction manuals translated into Vietnamese,” says Rebecca Reed, marketing communications manager. A Korean translation could come next.
Orders for thrones without hidden circulation pipes are up as pedicurists look for units that are easier to clean. But some in the industry worry that people will think these units don’t have to be cleaned at all.
Some of the spas involved in the San Jose outbreak are no-pipe units, King says.
“They’re not work-free,”Reed warns. European Touch has come out with no-pipe models as well, but tries to make customers understand that they still must clean the tubs. “It’s still the salon’s responsibility to remove and clean the footplate, scrub the tub, run the cleaner through it, and do the end-of-the-night procedure with the bleach,”Reed says.
There Is Time to Clean, Disinfect
Amerispa is also hosting educational seminars throughout California to raise awareness about cleanliness and state requirements. The company has had sanitation expert King speak at the gatherings.
The most important message at the seminar is how to work the cleaning and disinfecting process into a tight schedule.
“When you reach for the massage lotion, stop!” says King. A tech can take a moment to wipe out the junk, scrub out the tub with a surfactant detergent, then put in the disinfectant and let it circulate for 10 minutes. While the tub swishes away, the tech can continue with the massage, clean the nails, put on the toe separators and polish. That part of the service usually takes about 15 minutes — more than enough time to disinfect properly.
“There is not a client in the world who would care if you took a few minutes to properly clean and disinfect the tub,” King says.
Smart salon owners and techs will find ways to advertise their safe practices, Nimh says.
At the deluxe Yamaguchi Salons based in Ventura, Calif., pedicurists start the process while the client is still sitting there. “We make certain they’re aware that we are sanitizing for their benefit,” operations manager Patricia Shepherd says.
But at the Scott-J Salon Spas in New York, the owner has opted to go without the circulating foot spas altogether. Instead, pedicurists bring an artsy copper pot to the patron. The decision was made in part for sanitation reasons, spa director Maurice Rodriguez says.
Confusion About Products, Labels
Some in the industry say even well-informed and well-intentioned techs get confused by labeling on the cleaning products.
“Labeling is a big part of the problem,” says Amerispa’s Casteel.
Soaps and detergents used in the cleaning step have no particular labeling requirements. However, you should look for a detergent that is a surfactant, or else your disinfectant won’t work.
The disinfectant used in the next step must be registered by the EPA. That outfit tests the product to make sure it works the way it’s supposed to. It also checks the instructions to see that they’re clear, EPA spokeswoman Enesta Jones says.
Proper spa cleaning requires both soap/detergent and disinfectant.
Tremors Felt in Other States
In California, the state Board of Barbering and Cosmetology ordered an inspections sweep of San Jose area salons after the outbreak came to light. It also mailed cleaning information out to all 37,000 licensed establishments.
More recently, board president Della Condon has suggested the board continue its outreach and training efforts throughout the state. More inspection sweeps are being planned. “We are looking at various options,” Department of Consumer Affairs spokeswoman Patti Roberts says.
Even before the San Jose outbreak, other states had started toughening up their own regulations.
Texas passed regulations similar to California’s in 2004 after a 2003 pedicure infection in Dallas. Similar regulations are on the horizon in Ohio and Illinois. In the meantime, some states have posted warnings and advice on their websites.
About 10 states have created new requirements for continuing education. In Texas, that includes four hours of sanitation lessons, podiatrist Arnold says. The Nail Manufacturers Council is also looking at the problem.
Already, many better salons are putting good sanitation into practice. That trend will speed up as more states adopt cleaning guidelines by the end of this year, sanitation expert King predicts. “The vast majority will be much clearer in the wording of what you are supposed to do,” she adds.
Plus, cosmetology schools will change their curricula and states will change their exams to include sanitation. “Schools will be required to teach more in-depth and with clarity,” King says.
Health departments and inspection agencies are likely to start working more closely together as well. Language barriers also need to be addressed, some say. A few pages of technical material in Vietnamese, Korean, and Spanish could prevent more outbreaks, distributor Nimh says.
He further predicts a long-term industry shake-out.
“The lower-end salons will have to die out, because their practices are unsafe,” Nimh says. “They should die out. Those who play by the rules and understand the rules are going to win.”