“Beauty salons can nail customers with doses of herpes, hepatitis, bacterial infections, tuberculosis — even HIV ...” claimed an article in the June 24, 2002, edition of the New York Post. But of the billions of nail services performed over the past two decades, one case each of herpes and hepatitis (and none of HIV or tuberculosis) doesn’t register as statistically significant, much less as a precipitator of an in-depth probe of nail salon hygiene practices.

Bu t that’s exactly what the New York Post did, reporting on 1,700 violations cited by the state board in the first half of 2002, as well as the findings of its own reporters in vi siting a random selection of Manhattan nail salons.

 “The media loves to play up the fear factor because it sells with consumers,” observes chemist Doug Schoon, vice president of science and technology at Vista, Calif.-based Creative Nail Design. “The incidence of bacterial and fungal infections versus the number of services is very low.”

The barrage of bad media in recent years has spurred nail techs to be more diligent in their sanitation and disinfection practices. But Schoon says the media, some manufacturers, and even some medical professionals are fostering fear for their own purposes, whether it’s to capture viewers or sales or simply to drive their own agendas.

 Whatever the reasons, the misinformation and well-intentioned (but some say misguided) recommendations are not only confusing but may significantly burden nail techs with costly, time-consuming practices that don’t offer additional protections. And in some cases they may cause more problems.

Case in point: at the March meeting of the American Academy of Dermatology (AAD) in San Francisco, Shelley Sekula-Gibbs, M.D., presented a recent study of nail industry standards and her recommendations to heighten salon disinfection practices. Among other things, she advocates mandatory sterilization of all metal implements and a two-step disinfection procedure for all pedicure tubs entailing one 10-minute cycle with a solution of diluted bleach followed by a second, 10-minute cycle using an EPA-registered tuberculocidal disinfectant.

Infection control and industry experts alike, however, view sterilization as an extreme and unnecessary requirement for salons. According to Dolly Sinha, a health communications specialist at the Centers for Disease Control and Prevention (CDC), salons are not viewed as a risk area for the spread of hepatitis, which is much more easily transmitted than HIV or tuberculosis. (See our article on the rapidly growing hepatitis C on page 74.) Nor does she consider sterilization of implements a necessary step.

Dean Peterson, director of the San Mateo County (California) Environmental Health Department, takes a slightly different view. “The salon setting is one that absolutely should cause concern,” he says. But, he adds, “I think that the guidelines to use a 10-minute disinfectant are adequate. The concern is whether establishments are following those practices.”

As for running whirlpool pedicure tubs for 10 minutes using an EPA-registered tuberculocidal disinfectant, the usage directions for these products clearly state that they are corrosive to plastic surfaces — the material from which most pedicure tubs are made.

Cosmetic Tools, not Medical Devices

Dr. Sekula-Gibbs is by no means the only dermatologist concerned about nail injuries and infections that patients attribute to professional nail services.

Bu t Schoon, who also co-chairs the ABA’s safety and standards committee, asserts that dermatologists see the worst-case scenarios rather than typical re sults. He also notes that infections such as onychomycosis can’t be blamed on salons just because the patient may get professional pedicures.

Even so, Schoon and other industry e perts do agree that state board disinfection regulations are outdated and not always relevant. But rather than promoting sterilization, they say some state board disinfection requirements exceed salon needs.

“Hospitals are only required to disinfect non-critical items [items that only come in contact with intact skin] with a low-level disinfectant,” Schoon says by way of example. “But some state boards have mandated that salons use tuberculocidal disinfectants, which are intermediate-level.”

Schoon and Nancy King, a nail tech and industry consultant in Phoenix, question why nail implements meant for use on intact skin (which is all a nail tech license allows) should be held to a higher standard than an equivalent item in a hospital setting.

Which Disinfectant  for Nail Salons?

According to the CDC’s “Sterilization or Disinfection of Medical Devices: General Principles,” sterilization is necessary only for devices or equipment that cut or pierce live, intact tissue or that come in contact with the vascular system (veins, etc.). As King points out, nail technicians are licensed to work only on the nails and stratum corneum, the uppermost layer of skin comprised of dead protein cells. “Nail techs can’t use any process, product, or procedure that affects live skin,” she notes.

 Whereas sterilization eradicates all microorganisms, including tough-to kill spores, disinfection can eliminate up to 99.9% of organisms. But unlike sterilization, there are several levels of disinfection: high, intermediate, and low.

And here’s where much of the misleading and misinformation cause confusion. These are not “good, better, best” ratings, explains Schoon, but rather efficacy classifications.

• High-level disinfection kills all organisms except spores. High-level disinfectants are marketed as chemical sterilants (also called sporicides) and are regulated by the FDA.

• Intermediate-level disinfection, according to the CDC, kills mycobacteria, most viruses, and bacteria. These disinfectants are EPA-registered and marketed as tuberculocidal.

Low-level disinfection kills many viruses and bacteria including all those that are common salon problems. These disinfectants are registered as “hospital-level” by the EPA.

Sanitation — removing all visible dirt and debris with soap and water — remains by far the most important step of the process, according to Schoon.

You may be tempted to cover your bases through exclusive use of a high-level disinfectant, but economics and safety dictate choosing the appropriate disinfectant for the job at hand. As Schoon points out, disinfectants are toxic, sometimes caustic chemicals strictly regulated by the EPA. For example, some high-level disinfectants are formulated with 2% glutaraldehyde. According to chemist Paul Bryson, co-director of research and development for Sherman Oaks, Calif.-based OPI, glutaraldeyhde is highly toxic and inappropriate for the salon environment.

During the course of their work on the Abrasive Task Force for the California Bureau, Schoon, Bryson, and King spent months researching sanitation, disinfection, and sterilization standards and practices in medical settings. They also consulted with doctors and scientists as well as the CDC, the EPA, and other state and federal agencies.

Drawing on the CDC’s General Principles (which define each level of disinfection as well as the types of devices and situations in which each should be used) as well as their other research, the three cut through the confusion to develop a clear-cut guide to disinfection for nail techs. (See “ATF Disinfection Guidelines for Nail Salons.”) While individual state board regulations still prevail, the ATF believes the guidelines will help to clarify nail tech disinfection standards. King says several state boards already have begun to rework their regulations based on the ATF’s recommended guidelines.

 Salon Show and Tell

With state board inspectors outnumbered and some consumers still oblivious to their own health and safety, proper disinfection practices are up to you. “Make your salon a safe haven,” Schoon advises. “Clean your salon and make a ceremony of your disinfection practices.” Even more to the point, King urges nail techs to pay attention to the small stuff, and the small print in particular. “Read the labels, know what you’re using, and use it the way it’s intended to be used,” she says.

For example, King says many nail techs will find they’re using disinfectants in the wrong concentrations and that they’re not changing the solution as frequently as necessary. “They read that you can mix the solution and store for 30 days, which some think means they can use it for 30 days. But once you use on instruments, it’s only effective for 24 hours.”

Re member that salon disinfectants are toxic chemicals, regulated by the EPA as “antimicrobial pesticides.” In particular, don’t confuse disinfectants with antiseptics, which are antimicrobials safe for use on skin. The ingredients in many disinfectants are toxic and readily absorbed by the skin. Pay careful attention to the “not safe for skin contact” warnings.

Finally, educate clients to appreciate your efforts. Talk up your disinfection practices and the protections they provide from infections. She’ll thank you at her next appointment (and her next ...)

Know What They Mean by “Clean”

Can’t keep the differences between sanitation, disinfection, and sterilization straight? Even some experts who know better sometimes switch the terms in a slip of the tongue. But make no mistake: Knowing their meanings and understanding the differences between each is as basic to maintaining salon standards as knowing the ABCs is to reading. The following are definitions put out by the Centers for Disease Control and Prevention (CDC).

Sterilization: “The use of a physical or chemical procedure to destroy all microbial life, including highly resistant bacterial endospores.” (Endospores are thick-walled bodies formed within the vegetative cells of certain bacteria. They are able to withstand adverse environmental conditions for prolonged periods.)

Disinfection: “The use of a chemical procedure that eliminates virtually all recognized pathogenic microorganisms but not necessarily all microbial forms (e.g., endospores).” (Microorganisms are living organisms — good and bad — that are invisible to the naked eye.)

Sanitation*:  To wash with soap and water to remove dirt and debris and to reduce the levels of microorganisms to a safe, acceptable level.  

*Generally accepted definition

ATF Disinfection Guidelines for Nail Salons

Non-Porous Instruments*/Intact Skin  

These guidelines apply to metal, glass, and hard polymer files, nippers, pushers, etc.

Step 1: Clean well with soap and water, scrubbing to remove all visible dirt and debris.  

Step 2: Disinfect using one of the following:

• An EPA-registered hospital-grade (low-level) disinfectant per the manufacturer’s instructions

 • Immersion in a 10% solution of bleach for 15 minutes

• Immersion in a solution of 70% (minimum) isopropyl alcohol for 15 minutes

• Immersion in a solution of 90% ethyl alcohol for 15 minutes

Non-Porous Instruments/Non-Intact Skin

These guidelines apply to skin accidentally nicked, cut, or scraped during the service

Step 1: Clean well with soap and water, scrubbing to remove all visible dirt and debris.  

Step 2:  Disinfect only with an EPA-registered hospital-grade (low-level) disinfectant per the manufacturer’s instructions.

Porous Instruments*/Intact Skin

These guidelines apply to wood, paper, and soft-polymer files, buffer blocks, arbor bands, etc.

Step 1:  Clean well with soap and water, scrubbing to remove all visible dirt and debris.  

Step 2:  EPA regulations prohibit the use of registered disinfectants on porous materials. Disinfect with one of the following methods:  • Immersion in a 10% solution of bleach for 15 minutes • Immersion in a solution of 70% (minimum) isopropyl alcohol for 15 minutes • Immersion in a solution of 90% ethyl alcohol for 15 minutes.

Porous Instruments/Non-Intact Skin

Step 1:  Porous items contaminated by blood cannot be re-used. Double-bag and discard.


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