Expert Opinion:

In the November 2014 issue of AIDS, Research and Human Retroviruses, it was reported that a 22-year-old Brazilian woman had likely contracted HIV by using the manicure equipment of a cousin who was unknowingly HIV positive at the time. This woman had no other risk factors for acquiring the disease, and other analysis provided substantial evidence that the sharing of the manicure tools was the culprit.

Although infection via this mode of transmission is rare, this case illustrates that it is possible. “Improperly disinfected manicure tools with possible blood-blood contact can result in transmission of bloodborne pathogens,” says Dr. Dana Stern, M.D., a board-certified dermatologist specializing in nails. “These pathogens include, but are not limited to, hepatitis B (HBV), hepatitis C (HCV), and human immunodeficiency virus (HIV).”

While most bloodborne pathogens are spread sexually or through the use of shared needles for illicit intravenous drug use, they can be transmitted via accidental needle sticks and other sharp object-related injuries. “Transmission of bloodborne diseases during nail services could occur when a small amount of pathogen-containing blood is present on the manicure equipment and comes into contact with another client or technician’s blood stream by a tiny opening in the skin such as a paper cut,” says Dr. Stern. “These small amounts of contamination are microscopic and would not be visible with the naked eye. In other words, the equipment would appear to be clean.”

Dr. Stern emphasizes that it is important to understand that not all bloodborne pathogens are alike. Certain viruses, such as HCV for example, can spread more easily through contact with manicure equipment or one-time-use items such as nail files because HCV can survive outside the human body for at least 16 hours — even up to four days — and HCV causes infection with relatively little viral exposure. 

The following are some precautions Dr. Stern suggests that all nail techs take to protect themselves from bloodborne pathogens:

> Vaccination against hepatitis B should be highly considered by any nail technician who works with the public.
> A tech who doesn’t regularly wear gloves should consider doing so, especially if she has a cut or opening in the skin.
> Avoiding credo-like blades is a protective measure for nail technicians. Be especially careful with all tools that can induce bleeding, including sharp-edged foot files and cuticle nippers.
> Work space precautions can serve to protect not just the health of the client but the nail technician as well. One-time-use items such as porous nail files and buffing blocks should be disposed of after every client. The alternative is that the nail technician is continuously handling viral contaminated equipment. Workspaces should be highly organized so that new and clean equipment is clearly separated from used and dirty tools.
>  Healthcare providers use the term “universal precautions.” This means they treat all patients and equipment as if it is known to be infectious. This concept is especially important for nail technicians who don’t routinely take the health history of their clients.

Tech Tips:
I actually never worry about contracting and/or spreading any bloodborne pathogens. It’s always on my mind, of course, but that’s why I take proper precautions. I never cut the eponychium, I always wear gloves, and I use hospital-grade disinfectant on everything — implements, desk, lamps — everything. I also use a new towel for every client. I actually treat every client like they have something contagious. Everyone gets a new file and everything is disinfected. From my knowledge, I have yet to deal with anything too serious, as I have new clients fill out a client sheet. It helps them, and it helps me help them.
Beth Albrecht, Nails by Beth, Kitchener, Ontario, Canada

I don’t really worry about this after doing nails for 28 years, but I am cautious. Very rarely is there any blood involved, and if there is I make sure not to touch it. I use styptic powder to clot any blood flow. Occasionally clients pick or bite at their cuticles, and in trying to file the nail or nip off dead skin flaps sticking up around that area, sometimes the skin will start to bleed. We have a first aid kit at the salon, and I immediately have the client wash the blood away with water and germicidal soap. The styptic powder really helps to stop further bleeding, and if it doesn’t work right away, then we use a folded up paper towel to add pressure until the bleeding does stop.
Jill Wright, Jill’s — A Place for Nails, Bowling Green, Ky.

For Further Reading:

The Occupational Safety & Health Administration (OSHA): Bloodborne Pathogens and Needlestick Prevention.The information on this website explains employer responsibilities and worker rights regarding bloodborne pathogens, discusses what can be done to control exposure, and includes a FAQ section and quick reference guide.

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