State inspectors are investigating a Ft. Worth, Texas, salon where a 46-year-old paraplegic woman allegedly contracted a staph infection that led to her death. Family members say Kim Jackson received a pedicure in a whirlpool spa last July. They claim that during the service the technician nicked her foot with a pumice, drawing blood. Jackson was subsequently treated for an MRSA staph infection and died on February 12. Her doctor listed the cause of death as a heart attack due to a staph infection on her foot that infected her blood.

“MRSA is a methicillin-resistant staph infection that has developed because of the overuse of antibiotics. Because it is resistant to various antibiotics, including penicillin-related antibiotics, much stronger drugs need to be used to combat it,” says Dr. Dennis Arnold, a podiatrist and founder of the International Pedicure Association. “Though we don’t know the particulars of this case, it’s more than likely a paraplegic would have poor circulation, making it more difficult to fight off an infection. We also don’t know what other medical problems she may have had and if they were properly treated.”

It’s unclear at this point whether staph bacteria were present in the whirlpool spa or were transmitted by the pumice or other means. Although staph can be found in foot spas, it’s a common organism that can be found just about anywhere. “The MRSA may not be related to the whirlpool, unlike the mycobacterium that caused the outbreaks in Northern California,” says Dr. Arnold.

Despite the difficulties of treating a Staph infection, it is easy to deal with in a salon setting. “Proper sanitation and disinfection is more than enough to control it,” says Doug Schoon, vice president of science and technology for Creative Nail Design. “In fact proper cleaning alone (sanitation) is enough; disinfection is icing on the cake, an added safety factor to ensure client safety.”

In response to the public’s concerns, the Texas Department of Licensing and Regulation recently adopted new standards requiring implements to be cleaned, disinfected, and sterilized by use of an autoclave, ultraviolet light, or dry heat.”

But according to Schoon, this solution is completely ineffectual and would not have made any difference in this case. “What nail professionals should do is find out their state regulations concerning sanitation and disinfection and obey them,” says Schoon. “This is also a state board problem. The boards and their inspectors have to understand the requirements and enforce them. They need to hold the salons accountable and the consumer should hold the stateboards accountable and expect them to enforce the regulations effectively.”

Nail techs can allay clients’ fears by demonstrating their knowledge of proper sanitation and disinfection procedures. “Walk clients through the salon and show them what you’re doing to ensure their safety,” says Schoon. “Show clients your logbook showing that the foot spas are cleaned and disinfected between each client. Tell clients not to shave their legs 24 hours before receiving a pedicure to minimize the risks of infection.”

And nail techs should be proactive. “This is where proper examination of the client comes in,” says Dr. Arnold. “Nail techs need to determine whether there should be a pedicure, partial pedicure, or referral to a podiatrist.” When working with a client who is diabetic or has a compromised immune system, Schoon urges nail techs work with her doctor. “Get written permission from her doctor and keep it in your files,” he says.