Getting nails done may pose health risk
Some local salons’ violations range from minor to perilous
ARIZONA DAILY STAR
Tucson, Arizona | Published: 05.03.2009
The summer rite of a pedicure has its risks: Unsanitary practices can lead to infections.
While some are merely unpleasant, others are dangerous. One young woman may have contracted flesh-eating bacteria while having her feet cleaned and toes painted at a Tucson salon.
Over the past 14 months, state records show that one-third of the 181 Tucson-area salons licensed only to do nails — and also, in some cases, skin care — agreed to pay fines for a variety of state violations, including not sterilizing instruments after each use and performing services without a proper license.
State officials stress — and records show — that the vast majority of the state’s salons have excellent safety standards and pass their inspections. But violations do occur, most of them concerning pedicures. Specifically, many nail salons are not properly cleaning whirlpool foot baths, which can cause skin, clipped nails, grease and debris from other clients to collect behind suction screens and contaminate what appears to be a fresh tub of water. It’s a scenario ripe for spreading infection-causing bacteria.
State regulations require pedicure spas to be drained, cleaned and disinfected in between each client. And at the end of each day, the salon must disinfect them again, after detaching all filters, screens, drains and other removable parts.
But at the Northwest Side Nails Rap III, 5095 N. La Cañada Drive, No. 101, a state investigator last September said she turned the handle on one pedicure spa and contaminated water poured out. Though the salon disputes it, the investigator described the water as being filled with “debris and numerous black, pin-like creatures.”
In January 2008, an inspector reported pulling the handles off a foot bath at the far East Side Nail Star, 105 S. Houghton Road, Suite 156, and smelling a sewer odor. The salon’s owner says she has since passed a state inspection and now knows how to properly clean the baths.
In another case, a salon was fined after a woman complained that callus removal in April 2008 left her feet bloodied and painful. Susie Watson, a mother of three, said L’Amour Nails at 7250 N. La Cholla Blvd., Suite 156, used a “razor” type of instrument, which the salon has denied. Nail salons aren’t supposed to do anything invasive, including taking out ingrown toenails or scraping off anything other than dead skin.
“It’s a little disappointing because having a pedicure is a nice way to do something relaxing that doesn’t cost a fortune,” said Watson, who is in her 40s. “But I won’t ever go for a pedicure again.”
Sixteen local nail salons paid fines in the past year after inspectors said they were improperly cleaning pedicure foot baths.
Contaminated water contains the risk of exposure to several types of fungi and mycobacteria from contaminated water, said infectious disease expert Dr. Sean P. Elliott, medical director of infection prevention at University Medical Center in Tucson. Even a small nick in the skin would be enough to cause ulcers and abscesses on the skin, he said. It’s also possible to contract athlete’s foot from pedicure baths, he said.
Instruments used to work on cuticles and calluses could also transmit infectious disease if they have not been properly cleaned. To prevent such problems, officials with the Arizona State Board of Cosmetology try to make an unannounced visit to each of the approximately 1,100 cosmetology, aesthetic and nail salons in the Tucson area once per year. But with just one inspector assigned to Southern Arizona, that doesn’t always happen.
Just four board employees —three full-time inspector-investigators and one full-time inspector — monitor all of Arizona’s 9,000 hair, nail and aesthetic salons and the 108,000 licensees who work in them. That’s the same number of inspectors it had five years ago, when there were at least 1,500 fewer salons in the state.
And it’s not easy for the public to get information about violations by specific salons. Details of disciplinary actions are not computerized — all the records are kept in paper files at the board’s offices in Tempe.
Checking out individual nail techs is no easier. The state does not require photos on their licenses.
There were 2,165 complaints filed with the board statewide in 2008 for a variety of problems, most of them involving injuries, infections and unlicensed workers, said board Deputy Director Donna Aune. Officials typically respond to complaints within a week, she said, and cases take an average of 150 days to resolve because they often require multiple visits and interviews.
Awareness of the risks of pedicures heightened in 2000, when contaminated whirlpool foot baths were blamed for infecting at least 110 customers at a salon in Watsonville, Calif., with M. fortuitum, a mycobacterium that caused pimply, pus-filled sores and boils on customers’ legs. The salon, the manufacturer and the supplier of the pedicure baths settled a lawsuit with 74 of the clients for $2.9 million.
Their sores ranged in size from pennies to silver dollars and varied in severity — one woman had more than two dozen, said Dr. Kevin L. Winthrop, an infectious-disease epidemiologist at Oregon Health and Science University who led the investigation as an employee of the federal Centers for Disease Control and Prevention.
When he went to the salon and removed a screen at the back of one of the footbaths, he found enough hair to make a toupee.
“I was surprised to see so much debris,” said Winthrop, who found the same mycobacterium in pedicure baths at several other California salons.
His investigation caused several states, including California and Arizona, to adopt regulations about cleaning salon foot baths.
Still, there was another outbreak in California in 2004 when clients from several nail salons in the San Jose area reported being infected with the mycobacterium M. chelonae, which also caused leg sores and skin infections.
Ninety people settled legal actions against 11 salons and several manufacturers and suppliers of footbaths for $7.9 million, said San Jose attorney Rob Bohn Jr., who represented many of the clients. Bohn said the clients included a woman with diabetes who had part of her foot amputated and a woman with lupus who died after fighting a mycobacterial infection for a year.
Violators face fines
After the pedicure that left her feet bloodied, Tucsonan Susie Watson complained to the Arizona State Board of Cosmetology. The salon was fined $250 and reimbursed the $30 cost of Watson’s pedicure. L’Amour Nails manager Tram Phan wrote an apology to the state board, saying his employees don’t speak English well, which may have caused communication problems with Watson.
Indeed, many local nail salons are operated by Vietnamese immigrants, and language can be a barrier, said David Nguyen, the owner of Nails Rap III, which was fined last year for not properly cleaning its pedicure spas. Nguyen said he didn’t agree with the fine against his salon but paid it because he could not afford the time or money to hire a translator and attend a hearing in Phoenix.
Other local salons were fined for having unlicensed workers, and workers who didn’t wash their hands in between clients. At some salons, workers ran out the back door when the inspector arrived.
The typical fine for a salon with no prior problems is $250, though Aune said the amounts are under review. The fine for an unlicensed worker was recently raised to $500 per person. The maximum fine, set by state statute, is $2,000. Salons that dispute the fines or don’t pay them have a hearing before the state board, which has shut salons down for non-compliance.
Following safety guidelines
The state requires that nail technicians have a license, which guarantees they’ve been trained in infection control.
Ten local nail salons were fined last year for performing waxing with only a nail technician’s license, and at three salons, inspectors found evidence of unhygienic waxing, including “double dipping” where wax is reused and may contain someone else’s hair.
Aune noted that someone who is not licensed for waxing may not know some of the risks involved — for example, that it could cause skin damage to people using the drug Retin A.
Queen Nails by Mindy, 9155 E. Tanque Verde Road, was fined $250 last year for not using proper “blood spill” procedures after giving a 14-year-old girl a lip wax that bled. The salon has since changed ownership.
The state requires that any shedding of blood in a salon be treated with a tuberculocidal disinfectant, or another disinfectant that is effective against HIV and hepatitis. Although the risk is minuscule, there is potential for acquiring blood-borne diseases in a nail salon that’s not following proper hygiene practices, said Elliott, the infectious-disease expert.
“If you use the same razor on two patients sequentially, you have the potential,” he said.
“Linda” Nhan Thi Dinh Vu of Canyon Nails on Sabino Canyon Road was ordered to pay $2,000 last November and the salon was placed on probation with the state after a client complained that she required surgery following a severe infection that she believes was caused by a pedicure.
State records say a 27-year-old Tucson woman had a pedicure and exfoliating scrub at Canyon Nails on July 5. A report says she had noticed the nail technician ate and then performed the pedicure without washing her hands. She later told an investigator that the pedicure spa was cleaned only with a sponge and water, using no soap or cleanser.
Shortly after her pedicure, the woman noticed discoloration and blisters on her left leg, the state report says. On July 7, she was admitted to a Tucson hospital with necrotizing fasciitis, also known as flesh-eating bacteria. On July 8 she had surgery to remove the diseased tissue, which had turned black and covered a large area from her shin to the back of her leg. She also had large blisters and will likely need skin grafts, the report says.
The salon was unable to prove that the pedicure and scrub were performed by a licensed nail technician. On July 24 a state investigator said she saw soiled instruments in a dirty container in the salon and watched an employee perform nail services without first washing her hands.
Also, state officials reported that Canyon Nails had a worn, wet pumice bar at a pedicure station. State rules forbid reusing pumice bars, which are porous and can’t be disinfected.
In addition to a fine, Vu was ordered to complete a law review and an infection-protection class. The salon is now being monitored by the state with regular, unannounced inspections. If it fails any of them, its license will be revoked.
So far the salon has passed all inspections, said Vu’s husband, Tuan Vu, who is now overseeing Canyon Nails. The Vus say they were out of the country when the pedicure in question was performed and that the employee who performed it no longer works there. Linda Vu wrote a letter of apology and asked for a chance to correct her mistake and take better care of her salon.
The report said the woman had shaved her legs shortly before the pedicure and that she has diabetes — both factors that put her at a higher risk for infection, Aune said.
State officials don’t recommend shaving within two days of a pedicure because it increases the risk of infection. Diabetics may still have pedicures and scrubs, but it’s important to disclose medical conditions to nail technicians.
“People need to be careful today with all the infections out there,” Aune said. “We do the best we can educating the consumer and the licensee, but there are things they need to know for themselves, too. It’s like what they are telling people with the flu: Make sure to wash your hands, that’s the standard — in hot, soapy water. The nail technician has to wash their hands, and the client should wash theirs, too. I would.”
Contact reporter Stephanie Innes at 573-4134 or firstname.lastname@example.org.