A common phrase I use when treating patients is “do as I say, not as I do.” A recent example of this would be my visit to the nail spa. Being a busy working mum I was desperate to have my toenails painted before heading off on holiday. Against my better judgement and knowledge, but with limited time on my side, I succumbed to the quick, cheap and easy pedicure. This supposed relaxing and energising treat was rather stressful for me. It highlighted and reinforced why these facilities are really a public health issue and can potentially turn into a health nightmare.
There is almost always a risk of attracting an infection no matter where you go. I don’t mean to sound alarmist – and it is true that millions of us get pedicures (and manicures) each year without any serious, or life-threatening side effects showing up. However you should never assume it won’t happen to you.
The bottom line is that many nail salons don’t provide the required level of cleanliness, nor do many have adequately trained nail technicians to prevent diseases from starting and spreading in their salons.
I cringed during my salon pedicure and here’s why:
1. THE FOOT SOAK
While I was impressed to see the facility had an individual liner for the foot spa, this doesn’t necessarily mean you won’t encounter a nasty germ. Even though a liner might be in place, germs still lurk in the plumbing of a whirlpool pedicure spa. The ‘f
resh’ water being drawn for you is probably not as fresh as you think it is.
The pedicure baths a salon provides are a breeding ground filled with unwanted microorganisms (tinea, nail fungus, various blood-borne diseases) and skin particles. Lots of feet get put into that tub, and not all of those feet are clean. If a spa doesn't correctly clean its foot tubs between each client (and allow the appropriate amount of time between clients to do a thorough job), the odds of leaving the spa with a fungal infection you didn't walk in with increase. Also, fungus isn't so easily removed from the surfaces it grows on, so a light cleaning may not rid a tub of its presence.
The Australian/ New Zealand Sterilisation Standards (AS/NZS 4185:2001) ensures that sterilisation is a process which ensures that all living microorganisms that may be present on an object are destroyed. Autoclaving a foot spa is simply not achievable.
2. THE SEALED AND SUPPOSEDLY STERILISED INSTRUMENT PACK
Another “good look” was the instruments neatly presented in a sealed sterilisation bag. Now podiatrists, like dentists, are governed by strict instrument reprocessing and infection control protocols. Instrument reprocessing is indeed a process – one that I undertake every day. In the salon I visited, the instruments appeared to be clean, but I can tell you that they were not sterile. There are certain indicators/markers on sterilising pouches which change colour. There are several other tell-tale signs and not one of them was evident. And even if the instruments had been correctly sterilised, it all became null and void with the use of the emery board, pumice stone and toe separators.
3. NAIL FILE/EMERY BOARD, PUMICE STONE AND TOE SEPARATORS
Any non-metal tools should be used on you and only you. It was at this point of my pedicure that I spoke up and ask the nail spa worker to not use the emery board. Taken from the storage container nearby it was clear that it had been used before on other unsuspecting patrons. Emery boards, pumice stones and toe separators can retain exfoliated skin particles, fungi, bacteria and viruses. These items used on an infected area can introduce the infection to an uninfected area on the same person or to the next user.
You wouldn’t share your toothbrush with other people living in your community, so why share these items? Bottom line is, it needs to one per person and disposed of, or a metal implement that can be reprocessed and autoclaved.
4. NAIL INFECTIONS, FOOT FUNGUS AND HAMMER TOES
In the vibrating chair next to me was an elderly lady who was enjoying a pedicure together with her daughter. Being a podiatrist I can’t help but take note of other people’s feet. I noted the thick and fungal infested toenails, together with bunion and hammer toes. Now this lady should not be having her feet attended to in a non-medical salon. Her own health and wellbeing, as well as that of others (including her own daughter) was compromised. These risks have already been explained.
Nail salons won’t turn away customers with nail infections or foot fungus. This means that people harbouring germs are being worked on next to you instead of being referred to an appropriate medical professional.
5. BLOOD BORNE PATHOGENS
To add insult to injury, the lady next to me was “cut” whilst having her cuticles cut back. Working with sharp tools can unfortunately result in cuts. However, cuticles should not be cut as it’s the nail's protective barrier. Cutting and pushing back, can damage it and increase the risk of infection. The manner in which the bleed was dealt with was not appropriate. Furthermore, I overhead the elderly lady mention that she was taking a blood thinning agent (Warfarin) because of her pacemaker.
Because there can be bleeding or skin breakthrough of the tissue surrounding the nail during cuticle trimming or callus removal, the possibility exists for transmission of blood-borne pathogens from client to client with non-sterilised instruments. While in theory the pathogens transmitted could include HIV, in reality transmission of Hepatitis B and C are more likely. Although not usually fatal, these diseases can certainly cause significant morbidity and represent a public health hazard.
In the case of Hepatitis B in pregnancy, transmission to the foetus is possible. I have lost count the number of times I have seen posts on local mums’ forums as to whether they should have a pedicure whilst expecting. Yes, if you can guarantee all infection parameters are in place, otherwise it’s a NO.
Also, just because you don’t see blood, it doesn’t mean your skin hasn’t been cut. Cuts in the skin can be microscopic. Customers do come with little cuts, scratches, hangnails, bitten nails, insect bites, paper cuts, split cuticles, etc.
6. FOOT RAZ0RS
Any form of cutting implement used should only be in the hands of someone trained. Someone who safely knows the various layers of the skin and what the difference is between callous that is normal and serves a purpose vs callous that is problematic and that requires attention. Not all callous should be removed and if it should, the safest place is the skilled practice hands of a podiatrist. I also won’t harp on again about the infection control risks – I think you’ve got the message.
7. TOXINS AND UV DAMAGE
I always love the colourful display of nail polishes and found it a challenge to choose a favourite. The one to choose however, would be the one that doesn’t contain any bugs but also the one that isn’t going to be damaging to the natural nail plate.
There is conflicting information as to whether bugs can survive in a bottle of nail polish that contain varying amounts of toxic and potentially hazardous ingredients. The nail polish debate is one for another day. In the meantime though, I am certainly not going to take the risk of sharing nail polish and I am going to avoid the harsh chemicals and very strong binding agents in some of these products. I’ve seen many damaged toenails from the application of gel based/artificial products. More on this topic at a later date, but in the interim I am regularly asked if the ultraviolet drying lamps will age skin as much as sunlight. The answer is yes, especially if you have manicures/pedicures regularly. Letting nails dry naturally may take longer, but you are not exposing your hands or feet to damaging rays.
For all of these important reasons, I’ve started the “Soul to Sole” medical pedicure. A luxurious, relaxing treat that results in pretty feet, not an unwanted fungal infection or worse. The environment I provide is one on one and you can relax knowing that all infection control aspects are covered by a professional podiatrist.