Can Salons Spread Infection?
In 1965, a medical researcher managed to trace several hepatitis B patients back to a barber who unintentionally transmitted the disease by shaving all the patients with the same razor. The barber had used a disinfectant, but it wasn't strong enough to kill all the germs.
In those days, many of the serious blood-borne diseases that plague us today—such as HIV/AIDS, hepatitis B and C—were less prevalent or did not exist. According to the Centers of Disease Control and Prevention (CDC), there are about 1.25 million Americans with chronic (long-term) hepatitis B, and 3.2 million with chronic hepatitis C. These diseases are spread by exposure to infected blood. This most commonly happens by sharing infected needles or having sex with someone who has the virus. Certain jobs, like those in the healthcare field, also put people at risk. But, there have been a percentage of hepatitis C cases where doctors haven’t been able to identify an obvious method of infection.
This leaves researchers to investigate what other factors may place people at risk.
A Closer Look at Salons
Texas dermatologist Shelly A. Sekula, MD, has looked closely at the sanitary practices of the cosmetology and barber industry and found conditions sadly lacking.
"Nail and hair salons may be a source of blood-borne as well as other infectious diseases," says Dr. Sekula, who practices in Houston, Texas, and chaired the Legislation Committee for the Texas Dermatological Society. "There is good evidence that razors, nail files, barber's scissors, tattoo needles, and body piercing instruments are risk factors for transmitting hepatitis B and C. Other research shows that hepatitis B can survive outside the body for seven days or more on chairs, headrests, workbenches, instruments and tools.”
Dr. Sekula's interest in this area began when she saw one patient with a contagious fungal infection on her toes and feet. When questioned, the patient remarked that she had noticed just "one little cut" after the pedicure. "And the red warning flags went up," Dr. Sekula says.
"If I was going into a nail salon, I would look for a photo license of the operator. I would also ask about sterilization procedures and would not permit an electric drill to be used on my nails. Nail drills whir so fast, they can easily penetrate the nail and cut you." And they may have cut the person before you, too. So if you do wear acrylic nails and opt for the nail drill, you can buy and bring your own drill bits, designed solely to reduce the risk of nail infections from the use of community, multiple-use instruments.
Adds Phoebe Rich, MD, former president of the Council for Nail Disorders in Schaumburg, Illinois, "There is a potential for the spread of infection if the salon instruments are not properly cared for."
Proper Precautions for Pretty (Safe) Nails and Hair
The best sterilization methods are steam, ethylene oxide gas, dry heat, and chemical germicides. Anything that can draw blood—nail clippers, cuticle scissors, callus paring blades, and reusable and straight razors—should be soaked in a chemical germicide.
"However, most states only require cosmetologists and barbers to use a low-level hospital grade disinfectant—which may or may not kill all the microorganisms," Dr. Sekula says. "To really be safe, I suggest bringing your own instruments."
And don't be fooled by operators who wear face masks. They're not protecting you—they're protecting themselves from breathing in fumes and nail dust.
Though cosmetologists rarely wear them, latex gloves are another important safety precaution. Why don't they wear them? Perception. If you sat down in a salon for a manicure or a pedicure, and the technician put on a pair of rubber gloves, you might think she had some contagious condition.
Actually, she would be protecting you from any ailments suffered by the previous client. Many professionals—health and dental workers, emergency teams, firefighters, police, and correctional officers—wear latex gloves because they are using a technique known as "universal precautions." That means limiting the spread of blood diseases by assuming that everybody's blood, bodily fluids, and tissues are infectious.
"The federal Occupational Safety and Health Administration (OSHA) requires any worker at risk of contracting an infection to wear gloves," Dr. Sekula says. "But, curiously, OSHA regulations leave it to employers and the various states to decide if workers in the cosmetology and barber industries should wear gloves."
Be Salon Selective
To help you decide if a salon provides sanitary nail services, the United States Food and Drug Administration (FDA) experts suggest considering the following:
Is the salon licensed?
Licenses should be prominently posted, both for the salon and the operators. If you don't see them, ask.
How are nail implements sanitized?
Autoclaving (heat sterilization) is best, says Ralph Daniel, MD, a dermatologist in Jackson, MS. But most states allow chemical sterilizing as long as the implements are immersed in the solution for at least 10 minutes between customers.
Ask the technician what the salon's practices are.
If they're using a chemical solution, check the product's label for words like "germicidal" to indicate that it is strong enough to kill bacteria. If in doubt, bring your own implements, Daniel suggests.
Is there a preservice scrub?
Both the nail technician and the client should wash their hands with an antimicrobial soap before working on a client's nails.
Is each customer given a fresh bowl of soapy water to soak their nails in and is a new nail file used for each customer?
Both practices should be followed.
Is the facility neat and clean?
Paul Kechijian, MD, a clinical associate professor of dermatology and chief of the nail section at New York University, compares selecting a salon to selecting a restaurant.
"Ask yourself when you walk in: Would you want to eat there?" he says.
Is there a strong smell of fumes in the salon?
If there is, it's a sign that the facility is poorly ventilated, says John Bailey, PhD, acting director of the FDA's Office of Cosmetics and Colors. Inhaling the fumes from nail products can make you sick.
The Spread of Disease
A client in a salon may have an injury to the cuticles, a cut in the nail folds, or could have bled when calluses were removed too deeply. A hair cutter could have accidentally nicked his client. Customers might have open areas or cracks in their scalps. Crusts, scales, and lice can attach to combs and brushes and easily transmit infection or infestation to the next unwitting patron.
In 1989, a warning was sounded that barber scissors and razors contaminated with blood can pass along HIV. However, no cases of accidental HIV transmission have been documented through the activities of barbers.
A medical researcher found that hepatitis C could be transmitted via the straight razors commonly used in barber shops to trim sideburns and necks. The researcher dunked razors from five different barber shops into five commonly-used sterilizing solutions. Results? None of the five solutions destroyed hepatitis C, even though some were soaked for six hours, 24 hours, and seven days.
It’s important to note, though, that the CDC has not had any reports of hepatitis B or C transmission to or from personal care workers (like manicurists or pedicurists). Injection drug use and unsafe sex remain the top ways that people contract the viruses. Cuts, nicks, and scrapes at the beauty salon or barber shop are far more likely to lead to other, less deadly, conditions for both clients and shop operators, including warts, bacterial and fungus infections, and reactions to various products and fumes.
Reducing the Risk
"The risks would be virtually eliminated if operators used disposable instruments, wore rubber gloves, employed proper hand washing, and used appropriate sterilization techniques," says Dr. Sekula. She would also like to see physicians appointed to the governing boards in every state so the beauty industry can have the latest health information.
The American Academy of Dermatology
United States Food and Drug Administration
Finger nails: looking good while playing it safe. US Food and Drug Administration website. Available at: http://www.fda.gov/fdac/features/095_nail.html.
Gitlin N, Nohe FS, Weiss M. Hepatitis C: risk of a haircut. Ann Intern Med. 1997;126:410-411.
Hair and nail salons linked to infectious diseases. American Academy of Dermatology website. Available at: http://www.aad.org/PressReleases/salons.html.
Hepatitis B. Dynamed website. Available at: http://www.ebscohost.com/dynamed/what.php.
Hepatitis C. Dynamed website. Available at: http://www.ebscohost.com/dynamed/what.php.
Viral hepatitis B fact sheet. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/ncidod/diseases/hepatitis/b/fact.htm.
Viral hepatitis C fact sheet. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/ncidod/diseases/hepatitis/c/fact.htm.
Wagner RF. Risks of infection to dermatologists, cosmetic workers, and the public. Int J Dermatol . 1990;29:253-257.
Last reviewed October 2007 by Richard Glickman-Simon, MD
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