Like millions of Americans who visit nail salons, Louise Forte enjoys being pampered and leaving with picture-perfect hands and nails.
Unfortunately, some manicures and pedicures can result in painful infections which last several weeks or months.
In recent years, there have been at least three cases reported in the media involving people in the United States who died from health problems that the victims' families claim stemmed from unsanitary nail salon practices.
This is why some people are urging their state board of cosmetology to require stricter rules for nail salons. Until the standards for nail salons are raised, knowing how to recognize questionable sanitation practices may save you thousands of dollars in medical bills, and perhaps, your life.
Thousands of people have contracted serious diseases after visiting a nail salon.
Sometimes, doctors have no choice but to cut deep into your finger or toe to remove an infection like the one 14-year-old Virgie Peterson developed under one of her acrylic nails.
"I had a third surgery," Peterson said. "He did a skin graft, took my skin off and put it on top of my finger with stitches."
Using unsanitary tools is how most nail infections and diseases are transmitted, which is why customer Paige Gupton says cleanliness is the number one thing she looks for in a nail salon.
"You don't want to get a fungus, you don't want to have to go to a podiatrist, you don't want to have to go to the doctor because of some infection that you received by going to a place that isn't kept clean," Gupton said.
Preventing disease and injury is the primary reason why state inspectors like Shelley Baucom visit nail salons. She's with the North Carolina Board of Cosmetic Art Examiners.
There's no way an inspector can be in a nail salon every day pointing out unsanitary practices, so that's why Baucom says it's important for customers to know what's right and wrong.
"Watch what is going on around you," said Baucom. "I know it's a time for you to be comfortable and you want to lay back and [feel as though] this is my time, but you also want to make sure that it's a good, good event for you and it doesn't end up carrying you to the doctor several weeks later or making you sick."
Foot spas are one of the easiest places for germs to collect and one of the more difficult things for nail technicians to clean.
The other major area of concern involves the tools nail technicians use. In North Carolina and other states, the tools must be thoroughly washed in warm, soapy water, placed in a disinfectant solution for 10 to 15 minutes, and left to dry in what's called a sterilizing machine.
Salons that follow their state's rules get a Grade A.
So, if a salon has a high grade, can you really trust it is a clean and safe place for you to go?
"Don't get too caught up with the grade of the salon," warned Dr. Robert Spalding. "You need to actually make your own identifications as far as disinfection practices."
Spalding is a podiatrist in Chattanooga, Tenn., and he travels the country urging state boards of cosmetology to raise their nail salon standards.
"Up to 75 percent of the nail salons in this country are not following their state standards for disinfection," said Spalding. "I find it very alarming and it's very concerning."
Spalding has written a book entitled Death By Pedicure: Dirty Secrets of Nail Salons, which documents some of the unsanitary practices occurring in U.S. salons. Some states have even reviewed the book to identify areas where they need to raise the standards in their state.
You can click through our slide show on this page to see some of the patients Spalding has treated for a variety of nail infections.
One patient had her right second toe amputated due to an infection after a nail technician removed a corn.
Some people have even gotten diseases, including Hepatitis.
Before someone polishes and primps your nails, go online to your state's cosmetology board website to see if your nail salon has been cited for any violations.
Look to see if all the nail technicians' licenses are posted and if they are up-to-date.
If the nail instruments are laying out in the open before you are seated—insist on getting a new set and make sure they come out of a sealed envelope.
Some salons use a machine called an autoclave to disinfect their instruments and this may be your best defense against contracting Hepatitis or any other infection.
An autoclave produces steam under pressure and it can destroy microscopic germs. This is the same process used by hospitals across the country to sanitize operating tools.
If your salon doesn't use an autoclave, Spalding recommends you find another place to get your nails done.
It may cost a bit more for that manicure or pedicure, but it's well worth it if it prevents you from getting an infection.
Texas and Iowa are the only two states that require nail salons to use autoclave machines. Oklahoma is considering it.
If you do have an infection requiring care from a podiatrist or any other doctor, you should report the incident so inspectors in your state can investigate the business to prevent other people from getting a similar or worse infection.
The following tips are from the Environmental Protection Agency:
Tips from Dr. Robert Spalding:
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