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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.
Look for the nail salon's state-issued license. If you don't see it prominently displayed, its likely the staff doesn't have the education and training to do the job.
If a manicurist pulls a tool from their pocket, that tool is no longer sanitary and you should not let them use it on you.
Buffers, nail files and scrubbers should be used only once and tossed away.
If you see a worker simply draining water from a foot spa and wiping it out dry with a towel, that's not good enough.
If you have a cut or open wound on your legs or feet, you shouldn't go to the salon because this could provide an opening for germs to enter your body.
Before placing your feet in a spa, look in the water to see if any black flecks come out that could be mold. If you see them, don't put your feet in!
Jessica Mears received a pedicure on November 24, 2004 in California. She died June 20, 2005.
Kimberly Jackson received a pedicure in July 2005 in Texas. She died on February 12, 2006.
According to the Centers for Disease Control and Prevention, each state has the authority to ban fish pedicures. They refer to a small fish call Garra rufa that eat away at dead skin on people's feet. The CDC says these fish pedicure tubs cannot be cleaned thoroughly between customers because the fish are present.
The following tips are from the Environmental Protection Agency:
Microorganisms in foot spas can enter through the skin; so broken skin (e.g., cuts and abrasions) should not come into contact with foot spa water.
Do not shave, use hair removal creams, or wax your legs during the 24 hours before receiving treatment in a foot spa.
Do not use a foot spa if your skin has any open wounds such as bug bites, bruises, scratches, cuts, scabs, poison ivy, etc.
Open wounds appear on the skin of feet and legs. Initially they may look like insect bites, but they increase in size and severity over time, and sometimes result in pus and scarring.
Some incidents of foot spa infections have been caused by Mycobacterium fortuitum. This organism can occur naturally in water and soil. Other organisms have also been found in footbath systems. The screens and tubes of foot spas are particularly good places for the bacteria to collect and grow, often forming dense layers of cells and proteins called biofilms, which can be very hard to remove.
Ask salon workers how the foot spas are maintained and how often.
A foot spa should be disinfected between each customer, and nightly. The disinfectant needs to work for the full time listed on its label, typically 10 minutes, depending on the type of disinfectant.
Proper cleaning and disinfection can greatly reduce the risk of getting an infection by reducing the bacteria that can build up in the foot spa system.
Salons should use an EPA-registered hospital disinfectant.
The label should list relevant product information, including: The terms "Disinfectant" and also "Hospital" or "Medical" or "Health Care". This indicates the product can be used as a disinfectant on surfaces in these environments, the EPA registration number, and some products may have instructions for both sanitizing and disinfecting footbaths. Pedicurists should follow disinfecting directions.
Do not use the foot spa if you are not sure it is disinfected and safe to use. Do not risk your health. You should report any problems to your state cosmetological board.
If a nail tech is willing to serve you with an obvious non diagnosed nail problem, they are also willing to contaminate the next client.
Nail techs should learn to refer to podiatrists rather than treat out of their scope of practice. They are not taught how to properly refer to physicians in existing cosmetology textbooks. The ANT course teaches nail teach to autoclave, refer and how to aseptically perform nail debridment services.
Nail techs and cosmetologists are in the healthcare profession when they provide pedicures whether they want to admit or not.
The 700,000 nail tech professionals in the 200,000 nail salons perform more high risk pedicures than the 15,000 podiatrists do in the US.
The dollar cost in this economy sometimes make people with nail problems show up in a cheap salon rather than seeking more professional medical care in a podiatry office.