Nail Salons Can Be Risky Business

According to Nails 1998-1999 Fact Book,¹ US consumers spent an estimated $6.28 billion on nail services in 1997. Many consumers patronize discount and full-service nail salons with a belief that the instruments have been sanitized appropriately. This study intends to show that consumers are indeed at risk for contracting fungal, yeast, and bacterial infections from nail salon equipment.

We inspected 4 salons and obtained bacterial, yeast, and fungal cultures from randomly selected nail instruments and 1 pedicure tub. No viral cultures or viral antigen tests were performed, but previous studies^{2 - 3} suggest that hepatitis viruses, especially hepatitis C virus, may not be killed by current salon practices. The results of our studies show that yeast and pathogenic bacteria are commonly present on nail instruments in nail salons. Tuberculocidal disinfectants used in some full-service salons may provide better instrument sanitation, but this may be the result of a better disinfection technique rather than of an enhanced killing effect.

The first discount salon we studied (salon A, Table 1) was cleaning their instruments with an unlabeled blue liquid. When cultured, the 3 instruments from this salon yielded Rhizopus arrhizus, Candida albicans, and coagulase-negative staphylococcus.

The second discount salon (salon B) cleaned their instruments with Barbicide (King Research Inc, Brooklyn, NY), which contains benzyl alconium chloride. When cultured, the 3 instruments yielded C albicans, Bacillus species, and diphtheroids. One of the fungal cultures yielded moderate yeast.

A full-service salon that used Hygenique (containing benzyl alconium chloride) (trademarked product no longer available) and 99% isopropyl alcohol to clean their instruments had similar results. Cultures of 3 pieces of equipment yielded C albicans, Streptococcus viridans, Enterococcus species, and coagulase-negative staphylococcus.

The only salon that did not have fungus, yeast, or bacteria living on each piece of equipment was a full-service salon (salon D) that disinfected their equipment in Barbicide Plus (King Research Inc), which also contains benzyl alconium chloride. Of the 8 separate pieces of equipment that were cultured, only 3 instruments yielded fungus, yeast, or bacteria. The fingernail buffer yielded coagulase-negative staphylococcus; the toenail buffer, Bacillus species; and the fingernail clipper, Bacillus species. Thus, 5 instruments yielded no fungus, yeast, or bacteria. However, the pedicure tub was being cleaned with Lysol Disinfectant Spray (Reckitt & Colman, Inc, Wayne, NJ) and yielded Pseudomonas aeruginosa, 2 other gram-negative rods, and diphtheroids (Table 1). Although, P aeruginosa lives in tap water, the question remains whether P aeruginosa living in a pedicure or manicure tub can result in nail infections (Figure 1).

We conclude that Barbicide Plus was the most effective of the disinfectants tested in eliminating fungus, yeast, and bacteria from nail salon equipment. Furthermore, Lysol Disinfectant Spray is not sufficient to kill P aeruginosa in a pedicure tub. However, more studies are needed.

It is obvious that during manicures and pedicures technicians may unintentially injure the cuticles, cut the nail folds, or remove calluses too deeply, which may result in bleeding and possible virus transmission.⁴ In 1997, the chief of liver transplantation at Emory University School of Medicine in Atlanta, Ga, investigated the possibility that hepatitis C virus could be transmitted by means of multiuse razors used to trim sideburns and the neck. Five solutions routinely used by 5 barber shops were evaluated. None of the solutions was able to destroy hepatitis C virus particles, despite soaking the instruments for 6 hours, 24 hours, and 7 days.³ Clearly, hepatitis C virus can be spread from one patron to the next.

On the basis of our study, we recommend the following: