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Tread Lightly Through That Salon Whirlpool

Study reveals bacteria found in salon foot baths can lead to dangerous infections

WEDNESDAY, May 1, 2002 (HealthDayNews) -- Before you slip those tired, aching tootsies into that tempting whirlpool bath at your favorite nail salon, take heed: Doing so could land you a nasty foot or leg infection.

Researchers from the Centers for Disease Control and Prevention (CDC) have documented an outbreak of a serious bacterial infection affecting 110 people who received whirlpool foot baths as part of a pedicure at a northern California nail salon. Their findings appear in tomorrow's New England Journal of Medicine.

The infection, known as mycobacterium fortuitum furunculosis, causes an inflammation of the skin that can easily turn into large, recurring painful boils -- in the California cases, developing anywhere from the feet to the knees.

While the bacteria that caused the painful infections actually came from the municipal water supply, the researchers say it was the sloppy housekeeping at the nail salon that let the germs breed to dangerous levels and threaten customers' health.

"Normally this bacteria is found in small amounts in water and soil, and is not considered dangerous. But in this case, it collected in a central location inside the foot baths, where it was allowed to grow to dangerously high levels," says study author Dr. Kevin Winthrop, a member of the CDC's Epidemic Intelligence Service.

Though the problem was found in California, Winthrop says he doesn't believe it's limited to that state. "This could easily occur anywhere in the country," he says.

Dermatologist Dr. Ted Daly agrees, saying he suspects complications due to inadequate hygiene practices in many salons are vastly underreported.

"Some people who operate these salons either do not pay attention to, or simply don't understand, the need for equipment like foot baths to be properly disinfected and cleaned on a regular basis," says Daly, an associate professor of dermatology at Nassau University Medical Center in New York.

"They also don't realize how serious the infections can be when bacteria such as what was found in this study gets into the body. It can cause some very serious problems," Daly says.

Indeed, while these infections often begin as small, benign-looking bumps on the skin, they can evolve into large, painful inflamed boils over a period of weeks or months that can be difficult to treat and often recur. Eventually, the boils can become ulcerated, breaking open and resulting in significant scarring. If left untreated long enough, the infection can land victims in the hospital, where intravenous drug treatment sometimes becomes necessary to survive.

The new report grew out of a single physician's experience with four patients who developed infections on their lower leg or foot within a six-month period, with no known cause. After questioning them, the doctor discovered all had received pedicures that included whirlpool foot baths at the same local nail salon.

The physician notified her local health department, which in turn launched the investigation in September 2000.

Ultimately, the researchers identified 110 patients who had picked up the nasty bug at the same salon. All but one was female, and 70 percent reported shaving their legs just before having the pedicure treatment, a fact Winthrop says may have been key to increasing the risk of infection.

"Tiny cuts and nicks on the legs from shaving gave the bacteria an easy entry point into the body," he says.

Incubation periods averaged about 23 days, but Winthrop says some people developed symptoms as soon as 10 days after exposure, while others took as long as 128 days.

Once it was clear a community-based outbreak had occurred, federal health officials went to the salon, examining the whirlpool foot baths.

According to Winthrop, they found large amounts of hair and skin debris behind a small suction screen in every whirlpool they examined -- the very debris that formed the nest that allowed the bacteria to multiply.

"In some instances, there was enough hair in there to make a small toupee, and they were just loaded with chunks of dead skin cells and other debris," says Winthrop. The salon's owner admitted to health officials that the areas behind these screens had never been cleaned.

Not surprisingly, tests of all the screens yielded high levels of not only the bacteria in question, but a variety of equally dangerous germs.

"We knew instantly that this was our source of infection," Winthrop says.

While this was the first reported outbreak of "community-acquired rapidly growing mycobacterium," a subsequent survey of 18 other California salons revealed that 89 percent were found to harbor similar bacterial infestations in their whirlpool foot baths. Winthrop says sporadic reports of similar infections traced to other California salons have begun surfacing since the initial investigation began.

While the California State Department of Health has proposed regulations forcing mandatory cleaning and sterilization of whirlpool foot baths in commercial salons, no laws are in place yet.

That's also the case in most parts of the United States.

What To Do: For more information on foot hygiene, visit The American Orthopaedic Foot and Ankle Society. For an eye-opening look at the health and safety issues of nail salons, read this Washington Post report.

SOURCES: Kevin Winthrop, M.D., Epidemic Intelligence Service division, Centers for Disease Control and Prevention, assigned to California State Health Department; Ted Daly, M.D., associate professor, dermatology, Nassau University Medical Center, and dermatologist, Garden City Dermatology, N.Y.; May 2, 2002, New England Journal of Medicine
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