Roger W asks about potential infections with nail care

By Dr. Nirenberg Sunday April 6, 2008

Dear Dr. Nirenberg:

I have had ingrown toenails that have required a podiatrist. Since then I have gone on a regular basis and have them trimmed. I understand that the instruments have been wiped or soaked in a sanitizing solution such as alcohol. I do not know if the buffing stone has been treated. I am concerned about MRSA and other transmittable pathogens. What is the proper treatment of instruments and buffing stones and how can I be assured it is being followed. Are there any epidemiological studies concerning transmission by podiatrist as well as pedicurist?

Thank you very much,

Roger W

Dear Roger:

Thanks for your question. I do not know of any studies with podiatrists, but in general, most podiatrists have a good understanding of sterilization procedures and adequately sterilize instruments. There have been studies showing Mycobacterium fortuitum outbreaks in nail salons. I found the following report:

In September 2000, a physician in northern California described four patients with persistent, culture-negative boils on the lower extremities. The patients had received pedicures at the same nail salon. We identified and investigated an outbreak of Mycobacterium fortuitum furunculosis among customers of this nail salon. METHODS: Patients were defined as salon customers with persistent skin infections below the knee. A case-control study was conducted that included the first 48 patients identified, and 56 unaffected friends and family members who had had a pedicure at the same salon served as controls. Selected M. fortuitum isolates, cultured from patients and the salon environment, were compared by pulsed-field gel electrophoresis. RESULTS: We identified 110 customers of the nail salon who had furunculosis. Cultures from 34 were positive for rapidly growing mycobacteria (32 M. fortuitum and 2 unidentified). Most of the affected patients had more than 1 boil (median, 2; range, 1 to 37). All patients and controls had had whirlpool footbaths. Shaving the legs with a razor before pedicure was a risk factor for infection (70 percent of patients vs. 31 percent of controls; adjusted odds ratio, 4.8; 95 percent confidence interval, 2.1 to 11.1). Cultures from all 10 footbaths at the salon yielded M. fortuitum. The M. fortuitum isolates from three footbaths and 14 patients were indistinguishable by electrophoresis. CONCLUSIONS: We identified a large outbreak of rapidly growing mycobacterial infections among persons who had had footbaths and pedicures at one nail salon. Physicians should suspect this cause in patients with persistent furunculosis after exposure to whirlpool footbaths.

I think nail salons are becoming more aware of this problem and beginning to take measures to improve sterility. Doctors and podiatrists are extensively schooled in infections and sterility, but I don’t know about pedicurists’ education.

Personally, I would feel comfortable with most podiatrists trimming my nails. My wife goes to a pedicurist occassionally for nail care and at her particular salon I feel comfortable.

Ultimately, if you have concerns though, you should discuss them with your podiatrist or pedicurist.

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