APIC Issues Infection Prevention Strategies When Visiting the Nail Salon or Tattoo Parlor

If youre thinking about heading to the nail salon for a little pampering or getting a new tattoo, follow these infection prevention strategies from the Association for Professionals in Infection Control and Epidemiology (APIC) to decrease your risk of getting an infection.

NAIL SALON
Treating yourself to a manicure or pedicure at the nail salon can be relaxing and rejuvenating. But did you know that without proper precaution, you are putting yourself at risk for infection? The skin on our hands and feet can easily be nicked and cut sometimes without even our knowing and whenever an open wound is exposed to skin-skin or skin-surface contact, you have a chance of picking up bacteria, fungi, or viruses that can develop into an infection. The most common infections acquired at the nail salon are warts and nail fungus.

Follow these infection prevention strategies to decrease your risk:
1. Do not get a manicure or pedicure if you have an infection on your hands or feet.
2. Do not get a manicure or pedicure if you have any open wounds, including bug bites, bruises, scratches, cuts, scabs, and poison ivy.
3. Look for a license. In the United States, the salon must be approved by the state health department and the nail technician should have a certificate from the board of cosmetology. The license means the salon is equipped to give a manicure or pedicure cleanly, but it does not guarantee the salon will do so on the day of your visit.
4. If considering a fish pedicure or fish spa where a tub of water is filled with small fish called Garra rufa that eat away dead skin on the clients feet, know that there are infection risks involved and that several states have banned the use of fish pedicures for various reasons.
5. Dont shave before getting a pedicure. Newly shaved legs can have tiny nicks you cant see that are susceptible to infections.
6. You and the nail technician should perform hand hygiene before beginning the manicure.
7. The nail technician should wear gloves and perform hand hygiene before donning and after removing.
8. Skip the cuticle pushing and clipping. Our cuticles are what separate us from the rest of the world bacteria, fungi, and viruses.
9. The metal tools the nail technicians use should be heat-sterilized in a sterilizer (also called an autoclave). Some salons will use chemical solutions (e.g., Barbicide) or UV light boxes to disinfect tools, which is legal and standard but not totally effective in killing all of the germs. Nail salon tools like pumice stones, emery boards, nail buffers, and foam toe separators cannot be properly sterilized so they should be disposed of after each use. Bring your own equipment and clean and disinfect it between uses with alcohol or hydrogen peroxide. You can buy the nail equipment for about $60.
10. Whirlpool footbaths although seemingly safe are difficult to clean and filled with city water, which may or may not be free of germs. Even though nail salons disinfect their tubs, research has shown that germs can be trapped in the equipment and have been linked to infections. Use plastic liners or trash bags in the footbaths to add an extra layer of infection protection. If your salon doesnt use a liner, bring your own.
11. Dont allow the technician to shave your skin calluses. If your calluses are thick and uncomfortable, opt for a deep soak (often with a chemical solution) and scrubbing to remove them.

TATTOO PARLOR
Tattooing (facial tattooing [i.e., permanent make-up] or body art) is an invasive procedure that has the potential to result in an infection. Infections are generally transmitted through unsterilized equipment or contaminated ink in a tattoo parlor. Unsterilized equipment or contaminated ink can cause skin infection (e.g., staph or strep infection) at the tattoo site or a bloodborne infection, such as hepatitis B. However, if proper infection prevention strategies are followed, the risk of infection can be decreased:
1. If you are susceptible to getting infections, check with your physician before getting a tattoo.
2. Investigate the tattoo parlor and tattoo technician (artist) before undergoing the procedure. Licensure requirements and inspection processes vary by state.
3. Sterile needles must be used for only ONE tattoo session, on only ONE client.
4. The parlor should use separate small containers of dye (ink) that are used for only ONE client and discarded after use.
5. Needles and the tips and tubes that hold them to the machine should be sterilized in an autoclave following each use. The machine cannot be sterilized, and so it should be covered with plastic during use and disinfected between clients.
6. The tattoo technician should perform hand hygiene frequently and wear gloves to protect the client and themselves.
7. The work area should be organized to prevent cross-contamination.
8. Tattoo sites should be disinfected before the procedure and dressed with an antiseptic ointment and sterile bandage after the procedure.
9. The client should be provided with written instructions on how to care for the tattoo and how to prevent infection (e.g., keeping the site clean and dry).
10. Contact your physician if you notice signs of possible infection such as redness, pus, or swelling.
Following these simple strategies can help reduce the risk of acquiring an infection when getting a manicure, pedicure, or tattoo.

Remember:
 First impressions are important! The salon (nail or tattoo) should look and smell clean.
 Speak up and feel free to ask questions.
 If you suspect that a salon is in violation of sanitary standards or state law, call the local health department to inform them.

Additional resources:
- APIC Text, Chapter 116 Body Piercing, Tattoos and Electrolysis.
- Environmental Protection Agency and the Centers for Disease Control and Prevention Preventing Pedicure Foot Spa Infections.
- U.S. Food and Drug Administration Think Before you Ink.
- Discovery Health -- Top 5 Infections You Can Pick Up at the Nail Salon.
- About.com Beauty -- How to Stay Safe at the Nail Salon.