Death by Manicure: The Case of the Poison Polish. Dr. Robert T. Spalding Jr.
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as a beacon for patrons of nail salons in the US and around the world. It is abundantly clear that Katie Johnson should not have been treated in a nail salon without written permission from her doctor. She apparently didn’t know that and neither do many others who believe they are in good care when they trust their hands or their feet to a technician.
Podiatrists and many other doctors know that many services are performed in nail salons for individuals with certain medical problems. These people should not patronize these establishments without the written permission of a physician who is closely monitoring their care. For example, regulations in Tennessee stipulate that written permission from a physician must be obtained before clients with skin diseases or lesions can receive services from nail techs. Unfortunately these regulations are not being enforced. Skin diseases could imply loss of surface tissue integrity as a result of diabetes, neuropathy, or vascular problems.
Physicians nationwide are failing to get a history of these services with their patient population. Each treating physician should develop a referral protocol for patients with significant foot problems before having their nails trimmed in nail salons.
With the exception of Texas, many state boards of cosmetology across the nation have rag-tagged, mismatched or even absent regulations to protect their citizens. The 28 states that have no laws against callus cutters are a perfect example. Also, there has been a historical resistance to sterilization because these states think that current disinfection protocol is sufficient. This is due to the fact nail technicians are not supposed to be working on medical problems or in situations that produce a blood field.
However, a significant problem exists like in the case of KE Nails where existing disinfection rules are not being followed. Disinfection soaking times with intermediate liquids such as70 percent alcohol or quaternary ammonium compounds are almost impossible to monitor effectively. The minimum 10-minute soaking time is sometimes shortchanged. There are now evolved bacteria that can even pump these disinfectants out of their systems and prevent being destroyed. Disinfection regulations are not effective unless the solutions are changed on a daily basis. Disinfection times have to be extended if the pre-cleaning or proper sanitation brushing with soap and water are improperly performed. Unfortunately, not every salon follows this protocol. When individuals without proper medical training and experience perform these services, regrettable issues can result as in the case of Katie Johnson.
State cosmetology boards such as the ones that have followed the Texas scenario have instituted other remedies. One issue is particularly important. The state boards of cosmetology should not be using the word “treatment” in the cosmetology regulations without mentioning the fact that the word treatment specifically excludes medical treatment.
Additionally, most of the state boards do not have physicians on their boards as consultants nor do they seek the guidance of physicians to review health citations commonly found in salons. Sadly, this can be the kiss of death for some poor patrons of nail salons. When individuals without proper medical training and experience perform these services regrettable issues can result. Most importantly, the state of Texas legislature and TDRL (Texas Department of Professional Licensing) should be highly commended for stepping up to the plate with this surprisingly unprecedented and meaningful self-regulated action.
Every tragedy or death should peel back a silver lining in the form of extra awareness. There should always be lessons learned for any needless death. It won’t bring the victim back, but it might help to stop more occurrences in the future. The sweeping new regulations implemented in Texas that may be adopted by other states should be named after Katie Johnson. But the good news was that from her death came clear direction for other states to improve conditions. Hopefully, this would be accomplished as quickly as Texas has recognized the need to do so.
Nail technicians could easily allay clients’ fears by demonstrating their knowledge of proper sanitation and disinfection procedures. Athena’s policy was to walk clients through the salon and show them what measures were in effect to ensure safety. If her patrons weren’t happy then neither was Athena. Clients were free to view a logbook that showed that the foot spas were cleaned and disinfected between each client. Clients were instructed not to shave their legs 24 hours before receiving a pedicure to minimize the risks of infection that could occur with any nicks or cuts. There was always a proper examination of the client so that the techs could determine whether there should be a pedicure, partial pedicure or referral to a podiatrist.
When working with a diabetic or someone who has a compromised immune system, written permission from the client’s doctor needs to be always obtained and a record kept on file.
Something else happened in 2006 that sent shockwaves through the nail technician industry and particularly SPAthena as it happened in Houston. A local beauty school was fined a record $250,000 and closed permanently. There had been several license revocations and an ever-widening investigation of at least 45 individuals across the nation who may have obtained cosmetology licenses by illegal means.
This sort of thing kept Athena awake at night, the very thought of someone doing potentially life-threatening work with the possibility that they were not properly qualified to do so was almost more than she could stand. Of course, this wasn’t as bad as an untrained surgeon performing operations, but the totally unethical aspect of it was completely alien to Athena who was trusted by her clients and peers implicitly because she was a certified Medical Nail Technician.
For those entering this program or interested in more information, the MNT certificate program is a 10-stage process that provides the student with an advanced course that is far beyond their former education. These nail technicians directly and indirectly benefit from this training. The curriculum is developed around 10 topics.
First, technicians learn to properly sterilize instruments to give their clients the ultimate in protection against disease transfer. Then come lessons in the practice of universal precautions to protect clients and themselves from the transfer of bacterial and fungal organisms. The third topic gives technicians advanced information on the types of pathology that should be referred to physicians. In the next stage technicians are given advanced information on the five types of “high risk or at risk” clients who cannot have pedicures. The fifth topic is where the technicians experience a practical internship in a podiatry office to learn how to care for problem nails, such as fungal nails or ingrown nails, and to perform advanced callus care.
They agree to practice these skills only while working under the direct supervision of a podiatrist. Stage six is all about technicians learning how to properly refer medical problems to physicians and how to encourage and receive referrals from physicians for beautification services. In the seventh topic the technicians are provided additional training to prepare them to function as podiatry assistants. They will learn the basic principles of the position, such as taking quality X-rays, medical charting, administrative work, medical strapping, basic orthotic casting, set up of a sterile field, checking of vitals signs, performing basic foot exams, and to understand the basic principals of biomechanics and gait. Other training may be added to the course in the future, when appropriate.
For topic eight, technicians are certified in CPR and given basic emergency care protocols that can be followed in their salons or as employees in medical offices. The ninth topic is where technicians practice healthy nail service protocols and will hold tighter restrictions on to whom they apply them; they will provide quality, safe care in applying any form of nail enhancement. And finally, in the tenth topic technicians are instructed in how to use vacuum systems for their electric files in order to reduce the exposure of their respiratory system to airborne fungal nail particles and artificial nail dust.
So it was definitely not for the faint-hearted. Athena was proud of what she had achieved but hated the idea of some people obtaining their qualifications by bogus means. To her it was just as bad as the disgraced athletes who are exposed as using steroids. People are in awe of how they have honed their bodies to physical perfection and then find out that their heroes and heroines cheated. It certainly sent the wrong message out, especially to kids who choose professional sports players as their role models.
CHAPTER 4
September 19th 2009
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