Infection Control - My Thumb - and - You!

Infection control-  sterilization and keeping things clean.  Hmm, not exactly a hot interesting topic but after a personal event that occurred this last month, thought we might should visit this issue.  It's a little off my usual, and a little bit of a Public Service Announcement-- today's topic is all about the back office, behind the scenes, what we do, and why we do it.

First- what happened to me last month.  For my birthday I splurged and went with my girls to get our nails "done."  I opted for the gel manicure and loved how shiny it looked and how well it held up.  Since I wash my hands a lot, my nails take a bit of a beating.  Polish lasts about 10 minutes, thus I usually don't do manicures often.  So, it was time to get another mani and did another round of gel polish.  Mid-mani I asked my young nail tech how they sterilized the instruments he was using.  His English skills were such that he could not understand my question.  His coworker pointed to a breadbox appearing appliance which I took to be a UV light.  He was further asked by my seatmate how long instruments needed to be in there to disinfect them- he said around two to three minutes.  Hmmm, suddenly I was very concerned but, since we were half done, (I should have known better) I continued on. My manicurist did not wear gloves, another red alert.
Fast forward two days- my right thumb is tender, swollen and pointedly infected.  By Sunday I can not pick up anything without pain, by Monday I had it lanced,  and pus poured out (lovely visual- sorry) and I'm the owner of a bottle of antibiotics.  My doctor's office told me this is not an uncommon occurrence.  I'm giving myself a dope-slap for not paying attention.  Yes, I know better! And that's my point- most of you are trusting the nail salons are doing a proper job of sterilization of their tools.  Hmmm, not so much.

As a dental hygienist, I'm very familiar with infection control.  It's a vital component of what we do. It keeps you safe, protected, and healthy.  Any break in that sterile chain and we automatically start all over.  It's drilled into us. Pun intended ;)
All of our instruments are run through an ultrasonic cleaner to remove debris, then dried and placed in sterilization bags.  Each bag has a sensor on the outside that indicates the bag has been sterilized.  Each bag should also contain an indicator placed inside as a second signal that sterilization has also occurred within the bag.  Bagged instruments are placed in a sterilizer- whether it's an autoclave, oven, or chem-clave.  It takes longer than two to three minutes to achieve sterilization. Some sterilizers are quick and can take four minutes while others take hours.  Sometimes autoclaves are packed too full and not all instruments get properly sterilized, hence the indicator inside the bag is vital. Sterilizers are checked regularly, spore tests done weekly.  (Spores are bacteria that are more resistant to killing.)  Many of these high tech tools can automatically record and document they are working properly and sterilizing.  Computers are in just about everything.

I always open my sterile instruments in front of my patients- and only after I wash my hands and put on gloves.  Our dental rooms are wiped down twice with a disinfectant, and the surfaces are left wet and air dry for ten minutes. We never reuse items that are labeled as "one time use" and are disposable.  Surgical masks and protective eye wear for EVERYONE in the dental operatory is a must in my book.  We also wear uniforms that stay at the office and are laundered there so no contaminates between home and the office!  We take sterilization very seriously.  All this is stuff you never see but happens with every patient, every time, even if it's only for a "quick tooth check." Infection control is vital to keep you healthy and protected.

                                     Back to My Poor Finger

Swollen and infected

SO, why did my finger get such an incredible, raging infection?  I think it's because there's a big difference in infection control between nail salons and dental offices. That difference is disinfection vs. sterilization.  We worry more because yes, I'm in your mouth- a direct line to your body.  You might not think about it, but if your manicurist breaches the skin- maybe around your cuticle, maybe a hangnail, maybe they slip- they also have a direct line into your body.

My finally healing thumb

 The Washington State minimum safety and sanitation standards for cosmetologists and nail salons only requires them to disinfect their tools.  The laws do talk about using autoclaves or dry heat sterilizers but then says they can then place their instruments in a UV sterilizer, which is a much less expensive option.  From what I've seen, most nail salons only use that UV light box.  Disinfection is not the same as sterilization.  Disinfection of instruments does not insure a 100% kill rate.  Rather, it says it eliminates most harmful microorganisms and inactivates viruses.  It does not kill spores.  Sterilization kills all pathogens, including spores.  Nowhere  in my research have I found any information that says a UV light is adequate for disinfection procedures, let alone sterilization.  All my queries about sterilization only bring up the tools I sited above.  A UV light is not good enough to clean tools that may breach your skin.  These are holding places for tools that have already been sterilized.  That's all they are good for.  Now, here's my biggest concern- sterilization is not required in nail salons.  Nowhere in the WAC laws do they require nail salons to sterilize their tools, just disinfect them!  Unfortunately my skin was breached with a nail tool and infection set in, VERY quickly and painfully.  Two days and my thumb started looking like a sausage ready to burst.  I have sent a complaint it to the Washington Health Dept.  Not to single out my manicurist, because many salons treat their tools the same way.  Instead, my goal is to educate and inform both the salon, and also the folks who set the laws, and now you.  Disinfection and sterilization are two distinctly different things.  With MRSA, VRSA, HIV, and Hepatitis, to name but a very few scary diseases, we all need to up our game, be educated and informed and raise our standards.  We all like inexpensive mani/pedi places.  And it's hard to communicate and ask questions of people who don't speak the same language, but it's time to insist on being protected, whether it's at our doctor or dental offices, hospitals, or hair and nail salons.  Don't pay the price, it's not worth it.


 Just as a reminder, gingivitis, gum disease, periodontitis, they're all also infections and infectious.

Be well my friends!
Barbara Tritz RDH
Specialist in Orofacial Myofunctional Therapy
PS. Thumb is on the mend :)

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