The sign in the window of Chau's Nails on Aurora Avenue North in Shoreline proudly advertises "SPA PED," a pedicure in a padded leather massage chair that sits like a throne atop a footbath.
Salon owner Chau Nguyen said she paid a total of $6,100 for two of the chairs and footbaths — hard earned at $20 a pedicure — because customers kept asking for them. But she knows such luxury comes with risks.
"If I don't clean, they get infection. They don't come back," said Nguyen as she poured hospital-grade disinfectant into the bubbling water.
Whether in a suburban storefront like Nguyen's, or a ritzy downtown salon, the booming $6 billion nail-service industry in the United States has become as much about preventing the spread of disease as it is about making fingers and toes pretty.
The cosmetology industry's growth — the number of salons in Washington has doubled in the past five years — combined with emergence of dangerous nail-salon infections in a few other states have spurred owners and state regulators here to step up preventive measures. But there's a lot of room for improvement.
While Washington licensing officials are considering beefing up regulations, only five state inspectors are assigned to check out more than 10,000 salons and 83 cosmetology schools in Washington. The law requires salons — which include barber, hair, nail and skin-care businesses — to be inspected every other year and schools once a year. And while inspectors uncover hundreds of unlicensed cosmetology businesses every year, the inspection schedule is three to four months behind.
At least one large, high-end salon — Gene Juarez in Bellevue — has never been inspected, according to a sampling of inspection reports. And the state can't say why.
"I wonder if they've just overlooked it," said Kathy Libbey, director of nail operations for Gene Juarez. "We're expecting it, and we're prepared."
Problems in California
The worry about infections in nail salons first emerged in October 2000, when more than 100 customers of one California pedicure salon got boils on their legs that left scars.
The cause was mycobacteria — commonly found in tap water — which presumably entered the footbaths through the plumbing and multiplied in the warm bits of hair and skin in the baths' filter screens. Since then, cases of the disease have popped up in Arizona, Georgia, Illinois and Oregon. And California is now coping with a new cluster in San Jose.
While the chance of contracting an infection is small, "I've seen some terrible, horrific scarring caused by the infections," said Della Condon, president of the California State Board of Barbering and Cosmetology. "The potential for harm is very great."
Condon attributes the infection's recent rise to the growing popularity of nail salons and the hard-to-clean equipment many use. Dirty tools and towels also can spread nail fungus.
"We certainly don't want to experience something like they had in California," said Trudie Touchette, who heads Washington's cosmetology program in the Department of Licensing, which inspects salons.
Washington has had no reports of bacterial infections from nail salons. But California never had a reported case either — until a doctor noticed that a few infected patients all had gotten pedicures at the same place.
Doctors are not required to report mycobacteria to public-health officials. Neither public-health officials nor the Department of Licensing randomly tests salon footbaths for the bacteria, or even asks doctors to keep an eye out.
"I don't think we have a solid way to know everything that happens on this front," said David Bernstein, a Bremerton podiatrist who heads the Podiatric Medical Board for the state Department of Health.
"Nobody's tracking this. I can't say I've ever really encouraged a patient to make a report," he said. "Oftentimes, doctors in their office will see something, treat it and off it goes."
Consumers can notify the state Department of Licensing about unsanitary conditions or infections. But that's not well known. Since the inspection program started, the state has received only about 50 consumer complaints.
"If we don't know, we can't do anything about it," Touchette said. But it also can be difficult to prove that a salon was the source of an infection unless a doctor verifies the connection, she said.
Inspections
The inspection program started in Washington in 1999, after a study revealed health and safety concerns, from improper handling of hazardous chemicals to repeated use of contaminated tools and supplies.
Two years ago, after learning about the California outbreaks, inspectors started unscrewing the filters in footbaths to see if operators were keeping them clean. The answer usually was no.
Now salons are advised to rigorously disinfect footbaths, and conditions are cleaner, Touchette said. Manicure implements must go through a similar process.
Some local salons — such as Gene Juarez — avoid the hassle of whirlpool footbaths by using plain bowls of water, which can be emptied and refilled with no pipes or filters to clean. But the bowls still must be carefully washed and sanitized between customers.
Anything that can't be sanitized, like an emery board, should be discarded after each use.
But the state has never levied a fine for inadequate cleanliness or sanitation, even though inspectors frequently note them in reports. Instead, the state's inspectors have focused on education and helping salon owners and nail technicians follow the rules.
"We have made improvements by leaps and bounds," said Susan Colard, who directs the state's inspection program for salons. "But we have a long ways to go."
In contrast, Oregon has four inspectors who monitor fewer than half the number of cosmetology facilities as in Washington, and they issue fines or sanctions all the time. In the last six years, Oregon has received about 1,300 consumer complaints about salons.
In Colorado, there are no routine inspections, but the state periodically makes unannounced inspections and responds to consumer complaints.
"It's not uncommon to see somebody with a $1,000 to $1,500 fine," said Kevin Heupel, director of Colorado's office of Barbering and Cosmetology Licensure. The violators also have to take a sanitation class and are put on probation for a year, he said.
In Washington, the Department of Licensing is considering new, stricter rules that would be more specific about proper sanitation, especially of foot spas, which aren't even officially mentioned in the rules now. The state also is considering fining salons on the spot for violations.
As for Chau's Nails, the state gave it a perfect score last year, on the one and only inspection it has had. It may be a modest place, but Nguyen works hard to keep the new spa chairs clean.
She also won't accept a customer if she sees any signs of fungus or infection on their nails.
"I say, 'I'm sorry, can you go to the doctor?' " Nguyen said.
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