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State Board Information
Illinois Department of Financial and Professional Regulation—Spa Safety Rules
California Department of Consumer Affairs
Board of Barbering and Cosmetology—
Whirlpool Footspa Safety Fact Sheet
Texas Department of Licensing and Regulation—
If You Do Nails, an Autoclave is Required
EPA—Recommended Cleaning and Disinfection Procedures for Foot Spa Basins in Salons
EPA—Preventing Pedicure Foot Spa Infections
Providers and clients must wash hands and feet thoroughly
before a service.
Clean with surfactant or enzymatic effectiveness and chlorinate pedicure equipment and facilities as prescribed by state requirements.
Require clients to avoid shaving before treatments because opportunistic bacteria can enter the body where even microscopic
skin breaks occur.
Assure clients that disinfection procedures as prescribed by law are being met and post past inspection results.
Do not allow unlicensed individuals, or anyone who is untrained before receiving a license, to provide services in the spa.
Do not service clients with any signs of infection.
Require clarification as to diagnosis, lab testing and medical prognosis of cellulitis and skin infections.
All implements, equipment, countertops, floors, neck rests and treatments tables must be cleaned, and all reusable implements
must be discarded or disinfected.
—NIC Health and Safety Report by Sue Sansom, September/October 2006 NIC Bulletin
According to the National-Interstate Council’s Health and Safety Report, authored by Sue Sansom, administrator of the Arizona Board of Cosmetology, and appearing in the NIC Bulletin from September/October 2006, the types of bacteria that commonly cause
spa health concerns are as follows.
Cellulitis. This is an infection of the skin caused by various bacteria. It is usually referred to as being noncontagious, but direct contact can transfer the infection to another person. Cellulitis is often used without specific laboratory conclusions.
Mycobacterium fortuitum furunculosis. This is the bacteria responsible for the original outbreak of pedicure station infestation in California and requires particular attention when offering pedicure treatments.
Mycobacterium chelonae. This is another opportunistic bacterium in the same category as Mycobacterium fortuitum furunculosis.
Methicillin-resistant staphylococcus aureus (MRSA). This is a very severe infection that is contracted in surgical and health care settings, and is thought to be passed on by local contact. A highly publicized case of the death of a Texas woman after receiving a pedicure was classified as MRSA.
It is a well-known fact that without making concerted efforts to keep your spa sanitary for your clients, you could wind up with major problems, including bacteria, lawsuits and unwanted media attention. The combination of the growing popularity of spas and recent press reports about illness—even death—resulting from unclean facilities has magnified the issue of sanitation, resulting in a make-or-break situation for all spas in the industry, from large destination spas to entrepreneurial one-room facilities.
A number of state cosmetology boards are cracking down on cleanliness regulations, as are the United States Environmental Protection Agency (EPA) and Centers for Disease Control (CDC). Many of these governmental entities and various industry organizations are providing updated guidelines to ensure spas remain germ-free and success-driven. Those that succeed in doing so can benefit from marketing themselves as a clean experience for clients. (See Online Resources for Spa Sanitation Guidelines.)
Common sanitation issues
It is often difficult for potential clients to dismiss the rare, yet hyped, cringe-worthy stories about bacteria-related illnesses brought about by unclean spa environments. One of the earliest and most memorable of them linked an outbreak of Legionnaires’ disease—a sometimes fatal form of pneumonia—to a whirlpool spa bath on a cruise ship, affecting 50 passengers in 1994.1 Since then, there have been similar occurrences leading to the understanding that communal tubs and other water-related spa areas hold the potential to transmit health-threatening organisms if not cleaned properly.2 (See Common Spa Bacteria.)
Manicures and pedicures recently have also garnered a lot of attention for being a sanitation risk, and the potential for infection is even greater with these services if cuticles are cut and instruments aren’t properly cleaned. Because of this, many professionals instruct clients to bring their own instruments to ensure sanitation.
In the wake of multiple incidents involving disease-spreading pedicure stations, national and state governmental agencies have both issued and updated guidelines to keep equipment sanitary. The EPA has issued precautions for clients, as well as instructions for spas to follow in order to help facilitate the health of clients who receive pedicures. The CDC also recently investigated mycobacteria in pedicure stations after an October 2000 incident occurring in California that left more than 100 clients with prolonged, scarring boils on their lower legs.3
States such as Arizona, California, Colorado, Illinois, Texas and Washington all recently have issued informational documents to businesses that offer pedicures about keeping their facilities sanitary and healthy. In May 2006, the Illinois Department of Financial and Professional Regulation (IDFPR) endorsed new rules that mandate stringent cleaning and sanitation standards developed in coordination with the Illinois Department of Public Health. The rules cover guidelines for sanitizing after each client, at the end of the day and at the end of every week. Because these have been set into place, the IDFPR is able to enforce them through disciplinary actions ranging from reprimand to license revocation.4
“Now that these rules have the force of law, we will be able to impose disciplines on salons that don’t understand how seriously we take these basic safety requirements,” says Daniel E. Bluthardt, director of the division of Illinois professional regulation.4 California enacted similar rules in 2001, following the previously mentioned mycobacteria outbreak. Texas took the guidelines a step further when its Department of Licensing and Regulation announced in May 2006 that it would require “all cosmetologists that provide manicure and pedicure services to sterilize reusable instruments in an autoclave.” Every state has guidelines for sanitation, even if it doesn’t have actual rules, so it is important to get a copy of them from your state board (See Online Resources for Spa Sanitation Guidelines.) Also, according to Jeannie Boniface, an infection control consultant and manager of the infection control division of KvG Group in Toronto, conversation is crucial for sanitation success in the spa industry. “Ask, ask, ask. If there is an open dialogue between the inspectors and the spas, a better understanding of compliance issues and protocol setup has to happen,” she says.
Although the incident in California in 2000—as well as more recent ones—initially were devastating for the industry, they are also helping to shed light on problems state boards had not counted on, resulting in a better, safer experience for clients.
How to stay sanitary
Although cleanliness is common sense, the methods needed for proper sterilization and disinfection may not be, depending on the type of equipment used and the germs you are trying to fight. (See General Spa Sanitation Musts.) According to Boniface, there are a variety of health concerns when it comes to the spa environment. “Just a few of the diseases that can be spread are the wart virus, bacterial skin infections from pedicure baths, methicillin-resistant Staphylococcus aureus (MRSA) from surfaces, fungal infections from tools that have been improperly cleaned and athlete’s foot from reusing slippers that haven’t been properly sanitized.”
When examining this laundry list of concerns, it may seem impossible to keep your entire spa sanitary day in and day out. However, according to Jean Kolb, spa director of Kohler Waters Spa in Kohler, Wisconsin, it is a non-negotiable part of running a successful spa. “You have to have proper procedures in place, and everyone must follow the same standards 100% of the time—not 98% of the time.”
Kohler Waters Spa is a world-class facility that specializes in water treatments due to its evolution from the bathroom and kitchen fixtures company of the same name. Because of the sheer volume of water that courses in and out of the spa each day, it has to stay on top of its sanitation practices. “We have standard operating procedures that are strictly followed,” says Kolb. “All of our mechanical equipment in the back is regulated so we can add whatever we need to it.”
Staff can also be a valuable factor in staying sanitary. “We have spa attendants who specifically are assigned to help with our wet treatment rooms because we have to turn them over in 10 minutes. We need to drain the tub, spray it, clean it, disinfect it, fill it, drain it and wipe it down,” she says. “Then, in the evening, we have further procedures to clean and disinfect the whirlpools. The same thing happens with our pedicure stations. It’s about diligence in making sure that everything you put in contact with your guests is clean and sanitary.”
In order to do this, you need to take a variety of steps, according to Boniface.
Spas need to step up their game and not only comply with regulations, but also go above and beyond all government expectations. Once this is done, facilities need to harness the power of marketing to let clients know how sanitary your spa is in order to put their minds at ease and allow you to cash in on your cleanliness.
Marketing: how and why
Boniface suggests spa professionals should use the best marketing tool available: word of mouth. “Talk with your clients. You usually have their undivided attention for 30–45 minutes. Use this time to educate them on what you do to keep them safe,” she says. To do this, offer a tour highlighting where dirty tools are stored, and where and how disinfection takes place.
“Clients will appreciate why they have to pay slightly higher prices when they see all the steps you take to keep them safe. And they will tell others—especially if the media brings attention back to the safety of the industry,” she explains. Boniface also suggests displaying signage at each workstation to indicate the area has been cleaned and disinfected for client safety. Other places to identify your spa’s efforts for cleanliness are on your Web site and in the spa menu.
Renu Day Spa in Deerfield, Illinois, highlights its stand on disinfecting and disposing of tools used in services on its Web site. It states that tools that aren’t disposable are thoroughly sanitized and that it constantly updates its inventory of U.S. Food and Drug Administration (FDA)-approved disinfectants. “We care for our clients, and our goal is to create a healthy and pleasant environment for them,” Renu’s site claims.
Indianapolis, Indiana’s Escape Day Spa utilizes its manicure and pedicure menu as a place to reassure clients by identifying the sanitation system it uses to eliminate fungus, harmful bacteria and germs. Spa Gregories in Newport Beach, California, also showcases its sanitation policy on its nails menu, explaining the exact procedure it follows so its clients can be confident in its cleanliness. In Raleigh, North Carolina, Majestic Nail & Day Spa uses the disclaimer, “Love being pampered, but concerned about sanitation?” at the bottom of its Web site’s home page. It then continues on, offering potential clients the opportunity to tour the facility in order to witness how seriously the spa takes sanitation.
Upgrade your knowledge
For spas, sanitation isn’t an option, it’s a must. A business that operates in an unhealthy way will end up hurting itself and the industry as a whole. If you are confused or concerned that your facility isn’t meeting your state’s sanitation regulations, contact your state board immediately. Also, keep up-to-date on continuing education opportunities regarding sanitation, disinfection and sterilization.
“Look for chances to upgrade your infection control knowledge to stay on top of the latest outbreaks, disinfectant technology and equipment,” encourages Boniface. “Stay in communication with your state board and never stop learning.
If you do this, yours will be one of the safest spas in the industry.”
1. World Health Organization, “Ship sanitation and health:” www.who.int/mediacentre/factsheets/fs269/en/print.html (Accessed July 9, 2007)
2. WebMD, “Spas: The Risks and Benefits,” by Colette Bouchez: www.webmd.com/skin-problems-and-treatments/features/spas-the-risks-and-benefits? (Accessed July 9, 2007)
3. Centers for Disease Control, “Mycobacteria in Nail Salon Whirlpool Footbaths, California:” www.cdc.gov/ncidod/EID/vol11no04/04-0936.htm (Accessed June 18, 2007)
4. Illinois Department of Financial and Professional Regulation, “Blagojevich Administration Enacts Salon Safety Rules to Prevent Infections:” www.idfpr.com/newsrls/052506SalonSafetyRules.asp (Accessed June 11, 2007)