Northern California bacterial outbreak In optimal conditions, certain bacteria can thrive and divide every twenty minutes. Optimal conditions include moisture, oxygen, and warm temperatures. These “perfect storm” environmental factors created the ideal setting for an outbreak of mycobacterial furunculosis in a California nail salon’s footbaths. In the fall of 2000, a physician in Northern California reported a group of female patients who reported developing boils on their lower legs. Over one hundred customers reported pustules that were slow to respond to antibiotics and which left the victims scarred. The patients reported small bumps that turned into purple pus-filled boils that “erupted discharge, seemed to heal, then formed again and spread to other areas.” Strong antibiotics were prescribed and patients were required to continue the treatments for six months. The treatment was “no picnic” said Betsy McCarty, Chief of Public Health for the Santa Cruz County Health Department. The antibiotics resulted in yeast infections, diarrhea, and nausea for the patients. Upon investigation of the nail salon, large amounts of skin debris and hair were found inside the inlet suction screens of every whirlpool footbath examined. “A bacterial soup was back there behind the screens,” said McCarty. “There was enough hair to make a toupee.” In response to the claims, the salon owner reported that the areas behind the screens were never cleaned. Cultures from all ten footbaths at this particular nail salon produced fortuitum. In addition, m. mucogenicum, m. smegmatis, unidentified mycobacteria, and nocardia organisms were also found in at least five of the footbaths. Unfortunately, this is more common than one might think. California investigators reported they found similar bacteria at 16-18 salons they checked. Investigators from 20/20, a prime- time news program, also went with inspectors to salons in Dallas, Boston, Houston, and Phoenix, and almost all of the salons tested positive for potentially harmful bacteria. Deaths in California Evidence suggests that an infection contracted from a pedicure may have caused the death of Gerry Ann Schabarum, wife of former California State Assemblyman and longtime Los Angeles County Supervisor, Pete Schabarum. According to Pasadena Weekly, Schabarum had been battling a staphylococcus infection for over a year. She suffered from rheumatoid arthritis, and because of a weakened immune system, the bacteria were able to take hold in her body. “It is tragic that another life may have been lost because of an unsanitary salon,” said Senator Leland Yee (D-San Francisco/San Mateo), the author of legislation signed into law to help clean up dirty salons. “While progress has been made,” Yee continued, “clearly more needs to be done to protect the health of nail salon consumers.” In addition, a Sunnyvale, California woman died in June of 2006. Jessica Mears was 43 years old. Her mother, Diana Mears, filed a wrongful death lawsuit in Santa Clara County Superior Court against Top Hair and Nails Salon in Mountain View. The suit claims Jessica Mears contracted a bacterial infection during a 2004 pedicure at the salon that left a large lesion on her left calf. Jessica Mears had lupus - a chronic disease that compromises the immune system. “The lesion never healed,” said Robert Bohn, Jr., the San Jose attorney representing Diana Mears. The end result was the loss of Mears’ life. A Death in Texas Kimberly Jackson of Fort Worth, Texas, died in February of 2006. Jackson was a paraplegic and couldn’t feel the massages and the bubbling water on her feet, but she loved the bright pink nail polish. Her heel was cut with a pumice stone during a pedicure. Several days later she sought out medical help for an infection in her foot and was treated with repeated rounds of antibiotics. Shortly after, the 46-year-old died of a heart attack triggered by the staph infection, according to family’s attorney, Steven C. Laird. “She was afraid she was going to lose her foot,” said
David Lee Jackson, her ex-husband. “Who would’ve thought this would take her life?” MRSA Outbreak in the Netherlands
In September 2005, a medical microbiologist from a regional medical microbiology laboratory in the Netherlands reported to the municipal health department of a recurring MRSA – methicillin-resistant Staphylococcus aureus – infection in a stylist. From December 2004 onward, the woman had recurrent infections on the legs, buttocks and groin, resulting in
incision and drainage of lesions. When an abscess developed in the genital area in July 2005, MRSA was cultured from a wound swab. In December 2005, the stylist was declared to be MRSA- free after antimicrobial treatment. Yet, in March 2006 the woman was tested again for MRSA colonization; test results showed that she had been re-infected, or that the therapy had failed. The stylist had eczema. Because of the “hands on” nature of her work, she was advised to temporarily stop providing services to customers. The municipal health department conducted a risk assessment of the woman’s contacts within her household and in the beauty salon.
In April 2006, a salon customer was hospitalized with an abscess of the breast caused by MRSA; in July 2006, another customer who had had boils since February 2006 was found to be MRSA positive. Both customers had been given wax treatments by the stylist during the period in which she had an infected hair follicle in her armpit.
Concern arose about the risk for infection to customers through instruments, materials (wax), or contact with other employees. The index patient and the other six employees of the salon regularly provided services to each other. In response, all working procedures and protocols in the salon were investigated, and the salon was advised to clean and disinfect instruments and procedure rooms. A total waxing procedure was observed and ten swabs were taken from used wax, wax implements, and the treatment room. All six employees were screened and informed about MRSA and the current situation. Arrangements were also made to test 22 regular customers who had received wax treatments by the index patient in the previous two months. In the following weeks, these customers were screened at the municipal health office and informed about the MRSA. Of the 22 regular customers, 21 completed a questionnaire and 19 were actually screened for MRSA by culturing samples from the pairs of openings of the nasal cavity, as well as the throats. Fortunately, all employees and the 19 selected regular customers were negative for MRSA colonization. All environmental swabs were also negative for MRSA. It became apparent that after performing waxing treatments, the stylist would touch the waxed skin of customers with ungloved hands to check for remaining hairs. She did not wash her hands. Ultimately, a total of 45 persons who had been in direct or indirect contact with the stylist were screened for MRSA: three family members, three roommates, 11 other persons (including secondary contacts), six beauty salon employees, and 22 customers (including regular customers). Fifteen persons had skin infections and ten were colonized with MRSA (stylist, family member, roommate, ex-partner of the roommate, customers and partners of the customers). Although skin infections never developed in the stylist’s family members, tests did show MRSA colonization in one of them. While the MRSA infections were treated, the damage to the salon was unrepairable. Although the prevalence of MRSA is low, local microbiologic laboratories should report outbreaks to the local municipal
Book Code: NTFL1024
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