Introduction
Podiatrists (medical professionals specialized in treating conditions related to the lower extremities) work in specialized and general clinics, evaluating and providing foot care to a wide range of patients. Most of these patients have non-curable systemic and long-standing foot issues, which the podiatrist takes care of.
If done without personal protective equipment and engineering controls, podiatry drills can be an occupational hazard for healthcare professionals. The nail dust generated during foot care procedures contains microbial debris, viable fungal elements (including saprophytes and dermatophytes), keratin hydrolysates, and keratin.
The occupational hazards related to nail dust generation are not just limited to podiatrists; they can affect nail bar technicians, foot care assistants, beauticians, others working in related health and beauty industries, and even the clients undergoing treatment.
What Are the Different Occupational Risk Factors That a Podiatrist Is Exposed To?
The different occupational risk factors associated with podiatry are:
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Allergies - The latex gloves used during nail surgical procedures can cause latex allergies.
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Bloodborne viruses - Many patients undergoing treatment may have infections, like hepatitis B or C and HIV (human immunodeficiency virus). These increase the risk to the podiatrists in developing such infections during procedures like debridement of ulcers and calluses using sharp instruments.
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Chemical Exposure - Podiatrists are also at increased risk of exposure to chemicals used for skin disinfection, treating calluses and corns, decontaminating instruments, and treating fungal infections.
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Musculoskeletal Disorders - Because of the working posture and workload, the podiatrist is at increased risk of developing musculoskeletal disorders like repetitive strain injuries.
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Microbial Dust - The podiatrists are also at risk of exposure to microbial dust generated during the reduction of nails, corns, and calluses or skin desquamation during treatment.
Why Nail Dust Is Considered an Occupational Risk Factor?
Podiatrists, along with other related health and beauty care professionals, are exposed to fine, respirable nail dust particles generated during filing or drilling toenails or fingernails. These even have the potential to cause eye injuries. Studies further suggested that the prevalence of asthma in those working in the podiatry specialty was four times higher compared to the general population. Studies further suggested an increased incidence of rhinitis and conjunctivitis in podiatrists.
Podiatrists use drills for treating thickened (onychauxic) nails to reduce pain, improve cosmetic appearance, treat subungual ulcerations, and allow better penetration of antifungal agents that are applied topically.
The size of nail dust particles is mostly less than 5 micrometers, with an average size of 0.8 to 1.6 micrometers, suggesting their deposition in the bronchioles and alveoli. The podiatry drills may also generate an aerosol of bacteria that can remain in the air for up to thirty minutes.
What Are the Microbes Encountered During Nail Dust Generation?
The nail drill used for reducing (thinning or sanding) nails rotates at a particular speed, generating nail dust collected in the dust bag through a local exhaust ventilation system. There is a possibility of infection transmission through aerosolization, body fluids, or the conjunctiva.
The different microbes that have been isolated from dust bags are:
Bacterial species:
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Streptococcus faecalis.
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Micrococci.
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Streptococcus pyogens.
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Streptococcus epidermidis.
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Diptheroid bacilli.
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Coliforms.
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Bacillus species.
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Some other species of streptococci and staphylococci.
Fungi:
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Dermatophytes.
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Candida species.
What Are the Nail Dust Associated Health Issues?
A common fungal infection affecting nails is referred to as onychomycosis. Both topical and oral antifungal agents can manage this condition. Cutting, abrading, or filing of nails may be required to increase the treatment outcome. Thickened nails may also develop due to psoriasis, diabetes, vascular disease, infection, or injury; these may also require mechanical therapy, which increases the risk of nail dust exposure.
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Nail dust was first described as an occupational hazard in the 1970s.
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Allergic hypersensitivity has been found with nail dust exposure.
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Nail dust from the fingers and toes can get deposited in the nose, conjunctiva, and respiratory tract, resulting in rhinitis, sneezing, bronchitis, conjunctivitis, coughing, itching, tearing, and asthmatic attacks.
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Nail dust has been categorized as an allergic sensitizer. An allergic sensitizer is a substance that triggers an irreversible allergic reaction when breathed in. The reaction may take place months or even years after exposure.
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Nail dust exposure also poses an increased risk of ocular trauma. There have been some reported cases of lacerated corneas during nail-grinding procedures.
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Ocular hazards can occur due to exposure to allergens, foreign bodies, viruses, bacteria, protozoa, and fungi, which can enter due to eye injury.
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The most common eye problems reported are itching, burning, excess lacrimation, and soreness.
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The aerosol that is generated during the procedures contains blood-borne pathogens.
What Are the Reduction Measures That Can Be Taken to Reduce Nail Dust Risk Exposure?
The measures that can be taken to reduce the risks of nail dust exposure are:
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Education and Training:
All the beauty and healthcare providers at risk of nail dust exposure should be adequately educated and trained on the importance of servicing and maintaining nail drills, identifying suspected fungal nails (in which treatment should be started only after confirming the diagnosis), and ensuring a safe workplace.
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Personal Protective Equipment:
Personal protective equipment should be used to protect the ocular and respiratory systems. The eye protection equipment used should have markings for dust and be of a grade to withstand the velocity of dust particles, along with the license and manufacturer name. The face masks used should also conform to the set standards.
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Proper Drilling Technique:
A proper drilling technique can reduce the number of small particles generated. Start with a coarse burr and then move on to a finishing burr. The shape of the burr also plays a role in dust generation.
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Engineering Controls:
A proper engineering control system also plays a role in nail dust generation. The first step towards this is an efficient, effective, and good-quality dust extraction system that requires regular testing. A secondary extraction system within the clinic further reduces air contamination.
Conclusion
Health care and beauty practitioners exposed to nail dust are exposed to various related health hazards like allergic hypersensitivity, ocular injury, infections, etc. Proper awareness of these potential risks, personal protective measures, engineering control measures, and proper drilling techniques play a major role in reducing the risk of exposure.
