Infection Control Lapse – Leeds, Grenville and Lanark District Health Unit

September 20, 2023

Health Unit issuing alert about risk of infection from salon

What is the situation?

The Leeds, Grenville, and Lanark District Health Unit (LGLDHU) is issuing a public notice about risk of infection for individuals who have received services at 1000 Nails in Gananoque during the time period of March 2019 to August 18, 2023, including manicures, pedicures and waxing services. The Health Unit is taking this added precaution in response to repeated inspections that have identified significant infractions not meeting public health requirements.

The Health Unit has identified that this operator may have used tools that were not properly cleaned and disinfected. While manicures, pedicures and waxing services are typically low risk for infection when proper infection prevention and control practices are followed, there is a risk that improper practices in this case may have caused skin infections from bacteria, and in rare circumstances may spread blood-borne infections such as hepatitis B, hepatitis C, and to an even lesser extent, HIV. No infection or illness has been linked to this situation at this time.

What should I do?

If you are at risk of exposure, as described above, speak to a healthcare provider (family physician, nurse practitioner, walk-in clinic nearby or online) about your risk of infection, including hepatitis B, hepatitis C and HIV.

Testing is free for Ontario residents with a health card (OHIP) number. If you are not an Ontario resident or do not have an OHIP number, contact the Health Unit for more information.

Below are some resources that you can bring to your healthcare provider about the situation:

Are the tests for blood-borne infections confidential?

If you use the investigation number “LGL-2023-00002” or the pre-filled requisition in this package, all your test results (positive and negative) will be received by the Health Unit. This will allow us to understand how many people have received testing, and what results have been received.

If you do not wish for the Health Unit to receive your negative test results, you can arrange with a healthcare provider to receive testing for hepatitis B, hepatitis C, and HIV without using the investigation number. Positive test results for hepatitis B, hepatitis C, and HIV are required to be reported to your local public health unit under the Health Protection and Promotion Act (HPPA). The Health Unit will not share your results with anyone else without your permission.

Will I only need one test, or do I have to retest again in the future?

Because it can take time for infection to “show up” on test results, you may need to be tested more than once to rule out infection. Contact your healthcare provider for information.

What if I get a positive test result?

A blood test would provide information about whether you are positive for any of the infections being tested. However, testing usually will not have information about where, when, or how you became infected with hepatitis B, hepatitis C, or HIV. If your test result is positive, the Health Unit will contact you and will provide more information. There are highly effective treatments available for the management of these infections.

Does anyone else in my home need to be tested?

At this time, nobody else in your home needs to be tested. If you test positive for an infection, the Health Unit will contact you with next steps for you and your household.

Are there some services that would be at greater risk of infection than others?

Manicures, pedicures and waxing services are not intended to pierce the skin or to draw blood. However, in some circumstances the tools used may get through skin, which may lead to infection with bacterial and with blood-borne infections. Different services have varying risk of causing infection. Tools such as blades, cutting tools (such as nippers) and files may inadvertently pierce the skin. These services may be part of callus removal, cuticle care, nail cutting, and others. At the other end of the risk spectrum, nail polish application alone would not have significant risk of infection.

In this case, the operator does not have a client list, and so the health unit has no way of knowing who has received services or which services they have received.

How did the Health Unit assess the risk?

The Health Unit’s assessment of the exposure was made with information from 1000 Nails, our inspection of the cleaning and disinfection processes used, and in consultation with Public Health Ontario. The Health Unit identified a number of practices that did not meet public health requirements, including the reuse of single-use tools, inadequate cleaning of tools, and improper disinfection of tools.

Based on all the information the Health Unit gathered, and in consultation with Public Health Ontario (which is the provincial organization that provides scientific and technical advice to health units across Ontario), the Health Unit determined that public notification would be appropriate to notify the public that there has been risk of exposure.

Has the Health Unit been inspecting this premises?

The Health Unit inspects on an annual basis all personal service settings such as piercing salons, tattoo parlours, nail salons, and others. In this case, multiple inspections of 1000 Nails have repeatedly identified significant infractions not meeting public health requirements. Practices not meeting public health requirements were identified during an inspection in August 22, 2022 that led to temporary closure of the premises. The operator was subsequently permitted to open after demonstrating practices that complied with public health requirements; however, with a recent public complaint and subsequent observations of previously-seen infractions have led to a concern that have been a risk of exposure to blood-borne infections for as long as this operator has been operating at this premises.

Is 1000 Nails currently providing services?

Yes. The Health Unit has worked with the operator to come into compliance with public health requirements, and therefore there is no public health prohibition on their continuing to provide services. The operator continues to have an order placed on them under Section 13 of the Health Protection and Promotion Act (HPPA), with specific conditions to meet public health requirements.

What is the Health Unit’s role regarding personal service settings such as nail salons?

The Health Unit works with personal service settings (PSSs) to ensure they meet public health requirements, with the aim of reducing the risk of infectious disease transmission. We are provincially mandated to inspect Personal Services Settings annually and respond to all complaints received. An inspection can only evaluate an operator’s practices and the conditions of the premises at that point in time. Progressive enforcement is implemented where there is lack of compliance and no immediate risk of infection is identified, with an initial emphasis on providing education to the operator. Public Health Inspectors may issue a legal order to temporarily close a personal service setting where a potential health hazard has been identified to facilitate corrective action; they do not have the power to permanently close any premises. 

It is essential for consumers to make informed decisions about the services they receive and where they will receive them. Information and tips can be found on our Beauty and Body Art webpage. Additionally, the Health Unit’s inspection reports are publicly posted, and can be found on the Health Unit’s website in the section entitled INSIGHT to assist in your decisions.

Information about IPAC Lapses

• Health units are mandated to inspect premises and follow-up on complaints related to infection prevention and control (IPAC) to assess the risk of transmission of infectious diseases, and to determine the appropriate public health response. Deviations in IPAC practices, called an IPAC lapse, can lead to the transmission of infectious diseases.
• In some instances, particularly where there is an elevated risk of blood borne infections, clients at risk due to an IPAC lapse are contacted directly (by letter) by the Health Unit to inform them of the risk and action to take.
  • In circumstances where the Health Unit is not able to receive a full client list, an IPAC lapse may be communicated through public notification rather than through client letters
  • There is risk of infection for any lapse, but we do not provide public notification or client letters in all cases – usually only for lapses involving invasive procedures where risk of infection relates to blood-borne diseases.
• The Health Unit is required to inform the public of IPAC lapses by posting them on our website.
• If you wish to submit a complaint about infection control practices a personal service setting, fill out the forms here: Infection Control Complaint Form.
• If you need more information about potential risk, contact 1-800-660-5853 ext 2222.

Resources about personal services procedures and blood-borne infections

Information about inspection of Personal Service Settings

• Health units are required to inspect personal service settings (PSS) such as piercing parlours, tattoo parlours, nail salons, and others.
• Always look for an establishment to have an INSIGHT Inspection Report sticker posted by the Health Unit.
• Health Unit inspection reports are publicly available and can be found on the Health Unit’s website in the section entitled INSIGHT.

Information about Beauty and Body Art Safety

The Health Unit has resources about beauty and body art safety to help you make informed decisions about services.