Is That Spa Clean Enough to Do Your Pedicure?

As the sun makes less of a cameo appearance and enjoys more of a starring role these days, and as we start shedding layers of clothes, our thoughts have taken a downward turn—to our feet! Are we really ready to bare these things? Shouldn’t we do something to spiffy them up? But wait—what was that we heard about spa pedicures and their association with infection?

To help you weigh wisely whether that hot pink pedicure is worth the risk, we got together with Ann Marie Pettis, director of Infection Prevention at Strong Memorial and Highland hospitals.

Scripts: We have our fingers (and toes!) crossed that warmer weather is afoot—which equals bare and sandaled feet. We’ve heard, however, that spa pedicures might be linked to some risks for infection. Can you elaborate?

Pettis: There’s potential for exposure to and subsequent infection from fungi and blood borne pathogens, such as hepatitis B and C, as well as HIV. This is because there’s a slight risk of a small amount of bleeding if pedicurists use instruments too aggressively and then don’t sanitize them adequately. Another common germ which is often found on the skin of healthy individuals is Staph aureus, which could make its way into the spa. Germs commonly found in water, such as Pseudomonas, might potentially be found at the spa as well.

Really, the pedicure instruments and the foot bath present the greatest risk. If you get a pedicure when you have a rash, cut, or even bug bites, you could make yourself more vulnerable to infection—and you also increase the chance of sharing an infection with the next customer. Another recommendation along these lines is to avoid waxing or shaving your legs for at least 24 hours before your treatment, since doing so can create tiny skin abrasions, opening you up to the possibility of infection.

Scripts: So are there ways to prevent infection at the spa? Can we still schedule our pedicures if we take certain precautions, or should tootsies never be handed over for treatment?

Pettis: I actually get a spa pedicure myself occasionally. My advice is to take a look around, and inquire about the spa’s sanitation practices before you kick off your shoes and socks. Feel free to ask the owner how they disinfect the instruments and foot bath between each customer. Make sure that they use an Environmental Protection Agency-approved disinfectant. Technically, the Department of Health is responsible for ensuring that spas meet sanitary standards, but with the large number of spas out there, this is a tall order—so, ultimately, you need to do your own “due diligence.” Since they’re at increased risk for infection as well as serious complications if an infection does occur, people with diabetes should be particularly cautious in evaluating the hygienic conditions of their go-to spa.

Some spas encourage customers to bring their own instruments, which they then store for your next visit. Not sharing instruments definitely decreases the risk of exposure to anyone else’s germs. And speaking of tools, your pedicurist should never trim any callous on your feet with a razor. Instead, they should carefully use a pumice stone (to avoid abrasions or bleeding).

Finally, try to be the first customer of the day. A spa is likely to be cleanest before all the “foot traffic” tromps through.

Scripts: Makes perfect sense. How can we tell, after returning home from the spa, if we might have picked something up?

Pettis: Keep an eye out for redness, tenderness, or rash in the area. If any of these show up post-pedicure, consider contacting your care provider.

Ann Marie Pettis directs Infection Prevention at both the University of Rochester Medical Center (Strong Memorial Hospital and Golisano Children’s Hospital) and affiliate Highland Hospital. An infection preventionist with more than 30 years’ experience, she’s published articles in peer-reviewed journals and trade publications, and lectures locally, nationally, and internationally. Leadership roles include serving as past president of Western New York Infection Control Organization and the Association for Professionals in Infection Control and Epidemiology (APIC) Finger Lakes Chapter. She recently completed her term as chair of the APIC Communications Committee.

A couple years back, she spoke to Scripts with some smart advice on whether or not handshakes should be taboo during cold and flu season. You can see that “Let’s (Not) Shake on It” video post here. Just a couple months ago, she talked with us again about finding a balance between cleanliness and germs (see here).

Dirty Work: Finding a Balance Between Cleanliness, Germs

A few months back, we came across a story carried by the NBC news website suggesting that exposure to dirt and germs might actually confer some possible positive health effects. That article referenced research published this fall in the Journal of Allergy and Clinical Immunology that found that Amish children who were raised on farms were less likely to develop allergies and asthma than their peers.

Before tossing aside our sponges with glee, we reached out to Ann Marie Pettis, director of Infection Prevention at Strong Memorial and Highland Hospitals, for more insight.

Scripts: We all know that keeping a clean house is important to our health. But how much is too much? Can you be too clean?

Pettis: I’ve certainly heard this message before, and it seems to make sense. The most important thing to remember on this topic is that striking a balance is key. Balance your cleaning and your aesthetics—no one wants to live in a dirty home—with your health. Exposure to the germs that we consider “good guys” makes sense, however there are germs you’ll never want exposure to, such as hepatitis, salmonella, HIV, etc. Don’t go overboard, like Lady MacBeth trying to “wash her evil deeds away,” but rather make good hygiene a priority. A baby is born with their mother’s immunity, which gradually wanes, as their own immunity develops. Recent studies seem to show that if babies are not exposed to those “good” germs (again, the kinds that don’t typically cause serious disease) he or she may be at a disadvantage. One is reminded of the old adage “You have to eat a peck of dirt before you die,” and perhaps there might be a grain of truth to that.

Scripts: Can you offer us some helpful guidelines as we go about our cleaning routines? Are there certain parts of the home that deserve more attention than others?

Pettis: Take a guess as to which room in our homes is the dirtiest. Many are surprised to find out that the kitchen, not the bathroom, takes the cake (or would it be the mud pie?) here. The number one offenders are dishrags and sponges. We encourage either the use of disposable dishrags, or to microwave sponges daily for two minutes, or soak them in bleach to kill the germs.

The sink is another culprit. Primarily, we’re concerned with germs that cause foodborne illnesses. The towels you use to dry your dishes can also get contaminated, so be sure to switch those out periodically. Be sure to use plastic cutting boards, not the pretty wooden ones (sorry!), and dishwash or bleach them when KP duty rolls around.

From there, it’s time to think about your faucets, toothbrush holders, and pet bowls and toys. A special note: if someone in your house is immunocompromised (sick), you need to keep both the bad and the good germs at bay. Make sure to wash their clothes in hot water, or, if you do use cold water, that you include some bleach if possible or then pitch them into the dryer on the hot cycle.

Scripts: On a related note, it seems pocket-sized hand sanitizers are all the rage. We know it’s important that health care workers are vigilant about clean hands, but is it possible for the average person to be overzealous in using these sorts of products? How often is reasonable, for application?

Pettis: Hands down, hand hygiene matters. Alcohol-based hand sanitizer is wonderful, but remember that if you overdo it, you could possibly break down your skin, which is your body’s best barrier against germs. When this starts to happen, you’ll see chapping and cracking. That’s a sure sign to slow down with it, or the germs will have an easier time getting past our defenses to make us sick.

Ann Marie Pettis directs Infection Prevention at both the University of Rochester Medical Center (Strong Memorial Hospital and Golisano Children’s Hospital) and affiliate Highland Hospital. An infection preventionist with more than 30 years experience, she’s published articles in peer-reviewed journals and trade publications, and lectures locally, nationally, and internationally. Leadership roles include serving as past president of Western New York Infection Control Organization and the Association for Professionals in Infection Control and Epidemiology (APIC) Finger Lakes Chapter. She recently completed her term as chair of the APIC Communications Committee.

A couple years back, she spoke to Scripts with some smart advice on whether or not handshakes should be taboo during cold and flu season. You can see that “Let’s (Not) Shake on It” video post here.

Fought Flu this Winter? You Still Need a Shot

As flu illness grips the nation, stubborn questions persist about vaccines. We got a hold of URMC’s top flu expert, chief of Infectious Diseases Dr. John Treanor, to make sense out of the myths.

Of note, Dr. Treanor headed up safety and efficacy trials right here in Rochester that were instrumental to the new synthetic Flublock vaccine winning FDA approval just last week. The vaccine is manufactured with the help of insect viruses and caterpillar cell lines, as opposed to being grown in a more traditional incubator: Hens’ eggs. The switch makes manufacturing large quantities much more efficient, meaning vaccines can be produced with less lead time, potentially arming the country faster (by weeks) in the face of a rising pandemic.

Scripts: If someone got the flu earlier this season, do they still need a flu shot?

Treanor: Yes, they should still consider getting vaccinated. Remember that more than one strain of flu can be out there at any given time. So, even if you’ve already had one of them, your body may still may be susceptible to the others. Today’s trivalent vaccines protect against the top three strains of flu predicted to circulate in a given season.

Scripts. Fair enough. But why do some people who get the shot still manage to get sick?

Treanor: That’s a really good question, and one we’re actively researching. Flu vaccines aren’t perfectly effective, because flu evolves. Scientists do the best job they can forecasting which strains of virus will be the big players in a coming season, but it’s impossible to always guess perfectly. Some years, predictions play out pretty accurately. Other years, they don’t match up as well.

Regardless, there is some evidence that the flu is less severe in people who get the shot, even if it doesn’t completely prevent the flu. Even if flu shots aren’t perfectly effective for every person every year, they’re our best chance against fighting off and spreading illness.

Scripts: I have a friend who got terribly sick a day or two after being immunized. I thought you couldn’t contract flu from the shot?

Treanor: You can’t. The vaccine really can’t make you sick because it doesn’t contain living virus. Each dose holds just enough inactivated (“dead”) virus, rousing your immune system with a dress rehearsal of sorts. Essentially, you practice turning out the antibodies you’ll need in the event of a real infection down the road. That’s why you might feel a low-grade fever, or a little soreness and swelling at the injection site. But it’s certainly not to be confused with a full-blown case of flu!

A few things make this myth particularly sticky. One is that, when we give the flu shot, there tend to be a host of other respiratory germs circulating. Rhinovirus, which causes the common cold, might easily be confused for a mild case of the flu — and accidentally attributed as a flu vaccine side-effect.

Another confounding factor is the lag time between the shot going into your arm and your body being fully protected. It can take a full two weeks to confer complete immunity, you may still be susceptible to flu in that brief time window after vaccination.

Scripts: Ok. But it’s almost February. Isn’t it a bit late to roll up my sleeve?

Treanor: No. Within reason, it’s also never too late to get vaccinated. Flu seasons hardly seem as predictable as they used to be. The H1N1 pandemic, which threw us for a loop a few years back, bore down hard in the spring! You just never know.

John Treanor, M.D., professor of Medicine, Microbiology and Immunology, serves as the chief of the Infectious Diseases Division of the Department of Medicine at URMC.

A widely recognized expert in influenza and vaccine research, he’s best known for helping to lead the nation’s efforts to find a vaccine to protect against bird flu. Largely as a result of his work (he led the pivotal studies that showed that large doses of the vaccine are safe and effective), in 2007 the U.S. Food and Drug Administration approved the first vaccine to prevent the disease.

A respected researcher on the “regular” flu as well, Treanor’s led investigations that show the promise of a new type of flu vaccine that could help avert crisis, helping the nation produce vast amounts of flu vaccine on short notice. He’s also a founder of the New York Influenza Center of Excellence, part of a network of centers established by the National Institute of Allergy and Infectious Diseases to protect people against seasonal flu and future flu pandemics. 

Gotta Go? Women of Every Age Can Improve Bladder Health

While there’s no shortage of advertisements touting products for “leaky pipes,” many women hesitate to broach the topic of bladder problems with their doctors. Some may dismiss the issue, believing that it’s a normal part of aging.

Certainly, urologists can tackle some of the issues women face, but the proximity of a woman’s bladder and urinary tract to her reproductive organs can complicate issues. Urogynecologists — specially trained physicians with expertise in both gynecology and urology — may be best equipped to address issues unique to women’s bladder health.

We sat down to discuss bladder health issues specific to women with urogynecologist Gunhilde Buchsbaum, M.D., who is hosting a free educational event for women on Nov. 14, “Maintaining Your Bladder Health.” (Please click here for details.)

Scripts:  When women think of the term “bladder health” they probably think mostly about incontinence. Are there other related issues they should be concerned about?

Buchsbaum:  Besides the common concern of incontinence, many women experience urinary tract infections, problems with frequent urination, and even bedwetting. Other concerns include painful bladder syndrome, bacterial cystitis, and bladder cancer.

It’s important for women to be aware of these problems, and to know they aren’t alone in facing them. So many women suffer in silence, either embarrassed by the problem or believing nothing can be done for it. In reality, there are many tools for evaluating and treating bladder problems, as well as steps women can take on their own to improve bladder health.

Scripts: What are some symptoms that might signal bladder problems?

Buchsbaum:  There are many things women can look for, some of which they might write off as normal, but may be worth investigating. Take urine leakage. It’s a common complaint of women. If you have this problem, you should tell your doctor. Don’t assume it’s something you just have to live with; there are many things that can be done to address it. Frequent or painful urination is another fairly common symptom, which may be a sign of infection or urethral stricture.

Other signs include blood in urine, which can indicate infection, kidney or bladder stones, or, in some cases, even bladder cancer. Without exception, if you find blood in your urine, you should consult your doctor. While it doesn’t necessarily mean there is a serious problem, if there is one, catching it early can make a big difference in identifying and treating a problem.

Scripts:  Issues with incontinence and that “gotta go” feeling seem so prevalent now. TV ads tout medications for it and women often crack jokes about it. Is it a normal part of a woman’s aging, especially if the woman has gone through childbirth? And is there really anything you can do to avoid it, or to treat it?

Buchsbaum: While it’s true that urinary incontinence becomes more common with age, it’s not a normal part of aging. There are steps women can take to help prevent it. These include doing pelvic floor exercises (think Kegel’s exercises); avoiding consumption of bladder irritants like caffeine, alcohol, and artificial sweeteners; and developing habits that will help with the urge to go to the bathroom.

When necessary, there are various treatment options depending on the type of incontinence and of the needs of the woman. For instance, stress incontinence – which occurs commonly with exercise, coughing, sneezing, or laughing – may be corrected with pelvic floor exercises, insertion of a device called a pessary to help control leakage, or surgical intervention.  Urge incontinence – a sudden and/or strong urge to urinate – can be treated with behavioral changes and, in some cases, medication or nerve stimulation techniques. Overflow incontinence – also known as urinary retention, when bladder is unable to fully empty – is usually treated with self-catheterization or, in certain cases, surgical intervention.

The bottom line is that there are very effective treatment options. Just ask.

Scripts:  What should women in their 20s know that might help them in their 30s, 40s and beyond? And if a woman is 50+, is it too late?

Buchsbaum: It is never too early and rarely too late for starting good bladder habits. Developing strong pelvic floor muscles (again, by performing Kegel’s excercises) is key for addressing stress and urge incontinence at all ages, but it’s best to start young, especially for women in childbearing years.  Limiting caffeine in your diet is a smart habit at any age.

Also, it is helpful for women to recognize symptoms of urinary tract infections (bladder) infections. These may vary from person to person and become less obvious in elderly women. For example, a young woman usually has the classic symptoms: urgency, frequency, and pain with urinating. An older woman may notice fatigue, confusion, low backache, or perhaps an increase in urinary incontinence. Women of all ages should know that incontinence is not normal.  Bladder leakage can get worse if not treated.

Scripts: What one thing do you recommend that a woman asks her doctor at her annual checkup with her primary care physician or gynecologist?

Buchsbaum: All women should ask about Kegel’s exercises, why they are important, and how to do them properly. They are perhaps the simplest step a woman can take to maintaining her bladder health.

Gunhilde Buchsbaum is a professor Obstetrics and Gynecology, professor of Urology, and director of urogynecology at URMC. She founded and directs the Pelvic Health and Continence Specialties practice at URMC’s Women’s Health Pavilion.

Sinus Infection? Don’t Badger Your Doc for an Antibiotic

Lingering cold? Runny nose? Fed up with being stuffed up?

If you’ve ever sought your doctor’s advice for nasty nasal congestion and pressure that you just can’t seem to shake, you’ll want to hear this: New research published earlier this month in the Journal of the American Medical Association showing that common antibiotics like amoxicillin were no better than a placebo when it came to clearing up uncomfortable sinus symptoms.

“This story is just publishing in mainstream media, but for clinicians, it’s actually fairly old news,” said URMC ear, nose and throat specialist Dr. Li Man. “For quite some time now, our current recommendations have been to encourage patients to wait it out a week to 10 days, since symptoms quite often resolve on their own.”

But in the real world, this “sit it out” scenario rarely plays out. “Patients clamor for medication anyway,” Man said. “And doctors too often cave, writing the prescriptions.”

To learn more about what we know – and don’t know – about treating sinus pain and infections, read on.

Scripts: Let’s start off by defining what we mean by a sinus infection. Is it just a cold run amok?

Man: That’s a great question to start with – because to be honest, as practitioners, our working definition is a bit fuzzy.

The strict description, of course, is an infection of one or more sinus cavities. But when it comes to making the diagnosis in clinic, there’s actually a bit of a recipe to it – say, if a patient presents with at least two major symptoms (like facial congestion and pus-like nasal discharge), or perhaps one major symptom plus two minor ones (fever and fatigue), we’d typically classify that as a sinus infection.

Scripts: What causes them?

Man: Our sinuses play a big (sometimes under-appreciated!) role in defending our body against harmful pathogens. Coated in mucus, they act almost like flypaper, catching and filtering out stray allergens, even germs, and essentially “sweeping” them away before they reach the lungs. Unfortunately, sometimes the sinuses can become blocked, filling with fluid that acts as a warm, wet breeding ground for viruses or bacteria – and giving rise to infection.

Amazingly, studies estimate that only 2 percent of viral upper respiratory tract infections develop into bacteria sinus infections. However, since viral colds and sinus infections share many of the same symptoms as bacterial infections, they can be easily confused – which pretty simply explains why antibiotics rarely prove effective (the drugs kill bacteria, but are powerless against non-living materials, like viruses.)

Scripts: So, if they’re worthless the majority of the time, why are they still routinely prescribed?

Man: A big part of it is that patients don’t want to be told to go home and simply wait it out – they want to feel proactive, they want a tangible solution, like a prescription – even if that prescription is futile against fighting their particular infection.

The other part of this is a sheer coincidence of timing; to the untrained eye, antibiotics can actually seem to be highly effective! If you consider that the average patient seeks help after four or five days of discomfort, attends an appointment with his doctor on day six and starts medicine soon after, he might very well be feeling better on day seven or eight – because that’s when the infection is resolving on its own. But he, of course, mistakenly attributes his recovery to the medication – and so he absolutely insists on having another prescription the next time he has an infection. You can see how the science has an uphill battle here.

Scripts: But as a doctor, it’s really important to not prescribe antibiotics willy-nilly, right?

Man: It’s incredibly important. If we’re not judicious about prescribing antibiotics, if we use them too liberally, we encourage the evolution of what we call “super bugs” – that is, bacteria that can evade and outlive even our best medicines. That’s why such prudent “antibiotic stewardship” is so critical – as a community of health care providers, we have to work together to safeguard the good medicines we currently have, so we can ensure that they’ll work when truly needed.

On a more personal front, antibiotics do carry some risks. For instance, in patients whose gastrointestinal tracts harbor a bacteria called C. difficile, a course of antibiotics might be all it takes to rouse a potentially life-threatening bowel infection. For others, it might merely mean the inconvenience of diarrhea. Regardless, when you consider that antibiotics are not entirely risk-free, you quickly see that, like all drugs, we must prescribe them with caution.

Scripts: So, if you’re facing a sinus infection, your doctor may instruct you to wait – and that’s really the best medicine?

Man: It’s not the quick fix most patients are hoping to hear, but yes – “watchful waiting” really is the wise thing to do. If you really want to be proactive, getting extra rest will help to bolster the immune system and drinking extra fluid will help to thin out mucus secretions – no prescription required!

At URMC, our otolaryngologists (ENT physicians) are trained in non-surgical and surgical treatment of diseases of the ears, nose, throat, head and neck, performing hundreds of procedures every year. To learn more or to make an appointment, click here.

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When Coughs Cross the Line: Simple Sniffles, or Something Serious?

It’s that time of year. Your home, school, or office sounds like a veritable orchestra of sniffles, coughs and sneezes.

Between the frantic tissue-grabbing, you might wonder: How do I know if the congestion is normal, or if it’s indicative of something worse? How long should I slog through symptoms before calling a doctor for advice?

These are all-too-common questions — so this week, we wanted to share some common sense, courtesy of URMC pulmonologist (lung disease specialist) Dr. Irene Perillo. In this week’s video post, she gives telltale symptoms (colored phlegm, long-lasting fevers and more) that might suggest something besides a simple cold virus is afoot. The knowledge is vital, she adds, since a cough that lingers too long might be evidence that a secondary bacterial infection — like pneumonia — has taken hold.

To hear Dr. Perillo, watch the clip below.

Did you know?

Though a cough that hangs around too long might actually be worth worrying about, most are short-lived, and caused by one of three common triggers:

1)      Post-nasal drip. If a cold virus has your nose running like a faucet, it’s possible that some of that congestion is tickling the back of your throat – prompting your throat muscles to cough in attempt to expel the irritant.

2)      Heart burn. Reflux disease (or GERD) – a chronic condition in which acid accidentally flows backward from the stomach and into the windpipe – also can irritate the throat, prompting coughing spells.

3)      Cough-variant asthma. Sometimes, asthma suffers don’t just wheeze – they cough if exposed to certain triggers, like heavy perfume or even cold air.

To learn about the care URMC provides to patients with pulmonary diseases – or for information on making an appointment with a specialist – click here

Could Sugar Supercharge Some Antibiotics?

While modern medicine boasts more and more implantable devices – items like urinary catheters, heart valves, even artificial hips – it’s important to note that these novel products carry some unique risks.

One in particular has to do with infection. It turns out that everyday bacteria have a nasty habit of building even hardier colonies atop foreign, implanted surfaces than they would on regular body surfaces (which are fed by rich blood supplies).

The result? Foreign-body-based bacterial fortresses are often trickier for standard antibiotics to penetrate and kill. As a result, these infections have wicked way of coming back, and in a worst case scenario, the only sure way to eradicate them is to remove the foreign body altogether. Such surgeries can be daunting for already-weak patients.

According to new research out of Boston University (still preliminary, of course), scientists suggest that pairing sugars with certain antibiotics might one day supercharge them, helping the medicine penetrate resilient colonies and kill bad bacteria for good.

To hear URMC infectious disease specialist Dr. John Treanor comment on the findings, watch the clip below.

John Treanor, M.D., professor of Medicine, Microbiology and Immunology, serves as the chief of the Infectious Diseases Division of the Department of Medicine at the University of Rochester Medical Center. He is a widely recognized expert in influenza and vaccine research.