HHE Report No. HETA-2015-0139-3338, Evaluation Of .
Evaluation of Ergonomics,Chemical Exposures, andVentilation at Four Nail SalonsHHE Report No. 2015-0139-3338March 2019
Authors:Kendra Broadwater, MPH, CIHSophia Chiu, MD, MPHAnalytical Support: Maxxam LaboratoriesDesktop Publisher: Jennifer TyrawskiEditor: Cheryl HamiltonIndustrial Hygiene Field Assistance: Michael Grant, Jessica Ramsey, Dylan NeuLogistics: Donnie Booher, Kevin MooreMedical Field Assistance: Kerton VictoryKeywords: North American Industry Classification System (NAICS) 812113 (Nail Salons), NewYork, Nail Salons, Cosmetology, Methacrylates, Acrylates, Volatile Organic Compounds,Ergonomics, MusculoskeletalDisclaimerThe Health Hazard Evaluation Program investigates possible health hazards in the workplace underthe authority of the Occupational Safety and Health Act of 1970 (29 U.S.C. § 669(a)(6)). The HealthHazard Evaluation Program also provides, upon request, technical assistance to federal, state, andlocal agencies to investigate occupational health hazards and to prevent occupational disease orinjury. Regulations guiding the Program can be found in Title 42, Code of Federal Regulations, Part85; Requests for Health Hazard Evaluations (42 CFR Part 85).Availability of ReportCopies of this report have been sent to the employers and employees at the nail salons. The stateand local health department and the Occupational Safety and Health Administration RegionalOffice have also received a copy. This report is not copyrighted and may be freely reproduced.Recommended CitationNIOSH [2019]. Evaluation of ergonomics, chemical exposures, and ventilation at four nail salons.By Broadwater K, Chiu S. Cincinnati, OH: U.S. Department of Health and Human Services,Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health,Health Hazard Evaluation Report ts/pdfs/2015-0139-3338.pdf.
Table of ContentsMain ReportIntroduction . 1Our Approach . 1Our Key Findings. 1Our Recommendations . 5Supporting Technical InformationSection A: Workplace Information. A-1Building and Business Information . A-1Employee Information . A-1Background about the Request . A-2Process Description . A-2Section B: Methods, Results, and Discussion . B-1Methods: Ergonomics Assessment . B-1Results: Ergonomics Assessment. B-1Methods: Chemical and Particulate Exposure . B-2Results: Chemical and Particulate Exposure . B-4Methods: Ventilation, Personal Protective Equipment, and Other Controls. B-6Results: Ventilation, Personal Protective Equipment, and Other Controls. B-6Discussion . B-8Limitations. B-12Conclusions . B-13Section C: Tables . C-1Summary and Other Tables . C-1Individual Full-shift Personal Exposure Sampling Results . C-7Section D: Occupational Exposure Limits . D-1Formaldehyde . D-2Methyl Methacrylate and Ethyl Methacrylate . D-2Ethyl Acetate and n-Butyl Acetate . D-3Toluene . D-3Acetone . D-3Section E: References . E-1
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IntroductionRequestA state health department requested help from the National Institute for Occupational Safety andHealth (NIOSH) because of concerns about chemical exposures and musculoskeletal disorders amongnail salon employees.WorkplaceNail salon technicians provided nail services, including applying, removing, filling, and polishing acrylicnails and providing standard polish, gel and shellac polish manicures and pedicures. Gel and shellacmanicures and pedicures involve polishes that are cured using ultraviolet lamps. Some technicians alsoprovided hair removal waxing services. From 3 to 11 employees worked at each of the four salons.To learn more about the workplace, go to Section A in the Supporting Technical InformationOur ApproachWe visited four nail salons to learn more about chemical and particulate exposures and the work-relatedhealth concerns of their technicians. We visited Salons A and B in August 2015. We visited Salon Bagain in March 2016. We visited Salon C in October 2016 and Salon D in November 2016.On the visits, we Observed work practices and conditions Inspected shop ventilation Measured employee exposures to volatile organic compounds in the air such as acetone, toluene,n-butyl acetate, ethyl acetate, formaldehyde, methyl methacrylate, and ethyl methacrylate Interviewed employees about their work and healthTo learn more about our methods, go to Section B in the Supporting Technical InformationOur Key FindingsEmployees worked in positions that posed risks for developing musculoskeletaldisorders. We observed employees repeatedly bending their necks and shoulders during nail services inways that might cause injury or pain (Figure 1).1
Figure 1. Two employees providing pedicures to clients. The left employee’s shoulders arehunched forward and her back rounded. The right employee’s back is unsupported by the lowchair back and her neck is bent forward and straining at the shoulder. Photos by NIOSH. We observed seated employees repeatedly lift and hold clients’ feet during pedicures toshoulder height during callus removal. This practice can put stress on employees’ upper backand shoulders. We found 4 of the 19 employees (21%) who had worked in the nail salon for 2 monthsreported musculoskeletal pain (neck, shoulder, and upper back pain) that got better awayfrom work.Work practices and conditions contributed to chemical exposures from nail polishremover, nail polish, acrylic polymers, and powders. Chemical storage was inappropriate. For example, we saw chemicals stored in unlabeledcontainers, open containers, and areas that were also used as employee break and lunch rooms(Figures 2 and 3). One salon employee stored bulk chemicals for the salon in a personalresidence.Figure 2. Nail salon productsstored under a sink in Salon A.Most of the containers were notproperly labeled with theircontents. Powder was stored in amislabeled container in the bottomright corner. Photo by NIOSH.2
Ten of 24 interviewed employees reported receivingtraining on chemical hazards since they began working atthe salon. Nine of 10 nail salon technicians observed (Salons B–D)performing pedicures wore gloves while providing theservice, but several technicians took gloves off for nailpolish application. We observed all nail salon techniciansremove nail polish from clients’ skin using bare fingers. Five of 14 nail salon technicians observed (Salons B–D)performing manicures (acrylic, dip acrylic, gel, orstandard) wore nitrile or latex gloves at some point whileproviding the service. Some of these employees only woregloves during nail polish removal or while shaping theFigure 3. New and usedacrylic nail using a powered rotary filing tool.chemical bottles (acetone, Employees we observed wore N95 respiratorsisopropyl alcohol, and cuticleincorrectly. Employees also wore other masks thatsoftener) stored in the breakwould not adequately protect against respiratory hazardsroom in Salon C. Above thesein the salons, like acrylic particulate.bottles was a shelf where bowlscontaining acetone were put to Personal exposures to formaldehyde in air exceeded thedry. Photo by NIOSH.NIOSH occupational exposure limit in each of thesalons where we took personal measurements. However,overexposures to formaldehyde can occur in many common indoor environments and may notnecessarily be due to salon product exposure. Personal exposures to acetone in the air at Salon C were much higher than exposures measuredin the other salons we assessed and in other nail salon studies. Total particulate concentrations at Salons C and D were higher near acrylic nail stations whereemployees used powered rotary filing tools to shape acrylic nails, as opposed to locations located3 or more meters away from the stations (Figure 4).3
Figure 4. The orange line shows total area air particulate concentrations near the acrylic nailapplication station in Salon C. The blue line shows total area air particulate concentrations atleast 3 meters from the acrylic nail application station. The boxed area indicates peaks ofparticulate concentrations near a powder acrylic nail application (called the dip system) at theacrylic nail station.Ventilation systems at the salons did not meet ventilation guidelines. Salon A did not have mechanical ventilation, relying on an open door for outdoor airintroduction. A mini split ductless unit was used for heating and cooling. Salons B and C each had one roof fan that exhausted indoor air from vents located in the shopceiling. Supply air came from doors and windows. Salon B had two in-wall air cooling units.Salon C had one in-wall air cooling unit. Salon D appeared to have a general ventilation system and a small direct exhaust system, but thesystems were not operating at the time of our visit. None of the salons had local exhaust ventilation at acrylic nail or manicure stations.To learn more about our results, go to Section B in the Supporting Technical Information4
Our RecommendationsThe Occupational Safety and Health Act requires employers to provide a safe workplace.Benefits of Improving Workplace Health and Safety: Improved worker health and well-being Improved image and reputation Better workplace morale Better products, processes, and services Better employee recruiting and retention Could increase overall cost savingsThe recommendations below are based on the findings of our evaluation. For each recommendation,we list a series of actions you can take to address the issue at your workplace. The actions at thebeginning of each list are preferable to the ones listed later. The list order is based on a well-acceptedapproach called the “hierarchy of controls.” The hierarchy of controls groups actions by their likelyeffectiveness in reducing or removing hazards. In most cases, the preferred approach is to eliminatehazardous materials or processes and install engineering controls to reduce exposure or shieldemployees. Until such controls are in place, or if they are not effective or feasible, administrativemeasures and personal protective equipment might be needed. Read more about the hierarchy ofcontrols: https://www.cdc.gov/niosh/topics/hierarchy/.We encourage the company to use a health and safety committee to discuss ourrecommendations and develop an action plan. Both employee representatives andmanagement representatives should be included on the committee. Helpful guidance can befound in Recommended Practices for Safety and Health html.Recommendation 1: Improve ergonomics during work tasks.Why? Awkward work postures, repetitive or fast work, and high force can result in musculoskeletalpain and disorders. These conditions can worsen over time and are associated with Increased use of sick leave Lower productivity Lower employee morale Lower quality of lifeStudies have found that musculoskeletal symptoms are more common among nail salon workers thanoffice workers. At all four salons, we observed employees working in awkward postures. Someemployees reported musculoskeletal pain that got better away from work.5
How? At your workplace, we recommend these specific actions:Raise the existing client pedicure chairs. When buying new chairs, chooseclient pedicure chairs that are tall enough for employees to comfortablywork on clients’ feet. Reduce the distance that employees need to lift clients’ legs when removingcallused skin. Reduce the amount of employee neck and back bending needed to see clients’ feetand toenails.Provide stationary magnifying glasses at work stations or safety glasseswith magnifying lenses to employees to reduce the need to bend at theshoulders and neck to see the client’s toenails or fingernails.Provide adjustable manicure and pedicure chairs to employees so theycan change their workstations to be more comfortable.Train employees on good ergonomic postures during nail services whenthey are hired and at least every year afterwards. Bring clients’ hands or feet up closer toward their faces to prevent increased bending atthe neck and hunching the shoulders. Move the foot pedal for the powered rotary filing tool to a comfortable position in frontof their bodies. Adjust the position of the foot pedal occasionally to remain comfortableand avoid repetitive strain. Adjust their chair/stool each time they move to a new workstation so that they arecomfortable, have both feet on the ground, and can use the back rest while working.Adjust the height as often as necessary to remain comfortable throughout the day. Place a pad on their side of the manicure workstation under their elbows or forearms toprevent sharp table corners from pressing into their arms. Learn more about reducingergonomic hazards through the Occupational Safety and Health Administration(OSHA) document Stay Healthy and Safe While Giving Manicures and Pedicures: A Guide forNail Salon Workers. It is available at https://www.osha.gov/SLTC/nailsalons/.6
Recommendation 2: Improve work practices, conditions, and training to reduceemployee contact with nail salon chemicals.Why? Some chemicals used in nail salons can be inhaled through the lungs or absorbed through theskin. Depending on exposure, some chemicals in nail salon products can cause health problems like Skin rash or contact dermatitis Eye, nose, throat irritation Asthma Neurological effects Reproductive problems CancerHow? At your workplace, we recommend these specific actions:Make sure products used in the nail salon do not include methylmethacrylate monomer. Use safety data sheets to find out which ingredients are in products used in the salon. Follow local and state rules regarding nail salon products. Methacrylate monomer is notallowed to be sold in the state where these salons were located, but one of the salons weevaluated used a liquid containing essentially all methyl methacrylate monomer.Use pressure-activated liquid product dispensers to limit the potentialfor spills. Use dispensers that are designed to reduce the risk of spills for common nail salonproducts, such as acetone and isopropyl alcohol. Pressure from a cotton ball or brush is needed to dispense product from thesecontainers, which remain closed when not in use. This reduces evaporation of theproduct into the air.Inform employees of the chemicals they are working with and theirpotential for causing health problems.Fulfill the requirements of the OSHA Hazard Communication Standard (CFR 1910.1200): Train employees on the hazards of the chemicals used in the salon.o Replace outdated material safety data sheets with safety data sheets that meet thecurrent OSHA Hazard Communication Standard.7
Ensure that employees know where safety data sheets for products are kept. Label all secondary containers that contain hazardous substances with their contents(e.g., if moved from the original container). Find more information about specific hazard communication requirements athttps://www.osha.gov/dsg/hazcom/index.html.Do not store chemicals in employee break areas or at home. Use a separate, well-ventilated area to store chemicals away from workers. Do not store chemicals in open containers when they are not in use. Keeping containersclosed prevents chemicals from evaporating and entering the air.Do not leave acetone in open bowls or containers to evaporate in theworkplace and do not heat acetone. Keeping chemical containers open can lead to higher than expected concentrations ofvolatile chemicals in the air. This is especially true when the storage space isunventilated. Wrap acetone-moistened cotton around clients’ nails for polish or gel manicure removal,rather than having clients soak their fingers in bowls of acetone.Reduce employees’ skin exposure to chemicals when they provide nailservices or handle nail salon products. Encourage employees to use tools and not bare fingers when applying acrylic nails andnail polish and when correcting polish mistakes. For example, a water-moistened cottonswab can be used to remove small amounts of wet nail polish from clients’ skin insteadof bare fingers. Train employees to practice good hand hygiene. This includes washing hands often,particularly:o Whenever chemicals or nail salon products are on their skino Before breaks, eating, and leaving worko After removing gloves and after cleaning their workstation or the salon Instruct employees to wear gloves to prevent skin exposure to chemicals. Nitrile glovescan protect against many chemicals used in the salon. Provide butyl gloves for employees’ use when they directly handle acetone, such aswhen transferring acetone between bottles, pouring acetone into the waste acetonecontainer, and cleaning up acetone spills. Nitrile gloves might not hold up well againstacetone and wearing natural rubber latex gloves can cause allergies.8
Encourage employees to report any work-related symptoms to theirsupervisor or the nail salon owner and to their primary health careprovider.Train employees who voluntarily wear N95 respirators about their use. Provide training to these employees on how to wear N95 respirators correctly. Inform employees that N95 respirators do not protect against exposures to gases orvapors. They do protect against dusts created during tasks like shaping acrylic nails withthe handheld powered rotary filing tool, applying powder during dip acrylic nailapplication, and filing natural nails. Review and share this respirator training tool available -133.pdf. Give employees who voluntarily wear N95 respirators a copy of the OSHA RespiratoryProtection Standard 1910.134 Appendix D. It is available athttps://www.osha.gov/pls/oshaweb/owadisp.show document?p table STANDARDS&p id 9784.Provide employees with splash-resistant eye protection, like goggles, touse when they refill liquid chemical containers.Recommendation 3: Improve ventilation to reduce airborne levels of chemicalsfrom nail salon products and improve indoor air quality.Why? Chemicals in nail salon products can get into the body by breathing in their dusts and vapors.Although employees’ airborne exposures to most chemicals we measured did not exceedoccupational exposure limits, improving ventilation will further reduce air levels. Introducing outdoorair into the shop can help reduce formaldehyde concentrations. Reducing and preventing exposurescan reduce health risks associated with these exposures.How? At your workplace, we recommend these specific actions:Make sure that the ventilation system provides a source of filtered outdoorair when the salon is occupied. It should meet the ASHRAE standards forventilation and thermal comfort. Work with a ventilation engineer to develop plans for a mechanical ventilation systemthat meets these requirements.9
ASHRAE recommends supplying at least 20 cubic feet per minute of outdoor air to theworkplace for each occupant, including both employees and customers.Ensure that the existing ventilation system is on and working duringbusiness hours. Work with building maintenance staff to do so if the nailsalon is in a leased space.Use local exhaust ventilation to reduce acrylic dust and chemicalexposures in air. Local exhaust ventilation can reduce chemical and dust exposures in the air during nailservices. It comes in many forms: portable units that filter or exhaust air to theoutdoors, manicure tables with integrated ventilation, and more. Use local exhaust ventilation that was designed for use in nail salons and evaluated foreffectiveness. Small tabletop filters or fans are not designed to reduce employees’chemical and dust exposures. Reduce the impact of the noise generated by the fan motors by housing the fans fartherfrom the workstation and insulating the fan and motor. Establish a maintenance plan to ensure that ventilation systems remain effective.10
Supporting Technical InformationEvaluation of Ergonomics, Chemical Exposures, andVentilation at Four Nail SalonsHHE Report No. 2015-0139-3338March 2019
Section A: Workplace InformationBuilding and Business InformationSalon A: Shop at the ground floor of a six-story building in a dense urban neighborhood No ducted ventilation system A mini split ductless unit for heating and cooling One exterior door at the front of the shopSalon B: Single-story, multi-tenant building with one main salon room in a dense urban neighborhood Exhaust vents along the salon ceiling centerline served by one roof exhaust fan Air conditioning units on the exterior wall without outdoor air introductionSalon C: Standalone building with the nail salon as the single business occupant in an urbanneighborhood Exhaust vents throughout the salon floor centerline served by one roof exhaust fan Baseboard radiant heating system and air conditioning units located on exterior wall withoutoutdoor air introductionSalon D: Shop on the second floor of an indoor shopping mall Front entrance was open to the common walkway of the mall during working hours Shop served by the mall’s air handling units with supply and return grilles on or near the ceiling.The shop also had two exhaust vents on or near ceiling.Employee Information Number of employees at time of evaluation: 24 (total)o Salon A: 5 employeeso Salon B: 11 employeeso Salon C: 3 employeeso Salon D: 5 employeesA-1
Reported length of shift: varies, 2–8 hours Median number of hours worked per week: 30 hours (range: 12–60 hours) Median job tenure: 9 months (range: 1 week–21 years). Six employees at one salon reportedworking there for only 1 week. Median age of employees: 36.5 years (range: 22–56 years) Sex: 88% female Race/ethnicity: 15 employees identified as Asian (Vietnamese); 9 employees identified asHispanic Additional information: All 24 employees participated in confidential interviews: 23 in personduring site visits and 1 by phone. One employee communicated solely in English during thesite visit. Interpreters in Spanish and Vietnamese allowed us to communicate with the otheremployees.Background about the RequestA state health department was asked to provide feedback to elected state officials about health effectsand possible exposures associated with nail salon work. The state health department requested helpfrom NIOSH in their evaluation of the health implications of working as a nail salon technician. Thespecific concerns were chemical and particulate exposures in the air and on the skin, and ergonomicsduring nail salon work. The state health department and NIOSH reached out to salons to participate inthe evaluations. No specific health issues were identified at any salon before the evaluations.Process DescriptionThe nail salon technicians at these salons provided a variety of services:Acrylic nails: application, fill, and removal. Standard acrylic nails were created when acrylic monomerliquid was mixed with acrylic polymer powders and applied to the natural nail (with or without a nailextension). The acrylic was shaped using a small brush when still curing and shaped further using ahandheld powered rotary filing tool to make the final nail shape after the acrylic had hardened. Then thenail was cleaned and painted using standard or gel polish. The dip acrylic nail manicure involvedalternating layers of cyanoacrylate nail glue and finely milled methacrylate polymer powder on thenatural nail with an extension. The nail was either dipped into or sprinkled with the powder. Theselayers were repeated several times to create a strong acrylic nail. The copolymer typically was pigmentedand the nail did not need further colored polish.Manicures and pedicures: during manicures and pedicures, technicians used hand tools to trim andshape the natural nail. Products used during this service included nail polish remover, disinfectants,rubbing alcohol, lotions and moisturizers, callus remover or softener, colored nail polishes, and clearcoats. Gel and shellac manicures and pedicures involved polish cured using ultraviolet light into a hard,shiny coating. This coating was generally removed by soaking in acetone.Technicians at three of the salons (B, C, and D) also provided waxing hair removal services.A-2
Section B: Methods, Results, and DiscussionOur objectives were to Identify and measure personal exposures in the air to chemicals in nail salon products Evaluate dermal exposures to nail salon products Evaluate job task ergonomics and determine if they could contribute to musculoskeletaldisorders Understand how the salons are ventilated Determine the prevalence of illnesses or health symptoms that might be related to chemicalexposures or ergonomic issues at each salonWe visited Salons A and B in August 2015. We visited Salon B again in March 2016. We visited Salon Cin October 2016 and Salon D in November 2016.Methods: Ergonomics AssessmentWe collected information regarding ergonomics through (1) conducting confidential employeeinterviews, (2) observing employees perform nail services, and (3) assessing workplace design andequipment.For confidential employee interviews, We invited all employees working during our site visits to participate. We asked employees about work history, work processes, and training. We conducted interviews in English or, with assistance from interpreters, in Vietnamese orSpanish.While observing employees providing nail services, we evaluated employees’ neck, arm, back, and legpositions. We assessed work positions to identify awkward positions, repetitive and high force tasks,and other characteristics that may contribute to musculoskeletal disorders or pain. We assessed howemployees hold and work on clients’ hands and feet and determined if those positions could bemodified to encourage neutral neck, back, and leg positions for the employee.Results: Ergonomics AssessmentConfidential Employee InterviewsTable C1 shows the services employees reported providing in the 4 weeks before the interview.Standard manicures and pedicures were the most commonly reported services, reported by 21 (88%)employees. Few employees reported working with customers who had open sores or cuts on theirhands (n 1) or feet (n 2).B-1
Four (21%) of the 19 employees who worked at the salon for at least 2 months reportedmusculoskeletal pain in the past 4 weeks. Two employees reported upper back pain that they stated wasbetter away from work. One employee reported upper back and shoulder pain while performingpedicures; this pain reportedly improved away from work. One employee reported neck pain thatworsened when looking down while performing manicures. This employee reported not having neckpain prior to working in the nail salon.ObservationsAcross the salons, we observed
ceiling. Supply air came from doors and windows. Salon B had two in-wall air cooling units. Salon C had one in-wall air cooling unit. Salon D appeared to have a general ventilation system and a small direct exhaust system, but
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