Tanning bed hygiene: Microbes found on tanning beds present a potential health risk

Abstract

To the Editor: The growing popularity of artificial tanning among adolescents and young adults is a cause for concern. On an average day in the United States, more than 1 million people tan in tanning salons. A recent study found that in most US cities, the density of indoor tanning facilities exceeded the numbers of two major institutions: Starbucks and McDonald's.1Hoerster K.D. Garrow R.L. Mayer J.A. Clapp E.J. Weeks J.R. Woodruff S.I. et al.Density of indoor tanning facilities in 116 large U.S. cities.Am J Prev Med. 2009; 36: 243-246Abstract Full Text Full Text PDF PubMed Scopus (58) Google Scholar Studies have documented the increased risk of skin cancer in tanning bed users.2International Agency for Research on Cancer Working Group on artificial ultraviolet (UV) light and skin cancerThe association of use of sunbeds with cutaneous malignant melanoma and other skin cancers: a systematic review.Int J Cancer. 2007; 120: 1116-1122PubMed Google Scholar There is currently little uniformity in the guidance provided by government, health agencies, or medical associations in regulatory approaches taken or proposed for the sanitary guidelines of the tanning salons. Although general cleanliness is encouraged, most states have no monitoring or enforcement methods. The purpose of this study was to investigate the microbiologic environment of the tanning salons by obtaining cultures from the tanning beds in 10 top-rated tanning salons in New York City to determine the sanitary status of the tanning beds.Ten tanning salons located in Manhattan's Upper East Side were selected based on their top rating in the “Best of New York” listing in New York Magazine. The lead investigator visited the salons and purchased one tanning session at each salon. Specimens were obtained using one sterile swab premoistened with nonbacteriostatic sterile saline solution. Samples were taken from the middle portion of a tanning unit in each salon, on the bed area where a patron's skin contact typically occurs. Cultures were plated on blood agar and then incubated at 37°C for 36 hours.In our study, no cleaning efforts by salon staff were observed before use of the tanning bed (one salon had a card placed on the bed stating that the bed had been cleaned). Cultures of all of the establishments studied (10/10) grew out pathogens (Fig 1). For the 10 establishments tested, five organisms were isolated from one site, four from one site, three from five sites, two from two sites, and one salon had one isolated organism. The most commonly found pathogens were Pseudomonas spp. (aeruginosa and putida [5/10]), Bacillus spp. (5/10), Klebsiella pneumonia (4/10), Enterococcus species (3/10), Staphylococcus aureus (3/10), and Enterobacter cloacae (2/10).The pathogens found in these tanning beds have been associated with serious skin infections.3Owens C.D. Stoessel K. Surgical site infections: epidemiology, microbiology and prevention.J Hosp Infect. 2008; 70: 3-10Abstract Full Text Full Text PDF PubMed Scopus (442) Google Scholar Given the direct contact of the skin of tanning salon patrons with the tanning bed surfaces tested, a concern for pathogen transmission and cutaneous infection is real.Legislatures in many states and counties have intervened to increase the regulation of tanning salons.4Lim H.W. Cyr W.H. DeFabo E. Robinson J. Weinstock M.A. Beer J.Z. et al.Scientific and regulatory issues related to indoor tanning.J Am Acad Dermatol. 2004; 51: 781-784Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar However, few states have clear guidelines for indoor tanning bed sanitation regulations, and these regulations are rarely enforced. According to the New York State Department of Health 2008 regulations, all salons are required by law to provide “adequate antimicrobial treatment by a disinfectant determined to be capable of destroying pathogenic organisms on treated surfaces.”5New York State Department of Health Web site. Proposed regulations for the addition of subpart 72-1 to Title 10 (tanning facilities). Available at: http://w3.health.state.ny.us/dbspace/propregs.nsf/108a43b5127d3477852569bc006381fb/a15b01620a950a8d852574cc00651d91?OpenDocument&Highlight=0, tanning. Accessed April 7, 2009.Google Scholar Based on the findings of this study, salons are not adhering to this policy. Other surveys also have shown poor rates of compliance with safety recommendations, making our experience not unusual.6Fairchild A.L. Gemson D.H. Safety information provided to customers of New York City suntanning salons.Am J Prev Med. 1992; 8: 381-383Abstract Full Text PDF PubMed Google Scholar Studies have shown that cleansing of the ultraviolet beds between patient visits varied from no cleansing at all to a sponge application of tap water or isopropyl rubbing alcohol.7Bruyneel-Rapp F. Dorsey S.B. Guin J.D. The tanning salon: an area survey of equipment, procedures, and practices.J Am Acad Dermatol. 1988; 18: 1030-1038Abstract Full Text PDF PubMed Scopus (28) Google Scholar Perniciaro et al8Perniciaro C. Dicken C.H. Tanning bed warts.J Am Acad Dermatol. 1988; 18: 586-587Abstract Full Text PDF PubMed Scopus (12) Google Scholar also revealed tanning beds as a likely source for sporadic indirect patient-to-patient transfer of human papillomavirus.This study shows that the risks associated with tanning bed exposure may go beyond skin cancer. The current regulations do not appear to be effective in ensuring hygienic conditions in tanning beds. There is a need for strict enforceable sanitation regulations for tanning salons in order to prevent the transmission of pathogenic organisms that could cause serious health problems. To the Editor: The growing popularity of artificial tanning among adolescents and young adults is a cause for concern. On an average day in the United States, more than 1 million people tan in tanning salons. A recent study found that in most US cities, the density of indoor tanning facilities exceeded the numbers of two major institutions: Starbucks and McDonald's.1Hoerster K.D. Garrow R.L. Mayer J.A. Clapp E.J. Weeks J.R. Woodruff S.I. et al.Density of indoor tanning facilities in 116 large U.S. cities.Am J Prev Med. 2009; 36: 243-246Abstract Full Text Full Text PDF PubMed Scopus (58) Google Scholar Studies have documented the increased risk of skin cancer in tanning bed users.2International Agency for Research on Cancer Working Group on artificial ultraviolet (UV) light and skin cancerThe association of use of sunbeds with cutaneous malignant melanoma and other skin cancers: a systematic review.Int J Cancer. 2007; 120: 1116-1122PubMed Google Scholar There is currently little uniformity in the guidance provided by government, health agencies, or medical associations in regulatory approaches taken or proposed for the sanitary guidelines of the tanning salons. Although general cleanliness is encouraged, most states have no monitoring or enforcement methods. The purpose of this study was to investigate the microbiologic environment of the tanning salons by obtaining cultures from the tanning beds in 10 top-rated tanning salons in New York City to determine the sanitary status of the tanning beds. Ten tanning salons located in Manhattan's Upper East Side were selected based on their top rating in the “Best of New York” listing in New York Magazine. The lead investigator visited the salons and purchased one tanning session at each salon. Specimens were obtained using one sterile swab premoistened with nonbacteriostatic sterile saline solution. Samples were taken from the middle portion of a tanning unit in each salon, on the bed area where a patron's skin contact typically occurs. Cultures were plated on blood agar and then incubated at 37°C for 36 hours. In our study, no cleaning efforts by salon staff were observed before use of the tanning bed (one salon had a card placed on the bed stating that the bed had been cleaned). Cultures of all of the establishments studied (10/10) grew out pathogens (Fig 1). For the 10 establishments tested, five organisms were isolated from one site, four from one site, three from five sites, two from two sites, and one salon had one isolated organism. The most commonly found pathogens were Pseudomonas spp. (aeruginosa and putida [5/10]), Bacillus spp. (5/10), Klebsiella pneumonia (4/10), Enterococcus species (3/10), Staphylococcus aureus (3/10), and Enterobacter cloacae (2/10). The pathogens found in these tanning beds have been associated with serious skin infections.3Owens C.D. Stoessel K. Surgical site infections: epidemiology, microbiology and prevention.J Hosp Infect. 2008; 70: 3-10Abstract Full Text Full Text PDF PubMed Scopus (442) Google Scholar Given the direct contact of the skin of tanning salon patrons with the tanning bed surfaces tested, a concern for pathogen transmission and cutaneous infection is real. Legislatures in many states and counties have intervened to increase the regulation of tanning salons.4Lim H.W. Cyr W.H. DeFabo E. Robinson J. Weinstock M.A. Beer J.Z. et al.Scientific and regulatory issues related to indoor tanning.J Am Acad Dermatol. 2004; 51: 781-784Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar However, few states have clear guidelines for indoor tanning bed sanitation regulations, and these regulations are rarely enforced. According to the New York State Department of Health 2008 regulations, all salons are required by law to provide “adequate antimicrobial treatment by a disinfectant determined to be capable of destroying pathogenic organisms on treated surfaces.”5New York State Department of Health Web site. Proposed regulations for the addition of subpart 72-1 to Title 10 (tanning facilities). Available at: http://w3.health.state.ny.us/dbspace/propregs.nsf/108a43b5127d3477852569bc006381fb/a15b01620a950a8d852574cc00651d91?OpenDocument&Highlight=0, tanning. Accessed April 7, 2009.Google Scholar Based on the findings of this study, salons are not adhering to this policy. Other surveys also have shown poor rates of compliance with safety recommendations, making our experience not unusual.6Fairchild A.L. Gemson D.H. Safety information provided to customers of New York City suntanning salons.Am J Prev Med. 1992; 8: 381-383Abstract Full Text PDF PubMed Google Scholar Studies have shown that cleansing of the ultraviolet beds between patient visits varied from no cleansing at all to a sponge application of tap water or isopropyl rubbing alcohol.7Bruyneel-Rapp F. Dorsey S.B. Guin J.D. The tanning salon: an area survey of equipment, procedures, and practices.J Am Acad Dermatol. 1988; 18: 1030-1038Abstract Full Text PDF PubMed Scopus (28) Google Scholar Perniciaro et al8Perniciaro C. Dicken C.H. Tanning bed warts.J Am Acad Dermatol. 1988; 18: 586-587Abstract Full Text PDF PubMed Scopus (12) Google Scholar also revealed tanning beds as a likely source for sporadic indirect patient-to-patient transfer of human papillomavirus. This study shows that the risks associated with tanning bed exposure may go beyond skin cancer. The current regulations do not appear to be effective in ensuring hygienic conditions in tanning beds. There is a need for strict enforceable sanitation regulations for tanning salons in order to prevent the transmission of pathogenic organisms that could cause serious health problems.