The Tacoma–Pierce County Department of Health, the Pierce County Antibiotic Resistance Task Force, and the Washington State Department of Licensing (DOL) designed an intervention to determine whether nail salon infection control practices could be improved by educating salon employees and their customers about good infection control practices.


Twenty intervention salons and 26 control salons completed the 3-month study. The intervention group received a letter asking them to “join our campaign to promote healthy people in healthy communities … .” Two DOL pamphlets on cleaning and disinfecting and a tent card with important infection control reminders—targeted to clients on one side and to salon workers on the other side—were also included. Outreach workers from the health department visited 25 (of the original 27) intervention salons once and talked about the materials included in the mailing. Inspection infractions were used to measure compliance with infection control practices. Each salon was inspected by the DOL at baseline, within 1 month after the educational mailing, and within 1 month after an outreach visit from the local health department.


Both groups exhibited statistically significant decreases in infractions; however, the intervention group exhibited a higher and more significant decrease in infractions than the control group.


The intervention and control groups underwent three DOL inspections, which may have resulted in a Hawthorne Effect, with both groups seeing a statistically significant decline in infractions after inspection visits. The more significant decrease in the number of infractions cited in the intervention salons may be due to the educational materials and the health education site visit they received.

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