Green Toenail Under an Acrylic Overlay

The green-black discoloration under the overlay suggests a bacterial infection, often called green nail syndrome, which is associated with Pseudomonas and trapped moisture under an artificial nail. The small cut, tenderness and the client's diabetes make this more serious, not less: diabetes reduces circulation and increases the risk of infection spreading. The technician must not file off the overlay and apply a salon antifungal cream and then proceed, because that is outside her scope and could spread infection or delay medical treatment. She should stop the service, put on clean gloves, avoid touching the area with bare hands, and explain that the client needs same-day assessment by a doctor or podiatrist. The old product should be removed only if a medical professional advises it, and the client should not have a new overlay until the infection has cleared and the skin is intact. The holiday deadline is not a reason to treat an infected diabetic foot in a nail salon.

The technician should stop using the drill and nippers on that client. She should put on clean gloves, clean and then disinfect the workstation, the UV lamp and any reusable implements that may have contacted the toe. The drill bit and nippers must be cleaned of visible debris and then sterilised or disinfected according to their classification and the manufacturer's instructions; a wipe with acetone is not sufficient. Single-use files and buffers should be discarded. The unlabelled monomer should not be used and should be removed from the station pending identification, because an unlabelled product cannot be assessed for safety. The client should be given a clear referral note and advised not to cover the toe with a tight shoe or nail product. The technician should wash her hands after glove removal, and the salon should record the incident and review why gloves and disinfection were not routine. Appointments after this client should not be rushed with contaminated tools.

The salon must replace the unlabelled monomer with a properly labelled product that has a Safety Data Sheet, and staff should know whether it is EMA or another approved monomer; unlabelled bottles cannot be traced or assessed. All products should be decanted only with labels showing name, batch and date. Implement single-use files and buffers, and have enough drill bits and nippers to allow cleaning, disinfection or sterilisation between clients. Acetone should be used only as a solvent, not as a disinfectant. Staff should wear gloves for all services that may contact blood or broken skin and should wash hands before and after every client. The salon should use a health questionnaire that asks about diabetes, circulation problems, infections and cuts, and should decline nail services over infected or broken skin. Keep an infection-control log and train staff on the difference between cleaning, sanitising and sterilising. Finally, display a clear referral policy so clients with suspected infection are sent to a medical professional without pressure to finish the appointment.