title: Risk for hepatitis B and C virus transmission in nail salons and barbershops and state regulatory requirements to prevent such transmission in the United States.
abstract: BACKGROUND
  The potential for hepatitis B and C virus (HBV/HCV) transmission in nail salons and barbershops has been reported, but a systematic review has not been conducted. These businesses are regulated by state cosmetology or barbering boards, but adequacy of sanitary requirements has not been evaluated.
  
  
  OBJECTIVE
  To conduct literature review to assess risk for HBV/HCV transmission in nail salons and barbershops and to evaluate sanitary requirements in HBV/HCV prevention in these businesses in 50 states and District of Columbia.
  
  
  METHODS
  Several search engines were used for literature search. Studies that quantified risks associated with manicuring, pedicuring, or barbering were included. State requirements for disinfection and sterilization were reviewed and evaluated.
  
  
  METHODS
  For literature review, odds ratios, 95% confidence intervals, and confounding adjustment were extracted and evaluated. For regulation review, requirements for disinfection or sterilization for multiuse items in nail salons and barbershops were assessed according to the US federal guidelines.
  
  
  RESULTS
  Forty-six studies were identified and 36 were included in this study. Overall, the results were not consistent on risk for HBV/HCV transmission in nail salons and barbershops. For sanitary requirements, disinfection with an Environmental Protection Agency-registered disinfectant is required in 39 states for nail salons and in 26 states for barbershops. Sterilization was described in 15 states for nail salons and in 11 states for barbershops, but the majority of these states listed it as an optional approach. Sanitary requirements are consistent in states where 1 board regulates both businesses but are substantially discrepant in states with separate boards.
  
  
  CONCLUSIONS
  Current literature cannot confirm or exclude the risk for HBV/HCV transmission in nail salons and barbershops. Existing sanitary requirements are adequate in the majority of states, but compliance is needed to prevent HBV/HCV transmission in these businesses.
authors.affiliation: Division of Surveillance and Investigation, Office of Epidemiology, Virginia Department of Health, Richmond, Virginia (Drs Yang and Woolard); Martha Jefferson Hospital at Sentara Health System, Charlottesville, Virginia (Dr Hall); and Centers for Disease Control and Prevention, Atlanta, Georgia (Ms Nuriddin).
authors.forename: Jun
authors.initials: J
authors.lastname: Yang
authors.forename: Keri
authors.initials: K
authors.lastname: Hall
authors.forename: Azizeh
authors.initials: A
authors.lastname: Nuriddin
authors.forename: Diane
authors.initials: D
authors.lastname: Woolard
mesh_terms: D001461:Barbering / Q000331:legislation & jurisprudence*; D004203:Disinfection / Q000331:legislation & jurisprudence*; D004219:District of Columbia; D006509:Hepatitis B / Q000517:prevention & control* / Q000635:transmission*; D006526:Hepatitis C / Q000517:prevention & control* / Q000635:transmission*; D006801:Humans; D009262:Nails; D016017:Odds Ratio; D012307:Risk Factors; D017751:Safety Management / Q000331:legislation & jurisprudence*; D013242:Sterilization / Q000331:legislation & jurisprudence*; D014481:United States