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Toenail Dust as a Potential Occupational Hazard in Podiatric Medicine: A Comprehensive Literature Review

Komal SainiCalifornia School of Podiatric Medicine at Samuel Merritt University, Oakland, CA.

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Tiffany TranCalifornia School of Podiatric Medicine at Samuel Merritt University, Oakland, CA.

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Melody KhosraviCalifornia School of Podiatric Medicine at Samuel Merritt University, Oakland, CA.

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Jannani KrishnanCalifornia School of Podiatric Medicine at Samuel Merritt University, Oakland, CA.

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Dyane E. TowerClinical Affairs, American Podiatric Medical Association, Bethesda, MD.

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Chia-Ding ShihCalifornia School of Podiatric Medicine at Samuel Merritt University, Oakland, CA.

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Background: Debridement of toenails is a common procedure that leads to the production of nail dust aerosols in the work environment. Previous studies indicate that inhaled nail dust can cause respiratory distress and eye irritation. This comprehensive review aimed to assess the available literature on the effect of nail dust exposure and to evaluate nail dust as a potential occupational hazard for podiatric physicians.

Methods: A comprehensive literature search was conducted via PubMed, Google Scholar, CINAHL, Cochrane Library, and ClinicalTrials.gov. Risks of bias of the collected studies were evaluated using various assessment tools to match the type of study design. A qualitative analysis of the included studies was performed, from which primary and secondary outcome measures were extracted: prevalence of symptoms and specific microorganisms in nail dust.

Results: Of 403 articles screened, eight met the inclusion criteria. The primary outcome measure resulted in a pooled prevalence of eye-related symptoms being the most consistent symptom reported (41%–48%). The secondary outcome measure resulted in a pooled prevalence of Trichophyton rubrum (9.52%–38%) and Aspergillus (11.11%–35.48%) as the most common microorganisms present in nail dust.

Conclusions: From the included eight articles, we found that nail dust is a potential occupational hazard, especially for those exposed more often. Aspergillus and T rubrum are most commonly associated with nail dust leading to development of respiratory illness. It is important to take preventive measures in podiatric medical clinics by using improved and efficient personal protective equipment for workers exposed to nail dust. Detailed health safety guidelines can be developed to decrease respiratory symptoms and diseases from nail dust exposure.

Corresponding author: Chia-Ding Shih, DPM, MPH, MA, California School of Podiatric Medicine at Samuel Merritt University, 450 30th St, Ste 2860, Oakland, CA 94609. (E-mail: cshih@SamuelMerritt.edu)