Woman develops potentially life-threatening infection after pedicure in Winnipeg spa

A Winnipeg woman who developed a life-threatening infection after a pedicure wants Manitoba to toughen up its regulation of spas and salons.

Lisa Cefali is infuriated Manitoba doesn’t perform annual inspections of spas and salons

A Winnipeg woman who developed a life-threatening infection after a pedicure wants Manitoba to toughen up its regulation of spas and salons. 3:14

A Winnipeg woman who developed a life-threatening infection after a pedicure wants Manitoba to toughen up its regulation of spas and salons.

In July 2014, Lisa Cefali got a pedicure at a Winnipeg salon before she was supposed to leave on a dream vacation to Europe with her sons.  A week later, her leg became so badly infected paramedics transported her to hospital from the Toronto airport moments before she was to board a flight to Italy. Cefali was admitted to hospital with a severe staphylococcal infection.

"I could have lost my life. I could have lost my leg," Cefali said.
Lisa Cefali got a pedicure at a Winnipeg salon and developed a life-threatening infection. (CBC)

Cefali's lawyers agreed to the interview with the CBC I-Team under the condition CBC not name the business as the matter is currently being negotiated with the spa's insurance companies.

Cefali believes the infection started as a result of a pedicure in a Winnipeg spa.  On a whim, the Friday before she was to leave, she arranged to meet a friend for pedicures.

"It started out very normally." Cefali said. "We're getting our feet done and we're just chatting.  At one point, the esthetician poked me and I jumped out of my seat."

"It was just really, really sharp because it went right into the toe," Cefali said. "I jumped out of my seat."

The woman apologized and continued with the pedicure.  But Cefali noticed something else.

"As she was razoring my feet I thought, well, isn't that interesting because my feet aren't that bad and there seemed to be a lot of skin that was on the towel. But it was a fleeting thought."

Two days later, the trouble started.
Cefali's foot upon arriving at the emergency room. (Supplied)

"Sunday evening I was just walking around at home and I noticed my heel, my left heel, really ached," Cefali said.  She decided she had probably just twisted her foot and thought it would go away.

But on Wednesday she woke up with a fever, chills and something else.

"I get up and my foot was killing me.  I look down and the top of it was red."  Despite the angry inflammation in her foot, Cefali chalked her symptoms up to a bug bite and the flu.  Her heart set on the European vacation, she popped Tylenol and went to bed early hoping to fight it off before her flight.

"Every three hours I would wake up in a sweat, change the sheets, start with the Tylenol again and set the alarm for 6 a.m. because I had to pack," she said.

The next day, Cefali made the first flight from Winnipeg to Toronto wearing compression socks.  But her symptoms grew worse. "Feeling shaky, fever symptoms, pain in the legs, I was having trouble walking now. It was not good."

Paramedics sent her to hospital

"She literally peeled off my flip flop at that point because it was so swollen now," Cefali said. The paramedics rushed her to the hospital.
Lisa Cefali's foot two hours after arriving in hospital, as doctors tracked the spread of her infection. (Supplied)

Cefali was immediately admitted and doctors confirmed she had a serious skin infection.

Medical records from the Etobicoke General Hospital note patches of inflammation on Cefali's left great toe and foot. The chart states "this lady has left foot cellulitis" and that "her foot swab has grown Staph aureus and group G strep."

As Cefali waited for the antibiotics to kick in, the infection worsened.

"The infection had moved right up my groin into my lymph nodes on my left leg.. I could see it was moving up my leg." Cefali said. "Every hour they would mark the infection up the legs."

Cefali proved to be allergic to the first round of medicine she was given to fight the infection.  Eventually, the medical team found the right combination of drugs. Cefali was discharged from hospital after seven days and sent directly home to Winnipeg to rest and continue a course of oral antibiotics.
Cefali's foot four hours later as doctors track the spread of infection up her calf. (Supplied)

"It felt really surreal because I couldn't believe that this was happening from a basic pedicure," Cefali said.

It took about two months before she could walk without crutches.

"I had gone to an established salon," Cefali said. "It was reputable so I was quite surprised that it happened."

The I-Team brought Cefali's story to Dr. Kelly MacDonald.  She did not treat Cefali but, as the Head of Adult Infectious Diseases at the University of Manitoba, she knows about infections.

"That's a pretty classic story for a soft tissue infection or a cellulitis," said MacDonald. "I think her story is quite consistent with a staphylococcal infection or a strep infection and I think it's a strong possibility that this occurred through this process."
Dr. Kelly MacDonald is the Head of Adult Infectious Diseases at the University of Manitoba. (CBC)

MacDonald said it is impossible to say for certain if the bacteria was introduced at the salon.  Strep G and staphylococcus bacteria can live in various places on the body and the skin and may even have come from Cefali's own body.  But, she said it is likely the bacteria entered her body through a break in the skin caused by the pedicure.

"You shouldn't really be having people do procedures on you where they are breaking the skin or where there is any blood involved because these are not medical establishments," MacDonald said, "You don't know that the instruments are being cleaned and sterilized necessarily in a way that absolutely protects you."

In Manitoba, salons and spas are not regularly monitored by health inspectors.  Inspections are only triggered by consumer complaint.  In Ontario, the province mandates annual inspections in addition to complaint-driven inspections.

The bar in California is also significantly higher than it is in Manitoba.  The state introduced a bill that toughened industry regulation nearly 10 years ago following the death of a woman who developed a serious infection after a pedicure. Today, California inspectors perform regular and surprise inspections as well as complaint-driven investigations.  
Lisa Cefali got a pre-vacation pedicure but instead of going to Italy, she ended up in hospital with a life-threatening infection. 1:40

California also posts all enforcement actions including the violation and the decision as well as fine, suspensions and probation information.  The penalties are stiff and expensive.  For example, if an inspector finds debris in a foot basin or jet, the business licence is immediately suspended, there may be fines and a probation period that could last for years.

"I think their budgets are a little more posh than ours," said Dr. MacDonald who noted that resources are more limited in Manitoba.

"Do we get sufficient bang for our buck when we take our public health officials away from other duties to address, you know, policing manicure salons?" she asked. "Are we taking them away from looking at other important public health issues when we have right now in the province for instance a syphilis outbreak which is from a public health standpoint a pretty high priority issue?

Cefali calls for annual inspections

As for Cefali, she wants the province to start annual health inspections of salons and spas and wants inspectors to come down hard on businesses that fail to make the grade.

"That there's fines if they don't act accordingly the way they should.  And  if once twice.. well then you fine them and you shut them down." Cefali said, "You should not have individuals fearing for their lives or knowing that something like this could happen."

Cefali suggests a public signage system at the front desk of salons and spas.

"I think the public should know as soon as they open the door there should be some certificate or something that says 'yes we have had zero complaints, zero days of accidents' much like construction sites," she said.

In a statement, Manitoba Health said it has no plans to introduce further legislation to change the way inspectors regulate the industry but added it will continue to monitor best practices for regulation.

CBC tried numerous times to contact the salon at which Cefali got the pedicure.  It did not return CBC's calls or emails.

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