The use of podiatry drills, in the absence of engineering controls and personal protective equipment, is an occupational hazard to the healthcare provider. Nail dust collected during foot care procedures performed in office settings has been found to contain keratin, keratin hydrolysates, microbial debris, and viable fungal elements, including dermatophytes (most commonly Trichophyton rubrum) and saprotrophs. Exposure to nail dust and the associated risk will vary with the policies and practices in place, the type of podiatry drill used, therapy technique, frequency of procedures, personal protective equipment utilized and the use of ventilation systems. Nail dust generation Healthcare providers may use podiatry drills on onychauxic (thickened) nails of patients to alleviate or eliminate pain, prevent or treat subungual ulcerations, allow better penetration of topical antifungal agents, or improve cosmesis, all in effort to improve the patient's “quality of life.” In a study conducted by Miller, 65% of respondents reported routinely drilling thickened toenails. However, the improved effectiveness of antifungal drugs such as itraconazole and terbinafine reduces the need to drill these infected nails. Podiatry drills have a mechanical rotating burr that can be set at a range of speeds usually up to 12,000 rpm and may or may not have an integrated local ventilation extraction system. Even with the most effective dust extractors, the electric nail debridement process is not totally risk free because the extractors range from 25% - 92% effective in reducing airborne particles. While the large particles settle out to the floor, varying amounts of smaller particles remain suspended and are inhaled by or adhere to the practitioner and clinical environment. The particle sizes range from 0.1 to 100 um and 86% of these particles are less than 5 um in diameter and therefore capable of entry into the alveoli. Health implications Fungi are ubiquitous organisms that play a vital role in decomposing organic matter. Many species of fungi live on the human body and some will infect nails causing a condition called onychomycosis. There are oral and topical antifungal therapies for this condition, however, in some instances cutting, filing, or abrading the nail may be necessary to improve cure rates. Thickened nails caused by injury, infection, diabetes, psoriasis, or vascular disease may require the use of a mechanical therapy, which can expose the healthcare worker to microbial dust. Exposure to nail dust was first discussed and described in the literature as an occupational hazard in the