Customers that undergo spa treatments using toothless Garra Rufa fish are at a 'very low' risk of catching an infection, according to new guidance on fish spas published by the UK's Health Protection Agency (HPA).

In a statement, the HPA outlined that in a fish spa setting there is the potential for transmission of a range of infections, either from fish to person (during the nibbling process), water to person (from the bacteria that can multiply in water), or person to person (via water, surrounding surfaces and fish).

However, the HPA concludes that "overall risk of infection is likely to be very low, if appropriate standards of hygiene are adhered to".

The guidance was issued by a multi-agency working group, established earlier this year, following a number of enquiries to the HPA from local environmental health practitioners questioning the safety of fish spas.

Dr Hilary Kirkbride, consultant epidemiologist at the HPA, said: "Provided that good standards of hygiene are followed by salons, members of the public are unlikely to get an infection from a fish spa pedicure, however the risk will be higher for certain people.

"Those with weakened immune systems or underlying medical conditions, including diabetes and psoriasis, are likely to be at increased risk of infection and so fish pedicures are not recommended for such individuals. We advise that operators of fish spas should not promote treatment to these groups."

The treatment has become popular in the UK and a number of operators, such as London-based Aqua Sheko and Appyfeet, base their entire business model on the Garra rufa treatments.

Speaking to Leisure Opportunities, a spokesperson for Sheffield-based Appy Feet said: "We operate under strict health and safety guidelines, and work very closely with the Health and Safety Executive, and local authorities, to ensure our spas are of the highest standard.

"Our tanks are operated in line with industry regulations and have a specially designed filtration system, developed and managed by a marine biologist, which sterilizes the water up to 8 times an hour, and the UV systems used ensure no diseases can live in the water.

"Every customer is required to complete a full health questionnaire, followed by a foot inspection. Anyone with cuts or open sores on their feet or hands are not allowed to take the treatment. In addition, the Garra Rufa fish used by Appy Feet do not have teeth, and cannot pierce skin. Therefore the transfer of fluids is not able to take place."

Michael Burke, from operator Dr Spafish, welcomed the HPA guidance, saying that it would benefit reputable operators who take hygiene seriously and only adversely affect companies which cut corners.

"It would be fair to say that not all involved in fish spas were fully aware of all the measures required to ensure public safety.

"We have written procedures that cover inspection of client’s feet to minimise any source of potential infection. Together with our disposable toweling system and our bespoke filtration, designed specifically for commercial fish spa use, we are confident that the public are protected.

Originating from Asia, the Garra rufa treatments are banned in a number of US states, including Florida, Texas, New Hampshire and Washington.