Hand hygiene.pdf

emoved 658 . A simple and practical solution allowing effective hand hygiene is for HCWs to
wear their ring(s) around their neck on a chain as a pendant.
20.5 FINGERNAILS AND ARTIFICIAL NAILS
Numerous studies have documented that subungual areas of the hand harbour high concentrations
of bacteria, most frequently coagulase-negative staphylococci, Gram-negative
rods (including Pseudomonas spp.), Corynebacteria, and yeasts 20,390,659 . Freshly applied nail
polish does not increase the number of bacteria recovered from periungual skin, but chipped
nail polish may support the growth of larger numbers of organisms on fingernails 660,661 . Even
after careful handwashing or surgical scrubs, HCWs often harbour substantial numbers of
potential pathogens in the subungual spaces 96,662,663 . In particular, the presence of fingernail
disease may reduce the efficacy of hand hygiene and result in the transmission of pathogens.
A cluster of P. aeruginosa surgical-site infections resulted from colonization of a cardiac
surgeon’s onychomycotic nail 664 .
Whether artificial nails contribute to the transmission of HCAIs has been a matter of
debate for several years. A growing body of evidence suggests that wearing artificial nails
may contribute to the transmission of certain health care-associated pathogens. HCWs who
wear artificial nails are more likely to harbour Gram-negative pathogens on their fingertips
than those who have natural nails, both before and after handwashing 96,390,663,665 or
handrub with an alcohol-based gel 96 . It is not clear if the length of natural or artificial nails is
an important risk factor, since most bacterial growth occurs along the proximal 1 mm of the
nail, adjacent to subungal skin 96,661,663 . An outbreak of P. aeruginosa in a neonatal ICU was
attributed to two nurses (one with long natural nails and one with long artificial nails) who
carried the implicated strains of Pseudomonas spp. on their hands 666 . Case patients were
significantly more likely than controls to have been cared for by the two nurses during the
exposure period, suggesting that colonization of long or artificial nails with Pseudomonas
spp. may have played a role in causing the outbreak. HCWs wearing artificial nails have
also been epidemiologically implicated in several other outbreaks of infection caused by
Gram-negative bacilli or yeast 100,107,667 . In a recent study, multiple logistic regression analysis
showed the association of an outbreak of extended-spectrum beta-lactamase-producing
K. pneumonia in a neonatal ICU resulting from exposure to an HCW wearing artificial
fingernails 668 . Although the above reports provide the best evidence to date that wearing
artificial nails poses an infection hazard, additional studies of this issue are warranted. Long,
sharp fingernails, either natural or artificial, can puncture gloves easily 69 . They may also
limit HCWs’ performance in hand hygiene practices. In a recent survey among neonatal
ICU HCWs, 8% wore artificial fingernails at work, and knowledge among them about the
relationship between Gram-negative bacterial hand contamination and long or artificial fingernails
was limited 639 .
Jeanes & Green 669 reviewed other forms of nail art and technology in the context of hand
hygiene in health care including: applying artificial material to the nails for extensions; nail
sculpturing; protecting nails by covering them with a protective layer of artificial material;
and nail jewellery, where decorations such as stones may be applied to the nails or the nails
are pierced. In addition to possible limitations of care practice, there may be many potential
health problems, including local infection for individuals who have undergone some form
of nail technology 669 .
Each health-care facility should develop policies on the wearing of jewellery, artificial
fingernails or nail polish by HCWs. The policies should take into account the risks of transmission
of infection to patients and HCWs, rather than cultural preferences.