What’ s clear from the literature is that hand hygiene really does begin with having healthy hands. There’ s a lot of data that shows when we have red, cracked hands with wounds on them, we have higher microbial loads which can threaten our skin integrity.”— Emily Sickbert-Bennett, PhD, CIC
She reminded attendees that nails of healthcare workers can serve as a reservoir for microbial organisms, both pathogenic and non-pathogenic, and that the greatest burden tends to be the subungual region.
“ Having short, natural nails also leads to lower levels of microorganisms on our skin,” Sickbert-Bennett said.“ We also know that nails of healthcare workers can serve as a reservoir for these microbes and the greatest burden of these organisms tends to be under the fingernail region. There have been several outbreaks that have been linked to artificial nails, most commonly with Gram-negative organisms and yeast, occurring in surgery patients, hemodialysis patients, and also in neonatal ICU populations.”
She addressed the science of fingernail characteristics.“ We see increased bacterial carriage when we have longer fingernail lengths, and again, this makes sense in terms of increased surface area for microbes to hide. Longer fingernails also can increase the rate of glove perforation, so it’ s important to think about the impact that nail length has on the effectiveness of our glove use as well.”
Sickbert-Bennett continued,“ Nail polish is a little bit trickier; there are studies that clearly demonstrate that chipped nail polish is associated with a higher bacterial burden than natural nails, so those are times when our hands might have more contamination on them.” She pointed to a study by Hewlett( 2018) that found natural fingernails and those with standard fingernail polish were shown to be more amenable to cleaning with alcohol-based handrubs than gel or shellac fingernails.“ Very few studies actually have looked clearly at the difference between natural nails, standard polish and gel polish,” she said.“ This is not a very well-studied topic, and the strongest data seems to be related to length and intactness of the fingernail polish.”
Regarding fingernail care, the SHEA Compendium addresses the importance of maintaining short, natural fingernails, with the length ideally not extending past the fingertip. The guidance also says that healthcare personnel who provide direct pr indirect care in high-risk areas such as the ICU and the perioperative arena, should not wear artificial nails. Prohibitions against fingernail polish are left to the discretion of the facility’ s infection prevention and control department, except among scrubbed individuals who interact with the sterile field during surgical procedures.
The issue, Sickbert-Bennett emphasized, is that strict fingernail policies without clear rationale can hinder healthcare personnel from embracing hand hygiene as a foundational infection prevention strategy.
The next tough issue she addressed was glove use. As we know, gloves provide the advantage of reduced hand
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