Proof is in the Pathogens How to Ban Artificial Nails in Your Hospital, The

Alabama Nurse,  Jun-Aug 2005  

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As part of a new, dress code policy, Greenville (SC) Hospital System banned the wearing of artificial nails among staff last year, but that didn't stop some stragglers from donning the decorative tips.

One surgical technician found out firsthand why hospital officials wanted to do away with artificial nails. Staff took a culture of the woman's hands to show her how false nails can harbor pathogens, which healthcare workers can transmit to patients.

The technician "was not real happy" about having a culture taken and scrubbed her hands well beforehand, says Connie Steed, RN, BSN, CIC, Greenville's director of IC. "And they still grew an unbelievable amount of organisms on the plate." The employee went home and promptly removed her nails after the procedure.

Staff took a laminate of the results and posted it around the facility so employees could see that false nails can indeed harbor pathogens. After taking steps like these and instituting other, more widespread educational efforts, "it's now rare for us to find anyone with false nails," Steed says.

Forbidding false nails

Like Greenville, hospitals and healthcare facilities across the country are wrestling with many issues surrounding false nails, such as

* whether to ban artificial nails among all employees or only direct care staff

* how to determine which patients are at high risk of infection

* how to educate staff on the infection control issues associated with false nails

* how to set up an effective program to monitor staff compliance

"It's an ongoing issue," says Gail Bennett, RN, MSN, CIC, executive director of ICP Associates in Rome, GA. Hospitals considered bans on false nails even before the CDC published its hand-hygiene guidelines in October, 2002, she says. In those guidelines, the CDC recommended staff who have direct contact with high-risk patients avoid false nails and that staff with natural nails trim them to 1/4 in long.

In addition, the Joint Commission on Accreditation of Healthcare Organizations carried over from 2004 to 2005 its National Patient Safety Goal #7, which requires staff to dispense with false nails when dealing with high-risk patients.

Determining which patients fall into the high-risk category, however, can be difficult and a matter of opinion. The CDC gives examples of immunocompromised and operating room patients as those who are high risk.

"But then there are issues about cancer and transplant patients," Bennett says, adding, "The emergency room {ER} could encounter a patient who is severely immunocompromised" and not know about the patient's condition when he or she first enters the hospital.

In addition, the staffing issues caused by the nursing shortage mean employees from various departments may find themselves working with high-risk patients on any given day, Bennett says. Healthcare facilities need to maintain the flexibility to use staff in different departments.

The most logical solution, she says, is to ban false nails among all staff who cares for patients. That way, you've also covered 'floater" staff who work in different departments and may spread infection among both low- and high-risk patients.

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Copyright Alabama State Nurses' Association Jun-Aug 2005
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