Avoiding Use of Artificial Nails in the Perioperative Setting

Artificial Nails and Nail Polish 

Artificial nails and fingernails with chipped nail polish can increase health care–associated infections in the perioperative setting. AORN defines artificial nails as substances or devices applied or added to the natural nails to extend or augment (ie, sculpt, shape) the wearer’s nails. These include bonding, extensions, tips, gel and acrylic overlays, and wraps.¹ Applying these nail enhancements will produce additional surface areas where germs and pathogens, such as methicillin-resistant Staphylococcus aureus (MRSA), Clostridioides difficile, and Candida albicans, may hide and pose a threat for disease transmission.  

Studies suggest that the microbial burden of HCWs’ fingernails is greater on artificial nails than natural nails and that gel-based nail polish may be connected to increased pathogen counts since handwashing is not as effective in removing bacteria from the gel polish.2 Hand hygiene may also be ineffective with the addition of nail art, including designs, stones, piercings, or sculptures, because it adds an extra layer where germs to grow. Sidebar 1 outlines AORN recommendations regarding artificial nails and nail polish.¹ 

Sidebar 1. AORN Recommendations Regarding Artificial Nails and Nail Polish¹ 

• Maintain healthy, short, natural fingernails.
• Do not wear artificial fingernails or extenders in the perioperative setting.
• Do not wear nail lacquer (ie, nail polish) or enhanced nail lacquer (eg, self-adherent colored plastic films, dipped nail coating, and ultraviolet-cured nail lacquer) while performing the scrub role.
• Convene an interdisciplinary team to determine whether non-scrubbed personnel will be permitted to wear nail lacquer or enhanced nail lacquer in the perioperative setting.
  • If wearing nail lacquer or enhanced nail lacquer is approved by the health care organization, the lacquer should be free of chips and cracks. 

Although a fresh manicure may look nice, one study suggests that wearing artificial nails or gel or other nail polish can increase the bacterial load of fingernails.³ Cultures were obtained from 21 HCWs who had artificial nails and 20 HCWs who did not have artificial nails or any type of polish on their nails, and the results were alarming. Overall, 86% of HCWs with artificial nails had pathogens on their hands before handwashing; only 11% of those pathogens were removed after handwashing. Comparatively, almost 80% of the bacteria on the hands of HCWs without artificial nails or polish on their nails was eliminated after handwashing. The study also showed that the subungual region of the nail is often neglected during handwashing. This is the region where the nail grows out and leaves space for bacteria to grow between the polish and lunula of the nail.⁴  

Creating Policies 

When creating policies for health care organizations regarding nails, it is important to address the link between artificial nails and nail polish and infection rates with evidence-based research Taking an additional step, such as forgoing the application of artificial nails and gel polish, may be the saving grace to decrease the incidence of negative health care experiences, such as infections. For example, at Boston Children’s Hospital, Massachusetts, where the authors of this article work, is committed to patient safety and, as such, the policy at this facility states that OR nurses cannot wear any kind of polish or artificial nails. Sidebar 2 provides key takeaways from this article about artificial nails and nail polish in the perioperative environment. 

Sidebar 2. Key Takeaways About Artificial Nails and Nail Polish in the Perioperative Environment  

• Contact surfaces in the OR may harbor various germs and pathogens that may transfer from one person to another and may cause infection when introduced through open membranes. 
• Handwashing is the number one way to prevent the risk of infection to other health care workers.
• Artificial nails; gel nails; and even basic nail polish art, including designs, stones, piercings, or sculptures, add an extra layer where germs can grow.
• It is best practice to NOT wear any nail polish or artificial nails because it jeopardizes patient safety.
• Patient safety is always the priority; this means sacrificing how your hands look to keep them as sterile as possible during surgical procedures, even while wearing sterile gloves.