Artificial fingernails on health care workers (HCWs) have been linked to infectious outbreaks and deaths among hospitalized patients. Studies indicate that artificial nails are more likely to be colonized with bacteria and yeast than natural nails. The organisms found are also more likely to be pathogens and to cause disease in the patient. The longer the HCW has had artificial nails the worse the potential for problems becomes. This is before and after proper hand washing by the HCW. It is even true after a 5 minute surgical scrub by HCWs. Artificial nails are also more likely to puncture a glove, putting both the patient and the HCW at risk.

Artificial nails include anything applied to the natural nail other than polish; such as artificial tips, wraps, appliqués, acrylics and gels. Also found to be problematic in terms of infection control are natural nails longer than ¼ inch and natural nails with chipped polish.

A search of PubMed on the terms “artificial nails” turns up many articles on this issue. Operating rooms and Neonatal Intensive Care Units were most often cited as locations where multiple infections among patients could be linked by epidemiological association to a staff member with artificial nails. Caution is also urged in any setting where a patient’s immune system may be stressed.

Many hospitals in the US now ban artificial nails, long nails or chipped nail polish on any employee who provides direct patient care or has contact with patient equipment, supplies, medications or food. This is supported by the CDC Guidelines for Hand Hygiene for individuals providing direct patient care in intensive care units and transplant units. Personally, I will no longer accept care from any provider with artificial nails or excessively long nails. It just is not worth the risk. I also recommend to the new parents that I teach that they follow the same precautions and remove their own artificial nails and keep natural nails’ length to ¼ inch or shorter.

If you work in a health care facility and need to institute a ban on artificial nails you may find this pipelinked reference valuable, as it provides a template to facilitate policy implementation. It is only available to paid subscribers of the American Journal of Infection Control so you may want to have your facility librarian get a copy for you. When artificial nails were banned at the hospital where I am employed there was surprisingly little resistance from staff. The evidence of potential harm to the patients we care for was overwhelming.

Most of my information came from an annotated bibliography put together by my hospital’s infection control nurse which I confirmed with my own PubMed search.

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