Dermatology Online Journal

Pathogen carriage in health care workers wearing nail cosmetics
Robert Baran
Abstracts of the Fifth Meeting of the European Nail Society:DOJ 9(1): 17D

Cannes, France

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It cannot be definitively established that artificial nails or even nail varnish present absolutely no risk of spreading bacteria, especially considering that perionychial infection may be associated with sculptured nails. Promotion of fungal and bacterial sculptured nail carriage may be partially related to the increased hydration of the false nail due to the high permeability of acrylic monomers.

Long nails - both natural and artificial – can facilitate colonization of bacteria on the hands by making handwashing less effective and the use of gloves less practical The longer the nail the more likely it is that bacteria reside under its free edge. Anecdotal reports from North America have suggested that nurses who wear acrylic fingernails may become colonised or infected by Candida and, thus, become a possible risk to susceptible patients.

In 1982, Nava noted that polished nails pose no problem of infection if they are manicured and have no chips or cracks. A statement confirmed by Baumgardner et al who showed that nail polish worn on short, healthy nails does not appear to be associated with increased microbial counts on the fingernails. However, this contradicts a previous statement that nail polish and rings make hands difficult to decontaminate and that "recommended practices preclude artificial nails". Bacterial counts apparently were not affected by the use of different scrub solutions (povidone-iodine, hexachlorophene, and 4 % chlorhexidine gluconate solution in the subjects whose nails were cultured after scrubbing. In addition, it has been shown that fingernail polish worn longer than four days fosters increased numbers of bacteria on the fingernails of Operating Room Nurses after surgical hand scrubs.

After handwashing, there were higher numbers of colony-forming units of gram-negative rods cultured from the fingertips of nurses with artificial nails than from those of nurses with natural nails Because of the number of nosocomial infections caused by gram-negative rods, health care workers who wear artificial nails should consider the potential risk of increased carriage of gram-negative rods. Certain genera of bacteria, e.g. Serratia, Acinobacter and Pseudomonas, were recovered only from those nurses with artificial nails.

More recently, researchers from Oklahoma City found that of 439 infants admitted to the NICU during the 15-month study period, 46 (11 %) acquired P. aeruginosa; sixteen 16 (35 %) of whom died. Molecular typing confirmed that the genotypes isolated from the hands of two nurses were the same as those found in 90 % of their case patients, and that these genotypes differed from those found in patients in other parts of the hospital or in those who arrived in the NICU after the study period. In addition, 92 of the 104 health care workers were assessed for fingernail length and presence of artificial nails. Those with short – or medium – length nails had a low risk of P. aeruginosa colonization (one in 80), whereas those with long natural or artificial nails had a significant risk (two in 12).

Three case reports of Pseudomonas corneal ulcers following injury to the eye of wearers of artificial nails have been published. If transmission occurs on one individual, there is no reason why it cannot occur from person to person. An increased rate of infection and colonization with P. aeruginosa among infants in neonatal intensive care units should be investigated by assessing potential reservoirs, including environmental sources as well as patients and health care workers.

Another report also associated artificial nails with fatality. During a one-month period in 1994, seven cardiac surgery patients at a California hospital acquired postoperative Serratia marcescens infection, and one died. Researchers identified a scrub nurse as the likely source of the outbreak. An exfoliant cream she regularly used, tested positive for the strain of S. marcescens that had caused the outbreak. Several controlled studies show that artificial nails harbour more bacteria than do natural nails. In a 1998 study, a perioperative nurse manager and clinical nurse specialist, along with her colleagues at St Luke's Episcopal Hospital in Houston, cultured the nails of 89 operating room staff members before and after a five-minute surgical scrub. Colonisation by Gram-negative rods was much more common among staff members with artificial nails than among those with natural nails, both before (44 % vs. 16 %) and after (37 % vs. 6 %) the surgical scrub. The researchers concluded that artificial nails contain more bacteria than natural nails, placing patients at increased risk for infection.

The Association of Operating Room Nurses (AORN) recommends that artificial nails should not be worn by operating room personnel, citing reports of fungal and bacterial infections. In addition, concerns have also been raised by others that the use of artificial fingernails and nail polish may discourage vigorous handwashing. Therefore, many hospitals have adopted AORN'S guidelines, and some have extended them beyond the operating theatre, for example, in prohibiting nurses who work in the neonatal intensive care and labour and delivery units from wearing artificial nails.

References

Baran R. Nail beauty therapy: an attractive enhancement or a potential hazard ? J Cosm Dermatol 2002; 1:24-29.

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