Have you ever taken a look at your doctor’s nails? Are they long, polished or fake? If so your doctor may not be following the proper health care policy.

Nice nails, too bad they could make your patient extremely ill. Credit: Adeola Adewale.

To help hospitals understand the risks of artificial nails, the World Health Organization (WHO), the directing and coordinating authority for health within the United Nations system, released their WHO Guidelines on Hand Hygiene in Health Care [PDF] in October 2009. This paper provided healthcare workers (HCWs), hospital administrators and health authorities with a thorough review of evidence on hand hygiene in health care and specific recommendations, including telling HCWs to keep natural nails short (0.5 centimeter long), providing clean running water in medical facilities for hand washing, and wall mounted soap dispenser by the sink in every patient’s room to improve practices and reduce transmission of pathogenic microorganisms to patients and HCWs.

However, the most interesting aspect is a small reference to the problem of artificial acrylic nails being a source of infection.

The concern began with a study published in September, 1999, in the journal Clinical Infectious Diseases. Researchers at the University of Michigan and Michigan Veterans Affairs Medical Centers found that 86% of a volunteer group of HCWs with artificial nails had a pathogen such as Staphylococcus aureus, which causes staph infections, or yeast under their nails, compared with 35% of a control group of HCWs without artificial nails. Staph and yeast both cause infections, ranging from inflammation to blood poisoning. After cleaning their hands with soap or gel, 68% of HCWs with artificial nails still carried pathogens compared to 28% of control HCWs. The study concluded, “Artificial acrylic fingernails could contribute to the transmission of pathogens, and their use by HCWs should be discouraged.”

Major hospitals and the Centers for Disease Control (CDC) agreed. According to CDC’s Morbidity and Mortality Weekly Report published October 25, 2002, “Health care workers who wear artificial nails are more likely to harbor gram-negative pathogens on their fingertips than are those who have natural nails, both before and after hand washing.”

According to the University of California San Francisco Medical Center, outbreaks of infections have been traced to the artificial fingernails of health care workers by researchers at the Stamford Hospital in Stamford, CT, the Acute Disease Division of the Oklahoma State Department of Health,and the Columbia University College of Physicians and Surgeons in New York City.

Even more disturbing, according to a Oklahoma State Department of Health study done in 2000 and published online at Pubmed.gov, “46 [neonatal intensive care unit] patients in a university-affiliated children's hospital acquired P. aeruginosa, a bacteria that can cause blood poisoning, and 16 of them died; this outbreak was linked epidemiologically to 2 nurses, one with artificial nails and another with long, natural nails.”

St. Louis hospitals also have guidelines on nails. Shawn E. Ray, MSN RN and Director of Organizational Effectiveness at Barnes-Jewish Hospital, tells SciJourner that Barnes-Jewish Hospital implemented their policy on fingernails in 2003.  According to Ray, the policy states, “Employees with direct or indirect contact with patients or patient care items will not wear artificial fingernails, extenders, wraps, or nail art while at work.”

So if you see a nurse with long nails you better run!

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  1. I love this article because I see alot of HCWs with artificial nails and I feel that they do carry alot of germs that can be transmitted to others.

  2. I really liked your article and how you used your resoures, and i never would have thought that fake nails/long nails would be so unhealthy in hospitals or any type of setting.:good

  3. I think that it is a goood idea for doctors,(people that help take care of others needs)should not wear fake nails because of thier patients health.

  4. I was told that thier is some sort of "JCO" approved nail acrylic? has anyone ever heard of this? and my second question is the red tech school im going to will allow us to have nail polish but only a certain color? which to me seems odd if we are complying with the health aspects of our nails why does it matter what color they are as long as the length is kept short and thier are no chips? someone please help me?

  5. this will end up going the same way as not using mobile phones in hospitals. It is utter nonsense concentrate more on how many nurses are assaulted at work !

  6. If they’re wearing gloves, which they should be, does it still have the same effect on patients? It is interesting to me that this wasn’t brought up. Something to think about.