Does the use of nail products contribute to nosocomial infections? There is sufficient evidence that is provided that confirms hands are vehicles for the spread of many microorganisms. Acrylic nails are known to harbor and manifest an increased load of bacteria because the area under and around the nail is harder to reach resulting in ineffective hand hygiene. The new and popular UV-gel cured nails, which is advertised as “chip proof” and “long lasting” but as everything, has its own downfalls. Therefore, all varnished nails have an increased bacterial load in comparison to short natural nail increasing the risk of acquiring nosocomial infections.
Nosocomial infections, which are infections that are acquired in the healthcare setting are a major problem for patients and patient safety. One reason for acquiring nosocomial infection can be insufficient hand hygiene. “Hand hygiene is the single most important intervention in interrupting transmission of microorganisms and thus preventing nosocomial infections.” (Open Access: Prevention and treatment of neonatal nosocomial infections; 2017) It is the most effective and least expensive measure. The CDC data that was collected in 2016 in comparison to 2015 showed, New York had a decrease in the number of incidences of 3 HAI (healthcare associated infections). These HAI included central line associated bloodstream infections, C. difficile events and surgical site infection (specifically colon surgery), despite New York having still 9% higher rates compared to the national baseline. Although there was not an increase in incidences in any healthcare associated infections, catheter associated urinary tract infections are also still 10% higher compared to the national baseline.
The link between hand hygiene and health was made a little less than two centuries ago. It was started by a man named Igaz Semmelweis, a Hungarian doctor who was working in Vienna General Hospital, who is now called the father of hand hygiene. It was in 1846 when Semmelweis investigated the major difference in mortality rates between two maternity wards; one run by doctors and other run by midwives. Semmelweis realized doctors would visit patients directly after an autopsy, and came to a conclusion they were carrying “cadaverous particles” on their hands. Semmelweis directly related “cadaverous particles” to be the reason why puerperal fever was acquired by these mother. Semmelweis implemented a new rule for doctors to perform hand washing with chlorinated lime solution. Resulting in major decrease in deaths to 3% at that maternity ward. This was the first evidence that provided hand washing with an antiseptic agent can reduce the spread of infection. Unfortunately, Semmelweis’ speculation was not widely accepted by others, as doctors and colleagues thought he was blaming them for the deaths of their patients. Years later a women named Florence Nightingale, who is known as the Mother of Modern Nursing was discovered. Florence Nightingale was woman who had the greatest influence on modern nursing. Nightingale is considered the first nursing theorist and believed environment had a big influence on patient outcomes. Her Environmental Theory are still practiced today, as one aspect of the theory focuses on patient cleanliness and frequent hand washing of nurses. As Nightingale states in, Note on Nursing, a book written by Florence Nightingale herself, “Every nurse ought to be careful to wash her hands very frequently during the day.” Nightingale implemented handwashing and other practices in the was hospital she worked at during the Crimean War. Nightingale’s hand hygiene practices achieved a reduction in infections. It wasn’t until 1980, where the evolution of hand hygiene became nationally implemented. “The first national hand hygiene guidelines were published in the 1980s. In 1995 and 1996, the CDC/Healthcare Infection Control Practices Advisory Committee (HICPAC) in the USA recommended that either antimicrobial soap or a waterless antiseptic agent be used for cleansing hands upon leaving the rooms of patients with multidrug-resistant pathogens. More recently, the HICPAC guidelines issued in 2002 defined alcohol-based handrubbing, where available, as the standard of care for hand hygiene practices in health-care settings, whereas handwashing is reserved for particular situations only” (Geneva: World Health Organization; 2009.) Significant progress in the reduction of nosocomial infections has been achieved since hand hygiene practices have been strongly implemented. However, with always having room for improvement, research is always being done in how to further reduce the spread of nosocomial infections among healthcare workers to patients. New challenges and problems arise with hand hygiene as the wear of nail polish, nail extensions, artificial nails become more popular in the late 20th century.
The wear of nail polish goes as far back as 3000 B.C., where it was used to distinguish between the ruling class and the general population. It wasn’t until the late 20th century where manicures became regularly popular. The invention of nail extensions was created by a dentist, Dr. Fred Slack when he broke a fingernail at work and created an artificial nail using dental acrylic as a replacement for the time being. Slacks brother then was the first to perfect the invention and started the company Patti nails.
In 1997-1998, the contaminated long fingernails of two nurses was linked to 16 neonatal deaths in the neonatal intensive care unit of a university-affiliated children’s hospital. (Infection Control and Hospital Epidemiology: A Prolonged Outbreak of Pseudomonas Aeruginosa Infections in a Neonatal Intensive Care Unit: Did staff fingernails play a role in disease transmission; 2000) The unfortunate event lead to numerous studies identifying that artificial and long nails are more likely to be colonised with bacteria than short nails. (Art & Science: Infection control in the neonatal intensive care unit; 2007.) Majority of the organisms found on the hands of healthcare workers are found around nails and subungual area of nails. Artificial nails have higher rates of colonization with gram-negative flora such as Pseudomonas aeruginosa, Serratia marcescens and Klebsiella pneumoniae as well as yeast, Candida albicans. (Open Access: Prevention and treatment of neonatal nosocomial infections; 2017) Nails that are short and unpolished make cleaning easier and more more effective as the subungual area and the nail bed are not obscured. Opposed to acrylic nails, which are almost always long and polished, make effective cleaning more difficult. Acrylic nails compared to freshly applied nail polish have a lower bacterial load. However, although freshly applied nail polish on short natural nails does not increase the number of microorganisms, the downside of the application is their rapid wear at the edges and chipping as early as 4 days. Chipped nail polish increases the number of microorganisms on fingernails. (Aron Journal: Clinical Issues 1.2; 2015) The chipped area can become a reservoir for pathogens to multiply in. As the cosmetic nail industry continues to grow, products have expanded beyond acrylic glued nails and nail polish. Different nails coverings now include; dip powder nails, UV-cured gel nails, nail wraps and shellac; a UV-cured nail lacquer. “Gel-type vanishes does not chip or wear, it can remain intact on the nail for as long as 14 days; however, as the nail regrows, gaps appear at the base.” (Journal of Hospital Infection: Nail microbial colonization following hand disinfection:a qualitative pilot study; 2018.) In addition to the gap that forms between the nail and the cuticle, oftentimes UV-cured nails have the tendency to lift from the fingernail, providing a dark, moist place to potentiate growth of microorganisms.
Two studies that were focused on, provided statistical data in supporting the thesis of this research paper. However, in one study the data presented do no indicate an increased burden of microorganisms in healthcare workers who wear gel polish. (American Journal of Infection Control: Evaluation of the bacterial burden of gel nails, standard nail polish, and natural nails on the hand of healthcare workers; 2018) Though, both have agreed that there is a high probability of ineffective hand hygiene with long fingernails and UV-cured nails. “Potentially pathogenic microorganisms were isolated significantly more frequently in the care of long fingernails and in the group of varnished nails regardless of the type of varnish” (Journal of Hospital Infection: Nail microbial colonization following hand disinfection:a qualitative pilot study; 2018.) These pathogenic bacteria included; Staphylococcus aureus, Staphylococcus mitis, Staphylococcus faecalis, Staphylococcus faecium and Citrobacter freundii, Escherichia coli, Klebsiella spp. The results show, regardless of the nail products (natural nail, nail polish, and gel polish), all 3 nail types are contaminated with bacteria overtime. In comparison to the other study, it states “Hand hygiene showed a significant reduction of microbial organisms for natural nails and standard polish but not for gel nails. One possible explanation of this finding is that there is nail overgrowth that occurs with the thicker nail gel polish, which could produce relatively deep crevices that may be more difficult to clean with alcohol hand gel.” (American Journal of Infection Control: Evaluation of the bacterial burden of gel nails, standard nail polish, and natural nails on the hand of healthcare workers; 2018) Additionally, results indicated that nail length vs. varnish were equally important factors. Disinfection of short varnished nails showed similar results in comparison to natural nails, however long nails have a lack of efficacy of hand hygiene.