Artificial Nails/Nail Enhancements THE EVIDENCE . Sherry David ICP Contact Program of Hospital Epidemiology 356-1606. 7th National Patient Safety Goal. JCAHO 2004 National Patient Safety Goal 7.) Reduce the risk of health care-acquired infections.
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Sherry David ICP
Program of Hospital Epidemiology
a.) Comply with the current hand hygiene
One hand polished: one hand left unpolished
Daily for four days
24 of 26 completed
23/24 had chipped polish by fourth day
No statistically significant difference in colony forming units (cfu) between polished and unpolished nailsEffects of Nail Polish on Microbial Counts of Fingernails
Baumgardner, C. et al. (1993). American Operating Room Nurses Journal. 58(1): 84-88.
28 yo hit in her right eye with a piece of nail debris while manicuring her artificial nails
Corneal culture grew PSA
37 yo scratched her L eye with a sculptured fingernail
Corneal culture grew PSA
20 yo brushed across her L eye with the tip of her artificial nail
Corneal culture grew PSAPseudomonas Corneal Ulcers after Artificial Fingernail Injuries
Parker, AV et al (1989). American Journal of Ophthalmology. 107(5), 548-549.
April to June 2001, outbreak of ESBL K pneumoniae in NICU in a NYC hospital
Typed by PFGE: 13/19 case infants harbored the outbreak Clone A
Method: Cx of GI tract of pts, HCW hands, and the environment
Attack rate - 45%: 9/19 developed invasive disease
6 case of sepsis
Clone A found on 2 HCW’s
1 wore artificial nails - RN 53
one with natural nail length > ¼ inch - RN 23ESBL-producing Klebsiella pneumoniae in a NICU linked to artificial nails
Gupta, A. et al. (2004). Infection Control Hospital Epidemiology. 25(3):210-5.
Transfer from local hosp
Chest tube, UAC
Type of enteral feeding
Very low birth weight, Intubation, CVC, Intra-lipids, LOS, Exposure to RN 53
LOS, Exposure to RN 53
Cost of outbreak $350,000 (estimated)Results: Risk Factors for Acquisition
Results: Institution-wide ban on wearing of artificial nails
Jan 1997- Mar 1998 in an Oklahoma NICU 46 pts. developed BSI with PSA - 16 deaths (35%)
15 of 20 pts. had genotype A & 3 had genotype B
3 Nurses had PSA isolated from hands;
Nurse A1 (Long natural nails) and A2 (short natural nails) had genotype A on their hands
Nurse B (Long artificial nails) had genotype B on her handsProlonged Outbreak of Pseudomonas aeruginosa (PSA) in an NICU
Moolenaar, R. et al. (2000). Infection Control Hospital Epidemiology. 21(2), 80-85.
Case Control Study
Case Control Study with PSA -
1997, 3 pts. post-laminectomy with deep wound infections due to Candida albicans (CA)
PFGE revealed identical isolates
One OR tech scrubbed in on all 3 cases and the same CA strain was isolated in her throat
3 mos prior she removed her artificial nails. The nails were present during the 3 surgeries. She was treated and removed from duty for 14 days
No difference for:
Age, sex, time of surgery,
Intra-op radiology, skin prep, pre-op ATB, pre-op shower, etc.
Only one common factor…the OR tech who had artificial nailsCandida Osteomyelitis and Diskitis after Spinal Surgery: An Outbreak that Implicates Artificial Nails
Parry, M. et al. (2001) Clinical Infectious Diseases. (32), 352-357.
Aug-Sept 1994, 7 cardio-vascular surgery patients at a California hospital with post-op wound infections; one death
No difference for:
Age, race, gender, wt. BMI, and number of discharge dx.
Exposure to scrub nurse A (wore artificial nails), was significant in all stratified analyses; hand cultures were negative
Environmental Home Culture
Isolates from the exfoliant cream had the same PFGE pattern as the outbreak strain; the exfoliant was identified as the reservoir!Postoperative Serratia marcescens Wound Infections Traced to an Out-of Hospital Source
Passaro, K. et al. (1997). Journal of Infectious Disease. 175(4): 992-995.
Surveillance cx of environment were negative
10/165 HCW had PSA on hands
Case Control Study indicate:
Risk factors were care by older nurses & nurses with artificial nailsEndemic Pseudomonas aeruginosaInfection in an NICU
Foca, M. et al. (2000). NEJM. (343), 695-700.
56 nurses with artificial nails and
56 nurses with natural nails
Nurses were paired from the same patient care area and were free of active infection
No difference in both groups for:
Type of soap used
Number of handwashings
Time between handwashings and collection of culturesBacterial Carriage by Artificial vs. Natural Nails
Pottinger, J. et al. (1989). American Journal of Infection Control. 17(6): 340-344.
Number of Nurses with gram-negative rods and gram-positive cocci before and after handwashing
Artificial nails are applied with resin.
A fiberglass mesh may be used as
in enamel. Rhinestones, glitter, pearls,
etc. may be added.
But can harbor bacteria!
Pseudomonas nail infection