RN, BSN, CPN
Should nurses think twice before visiting the nail salon?
No nurse wants to envision their perfectly manicured nails as 10 perilous Petri dishes, but that’s precisely how infection control experts view them.
Hospitals have long noticed the threat of certain manicures as vessels for infection transmission. Many hospitals have adopted employee policies discouraging or prohibiting employees from having artificial nails and certain manicures.
This is not welcoming news for nurses.
According to a survey cited in the “Journal of PeriAnesthesia Nursing,” 89% of nurses report burnout as the primary issue driving nurses to leave the profession. And now you’re telling them they can’t have pretty nails?
Yet, as an evidence-based profession, the facts are hard to ignore.
Science shows that short, unpolished nails and those with intact, standard polish are generally the safest. Meanwhile, artificial nails and gel manicures harbor bacteria and are difficult to clean effectively. This makes them bacterial breeding grounds.
Artificial nails or enhancements include fake nails, acrylic nails, wraps, gel manicures, dip powder nails, or nail extensions. Because these additives superficially adhere to the nail bed, cracks can form, allowing bacteria to invade and fester, as noted in the “Journal of the American Academy of Dermatology.”
This is not a new concern. An almost 34-year-old comparative study in the “American Journal of Infection Control” compared the fingertip cultures of 56 nurses with artificial nails and 56 nurses with natural nails.
Even after hand washing, the artificial nails harbored higher counts of gram-negative bacteria responsible for hospital-acquired infections, such as Enterobacter, Serratia, Klebsiella, and Pseudomonas.
Gram-negative bacteria are more complex to kill than gram-positive bacteria [3], according to the 1989 study in the “American Journal of Infection Control,” so it’s especially concerning to think that our nails could help increase their spread.
For this reason, the Centers for Disease Control and Prevention (CDC) advises healthcare workers against artificial nails. Even for natural (unpolished) nails, it’s recommended they’re kept less than 1/4 in length. This is because longer nails harbor more dirt and bacteria, potentially spreading infection, according to the CDC.
Artificial nails and enhancements are not the only manicures bad for bacterial spread. According to this 2020 study, artificial and gel manicures correlate with “higher numbers and more species of microbes than bare nails.”
Gel manicures gained popularity in 2012, according to Nail Knowledge. This type of manicure uses a special gel polish that cures under ultraviolet light. The result is a manicure that can last weeks without chipping.
This durable quality makes gel manicures a disaster for infection control. As the gel manicure grows out with the nail, the intact polish peels up, creating a gap for bacterial entry.
A 2018 study found gel manicures might be more challenging to clean with alcohol hand gel. Hand hygiene with alcohol hand gel reduced bacteria on natural nails (no polish) and nails with standard polish but did not mitigate bacteria on gel-manicured nails.
This is concerning as alcohol-based hand sanitizer is commonly used for hand hygiene between patient contact.
Under most circumstances, the CDC recommends healthcare workers use alcohol-based hand sanitizer to remove germs from their hands. After hand hygiene with hand sanitizer, soap, and water, they recognize that germs live under artificial fingernails. Still, the organization’s recommendation to avoid these manicures only extends to providers who come in direct contact with high-risk patients.
The World Health Organization, on the other hand, prohibits artificial nails and extenders for all healthcare workers.
So, what’s a nurse to do? Even in hospitals with policies against artificial and gel manicures, healthcare providers still have them. With nationwide nurse staffing crises, nurses will unlikely be sent home because of their manicures.
It becomes a question of education and enforcement. Nurses will have to decide to forgo this self-care service for the sake of patient safety.
There is no questioning that hands are covered in germs, so it is safe to think that additives are a perfect place for bacteria to hide and multiply. Even after nurses wash their hands, they touch their patients, hospital equipment, phones, and keyboards, continually increasing their hands’ bacterial burden and feeding the dark gaps and cracks within their manicured nails.
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