Artificial nails and infection risks in healthcare settings

Artificial nails, or fake nails, are extensions used as fashion accessories that can potentially pose transmission risks in healthcare settings. There are several types of artificial nails, such as acrylics, gels, wraps, polygel, press-on nails and more. Nail jewellery is another type of enhancement that can present similar challenges as artificial nails in healthcare environments. A study indicates that artificial nails are more prone to harbouring microorganisms compared to natural nails.[1] Hand hygiene is an effective method to prevent the transmission of infections and depends on both individual and system-level factors.[2,3] Evidence suggests that artificial nails are linked to ineffective hand hygiene. Artificial nails have rough surfaces and small gaps between the natural nail and the artificial material, creating an environment that is suitable for microorganism growth. Hand hygiene with soap and water or alcohol-based sanitisers may not be sufficient to fully eradicate these microbes.[4] A case–control study revealed that staff with artificial nails harboured higher levels of microorganisms on their nails compared to those with natural nails, both before and after hand disinfection with soap and alcohol-based hand sanitiser.[4] Artificial nails are also associated with healthcare-associated infections. Outbreaks involving organisms such as Pseudomonas, Klebsiella, Serratia and Candida are well documented. One study demonstrated that Pseudomonas aeruginosa infections among neonates were linked to two staff members with artificial nails who were found to be carrying the same organism.[5,6] The Centers for Disease Control and Prevention (CDC) recommends that healthcare workers, especially those involved in direct patient care and/or working in critical care areas such as intensive care units and operating rooms, should not wear artificial nails.[7] Despite multiple outbreaks being linked to artificial nails and CDC recommendations, their use remains a challenge in healthcare settings. Lack of staff awareness, unclear policies or ineffective implementation and poor communication regarding artificial nails can contribute to noncompliance; therefore, a multidimensional approach is needed to address this issue. In summary, artificial nails or any nail products other than regular nail polish should be discouraged among healthcare workers who are involved in direct patient care. It is also recommended that the staff who prepare products for patients, such as in the pharmacy, or are involved in environmental care services, should also not use such products to avoid any indirect transmission of microorganisms. Natural nails should also be trimmed and not kept more than ¼ inches over the fingertips. Regular nail polish when used should also be free of chips, as chips can promote bacterial growth and are difficult to disinfect. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.