Noah Sinclair
Hospitals have long been concerned about the threat of certain manicures as a means of transmitting infections. Most hospitals have policies that discourage or prohibit employees from having artificial nails and certain manicures, in line with infection control protocols. Gel nails, in particular, are difficult to clean effectively and can harbour bacteria, making them a potential health risk in a hospital setting. While some hospitals may allow gel nails, the general recommendation is to treat them as artificial nails and avoid wearing them in high-risk areas.
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Infection risk
The use of gel nails by healthcare workers in hospitals is a contentious issue due to the potential risk of infection. Hospitals have long been aware of the threat posed by certain manicures as a means of transmitting infections. The concern is that cracks can form between the artificial nail and the nail bed, allowing bacteria to enter and multiply. This risk is not unique to gel nails, as it applies to all types of artificial nails and enhancements, including acrylic nails, wraps, dip powder nails, and nail extensions.
Several studies have been conducted to investigate the potential risk of infection associated with artificial nails. A 1989 study published in the "American Journal of Infection Control" found that artificial nails harboured higher counts of gram-negative bacteria, such as Enterobacter, Serratia, Klebsiella, and Pseudomonas, even after hand washing. These types of bacteria are known to cause hospital-acquired infections and are more challenging to eradicate than gram-positive bacteria. Additionally, the Cochrane Review, published in 2014, and the systematic review by Francis et al. in 2016, examined the relationship between the presence of personal items in the operating room and surgical site infections, but none of the included studies specifically addressed the wearing of nail polish.
The Association of Operating Room Nurses (AORN) has recently stated that gel polish should not be worn in operating rooms due to a lack of evidence supporting its safe use. This position is endorsed by the Association for Professionals in Infection Control and Epidemiology (APIC). The Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA) also recommend a conservative approach, suggesting that gel nails be treated as artificial nails and not worn in high-risk areas for infection.
Based on this evidence and the guidelines provided by organisations such as the CDC and WHO, many hospitals have implemented policies discouraging or prohibiting employees from having artificial nails and certain types of manicures. These policies aim to reduce the potential risk of spreading infections and prioritise patient safety. However, the enforcement of these policies and the education of healthcare providers remain important factors in ensuring compliance.
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Hand hygiene
The World Health Organization (WHO) prohibits artificial nails, nail gels, and extenders for all healthcare workers. The Centers for Disease Control and Prevention (CDC), on the other hand, only recommends against these manicures for providers who come into direct contact with high-risk patients. The CDC also advises healthcare workers to use alcohol-based hand sanitizer to remove germs from their hands between patient contact. However, hand hygiene with alcohol hand gel is ineffective against bacteria on gel-manicured nails, making it a potential bacterial breeding ground.
A study published in the American Journal of Infection Control compared the fingertip cultures of nurses with artificial nails and those with natural nails. The study found that even after hand washing, artificial nails harbored higher counts of gram-negative bacteria responsible for hospital-acquired infections. Another study evaluated the bacterial burden of gel nails, standard nail polish, and natural nails on the hands of healthcare workers over 14 days. It found that while all three nail types became more contaminated with bacteria over time, hand hygiene with alcohol hand gel reduced bacteria on natural nails and nails with standard polish but not on gel-manicured nails.
Based on the available evidence and guidelines, most hospitals have adopted policies discouraging or prohibiting employees from having artificial nails and certain manicures, including gel nails. The Association of Operating Room Nurses (AORN) and the Association for Professionals in Infection Control and Epidemiology (APIC) have also made statements recommending against the use of gel polish in operating rooms due to a lack of evidence supporting its safe use. Given the potential risk of spreading infection, hospitals' stringent approach to nail grooming, emphasizing clean, short, and natural nails, is crucial for patient safety.
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Artificial nails
The World Health Organization (WHO) prohibits artificial nails and extenders for all healthcare workers. The Centers for Disease Control (CDC) guidelines state that providers in high-risk areas must not wear artificial nails, although many organisations following CDC guidelines have chosen to expand this ban to all care providers. The CDC also recommends keeping natural nails short, at less than 1/4-inch long.
In addition to the CDC and WHO, hospitals can refer to guidelines from organisations such as the Association of Operating Room Nurses (AORN) and the Association for Professionals in Infection Control and Epidemiology (APIC). The AORN has recently made a position statement recommending that gel polish not be worn in operating rooms due to a lack of evidence supporting its safe use.
Some hospitals that have adopted policies prohibiting artificial nails include all Kaiser facilities in California, New York-Presbyterian Hospital, and Boston Children's Hospital.
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Natural nails
Hospitals have strict dress codes for their staff to ensure a professional and hygienic appearance, creating a positive impression on patients and promoting a safe and sterile environment. These dress codes include guidelines for personal hygiene, hair, nails, makeup, jewellery, clothing, and shoes.
Regarding nails, most hospitals have policies that discourage or prohibit employees from having artificial nails, nail extensions, and certain manicures, in alignment with infection control protocols. Artificial nails, including gel manicures, can harbour bacteria and are difficult to clean effectively, making them a potential source of bacterial growth and infection transmission.
While some hospitals may allow nail polish on natural nails, others may prohibit its use to prevent chipping or peeling, which can lead to contamination. It is essential for healthcare workers to refer to their specific facility's policies regarding the use of nail polish. Overall, the priority is to maintain clean, short, and well-groomed natural nails to uphold the highest standards of professionalism and patient care.
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Hospital policies
Some hospitals, such as all Kaiser facilities in California, New York-Presbyterian Hospital, and Boston Children's Hospital, do not allow artificial fingernails for healthcare workers. The Association of Operating Room Nurses (AORN) has also made a statement asserting that gel polish should not be worn in operating rooms due to a lack of evidence supporting its safe use. The Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA) recommend that gel nails be treated as artificial nails and, at the very least, not worn in high-infection-risk areas.
The CDC and WHO guidelines recommend keeping natural nails short, less than 1/4 inch long. The UCSF Medical Center has a comprehensive hand hygiene campaign that includes the removal of artificial nails and trimming of long natural nails. The CDC's 2002 draft revision of the Guideline for Hand Hygiene in Healthcare Settings also recommends not wearing artificial nails or extenders when providing patient care.
While some hospitals have policies against artificial and gel manicures, enforcement can be challenging, and some healthcare providers still choose to have them. The question of allowing gel nails in hospitals involves balancing the interests of safety and individual expression.
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Frequently asked questions
No, gel nails are not allowed in hospitals. The World Health Organization (WHO) prohibits artificial nails, nail gels, and gel colors for all healthcare workers. The Centers for Disease Control (CDC) also recommends that providers in high-risk areas must not wear artificial nails.
Gel nails are prohibited in hospitals because they are difficult to clean effectively and can harbor bacteria, making them a breeding ground for bacterial infections.
Examples of hospitals that do not allow gel nails include all Kaiser facilities in California, New York-Presbyterian Hospital, and Boston Children's Hospital.
Yes, regular nail polish is generally allowed in hospitals as long as it is intact. However, some hospitals have adopted a ""clean, short, natural nails" policy, prohibiting all nail polish for workers in patient care areas.
Non-compliance with the hospital's policy on gel nails can result in disciplinary action, as each employee is responsible for maintaining hand hygiene and adhering to the hospital's infection control protocols.
