Caleb Foster
Doctors and other healthcare workers must take several factors into account when considering whether to wear nail polish, including gel nail polish. The most important consideration is the risk of infection. Multiple studies have investigated the relationship between wearing nail polish and infection rates, with a focus on bacterial contamination of healthcare workers' hands. The Robert Koch Institute and other international organisations recommend prohibiting painted or gelled fingernails in risk areas of hospitals and medical practices. Additionally, the pulse oximeter, a device that monitors oxygen levels in the blood, may be affected by nail polish, potentially impacting patient safety. While some surgical facilities permit clear, chip-resistant nail polish, the consensus is that artificial nails and gel polish should be removed before surgery.
| Characteristics | Values |
|---|---|
| Can doctors wear nail polish? | Yes, but only if it is not chipped. |
| Can doctors wear gel nail polish? | No, it is prohibited in hospitals and medical practices due to the risk of infection. |
| Can doctors wear nail polish during surgery? | No, as it can affect the results of a pulse oximeter, which is a device that monitors oxygen levels in the blood. |
| Can doctors wear toenail polish during surgery? | Yes, but it is best to consult with the surgeon to confirm their specific requirements. |
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What You'll Learn
Hospitals may have different policies on nail polish
The Robert Koch Institute and other international organisations recommend prohibiting coloured nail varnish and gelled fingernails in risk areas of hospitals and medical practices. This is because contaminations are not visible, and the necessary removal may not be carried out. Hospitals may also have different policies on artificial nails and gel nails, with some including them in bans on artificial nails, while others may allow them as long as they are not chipped.
Some hospitals may also have rules about unusual hairstyles, banning hair in bright, unnatural colours, and some specifically ban unusual styles like dreadlocks, Mohawks, and long spiked hair. These rules can be off-putting to nurses, especially students entering the profession, who may feel that their personal expression is being restricted. However, hospitals have to balance the conflicting demands of patient safety, patient satisfaction, and employee satisfaction when making rules about appearance.
Additionally, hospitals typically prohibit visible tattoos but often allow employees to cover them with long sleeves, Band-Aids, or larger bandages. While tattoos don't present the same safety issues as nail polish in terms of harbouring germs, they can upset patients and other staff.
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Nail polish can affect pulse oximeter readings
While there are no explicit rules prohibiting doctors from wearing nail polish, the impact of nail polish on pulse oximetry readings has been a topic of interest. Pulse oximetry is a widely used, non-invasive method to measure functional oxygen saturation (SpO2) in the blood, along with heart rate and tissue perfusion. It is an essential tool in medical practice, especially in critical care settings.
Several studies have investigated the effect of nail polish on pulse oximetry readings. One study examined the impact of various nail polish colours on oxygen saturation measurements. Fourteen adult volunteers had their fingers painted with blue, green, purple, black, and red nail polish. Results indicated that black, blue, and green nail polish significantly lowered oximeter readings, with blue and green causing the greatest decreases.
Another study tested ten different gel nail polish colours, including black, purple, navy blue, green, light blue, white, yellow, orange, pink, and red. Using two different pulse oximeters, the study found that light blue and orange gel nail polish resulted in a significant increase in SpO2 readings. The study concluded that gel-based manicures could lead to overestimations of actual readings, potentially delaying the detection of hypoxaemia.
The impact of nail polish on pulse oximetry readings is attributed to the absorption of light by the nail polish. Pulse oximeters use specific wavelengths of light (660 nm and 940 nm) to measure oxygen saturation. Some nail polishes absorb light at these wavelengths, leading to inaccurate readings.
It is important to note that the effect of nail polish on pulse oximetry readings can vary depending on the colour, brand, and type (gel or regular) of nail polish. Therefore, it is generally recommended to remove nail polish before pulse oximetry monitoring to ensure accurate readings.
In summary, while nail polish can affect pulse oximeter readings, the impact varies depending on the specific characteristics of the nail polish. To ensure accurate medical measurements, it is advisable to remove nail polish or use alternative monitoring techniques.
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Bacterial transmission is higher with chipped nail polish
While there is no consensus on the impact of nail polish on bacterial transmission, chipped nail polish in particular has been associated with higher bacterial counts and an increased risk of infection. This is because chipped nail polish can create small cracks and crevices that provide an ideal environment for microbial growth and invasion, even with proper handwashing.
Several studies have investigated the relationship between nail polish and bacterial transmission. One study compared bacterial contamination on the hands of healthcare workers with freshly applied nail polish, old or chipped nail polish, and no nail polish. The study found no significant difference in bacterial counts between freshly polished nails and unpolished nails or between unpolished nails and chipped polished nails. However, it is important to note that this study may not have been sufficiently powered to detect significant differences.
Another study compared one-day-old nail polish to four-day-old nail polish and found that the older polish exhibited significantly more microorganisms, suggesting that the duration of wear may be a factor in bacterial transmission. Additionally, a systematic review published in 2016 included 17 studies on the relationship between personal items in the operating room and surgical site infections, but none of the studies specifically addressed the wearing of nail polish.
Despite the lack of conclusive evidence from these studies, guidelines from the Public Health Agency of Canada (PHAC) recommend that healthcare workers avoid chipped nail polish due to the potential risk of increased bacterial transmission. This recommendation is based on a moderate level of evidence. Similarly, the National Health Service (NHS) in the UK advises a "bare below the elbows" policy, which includes avoiding nail polish, to reduce the risk of bacterial spread.
In the context of the COVID-19 pandemic, nail hygiene has gained recognition as an important component of disease transmission prevention. The Centers for Disease Control and Prevention (CDC) has issued guidance on nail maintenance to prevent the spread of SARS-CoV-2, emphasizing proper nail grooming and cleaning of nail-grooming tools. Overall, while the evidence on the impact of chipped nail polish on bacterial transmission is limited, the current recommendations and guidelines suggest that it is advisable to avoid chipped nail polish in healthcare settings to minimize the risk of infection.
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Some surgical facilities permit clear nail polish
Policies on nail polish for doctors vary between different hospitals and surgical facilities. While some hospitals do not allow nail polish in operating rooms, others permit clear nail polish. This is because chipped nail polish can lead to an increased risk of bacterial transmission.
The Robert Koch Institute, in agreement with other international organisations, recommends prohibiting non-transparent nail varnish and gelled fingernails in risk areas of hospitals and medical practices. This is because contaminations are not visible, and the necessary removal may not be carried out.
Some hospitals have a policy of 'bare below the elbows', which includes nail polish. This policy is based on the idea that being completely bare would result in better surgical outcomes due to decreased fomite (and, as a result, bacteria) spread by minimising fabric rub on the skin.
There is also a concern about the potential for bacterial contamination on the hands of healthcare workers with nail polish. A 1994 RCT compared bacterial contamination of healthcare worker hands with freshly applied nail polish, old or chipped nail polish, and no nail polish. The results showed that chipped nail polish could lead to an increased risk of bacterial transmission.
As a result, some surgical facilities permit clear nail polish, provided it is well-kept and not chipped.
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WHO and CDC guidelines recommend against artificial nails
The World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) have specific guidelines in place regarding artificial nails for healthcare workers. The WHO guidelines clearly prohibit artificial nails, nail extenders, and gels for all healthcare workers, with no exceptions. This means that any direct care provider, including doctors, should not have artificial nails or extenders if their organization follows WHO guidelines.
On the other hand, the CDC guidelines focus on healthcare personnel who care for patients at high risk of acquiring infections, such as those in intensive care units or transplant units. According to the CDC, health care providers in high-risk areas must not wear artificial nails and should maintain natural nails at a length of less than one-quarter inch. However, it is important to note that many organizations adhering to CDC guidelines have chosen to broaden this restriction to all care providers, banning not only artificial nails but also nail gels and gel colors.
The primary concern behind these guidelines is the potential for increased bacterial transmission associated with artificial nails and chipped or old nail polish. While there is some debate about the impact of nail polish on surgical site infections, the presence of bacteria on the hands of healthcare workers is a critical factor in preventing healthcare-associated infections in patients. Therefore, the CDC and WHO guidelines aim to minimize the risk of infection by prohibiting artificial nails and encouraging proper hand hygiene practices.
It is worth mentioning that individual organizations may have their own policies regarding nail polish and artificial nails, which can vary depending on the hospital or healthcare facility. Some hospitals may prohibit nail polish in certain areas, such as the operating room, while allowing it in other wards as long as it is well-maintained and free from chipping. Ultimately, the decision-making process for these policies should incorporate evidence-based guidelines from specialized resources and adapt them to the specific needs and risks of each healthcare setting.
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Frequently asked questions
There is no definitive answer to this question as it depends on the specific hospital and department's policies. Some hospitals prohibit gel manicures due to the risk of infection, while others may allow it as long as the nail polish is not chipped or cracked. It is recommended to follow the guidelines set by the CDC or WHO, which advise against the use of artificial nails, nail gels, and gel colors by care providers to ensure safety.
The primary concern with wearing gel nail polish in a hospital setting is the potential for bacterial contamination and the spread of infection. Studies have shown that chipped or old nail polish can harbor bacteria, increasing the risk of transmitting infections to patients.
Yes, some hospitals may allow doctors to wear nail polish as long as it is well-maintained and not chipped. However, it is essential to check with the specific hospital's policy, as some may have a "bare below the elbows" rule that includes nail polish.
The guidelines vary depending on the organization and the country. The CDC and WHO guidelines recommend that providers in high-risk areas do not wear artificial nails or nail gels. The Robert Koch Institute also recommends prohibiting non-transparent nail varnish and gelled fingernails in risk areas to ensure that contaminations are visible.
