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Discussion

Nails and Nursing

How are you allowed to have your nails in nursing? Could certain areas allow them to be longer (even if they're natural, well groomed and you wear gloves)? 

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    I've noticed a drift from policy with a lot of nurses wearing some kind of nail enhancements, like gels, shellacs, acrylics, and powder dips.

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    I would look into your policy at your healthcare facility. Most allow 1/2 inch w no acrylic and not artificial nails. 
    In my experience they do not enforce it daily, but when DOH arrives it is something to be aware of.

    The main point of short nails is infection control. So just make sure they are short enough you can clean underneath. Hospital administration does also not like chipped nails - I feel like this has been more of an issue than long nails in my experience.

     

    Hope this helps ? 

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    Nurse Beth said:

    I've noticed a drift from policy with a lot of nurses wearing some kind of nail enhancements, like gels, shellacs, acrylics, and powder dips.

    Were these nurses working in certain areas or just in general terms?

     

    Nurse Alexa said:

    I would look into your policy at your healthcare facility. Most allow 1/2 inch w no acrylic and not artificial nails. 
    In my experience they do not enforce it daily, but when DOH arrives it is something to be aware of.

    The main point of short nails is infection control. So just make sure they are short enough you can clean underneath. Hospital administration does also not like chipped nails - I feel like this has been more of an issue than long nails in my experience.

     

    Hope this helps ? 

    I don't belong to a health facility as of yet. Do you think having natural nails past the fingertip area that are kept clean and not sharp enough to break gloves should be fine? 

     

     

     

     

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    Bones17 said:

    I don't belong to a health facility as of yet. Do you think having natural nails past the fingertip area that are kept clean and not sharp enough to break gloves should be fine? 

    It's going to depend on the facility policy. I once worked at a place that specified no more than 1/4 inch beyond finger tip for natural nails

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    Definitely varies widely.  At my outpatient clinic, the handbook said all clinical staff had to have short, natural, unpainted nails. In reality, both MAs and nurses would show up with long acrylics, and nobody enforced the rule.

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    Everywhere I've worked has had a policy of nothing longer than 1/4" beyond the fingertip (which is actually pretty long), no artificial nails, and if polish is allowed, it must be unchipped.

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    We recently interviewed a new grad nurse for our facility, a friend of a current employee. She had long acrylic nails, beautifully done, I might add. Personalitywise, she nailed the interview. My clinic manager mentioned acceptable nail length and policy, new grad nurse stated that she would NOT be trimming nails or getting rid of acrylic, etc. Interview went on about 30 minutes longer. After she left, manager said because of nails, no-go. That was a couple of months ago, her friend in clinic stated that new nurse still doesn't have a job. Not sure if it has to do with her nails, but interesting, especially in the current need for nurses drive

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    • Experts

    Speaking of nails, I feel as though HR crucified me with nine inchers.

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    Nurse Alexa said:

    In my experience they do not enforce it daily, but when DOH arrives it is something to be aware of.

    I was a DOH surveyor and I don't remember us looking at nurses's nails.  If there was a trend of infections on the unit, then the length and cleanliness of nails may have come into question.

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    • Experts

    ECRI (originally founded as Emergency Care Research Institute) is an independent nonprofit organization tasked with "improving the safety, quality, and cost-effectiveness of care across all healthcare settings worldwide."

    ERCI Apr 20, 2020

    Healthcare Acquired Infection Risks from Worker Fingernails and Polish
     

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    Pointing fingers: the nail and infection connection

    ECRI recently published a clinical evidence assessment that compares the microbial burden of healthcare workers' natural fingernails with those of polished and artificial nails, and details investigations of infection outbreaks linking healthcare workers' treated nails to patient infections and deaths.

    ECRI identified five published studies describing epidemiologic investigations that traced HAIs to contaminated fingernails. The case investigations described serious infections and deaths in NICUs and cardiac surgery units that were linked to artificial or polished fingernails. One outbreak was traced to a worker's fingernail that was persistently infected for several years, but hidden by polish.

    Data from ten studies on the microbial burden of healthcare workers' fingernails suggests that there is a higher bacterial load on artificial nails than on natural nails. Chipped nail polish also poses increased risk compared to recently painted, unchipped nails. Finally, gel-based nail polish may be associated with higher pathogen counts and handwashing may not be effective for removing bacteria from gel polish....

    While preventing HAIs requires a systemic strategy and implementation, it is important that healthcare workers and policy makers address the link between fingernails and infection, and review the evidence-based guidelines provided by leading health institutes. The World Health Organization (WHO) and AORN recommend against healthcare workers wearing fingernail polish or artificial nails, in addition to keeping fingernails short, to prevent the spread of pathogens.

    Joint Commission : CDC or WHO - Artificial Nails and Gels

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    Each organization must follow the IA, IB and IC recommendations from the guideline it chooses (CDC or WHO). Therefore, if WHO is chosen, no direct care providers should have artificial nails or extenders. If CDC is chosen, providers in high-risk areas must not wear artificial nails.

    Current Guidelines About Wearing Artificial Nails and Nail Polish in the Healthcare Settings
     

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    As early as 2002, the Centers for Disease Control and Prevention (CDC) published a Guideline for Hand Hygiene in Health-Care Settings, which recommended that healthcare workers "not wear artificial nails or extenders (nail polish) when having direct contact with patients at high risk" (eg, those in intensive care units, transplant units, or operating rooms).

    This recommendation is considered a Category IA, which is defined as "strongly recommended for implementation and strongly supported by well-designed experimental, clinical or epidemiological studies.” The CDC further advises nurses to check their facility's policy regarding artificial nails, which may be stricter.

    Saved $$ by having natural nails, no polish throughout my nursing career... to spend on needlepoint canvases.

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    Thanks for all the research.  Excellent points.

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