Hospital-acquired infections (HAIs) affect at least one in every ten patients attended to in the acute hospital setup. An unquantifiable number of patients discharged from hospitals also depicts infection linked to the hospital environment. Analysis of the costs of HAIs on patients is even worse. The expenses range from hospital readmissions to few days off-work while the social and economic burdens are unquantifiable. Patients affected by HAIs always have a history of surgery, nursing care, and drug therapy in hospital settings. Notably, significant evidence points to the hygiene practices among healthcare workers (HCWs) as the foundation for common HAIs (White, 2013). Given that HCWs care for different patients, their hands are undoubted channels for HAIs transfer. Studies indicate that hands are dominated by flora, bacteria, and potential pathogens. According to recent studies, the greatest HAIs in healthcare settings emerge from nurses’ artificial nails and jewelry.
Artificial fingernails worn by nurses are major sources of HAIs compared to natural trimmed nails among the immunocompromised population. Artificial nails are a current populous fashion among nurses and entail various varieties, including overlays, bonding, silk, and warps. They are glued to the nail or attached to the nail surfaces through a hole. According to White (2013), nurses and other Americans spend more than $265 million on acrylic nails annually. Despite the elegance and beauty they create, there is a great correlation between artificial nails and HAIs. Besides, they have been mentioned in deadly disease outbreaks in hospitals and other acute care setups. Scientific evidence solidifying the correlation between acrylic nails and HAIs relies on the number of microorganisms that develop through artificial surfaces. Pathogens and disease-causing bacteria are more likely to grow on artificial surfaces than natural trimmed nails (Hewlett et al., 2018). Despite the standard operating procedures involved in nursing care, disease transmissions from artificial nails continue to grow among the immunocompromised population. Patient safety is the primary duty of nurses; hence, they should be prohibited from wearing artificial nails or other jewelry while attending to patients to limit disease risks.
Delegate your assignment to our experts and they will do the rest.
Application in Clinical Care Setting
Hands of HCWs are the common channels for the transmission of microorganisms among patients in clinical care settings. In the recent past, hand washing and disinfection were the essential techniques for preventing disease transmission through hospital staff’s hands. However, the approach is different with artificial nails, which are less likely to be sterilized through normal approaches. Nurses acquire pathogenic microorganisms in large numbers when handling moist and contaminated surfaces like body fluids in clinical settings. Nurses within the operating and surgical theaters are also more likely to be exposed to pathogenic microorganisms through specimens and body fluids. Such contaminants are more likely to stick on artificial nails worn by nurses compared to natural trimmed nails. Besides, the texture and sharpness of acrylic nails attract the resident skin flora. Nurses can easily transmit pathogenic microorganisms to other patients, especially during the surgical scrub procedure involved in theatre (Arrowsmith & Taylor, 2014). Although antiseptic formulations and scrubs sterilize nurses’ hands, artificial nails are more likely to reduce the efficacy.
Nurses are obligated to grant patients’ safety; hence, any disease transmission aspect should be eliminated. Nursing is a profession founded on professional values and morals while attending to patients. Apart from common ethical values such as human dignity, integrity, and honesty, nurses should depict other professional qualifications in clinical care settings. Given that the immunocompromised population is highly susceptible to nosocomial infections, prototypical hygiene is necessary when handling patients. The transfer of disease-causing pathogenic microorganisms through artificial nails is thus an abuse to the nurses’ primary function, granting patient safety. While beauty and fashion are on the rise, nurses should be educated to realize that artificial nails do not depict beauty in clinical care settings but are highly potential spreaders of HAIs among the immunocompromised population.
PICOT Question
For the immunocompromised population, does the mandation of having clean trimmed nails while working as a nurse in a hospital reduce the spread of infection among patients compared with using artificial nails?
Literature Review
Had hygiene (HH) among HCWs is an important factor in limiting HAIs. Despite frequent awareness of HH, HAIs are common given the condition of nurses’ hands. Research indicates that artificially attached nails might be easily colonized by pathogenic microorganisms leading to horizontal transmission of HAIs. According to a study conducted by Walaszek et al. (2018) on nurses and midwives, artificially coated nails and long nails acted as potential spreaders of HAIs. Artificial nails increased the risk of ineffective hand disinfection “(OR=7.2 148 95%CI 1.25-40.91, p<0.05) in comparison to the control (OR=9.2 95%CI 1.29-65.37, p<0.05).” Ineffective disinfection encourages the transfer of bacteria hence increasing the transmission of HAIs from nurses to patients.
Artificial nails are highly potential transmitters of HAIs, given that pathogenic microorganisms embedded in the surface during patient handling cannot be easily removed by hand hygiene. Hewlett et al. (2018) researched to determine the effectiveness of hand washing on eliminating pathogens from acrylic nails. The survey involved 88 HCWs subjected to standard and gel polish. Researchers extracted cultures after the first, seventh, and fourteenth day before and after hand washing with alcohol hand gel. Although bacteria burden increased in all nail types (P < 0.0001), there was no significant reduction in gel polish (P < 0.98) (Hewlett et al., 2018). The research indicates that acrylic surfaces become more contained with bacteria during clinical care than natural nails.
Several disease outbreaks in hospital settings have been linked to artificial fingernails. Most of the outbreaks emerge from gram-negative bacilli and Candida species. The settings of such outbreaks involve surgical theatres, hemodialysis centers, and NICU. In one outbreak involving five hemodialysis patients, all of them depicted Serratia marcescens and/or Achromobacter xylosoxidans after hemodialysis. After an epidemiologic examination, results indicated that contamination emerged from a nurse preparing heparin and saline mixture without using gloves to cover her artificial fingernails. Moreover, Serratia marcescens cultured from acrylic nails have been linked to several wound infections in California hospitals (White, 2013). Given that acrylic nails are implicated in several disease outbreaks, they remain a danger to an immunocompromised population.
Artificial fingernails are potential spreaders of bacteria from nurses’ hands to patients during infections through surgical wounds. Surgical scrubbing has a great potential of reducing the transfer of bacteria to patients during surgery. However, artificial fingernails might reduce such an efficacy given that microscopic organisms remain on the nail surface. Arrowsmith and Taylor (2014) conducted a metal analysis of randomized controlled trials (RCTs) to establish the link between artificial nails and postoperative infection rates. Apart from the surgical wound infections identified in the meta-analysis, patient mortality and long hospital stays were inevitable. Such effects emerged from wearing artificial nails or nail polish by nurses during cardiac, vascular, and laminectomy operations.
Conclusion
Nurses should be prohibited from wearing artificial nails while attending to patients to limit disease risks among the immunocompromised population. Artificial fingernails trigger ineffective hand disinfection hence allowing the transfer of pathogenic microorganisms to patients. Several disease outbreaks in hospital settings involving gram-negative bacilli, Candida species, Serratia marcescens, and Achromobacter xylosoxidans are also linked to acrylic nails. Finally, acrylic nails spread bacteria from nurses’ hands to patients during infections through surgical wounds. Given the high possibilities of spreading HAIs to the immunocompromised population, nurses should avoid wearing artificial nails while in the clinical care setting.
References
Arrowsmith, V., & Taylor, R. (2014). Removal of nail polish and finger rings to prevent surgical infection. Cochrane Systematic Reviews , 1-15. https://doi.org/10.1002/14651858.cd003325.pub3
Hewlett, A., Hohenberger, H., Murphy, C., Helget, L., Hausmann, H., & Lyden, E. et al. (2018). Evaluation of the bacterial burden of gel nails, standard nail polish, and natural nails on the hands of health care workers. American Journal of Infection Control , 46 (12), 1356-1359. https://doi.org/10.1016/j.ajic.2018.05.022
Wałaszek, M., Kołpa, M., Różańska, A., Jagiencarz-Starzec, B., Wolak, Z., & Wójkowska-Mach, J. (2018). Nail microbial colonization following hand disinfection: a qualitative pilot study. Journal of Hospital Infection , 100 (2), 207-210. https://doi.org/10.1016/j.jhin.2018.06.023
White, J. (2013). Jewelry and artificial fingernails in the health care environment: Infection risk or urban legend? Clinical Microbiology Newsletter , 35 (8), 61-67. https://doi.org/10.1016/j.clinmicnews.2013.03.003
