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Letter in reply to: Nail polish used by healthcare personnel does not increase the rate of healthcare-associated infections

Published online by Cambridge University Press:  06 May 2024

Janet B. Glowicz Open the ORCID record for Janet B. Glowicz [Opens in a new window] ,
Emily Landon  and
Katherine D. Ellingson
Janet B. Glowicz*
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
Emily Landon
Affiliation:
Department of Infectious Diseases, MacLean Center for Clinical Medical Ethics, The University of Chicago Medical Center, Chicago, IL, USA
Katherine D. Ellingson
Affiliation:
Department of Epidemiology and Biostatistics, College of Public Health, The University of Arizona, Tucson, AZ, USA
*
Corresponding author: Janet B. Glowicz; Email: kvi1@cdc.gov
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Letter in Reply
Information
Infection Control & Hospital Epidemiology , Volume 45 , Issue 8 , August 2024 , pp. 1022
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This is a work of the US Government and is not subject to copyright protection within the United States. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America.
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© United States Department of Health and Human Services - Centers for Disease Control and Prevention, 2024

We thank Augustin and Augustin Reference Augustin and Augustin1 for their thoughtful response to the updated SHEA/IDSA/APIC Strategies to Prevent Healthcare-Associated Infections through Hand Hygiene. Reference Glowicz, Landon and Sickbert-Bennett2 In these updated recommendations, promotion of healthy hand skin and fingernails is considered the first essential practice. As you noted, there is a large body of evidence indicating the need to include fingernail care in hand hygiene policies. The high quality of evidence designation in the table you highlighted is intended to apply only to the inclusion of nailcare in facility-specific policies; the individual sub-bullets are provided as reasonable recommendations for Infection Prevention (IP) programs to consider when creating policies. We agree that evidence regarding the association between nail polish and healthcare-associated infection is not robust, and there is a theoretical concern for reducing the effectiveness of hand hygiene (eg, difficulty cleaning nail beds). In light of this, we therefore recommend that IP programs play a role in developing practical policies that consider patient and procedure risks relative to nail polish. The recommendation against use of nail polish is made only for scrubbed surgical personnel and aligns with domestic and international guidelines (United States Association of Perioperative Nurses, World Health Organization, and National Institute for Health and Care Excellence) which include removal of fingernail polish as a step in surgical hand antisepsis. We do not differentiate between various types of nail polish (eg, standard, gel shellac, ultraviolet) as it is not feasible for those charged with assessing adherence to determine which methods of nail polish application were used. As noted by Cochrane reviewers, randomized control trials linking nail polish or jewelry to surgical site infections are not likely to be done as it may not be possible to ethically conduct such studies. Reference Arrowsmith and Taylor3 IP programs conduct annual risk assessments and depending on their facility-specific risks and prevention priorities may choose to allow nail polish.

Financial support

We received no specific funding for this work.

Footnotes

The authors report no potential conflicts of interest. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention (CDC). This activity was reviewed by CDC and was conducted consistent with applicable federal law and CDC policy (see eg, 45 C.F.R. part 46.102(l)(2), 21 C.F.R. part 56; 42 U.S.C. §241(d); 5 U.S.C. §552a; 44 U.S.C. §3501 et seq).

References

Augustin, G, Augustin, K. Nail polish used by healthcare personnel does not increase the rate of healthcare-associated infections. Infect Control Hosp Epidemiol 2024;45:1–2.CrossRefGoogle Scholar
Glowicz, JB, Landon, E, Sickbert-Bennett, EE, et al. SHEA/IDSA/APIC practice recommendation: strategies to prevent healthcare associated infections through hand hygiene: 2022 update. Infect Control Hosp Epidemiol 2023;44:355–376.CrossRefGoogle ScholarPubMed
Arrowsmith, VA, Taylor, R. Removal of fingernail polish and finger rings to prevent surgical infection. Cochrane Database Syst Rev 2014;2014:CD003325.Google ScholarPubMed