Hand Hygiene Includes Jewelry, Nail Polish in Infection Transmission Recommendations

A new policy paper recently examined the effect of jewelry and nail polish worn by healthcare workers in a clinical setting and the risk they present to infection transmission.

The Canadian Agency for Drugs and Technologies in Health (CADTH) wrote that they are an “independent, not-for-profit organization responsible for providing Canada’s health care decision-makers with objective evidence to help make informed decisions about the optimal use of drugs, medical devices, diagnostics, and procedures in our health care system.”

CADTH estimates that between 5% and 10% of hospitalized patients in Canada will develop a healthcare-associated infection. Some of the infections most at risk for transmission by healthcare workers are Clostridium difficile (C. difficile) and Staphylococcus aureus (MRSA).

While hand washing is an important part of the prevention process, contact between other patients and the healthcare workers create an easy pathway for transmission. Two issues presented in hand washing are nail polish and jewelry around the wrist: skin under rings may be more heavily colonized with microorganisms than the rest of the hand, the paper said. Additionally, chipped nail polish may have more microorganisms than un-chipped polish.

The CADTH set out to answer two key questions about infection transmission. First, what is the evidence surrounding the effect of health care worker’s jewelry or nail polish on infection transmission? Second, what are the evidence-based guidelines regarding this issue in a hospital or residential care setting?

The agency conducted a literature review of 275 studies published in the last 5 years to determine if there was an infection transmission risk presented by healthcare workers who wore nail polish or jewelry in a healthcare setting. Ultimately, after exclusions, 5 reports remained in their review: 2 systematic reviews and 3 guideline reports.

Notes from the findings include:

• No relationship existed between wearing a wedding band and an increased number of surgical infections (Francis, et al., 2016).
• There was insufficient evidence supporting the idea that finger rings or nail polish have an effect on postoperative wound infection (Arrowsmith and Taylor, 2014).
• Loveday et al. recommended in 2014 that fingernails are cut short and clean and workers do not wear false nails or polish.
• In a 2012 paper from the National Institute for Health and Care Excellence — which has since been withdrawn, the authors noted – healthcare workers should remove wrist and hand jewelry as well as nail polish on short, clean fingernails.
• The Public Health Agency of Canada said in 2012 that no hand jewelry other than a finger ring/band should be worn when providing patient care, and nails should be natural and kept short. If nail polish is worn, they added, it should not be chipped.

Overall, the CADTH determined that there was not strong evidence among most of the published literature included in their review. While some seemed to suggest that the infection transmission risk is not impacted by the wearing of jewelry or nail polish, others did not specifically agree.

“It appears that wearing a simple finger band and un-chipped nail polish may be acceptable, although removal of all finger and wrist jewelry and wearing no nail polish may be the safest option to prevent infection transmission in most health care settings,” the paper concluded.

The paper in full, titled “Jewellery and Nail Polish Worn by Health Care Workers and the Risk of Infection Transmission: A Review of Clinical Evidence and Guidelines,” can be found here.