Hospitals point fingers at fancy nails
Workers told to go natural after studies reveal germ danger
Nancy Longfield, a cardiology nurse at Providence St. Vincent Medical Center, wore artificial nails for 15 years.
'They looked very nice, and they made me feel feminine,' said Longfield, who saw her manicurist every two weeks.
Laurie Sass, a trauma nurse at Legacy Emanuel Hospital & Health Center, wore fake nails for about eight years. She did the work herself, using off-the-shelf kits. She wore them for 'beauty and because my nails don't naturally grow very well. They chip and peel.'
But, like most health care workers in Portland and around the country, both women have had to stop wearing artificial nails because of studies showing that fake nails and other 'nail enhancements' can harbor dangerous germs that could be passed on to sick patients.
The studies Ñ by the national Centers for Disease Control and Prevention and other research groups Ñ linked numerous infection outbreaks in hospitals around the country to health care workers who wore their nails long or had artificial nails.
Some of the infected patients died, including 16 infants in one Oklahoma City hospital. None of the infections cited was found in Oregon.
Based on the studies, the CDC last fall issued new hand-hygiene guidelines banning artificial nails for health care workers who care for 'patients at high risk,' such as those in intensive care units or operating rooms.
The guidelines also recommended more aggressive hand-cleaning practices for health care workers, including frequent use of waterless, alcohol-based hand 'sanitizers' to help prevent the spread of infections in hospitals and other medical settings.
Hospitals across the country Ñ including those in the Portland area Ñ are adopting policies beyond what the CDC recommended, banning artificial nails for most health care workers, not just those with very sick patients. They include doctors, nurses, respiratory and physical therapists, lab technicians Ñ anyone who has direct contact with patients.
'We view all of our patients as high risk or having the potential to be high risk, so we want all of our health care givers to remove their artificial nails,' said Lori Moore, an infection control nurse at St. Vincent who is helping to implement an artificial-nails ban at the hospital.
Or, as Dana Barron, infection control officer for Kaiser Permanente Northwest, put it, 'If it's not natural, you can't have it.' Kaiser's artificial-nail ban went into effect in November.
Moore, who also wore artificial nails until she heard about the CDC studies, said she hasn't heard any complaints from St. Vincent workers.
'Once I tell them that studies have shown there's a transmission of bacteria from workers who wear artificial fingernails, they want to do the right thing. They want to take care of their patients,' she said.
That's how Longfield and Sass felt about removing their artificial nails, even though it required some emotional adjustment.
'I was disappointed at first,' said Longfield, who said neither she nor her patients had problems with infections in all the years she wore artificial nails.
'But I know the seriousness of infection and see it on a daily basis,' said Longfield, whose patients include people recovering from heart surgery. 'I don't want to risk anyone's health.'
Besides, she has found other ways to pamper herself, Longfield said. She gets weekly pedicures and monthly massages.
Sass was pragmatic. She quickly adapted. Maintaining her nails took too much time, she said, 'and there was the cost factor of always repairing nails.'
Keep them short
Moore said St. Vincent health care workers now are required to keep their natural nails clean and short, no longer than a quarter-inch beyond the end of the fingertip. Polish may be worn if it's not chipped.
The nail ban went into effect June 1 at St. Vincent, though workers have until Aug. 1 to comply. It is part of an overall hand-hygiene policy being adopted by all seven of Providence Health System's Oregon hospitals, Moore said.
A survey of other local hospitals show that most have adopted or will soon adopt similar bans on artificial nails:
• Kaiser's ban affects all workers, including physicians, who have direct contact with patients.
When the ban was first announced, 'it was difficult for people to have to remove them,' Barron said. 'Their nails always looked nice. We made (the nail ban) a condition of employment but didn't have anybody quit. When they saw the evidence, they were more than willing to have (their artificial nails) removed.'
Nail polish is not banned, Barron said, but must be intact: 'There is not enough evidence to prohibit wearing them. The CDC guidelines don't prohibit it.'
• Legacy Health System is developing a policy that should be in place by the end of the year, said spokeswoman Lise Harwin. It will include a ban on artificial nails for all workers who care for patients and limit the length of their natural nails to a quarter-inch.
Right now, the nail ban applies to workers in the neonatal intensive care unit at Legacy Emanuel Hospital & Health Center and in surgery units in all four Legacy hospitals.
Until the wider policy is implemented, Legacy is discouraging workers from wearing artificial nails, Harwin said.
• Oregon Health & Science University is creating a policy that will prevent most health care workers at its hospital and clinics from wearing artificial nails, said spokeswoman Christine Pashley. Natural nails will have to be less than a quarter-inch long. Nail polish likely will be allowed but should not be chipped.
No date has been set yet for the rules to go into effect, Pashley said.
Hands and nails have always been known to harbor germs and are the most common way germs are transmitted, said June Ann Cole, a clinical nurse for the Oregon Nurses Association, whose specialty is occupational health and safety.
But most 'nail enhancements' available at drugstores or salons Ñ including artificial nails, wraps, tips, acrylics and gels Ñ have been shown to be particular sources of bacteria, Cole said.
She cited one study of a group of nurses who had washed their hands. Bacteria were still present in 5 percent of those with natural nails; 10 percent of those with polished nails; and 35 percent of those wearing artificial nails.
Cole said the association, which represents more than 10,000 registered nurses throughout Oregon, notified members of the CDC's recommendations in a recent edition of its newsletter.
She said nurses probably won't have a problem with the ban 'if health care facilities do a good job of presenting the evidence.'
Gloves that health care workers wear most of the time don't offer absolute protection, said St. Vincent's Moore.
'When (health care workers) take blood pressure or give medications, they don't necessarily wear gloves,' she said.
Plus, just the act of taking off gloves can transfer germs to a care worker's hands, she said. And sometimes gloves tear.
Not to worry
Despite the CDC's findings, people who aren't health care workers should not worry about harboring germs in their artificial nails that could infect family or friends, said Dr. Alex Schafir, an internist and instructor at St. Vincent.
'The organisms (in the CDC studies) were only found in health care settings,' he said. 'These were people who wouldn't otherwise have been exposed to those germs.
'There is not much reason to think that people with artificial nails would result in an increase in infections out in the community.'
Manicurist Sharon Korter, owner of Sylvie Day Spa & Salon in Northwest Portland, said people should not have trouble with artificial nails if they care for them properly.
'If people maintain their nails with a nail brush and visit (the manicurist) every two or three weeks, they shouldn't cause problems,' Korter said.