By these members of the Nurses Leadership Council, a group of nurse educators who advised the American Chemistry Council’s Chlorine Chemistry Council for several years in the early 2000’s: Nettie Birnbach, RN, EdD, FAAN; Ann W. Burgess, RN, DNSc, CS, FAAN; Willa M. Doswell, RN, PhD, FAAN; Lucie S. Kelly, RN, PhD, FAAN; Donna A. Peters, RN, PhD, FAAN; and Marlene R. Ventura, RN, EdD, FAAN

Long, sleek, richly colored nails crowning fingers adorned with intricately designed rings are a fashion statement—and, unfortunately, a bacterial bonanza. Why? Because long fingernails, rings, and all sorts of nail treatments are known to harbor bacteria, such as Pseudomonas aeruginosa and Klebsiella, as well as the yeast Candida parapsilosis, which can wreak havoc on patients’ health.1,2
In 1997–1998, 16 babies died in the neonatal ICU at Children’s Hospital of Oklahoma, Oklahoma City. The deaths were linked to the babies’ exposure to two nurses harboring P. aeruginosa under long or artificial fingernails. After investigating, the U.S. Centers for Disease Control and Prevention (CDC) recommended improved handwashing and short, natural fingernails for nurses. As a result, all nurses at Children’s Hospital now have piano-playing-length nails.3
A study conducted at the University of Michigan and Dalhousie University found that of seven healthcare workers with longer nails, all seven harbored harmful germs compared with two of 11 healthcare workers with shorter nails, suggesting long nails are a health hazard.4
The unfortunate reality today is that about one in 10 patients acquires an infection as a direct result of being hospitalized.5 Fearful of acquiring infections, patients may opt to postpone or avoid medical procedures instead of seeking timely treatment in hospitals. Modern hospitals contain an amazing array of computerized instrumentation designed to enhance patient care. Ironically, in spite of these high-tech amenities, invisible armies of the oldest forms of life on earth jeopardize the safety of patients and healthcare workers.

An awareness of the presence of germs in healthcare settings is critical to establishing a truly healing environment.  Infection control programs, when properly carried out, make use of Environmental Protection Agency-registered disinfectants, such as chlorine bleach, to kill germs that live on hospital surfaces, needles, syringes, and numerous other bacterial bastions. But since hands are the primary instrument of nursing care and potential conduits of disease, hand hygiene is the subject of enormous concern. About a third of all hospital infections can be prevented by handwashing, identifying patients at risk, and attending to sterilization and disinfection procedures.5 According to the CDC, handwashing is the single most important tool available to prevent the spread of infections.6
In addition to thorough washing with soap and water, proper hand hygiene includes attention to fingernails and jewelry. The longer the fingernails and more intricate the jewelry, the greater the available surface area to which germs may attach.  Grooves, scratches, or chips in nails or nail polish and intricate jewelry surfaces provide a multitude of safe environments for microbes. Artificial nail applications, with their dark, moist areas, are particularly inviting to microbes.7 Rings, especially those parts in contact with skin, also act as moisture traps, providing another haven for microscopic life. Additionally, sharp edges of jewelry or ragged fingernails have the potential to tear examination gloves, breaking this protective barrier. It makes sense for nurses to trim fingernails to the tips of fingers (no longer than about 3 mm),1 file them and relegate all but the simplest adornments to the jewelry box before reporting for duty.

Do nurses know how patients feel about the choice of fashionable versus hygienic nails? We can offer one account. Recently, our colleague Mary related something that happened during her annual physical exam. Mary’s doctor suggested his nurse remove an ear wax build-up in Mary’s ear using warm water irrigation. After consenting to the treatment, Mary watched, appalled, while the nurse assigned to the task submerged her entire hand into the basin of irrigation water to sense its temperature. The fingers of the nurse were topped with half-inch-long, silver-painted nails. Mary was struck with the thought that whatever germs were harbored under those pretty nails would soon be injected into her ear canals!  She quickly declined treatment.

As caregivers, nurses can instill confidence in patients by demonstrating good hand hygiene that includes not only frequent handwashing, but also forgoing fashion for cleanliness. Nurses’ hands are simply too important to become vehicles of germ transmission.


1 Long Fingernails on Health Care Workers Potential Risk to Patients. Infectious Disease Society of America website. Accessed April 1, 2004.

2 Potentially fatal germs under fingernails of hospital personnel should be “eradicated,” study says. CNN website. Accessed April 1, 2004.

3 Cole C. Nail bacteria linked to baby deaths. Available at: Accessed April 1, 2004.

4 McNeil SA, Phelps A, Barnes AL, Kauffman CA. The effect of fingernail length on microbial colonization of the hands of health care workers. Presented at: Infectious Disease Society of America 39th Annual Meeting, 2001, San Francisco, CA.

5 Tilton D. Nosocomial infections: diseases from within our doors. Accessed April 1, 2004.

6 O’Boyle CA, Henly SJ, Larson E. Understanding adherence to hand hygiene recommendations: The theory of planned behavior. Am J Infect Control. 2001 Dec;29(6):352-360.

7 Bjerke NB. Disinfecting those digits is critical to good handwashing. Infection Control Today website. Available at: Accessed April 1, 2004.

Copyright 2003. Nursing Spectrum Nurse Wire. All rights reserved. Used with permission.


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