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I have lost several clients who work in the medical field because they are no longer allowed to wear acrylic nails. What can you tell me about acrylic versus natural nails in terms of spreading bacteria?

I have lost several clients who work in the medical field because they are no longer allowed to wear acrylic nails versus natural nails in terms of spreading bacteria?

Doug Schoon: Normal, everyday bacteria can collect under the nail plate - that’s life! The only way to remove these bacteria is by properly scrubbing under the free edge of the natural nail. Obviously, longer natural nails can harbor more bacteria, since the plate is longer (just like a bigger house can hold more people). The same applies to artificial nails and that is how this issue began.

Scientific studies done over the last 10 years show that on the average, nurses do not always properly wash their hands between patients and when they do wash, they are often in too much of a hurry. Nurses spend about four to six seconds washing their hands and scrub their nails for no less than 30 seconds between every patient. The same experts also agree that if this were done, there would be a dramatic drop in the number of infections transmitted from patient to patient by nurses.

This is long-standing problem came to national attention when three nurses in an neonatal intensive care unit improperly washed their hands and then used a shared, “community” hand cream that had been sitting by the sink (which was strictly against the hospital’s policy). This hand cream was contaminated with a common bacteria that later caused the death of three infants who were in the unit because they were already seriously ill. One of these nurses had short naturals nails, and one had long natural nails, and once had long artificial nails. The news headlines suggested that artificial nails kill babies, which, of course, is not what happened.

Later, several other studies confirmed that the longer the nail plate, the more time must be spent scrubbing to ensure patient safety. Cracked and chipped nail polish was also cited as contributing to increased amounts of bacteria on fingernails. What did the hospitals do? Rather than insist nurses start washing their hands properly, nurses at several large hospital chains were told they could no longer wear artificial nails. Nail polish is still allowed in many hospitals, but it’s not supposed to be cracked or chipped. Of course this does not address the problem at all. Nurses still do not properly wash their hands.

Hospitals were given guidance by the Centers for Disease Control (CDC), which recommend that nurses involved in critical care areas (high-risk situations like surgery wards and intensive care units) should not wear artificial nails. But some hospital workers - even receptionists and secretaries - must remove their artificial nails.

The Nail Manufacturers Council (NMC) strongly disagrees with this approach and is working closely with the CDC and the Association for Professionals in Infection Control and Epidemiology (APIC) to resolve this more practically. The NMC hopes these associations will address the hand-washing problems as the primary problem, as well as make rational recommendations for personal grooming.

For more on on this topic, see “Long Nails and Nursing Don’t Mix” in NAILS’ August 2000 issue.

I do a lot of pedicures involving ingrown toenails. I use various implements that are on the market for nail techs and they work really well for me, but at what point, if any, should I send these clients to a podiatrist?

Dr. Johanna Youner: the pedicurist should refer the client to the podiatrist when the client starts to get chronic infections at the site. Keeping the nail thinner (use your heavy-duty emery board to thin the nail near the sidewall) will hold trouble at bay for a while. If the ingrown nails is literally curling on itself at the sidewall, it’s time to refer your client to a doctor. Also, if the ingrown is so deep down the side of the nail that a corn is developing in the nail fold, you should refer her. A nail softener works well on ingrown nails - any of the formulations with salicylic acid or uric acid designed especially for nails will help.

I live in the Bahamas where the population is predominantly black. A lot of my customer’s toenails are dark and applying polish (especially light shades) does not look so nice. Is there a base coat I can use to camouflage the dark nails to achieve the actual color of the polish?

Maisie Dunbar: As African-American women age, their toes often take on a darker pigment. To neutralize this ensure good polish coverage, I use a soft white (lik Essie Marshmallow) under the polish they select. If the client wants a white or pale polish shade, I will first apply a base coat (I usually use a ridge filler for its thickness and opacity), then the soft white, then two coats of the desired color, and finally top coat. Be sure to write down the name of the neutralizing base shade since your clients won’t remember it.

If client wants a French nail, I apply a clear base coat followed by a coat followed by a coat of beige over the whole nail. Next I paint the free edge with a soft white. Then I cover the whole nail with an additional coat of beige. This produces a very natural look.

The skin on my client’s feet peels until it is raw and there are little bumps. This is only on two different areas of her feet. She’s seen a dermatologist, but nothing has worked to fix the problem. What could be the cause?

Dr. Youner: There are so many possible causes of peeling it’s difficult to say. Peeling skin can be the result of an allergic reaction (for instance to shoe dye or nylon), sensitive skin (atopic dermatitis), or an auto immune condition (psoriasis). There is a serious skin condition called epidermolysis bullosa where the skin literally sloughs off. A fungal infection of the skin can also cause peeling.

The little bumps could also be many different things. If they’re hard, they could be pieces of the outer layer of epidermis being pushed into the skin creating little plugs. Some call them intractable plantar keratoses. The little bumps could also be allergic or fungal, or even warts a strong these conditions are treated with a strong steroid cream unless they are fungal or bacterial infections. Small areas of skin can become sensitive areas of skin can become sensitive over the years - for instance, underarm deodorant can start causing allergic reactions over a long period. The answer could prove very simple with some detective work.


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