It’s been more than half a decade since the Centers for Disease Control and Prevention (CDC) published the much talked about “Guideline for Hand Hygiene in Health-Care Settings.” The guide quickly fueled a debate over the wearing of nail products in a clinical setting. Health care worker clients wanted to keep their nail extensions and nail technicians wanted to keep their clients. Fast-forward to today and we find compliance relatively easy and painless, perhaps even good for the business of nails.

As hospitals scrambled to reduce possible risk, they also grappled with the fallout from unhappy employees. The result is strikingly similar additions to the dress codes for most clinical workers. Vanderbilt Medical Center in Nashville, Tenn., requires “Fingernails [to be] kept clean, well cared for, and no longer than ¼-inch from fingertip in length. Artificial and long natural fingernails are not permitted for those providing direct patient care. The definition of artificial fingernails includes, but is not limited to, acrylic nails, all overlays, tips, bondings, extensions, tapes, inlays, and wraps. Nail jewelry is not permitted. Nail polish, if worn, is well maintained. Chipped nail polish is not allowed.” While quite detailed, the fingernail section of the dress code is in keeping with the CDC’s 63-page guideline. It is interesting that the CDC notes, “Whether artificial nails contribute to transmission of health-care associated infections is unknown.”

As the dust over this issue has settled, salons have seen the steady rise in demand for natural nail services. Well informed salon owners and technicians have embraced the opportunity to serve this new market. So what exactly can heath care workers wear?

Health care workers involved in direct patient care that might involve the transfer of blood or fluids will likely forgo enhancements of any kind. Nix those long natural nails too. The safest bet for nurses in a clinical setting is “short, clean, and unpolished,” according to Peggy Prouty of Peggy’s Nails in Boulder, Colo. In addition to regular manicures and nail trims, she advises clients to use a cuticle oil regularly to moisturize and protect the nails from tiny splits or hangnails, which could be portals of entry for bacteria. Prouty, who has more than a decade of experience, has seen her clientele grow to mostly natural nail care over the past few years. She doesn’t see as many people in the salon from the health care fields as she once did.

What about wearing gloves, you ask? The CDC advises that wearing gloves can reduce pathogens but “does not offer complete protection against hand contamination.” It becomes increasingly clear that the aim of the CDC guidelines for healthcare are three-fold — wash well, glove-up, and reduce the places bacteria have to hide. Stop playing hide-and-seek with pathogens by scheduling manicures and frequent polish changes for nurses or other health care workers. Put together a retail package including: light colored polish, polish remover, cuticle oil, and a file or natural nail buffer. Encourage clients involved in patient care to change polish every four days (a CDC recommendation) or when it becomes chipped. Chipped polish may up the risk of contamination.

While enhancements and long nails still seem to be a no-no, nurses can and should enjoy the healthy benefits of well-maintained natural nails.

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