Infection control is a hot topic these days. Let’s face it: The world is a grimy place. As doctors and executives learn more about how infectious diseases are transmitted, many hospital administrators have begun to look at the way the hospital itself operates for ways to better protect both patients and staff from possibly harmful bacteria that can cause infections.

Nancy Plasse, RN, assistant general counsel at Good Samaritan Health System in San Jose, Calif., recently con­tacted NAILS Magazine to request in­formation about acrylic nails for her research regarding whether acrylic nails should be worn by operating room personnel. Good Samaritan is consid­ering banning acrylic nails in its oper­ating rooms because of the concern over the potential for nurses to pass nail-bound bacteria to patients. Plasse emphasizes, ‘We have to do what’s best for the good of the patient, and that certainly means clean, intact nails.”

Infection control is not the only issue that affects doctors and nurses who wear acrylic nails in the OR. Given the need for frequent hand­-scrubbing, is it even possible for doc­tors and nurses to maintain artificial nails? And what nail care can you provide so they can continue to pro­vide the best possible care for their patients? To answer these questions, NAILS talked with dermatologists, surgeons, and other medical experts across the country. While most said hospitals in their area did not have a formal policy regarding acrylics in the operating room, they agreed that the subject deserves attention.

Scrubbing Up is Hard With (and on) Artificial Nails

First, what is the possibility that acrylic nails in the OR could cause ei­ther infection-control problems or trouble with the nails themselves? “Anything that makes the scrub process less effective needs to be viewed with concern and suspi­cion,” says Michael B. Mayer M.D., professor of surgery in or­thopedics at Dartmouth Hitchcock Medical Center in Lebanon, N.H. “One needs to be able to thorough­ly cleanse the surface of the hands to the elbows, removing all scales and other [material] that may cling,” he adds. Mayer says that the process is made more difficult if the person is wearing artificial nails or overly long nails.

The need for frequent scrubbing is also tough on the acrylic nails themselves, our experts say, and that can make it difficult to main­tain the nails and prevent nail infec­tions. “A surgical nurse will scrub four to five times in an eight-hour shift,” says Plasse. “That means 10 minutes of scrubbing each time, with brushes and harsh cleaners.”

Water, Water, Everywhere

Clients whose hands are constantly in water are generally recommended against wearing acrylics. The constant exposure to water contributes to product lifting creating a breeding around for bacteria between the artificial product and the nail bed. Clients with continually wet hands in­crease the odds for a paronychia infection, which is a yeast infection usually found beneath the nail fold. Richard Scher, M.D., a dermatologist who practices in New York, says, “OR nurses are certainly more susceptible to [ yeast] infections because of their exposure to water.”

Because of this increased chance of infection, the possibility of lifting, and the L1Ct that artificial nails can more easily harbor microorganisms, the Association of Operating Room Nurses, Inc. (AORN), has recom­mended that, artificial nails not be worn in the operating room. According to the association’s 1994 Stan­dards and Recommended Practices, “Fungal growth is a problem even with proper application of the nails. It is difficult to get a bond between the actual nail and the artificial nail, and trapped water can result in mi­crobial growth.” Citing reports that documented the development of dermatitis and infections under and around such nails, the AORN con­cludes, “These conditions could potentially lead to the contamination of the surgical environment.

Still, some nurses disagree with their hospital’s ban on acrylics. “I don’t like it,” says a registered nurse from Kentucky who, asked not to be named. “We have about 25 nurses in our department, and about a quarter of than wore acrylics.” Three months ago, the hospital informed the nurses of a new written policy banning all forms of acrylics nails. “I can understand it if a nurse has fake nails that extend beyond the natural nail,” she says. “But I was using acrylic just as an overlay on my natural nail. I was using it more like polish - just as a hardener.

“I can see their point,” she adds, noting that she understands the hospital’s concern about sanitation. “I can see how you don’t want flak­ing from acrylics. But I keep my nails fairly short, wear gloves for all invasive procedures, and do a lot of hand-washing.”

It’s not the acrylic material itself that causes acrylic nails to be a po­tential problem in the operating room, says Robert Powitz, Ph.D., a consulting environmental health of­ficer in Old Saybrook, Conn. “The acrylic nail itself will not support bacteria,” he says. Instead, apart from the potential fungal problems, it’s the added length of most acrylic nails that can cause problems, Powitz explains. “Longer nails are just more difficult to clean under­neath.” he says. “Anything we can do to reduce the possibility of con­tamination is probably a good idea.”

Long Nails and Gloves Don't Mix

Long acrylic nails can be a particular problem when it comes to prolonging the life of surgical gloves, our experts say. “Studies show that surgical gloves last only a short period of time (without developing minute tears) - about 40 min­utes,” notes Powitz.

Obviously, keeping surgical gloves intact and free from tears is a high priority in the operating room, says Phsse. “just like latex condoms, latex gloves can break. And some people believe that longer acrylic nails can possibly cause wearing and breaks in the gloves.” Using double gloves is an option, she says, noting that it would be fairly easy for nurses who are handing instruments to the surgeon to use’ double gloves. But dou­ble-gloving does cause a definite de­crease in manual dexterity, she says. “For example, for female surgeons who are working on nerves and blood vessels, it would be difficult to use double gloves.”

No one in the medical field wants to put unnecessary limits on nurses’ personal freedom, Plasse emphasizes. ‘‘I’ve worn acrylics for 10 years!” she says. Plasse’ says that before Good Samaritan decides whether to ban acrylic nails in the operating room, “We truly owe it to nurses to make sure [a ban is] necessary,” she says. “Obviously, our first priority is the health and safety of our patients and to our staff.”