AORN addresses issue of fingernails
AORN addresses issue of fingernails
To help our readers, Same-Day Surgery newsletter is printing advice on the top 10 areas that receive the most questions at the Center for Nursing Practice, Research, and Health Policy at the Association of Operating Room Nurses (AORN) in Denver. The third topic, addressed in this month’s issue, focuses on fingernails:
The AORN Recommended Practices for Surgical Attire was revised in 1994. Recommended Practice V, referring to concerns about nails, states, "Fingernails must be kept short, clean, and healthy."1 The interpretive statement, rationale, and discussion go on to state that "fingernails must be short and maintained in good condition. The subungual region harbors the majority of microorganisms on the hand.
Long nails are harder to clean
"Removing debris from fingernails requires vigorous brushing and running water; additional effort is necessary for longer fingernails. Long fingernails may scratch or gouge patients during the moving or positioning processes."1
The traditional recommendation against nail polish has had little supporting research, and recent studies found no increase in microbial growth related to the wearing of freshly applied nail polish. Concern was expressed, however, that individuals who spend considerable time and money on maintaining their nails may be less inclined to perform a vigorous surgical scrub in order to protect their nails. If this occurred, there could be detrimental effect on bacterial growth on the hands, not from the polish itself, but from a change in hand hygienic practices.
Available data suggest that nail polish that is obviously chipped or worn longer than four days has a tendency to harbor greater numbers of bacteria. This time frame may suggest a guide for changing polish so that nails remain well-manicured. Therefore, surgical conscience must be a foremost behavior in individuals who choose to wear nail polish in the surgical setting.
The recommended practice goes on to state that "artificial nails should not be worn within the semirestricted and restricted areas of the practice setting. Artificial or acrylic nails on healthy hands have not been proven to increase the risk of surgical infection. However, artificial nails may harbor organisms and prevent effective handwashing. Higher numbers of gram-negative microorganisms have been cultured from the fingertips of personnel wearing artificial nails than from personnel with natural nails, both before and after handwashing. Fungal growth occurs frequently under artificial nails as a result of moisture becoming trapped between the natural and artificial nails."1
Reference
1. Association of Operating Room Nurses, Inc. "Recommended practices for surgical attire." In AORN Standards and Recommended Practices. Denver; 1996, p. 143.
[Editor’s note: This article was reprinted with permission from AORN Online (http://www.aorn.org/), 1997. AORN, 2170 S. Parker Road, Suite 300, Denver, CO 80231.]
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