Effects of nail polish on microbial growth of fingernails. Dispelling sacred cows

The glitz and glamour randomized trial: the effect of fingernail polish on post-caesarean surgical site infection

Current surgical scrub guidelines suggest that fingernail polish should not be worn by healthcare providers despite collective evidence not demonstrating a relationship between fingernail polish and surgical-site infection (SSI). The purpose of this study was to determine the effect of surgical staff wearing nail polish on the incidence of SSI after caesarean delivery. In this calendar block-randomised clinical trial, surgical staff were assigned to wear nail polish or to have unpainted nails for alternating two-week periods. The primary outcome was surgical site infection within 6 weeks of caesarean delivery. There were 372 patients in the nail polish arm and 465 in the polish-free arm. The rate of SSIs was not significantly different between the nail polish arm and the polish-free arm (1.3% vs 2.8% p = .155). We found the rate of SSI following caesarean delivery is not significantly affected by surgical staff wearing fingernail polish.Impact StatementWhat is already known on this subject? Current surgical scrub guidelines state that fingernail polish should not be worn by healthcare providers even though the collective evidence has not been able to show the relationship between fingernail polish and surgical site infection. Previous studies have only used bacterial colony count after handwashing as a primary endpoint. The evidence they provide for developing scrub guidelines have been contradictory and inconclusive.What do the results of this study add? To better inform surgical scrub guidelines, evidence is needed that evaluates the effect of fingernail polish on clinically significant endpoints. Our study, Glitz & Glamour, examined 885 non-emergent Caesarian sections using a calendar-block schedule to determine if wearing nail polish had an impact on rates of surgical site infection.What are the implications of these findings for clinical practice and/or further research? Results suggested that fingernail polish had no difference on frequency of surgical site infections, and neither condition of the polish (chipped vs. freshly applied) nor the type of polish (gel vs. regular) had any impact either.

Microbial Growth on the Nails of Direct Patient Care Nurses Wearing Nail Polish

OBJECTIVES

To determine whether nurses wearing nail polish pose a greater infection risk to patients than nurses who are not wearing nail polish.

SAMPLE & SETTING

89 direct patient care oncology nurses at a large midwestern National Cancer Institute-designated comprehensive cancer center.

METHODS & VARIABLES

The investigators assigned participants' three middle fingers of their dominant hand to three groups.

RESULTS

Comparison of colony-forming units revealed that one-day-old polish exhibited fewer gram-positive microorganisms than the unpolished nail (p = 0.04). The four-day-old polish showed significantly more microorganisms than the one-day-old polish (p = 0.03). The same trend was demonstrated for gram-negative microorganisms, but the difference was not statistically significant (p = 0.3 and p = 0.17, respectively).

IMPLICATIONS FOR NURSING

The results should be interpreted and applied to expert nursing practice in the care of vulnerable patient populations. Each institution and practitioner should make their own decisions and interpretation of evidence into practice.

Evaluation of the bacterial burden of gel nails, standard nail polish, and natural nails on the hands of health care workers

BACKGROUND

Acrylic nails harbor more bacteria than natural nails, and wear is not recommended for health care workers (HCWs). Little is known about the new and popular gel nail products. This study sought to evaluate the bacterial burden of gel nails, standard nail polish, and natural nails on the hands of HCWs.

METHODS

The study was conducted at 3 health centers. Nails on the dominant hand of 88 HCWs were painted with gel polish and standard polish. Cultures were obtained on days 1, 7, and 14 of wear and before and after hand hygiene with alcohol hand gel.

RESULTS

A total of 741 cultures were obtained. Bacterial burden increased over time for all nail types (P ≤ .0001). Reductions in the bacterial burden of natural nails and standard polish, but not gel polish, (P = .001, P = .0028, and P = .98, respectively) were seen after hand hygiene. All 3 nail types become more contaminated with bacteria over time. Standard polish and natural nails may be more amenable to hand hygiene than gel polish.

CONCLUSIONS

This study did not show an increased number of microorganisms on nails with gel polish; however, gel nails may be more difficult to clean using alcohol hand gel.

Searching for the “sacred cow”: a conceptual analysis of the term in nursing literature

Purpose

The idiom “sacred cow” is problematic due to its inaccuracy and cultural insensitivity. The purpose of this paper is to examine the term’s meaning within the nursing literature, describe connotations in religious contexts, explore subject headings applied to research using the phrase, and discuss alternative terminology.

Design/methodology/approach

This paper employs Rodgers’ evolutionary concept analysis methodology to identify the concept “sacred cow” and surrogate terms, collect and analyze sample articles and headings, explore an exemplary case, and look for concept implications.

Findings

The term “sacred cow” appears frequently in the healthcare literature, particularly within the nursing literature. Its meaning within this literature pertains primarily to practices not supported by empirical evidence and performed to maintain a status quo. Headings applied to the relevant literature do not describe this concept, and more accurate headings could not be found within widely used controlled vocabularies.

Research limitations/implications

“Sacred cow” is an inaccurate descriptor for practices not supported by evidence as these practices do not usually apply to holiness or cattle. The term’s implied meaning comes only when viewed within a context satirizing beliefs considered as “other.”

Originality/value

This paper appears to be the first to methodically explore the concept of “sacred cow” within the nursing literature. The paper breaks ground in proposing solutions for the lack of applicable controlled vocabulary. By exploring these topics, it is hoped future authors use more accurate, culturally neutral terminology when discussing non-evidence-based practices and indexers increase discoverability by using more descriptive headings.

Prediction of a nail polish colour applied on a nail

OBJECTIVE

The colour of a nail polish varies according to the nail on which it is applied. The objective of this study was to predict the colour of the nail polish on a given nail and to study how the colour varies depending on the nail polish thickness.

METHODS

Six nail polishes were applied in one, two and three layers on the nails of one subject, thus forming eighteen samples. The spectral reflectances of the eighteen nail polishes applied on the nails with different thicknesses were obtained by spectrophotometry. The spectral reflectances of the nails without polish were also measured using the same technique. The thicknesses of nail polishes were measured by high-definition optical coherence tomography (HD-OCT). Then, to determine the physical parameters of the nail polish itself, we applied the six nail polishes on an opacity drawdown chart and we measured the spectral reflectance and the thickness of each patch using spectrophotometry and HD-OCT, respectively. The Kubelka-Munk theory was used to get the predicted spectral reflectance of the nail polish applied on the nail according to the polish thickness by knowing the parameter of the polish itself and the spectral reflectance of the nail. The predicted spectral reflectances were finally compared with those measured directly on the nails.

RESULTS

The predicted spectral reflectances were rather close to measured ones. Consequently, knowing the colour of the nail without polish and the optical parameters of the nail polish itself, we can estimate the colour of the nail polish applied on the nail depending on its thickness.

CONCLUSION

Our study showed that the Kubelka-Munk theory can be used to predict the nail polish colour. The ability to predict the real colour of a nail polish applied on a nail could help a nail polish manufacturer to improve his polish formulae in order to obtain a precise colour.

Removal of nail polish and finger rings to prevent surgical infection

BACKGROUND

Surgical wound infections may be caused by the transfer of bacteria from the hands of surgical teams to patients during operations. Surgical scrubbing prior to surgery reduces the number of bacteria on the skin, but wearing rings and nail polish on the fingers may reduce the efficacy of scrubbing, as bacteria may remain in microscopic imperfections of nail polish and on the skin beneath rings.

OBJECTIVES

To assess the effect of the presence or absence of rings and nail polish on the hands of the surgical scrub team on postoperative wound infection rates.

SEARCH METHODS

For this fifth update, we searched The Cochrane Wounds Group Specialised Register (searched 23 July 2014); The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE and EBSCO CINAHL.

SELECTION CRITERIA

Randomised controlled trials (RCTs) evaluating the effect of wearing or removing finger rings and nail polish on the efficacy of the surgical scrub and postoperative wound infection rate.

DATA COLLECTION AND ANALYSIS

All abstracts were checked against a checklist to determine whether they fulfilled the inclusion criteria. Full reports of relevant studies were obtained. Excluded trial reports were checked by all review authors to ensure appropriate exclusion.

MAIN RESULTS

We identified: no new trials; no RCTs that compared wearing of rings with the removal of rings; and no trials of nail polish versus no nail polish that measured surgical infection rates. We found one small RCT (102 scrub nurses) that evaluated the effect of nail polish on the number of bacterial colony forming units left on hands after pre-operative surgical scrubbing. Nurses had either unpolished nails, freshly-applied nail polish (less than two days old), or old nail polish (more than four days old). There were no significant differences in the number of bacteria on hands between the groups before and after surgical scrubbing.

AUTHORS' CONCLUSIONS

No trials have investigated whether wearing nail polish or finger rings affects the rate of surgical wound infection. There is insufficient evidence to determine whether wearing nail polish affects the number of bacteria on the skin post-scrub.

Removal of nail polish and finger rings to prevent surgical infection

BACKGROUND

Surgical wound infections may be caused by the transfer of bacteria from the hands of surgical teams to patients during operations. Surgical scrubbing prior to surgery reduces the number of bacteria on the skin, but wearing rings and nail polish on the fingers may reduce the efficacy of scrubbing, as bacteria may remain in microscopic imperfections of nail polish and on the skin beneath rings.

OBJECTIVES

To assess the effect of the presence or absence of rings and nail polish on the hands of the surgical scrub team on postoperative wound infection rates.

SEARCH METHODS

For this update, we searched The Cochrane Wounds Group Specialised Register (searched 27 January 2012); The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 1); Ovid MEDLINE (2010 to January Week 2 2012); Ovid MEDLINE (In-Process & Other Non-Indexed Citations, January 26, 2012); Ovid EMBASE (2010 to 2012 Week 03); and EBSCO CINAHL (2010 to January 6 2012).

SELECTION CRITERIA

Randomised controlled trials (RCTs) evaluating the effect of wearing or removing finger rings and nail polish on the efficacy of the surgical scrub and postoperative wound infection rate.

DATA COLLECTION AND ANALYSIS

All abstracts were checked against a checklist to determine whether they fulfilled the inclusion criteria. Full reports of relevant studies were obtained. Excluded trial reports were checked by all authors to ensure appropriate exclusion.

MAIN RESULTS

We identified: no new trials; no RCTs that compared wearing of rings with the removal of rings; and no trials of nail polish versus no nail polish that measured surgical infection rates. We found one small RCT (102 scrub nurses) that evaluated the effect of nail polish on the number of bacterial colony forming units left on hands after pre-operative surgical scrubbing. Nurses had either unpolished nails, freshly-applied nail polish (less than two days old), or old nail polish (more than four days old). There were no significant differences in the number of bacteria on hands between the groups before and after surgical scrubbing.

AUTHORS' CONCLUSIONS

No trials have investigated whether wearing nail polish or finger rings affects the rate of surgical wound infection. There is insufficient evidence to determine whether wearing nail polish affects the number of bacteria on the skin post-scrub.

[Assessing the wearing of jewellery by French healthcare professionals]

OBJECTIVE

A prospective observation study was undertaken in seven medical centers, in the French region Alpes-Maritime, to assess nail hygiene of healthcare professionals and how often they wear hand jewellery.

METHOD

Seven hundred and six healthcare workers in seven medical centers were interviewed from March to April 2008.

RESULTS

Among the 706 professionals, 306 (43%) were wearing one or several pieces of jewellery. The nails of 81 (11.5%) were non-standard according to guidelines. Three hundred and forty-four health care professionals (49%) were wearing one or several pieces of jewellery and/or presented with non-standard nails. In univariate analysis, the wearing of jewellery was linked to the medical centre (P<0.001), to the professional category (p<0.001), to the number of times people washed their hands or used hand gel per day (ABHR) by categories (<10 times per day or ≥10 times per day) (P<0.017). In the multivariate analysis, the risk factors linked to the wearing of jewellery were the medical centers, the professional category, and the age.

CONCLUSION

There are still too many healthcare professionals who do not comply to French recommendations on hand hygiene concerning the wearing of jewellery and nail hygiene standards.

Outbreaks where food workers have been implicated in the spread of foodborne disease. Part 9. Washing and drying of hands to reduce microbial contamination

During various daily activities at home and work, hands quickly become contaminated. Some activities increase the risk of finger contamination by pathogens more than others, such as the use of toilet paper to clean up following a diarrheal episode, changing the diaper of a sick infant, blowing a nose, or touching raw food materials. Many foodborne outbreak investigation reports have identified the hands of food workers as the source of pathogens in the implicated food. The most convenient and efficient way of removing pathogens from hands is through hand washing. Important components of hand washing are potable water for rinsing and soaps to loosen microbes from the skin. Hand washing should occur after any activity that soils hands and certainly before preparing, serving, or eating food. Antimicrobial soaps are marginally more effective than plain soaps, but constant use results in a buildup of the antimicrobial compound on the skin. The time taken to wash hands and the degree of friction generated during lathering are more important than water temperature for removing soil and microorganisms. However, excessive washing and scrubbing can cause skin damage and infections. Drying hands with a towel removes pathogens first by friction during rubbing with the drying material and then by wicking away the moisture into that material. Paper rather than cloth towels should be encouraged, although single-use cloth towels are present in the washrooms of higher class hotels and restaurants. Warm air dryers remove moisture and any surface microorganisms loosened by washing from hands by evaporation while the hands are rubbed together vigorously; however, these dryers take too long for efficient use. The newer dryers with high-speed air blades can achieve dryness in 10 to 15 s without hand rubbing.

Outbreaks where food workers have been implicated in the spread of foodborne disease. Part 8. Gloves as barriers to prevent contamination of food by workers

The role played by food workers and other individuals in the contamination of food has been identified as an important contributing factor leading to foodborne outbreaks. To prevent direct bare hand contact with food and food surfaces, many jurisdictions have made glove use compulsory for food production and preparation. When properly used, gloves can substantially reduce opportunities for food contamination. However, gloves have limitations and may become a source of contamination if they are punctured or improperly used. Experiments conducted in clinical and dental settings have revealed pinhole leaks in gloves. Although such loss of glove integrity can lead to contamination of foods and surfaces, in the food industry improper use of gloves is more likely than leakage to lead to food contamination and outbreaks. Wearing jewelry (e.g., rings) and artificial nails is discouraged because these items can puncture gloves and allow accumulation of microbial populations under them. Occlusion of the skin during long-term glove use in food operations creates the warm, moist conditions necessary for microbial proliferation and can increase pathogen transfer onto foods through leaks or exposed skin or during glove removal. The most important issue is that glove use can create a false sense of security, resulting in more high-risk behaviors that can lead to cross-contamination when employees are not adequately trained.

Hand adornment and infection control

Studies have shown that despite infection control guidelines recommending that false fingernails, nail varnish, stoned rings and wrist watches not be worn by clinical staff, a large proportion of them continue to do so. The recently updated epic guidelines (Pratt et al, 2007) state that hand jewellery and false finger nails should be kept short, clean and free from nail polish. This article discusses the bacterial carriage, contributions to outbreaks of infection and interference with proper hand hygiene practices, thereby explaining why these recommendations are made in infection control policies and guidelines.

A comparison of hand washing techniques to remove Escherichia coli and caliciviruses under natural or artificial fingernails

Compared with other parts of the hand, the area beneath fingernails harbors the most microorganisms and is most difficult to clean. Artificial fingernails, which are usually long and polished, reportedly harbor higher microbial populations than natural nails. Hence, the efficacy of different hand washing methods for removing microbes from natural and artificial fingernails was evaluated. Strains of nonpathogenic Escherichia coli JM109 and feline calicivirus (FCV) strain F9 were used as bacterial and viral indicators, respectively. Volunteers with artificial or natural nails were artificially contaminated with ground beef containing E. coli JM109 or artificial feces containing FCV. Volunteers washed their hands with tap water, regular liquid soap, antibacterial liquid soap, alcohol-based hand sanitizer gel, regular liquid soap followed by alcohol gel, or regular liquid soap plus a nailbrush. The greatest reduction of inoculated microbial populations was obtained by washing with liquid soap plus a nailbrush, and the least reduction was obtained by rubbing hands with alcohol gel. Lower but not significantly different (P > 0.05) reductions of E. coli and FCV counts were obtained from beneath artificial than from natural fingernails. However, significantly (P < or = 0.05) higher E. coli and FCV counts were recovered from hands with artificial nails than from natural nails before and after hand washing. In addition, microbial cell numbers were correlated with fingernail length, with greater numbers beneath fingernails with longer nails. These results indicate that best practices for fingernail sanitation of food handlers are to maintain short fingernails and scrub fingernails with soap and a nailbrush when washing hands.

Guideline for Hand Hygiene in Health-Care Settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HIPAC/SHEA/APIC/IDSA Hand Hygiene Task Force

The Guideline for Hand Hygiene in Health-Care Settings provides health-care workers (HCWs) with a review of data regarding handwashing and hand antisepsis in health-care settings. In addition, it provides specific recommendations to promote improved hand-hygiene practices and reduce transmission of pathogenic microorganisms to patients and personnel in health-care settings. This report reviews studies published since the 1985 CDC guideline (Garner JS, Favero MS. CDC guideline for handwashing and hospital environmental control, 1985. Infect Control 1986;7:231-43) and the 1995 APIC guideline (Larson EL, APIC Guidelines Committee. APIC guideline for handwashing and hand antisepsis in health care settings. Am J Infect Control 1995;23:251-69) were issued and provides an in-depth review of hand-hygiene practices of HCWs, levels of adherence of personnel to recommended handwashing practices, and factors adversely affecting adherence. New studies of the in vivo efficacy of alcohol-based hand rubs and the low incidence of dermatitis associated with their use are reviewed. Recent studies demonstrating the value of multidisciplinary hand-hygiene promotion programs and the potential role of alcohol-based hand rubs in improving hand-hygiene practices are summarized. Recommendations concerning related issues (e.g., the use of surgical hand antiseptics, hand lotions or creams, and wearing of artificial fingernails) are also included.

Guideline for Hand Hygiene in Health-Care Settings: recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force

The Guideline for Hand Hygiene in Health-Care Settings provides health-care workers (HCWs) with a review of data regarding handwashing and hand antisepsis in health-care settings. In addition, it provides specific recommendations to promote improved hand-hygiene practices and reduce transmission of pathogenic microorganisms to patients and personnel in health-care settings. This report reviews studies published since the 1985 CDC guideline (Garner JS, Favero MS. CDC guideline for handwashing and hospital environmental control, 1985. Infect Control 1986;7:231-43) and the 1995 APIC guideline (Larson EL, APIC Guidelines Committee. APIC guideline for handwashing and hand antisepsis in health care settings. Am J Infect Control 1995;23:251-69) were issued and provides an in-depth review of hand-hygiene practices of HCWs, levels of adherence of personnel to recommended handwashing practices, and factors adversely affecting adherence. New studies of the in vivo efficacy of alcohol-based hand rubs and the low incidence of dermatitis associated with their use are reviewed. Recent studies demonstrating the value of multidisciplinary hand-hygiene promotion programs and the potential role of alcohol-based hand rubs in improving hand-hygiene practices are summarized. Recommendations concerning related issues (e.g., the use of surgical hand antiseptics, hand lotions or creams, and wearing of artificial fingernails) are also included.

Nail beauty therapy: an attractive enhancement or a potential hazard?

Nail coatings which harden upon evaporation and coatings that polymerize may produce some reactions at the site of application to the nail itself, and distant reactions when small amounts of nail cosmetics are transferred by the hand to other areas of the skin. Nail cosmetic hazards may be occupational, or accidental, especially in children. Individuals wearing artificial nails tend to wear their nails longer, and are more careful about their nails when washing their hands. The sanitary conditions for the application of artificial nails are therefore paramount in preventing nail infections.

Removal of nail polish and finger rings to prevent surgical infection

BACKGROUND

Surgical wound infection may be caused by transfer of bacteria from the hands of the surgical team during operative procedures. Careful surgical scrubbing is therefore performed to reduce the number of bacteria on the skin. The wearing of finger rings and nail polish is thought to reduce the efficacy of the scrub as they are thought to harbour bacteria in microscopic imperfections of nail polish and on the skin beneath finger rings.

OBJECTIVES

To assess the effect of removal of finger rings and nail polish by the surgical scrub team, on postoperative wound infection rates.

SEARCH STRATEGY

We searched the Cochrane Wounds Group Specialised Trials Register up to November 2000 using the search strategy developed by the Cochrane Wounds Group. We wrote to manufacturers of surgical scrubbing agents for ongoing and unpublished research. Reference lists of articles were searched and relevant journals outside the electronic databases were hand searched. No restriction was placed on literature based on date of publication, language or publication status.

SELECTION CRITERIA

Randomised controlled trials evaluating the effect of wearing or removal of finger rings and nail polish by the surgical scrub team on post operative wound infections and number of bacteria on the hands of the surgical scrub team.

DATA COLLECTION AND ANALYSIS

The abstracts of studies identified were scanned by all reviewers. All abstracts were checked against a checklist to determine whether they fulfilled the inclusion criteria. Full reports of relevant studies were obtained and checked against the checklist by two reviewers. The full reports of all excluded trials were checked by all reviewers independently to ensure appropriate exclusion.

MAIN RESULTS

We found no randomised controlled trials that compared the wearing of finger rings with the removal of finger rings. We found no trials of nail polish wearing / removal that measured patient outcomes, including surgical infection. We found one small randomised controlled trial which evaluated the effect of nail polish on the number of bacterial colony forming units on the hands after pre-operative hand washing (also called surgical scrubbing). Nurses were allocated to: unpolished nails, freshly applied nail polish (less than two days old), or old nail polish (more than four days old). Both before and after surgical scrubbing, there was no significant difference in the number of bacteria on the hands.

REVIEWER'S CONCLUSIONS

There is no evidence of the effect of removing nail polish or finger rings on the rate of surgical wound infection. There is insufficient evidence of the effect of wearing nail polish on the number of bacteria on the skin. However, the one trial making this comparison trial was too small to exclude anything other than a very large difference in the number of bacteria on the skin.

Pathogenic organisms associated with artificial fingernails worn by healthcare workers

OBJECTIVE

To determine differences in the identity and quantity of microbial flora from healthcare workers (HCWs) wearing artificial nails compared with control HCWs with native nails.

DESIGN

Two separate studies were undertaken. In study 1, 12 HCWs who did not normally wear artificial nails wore polished artificial nails on their nondominant hand for 15 days. Identity and quantity of microflora were compared between the artificial nails and the polished native nails of the other hand. In study 2, the microbial flora of the nails of 30 HCWs who wore permanent acrylic artificial nails were compared with that of control HCWs who had native nails. In both studies, nail surfaces were swabbed and subungual debris was collected to obtain material for culture. Staphylococcus aureus, gram-negative bacilli, enterococci, and yeasts were considered to be potential pathogens. All organisms were identified and quantified.

RESULTS

In study 1, potential pathogens were isolated from more samples obtained from artificial nails than native nails (92% vs. 62%; P<.001). Colonization of artificial nails increased over time; by day 15, 71% of cultures yielded a pathogen compared with 21% on day 1 (P=.004). A significantly greater quantity of organisms (expressed as mean log10 colony-forming units +/- standard deviation) was isolated from the subungual area than the nail surface; this was noted for both artificial (5.0+/-1.4 vs. 4.1+/-1.0; P<.001) and native nails (4.9+/-1.3 vs. 3.7+/-0.8; P<.001). More organisms were found on the surface of artificial nails than native nails (P=.008), but there were no differences noted in the quantities of organisms isolated from the subungual areas. In study 2, HCWs wearing artificial nails were more likely to have a pathogen isolated than controls (87% vs. 43%; P=.001). More HCWs with artificial nails had gram-negative bacilli (47% vs. 17%; P=.03) and yeasts (50% vs. 13%; P=.006) than control HCWs. However, the quantities of organisms isolated from HCWs wearing artificial nails and controls did not differ.

CONCLUSIONS

Artificial fingernails were more likely to harbor pathogens, especially gram-negative bacilli and yeasts, than native nails. The longer artificial nails were worn, the more likely that a pathogen was isolated. Current recommendations restricting artificial fingernails in certain healthcare settings appear justified.

Guideline for Prevention of Surgical Site Infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee

EXECUTIVE SUMMARY The "Guideline for Prevention of Surgical Site Infection, 1999" presents the Centers for Disease Control and Prevention (CDC)'s recommendations for the prevention of surgical site infections (SSIs), formerly called surgical wound infections. This two-part guideline updates and replaces previous guidelines.1,2 Part I, "Surgical Site Infection: An Overview," describes the epidemiology, definitions, microbiology, pathogenesis, and surveillance of SSIs. Included is a detailed discussion of the pre-, intra-, and postoperative issues relevant to SSI genesis. Part II, "Recommendations for Prevention of Surgical Site Infection," represents the consensus of the Hospital Infection Control Practices Advisory Committee (HICPAC) regarding strategies for the prevention of SSIs.3 Whenever possible, the recommendations in Part II are based on data from well-designed scientific studies. However, there are a limited number of studies that clearly validate risk factors and prevention measures for SSI. By necessity, available studies have often been conducted in narrowly defined patient populations or for specific kinds of operations, making generalization of their findings to all specialties and types of operations potentially problematic. This is especially true regarding the implementation of SSI prevention measures. Finally, some of the infection control practices routinely used by surgical teams cannot be rigorously studied for ethical or logistical reasons (e.g., wearing vs not wearing gloves). Thus, some of the recommendations in Part II are based on a strong theoretical rationale and suggestive evidence in the absence of confirmatory scientific knowledge.It has been estimated that approximately 75% of all operations in the United States will be performed in "ambulatory," "same-day," or "outpatient" operating rooms by the turn of the century.4 In recommending various SSI prevention methods, this document makes no distinction between surgical care delivered in such settings and that provided in conventional inpatient operating rooms. This document is primarily intended for use by surgeons, operating room nurses, postoperative inpatient and clinic nurses, infection control professionals, anesthesiologists, healthcare epidemiologists, and other personnel directly responsible for the prevention of nosocomial infections. This document does not: Specifically address issues unique to burns, trauma, transplant procedures, or transmission of bloodborne pathogens from healthcare worker to patient, nor does it specifically address details of SSI prevention in pediatric surgical practice. It has been recently shown in a multicenter study of pediatric surgical patients that characteristics related to the operations are more important than those related to the physiologic status of the patients.5 In general, all SSI prevention measures effective in adult surgical care are indicated in pediatric surgical care. Specifically address procedures performed outside of the operating room (e.g., endoscopic procedures), nor does it provide guidance for infection prevention for invasive procedures such as cardiac catheterization or interventional radiology. Nonetheless, it is likely that many SSI prevention strategies also could be applied or adapted to reduce infectious complications associated with these procedures. Specifically recommend SSI prevention methods unique to minimally invasive operations (i.e., laparoscopic surgery). Available SSI surveillance data indicate that laparoscopic operations generally have a lower or comparable SSI risk when contrasted to open operations.6-11 SSI prevention measures applicable in open operations (e.g., open cholecystectomy) are indicated for their laparoscopic counterparts (e.g., laparoscopic cholecystectomy). Recommend specific antiseptic agents for patient preoperative skin preparations or for healthcare worker hand/forearm antisepsis. Hospitals should choose from products recommended for these activitie

Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee

The “Guideline for Prevention of Surgical Site Infection, 1999” presents the Centers for Disease Control and Prevention (CDC)'s recommendations for the prevention of surgical site infections (SSIs), formerly called surgical wound infections. This two-part guideline updates and replaces previous guidelines.

Part I, “Surgical Site Infection: An Overview,” describes the epidemiology, definitions, microbiology, pathogenesis, and surveillance of SSIs. Included is a detailed discussion of the pre-, intra-, and postoperative issues relevant to SSI genesis.

Bacterial carriage on the fingernails of OR nurses

This study provides statistically significant data that demonstrate that chipped fingernail polish or fingernail polish worn longer than four days fosters increased numbers of bacteria on the fingernails of OR nurses after surgical hand scrubs. There were no significant correlations between fingernail length and the numbers of bacterial colonies on the fingernails of the study groups tested after performing a standard surgical hand scrub. A convenience sample of 102 perioperative nurses with either freshly polished fingernails; chipped fingernail polish; or natural, polish-free fingernails participated. The data suggest OR nurses can wear fresh fingernail polish on healthy fingernails without risking increased bacterial counts.