Artificial Fingernails Research Articles

Survey of knowledge, beliefs, and practices of neonatal intensive care unit healthcare workers regarding nosocomial infections, central venous catheter care, and hand hygiene.

To assess the knowledge, beliefs, and practices of neonatal intensive care unit (NICU) healthcare workers (HCWs). Self-administered survey. A 55-bed NICU. NICU HCWs (N = 215). The response rate was 68%. Ninety-two percent knew central venous catheters (CVCs) should be capped, clamped, or connected to running fluids at all times. Ninety-five percent knew when to change gloves. Thirty-one percent knew the recommended duration for handwashing. Most HCWs believed sterile technique in CVC care (96%), gloves (91%), and handwashing (99%) prevent nosocomial infection (NI). Sixty-seven percent used sterile barriers to insert CVCs, 76% reported wearing gloves, 81% reported routine handwashing, 35% knew that bacterial hand counts are higher with rings, 30% knew that long fingernails are associated with higher gram-negative bacterial hand contamination, and 35% knew that artificial fingernails are associated with higher gram-negative bacterial hand contamination. Most (93%) believed HCWs can affect outcomes of patients with NIs. Fewer believed rings (40%), artificial fingernails (61%), and long fingernails (48%) play a role in NIs, or that policies concerning number of rings (50%), cutting fingernails (35%), or prohibiting artificial fingernails (47%) would prevent NIs. Sixty-one percent of HCWs regularly wore at least one ring to work, 56% wore their fingernails shorter than the fingertip, and 8% wore artificial fingernails. A disconnect existed between CVC knowledge and beliefs and practice. HCWs did not know the relationship between bacterial hand counts and rings and fingernails, and did not believe rings or long or artificial fingernails increased the risk of NIs.

Greater KC APIC Chapter Taking the Lead in Collaborative Efforts Regarding Artificial Nails with Metropolitan Area Healthcare Facilities

ISSUE: The Greater Kansas City APIC Chapter collaborated to develop a position statement in response to the JCAHO Patient Safety Goal # 7.a “Comply with current CDC hand hygiene guidelines.” A consensus statement was developed to provide area hospitals with direction regarding the use of artificial nails in by direct patient-care providers. Without consensus of the majority of hospitals, concern was raised that nurses would choose hospitals that allowed artificial fingernails. PROJECT: An APIC task force met to review current medical literature, HICPAC's Hand Hygiene Guideline, and the JCAHO's patient safety goals. The task force developed a questionnaire and asked all members of the APIC chapter to interview the director of nursing and the human resources director in their facilities. A consensus statement was written and approved by the APIC chapter and sent to all area hospitals as well as to the Missouri and Kansas Hospital Associations. RESULTS: Prior to the initiative, 33% of area hospitals had a “no artificial fingernail” policy. Following consensus statement development and dissemination, 70% of hospitals planned to implement such a policy.

Outbreak of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae in a neonatal intensive care unit linked to artificial nails.

From April to June 2001, an outbreak of extended-spectrum beta-lactamase (ESBL)-producing Klebsiella pneumoniae infections was investigated in our neonatal intensive care unit. Cultures of the gastrointestinal tracts of patients, the hands of healthcare workers (HCWs), and the environment were performed to detect potential reservoirs for ESBL-producing K. pneumoniae. Strains of K. pneumoniae were typed by pulsed-field gel electrophoresis using XbaI. A case-control study was performed to determine risk factors for acquisition of the outbreak clone (clone A); cases were infants infected or colonized with clone A and controls (3 per case) were infants with negative surveillance cultures. During the study period, 19 case-infants, of whom 13 were detected by surveillance cultures, harbored clone A. The overall attack rate for the outbreak strain was 45%; 9 of 19 infants presented with invasive disease (n = 6) or developed invasive disease (n = 3) after colonization was detected. Clone A was found on the hands of 2 HCWs, 1 of whom wore artificial nails, and on the designated stethoscope of a case-infant. Multiple logistic regression analysis revealed that length of stay per day (odds ratio [OR], 1.05; 95% confidence interval [CI95], 1.02 to 1.09) and exposure to the HCW wearing artificial fingernails (OR, 7.87; CI95, 1.75 to 35.36) were associated with infection or colonization with clone A. Short, well-groomed, natural nails should be mandatory for HCWs with direct patient contact

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 ≤ 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 hicpac/shea/apic/idsa hand hygiene task force

SummaryThe 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.

Amended final report on the safety assessment of ethyl methacrylate.

Ethyl Methacrylate is a methacrylate ester used as a chemical additive in artificial fingernail enhancement products. These products may be applied by trained professionals or be provided directly to consumers with instructions for use. Ethyl Methacrylate readily polymerizes and rapidly reacts with multifunction methacrylates to form a highly cross-linked polymer. The oral LD(50) of Ethyl Methacrylate for rats ranged from 12.7 to 18.14 g/kg. In acute studies with rats, hemoglobinuria and respiratory tract lesions were observed. Animal studies indicate that Ethyl Methacrylate is a skin irritant and sensitizer. In some cases the results were dependent on the vehicle. Evidence of embryotoxicity and teratogenicity were observed in rats injected intraperitoneally with 0.1223 to 0.4076 ml/kg Ethyl Methacrylate. Positive evidence of mutagenicity was observed in the L5178Y mouse lymphoma cell assay, but not in two Ames tests. Case reports cite examples of individuals suffering allergic contact dermatitis from exposure to Ethyl Methacrylate and related methacrylates, and some degree of cross-reactivity appears to exist between widely used acrylates and methacrylates. Information from several clinical registries of sensitization reactions to various agents reported that Ethyl Methacrylate is a sensitizer, but not a potent one. Because Ethyl Methacrylate monomer is short-lived in the normal course of using artificial fingernail-enhancement products, the primary hazard is expected to be inadvertant skin contact. In order to avoid sensitization, it is necessary to avoid skin contact. It is recommended that fingernail-enhancement products containing Ethyl Methacrylate include directions to avoid skin contact because of the sensitizing potential. Based on the available data on the formulation of nail products containing this ingredient, it is concluded that Ethyl Methacrylate is safe as used, when application is accompanied by directions for use as above.

Infection control in pediatric hospitals.

Important characteristics of hospital infection control are specific to pediatric facilities. For example, colonization and infection with vancomycin-resistant enterococci, which are widely spread in many units housing adult patients, are uncommon in children, especially in the neonatal intensive care unit where vancomycin use is heavy. Characteristics of the neonatal intensive care unit, such as the insulated environment and infrequent treatment with antibiotics with broad anaerobic activity, likely account for this finding. Artificial fingernails have been discovered to promote colonization with potential pathogens; their implication in recent nursery epidemics emphasizes the need to prohibit their use in this environment in particular. Finally, nosocomial viral infections occur with regularity in pediatric hospitals. Programs that successfully and cost-effectively control hospital spread of respiratory syncytial virus, however, demonstrate that rational, multifaceted interventions can nearly eliminate transmission of certain viral pathogens on the pediatric wards.

Risk of Infection Associated With Artificial Fingernails

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Controlling Chemical Hazards During the Application of Artificial Fingernails

Controlling Chemical Hazards During the Application of Artificial Fingernails

Controlling Chemical Hazards During the Application of Artificial Fingernails

Controlling Chemical Hazards During the Application of Artificial Fingernails

Artificial Nails Undermine Infection Control

Two studies add to the evidence that health care personnel who wear artificial acrylic fingernails to work may jeopardize patient safety.Three of 36

Endemic Pseudomonas aeruginosa infection in a neonatal intensive care unit.

Nosocomial infections due to Pseudomonas aeruginosa have been well described, but the environmental reservoir of the organism varies. We conducted an epidemiologic and molecular investigation of endemic P. aeruginosa infection among infants in a neonatal intensive care unit that was associated with carriage of the organisms on the hands of health care workers. In August 1998, colonization or infection with P. aeruginosa was identified in six infants. Surveillance cultures for P. aeruginosa were obtained from the other 27 infants in the unit, and possible environmental reservoirs were also assessed. The hands of health care workers were inspected and cultured, and risk factors for P. aeruginosa colonization were evaluated. Isolates were analyzed for clonality by pulsed-field gel electrophoresis. Surveillance cultures showed that three additional infants were colonized with P. aeruginosa. Cultures of environmental specimens were negative, but cultures of the hands of 10 of 165 health care workers (6 percent) were positive for P. aeruginosa. Increasing age (P=0.05) and a history of the use of artificial fingernails or nail wraps (P=0.03) were both risk factors for colonization of the hands. From January 1997 to August 1998, 49 infants were infected or colonized with P. aeruginosa. Pulsed-field gel electrophoresis demonstrated that 17 of these infants and 1 health care worker who had onychomycosis had the same clone. Infants who were exposed to this health care worker in August 1998 were at greater risk of having this clone than infants who were not exposed to this health care worker (odds ratio, 41.2; 95 percent confidence interval, 1.8 to 940.0; P=0.006). An increased rate of infection and colonization with P. aeruginosa among infants in neonatal intensive care units should be investigated by assessing potential reservoirs, including environmental sources as well as patients and health care workers.

Pathogenic organisms associated with artificial fingernails worn by healthcare workers.

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. 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. 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. 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.

A prolonged outbreak of Pseudomonas aeruginosa in a neonatal intensive care unit: did staff fingernails play a role in disease transmission?

To describe an outbreak of Pseudomonas aeruginosa bloodstream infection (BSI) and endotracheal tube (ETT) colonization in a neonatal intensive care unit (NICU), determine risk factors for infection, and make preventive recommendations. A 15-month cohort study followed by a case-control study with an environmental survey and molecular typing of available isolates using pulsed-field gel electrophoresis. Neonates in the NICU of a university-affiliated children's hospital. Improved hand washing and restriction of use of long or artificial fingernails. Of 439 neonates admitted during the study period, 46 (10.5%) acquired P aeruginosa; 16 (35%) of those died. Fifteen (75%) of 20 patients for whom isolates were genotyped had genotype A, and 3 (15%) had genotype B. Of 104 healthcare workers (HCWs) from whom hand cultures were obtained, P aeruginosa was isolated from three nurses. Cultures from nurses A-1 and A-2 grew genotype A, and cultures from nurse B grew genotype B. Nurse A-1 had long natural fingernails, nurse B had long artificial fingernails, and nurse A-2 had short natural fingernails. On multivariate logistic regression analysis, exposure to nurse A-1 and exposure to nurse B were each independently associated with acquiring a BSI or ETT colonization with P aeruginosa, but other variables, including exposure to nurse A-2, were not. Epidemiological evidence demonstrated an association between acquiring P aeruginosa and exposure to two nurses. Genetic and environmental evidence supported that association and suggested, but did not prove, a possible role for long or artificial fingernails in the colonization of HCWs' hands with P aeruginosa. Requiring short natural fingernails in NICUs is a reasonable policy that might reduce the incidence of hospital-acquired infections.

The use of protective digit prostheses in management of microangiopathy of fingers

Small artery occlusive disease (microangiopathy) of the palm and digital arteries may produce ischemia with painful ulcerations on the digits. These ulcerations may contribute to secondary infection and severe intolerance to thermal changes. The use of gauze wrappings to minimize ulceration has been tried; however, it is unhygienic and unsightly. A custom-made digit prosthesis is constructed with medical grade silicone over an artificial finger nail to provide positive seating of the prosthesis. The digit prosthesis is hygienic, esthetically acceptable to the patient and greatly protects ulcerated finger tips. (J Prosthet Dent 1999;82:246-8.)

Single-use devices; sinks in the OR; artificial fingernails; flooring products; terminal cleaning; item documentation

Single-use devices; sinks in the OR; artificial fingernails; flooring products; terminal cleaning; item documentation

Identifying surgical sites; Medicare reimbursement; artificial fingernails; acronyms; salespeople in the OR

AORN JournalVolume 69, Issue 3 p. 652-658 Department Identifying surgical sites; Medicare reimbursement; artificial fingernails; acronyms; salespeople in the OR Dorothy M. Fogg RN, MA, Dorothy M. Fogg RN, MA Perioperative Nursing Specialist Center for Nursing Practice, Health Policy, and ResearchSearch for more papers by this author Dorothy M. Fogg RN, MA, Dorothy M. Fogg RN, MA Perioperative Nursing Specialist Center for Nursing Practice, Health Policy, and ResearchSearch for more papers by this author First published: 01 March 1999 https://doi.org/10.1016/S0001-2092(06)62479-4Citations: 2Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume69, Issue3March 1999Pages 652-658 RelatedInformation

Injuries to Kids from Artificial Fingernail Primers

Artificial fingernails have become a widely popular cosmetic product. Their availability for home application has resulted in an increase in reported childhood injuries from exposure to fingernail primers -- corrosive agents used to etch the real nail to allow the artificial …

Impact of a 5-minute scrub on the microbial flora found on artificial, polished, or natural fingernails of operating room personnel.

Impact of a 5-minute scrub on the microbial flora found on artificial, polished, or natural fingernails of operating room personnel.

Methemoglobinemia From Artificial Fingernail Solution

<h3>To the Editor.</h3> —Fingernail care products account for a significant number of pediatric poisonings in the United States with a total of 19 342 pediatric exposures (resulting in 1 fatality) recorded by regional Poison Control Centers in 1995.¹Nail polishes and nail polish removers may contain a variety of hydrocarbon-based solvents while nail adhesives usually contain various acrylic ester monomers. The chemical<i>N,N</i>-dimethyl-<i>p</i>-toluidine is a chemical commonly found in artificial fingernail solutions. Its oxidation metabolite phenylhydroxylamine is presumably one of the most potent chemical producers of methemoglobin.^2,3We describe a case of ingestion by an infant of this chemical resulting in methemoglobinemia. <h3>Report of a Case.</h3> —A healthy 5-month-old boy was unintentionally fed about 30 mL of artificial fingernail solution (Fast Set Acrylic Liquid for Nails by Procare) by his 6-year-old sibling. The product was a strong-smelling, clear liquid containing unspecified concentrations of acrylic ester