The caregiver is doing a great job with my mother, but it seems to defy common sense to have such long nails while bathing her and wiping her. I worry about the hygiene aspect (I know she washes her hands, but quickly; I don't think she always wears the surgical gloves we have on hand). But I'm more concerned with the sharp nails around my mother's very fragile skin, especially in the vaginal and anal areas. Any opinions or knowledge about this?
Fingernails should be kept short, clean, and healthy.
A single-use nail cleaner should be used under running water to clean the debris from the subungual area, which harbors the most organisms found on the hands.
Long fingernails may pose a hazard to patient safety when moving or positioning the patient.
Long fingernails require extra effort when cleaning subungual areas.
When fingernails are long, gloves may tear, presenting a risk to both the nurse and the patient.
The AORN has the following recommendations about fingernail polish:
If used, nail polish should not be chipped.
Studies have demonstrated that chipped nail polish may support the growth of organisms on the fingernails.
While no studies have demonstrated a relationship between freshly applied nail polish and infection,[1] there is concern that individuals with fresh manicures may be hesitant to perform rigorous hand hygiene in an effort to protect their nails. Compromises in hand hygiene technique may then lead to transmission of infection.
If nail polish is worn, it should not be worn for more than 4 days. At the end of 4 days, nail polish should be removed and freshly reapplied.
Individuals who choose to wear nail polish should be guided by their surgical conscience, which requires a combination of clinical experience, judgment, critical thinking, and the ability to question a practice when one believes it is not the right thing to do.
The AORN recommends the following concerning acrylic (artificial) nails:
Artificial nails should NOT be worn.
Numerous studies validate the increased number of bacteria cultured from the fingertips of persons wearing artificial nails, both before and after hand washing.
State Boards of Cosmetology report that fungal growth occurs more frequently under artificial nails.
The Bottom Line
Even the World Health Organization guidelines on hand hygiene state that wearing artificial acrylic nails can contribute to hands remaining contaminated with pathogens after use of soap or alcohol-based hand gels.[8] Considering all of these recommendations and cautions about long fingernails, nail polish, and acrylic nails, the answer to your question regarding a colleague who still wears artificial nails might be summed up by suggesting that nurses refrain from such a practice in the interest of preventing healthcare-associated infection. All nurses, not just those who care for perioperative patients or others at high risk for infection, should be guided by their conscience and the research data that suggest that both artificial nails and even nail polish can put patients at risk.
CDC or WHO - Artificial Nails and Gels
The CDC guidelines say that health care personnel should not wear artificial nails and should keep natural nails less than one quarter inch long if they care for patients at high risk of acquiring infections (e.g. patients in intensive care units or in transplant units). The WHO guidelines prohibit artificial nails and extenders for all healthcare workers. Will Joint Commission actually be requiring this?
Each organization must follow the IA, IB and IC recommendations from the guideline it chooses (CDC or WHO). Therefore, if WHO is chosen, no direct care providers should have artificial nails or extenders. If CDC is chosen, providers in high-risk areas must not wear artificial nails.
Many organizations following CDC guidelines have chosen to expand the ban on artificial nails, nail gels, gel colors, etc., to all care providers in the interest of safety. Regarding the length of natural nails, each organization may choose its own approach since the level of recommendation in both the CDC and WHO guidelines is "II", thereby making compliance optional.
In addition to the CDC and WHO, organization's requirements should incorporate evidence-based guidelines for specialized and/or procedural areas. AORN, AAMI and APIC are additional examples of resources for such guidelines.
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.
Could we stay on the topic of how these nails affect caregivers and not give meaningless personal opinions about what kind of women wear artificial nails, or what you personally think about them. It's not the point and it's going to offend someone. I'm sure I can't be the only regular poster on AC who has worn or wears nails for myriad reasons and no one needs the baseless judgment.
Now, out of habit, I keep my nails so short they couldn't scratch anyone.
Also, when I worked Elder Care, we could not have long fake nails either. It was as much to protect US as our clients.
Short nails are essential for infection control. When mom gets C-Diff and worker takes it home to her baby, she is not going to be happy at all!
Anyway. There are many studies done about this very thing, how that wearing artificial nails in healthcare environment has directly contributed to more contamination, more infections. Google those and read a few, if you want to have a better understanding of how to approach the topic from a scientific standpoint and you can approach this in a way to enlist the willing compliance of the caregiver. They sound like they want to take good care of your mom and they must not be aware of the potential for problems with the nails.
I see those long fingernails on many caregivers and wonder how the heck they can work with them. Even when using gloves the long nail will cause the glove to tear.
Unfortunately the policy of short finger nails is overlooked more often than not these days.
You can call the agency to report it, then the employee may quit and the employer will be short staffed, so many employers do nothing.
I myself am a handwashing freak but I know the dangers of not following infection control.
I agree 100% long fingernails are an issue when delivering patient care & can’t understand how the employee can perform their job with them (same with computers) but I don’t know the solution.
I used to wear acrylic nails because my own nails were so thin and ugly. I never had a problem scratching myself or tearing delicate skin. And I worked in health care. If I was giving a bath to a patient the washcloth would be between my gloved hand and the patient's skin. Same with toileting. The tissue paper would be between my gloved hand and the delicate skin. Your caregiver's hands should not be coming in contact with your mom's skin during bathing or toileting but not because of her nails but because of hygiene purposes. The caregiver should be gloved any time she has contact with your mom during bathing and toileting.