Healthcare associated infections (HAIs) are considered an important public health problem. In a 2012 report by the Public Health Agency of Canada (PHAC), it was estimated that 5% to 10% of patients hospitalized in Canada will develop a HAI. Pathogens (microorganisms) that cause HAIs can be transmitted from other patients, hospital personnel, or the hospital/medical centre environment. Microorganisms can be transmitted to patients via direct or indirect contact, and health care workers are often the conduit for this transmission. These microorganisms can include such pathogens as Clostridium difficile and antibiotic-resistant organisms such as methicillin-resistant Staphylococcus aureus (MRSA). The hands of a health care worker can become contaminated by any procedures involving contact with patients, including taking a pulse, blood pressure, or body temperature. The health care worker may then have contact with other patients, resulting in cross-transmission or cross-infection from health care worker to patient.
The World Health Organization considers hand hygiene – handwashing using soap and water or a disinfectant hand rub – to be an important process in the prevention of pathogen transmission by the contact route. However, there are questions regarding aspects of hand hygiene which may impact adequate hand disinfection. Two issues are the wearing of hand or wrist jewellery and wearing nail polish. It has been found that skin under rings may be more heavily colonized with microorganisms than the rest of the hand, and that rings may also increase the risk of glove tears. Wrist jewellery may prevent proper washing of the skin, and skin may not be dried properly following handwashing if wrist jewellery is present. As well, chipped nail polish or nail polish worn for more than four days has been shown to foster the presence of microorganisms which resist removal by handwashing. Some guidelines have previously recommended that when performing hand hygiene, nails be free of nail polish, and no wearing of jewellery below the elbows, but it is felt that the evidence supporting these recommendations may be inconclusive. Considering the differing opinions regarding the role that the wearing of nail polish and hand or wrist jewellery might have in impacting disinfection during the handwashing process, this report aims to review the current clinical evidence and evidence-based guideline recommendations for this procedure.
About the Series
Rapid Response Report: Summary with Critical Appraisal
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