Healthcare workers with artificial nails are more likely than those with natural nails to harbour gram-negative pathogens on their fingertips. The consensus recommendations from the World Health Organisation are that healthcare workers do not wear artificial fingernails or extenders when having direct contact with patients and natural nails should be kept short (< 0.5cm long).

Any such targets should first be realistic and attainable, in view of the long-term efforts required to bring about improvements in hand hygiene behaviour.  Aiming for complete compliance in the short term would obviously be difficult to achieve in facilities where initial compliance rate may be less than 40%.

What should be aimed for is the establishment of a baseline, and a steady, sustainable, month by month, year on year improvement.

Patients and visitors should be encouraged to perform hand hygiene on:

entry to a healthcare facility
entry to a ward
prior to visiting a patient
at mealtimes

Having Alcohol-based handrub available in high traffic areas eg. foyers, entrances to wards, with signage about appropriate use with help encourage this.

If relatives and carers are helping to nurse a patient they should be shown how and when to clean their hands during a sequence of care. However, they are unlikely to touch other patients in a similar way so are unlikely to transfer infection to other patients.

Patients can transfer pathogens from one site on their body to another. If patients are having contact with their wound or the insertion site of a device, hand hygiene should be encouraged. In the same way visitors having contact with the patient should perform hand hygiene. In instances where visitors are likely to have physical contact with more than one patient, then hand hygiene should be performed before and after touching a patient, and after body fluid exposure (see The 5 Moments for further details).

Artificial, painted and chipped nails should not be worn in clinical areas as they can harbour microorganisms and are linked with outbreaks of infections.

Please note: This includes all types of nail coverings e.g. Shellac, Gel, SNS etc.

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