It's 'yes' for artificial nails, but not in the OR

AORN, CDC prohibit them on all surg personnel

You have switched from razors to clippers to remove hair, you developed strict, scientifically based protocols for administration of prophylactic antibiotics, and your staff scrub their hands in the proper manner. Although all of these steps reduce the risk of infection in the operating room, have you checked your staff's nails?

Although artificial nails are popular and attractive, they should not be worn by any staff member in an operating room, whether they circulate or scrub in for the procedure, says Carol Petersen, RN, MAOM, CNOR, perioperative nursing specialist at the Center for Nursing Practice, Association of periOperative Registered Nurses (AORN) in Denver. AORN's recommended practice for surgical hand asepsis states that "artificial nails should not be worn, and nails should be kept short, clean, and healthy,"1 she adds.

Artificial nails are defined by AORN as any nail other than a person's natural nail, Petersen points out. This includes acrylic or gel overlays that are bonded to the natural nail, she says. Even though the material is bonded to the nail, there is always a chance for a gap between the natural nail and the overlay so there is an opportunity for microorganisms to develop, she adds.

In addition to AORN recommendations regarding artificial nails, the Centers for Disease Control and Prevention also say health care personnel who care for high-risk patients, such as personnel in intensive care units or operating rooms, should not wear artificial nails and that natural nails should not be more than ¼-inch long, Petersen says.

Outpatient surgery staff members at Columbia St. Mary's Hospital in Milwaukee are not allowed to wear artificial nails, and the policy is clearly spelled out in the hand hygiene policy, says Jane Kusler-Jensen, RN, BSN, MBA, CNOR, director of perioperative services at the hospital. Although the hand hygiene policies are being reviewed, overall, everyone is happy with the requirements, she says. "We don't allow artificial nails of any type, and we only allow nail polish if it's in good condition." Nail polish is in good condition if there are no chips, she says. "It is hard to keep nail polish in good condition in the operating room because the mechanical hand scrub required for the operating room staff is hard on polish as well as artificial nails and creates openings for bacteria," Kusler-Jensen points out.

Use staff audits to monitor hand hygiene

One part of the hand hygiene policy review is a hand hygiene audit that will be conducted throughout the hospital as well as all surgery areas, reports Kusler-Jensen. "We've just finished the pilot project in the surgery department that tested our audit tool, and after evaluating the tool and the data, we'll roll it out to all areas of the hospital," she says.

Operating room coordinators and supervisors conducted the audit by having 50 staff members complete a questionnaire and by observing scrub techniques of all staff members in the operating rooms, Kusler-Jensen explains. "Once we collect the data, we'll use the information to update or enhance our policies and to educate staff members about potential weaknesses in hand hygiene practices," she says.

Although Kusler-Jensen admits that staff members in some units of the hospital are resistant to a ban on all artificial nails, surgery staff members usually don't complain. "Most surgical nurses started surgery at a young age, and they've grown up with the expectation that artificial nails and nail polish are not allowed," she says.

The key to development, implementation, and acceptance of a good hand hygiene policy that addresses nails is to make sure the policy is based on up-to-date, evidence-based practice, recommends Kusler-Jensen. "Remember that the patient's safety is more important than the appearance of someone's nails," she says.


  1. Association of periOperative Registered Nurses. Recommended practices for surgical hand antisepsis/hand scrubs. Standards, Recommended Practices, and Guidelines. Denver, CO: 2007; pp. 565-573.


To see a full copy of the Centers for Disease Control and Prevention hand hygiene guidelines, go to