What should you do about shellac nails?

Have your staff members' shellac nails raised questions about whether they are artificial and an infection control threat?

This relatively new nail product is considered essentially to be nail polish by the Association of periOperative Registered Nurses (AORN), according to Ramona L. Conner, MSN, RN, CNOR, Manager, Standards and Recommended Practices, AORN.

While shellac is commonly considered to be more durable than other nail polishes, it will chip, Conner warns.

"Just as with nail polish, the shellac polish should be removed and replaced when it is chipped," she says. "Fingernail polish, including shellac, that is chipped may harbor pathogens in large numbers."

AORN's "Recommended Practices for Hand Hygiene in the Perioperative Setting" states: "It has been shown that fingernail polish becomes chipped by the fourth day of wear. Chipped fingernail polish should be removed to prevent possible contamination of the environment or the patient. Glove tears occasionally occur during a surgical procedure; chipped fingernail polish could be deposited on the sterile field or in the wound."

Conner suggests that mangers incorporate this position into their policies and procedures.

This viewpoint on shellac nails is supported by the Centers for Disease Control and Prevention. In its "Guideline for Hand Hygiene in Health-Care Settings," it states: "Freshly applied nail polish does not increase the number of bacteria recovered from periungual skin, but chipped nail polish may support the growth of larger numbers of organisms on fingernails."

It is uncertain how long shellac can be worn before it chips, Conner says. She does offer this caveat, however: "We are not aware of any reports of patient infection resulting from healthcare workers wearing shellac nail polish."

Standards from the Accreditation Association for Ambulatory Health Care (AAAHC) do not specifically address nail polish, says Michon Villanueva, assistant director of accreditation services. "The standards do require that organizations adopt nationally recognized guidelines with regard to infection control. Within those guidelines there may be specific language about nail polish and any associated recommendations," says Villanueva, who points to the AORN guidance. The Joint Commission takes a similar approach, according to a spokesperson.