Evidence Based Paper
Jennifer Fisher
Grand Canyon University
NUR 312
Professor Evinrude & Hemmila
November 12, 2010
Clinical Instructor: Colin
Evidence Based Paper
Population: Patients in the hospital setting
Intervention: program to decrease infection rates in hospital patients
Comparison: Infection rate with use of artificial nails
Outcome: Decreased infection rate of patients
Write out your question: Is there a decreased infection rate in patients who are cared for by nurses with real nails instead of artificial nails?
Introduction
Staphylococcus, pseudomonas, acinitobacter, serratia are all bacteria causing nosocomial infections within the hospital. Washing hands and using gloves are both great protective margins, however, what happens when those barriers break and can no longer protect the patient or healthcare worker? Hospitals are continuing to see a marginal increase in nosocomial infection rates among patients. Best practice for healthcare workers to keep the infection rates down is to refrain from the use of artificial nails, keeping their natural nails short and clean.
Body
In the past years nosocomial infections have greatly increased within the hospital settings. It was found that nearly 98,000 people die annually pertaining to hospital – acquired infections (Aragon, 2005). These infections have been deemed completely avoidable and preventable (Aragon, 2005). However, they are continuing to increase due to multiple factors, namely poor hand hygiene which allows for bacteria to grow and multiply underneath the health care worker’s nails.
In one study it was found that Serratia marcescens, a gram-negative bacilli, was being transferred to the patient’s via a medical professional. Complications including surgical site infection, development of bacteremia, and death all occurred (Passaro, 1997). These complications in such a short amount time caused great concern causing a case study to be opened. In this study there were seven patients in all who met the criteria to be a part of it. This case study was created to trace the route of infection to verify how the patients were developing the nosocomial infections. Through the study it was found that the scrub nurse wore artificial nails, which had Serratia marcescens bacteria under the nails. The bacterium was thus continued when her lotion was contaminated, harboring the bacteria and allowing it to grow (Passaro, 1997). When in the operating room, continuing her patient care, the nurse would then contaminate them thus causing a nosocomial infection. Upon discarding her lotion and removing her artificial nails the nurse had no additional nosocomial cases identified (Passaro, 1997). This case is just one of many that shows the hazards of wearing artificial nails in the hospital setting.
John M. Boyce and Didier Pittet found that bacteria gather in high concentrations in subungual areas of one’s hand (Boyce, 2002). It was further found that these bacteria are “far more likely to be harbor gram – negative pathogens on their fingertips” (Boyce, 2002). With healthcare workers, especially nurses, this bacteria growth is immense and are easily transported from patient to patient thus causing nosocomial infections in patients. Artificial nails are not the only carriers in transmitting infections; long nails are also highly infective. There are two major issues with having long real nails. They are: 1) Higher chance of spreading infections than with short and clean – cut nails and 2) Gloves are easily broken by the long nails (Boyce, 2002). By the gloves breaking it causes further complications in the protection of the healthcare worker, prevention of infection in the patient, thus causing an increased risk of cross – contamination between patients occur (Boyce, 2002).
Conclusion
Nosocomial infections seem to be an ever – present complication of being in the hospital. While there are numerous ways to prevent the spread of infections in the healthcare setting the primary way is through hand hygiene, starting with the healthcare workers fingernails. As seen above and in many other cases that are growing, artificial nails harbor many infectious bacteria that are spread from patient to patient via the nurse, physician, and any other healthcare worker. In order to decrease the alarming infection rates in hospitals, any personnel having patient contact should refrain from the use/wearing of artificial nails.
Resources:
Aragon, D., Sole, M.L., Brown, S. (2005). Outcomes of an infection prevention project focusing on hand hygiene and isolation practices. AACN Clinical Issues. Vol. 16, Number 2, pp. 121-132.
Boyce, J.M, Pittet, D. (October 25, 2002) Guideline for hand hygiene in health-care settings: recommendations of the healthcare infection control practice advisory committee and the hicpac/shea/apic/idsa hand hygiene task force. Found at: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5116a1.htm
Callaghan, C. (2007) Infection control in the neonatal intensive care unit. Nursing Standard. 22.1, 35-41. Date of acceptance: May 25, 2007.
Passaro, D.J., Waring, L., Armstrong, R. et al., Postoperative Serratia marcescens wound infections traced to an out – of –hospital source. J Infect Dis 175 (1997), pp. 992 -995.
Hedderwick, Sara A., McNeil, Shelly A., Lyons, Michael J., Kauffman, Carol A. Pathogenic Organisms Associated with Artificial Fingernails Worn by Healthcare Workers. Infection Control and Hospital Epidemiology. Vol. 21, No. 8 (Aug., 2000), PP. 505-509. Published by: The University of Chicago Press. Found at: htpp://www.jstor.org/stable/30143115 Found on November 12, 2010.
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