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Effectiveness of hand hygiene and the condition of fingernails. A qualitative evaluation of nail microbial colonization following hand disinfection, a pilot study

Authors:

Abstract

Effective hand hygiene (HH) among healthcare workers is one of the basic principles of preventing nosocomial infections. The aim of the study was a qualitative examination of microbial colonization of nails following HH. The results were stratified by nail length: short vs. long and the presence of a varnish coating: natural vs. varnished. The presence of potentially pathogenic microorganisms was correlated with nail length, (OR=7.1, 95%CI 1.83-27.39, p<0.001) and the presence of UV-cured nail polish (OR=7.2, 95%CI 1.25-40.91, p<0.05). There is a high probability of ineffective HH when keeping long nails and when UV-cured nail polish is present on them.
Short report
Nail microbial colonization following hand disinfection:
a qualitative pilot study
M.Z. Wałaszek
a,b
, M. Kołpa
a
,A.Ro
´_
za
nska
c
, B. Jagiencarz-Starzec
b
, Z. Wolak
a
,
J. Wo
´jkowska-Mach
c,*
a
Department of Nursing, Institute of Health Sciences, State Higher Vocational School in Tarno
´w, Poland
b
St Łukasz Voivodeship Hospital, Tarno
´w, Poland
c
Department of Microbiology, Jagiellonian University Medical College, Krako
´w, Poland
ARTICLE INFO
Article history:
Received 7 May 2018
Accepted 27 June 2018
Available online xxx
Keywords:
Hand hygiene
Nail polish
UV-cured nails
Gel nails
Hybrid nails
Nurse
Healthcare-associated
infections
SUMMARY
Effective hand hygiene among healthcare workers is one of the basic principles of pre-
venting nosocomial infections. The aim of the study was a qualitative examination of
microbial colonization of nails following hand hygiene. The results were stratified by nail
length: short versus long and the presence of a varnish coating: natural versus varnished.
The presence of potentially pathogenic micro-organisms was correlated with nail length
(odds ratio: 7.1; 95% confidence interval: 1.83e27.39; P<0.001) and the presence of
ultraviolet (UV)-cured nail polish (7.2; 1.25e40.91; P<0.05). There is a high probability of
ineffective hand hygiene when keeping long nails and when UV-cured nail polish is present
on them.
ª2018 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.
Introduction
One of the reasons behind healthcare-associated infections
(HCAIs) can be insufficient hand hygiene among healthcare
workers. Despite raising healthcare workers’ awareness about
the importance of hand hygiene for patients’ safety, it is car-
ried out too infrequently and often ineffectively [1]. Among the
factors influencing the microbiological effectiveness of hand
hygiene is the condition of hands and nails, including the
presence of artificial nail coatings. Numerous studies have
found that artificially attached nails, the so-called nail tips,
may be colonized by pathogenic micro-organisms, which, due
to horizontal transmission, can lead to epidemics [2]. The
matter that has yet to be clarified is the application of various
types of nail coatings often employed for nail protection be-
sides nail polish, e.g. conditioners [3e6].
The present study, conducted among the medical staff of a
multi-specialty hospital, concerns the evaluation of effec-
tiveness of properly conducted hand hygiene using a
* Corresponding author. Address: Department of Microbiology,
Jagiellonian University Medical College, ul. Czysta 18, 31e121 Krako
´w,
Poland. Tel.: D48 12 633 60 33; fax: D48 12 423 39 24.
E-mail address: mbmach@cyf-kr.edu.pl (J. Wo
´jkowska-Mach).
Available online at www.sciencedirect.com
Journal of Hospital Infection
journal homepage: www.elsevier.com/locate/jhin
https://doi.org/10.1016/j.jhin.2018.06.023
0195-6701/ª2018 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.
Journal of Hospital Infection xxx (2018) 1e4
Please cite this article in press as: Wałaszek MZ, et al., Nail microbial colonization following hand disinfection: a qualitative pilot study, Journal of
Hospital Infection (2018), https://doi.org/10.1016/j.jhin.2018.06.023
qualitative assessment of microbiological purity of the finger-
nail area depending on the condition of the nails, their length
and artificial coating. The impact of various artificial coatings
was subjected to special attention. The previous experiences
of the authors indicated poor hand hygiene compliance with
the World Health Organization (WHO) guidelines and numerous
barriers in following them, including ones that were socially
and culturally conditioned, despite the fact that the Polish
recommendations require the application of the Ayliffe tech-
nique in accordance with the WHO regulations [1,7].
Methods
The study was carried out in a hospital in Małopolska,
Poland, in which out of 686 nurses and midwives (NMs)
employed, a sample of 110 NMs was drawn comprising em-
ployees who worked in various hospital units. Healthcare
workers qualified for the study needed to have healthy and
undamaged hand skin and healthy fingernails. Each NM had an
opportunity to be selected; the draw was conducted using a
standardized table of random numbers. The study was carried
out from January to December 2017. The control group was NMs
with natural fingernails, whereas the test group was divided
into four subgroups in terms of the type of coating covering the
nails:
1. Traditional nail polish; nail varnish applied directly to the
nail plate; its durability is short.
2. Varnish-type conditioners; nail conditioner applied directly
on the nail plate.
3. Hybrid ultraviolet (UV)-cured coatings; varnish which is
cured with UV rays following its application; it is durable
and highly glossy, does not chip off and has a non-porous
structure.
4. Gel UV-cured coatings; varnish which cures and extends the
nail plate; varnish is smooth, non-porous and very hard.
The downside of the application of the traditional nail polish
and varnish-type conditioners is their rapid wear at the edges
and chipping. Whereas the hybrid- and gel-type varnish does
not chip off or wear, it can remain intact on the nails for as long
as 14 days; however, as the nails regrow, gaps appear at the
base. The study protocol did not include a question about how
long the nail polish was in place.
Taking material for the study was preceded by a conversa-
tion with the researcher, who informed the subject about the
rules of hand hygiene according to the Ayliffe technique and
controlled the course of the procedure directly. The materials
were taken in the place of work of the studied subjects, always
after alcohol-based hand rub (Skinman Soft, Ecolab, Krako
´w,
Poland). The researcher also assessed the condition of the
fingernails, including measuring the lengths of nail plates
extending beyond the fingertip and the coating. Short finger-
nails were defined as 0.2 cm and not extending beyond the
fingertip in visual assessment. Natural nails were defined as not
having any varnish on them. None of the subjects had artificial
nails (nail tips).
Swabs from the nail area (nail plate, under the nail plate,
around the nail plate) were taken immediately after the
properly performed hand hygiene procedure, using a sterile
polystyrene loop with the capacity of 1
m
L for each finger
individually. Subsequently, the same activity was repeated by
taking material using a swab. Following the swab from all fin-
gernails of the right hand, the loop and swab without substrate
were placed directly in Tryptic Soy Broth and shaken in order to
homogenize the suspension. The same procedure was applied
when taking material from the other hand. The results for both
hands were pooled to obtain one NM result.
The tests were performed while respecting the rules of
anonymity of the participants. The material taken was coded
and the participants in the study received access codes for
their own results only.
The suspension was incubated for 24 h at 35e37C in aerobic
conditions and then cultured on Columbia Agar medium with
the addition of 5% sheep blood and reincubated while main-
taining the above conditions. Identification of micro-organisms
was performed using the semi-automated Phoenix system
(BectoneDickinson, Rungis, France) according to standard
methods. Because the nail size differed between individuals,
we could not compare culture results quantitatively; the cul-
tures were therefore evaluated only qualitatively. For the
purposes of this study, the micro-organisms cultured from the
(around) nail area were divided into two groups: bacteria
characteristic of the natural flora of dry, healthy human skin,
and other (remaining) potentially pathogenic bacteria [8].An
NM was considered as having pathogenic flora if at least one
pathogenic bacterium had been identified. Ineffective hand
hygiene was defined as isolating pathogenic bacteria following
the performance of a technically correct Ayliffe technique
procedure.
During the study, there were no significant changes in the
hospital in regard to the epidemiology or microbiology of
HCAIs; there were also no outbreaks.
The statistical analysis of the collected material employed
the SPSS Statistics 24 program (IBM, Armonk, NY, USA). Calcu-
lations included: the average, median, standard deviation (SD),
and 95% confidence interval (CI). For properties ordinal or
dichotomous in character, information on the number and
percentage share of individual variants was used. The level of
(Pearson’s
c
2
-test) statistical significance was calculated for
the ordinal and nominal scale, Fisher’s
c
2
-test for variables of
small value, and analysis of variance for the quantitative scale.
The assumed level of statistical significance was P<0.05.
Spearman’s rank correlation coefficient was employed to
describe correlation strengths for the qualitative variables
studied. In order to calculate the probability of occurrence of
the phenomena studied, odds ratio (OR) was determined with
95% CI.
The use of data was approved by the Bioethical Committee
of the Jagiellonian University (no. KBET/122.6120.118.2016).
Results
The study included 99 NMs working in 10 hospital wards,
with a median age of 45 years; 11 nurses from the drawn group
were excluded due to having dermatological conditions. Forty-
five NMs (46%) had natural nails, and 44 (44%) had nail polish in
the form of traditional varnish (N¼10), conditioner in the form
of a colourless varnish (N¼11), curing hybrid (N¼15) and gel
(N¼7) varnish. The NMs who had natural fingernails were
chronologically one year younger than those who had finger-
nails covered with artificial coatings (P¼0.483), and they had
two years less seniority (P¼0.239). Forty (40%) NMs had long
M.Z. Wałaszek et al. / Journal of Hospital Infection xxx (2018) 1e42
Please cite this article in press as: Wałaszek MZ, et al., Nail microbial colonization following hand disinfection: a qualitative pilot study, Journal of
Hospital Infection (2018), https://doi.org/10.1016/j.jhin.2018.06.023
nails. NMs with artificially coated nails worked significantly
more often in surgical units (gynaecologyeobstetrics and
neurosurgery). These wards also had the highest proportion of
nurses with long nails. There was a significant association be-
tween the fingernail length and the use of nail polish: the
longer the nails, the more frequently they were covered with
some kind of varnish (Spearman’s rank correlation coefficient
r¼0.214; OR: 2.5; 95% CI: 1.07e5.68; P<0.05).
Following proper hand hygiene, both commensal and
potentially pathogenic micro-organisms were cultured in the
spaces around the nail. There was no association between
either nail length or nail coating and the number of colony-
forming units of commensal flora (OR: 1.7; 95% CI: 0.70e4.42;
P¼0.265 and OR: 2.1; 95% CI: 0.88e5.12, respectively;
P¼0.170) (Table I). However, potentially pathogenic micro-
organisms (Table II) were isolated significantly more
frequently in the case of long fingernails (OR: 7.1; 95% CI:
1.83e27.39; P<0.001) and in the group with varnished nails
(OR: 6.1 95%; CI: 1.29e29.12; P<0.05) regardless of the type
of varnish (Table I). Nails covered with hybrid and gel UV-cured
nails significantly increased the risk of ineffective hand disin-
fection in comparison to the control (OR: 7.2; 95% CI:
1.25e40.91; P<0.05 and OR: 9.2; 95% CI: 1.29e65.37,
respectively; P<0.05) (Table III).
Discussion
A high proportion of healthcare workers with fingernails
with artificial coatings was found, especially in surgical wards,
which, unfortunately, indicates poor effectiveness of the nail
polish ban among the Polish NMs. To date, reports have focused
on the problem of transmission of micro-organisms by staff with
attached (artificial) fingernails in the ‘nail tips’ type [2].
Fortunately, this fashion has largely passed, including among
the Polish healthcare workers.
Our results indicate that for effective hand hygiene, keep-
ing the nails at an appropriate length may be at least as
important as avoiding the use of nail varnish coatings. The
problem with longer nails is presumably the lack of efficacy of
hand hygiene using the rub method. Indeed we found that
disinfection of hands with short varnished fingernails was in
some instances as effective as in the control group; other
studies have also reported that healthy short nails, even when
covered with varnish, can be disinfected effectively
[3,5,6,9,10].
Table I
Micro-organisms cultured from materials obtained from short and long nails as well as natural and varnished nails following a properly
conducted hand disinfection
Microbial species Fingernails
a
Total P-value;
OR (95% CI)
Fingernails
a
Total P-value; OR
(95% CI)
Short
(N¼59)
Long
(N¼40)
Natural
b
(N¼45)
With
varnish
c
(N¼44)
Gram-positive cocci
(potentially pathogenic)
10 (10.1%) <0.001;
7.1 (1.83e27.39)
11 (11.1) <0.05;
6.1 (1.29e29.12)
Staphylococcus aureus 1 (1.7%) 3 (7.5%) 4 (4.0%) 1 (2.2%) 2 (4.5%) 3 (3.0)
Streptococcus mitis 0 2 (5.0%) 2 (2.0%) 1 (2.2%) 1 (2.3%) 2 (2.0)
Enterococcus faecalis 0 3 (7.5%) 3 (3.0%) 0 4 (9.1%) 4 (4.0)
Enterococcus faecium 1 (1.7%) 0 1 (1.0%) 0 2 (4.5%) 2 (2.0)
Enterobacteriaceae
(potentially pathogenic)
4 (4.0%) 3 (3.0)
Citrobacter freundii 1 (1.7%) 1 (2.5%) 2 (2.0%) 0 1 (2.3%) 1 (1.0)
Escherichia coli 0 1 (2.5%) 1 (1.0%) 0 1 (2.3%) 1 (1.0)
Klebsiella spp. 0 1 (2.5%) 1 (1.0%) 0 1 (2.3%) 1 (1.0)
Total 3 (5.1%) 11 (27.5%) 14 (14.1%) 2 (4.4%) 12 (27.3%) 14 (14.1)
Commensal bacteria
Coagulase-negative
staphylococci
39 (66.1%) 31 (77.5%) 70 (70.1) 0.265;
1.7 (0.70e4.42)
12 (26.7%) 19 (42.2%) 31 (31.3) 0.170;
2.1 (0.88e5.12)
OR, odds ratio; CI, confidence interval.
a
Values refer to the number of NMs with a potentially pathogenic microbe cultured on nails.
b
Nails (long and short) without varnish.
c
Nails (long and short) with varnish (type: conditioner, traditional varnish or hybrid/gel UV-cured varnish).
Table II
Analysis of varnish type versus nail length
Varnish type Long nails Short nails Total P-value OR (95% CI)
Varnish 5 (55.6%) 4 (44.4%) 9 (100%) 0.142 3.1 (0.71e13.30)
Conditioner 2 (13.3%) 13 (86.7%) 15 (100%) 0.313 0.4 (0.07e1.91)
Cured: hybrid 11 (55.0%) 9 (45.0%) 20 (100%) 0.055 3.0 (1.01e8.96)
Cured: gel 9 (90.0%) 1 (10.0%) 10 (100%) <0.001 22.2 (2.54e192.91)
Natural nails (control) 13 (28.9%) 32 (71.1%) 45 (100%) <0.01 e
OR, odds ratio; CI, confidence interval.
M.Z. Wałaszek et al. / Journal of Hospital Infection xxx (2018) 1e43
Please cite this article in press as: Wałaszek MZ, et al., Nail microbial colonization following hand disinfection: a qualitative pilot study, Journal of
Hospital Infection (2018), https://doi.org/10.1016/j.jhin.2018.06.023
Short unvarnished nails enabled medical workers to perform
effective hand hygiene. Whereas we would not advocate
allowing the use of any nail varnish, our finding that ineffective
disinfection was closely associated with hybrid and gel UV-
curing indicates that these types of coatings should be
strictly prohibited in healthcare. The fact that natural and
varnished nails can be shortened easily at any time, whereas
UV-cured fingernails are less likely to be regularly shortened,
given that this is a professional cosmetic procedure, may be a
key reason for the difference.
The main limitation of this study is the relatively small
number of participants/subjects. Another limitation is that
our method for assessment of the flora forming the normal
hand skin flora was qualitative rather than quantitative, and
focused on the nail rather than on the whole hand. Never-
theless, we believe that our results point to a need for
research among NMs, examining social and cultural issues
relating to nail care, as well as larger studies to determine the
relative importance of length of nails and different nail var-
nish techniques for good hand hygiene, especially in countries
such as ours where it is difficult to outlaw the use of nail
varnish among NMs.
Conflict of interest statement
None declared.
Funding sources
None.
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Table III
Isolation of potentially pathogenic microbes in comparison to the natural fingernails as control
Varnish type Positive culture Negative culture Total P-value
a
OR (95%CI)
Varnish 2 (22.2%) 7 (77.8%) 9 (100%) 0.125 6.1 (0.73e51.00)
Conditioner 2 (13.3%) 13 (86.7%) 15 (100%) 0.258 3.3 (0.42e25.84)
Cured: hybrid 5 (25.0%) 15 (75.0%) 20 (100%) <0.05 7.2 (1.25e40.91)
Cured: gel 3 (30.0%) 7 (70.0%) 10 (100%) <0.05 9.2 (1.29e65.37)
Natural nails (control) 2 (4.4%) 48 (95.6%) 45 (100%) 0.159 e
OR, odds ratio; CI, confidence interval.
M.Z. Wałaszek et al. / Journal of Hospital Infection xxx (2018) 1e44
Please cite this article in press as: Wałaszek MZ, et al., Nail microbial colonization following hand disinfection: a qualitative pilot study, Journal of
Hospital Infection (2018), https://doi.org/10.1016/j.jhin.2018.06.023
... Sağlık bakımı ilişkili infeksiyonlar, önemli bir sağlık sorunudur ve bu infeksiyonların oluşmasının arkasındaki nedenlerden birisi sağlık çalışanlarının yetersiz el hijyenidir [1] . Mikroorganizmalar çoğu zaman sağlık çalışanlarının elleriyle taşınmakta ve bu yolla sağlık hizmetiyle ilişkili infeksiyon oranları artmaktadır [2] . ...
... Her ne kadar KNS koloni sayılarında iki hastane ve bölümleri arasında farklılık görülmüş olsa da patojen olarak kabul edi- [25] . Walaszek ve arkadaşları kullanılan oje farklılıklarının da (ultraviyole ve hibrit gibi) el hijyeninin sağlamada etkili olduğunu bildirirken tırnak uzunluğunun önemli olduğunu vurgulamışlardır [1] . Sonuçlar karşılaştırıldığında bu çalışmada kontrol grubundan alınan örneklerde patojen insidansları %5.6, deney grubu 1 için %4.05 ve deney grubu 2 için %7.1 olarak bulunmuş ve literatüre göre oranın daha düşük olduğu görülmektedir. ...
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Z Giriş: İnfeksiyonların önlenmesinde ameliyathane ve yoğun bakım gibi özellikli birimlerde çalışanların el hijyeninin sağlanması oldukça önemli, en etkili ve en ucuz yöntemdir. Bu çalışma; ameliyathane ve yoğun bakımlarda hemşirelerin oje kullanımının ellerdeki bakteriyel üreme üzerine etkisini belirlemek amacıyla planlandı. Materyal ve Metod: Çalışmanın evrenini bir ilde bulunan eğitim araştırma ve devlet hastanesinin yoğun bakım ünitelerinde ve ame-liyathanelerinde çalışan hemşireler oluşturdu. Çalışma yoğun bakımlarda 43, ameliyathanelerde 29 olmak üzere çalışmaya katılmayı kabul eden toplamda 72 hemşirede gerçekleştirildi. Araştırmaya katılanların el florası üzerindeki bakteri kolonizasyonunu ölçmek için hemşirelerinden önce ojesiz hijyenik el yıkama sonrası ilk örnek, oje sürüldükten 24 saat sonra hijyenik el yıkama sonrası ikinci örnek ve oje sürüldükten 72 saat sonra hijyenik el yıkama sonrası üçüncü örnek alındı. Hemşirelerin tırnak ve ellerinden alınan örnekler kanlı agar besiyerlerine ekilerek sonuçlar değerlendirildi. Bulgular: Hemşirelerden üç aşamada alınan örneklerde, toplam üreyen koloni sayısı açısından bakıldığında gruplar arası hem sağ ve sol el, hem de sağ ve sol tırnaklarda, istatistiksel olarak anlamlı bir fark olmadığı görüldü (p≥ 0.05). Alınan örneklerde koagülaz negatif stafilokok (KNS), Staphylococcus aureus, Bacillus spp., Enterococcus spp., Streptococcus pyogenes, Acinetobacter spp., Klebsiella spp., Candida spp. ve Non-candida mantar türlerinin ürediği tespit edildi. Bu türler arasında en sık üreyen mikroorganizmanın KNS olduğu görüldü. Ayrıca üreyen toplam koloni sayıları açısından yoğun bakım ve ameliyathaneler karşılaştırıldığında sağ el, sağ ve sol tırnaklarda fark görülmezken, sol elde üreyen toplam koloni sayısı ameliyathanede çalışan hemşirelerde anlamlı şekilde daha yüksek bulundu (p≤ 0.05). Sonuç: Ameliyathane ve yoğun bakım hemşirelerinde bütünlüğü bozulmamış oje kullanımının 72 saate kadar eldeki bakteriyel üreme üzerine etkisinin olmadığı bulundu. Anahtar Kelimeler: El hijyeni; Ameliyathane; Yoğun bakım; Hemşire; Sağlık bakım ilişkili infeksiyonlar Makale atıfı: Yiğit Ü, Soysal GE, Özarslan TO, İlçe A, Sırmatel F, Akdeniz H. Oje kullanımının eldeki bakteriyel üreme üzerine etkisi. FLORA 2021;26(3):528-36. KLİNİK ÇALIŞMA/RESEARCH ARTICLE flora FLORA 2021;26(3):528-536 • Introduction: In the prevention of infections, hand hygiene is a very important, the most effective and inexpensive method. In studies on the use of nail polish, its impact on hand hygiene is not clear. The aim of this study was to determine the effect of nail polish use of nurses in operating rooms and intensive care units on bacterial growth in hands.
... The 100% growth rate from the hands of nurses was higher than the growth rates identified in two studies, ranging from 5.1% to 77.5%. 40,45 The growth from this study was in keeping with studies assessing damaged skin and poor nail hygiene. 40,45 There were no specific studies identified that assessed the hand hygiene of only surgeons in the OT environment. ...
... 40,45 The growth from this study was in keeping with studies assessing damaged skin and poor nail hygiene. 40,45 There were no specific studies identified that assessed the hand hygiene of only surgeons in the OT environment. ...
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Background Effort is invested in maintaining sterility of the operating field, but less attention is paid to potential healthcare associated infection (HAIs) sources through patient contact by non-scrubbed healthcare providers (HCPs). A single microbiological assessment of hands can provide a good assessment of the potential dynamic transmission of microorganisms. The aim of this study was to identify and quantify the microbial growth on the hands of HCPs in the operating theatres of Chris Hani Baragwanath Academic Hospital.MethodsA prospective, contextual and descriptive study design was followed. Seventy-five samples were collected using convenience sampling from an equal number of surgeons, anaesthetists and nurses. Specimens were taken using agar platesand underwent semi-quantitative analysis.ResultsAll hands of HCPs displayed growth, of which 82% grew commensals and 80% grew pathogens. Twelve commensal microorganisms and 27 pathological microorganisms were noted. Two or more organisms were cultured on 76% of HCPs’ hands. Comparisons of commensal, pathological and combined levels of contaminationamong the three groups were not statistically significant (p=0.266, p=0.673, p=0.180). There was no significant difference between the growth of combined microorganisms (p=0.927)and pathological microorganisms (p=0.499) among the groups.Surgeons had significantly more commensal growth (p=0.019) than anaesthetists and nurses. There was no statistically significant difference between sexes (p=0.611).Conclusion It was concerning that 100% of the hands of HCPs who were about to commence with the surgical list had microbial growth. These HCPs could have already been in contact with patients and equipment in the theatre environment. Microorganisms cultured on hands are a source of cross-transmission which may result in HAIs. Institutions require the implementation of a multidimensional model to amend guidelines, implement guidelines and increase awareness of hand hygiene.
... Numerous studies have confirmed that the presence of jewelry on the hands of medical workers can be the reason for their ineffective disinfection (18)(19)(20)(21). In a study that was conducted in Poland in 2017, which examined 100 nurses, as many as 28% of the subjects wore rings or wedding bands (22). The study by Martin (23) shows that an attempt DYSKUSJA Badani przez nas respondenci prezentowali wysokie poparcie dla przestrzegania zasad higieny rąk, mimo to w praktyce realizowali te zasady znacznie rzadziej. ...
... Liczne badania udowodniły, że obecność biżuterii na dłoniach pracowników medycznych może być przyczyną nieskutecznej ich dezynfekcji (18)(19)(20)(21). W badaniu przeprowadzonym w Polsce w 2017 roku, w którym zbadano 100 pielęgniarek, aż 28% z nich nosiło na dłoniach pierścionki lub obrączkę (22). Badanie Martin (23) pokazuje, że próba wdrożenia zasady "nic poniżej łokcia" może być trudnym przedsięwzięciem w zakładach opieki zdrowotnej. ...
Article
Introduction: The guidelines issued by the World Health Organization (WHO) in 2009 regarding hand hygiene (HH) in health care provided health care professionals with scientific evidence that argued that HH principles should be respected when dealing with patients. Despite the passage of years and strenuous attempts to introduce these recommendations to the Polish health care facilities for the prevention of healthcare-associated infections (HAI), these principles are still not being implemented in an optimal way for the patient's safety. Objective of work: The aim was to examine the views and attitudes of physicians (L) and nurses (P) towards the WHO rules of hand hygiene. Material and methods: The study was performed by means of a diagnostic survey using a questionnaire of our own design; random sampling was used. The study involved 231 LP: 173 (74.9%) women, 58 (25.1%) men, including 93 (40.3%) doctors and 138 (59.7%) nurses. The study was conducted in a multiprofile hospital in Małopolska in 2017. The difference between what the respondents think (their views) and what they do in reality (what attitudes they display) was examined in relation to WHO principles, such as wearing natural short nails and jewelry on their hands. Results: Negative practice of observing these HH principles in relation to views was detected (R = -0.014, p<0.05, R2 = 0.016). Respondents supported the view that the ring could affect HAI and rarely used it in practice, the practice was positive (R = 0.298, p <0.001, R2 = 0.085). Women strongly emphasized the view that wearing long nails has an impact on HAI spread, but in practice they often declared keeping long nails, practice was negative (R = -0.241, p <0.01, R2 = 0.054). In response to the question about the impact of nail painting on the spread of HAI, this view was poorly represented, in practice some of them wore painted nails, the practice was negative (R = -0.226, p <0.01, R2 = 0.045). Conclusion: Despite high support for the principles of hand hygiene, in practice, these principles were not always respected, the impact on the practice was negative in areas such as: general adherence to the HH principles, wearing long and painted nails. The compatibility of views with practice was detected in relation to wearing a wedding ring.
... Children get sick from contaminated hands if they don't wash hands frequently with soap and keep their fingernails short. The area beneath the fingernails has the highest concentration of microorganisms on the hands and is the most difficult to clean [75][76][77][78]. Mouthing of soil contaminated materials is also the other direct impact of fecally contaminated soil in exposure to intestinal parasites. ...
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Background Children in low-resource settings are exposed to multiple risk factors for enteropathogens. However, the probability of exposures may be different across exposure pathways. Accordingly, this study was conducted to assess environmental exposures of children to intestinal parasites in the east Dembiya district of Ethiopia. Methods A cross-sectional study was conducted for 372 households with children aged 24–59 months. The potential for external exposure of children to intestinal parasites was assessed by determining the presence of fecal indicator organism ( Escherichia coli ( E. coli )) in drinking water at point of use, ready-to-eat foods, and courtyard soil from children’s outdoor play areas. For internal exposure assessment, ova of parasites in stool samples was detected using wet mount and Kato-Katz techniques to estimate exposure to intestinal parasites. The external and internal exposure assessments were also complemented using questionnaire and spot-check observations to assess behaviors that result in high risk of exposure. Individual and community-level predictors of intestinal parasites were identified using a multilevel logistic regression model. Statistically significant variables were identified on the basis of adjusted odds ratio (AOR) with 95% confidence interval (CI) and p -value < 0.05. Results Ova of one or more intestinal parasites was detected among 178 (47.8%) (95% CI 42.8, 52.6%) of the children. The most common intestinal parasites were A. lumbricoides (20.7%) and S. mansoni (19.1%). Furthermore, E. coli was detected in 69.1% of drinking water samples at point of use, 67.5% of ready-to-eat food samples, and 83.1% of courtyard soil samples from children’s outdoor play areas. Exposure of children to intestinal parasites among children in the studied region was associated with poor hand hygiene of mothers (AOR 1.98, 95% CI (1.07, 3.66), poor hand hygiene of children (AOR 3.20, 95% CI (1.77, 5.77), mouthing of soil contaminated materials (AOR 2.31, 95% CI (1.26, 4.24), open defecation practices (AOR 2.22, 95% CI (1.20, 4.10), limited access to water (AOR 2.38, 95% CI (1.13, 5.01), water contamination (AOR 2.51, 95% CI (1.31, 4.80), food contamination (AOR 3.21, 95% CI (1.69, 6.09), and soil contamination (AOR 2.56, 95% CI (1.34, 4.90). Conclusion An extensive E. coli contamination of water, foods, and courtyard soil was found in the studied region and the potential sources of contamination were open defecation practices, unhygienic disposal of wastes, poor animal husbandry and keeping practices, and poor water and food safety measures at household level. Moreover, fecal contamination of water, foods, and soil linked to exposure of children to intestinal parasites in the studied region. Thus, it is critical to implement individual-level interventions (such as latrine utilization, hand hygiene promotion, food safety, home-based water treatment, and containment of domestic animals), plus community-level interventions (such as protecting water sources from contamination, source-based water treatment, and community-driven sanitation).
... The microbiota of the hair and fingernails, highly keratinized structures, is highly variable among human beings, but the presence of unique individual signatures might have applications in forensic science [78]. Moreover, fingernails can be easily colonized by a range of microbes, including pathogens that can represent a possible source of infection [79][80][81]. ...
Article
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The human skin microbiota is essential for maintaining homeostasis and ensuring barrier functions. Over the years, the characterization of its composition and taxonomic diversity has reached outstanding goals, with more than 10 million bacterial genes collected and cataloged. Nevertheless, the study of the skin microbiota presents specific challenges that need to be addressed in study design. Benchmarking procedures and reproducible and robust analysis workflows for increasing comparability among studies are required. For various reasons and because of specific technical problems, these issues have been investigated in gut microbiota studies, but they have been largely overlooked for skin microbiota. After a short description of the skin microbiota, the review tackles methodological aspects and their pitfalls, covering NGS approaches and high throughput culture-based techniques. Recent insights into the “core” and “transient” types of skin microbiota and how the manipulation of these communities can prevent or combat skin diseases are also covered. Finally, this review includes an overview of the main dermatological diseases, the changes in the microbiota composition associated with them, and the recommended skin sampling procedures. The last section focuses on topical and oral probiotics to improve and maintain skin health, considering their possible applications for skin diseases.
... Following the survey, mothers were informed about "correct hand washing," "using paper towels to close the taps," and "nail hygiene." [12][13][14] The independent variables were educational status, family type, the number of children, and monthly income, and the dependent variables were parameters of mothers' personal and nutritional hygiene practices related to prevention of gastroenteritis and their approach to the child with gastroenteritis/diarrhea. Besides descriptive statistics in the analysis of the data, the chi-square test was used to compare categorical data and independent t-test was used to compare numerical data. ...
Article
Gastrointestinal infection is an important public health problem in children and is frequently seen in developing countries due to low socioeconomic status and education levels, not obeying hygiene rules, and lack of environmental sanitation. Prevention of diarrheal diseases and raising the awareness of the mothers about diarrhea/gastroenteritis is a very important subject. The aim of this study was to evaluate the knowledge and attitude of the mothers, who attended a pediatric outpatient clinic for any reason, about the management and prevention of gastroenteritis in children. This cross-sectional study was performed in Konya, Turkey. The study was carried out with mothers who attended the pediatric outpatient clinic of a faculty of medicine and who had a baby between 0 and 2 years of age. Surveys prepared according to the literature, were used for collecting data. Descriptive statistics, chi-square test, and independent t-test were used for data analysis. A p-value of < 0.05 was considered to be significant. The mean age of mothers was 31.7 ± 7.2 years. Of all the mothers, 97.2% had short nails, 76.3% regularly cleaned their nails once a week, and 92.2% used soap for hand washing every time. A mean score of 8.7 ± 2.8 for a question giving 12 situations where hand washing was necessary was obtained. Of the mother's babies, 40.3% had had diarrhea at least once. In terms of giving baby water and changing feeding behavior during diarrhea/gastroenteritis, significant differences were found between mothers whose babies had diarrhea/gastroenteritis previously and those whose babies had not experienced diarrhea/gastroenteritis. 83.6% of mothers had never heard about vaccination against rotavirus. Washing hands correctly and mothers' knowledge about proper water and food hygiene are important points in protecting children against diarrheal and gastroenteritis diseases. However, there is lack of knowledge and good practice, both in protecting children from, and managing children with, diarrhea. Thus, we believe that it would be beneficial to inform and educate mothers with little children, regularly about these issues.
... Há evidências que esfregar as mãos com solução a base de álcool por um tempo inferior a 15 segundos e maior de 30 segundos não reduz em maior quantidade os microrganismos do que realizar o procedimento em 30 segundos [26]. Como também que a eficácia da higienização das mãos entre os profissionais da saúde pode ser afetada e consequentemente reduzida na presença de unhas longas e esmalte de unha quando comparado, respectivamente, unhas curtas e sem esmalte [27]. ...
Article
Objetivo: Verificar a eficácia da lavagem das mãos no controle de disseminação de microrganismos. Método: Delineamento experimental realizado em universitários da área da saúde, utilizando como antissépticos água e sabão e álcool 70% (gel e liquida). Os procedimentos de lavagem simples das mãos e uso de álcool 70% foram distribuídos em cinco grupos: Grupo sem lavagem das mãos (MS); Grupo lavagem simples das mãos com água e sabão (LS); Grupo lavagem das mãos com água e sabão e uso de álcool 70% (liquido) (LSA70), Grupo lavagem das mãos com água e sabão e uso de álcool 70% (gel) (LSAG) e Grupo apenas com uso de álcool gel (MAG). Resultados: Participaram do estudo 125 universitários. Foi observada significância estatística quando comparado os seguintes grupos: MS versus MAG (p<0,001), MS versus LSA70 (p<0,001), LS versus MAG (p<0,05), MS versus LSAG (p<0,001), LSAG versus MAG (p<0,001) e LSAG versus LSA70 (p<0,05). Conclusão: O álcool 70% foi eficaz na redução de crescimento de microrganismos em relação à lavagem simples das mãos. O álcool em forma de gel demonstrou ter melhor resultado quando aplicado sem a lavagem previa das mãos enquanto que o álcool na forma liquida foi mais eficaz após a lavagem das mãos.
... The personnel did not accept the patient as a partner who could remind them of HH, while the patients were reluctant to do so and it was rare that it occurred [17]. There are numerous non-medical (e.g., cultural) difficulties in the implementation of HH principles (e.g., among the Polish nurses and midwives, as many as 40% wear long nails at work, which are also varnished) [18]. Regrettably, the results of this study suggest big problems associated with the practical implementation of the principles of standard isolation, as none of the medical worker groups studied demonstrated full support for their application. ...
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Standard precautions (SPs) guidelines are the minimum infection prevention practices that apply to all types of patient care, regardless of suspected or confirmed infection status of the patient. They are based on risk assessment, make use of common sense practices and personal protective equipment that protect healthcare providers from infection and prevent the spread of infection from patient to patient. The aim of this study was to determine medical staff's attitudes towards SPs and analyse the factors shaping these attitudes. The study was conducted using a questionnaire that comprised 25 statements describing the attitudes of medical personnel towards SPs. They were designed to pinpoint the factors that determine these attitudes. There were five factors identified that shape employees' attitudes towards SPs: assessment of the situation, favourable patterns of behaviour, negative norms, unfavourable patterns of behaviour and rationalising. The study analysed 505 questionnaires filled in by hospital workers from five Polish cities. The majority of the respondents were women (92.1%), nurses (87.5%); the average age was 41.8 and the average seniority was 19.2 years. Over one-third of the respondents worked in non-surgical (36.4%) and surgical (31.6%) wards, 12.3% were employed in intensive care units (ICUs) and 8.9% in emergency departments (EDs). The variable significantly affecting the level of acceptance of SPs was seniority: initially the support was high, then it later decreased, with the greatest decrease occurring between the third and eighth year of work. The staff of medical wards and ICUs demonstrated significantly lower support for SPs and strong environmental impact on SPs perception; low degree of acceptance among medical ward staff correlated negatively with factors from the category "favourable patterns of behaviour". The substantially strongest support for SPs was found in ED workers. The results indicate the need for continuous education of individual groups of workers concerning the application of SPs, but also the necessity to change the organisational culture in Polish hospitals.
Article
Objective: To evaluate the effectiveness of handwashing with water and wood ash in reducing faecal contamination of the hands. Design: A cluster randomised controlled trial was employed with two arms: handwashing with water and wood ash versus handwashing with water alone. Setting: Rural households of East Dembiya District, Central Gondar Zone, Amhara National Regional State, Ethiopia. Participants: 440 mothers and caregivers of children younger than 5 years assigned (1:1, 220 in each group) in clusters, with buffer zones between each cluster. Intervention: Health education on effective handwashing was given to the intervention and control groups. Participants in the intervention group used wood ash of the same quantity (ie, one closed palm). Outcome measures: The primary outcome was microbial contamination of the hands, measured by means of Escherichia coli counts before and after handwashing. Results: At baseline, 75.9% and 67.7% of the participants in the intervention and control groups, respectively, had dirt on their fingernails, and the hands of all participants in both groups were contaminated with E. coli. The mean E. coli counts recovered at baseline were 3.07 log10 colony forming unit (CFU)/swab in the intervention group and 3.03 log10 CFU/swab in the control group, while at endline it was 1.4 log10 CFU/swab in the intervention group and 3.02 log10 CFU/swab in the control group. The mean E.coli counts was reduced by 1.65 log10 due to the intervention (difference-in-differences: β= -1.65, 95% CI= -1.84 to -1.46). Conclusion: Two-thirds of the swab samples tested positive for E. coli after handwashing with water and wood ash, which indicates wood ash is not very effective in terms of completely removing micro-organisms on the hands. However, wood ash was significantly better than water alone in reducing the concentration of faecal coliform organisms on the hands. Local health authorities should primarily promote handwashing with soap. However, in the absence of soap, use of wood ash over water alone might be appropriate. Trial registration number: PACTR202011855730652.
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The commensal microbiome influences skin immunity, but its function in toenail health remains unclear. Paronychia is one of the most common inflammatory toenail diseases, but antibiotic treatment is seldom effective in clinical cases. In this study, we performed 16S rRNA sequencing to investigate the characteristics of microbes associated with paronychia in order to identify the key microorganisms involved in inflammation. Seventy dermic samples were collected from patients with paronychia and the differences in dermic microbiota were analyzed in patients with different inflammation severities. Distinct clustering of dermal microbiota was observed in the dermis with different inflammation severities. A higher relative abundance of anaerobic microorganisms such as Parvimona , Prevotella , and Peptoniphilus was observed in severe paronychia, whereas Lactobacillus disappeared with disease progression. Co-occurring network analysis suggested that the disturbance of the dermic microbiome and attenuation of antagonism by Lactobacillus against anaerobic pathogens may aggravate inflammation in paronychia. Functional analysis showed that dermic microbiome disturbance may worsen microbial metabolism and tissue repair in the skin. In conclusion, we revealed that an increased abundance of anaerobic microorganisms and loss of Lactobacillus in the dermis may promote paronychia progression and microbiological imbalance may aggravate inflammation in patients with paronychia.
Article
The role of pre-operative disinfection of the surgeon's hands and the skin of the operative site in the prevention of wound infection remains uncertain. The normal resident skin flora, consisting mainly of coagulase-negative staphylococci and aerobic and anaerobic diphtheroids, is an uncommon cause of infection except in prosthetic operations. Staphylococcus aureus is rarely a resident on normal skin other than the perineum, and is mostly present on the hands as a transient acquired from the nose. Nevertheless, it seems rational to kill or remove all transients on the hands of the surgeon and reduce residents to low levels. Surgical skin disinfection is usually assessed by measuring the reduction in organisms on the hands immediately after disinfection, after repeated applications of the disinfectant and after wearing gloves for two to three hours. The hands are commonly sampled in a bowl or plastic bag containing Ringer's or a similar solution and relevant neutralizers, or by the use of glove washings. A standardized technique is necessary to provide a statistical comparison between agents. Antiseptic detergents, chlorhexidine or povidone iodine show immediate reductions in bacterial counts of 70% to 80%, increasing to 99% after repeated application. Hexachloraphene and triclosan detergents show a lower immediate reduction but a good residual effect. Seventy percent ethyl or 60% propyl alcohol, with or without an antiseptic, show an immediate reduction of over 95%, and in excess of 99% on repeated application. Residual levels of organisms tend to be lower after repeated alcohol treatment than following the use of antiseptic detergents. A two to three-minute application of the antiseptic to the hands, without a scrubbing brush, is commonly recommended in the UK, but possibly in routine surgery an application time of 30 seconds is sufficient, killing or removing transients and superficial residents.
Article
This paper is a report of a study of the impact of finger rings, wrist watches, nail polish, length of fingernails, hand lotion, gender and occupation on hand microbiology of healthcare workers. The impact of the above mentioned variables on hand microbiology of healthcare workers is not well defined. Large scale studies suitable for multivariate analysis are needed to elucidate their role. Both hands of 465 Norwegian healthcare workers were sampled by the glove juice method during two study periods (2004 and 2007), and examined for total number of bacteria and presence of Staphylococcus aureus, Enterobacteriacea and non-fermentative Gram-negative rods. Multiple regression analysis was performed. The use of a wrist watch was associated with an enhanced total bacterial count on hands compared to hands without a watch [(B) 3·25 (95% CI: 1·73-6·07), P <0·001], while the use of one plain finger ring increased the carriage rate of Enterobacteriaceae [odds ratio 2·71 (95% CI: 1·42-5·20), P = 0·003]. The carriage rate of Staphylococcus aureus was enhanced with fingernails longer than 2 mm [odds ratio 2·17 (95% CI: 1·29-3·66), P = 0·004] and after recent use of hand lotion [odds ratio 22·52 (95% CI: 4·05-125·30), P < 0·001]. No effect of nail polish was observed. We found an association between occupation and carriage rate of S. aureus and Enterobacteriaceae. Health care workers should remove finger rings and watches at work. Fingernails should be shorter than 2 mm, nail polish may be used.
Article
Hand hygiene of healthcare personnel is one of the most important interventions for reducing transmission of nosocomial pathogens. Previous studies have demonstrated that the use of alcohol-based hand gel increases hand hygiene compliance, but that effective use of this product cannot be taken for granted. Evaluate factors associated with poor hand hygiene effectiveness of hospital workers using an alcohol-based hand gel and the effect of an education program. A direct observational prospective study of hand hygiene effectiveness prior to training and immediately after training. 3067 hospital workers of different professional categories in several hospital units in the University Hospital of Nancy (France). Time after program start (OR 0.97, 95%CI 0.96-0.97) and being female (OR 0.37, 0.24-0.58) were highly associated with increased effectiveness of hand hygiene prior to training. Wearing rings other than a wedding ring (OR 1.8, 1.2-2.7), a bracelet (OR 2.0, 1.1-3.6), a watch (OR 1.9, 1.3-2.9) and having long nails were associated with ineffective hand rub use. Professional background was also a strong predictor with nurses and especially senior nurses demonstrating much better effectiveness than all other professional groups. Wearing wedding rings or long sleeves, and having varnished nails, visibly dirty hands prior to washing and cutaneous lesions were not associated with effective gel use. These results demonstrate that an educational program can significantly improve the proper practices for using hand rub and hand washing compliance. This study has also demonstrated that wearing rings, bracelets, watches and long nails impair hand gel application but that wedding rings, long sleeves and varnished nails do not. The finding of that hand hygiene effectiveness increased with time even prior to training indicates that knowledge gained by staff trained early diffused into those who had not yet been trained.
Article
This study provides statistically significant data that demonstrate that chipped fingernail polish or fingernail polish worn longer than four days fosters increased numbers of bacteria on the fingernails of OR nurses after surgical hand scrubs. There were no significant correlations between fingernail length and the numbers of bacterial colonies on the fingernails of the study groups tested after performing a standard surgical hand scrub. A convenience sample of 102 perioperative nurses with either freshly polished fingernails; chipped fingernail polish; or natural, polish-free fingernails participated. The data suggest OR nurses can wear fresh fingernail polish on healthy fingernails without risking increased bacterial counts.
Article
Surgical wound infection may be caused by transfer of bacteria from the hands of the surgical team during operative procedures. Careful surgical scrubbing is therefore performed to reduce the number of bacteria on the skin. The wearing of finger rings and nail polish is thought to reduce the efficacy of the scrub as they are thought to harbour bacteria in microscopic imperfections of nail polish and on the skin beneath finger rings. To assess the effect of removal of finger rings and nail polish by the surgical scrub team, on postoperative wound infection rates. We searched the Cochrane Wounds Group Specialised Trials Register up to November 2000 using the search strategy developed by the Cochrane Wounds Group. We wrote to manufacturers of surgical scrubbing agents for ongoing and unpublished research. Reference lists of articles were searched and relevant journals outside the electronic databases were hand searched. No restriction was placed on literature based on date of publication, language or publication status. Randomised controlled trials evaluating the effect of wearing or removal of finger rings and nail polish by the surgical scrub team on post operative wound infections and number of bacteria on the hands of the surgical scrub team. The abstracts of studies identified were scanned by all reviewers. All abstracts were checked against a checklist to determine whether they fulfilled the inclusion criteria. Full reports of relevant studies were obtained and checked against the checklist by two reviewers. The full reports of all excluded trials were checked by all reviewers independently to ensure appropriate exclusion. We found no randomised controlled trials that compared the wearing of finger rings with the removal of finger rings. We found no trials of nail polish wearing / removal that measured patient outcomes, including surgical infection. We found one small randomised controlled trial which evaluated the effect of nail polish on the number of bacterial colony forming units on the hands after pre-operative hand washing (also called surgical scrubbing). Nurses were allocated to: unpolished nails, freshly applied nail polish (less than two days old), or old nail polish (more than four days old). Both before and after surgical scrubbing, there was no significant difference in the number of bacteria on the hands. There is no evidence of the effect of removing nail polish or finger rings on the rate of surgical wound infection. There is insufficient evidence of the effect of wearing nail polish on the number of bacteria on the skin. However, the one trial making this comparison trial was too small to exclude anything other than a very large difference in the number of bacteria on the skin.
Article
We examined a cluster of 5 hemodialysis patients who contracted gram-negative bacteremia. A nurse who used an artificial fingernail to open a vial of heparin that was mixed to make a flush solution had a culture of an artificial fingernail specimen positive for Serratia marcescens. The typing of the S. marcescens strains isolated from the 5 patients and the nurse showed them to be identical. This finding provides strong support for policies prohibiting artificial nails for healthcare workers in all hemodialysis units.
Article
Studies have shown that despite infection control guidelines recommending that false fingernails, nail varnish, stoned rings and wrist watches not be worn by clinical staff, a large proportion of them continue to do so. The recently updated epic guidelines (Pratt et al, 2007) state that hand jewellery and false finger nails should be kept short, clean and free from nail polish. This article discusses the bacterial carriage, contributions to outbreaks of infection and interference with proper hand hygiene practices, thereby explaining why these recommendations are made in infection control policies and guidelines.
Article
Microbes found on the skin are usually regarded as pathogens, potential pathogens or innocuous symbiotic organisms. Advances in microbiology and immunology are revising our understanding of the molecular mechanisms of microbial virulence and the specific events involved in the host-microbe interaction. Current data contradict some historical classifications of cutaneous microbiota and suggest that these organisms may protect the host, defining them not as simple symbiotic microbes but rather as mutualistic. This review will summarize current information on bacterial skin flora including Staphylococcus, Corynebacterium, Propionibacterium, Streptococcus and Pseudomonas. Specifically, the review will discuss our current understanding of the cutaneous microbiota as well as shifting paradigms in the interpretation of the roles microbes play in skin health and disease.