In July 2000, Better Homes and Gardens published an article entitled "Fake Nails Might Make You Sick." Last year, an outbreak of Pseudomonas aeruginosa in an Oklahoma City neonatal intensive care unit was linked to the deaths of 16 newborns within 15 months. Nurses with long or artificial nails had a higher rate of colonization with P. aeruginosa than did those with short, natural nails. In this issue of AJN, Melissa L. Earl, Marguerite M. Jackson, and Leland S. Rickman, report on the use of handwashing gels by nurses and other personnel when dispensers were placed on units and in patient rooms. While handwashing rates did improve, nurses washed their hands only 57% of the time it was called for. The study found that physicians had the lowest handwashing compliance rates, followed by nurses; ancillary personnel had the highest rates. Why weren't nurses the most compliant? FIGURES 1-3
The 1999 Institute of Medicine (IOM) report, To Err Is Human: Building a Safer Health System, notes that errors of omission can jeopardize safety: if you don't take an action that can prevent injury and an injury occurs, it's still an error. The report also stresses that, while people make mistakes, well-designed systems can prevent them from affecting patients or from happening at all.
In a bold response to the IOM report, the Leapfrog Group, a coalition of 60 corporations (including General Electric, General Motors, and IBM) announced that it would survey hospitals about safety indicators and steer their employees to the highest-scoring institutions. (See February News.)
An AJN editorial in June 2000 urged nurses to read the IOM report and use it to create safer hospitals for patients. Nurses everywhere, every day, can and do prevent errors, injury, and infection. But people are more concerned about being the victim of a mistake while in a hospital than while in an airplane (according to the Kaiser Family Foundation and the Agency for Healthcare Research and Quality), so there's more that nurses must do. For example, if nurses nationwide took the following actions, multiple infections could be prevented.
Be an advocate of strict hand-washing policies and practices. Our own dentists and dental hygienists consistently wash their hands in front of us. Can patients be equally confident that nurses, physicians, or other providers have washed their hands before changing dressings or IV tubings?
Address the factors that undermine effective handwashing. A September 2000 Research for Practice column delineated evidence showing that nurses and other providers shouldn't wear artificial or long fingernails because they harbor significantly more bacteria even after hand-washing. And gloves are not the solution. Numerous studies have shown that gloves are not hole free, and long and artificial nails are much more likely to tear gloves.
Ban long and artificial nails in health care settings. During the past few years, we have seen such policies enacted at a number of hospitals. Compliance improves as research supporting the ban is shared and peer pressure is applied.
We call on all nurses-whether or not in contact with patients-to become role models of prevention. Whether you're a staff nurse, primary care provider, educator, administrator, or researcher, don't wear artificial or long nails, and wash your hands when you should.