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May is the time of the year to recognize and honor nurses. Nurses Week culminates on May 12, International Nurses Day (Florence Nightingale's birthday). In Notes on Nursing, Ms Nightingale remarked on the importance of hand washing: "Every nurse ought to be careful to wash her hands very frequently during the day."1 In 2023, new knowledge has shed a different light on handwashing. In a collaborative effort, the Society for Healthcare Epidemiology, the Infectious Diseases Society of America, the Association for Professionals in Infection Control and Epidemiology, the American Hospital Association, and The Joint Commission published an expert guidance document on infection hazards, including fingernails/nail folds, sinks, and excessive handwashing.2 Their new recommendations for healthcare workers include:2,3


* Nails should remain natural and not extend beyond the fingertips


* Avoid overwashing hands so that they do not become dry or cracked, facilitating increased bacterial carriage. Use alcohol-based sanitizers; however, after repeated hand sanitizer use, soap and water rinse are often needed


* Place hand sanitizer dispensers both inside and outside every patient's room


* Position dedicated handwashing sinks and do not dispose of other fluids in these sinks (biofilms can form on disposed products, with organisms becoming aerosolized, spreading disease)


* Clean sink drains with products newly approved by the US Environmental Protection Agency that can remove biofilm, rather than using bleach.


* Hand care also includes moisturizer use, applied after an alcohol hand rub or hand washing, to maintain an intact stratum corneum with 10% moisture content. Preferred moisturizers may contain water-binding humectants (urea, lactic acid, glycerin, ceramides) or have emollient bases that prevent water loss. They should be free of common allergens including fragrances and lanolin.



Now that our hands are clean and intact, we can consider typing a manuscript. With the advent of artificial intelligence (AI) authoring tools, such as ChatGPT and GPT-3, AI can now serve as a sort of electronic ghost author. The implications of these AI authoring tools have yet to be fully appreciated, but discussions about them and the possible challenges they could present have sparked concerns regarding authorship.4 The International Committee of Medical Journal Editors (ICMJE) has defined four authorship criteria:5


* Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND


* Drafting the work or revising it critically for important intellectual content; AND


* Final approval of the version to be published; AND


* Accountability for all aspects of the work to ensure questions related to the accuracy or integrity of the work are appropriately investigated and resolved.



As AI opens a whole new authorship world, we believe it is important to provide our authors and readers with Wolters Kluwer's current official Artificial Intelligence Authoring Tools and Authorship Policy:


It is our position that an AI authoring tool does not meet the standards required for authorship as defined by the ICMJE[horizontal ellipsis].5However, we do concede that an AI Authoring Tool may be listed in the Acknowledgments section of a manuscript when appropriate.


The ICMJE also recommends individuals who may be included in acknowledgments, including those involved with funding acquisition, the general research group, or administrative supervision, as well as those who provided writing or editing assistance. Always check with the acknowledged individual before submitting for publication.


Elizabeth A. Ayello, PhD, MS, RN, CWON, FAAN

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R. Gary Sibbald, MD, MEd, FAAD, JM

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1. Nightingale F. Notes on Nursing. What it is, And What It is Not. 160th Anniversary Commemorative Edition. Wolters Kluwer: Philadephia PA; 2020. [Context Link]


2. Glowicz J, Landon E, Sickbert-Bennett E, et al. SHEA/IDSA/APIC Practice Recommendation: strategies to prevent healthcare-associated infections through hand hygiene: 2022 Update. Infect Control Hosp Epidemiol 2023:1-22. [Context Link]


3. Clark C. New guidance targets infection hazards in fingernails, sinks, excessive handwashing. MedPage Today. Last accessed February 19, 2023. [Context Link]


4. Stokel-Walker C. ChatGPT listed as author on research papers: many scientists disapprove. Nature 2023;613:620-1. Last accessed February 19, 2023. [Context Link]


5. International Committee of Medical Journal Editors. Defining the role of authors and contributors. Last accessed February 19, 2023. [Context Link]