Removal of nail polish and finger rings to prevent surgical infection

Arrowsmith VA, Maunder JA, Taylor R, Sargent RJ

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Summary

Removing nail polish and finger rings to prevent surgical infection

People having surgery can get a serious wound infection from bacteria (germs) on the hands of operating theatre staff (doctors, nurses, and assistants). Theatre staff scrub their hands intensively before operations to reduce the number of bacteria on their hands. It may be that nail polish (varnish) and rings (jewellery) hide bacteria and reduce the effectiveness of hand scrubbing. The review found no evidence from trials about the effect of staff wearing rings. One small trial suggests that there might be differences between varnished and unvarnished nails, but there is not enough evidence to be certain.

This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2009 Issue 4, Copyright © 2009 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
This record should be cited as: Arrowsmith VA, Maunder JA, Taylor R, Sargent RJ. Removal of nail polish and finger rings to prevent surgical infection. Cochrane Database of Systematic Reviews 2001, Issue 1. Art. No.: CD003325. DOI: 10.1002/14651858.CD003325.

This version first published online: October 23. 2001
Last assessed as up-to-date: March 24. 2008

Abstract

Background

Surgical wound infection may be caused by transfer of bacteria from the hands of the surgical team during operative procedures. Careful surgical scrubbing is performed to reduce the number of bacteria on the skin. Wearing 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.

Objectives

To assess the effect of removing finger rings and nail polish by the surgical scrub team, on postoperative wound infection rates.

Search strategy

For the second update of this review we searched the Cochrane Wounds Group Specialised Register (Searched March 2008), The Cochrane Central Register of Controlled Trials (CENTRAL) - The Cochrane Library Issue 1 2008, MEDLINE (1950 to March 2008), EMBASE (1980 to 2008 Week 12) and CINAHL (1982 to March 2008). We wrote to manufacturers of surgical scrubbing agents for ongoing and unpublished research. Reference lists of articles were searched. No restriction was placed on literature based on date of publication, language or publication status.

Selection criteria

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.

Data collection and analysis

The abstracts of studies identified were scanned by all authors. 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 authors. The full reports of all excluded trials were checked by all authors independently to ensure appropriate exclusion.

Main results

No new trials were identified by the updated searches. 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.

Authors' conclusions

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.

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