Edmond [ 8 ] states that ‘ bare below the elbows ’ should include :
• Short sleeves
• No wrist jewellery
• No rings except a wedding band .
International guidelines for staff working in human medicine vary from a complete prohibition of jewellery and nail art to permitting one simple finger band ( Figure 3 ) and unchipped nail polish ; however , as noted previously , nail art does not have to be chipped to be a contamination risk .
There appears to be a lack of evidence on whether or not wearing such items increases the risk of contamination , but there is biological plausibility that infection can be transmitted by such fomites in the veterinary environment .
Nail art / varnish
Systematic reviews on this topic conducted in Canada concluded that there was insufficient evidence to pinpoint the exact effect of nail varnish on surgical site infection , but that it does provide a breeding ground for microorganisms that are resistant to handwashing [ 2 ] . This brings into question the sensibleness of wearing nail varnish / art in a veterinary setting . Nail varnish does not even have to be chipped because , if it has been in place for 4 days , wear and tear on the surface will lead to tiny defects that can harbour harmful microorganisms [ 2 ] .
It has also been evidenced that acrylic fingernails ( Figure 2 ) have high bacterial counts , both before and after handwashing , because the quality of the surface of the acrylic will deteriorate , which will allow bacteria to colonise the nail [ 9 ] . False nails have also been shown to carry more bacterial pathogens on the underside than natural nails , both before and after handwashing [ 10 ] .
Figure 3 . An example of a simple finger band .
With all this in mind , as a precautionary measure it seems sensible for veterinary professionals to remove all hand / wrist jewellery and nail art / varnish to minimise infection transmission . In doing so , we are upholding the promise made in the RCVS declaration to ensure the health and welfare of animals committed to our care [ 12 ] .
PPE / gloves
Wearing gloves over jewellery and nail art would not be an adequate response to the issue for a variety of reasons . Often gloves are being donned and removed at inappropriate times , which increases the risk of cross-contamination [ 9 , 13 ] . Furthermore , wearing gloves can sometimes lead to over-confidence in their role in hygiene and a reduction in handwashing [ 13 , 14 ] . Additionally , in light of the profession ' s sustainability goals , the unnecessary use of gloves should be avoided .
Figure 2 . Nail varnish / art and acrylic nails can present risks of infection transmission .
A human medical study evidenced that it was nurses who achieved the better standards of hand hygiene within a hospital setting , but unfortunately only 9.5 % of all participants conducted hand hygiene correctly ; if they were also wearing nail art at this time , this would cause further concerns regarding infection control [ 11 ] .
Glove punctures are common in medical practice , and such incidents can expose the nails beneath . Evidence suggests that fingernails over 2 mm long are associated with higher bacterial counts after handwashing [ 9 , 15 ] . Longer nails also prevent the use of appropriate handwashing techniques , and hand jewellery may prevent appropriately sized gloves being chosen [ 10 , 16 ] .
The veterinary industry is often slightly behind human medicine , and this is one area where this appears to be the case . UK healthcare providers have been ensuring that their employees follow the ‘ bare below the elbows ’ concept since 2007 [ 11 ] .
26 Veterinary Nursing Journal