Infection Control 101 Handwashing!!!

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Infection Control 101Handwashing!!!
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Handwashing and Long/Artificial Fingernails

• Decrease effectiveness of gloves
• Decrease the effectiveness of handwashing
• Decrease the effectiveness of waterless hand
  sanitizers
• Higher of pathogens/bacteria
• Studies linking long and artificial nails to
  infection
• Can lead to fungal nail infection

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Bacterial carriage Artificial NailsAJIC 1989
Dec17(6)340-4

• VA Medical Center, Sioux Falls, S.D
• Cultures before and after handwashing
• 56 in each group
• Higher number of GNR with artificial nails

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Pathogens and artificial nailsInfect Control
Hosp Epidemiol 2000 Aug21(8)505-9

• Study 1
• 12 HCW artificial nails on non-dominant hand,
  natural nails on dominant hand
• More samples contained pathogens from artificial
  nails than native nails 92 vs 62
• Study 2 Case control study n60
• Those with artificial nails were more likely to
  have a pathogen (87 vs 43)

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Soap versus Hand Gel-Clin Infect Dis 2001
Feb132(3)367-72

• Michigan Medical School, Ann Arbor
• Case Control Study compared HCW with and without
  artificial nails n41
• Before and after washing with soap
• Before and after alcohol waterless hand gel

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Soap versus Hand Gel (cont)

• Artificial Nails
• 86 pathogens prior to washing
• 11 cleared pathogens w soap
• 38 cleared pathogens with gel

• Natural nails
• 35 pathogens prior to washing
• 14 cleared pathogens w soap
• 80 cleared pathogens with gel

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S. marcescens wound infectionsJ Infect Dis 1997
Apr175(4) 992-5

• S marcescens in 1 SSI 1992
• September 1994-1 month time period
• 6 of 31 cardiac post op S.marcescens infections
• 1 of 29 vascular post-op S.marcescens infections
• 5 SSI, 2 BSI, 1 death

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S.marcescens investigation

• Hospital suspended elective cardiac surgery
• Isolates typed-identical
• Cultures collected
• Hands of MDs, nurses,( OR ICU), pharmacists
• Environmental-OR,cardiac cath,lounges in ICU
• Water- OR, cath lab, ICU faucets
• All cultures negative

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Investigation break-through

• Earlier surgery e.g Monday had higher association
  with infection
• Final SSI linked only to one scrub nurse
• Home cultures revealed S.marcescens in exfoliant
  cream identical molecular typing to cases
• Nurse removed artificial nails during study period

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Candida Osteo/Diskitis after Spinal Surgery CID
2001l32352-7

• Feb 1997-3 post-op lami C.albicans infections
  (1st in 10 years)
• Identical PFGE isolates
• Case control study- scrub tech w artificial nails
• Procedure required kneading of bone wax

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Oklahoma NICU- P aeruginosaInfect Control Hosp
Epidemiol 2000 Feb21(2)80-5

• 15 month time period 439 admitted
• 46 infants- (10.5) BSI and ET tube colonization
• 16 deaths (35)
• Long nails- artificial and natural 2 nurses

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Handwashing and Fingernails

• Studies linking long and artificial nails to
  infection
• Decrease effectiveness of gloves
• Decrease the effectiveness of handwashing
• Decrease the effectiveness of waterless hand
  sanitizers
• Higher of pathogens/bacteria
• Can lead to fungal nail infection

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WHY???
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