Removal of nail polish and finger rings to prevent surgical infection

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 therefore performed to reduce the number of bacteria on the skin. The wearing of 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 removal of finger rings and nail polish by the surgical scrub team, on postoperative wound infection rates. SEARCH STRATEGY: We searched the Cochrane Wounds Group Specialised Trials Register up to November 2000 using the search strategy developed by the Cochrane Wounds Group. We wrote to manufacturers of surgical scrubbing agents for ongoing and unpublished research. Reference lists of articles were searched and relevant journals outside the electronic databases were hand 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 reviewers. 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 reviewers. The full reports of all excluded trials were checked by all reviewers independently to ensure appropriate exclusion. MAIN RESULTS: 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. REVIEWER'S 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.