Nail Polish remains inappropriate for clinical care: a narrative review

Background Recently, there have been changes to healthcare practices and even national guidelines to allow the use of nail polish. These changes are based on some recent laboratory studies which have challenged the long-standing recommendations that only unadorned nails are acceptable in healthcare. We aimed to review this recent literature in detail in order to determine whether it supports changing recommendations concerning nail polish. Methods We performed a narrative review of the literature as well as an in-depth analysis of the body of recent laboratory studies that the changed recommendations are based on. We also gathered data about how gel manicures are applied, as well as the potential complications for implementation and monitoring to ensure that only short, freshly painted nails would be allowed in healthcare. Results The recent body of literature presents a number of methodological issues as well as practical ones. There are a number of practical and implementation issues that have been identified which would make the use of nail polish in healthcare unacceptable, even if short, freshly polished nails were acceptable from a microbiological standpoint. Conclusion There is not enough evidence to change the current recommendations that nail polish should not be allowed in healthcare, and permitting its use is a risk to patient safety. Implementation issues must also be taken into account including: not being able to see the length or cleanliness of healthcare workers’ nails when there is polish on them, practical difficulties for keeping nails short and in good condition, and potential resource issues for IPC departments to ensure adherence to correct application and nail health among staff.