Field Epidemiology Manual Wiki

Nails, rings, watches, bracelets

Last modified at 4/21/2016 7:09 PM by Vladimir Prikazsky

Numerous studies have shown that in the region under and around the nails carries a multitude of  bacteria (e.g. coagulase-negative staphylococci, corynebacteria, on occasion Gram-negative rods including Pseudomonas species) as well as some fungi. Nail polish can have a positive impact on the growth of microorganisms. Moreover, in the cracks generated in the nail polish, the microorganisms are protected from removal by washing. Artificial nails and nail art are a problem because under them multiple microorganisms can be deposited, and can not be removed when performing hand hygiene. A further problem is that long nails can cause damage to the glove.

The wearing of rings (especially smooth wedding rings without stones) has not been clearly proven to increase the number of microorganisms, but certainly, rings with precious or semi-precious stones, watches and bracelets, make it difficult to properly perform hand hygiene and can interfere with glove wearing.

So before direct contact with patients, as part of standard precautions healthcare workers should remove rings, watches and bracelets. Artificial nails are prohibited, as well as nail polish on natural nails.

Another related aspect is whether staff should be “bare below the elbows”.  This proposal came from observations made during hospital visits by improvement teams in England who observed that the wearing of long-sleeved shirts resulted in hand hygiene not being performed properly, especially in the wrist area.


Link to IC/HH Core competencies: Area 4 Infection control activities: Domain Elaborating infection control intervention ICA 1-2


  1. Gupta A, Della-Latta P, Todd B et al. Outbreak of extended-spectrum betalactamase producing Klebsiella pneumonia in a neonatal intensive care unit linked to artificial nails. Infect Control Hosp Epidemiol 2004;25:210-5.
  2. Jeanes A, Green J.Nail. A review of current infection control issues. J Hosp Infect. 2001 Oct;49(2):139-42.