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AORN says that nail polish that is unchipped may be worn by staff in the operating room. Studies have demonstrated that nail polish begins to harbor microorganisms when it is chipped or worn for more than 4 days. Artificial nails (defined as any fingernail enhancement, resin bonding, extension, tip, gel or acrylic treatment) should not be worn in the perioperative environment, says AORN. Studies have shown higher microbial counts under artificial nails than under natural nails before and after hand washing. When we asked if nail polish and gel nail finishes are allowed in your surgical suite, 46% said nail polish is OK, artificial nails are not, 36% said both are forbidden and 14% said either is fine.
Maybe it's asking too much of community-based hospitals and physician-owned surgical centers to be predictable, high-reliability organizations. To practice, as Atul Gawande, MD, puts it, "large-scale, production-line medicine?" But wherever possible, for the sake of the quality and the safety of your care, get your surgeons and staff to agree on precise standards of care and figure out how to standardize it.
