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Health care workers who wear artifical nails are more likely to harbor pathogens than those who don't, according to a majority of studies that focus on fingernails and infection control.

Enid Eck, MPH, RN, had read the body of literature, weighed recommendations from various professional societies and consulted with other infection experts. Her scale was finally tipped the night she saw a Pseudomonas aeruginosa outbreak-and its likely vector-detailed on network television.

"I went to our medical directors and quality committees," recalled Eck, senior consultant on HIV and infectious disease with the California Division of Kaiser Permanente. "I said, 'OK, it's on "60 Minutes" now, folks.' This was our chance to be leaders."

Eck and other Kaiser officials began taking aim at what they perceived to be a major culprit in the spread of nosocomial infection: artificial fingernails and exceptionally long natural nails. By July, they were ready to act throughout the Southern California region.

"We gave our [health care workers] the Fourth of July holiday weekend," Eck said. "If they wanted red, white and blue nails, they could do that. But the Monday after, the nails had to be gone."

Kaiser, which later expanded the policy nationwide, has plenty of company. Seton Healthcare Network in Austin, Texas; Northwestern Memorial Hospital in Chicago; New York-Presbyterian Hospital and many more have said no to fake nails.

Plenty of research supports their decision. The University of Michigan Health System's Infection Control & Epidemiology department cites no less than 21 studies, most of them published in the last decade, that focus on fingernails and infection control. The majority echoes a single message-that health care workers who wear artificial nails are more likely to harbor pathogens than those who don't.

Public attention

Then there are those headline-generating outbreaks. It was Pseudomonas that killed 16 babies in a neonatal ICU in Oklahoma City in 1997 and 1998. That contagion eventually was traced to two nurses, one with artificial nails and another with long natural nails.

In a 1994 outbreak of Serratia marcescens among cardiovascular surgery patients at a California hospital, the trail led to a jar of exfoliant cream in the home of a scrub nurse who wore artificial nails.

In 1996, an operating room technician with artificial nails was implicated in the post-laminectomy deep wound infections (Candida albicans) of three patients in a Connecticut hospital.

Research offers several logical reasons to suspect artificial nails. First, most handborne microbes congregate in the subungual zone (the crook between the fingertip and the nail), and long nails of any material make it harder to clean this area.

Second, an artificial nail can separate from the natural nail base if bumped or snagged, leaving an opening that invites dirt and germs. Gram-negative bacteria or fungi then can spread to the natural nail.

Further, long nails are more likely to tear latex gloves, bringing nurses into contact with skin or fluids.

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