Young Kim	More NurseWeek Features   Smoke-Free Zone   Nurses and patients tackle nicotine addiction   Bloodless Survival     Surgical techniques to use when transfusion drops out of the equation
The CDC’s latest hand hygiene guidelines issued in October 2002 make no recommendation regarding wearing rings in a health care setting and classify the issue as “unresolved.”

When Kaiser Permanente moved to prohibit patient care employees from wearing artificial nails, the health care giant also tackled another potential source of nosocomial infection—rings.

In its nationwide hand hygiene policy, Kaiser prohibits clinicians from wearing jewelry of any kind in the OR. In other parts of the hospital, rings other than plain bands are discouraged, said Sue Barnes, RN.

Barnes, a senior consultant in patient care services in Kaiser’s Northern California region, specializes in infection control. The role of rings in potential hand contamination has received less attention and research focus than the issue of artificial nails and long natural nails.

Yet a recent study of ICU nurses that found that a strong association between hand contamination and ring wearing could draw more attention to the question of whether nurses should be asked to take off their rings at work.

“I think as we go down the road, as evidence collects that identifies this as a risk, the community will have more stringent policies,” Barnes said.

Barnes said she’s had inquiries from Kaiser physicians in response to the most recent ring-wearing study, published last year by the Infectious Diseases Society of America in its journal, Clinical Infectious Diseases.

“We’ll be discussing the issue to see if we need to adjust our policies,” Barnes said.

The study, “Impact of Ring Wearing on Hand Contamination and Comparison of Hand Hygiene Agents in a Hospital,” compared handwashing agents and looked at risk factors for hand contamination. It concluded that rings on nurses’ hands resulted in an increased presence of Staphylococcus aureus, gram-negative bacilli and Candida species. The increase was larger when more than one ring was worn.

The study focused on 66 surgical critical care unit nurses at Rush Presbyterian-St. Luke’s Medical Center in Chicago. Sampling each participant once a day, the researchers cultured 564 hands during 282 sampling episodes.

The study evaluated three handwashing agents: an alcohol-based hand rub, an antibacterial hand wipe and plain soap and water. Researchers tested one hand after a nurse’s patient care encounter and cultured the other hand after the nurse performed handwashing procedures using one of the three agents. The presence of rings, artificial nails and cuts on hands were noted.

Where’s the risk? Although the study found ring wearing increased hand contamination with potential nosocomial pathogens, its principal investigator, William Trick, MD, said the study didn’t examine the risk to patients.

“Finding contamination on a ring doesn’t mean it’s transferred to the patient,” said Trick, a staff member of the Collaborative Research Unit of John Stroger Hospital of Cook County in Chicago.

Unlike artificial nails, the wearing of rings has not been connected to any episodes of patient infection. Earlier studies that addressed ring wearing have shown that after handwashing the presence of bacteria on hands with and without rings was similar.

The CDC’s latest hand hygiene guidelines issued in October 2002 make no recommendation regarding wearing rings in a health care setting and classify the issue as “unresolved.” The CDC policy suggests—rather than recommends—removing rings, watches and bracelets before surgical scrubbing.

Before the CDC would recommend banning rings, Trick said, it would need to see documentation that contamination is transferred to patients.