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“The use of rings could be a potentially
contentious issue,” Trick said. “I
have heard people say they are symbolic, and they
don’t want to remove them.”
Trick leaves his ring
at home and found that many nurses do the same.
In his study, the nurses who wore rings at home
but removed them before work showed no greater
hand contamination than RNs who never wore rings.
The study found that the type of ring wasn’t
a factor in the presence of contamination. Rings
with smooth bands, set with gemstones or etched
with a pattern all showed the same levels of contamination.
Whether to wear rings is a personal decision
people have to make, Trick said, but he hopes
hospitals will educate nursing staff and share
the research data with them.
Spotty evidence.
Before ring wearing becomes “the next hill
to die on,” there needs to be a lot more
scientific evidence to support the risk to patient
safety, said Annemarie Flood, RN, a certified
infection control nurse. After initial resistance,
people have accepted that artificial nails shouldn’t
be worn at work, she said, but that’s because
nails have been associated with infection outbreaks.
Flood, who works in the epidemiology department
of UCLA Medical Center, said the wearing of rings
and other jewelry is not addressed in UCLA’s
hand hygiene policy, but jewelry is covered in
the dress code.
“You should remove your rings or at least
move them when you’re scrubbing in,”
she said. “Jewelry should be small and not
interfere with patient care.”
Most people who scrub in remove their rings and
keep them off, Flood said. She doesn’t see
a need to change practices.
“I will wait for the science and wait for
the studies to come out,” Flood said. “We
always hope to base our practices on science.”
The CDC has no immediate plans to update its
hand hygiene policy, said spokeswoman Rachael
Lawton, unless enough new information became available.
“A handful of studies isn’t going
to do it,” she said.
The Association of periOperative Registered Nurses
recommends rings not be worn in surgical settings,
and Vicki Brinsko, RN, CIC, said nurses should
follow the same scrubbing guidelines when performing
any invasive procedures.
“If you’re delivering day-to-day
health care like taking blood pressure, I think
it’s fine to leave your ring on,”
she said, although she cautions against wearing
large, ornate rings that could cause gloves to
tear.
Brinsko teaches “Infection Control 101”
at Belmont University and is the infection control
coordinator at Vanderbilt University Medical Center,
both of which are located in Nashville, Tenn.
She also practices bedside nursing on the weekends.
She wears a wedding band and usually leaves it
on while working. When she performs an invasive
procedure or enters a surgical setting for observations,
she removes her ring and pins it inside the pocket
of her scrubs.
More data needed.
Before hospitals make strong recommendations about
removing rings, more data are needed, said epidemiologist
John Boyce, MD, head of the Hand Hygiene Resource
Center at Saint Raphael Healthcare System in New
Haven, Conn. Boyce also chairs the hand hygiene
task force of the Healthcare Infection Control
Practices Advisory Committee. No one knows if
ring wearing poses a threat to patients, he said,
and there need to be more studies in that area.
“There isn’t sufficient evidence
to make a strong recommendation,” Boyce
said. “I wouldn’t come down on either
side of the fence.”
Donald Goldmann, MD, with the department of infectious
diseases at Children’s Hospital Boston,
said he’d rather people didn’t wear
rings at work. It’s common practice not
to wear them in the OR at his hospital, but he
isn’t prepared to call for a ban on ring
wearing.
“On the face of it, it would be better
if people didn’t wear rings,” Goldmann
said. “But I don’t know what it means
for someone to take off a $1,000 ring and put
it in a locker while they work.”
A bigger issue, he said, is getting health care
professionals to comply with established handwashing
practices. CDC guidelines say the most important
factor in reducing nosocomial infection is handwashing.
Yet studies suggest some clinicians fail to perform
this basic infection control procedure.
Handwashing shouldn’t be taken lightly,
Goldmann said, and it needs to happen every time
a doctor or nurse leaves a patient’s bedside.
“The time when people can say there isn’t
time for hand hygiene has passed,” Goldmann
explained. “This is not a trivial matter.”
Contact
Donna Hemmila at dhemmila@prodigy.net.
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