Denise Thompson MBus. – UKAPP Medical Liaison

The purpose of this article is to hopefully inform the reader of the importance of suitable below the elbow cleanliness in a studio setting.

In order to give the best understanding of the importance of hand hygiene there will be a brief history of handwashing to give a foundation to the rest of the article.

According to National Geographic (Online, 2020) during the 1840s the Hungarian Physician Ignaz Semmelweis became perturbed around the causes of high levels of puerperal fever (childbed fever) that appeared to be happening even within the highest standards of medical care settings. Semmelweis worked in a general hospital that had two very different maternity ward settings. One which was ran by female nurses and the other was run by male doctors. National Geographic continue to state that the male led ward had a much higher rate of deaths (Twice of that than the female led ward). The only difference between how both wards were run was that during the mornings, the doctors would attend autopsies alongside medical students as part of ongoing training. After this they would
return to the maternity ward to help in the delivery of babies. No hand washing was going on between any of the interactions which turned out to be the cause of the higher-than-normal death rate. Women were becoming infected by the cadavers’ particles which intern led to high temperatures, and then death.

“In 1847, Semmelweis implemented mandatory handwashing among the students and doctors who
worked for him at the Vienna General Hospital” (N.Strochlic, ‘wash your hands’ was once
controversial medical advice 2020).

The reason for delivering this background will become apparent when a specific journal article is spoken about later. A commonly seen, yet often ignored issue within the piercing industry surrounds that of hand hygiene. Not necessarily of hand washing, but of items being worn on the wrists and/or fingers that
can act as possible risks of cross contamination. An extension to this is the wearing of nail polish, false nails as well as overly long natural nails.

The first journal was in regards to research on the Impact of the use of rings and nail polish on hand hygiene quality in healthcare workers. Interestingly, the overall conclusion was not that of showing a direct correlation between contamination because of nail varnish wearing or long nails etc. it actually showed another issue caused by wearing nail varnish. According to the Journal of Infection Control (2020) people who took part in the study were found to have poorer hand washing if they were wearing nail polish of any form. Another research piece that was close to this was “Evaluation of the bacterial burden of Gel Nails, standard nail polish, and natural nails on the hands of Health
Care Workers,” (2018) which indicated that standard polish had little to no effect on bacterial growth on the fingers and nails, however bacteria was proven to be harder to remove from gel polish specifically.

Further studies according to Fagernes et al. (2010) determined that nails regardless of being natural or acrylic that were longer than 2mm would harbour increased levels of bacteria. They continue to state that acrylic nails are commonly longer than 2 mm due to them being an extension of a fake nail, that are typically worn for longer periods of time permitting the natural nail to continue to grow.

“After surgical hand disinfection, more bacteria are found on polished nails, as compared to unpolished ones. Therefore, artificial nails (acrylic, gel, or nail tips) have been recognised as a source of infection in several studies”. Szumska et al (2022)

In conclusion, it would be deemed good practise to avoid any form of nail covering for vanity reasons and ensure that nails are kept below 2mm in length. Combined with good hand washing practices as well as being bare below the elbow will ensure potential contamination is kept to an even lower
level.

Further information:

For further information, please email health@safepiercing.co.uk

You can also find a World Health Organisation (WHO) handwashing course here: https://openwho.org/courses/IPC-HH-en

And an NHS handwashing guide here: https://www.nhs.uk/live-well/best-way-to-wash-your-hands/

References
Fagernes, M. and Lingaas, E. (2010) “Factors interfering with the microflora on hands: A regression
analysis of samples from 465 healthcare workers,” Journal of Advanced Nursing, 67(2), pp. 297–307.
Available at: https://doi.org/10.1111/j.1365-2648.2010.05462.x.
Hewlett, A.L. et al. (2018) “Evaluation of the bacterial burden of Gel Nails, standard nail polish, and
natural nails on the hands of Health Care Workers,” American Journal of Infection Control, 46(12),
pp. 1356–1359. Available at: https://doi.org/10.1016/j.ajic.2018.05.022.
Olivares A., F. et al. (2020) “Impact of the use of rings and nail polish on hand hygiene quality in
healthcare workers,” Infection control, 37(1), pp. 23–31. Available at:
https://doi.org/10.4067/s0716-10182020000100023.
Szumska, E. et al. (2022) “The association between hand disinfection techniques and their barriers,
as well as the ‘bare below the elbows’ concept, among healthcare professionals—a study based on a
Polish population,” International Journal of Environmental Research and Public Health, 19(18), p.
11781. Available at: https://doi.org/10.3390/ijerph191811781.
'Wash your hands' was once controversial medical advice (2020) National Geographic. Available at:
https://www.nationalgeographic.co.uk/science-and-technology/2020/03/wash-your-hands-was-
once-controversial-medical-advice (Accessed: October 23, 2022).
Bibliography
Emilia Szumska, Przemyslaw Czajkowski, Michal Zablocki, Dorota Rozkiewicz, The Association
between Hand Disinfection Techniques and Their Barriers, as Well as the “Bare below the Elbows”
Concept, among Healthcare Professionals—A Study Based on a Polish Population, International
Journal of Environmental Research and Public Health, 10.3390/ijerph191811781, 19, 18, (11781),
(2022).
Fagernes, M. and Lingaas, E. (2010) “Factors interfering with the microflora on hands: A regression
analysis of samples from 465 healthcare workers,” Journal of Advanced Nursing, 67(2), pp. 297–307.
Available at: https://doi.org/10.1111/j.1365-2648.2010.05462.x.
Hewlett, A.L. et al. (2018) “Evaluation of the bacterial burden of Gel Nails, standard nail polish, and
natural nails on the hands of Health Care Workers,” American Journal of Infection Control, 46(12),
pp. 1356–1359. Available at: https://doi.org/10.1016/j.ajic.2018.05.022.
Olivares A., F. et al. (2020) “Impact of the use of rings and nail polish on hand hygiene quality in
healthcare workers,” Infection control, 37(1), pp. 23–31. Available at:
https://doi.org/10.4067/s0716-10182020000100023.

Szumska, E. et al. (2022) “The association between hand disinfection techniques and their barriers,
as well as the ‘bare below the elbows’ concept, among healthcare professionals—a study based on a
Polish population,” International Journal of Environmental Research and Public Health, 19(18), p.
11781. Available at: https://doi.org/10.3390/ijerph191811781.
'Wash your hands' was once controversial medical advice (2020) National Geographic. Available at:
https://www.nationalgeographic.co.uk/science-and-technology/2020/03/wash-your-hands-was-
once-controversial-medical-advice (Accessed: October 23, 2022).