KNOWLEDGE Caution: germ transmission! Workwear and nail polish as a hygiene risk Wearing medical workwear and refraining from using nail polish or artificial fingernails are among the established hygiene measures [1-3]. What is the current evidence on this? Bare below the elbow for medical workwear Up to 30% of medical and nursing garments are contaminated with pathogenic bacteria [4]. Depending on the area of activity, these rates can be even higher. One study found that 63% of examined textiles contained potentially pathogenic bacteria. Parts of the garments that often come into contact with the hands, such as sleeves or smock pockets, were found to be particularly contaminated with germs [5]. A recent study further demonstrates that consistent implementation of the ‘bare below the elbow‘ concept was associated with significantly lower contamination of sleeves. These data provide direct microbiological evidence that keeping the forearms uncovered reduces the microbiological burden on healthcare attire [6]. To make smock use safer and facilitate efficient hand disinfection, it is therefore recommended that short-sleeved clothing is worn. Nail polish put to the test In addition to not wearing watches or jewellery, the ‘bare below the elbow‘ concept also includes not wearing nail polish or artificial nails, as these could affect the effectiveness of hand hygiene. For example, microcracks in nail polish can impair its effectiveness [1]. However, recent studies paint a more nuanced picture. One such study shows that intact UV nail polish (gel or shellac manicures) is not associated with a higher bacterial load than unpolished nails [7]. Earlier studies have come to similar conclusions [8-10]. Nevertheless, nail length does have a negative impact: nails longer than 2 mm were associated with an increased bacterial load [8]. Furthermore, hand hygiene was less effective with longer nails, and this effect was exacerbated by gel manicures [11]. References: 1. KRINKO (2016) Händehygiene in Einrichtungen des Gesundheitswesens. Bundesgesundheitsbl 59:1189–1220. 2. KRINKO (2015) Infektionsprävention im Rahmen der Pflege und Behandlung von Patienten mit übertragbaren Krankheiten. Bundesgesundheitsbl 58: 1151– 1170. 3. WHO (2009) WHO Guidelines on Hand Hygiene in Health Care. ISBN 978 92 4 159790 6 4. Thom KA et al. (2018) Am J Infect Control 46(5): 503–506. 5. Wiener-Well Y et al. (2021) Am J Infect Control 39(7): 4555–559. 6. Damonti et al. (2025) Antimicrob Steward Healthc Epidemiol. 5, e336, 1–3. 7. Arreba P et al. (2025) J Hosp Infect 157: 40–44. 8. Hardy J et al. (2017) Vet Surg 46(7): 952–961. 9. Hewlett A et al.. (2018) Am J Infect Control 46(12): 1356–1359. 10. Nolan B et al. (2022) J Obstet Gynaecol 42(7): 2758–2763. 11. Wałaszek MZ et al. (2018) J Hosp Infect 100(2): 207–210. 17
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