Plastic Surgical Nursing (PSN), the official journal of the International Society of Plastic and Aesthetic Nurses (ISPAN) publishes this column to provide accurate, evidence-based information about fundamental best practices for plastic and aesthetic nurses.
During the recent coronavirus (COVID-19) pandemic, there was an astounding increase in the performance of hand hygiene and surface cleaning. The pandemic illustrated the necessity and importance of performing these very basic functions. Performing frequent hand hygiene is the best and easiest method for preventing the spread of microorganisms (World Health Organization [WHO], 2010) and is a practice that should be fundamental for plastic and aesthetic nurses.
Normal skin flora is composed of transient and resident microorganisms (Association of periOperative Registered Nurses [AORN], 2021). The transient organisms reside in the superficial layers of the skin. Health care providers acquire these microorganisms when caring for patients and when coming into contact with contaminated surfaces. The condition of the health care provider's skin and nails and the presence or absence of jewelry directly affects the number of transient organisms on an individual's hands. The purpose of hand hygiene is to remove soil and transient microorganisms from the hands. Transient microorganisms are easily removed by hand hygiene.
It is important for plastic and aesthetic nurses to maintain healthy hands and fingernails (AORN, 2021). Healthy skin and fingernails are essential for preventing transmission of microorganisms from the nurse's hands to the patient and/or the environment. To prevent glove puncture and the potential for injuring patients, health care personnel should keep their fingernails short. Long nails may limit the effectiveness of hand hygiene. Likewise, health care providers should not wear artificial fingernails or extenders, as these have been implicated in outbreaks caused by gram-negative bacteria and yeasts (Boyce et al., 2002; Ellingson et al., 2014; WHO, 2009). Evidence regarding the safety or harm of wearing nail polish is lacking; however, wearing nail polish could potentially hinder the nurse from performing effective hand hygiene and pathogens may reside in chipped or old nail polish (AORN, 2021). Wearing ultraviolet-cured nail polish (i.e., gel) may damage the underlying natural fingernail or harbor pathogens in the gap created between the cuticle and polish as the nail grows.
Hand dermatitis increases the risk for transmitting infection to the patient; therefore, plastic and aesthetic nurses should take measures to moisturize their hands and prevent hand dermatitis (AORN, 2021). Using moisturizing products helps minimize dryness and dermatitis caused by irritation from hand hygiene. Allowing the hands to dry thoroughly after hand washing or using an alcohol-based hand rub before donning gloves will help prevent irritation caused by wearing gloves over wet skin. In the absence of visible soil, disinfect hands with an alcohol-based hand rub rather than washing with soap and water. Alcohol-based hand rubs are less likely to irritate the hands and cause contact dermatitis. However, using alcohol-based hand rubs may not be effective when hands are soiled with organic material. Likewise, spores are more effectively removed from the hands by washing with soap and water. Wash hands with soap and water when hands are visibly soiled, after exposure to blood or body fluids, and when caring for patients with spore-forming organisms (e.g., Clostridium difficile). Health care providers with dermatitis, oozing lesions, or nonintact skin should not provide patient care.
Wearing rings, watches, or bracelets while performing hand hygiene may impede the removal of microorganisms from the hands (AORN, 2021). Wearing jewelry on the hands or wrists has also been associated with increased bacteria on the hands (Fagernes & Lingaas, 2011) and ineffective use of alcohol-based hand rubs (Hautemaniere et al., 2010). Microorganisms residing on the jewelry worn by health care providers may be transmitted to the patient and result in the patient developing a health care-associated infection (AORN, 2021). Plastic and aesthetic nurses and other health care providers should perform hand hygiene
* before and after contact with the patient or patient surroundings,
* before performing a clean or sterile task,
* after actual or potential contact with blood or body fluids,
* when hands are potentially or visibly soiled, before and after eating, and
* after using the restroom.
Plastic and aesthetic nurses and other health care providers should perform hand washing with soap and water as shown in Figure 1. Plastic and aesthetic nurses and other health care providers should perform hand hygiene using alcohol-based hand rubs as shown in Figure 2.
If you are a plastic or aesthetic nurse and would like to write about an issue of fundamental importance to plastic or aesthetic nurses, or if you would like to see your issue presented in a futureFundamentals of Plastic and Aesthetic Nursing Practicecolumn ofPSN, please contact Sharon Ann Van Wicklin, Editor-in-Chief atmailto:[email protected].
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