title: Removal of nail polish and finger rings to prevent surgical infection.
abstract: BACKGROUND
  Surgical wound infections may be caused by the transfer of bacteria from the hands of surgical teams to patients during operations. Surgical scrubbing prior to surgery reduces the number of bacteria on the skin, but wearing rings and nail polish on the fingers may reduce the efficacy of scrubbing, as bacteria may remain in microscopic imperfections of nail polish and on the skin beneath rings.
  
  
  OBJECTIVE
  To assess the effect of the presence or absence of rings and nail polish on the hands of the surgical scrub team on postoperative wound infection rates.
  
  
  METHODS
  For this update, we searched The Cochrane Wounds Group Specialised Register (searched 27 January 2012); The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 1); Ovid MEDLINE (2010 to January Week 2 2012); Ovid MEDLINE (In-Process & Other Non-Indexed Citations, January 26, 2012); Ovid EMBASE (2010 to 2012 Week 03); and EBSCO CINAHL (2010 to January 6 2012).
  
  
  METHODS
  Randomised controlled trials (RCTs) evaluating the effect of wearing or removing finger rings and nail polish on the efficacy of the surgical scrub and postoperative wound infection rate.
  
  
  METHODS
  All abstracts were checked against a checklist to determine whether they fulfilled the inclusion criteria. Full reports of relevant studies were obtained. Excluded trial reports were checked by all authors to ensure appropriate exclusion.
  
  
  RESULTS
  We identified: no new trials; no RCTs that compared wearing of rings with the removal of rings; and no trials of nail polish versus no nail polish that measured surgical infection rates. We found one small RCT (102 scrub nurses) that evaluated the effect of nail polish on the number of bacterial colony forming units left on hands after pre-operative surgical scrubbing. Nurses had either unpolished nails, freshly-applied nail polish (less than two days old), or old nail polish (more than four days old). There were no significant differences in the number of bacteria on hands between the groups before and after surgical scrubbing.
  
  
  CONCLUSIONS
  No trials have investigated whether wearing nail polish or finger rings affects the rate of surgical wound infection. There is insufficient evidence to determine whether wearing nail polish affects the number of bacteria on the skin post-scrub.
authors.affiliation: School of Health and Social Welfare, Open University, Milton Keynes, UK. v.a.arrowsmith@open.ac.uk.
authors.forename: Vickie A
authors.initials: VA
authors.lastname: Arrowsmith
authors.forename: Rosemary
authors.initials: R
authors.lastname: Taylor
mesh_terms: D001419:Bacteria / Q000302:isolation & purification; D015169:Colony Count, Microbial; D003358:Cosmetics / Q000009:adverse effects*; D013502:General Surgery; D006225:Hand / Q000382:microbiology*; D006235:Hand Disinfection; D006801:Humans; D055498:Jewelry / Q000382:microbiology; D009262:Nails / Q000382:microbiology*; D009740:Nursing Staff; D009872:Operating Room Technicians; D016032:Randomized Controlled Trials as Topic; D013530:Surgical Wound Infection / Q000517:prevention & control*
chemical_list: D003358:Cosmetics