UCSF HOSPITAL EPIDEMIOLOGY AND INFECTION CONTROL (HEIC)
This page contains Frequently Asked Questions (FAQ) sheets that provide answers to the questions most commonly asked of the Department of Hospital Epidemiology and Infection Control. To view, please click on the title of the FAQ sheet listed below.
What is the UCSF Medical Center’s policy on fingernails?
Who is responsible for giving TB skin tests to patients?
How do I get fit tested for a N95 respirator?
Where do I get more Isolation Signs?
Where do I order the "Wash your hands with soap and water on EXIT" Sign?
What items can be stored under the sinks at UCSF?
What isolation precautions are needed for patients with methicillin- resistant Staphylococcus aureus (MRSA)?
Q: When was this policy implemented?
A. On February 1, 2003.
Q: What healthcare workers are affected by the restrictions?
A: Personnel affected include, but are not limited to nurses, physicians, respiratory therapists, phlebotomists, PCAs, PSAs, and anyone who has direct patient contact or staff who handle patient care products.
Q: Why are nail enhancements such as artificial nails, wraps, tips, acrylics, gels, etc. no longer permitted for these staff?
A: Employees have a responsibility for maintaining hand hygiene by adhering to specific infection control practices. Artificial fingernail enhancements contribute to nail changes that can increase the risk of colonization and transmission of pathogens to patients. Outbreaks of infections have been traced to the artificial fingernails of health care workers. For those reasons they are prohibited for anyone having patient contact. See Research Based Rationale for Elimination of Artificial Fingernails below.
Q: How short should I keep my nails?
A: Nails are to be kept clean and short. They should not extend past the fingertips.
Q: I already use good hand hygiene techniques. Won't that prevent contamination or colonization?A: Studies have shown that hospital personnel with nail enhancements can have more bacteria both before and after hand washing than personnel with natural nails. Long natural nails can also harbor bacteria. See #1 and #3 under Other Resources below.
Q: If I wear gloves doesn’t that protect the patient?
A: Gloves are not a substitute for hand washing and artificial nails may harbor organisms and prevent effective hand washing. Long nails, artificial or natural, may cause gloves to tear more readily. See EVIDENCE AND CURRENT STANDARDS below.
Q: Who enforces this policy?A: Each employee has a responsibility for maintaining hand hygiene, which now includes the removal of artificial nails and trimming long, natural nails, as defined by the policy. Managers will ensure that these standards are maintained. Additionally, the UCSF Medical Center will, in 2007, roll out a comprehensive hand hygiene campaign that will include education and monitoring to ensure that all staff are complying with existing hand hygiene policies, including the length and condition of nails.
2. "Guidelines for Perinatal Care", American Academy of Pediatrics and The American College of Obstetricians and Gynecologists; Hauth, JC, et al. 1997; pg. 256:
"Fingernails should be trimmed short, and no false fingernails or nail polish should be permitted."
3. Growing numbers of hospitals and health care centers do not allow artificial fingernails for health care workers. These include all Kaiser facilities in California, New York Presbyterian Hospital, Boston Childrens' Hospital, and many more.
PROPOSED STANDARDS1. CDC Guidelines 2002 Draft Revision of the Guideline for Hand Hygiene in Health Care Settings, Centers for Disease Control, 1992, pg. 46:
1. Candida osteomyelitis and Diskitis after Spinal Surgery: An Outbreak That Implicates Artificial Nail Use. Parry MF, Grant B, Yukna M, Adler-Klein D, McLeod GX, Taddonio R, Rosenstein C. Clin Infect Dis 2001 Feb 1;32(3):352-7 (ISSN: 1058-4838); The Stamford Hospital, Stamford, CT, and Columbia University College of Physicians and Surgeons, NY, USA.
2. Long or Artificial Fingernails Implicated in ICU Outbreak of P. aeruginosa. Moolenaar RL, Crutcher JM, San Joaquin VH, Sewell LV, Hutwagner LC, Carson LA, Robison DA, Smithee LM, Jarvis WR. Infect Control Hosp Epidemiol 2000 Feb; 21(2):80-5 (ISSN: 0899-823X) Acute Disease Division, Oklahoma State Department of Health, Oklahoma City, USA.
3. Endemic Pseudomonas aeruginosa infection in a neonatal intensive care unit. Foca M, Jakob K, Whittier S, Della Latta P, Factor S, Rubenstein D, Saiman L. N Engl J Med 2000 Sep 7; 343(10): 695-700 (ISSN: 0028-4793). Department of Pediatrics, New York-Presbyterian Hospital and Columbia-Presbyterian Medical Center, New York, USA.
1. Impact of a 5-minute scrub on the microbial flora found on artificial, polished, or natural fingernails of operating room personnel. Edel E, Houston S, Kennedy V, LaRocco M. Nursing Research, 47(1), 54-59 (1998).
The results of this study indicate that OR personnel with artificial fingernails more often harbored gram-negative rods both before and after a 5-minute scrub using microbial soap. Additionally, artificial nails had higher bacterial loads, as compared with natural or polished nails.
2. Pathogenic organisms associated with artificial fingernails worn by healthcare workers. Hedderwick S, McNeil S, Lyons M, Kauffman CA. Infection Control and Hospital Epidemiology, 21(8), 505-509 (2000).
Artificial fingernails were more likely to harbor pathogens, especially gram-negative bacilli and yeasts, than native nails.
3. Effect of hand cleansing with antimicrobial soap or alcohol-based gel on microbial colonization of artificial fingernails worn by health care workers. McNeil SA, Foster CL, Hedderwick S, Kauffman CA. Clinical Infectious Disease, 32, 367-372 (2001).
4. Banning artificial nails from health care settings. Saiman L, Lerner A, Saal MA, Todd E, Fracaro M, Schneider N, Connell JA, Castellanos A, Scully B, Drusin LM. American Journal of Infection Control, 30, 252-254 (2002).
A. The doctor caring for the patient is responsible for placing the skin test. The doctor must first write an order in the chart for the tuberculin skin test and controls. The PPD and control will be sent to the floor in a multiple use vial. 0.1 ml should be drawn into a tuberculin syringe, and the test placed on the patient. The vial should be dated, then stored under refrigeration and protected from light. The remaining contents of the vial are good for 30 days when stored in this manner. If controls are desired, the order needs to specify which control(s) is to be used. Candida and mumps are the usual controls; tetanus is sometimes used. These three are all available in the pharmacy. Coccidioides has been used as a control, but it is not available nor stocked in the pharmacy. If you have questions, please call the pharmacy at 353-1028.A. You must first obtain a medical clearance, usually from Employee Health Services or other health care provider. Then call EHS at 476-1300 to make an appointment. Appointment times are available on Thursdays between 1:00 PM and 4:00 PM. Complete details can be found in “Respiratory Protection Program” found in the TB Exposure Control Plan.
A. Isolation signs can be ordered by contacting WorkflowOne (formerly Realizon) and providing the product numbers listed below for the signs you need. Product numbers are also listed on the back of each sign at the bottom.
Material Services also has a limited supply of precaution signs if needed quickly. They can be ordered using the online ordering tool https://creator.zoho.com/alfiolevy/ms-requests# along with your other supplies.
These signs reflect the revised Standard and Transmission-based Precautions policy. If your department still has old versions of the isolation signs, please discard them and order the new ones. Please contact us if you have any problems ordering signs.
Droplet Precautions Product Number: 500-0077
Airborne Precautions: Product Number: 500-0078
Contact Precautions: Product Number: 500-0075
A. Material Services has a limited supply of "Wash your Hands with Soap and Water on Exit" sign if needed quickly. They can be ordered using the online ordering tool https://creator.zoho.com/alfiolevy/ms-requests# along with your other supplies. Please use PMM# 58963.
Wash your hands with soap and water on EXIT: Product Number: 500-0450
A. In patient care areas, including nurses stations, adult inpatient units and patient examination and treatment rooms in the outpatient practices, only cleaning supplies (e.g., Sani-Cloth) are allowed under sinks. In pediatric units where under sink storage areas are accessible by children, cleaning solutions must not be stored under sinks. Items such as vases and non-paper products are allowed under sinks in areas such as staff lounges and conference rooms. Binders and office supplies should not be stored under sinks. Patient care items are specifically prohibited from being stored under sinks.
Q. What isolation precautions are needed for patients with nafcillin resistant Staphylococcus aureus (NRSA)?
A. At this time, Standard are required for patients with nafcillin resistant Staphylococcus aureus (NRSA), also called methicillin resistant Staphylococcus aureus (MRSA).
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