Nail Polish During Surgery
Patients should remove nail polish before surgery, as recommended by infection control guidelines. 1
Rationale for Removal
The primary concern with nail polish during surgery relates to infection control and patient monitoring, not cosmetic preferences:
Infection control guidelines specifically recommend removal of nail polish and rings as part of preoperative preparation. 1 This recommendation appears in systematic reviews of surgical wound care interventions and represents expert consensus on infection prevention practices.
Healthcare workers must keep fingernails short with smooth, filed edges to allow thorough cleaning and prevent glove tears. 1 While this guideline addresses healthcare providers rather than patients, the underlying principle of maintaining clean, unobstructed nail surfaces applies to the surgical environment.
Artificial nails harbor significantly more bacteria than natural nails and cannot be cleaned as effectively. 2, 3 Artificial nails increase infection risk substantially, with studies documenting post-surgical infections and even deaths attributed to artificial nails worn by surgical personnel. 3
Clinical Monitoring Concerns
Beyond infection control, nail polish interferes with intraoperative patient assessment:
Pulse oximetry readings may be affected by nail polish, particularly darker colors, potentially compromising the anesthesia team's ability to monitor oxygen saturation accurately during surgery.
Visual assessment of nail bed perfusion and color provides important clinical information about circulation and oxygenation status that becomes obscured with nail polish.
Practical Implementation
Develop local policies based on expert opinion requiring nail polish removal before surgery. 1 This should be communicated clearly during preoperative instructions:
Patients should remove all nail polish from fingers (and toes if relevant to the surgical site or monitoring needs) before arriving for surgery.
If polish remains at the time of surgery, it must be removed with acetone or nail polish remover before the procedure begins.
At minimum, polish should be removed from at least one finger on each hand to allow pulse oximetry monitoring, though complete removal is preferred for infection control.
Special Considerations
The evidence strongly discourages artificial nails in surgical settings. Artificial nails should not be worn by healthcare workers with direct patient contact, particularly in operating rooms or intensive care units. 1 While this guideline targets healthcare workers, patients undergoing surgery should similarly avoid artificial nails given the infection risks documented in the literature. 2, 3
Common pitfall: Some facilities may allow nail polish to remain if "at least one nail is polish-free for monitoring." This represents a compromise that addresses monitoring concerns but fails to address infection control principles. The safest approach mandates complete removal.