We thank Augustin and Augustin ^{Reference Augustin and Augustin1} for their thoughtful response to the updated SHEA/IDSA/APIC Strategies to Prevent Healthcare-Associated Infections through Hand Hygiene. ^{Reference Glowicz, Landon and Sickbert-Bennett2} In these updated recommendations, promotion of healthy hand skin and fingernails is considered the first essential practice. As you noted, there is a large body of evidence indicating the need to include fingernail care in hand hygiene policies. The high quality of evidence designation in the table you highlighted is intended to apply only to the inclusion of nailcare in facility-specific policies; the individual sub-bullets are provided as reasonable recommendations for Infection Prevention (IP) programs to consider when creating policies. We agree that evidence regarding the association between nail polish and healthcare-associated infection is not robust, and there is a theoretical concern for reducing the effectiveness of hand hygiene (eg, difficulty cleaning nail beds). In light of this, we therefore recommend that IP programs play a role in developing practical policies that consider patient and procedure risks relative to nail polish. The recommendation against use of nail polish is made only for scrubbed surgical personnel and aligns with domestic and international guidelines (United States Association of Perioperative Nurses, World Health Organization, and National Institute for Health and Care Excellence) which include removal of fingernail polish as a step in surgical hand antisepsis. We do not differentiate between various types of nail polish (eg, standard, gel shellac, ultraviolet) as it is not feasible for those charged with assessing adherence to determine which methods of nail polish application were used. As noted by Cochrane reviewers, randomized control trials linking nail polish or jewelry to surgical site infections are not likely to be done as it may not be possible to ethically conduct such studies. ^{Reference Arrowsmith and Taylor3} IP programs conduct annual risk assessments and depending on their facility-specific risks and prevention priorities may choose to allow nail polish.