To determine differences in the identity and quantity of microbial flora from healthcare workers (HCWs) wearing artificial nails compared with control HCWs with native nails.

Two separate studies were undertaken. In study 1, 12 HCWs who did not normally wear artificial nails wore polished artificial nails on their nondominant hand for 15 days. Identity and quantity of microflora were compared between the artificial nails and the polished native nails of the other hand. In study 2, the microbial flora of the nails of 30 HCWs who wore permanent acrylic artificial nails were compared with that of control HCWs who had native nails. In both studies, nail surfaces were swabbed and subungual debris was collected to obtain material for culture. Staphylococcus aureus, gram-negative bacilli, enterococci, and yeasts were considered to be potential pathogens. All organisms were identified and quantified.

In study 1, potential pathogens were isolated from more samples obtained from artificial nails than native nails (92% vs 62%; P<.001). Colonization of artificial nails increased over time; by day 15, 71% of cultures yielded a pathogen compared with 21% on day 1 (P=.004). A significantly greater quantity of organisms (expressed as mean log10 colony-forming units ± standard deviation) was isolated from the subungual area than the nail surface; this was noted for both artificial (5.0±1.4 vs 4.1 ±1.0; P<.001) and native nails (4.9±1.3 vs 3.7±0.8; P<.001). More organisms were found on the surface of artificial nails than native nails (P=.008), but there were no differences noted in the quantities of organisms isolated from the subungual areas. In study 2, HCWs wearing artificial nails were more likely to have a pathogen isolated than controls (87% vs 43%; P=.001). More HCWs with artificial nails had gram-negative bacilli (47% vs 17%; P=.03) and yeasts (50% vs 13%; P=.006) than control HCWs. However, the quantities of organisms isolated from HCWs wearing artificial nails and controls did not differ.

Artificial fingernails were more likely to harbor pathogens, especially gram-negative bacilli and yeasts, than native nails. The longer artificial nails were worn, the more likely that a pathogen was isolated. Current recommendations restricting artificial fingernails in certain healthcare settings appear justified.

To compare the epidemiology of vancomycin-resistant Enterococcus faecium (VRE) in a longterm–care unit and an acute-care hospital.

Point-prevalence surveys for VRE rectal colonization of patients were carried out over a 21-month period in patients in a long-term–care unit and an acutecare hospital (medical ward and intensive-care units). The environment and hands of healthcare workers also were sampled for VRE. Contour-clamped homogeneous electric field (CHEF) electrophoresis was used to evaluate possible transmission among roommates and the relatedness of patient strains to those in the environment and on the hands of healthcare workers.

A 200-bed Veterans Affairs Medical Center with an attached 90-bed long-term–care unit.

From December 1994 to January 1996, rectal VRE colonization of patients in the long-term–care unit increased significantly from 9% to 22%. In contrast, patients on the medical ward rarely were colonized after the first survey in December 1994, and only two intensivecare–unit patients were found to be colonized during the four surveys. The environment was contaminated persistently in the long-term–care unit. In the four surveys, carriage of VRE on hands of healthcare workers varied from 13% to 41%; 65% of healthcare workers with VRE found on their hands worked in the long-term–care unit.

Seven different strains were identified by CHEF typing. Although the initial survey found only vanA strains, subsequent surveys showed vanB strains also were present.

Residents of a long-term–care unit frequently were colonized with VRE, but infections were uncommon in this population. The environment of the long-term–care unit was contaminated with VRE, and VRE was found frequently on the hands of healthcare workers in this unit. Both vanA and vanB genotypes were found in this setting.