When preparing for surgery, patients are instructed to remove all nail polish, including gels and acrylics, from their fingernails and often their toenails. This is a mandatory safety precaution that directly impacts patient monitoring and infection control throughout the procedure. Understanding these reasons helps patients appreciate the safety measures taken by the surgical team. The rule ensures medical staff can accurately monitor the patient’s oxygen levels and quickly identify changes in their health status while under anesthesia.
The Critical Role of Pulse Oximetry
The reason for bare nails is to ensure the accuracy of the pulse oximeter, a device that measures the oxygen saturation in the patient’s blood. This clip-like device is placed on a fingertip and works by shining two wavelengths of light—red and infrared—through the finger. The oximeter measures how much light is absorbed by the oxygen-carrying hemoglobin to calculate the percentage of oxygen saturation.
Pigments in nail polish, particularly dark colors, can absorb or scatter the light signals emitted by the oximeter. This interference can lead to an inaccurate or unreliable reading, displaying a falsely low or high blood oxygen level. The thick, opaque nature of artificial nails, gels, and shellac also blocks light transmission, preventing the oximeter from getting any reading at all. An inaccurate reading can delay the surgical team from recognizing and treating a drop in oxygen, called hypoxemia, which is a safety concern during anesthesia.
Obscuring Visual Indicators of Patient Health
Surgical and anesthesia staff rely on visual checks of the nail beds to assess circulation and oxygenation. The nail bed is one of the few places where capillaries are close enough to the surface to be easily observed. This visual assessment provides a quick, real-time check that complements the data from the pulse oximeter.
One common visual test is the capillary refill time, which involves pressing briefly on the nail bed and observing how quickly the natural pink color returns. A delayed return suggests poor blood flow or circulation problems. Nail polish completely obscures this indicator. Staff also look for cyanosis, a bluish discoloration that signals low oxygen levels in the blood. This color change is often most easily detectable in the nail beds, and colored polish can mask this symptom, preventing timely intervention.
Infection Risk from Nail Enhancements
Nail enhancements, including acrylics, gels, and chipped polish, pose a serious risk related to hygiene and sterility. Studies show that artificial nails and polish, especially when chipped or lifted, harbor a greater number of microorganisms than natural, bare nails. These enhancements create microscopic spaces and crevices that are difficult to fully sterilize, even with rigorous scrubbing techniques.
Bacteria, including antibiotic-resistant strains, can reside under and around these enhancements, increasing the risk of transmitting pathogens during an invasive procedure. Furthermore, pieces of chipped polish or acrylic can flake off into the sterile surgical field. This contamination compromises the sterile environment, increasing the patient’s risk of developing a surgical site infection.
Pre-Surgical Guidelines for Nail Preparation
Pre-surgical instructions mandate the removal of all nail coatings before arriving at the hospital. This requirement includes traditional nail polish, gel manicures, shellac, dip powder, and artificial or acrylic nail extensions. Although some facilities may only require one bare finger for the pulse oximeter, the safest practice is to remove all enhancements from all fingers.
The patient should remove these coatings at home using an appropriate remover before the day of surgery. This prevents last-minute delays or the need for staff to use harsh solvents in the pre-operative area. Following these guidelines ensures the medical team has clear access to the patient’s reliable monitoring sites and maintains a sterile environment.