Potentially fatal germs under fingernails of hospital personnel should be 'eradicated,' study says

From staff and wire reports

ATLANTA (CNN) -- Hospitals with elevated rates of infections and death, especially among newborn babies, should be examined for "potential reservoirs" of bacteria, including under the fingernails of nurses and other medical personnel.

In a study reported in the September 7 issue of The New England Journal of Medicine (NEJM), researchers also said bacterial conditions such as ear-skin inflammations and fungal nail infections of health care workers "should be detected and eradicated" to reduce sickness and deaths among hospital patients.

"Requiring short, natural fingernails in (newborns' intensive care units) is a reasonable policy that might reduce the incidence of hospital-acquired infections," said a panel of physicians and other health-care specialists. Their report was published in the journal Infection Control and Hospital Epidemiology earlier this year.

The targeted bacterium, pseudomonas aeruginosa, is "found more frequently on people who have artificial nails, and that would include nail wraps and nail tips and other cosmetic-nail treatment," said Dr. Lisa Saiman, who worked in the study reported in the NEJM.

According to officials of the U.S. Centers for Disease Control and Prevention, a major advancement would be more frequent, more thorough hand washing by people who work in hospitals. Previous CDC studies have shown that only 40 percent to 50 percent of physicians and nurses wash their hands properly between seeing patients -- with nurses washing more often than doctors.

Pseudomonas aeruginosa, which can lead to death, causes between 10 percent and 20 percent of infections in most hospitals, medical scientists have estimated. In addition to newborns, patients particularly vulnerable to this bacterium are those with burn wounds, intravenous-drug addiction, cystic fibrosis, acute leukemia and organ transplants.

The bacterium's most serious infections include disease of the ear called malignant external otitis, blood poisoning (septicemia) and inflammation of the eyes (endophthalmitis), of the interior linings of the heart (endocarditis), of the lining of the brain and spinal cord (meningitis) and of the lungs (pneumonia).

The deaths of 16 infants in an Oklahoma City neonatal intensive-care unit ICU in 1997 and 1998 were blamed on pseudomonas aeruginosa. This easily transmitted bacterium was also found on 49 infants in the neonatal ICUs of New York Presbyterian Hospital about the same time.

"We found a new reservoir, a new place where the bacteria were - on the hands of health-care workers," said Saiman, who works at the New York hospital.

Pseudomonas aeruginosa also breeds in moist places often found in sinks, incubators, respiratory-therapy equipment and hand lotions. Administrators at the New York hospital recommended that personnel not use artificial nails, remove jewelry and limit therapy supplies at the patient's bedside, since those supplies can become contaminated. Also, nurses have stopped heating baby formula with water, which can carry the bacteria.

Despite its vigor, pseudomonas aeruginosa can be stopped with antibiotics, if the bacterium is detected in time.

CNN Medical Correspondent Holly Firfer the Associated Press contributed to this report.

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