Table I.

Recommendations for nail hygiene to prevent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission

Modification	Pathogens	Evidence	Recommendations
Nail length	•Gram-positive cocci, including Staphylococcus aureus, Streptococcus mitis, and Enterococcus fecalis. •Gram-negative bacilli, including Escherichia coli, Klebsiella, and Citrobacter freundii. • Human papillomavirus, Hepatitis B virus, Hepatitis C virus	•Longer nails are correlated with greater microbial counts than shorter nails. •Longer nails are more likely to harbor pathogenic organisms than shorter nails.	•Nails should be kept short (2 mm past fingertip). •Nail clippers and other nail grooming equipment should be properly cleaned after each use. Use a scrub brush soaked in 70%-90% alcohol to scrub equipment. Then rinse tools in hot water and dry completely. •The underside of the nail should be gently cleansed as part of handwashing.
Nail polish	•The number of pathogenic organisms on an intact coat of polish is similar to that of unpolished fingernails.	•Nails with intact coats of polish are not associated with greater counts of pathogenic organisms compared with unpolished nails. •Damaged nail polish has the potential to act as sources of microbial growth. •Use of nail polish is associated with poorer handwashing technique.	•Nail polish with signs of wear should be promptly removed or replaced. •Proper hand-washing technique is essential with and without nail polish.
Artificial nails	•Gram-positive cocci, including S aureus and Enterococcus sp. •Gram-negative bacilli, including Enterobacter, Pseudomonas, Klebsiella, Serratia.	•Artificial nails carry both greater counts and more species of microbes compared with bare nails. •Artificial nails inhibit thorough hand sanitization technique.	•Artificial nails should be avoided while COVID-19 is prevalent.
Gel nails	•Gram-positive cocci, including S aureus, S mitis, and E faecalis. •Enterobacteriaceae, including E coli, Klebsiella, and C freundii.	•Gel nails are associated with higher numbers and more species of microbes compared to bare nails.	•Gel nails should be avoided while COVID-19 is prevalent.
Hand jewelry	•Increased bacterial numbers (nonspecific)	•Includes rings, bracelets, and watches. •Jewelry inhibits proper handwashing technique.	•Jewelry should not be worn in the workplace.

COVID-19, Coronavirus disease 2019.