The question of gel nails often arises among dental nurses, particularly when a special occasion is coming up and you start to wonder whether having your nails done would really make a difference at work. Alongside this, there is a growing amount of mixed messaging. Some dental professionals and educators suggest that the CQC takes a more relaxed approach, while online forums and discussions include reports from dental managers who say their practices allow short gel nails under local policy. With so many conflicting views circulating, it can be difficult to know which information is reliable and what guidance should actually be followed.
What does the research say?
You'll find plenty of articles online warning that gel nails harbour more bacteria than natural nails. A 2018 study, for example, looked at 88 healthcare workers and found that while alcohol hand gel reduced bacterial burden on bare nails and standard nail polish, this reduction wasn't observed on gel nails. The study suggested that gel nails might be harder to clean effectively.
However, more recent research paints a different picture. A 2023 study published in the Journal of Hospital Infection looked at 46 healthcare workers over 21 days, comparing gel polish, standard polish and unpolished nails (all kept short at 2mm or less). The findings were very surprising: gel polish nails were not associated with a higher bacterial burden than unpolished nails within three weeks of application. In fact, by day 21, gel nails actually had a significantly lower bacterial count than bare nails before hand hygiene.
Perhaps most interesting was what the study found about standard nail polish. It was associated with a higher bacterial burden than both gel polish and unpolished nails from day 4 onwards. So if you thought regular polish was the safer alternative, this evidence actually suggests otherwise.
These findings are supported by a more recent 2025 study, also published in the Journal of Hospital Infection, which specifically examined whether gel nail polish affects bacterial load or the effectiveness of alcohol-based hand rub. The researchers concluded that gel nail polish did not negatively impact nail bacterial burden and did not impair the effectiveness of hand hygiene when alcohol-based hand rub was used. This conclusion related to gel nails specifically and was made on the basis that nails should still be short.
But what do the regulations actually say?
HTM01-05 guidance remains clear on this matter. Section 6.8 states:
“Fingernails should be kept clean, short and smooth. When viewed from the palm side, no nail should be visible beyond the fingertip. Staff undertaking dental procedures should not wear nail varnish and false fingernails.”
Section 6.23 reinforces this by explaining that long or false nails may damage gloves, which are your primary barrier against cross-contamination.
But the Health and Social Care Act 2008: Code of Practice on the Prevention and Control of Infections guidance also states:
“Registered providers are free to decide to use alternative approaches but should be prepared to justify to the CQC how the chosen approach is equally effective or better in ensuring that the criteria are met. Providers of regulated activities need to recognise that effective management of IPC is an important service-user safety issue.”
And the official government guidance on the code states:
“The law states that the code must be taken into account by the Care Quality Commission (CQC) when it makes decisions about registration and that providers must have regard to the code when deciding how they will meet the regulations. However, the code is not mandatory, so registered providers do not by law have to comply with the code. A registered provider may be able to demonstrate that it meets the regulations in a different way (equivalent or better) from that described in this document.”
Practices are expected to follow HTM 01-05 as the default standard; however, where a provider chooses to depart from it, that decision must be made at practice level, supported by documented risk assessment, and justified to the CQC as being equally effective or safer. This responsibility sits with the provider. Until guidance such as HTM 01-05 is formally updated, it remains the benchmark against which compliance will be judged.
So what does this actually mean for dental nurses?
The evidence base is evolving, and research published in 2023 and 2025 suggests the risks associated with gel polish on short, intact nails may be lower than previously thought. However, this evidence alone does not change national guidance. HTM 01-05 remains the recognised best-practice standard for dental settings.
Where a practice has formally reviewed the evidence, completed a documented risk assessment, and agreed a local policy that departs from HTM 01-05, dental nurses should follow their practice policy, as the responsibility for that decision sits with the provider. In the absence of such a formally agreed policy, HTM 01-05 should be followed as the default standard.
For dental nurses, the key point is clarity: follow written practice policy, understand who holds responsibility for deviations from national guidance, and avoid relying on informal advice or assumptions. Until national guidance is formally updated, any departure from HTM 01-05 remains a governance decision, not an individual one.
References
Care Quality Commission (2024) Regulation 12: Safe care and treatment. Available at:
https://www.cqc.org.uk/guidance-regulation/providers/regulations-service-providers-and-managers/health-social-care-act/regulation-12
NHS England (2013) HTM 01-05: Decontamination in primary care dental practices. Available at:
https://www.england.nhs.uk/wp-content/uploads/2021/05/HTM_01-05_2013.pdf
UK Government (2022) Health and Social Care Act 2008: Code of Practice on the prevention and control of infections and related guidance. Available at:
https://www.gov.uk/government/publications/the-health-and-social-care-act-2008-code-of-practice-on-the-prevention-and-control-of-infections-and-related-guidance
Today’s RDH (2023) Fingernail hygiene: An overlooked part of dental infection control. Available at:
https://www.todaysrdh.com/fingernail-hygiene-an-overlooked-part-of-dental-infection-control/
The Dentist UK (2024) Annual statement of infection control. Available at:
https://thedentistuk.com/annual-statement-of-infection-control/
Oriol, A., et al. (2023) Impact of nail polish on bacterial burden of healthcare workers’ fingernails. Journal of Hospital Infection. Available at:
https://www.sciencedirect.com/science/article/pii/S0195670124004080
Arreba, P., Iglesias, J., Ríos, J., Herrera, S., Marco, D.N. and Montoya, M. et al. (2025) Gel nail polish does not have a negative impact on the nail bacterial burden nor on the quality of hand hygiene with an alcohol-based hand rub. Journal of Hospital Infection, 157, pp. 40–44. Available at:
https://www.journalofhospitalinfection.com/article/S0195-6701(24)00408-0/abstract