When William Halstead introduced surgical gloves in 1896, he did it to protect healthcare professionals from harsh disinfectants that were causing severe dermatitis. Today, more than 110 years later, maintaining skin as a key barrier protection agent is just as vital for healthcare professionals as it was back then.
With new pathogens and microorganisms continually being discovered, protecting patients and healthcare professionals is an ongoing challenge. Because the skin is the body’s largest organ, covering a surface of approximately two square meters, healthy, intact skin is the greatest barrier protection against such risks. The epidermis, the outer most layer of the skin, is a complex multi-layered membrane with a thickness that varies from the thinnest on the eyelids to the thickest on the palms and soles of the feet.
The outermost of the epidermis’s five layers, the stratum corneum, is composed of approximately 15 layers, which are completely replaced every two weeks — with a new layer formed almost daily. Stratum corneum cells contain keratin, a protein that helps keep the skin hydrated by preventing water evaporation while retaining the skin’s hydration, softness and barrier effectiveness. A healthy stratum corneum will prevent cracks, which could become a potential portal for pathogen entry.
Unfortunately, during a healthcare worker’s day-to-day practices, overall skin barrier protection can become compromised. Standard precaution dictates that gloves be worn for protection. Thus, depending on the department, gloves can often be worn for hours at a time. Gloves are made with materials created to impede substances from permeation, and, as a result, they do not permit the evaporation of skin moisture. This can cause the skin to become macerated, weakening the epidermis. If this occurs, the stratum corneum can be altered, affecting its protective barrier properties.
Today, glove manufacturers offer a wide-range of styles and compositions suited for many different healthcare applications. And, in addition to protecting from various pathogens, they still protect the body’s most important barrier mechanism, the skin. However, while surgical gloves remain a vital tool for maintaining the skin as a barrier, simply wearing gloves is not enough to protect the skin completely. There are many other components, such as choosing the proper surgical glove, becoming aware of other skin-irritating substances, and knowing of practices that can protect one’s skin.
Skin's water content, humidity, pH, intracellular lipids, and rate of shedding all aid its protective barrier properties. Therefore, the following can disrupt and harm the skin’s lipid layer, adversely affecting the health of the skin:
- Frequent handwashing with detergents or soaps
- The use of alcohol-based hand rubs
- Seasonal changes, including dry air
- Use of caustic chemicals Glove powders
- Donning and removing gloves numerous times during a shift Increase in the number of patients (increasing frequency of glove change)
The potential of detergents to cause skin irritation varies considerably, and can be ameliorated by the addition of emollients and humectants. There are multiple products on the market; however, not all work well in healthcare facilities. Products should always go through the infection control department to ensure that they are compatible with other products used in a particular healthcare facility. This will ensure that the healthcare professionals’ hand-hygiene needs are met while minimizing irritant contact dermatitis that may be associated with certain non-optimal hand-hygiene practices.
Additionally, skin care products in the healthcare environment must not negate the effects of antimicrobial soaps and rubs used in the facility. It is also vital to ensure that lotions containing mineral oil, lanolin or petrolatum should not be used when wearing gloves, as they can negatively affect their composition.
The newest innovations for healthcare professionals have come in the form of protective, hand-healthy coatings applied to the inside of surgical and exam gloves. These coatings offer a means to keep skin moist and intact. But not all skin care product ingredients translate into formulations that can be used by a glove manufacturer as a hand-friendly coating. Some of the products are volatile liquids that evaporate quickly or may crystallize on the skin once any water evaporates. There are a number of additives that may work well for skin that is not covered with a glove barrier, but in the closed glove system could be potentially irritating. However, glycerin, a proven moisturizer found in numerous skin care lotions, has made the transition into a coating for gloves in healthcare.
The Dermatology Foundation’s “Dry Skin Model” describes the path to dry skin and states that if there are interventions along this path, the cycle of dry, damaged skin can be broken. Prudent use of proper skin care products and gloves enhanced with skin protective ingredients may be of significant help, especially to those healthcare professionals with skin prone to drying. And when safeguarding your skin, it is always important to determine if you have the right glove for the right task.
It is essential to strive to keep skin healthy and free from cracks, cuts and abrasions. It’s important to remember that moisturizing is beneficial for skin health and reducing microbial dispersion from skin — and to recognize that formulations in lotions and moisturizing products in gloves can differ and vary in their efficacy. The healthcare environment is continuously changing, and barrier protection must evolve with it to protect against recently discovered pathogens and microorganisms. As we accept the challenge to protect patients and safeguard healthcare workers, it is crucial to do everything possible to guard against transmitting potentially infectious agents, protecting skin to secure it as a fundamental barrier.
Ansell Healthcare has a full-time staff of clinical consultants with a comprehensive understanding of the complex issues relating to barrier protection. Ansell’s clinical consultants work with your staff to provide advanced solutions regarding allergy management, clinical hand barrier protection and cost and risk management. Their mission is to ensure that the most recent information is in the hands of the healthcare professionals they serve.
Lori F. Jensen, RN, and Pam Werner, RN, BSN, CNOR, MBA, are clinical consultants for Ansell Healthcare.