How to Comply With HAND-HYGIENE IMPERATIVES
By Deborah Davis, PhD, MBA, MS
There has been renewed emphasis placed on hand hygiene and skin wellness as a result of the Centers for Disease Control and Prevention (CDC)s Guideline for Hand Hygiene in Healthcare Settings. The guideline addresses issues that can result in higher incidence of nosocomial infections among patients, and notes that a key reason clinicians do not adhere to recommended hand hygiene guidelines is skin irritation and dryness.1
Q: Isnt irritant dermatitis an allergy that only affects certain people?
A: Anyone, allergic or non-allergic, can develop irritant contact dermatitis. Irritant dermatitis is usually due to a combination of a reduced ability of the skin to resist injury, and exposure to a strong concentration of irritating materials, such as soaps or chemicals. There are two types of irritant contact dermatitis: acute and chronic. Acute irritations have a rapid onset, may be severe in nature, and manifest for only a short period of time. Typical symptoms include redness, burning, itching, and pain. Chronic irritant dermatitis symptoms persist for a longer duration and include drying, crusting, hard bumps, sores, fissures, and cracks.
Q: But isnt irritant contact dermatitis nothing more than dry and broken skin that can be treated with common over-the-counter moisturizers and lotions (i.e., creams containing aloe vera)?
A: Although moisturizers and other hand-care products can be effective in treating hand problems, many over-the-counter hand-care products can become contaminated with infectious microorganisms. Plus, consumer products often contain fragrances and other additives that might prove irritating or incompatible with clinical hand-hygiene products. As a clinician, you must ensure you are using skin-care products with clinically proven ingredients. Hand-hygiene products with glycerin have been shown to attract moisture into skin, maintain skin lipids and oils, and reduce skin shedding. Gluconolocatone is known to minimize flakiness. Chitosan, which is widely used in wound dressings, helps to heal injured tissues. Provitamin B or panthenol improves skin barrier function (integrity) as well as improve skin texture and elasticity.
Q: Whats the best way for me to prevent dry skin since I have to wash my hands so often?
A: Studies demonstrate that hand lotions can reduce skin scaling and cracking, which may reduce microbial shedding from the hands. Choosing an effective emollient and promoting its use by staff are of key importance. Purchasers should seek the advice of pharmacists and infection control teams to ensure that hand-hygiene products are chosen carefully, in line with evidence-based recommendations.
Q: I barely have time practice appropriate hand hygiene; how can I possibly keep my hands moisturized as well?
A: The continuing nursing shortage and heavy staff workloads make it difficult for healthcare workers to find time to wash hands or use alcohol handrubs between patients, much less also apply a moisturizing product. Products and practices that make it easy for healthcare workers to comply with recommendations regarding the use of moisturizers have the potential to make a significant contribution to better hand hygiene, fewer healthcare-associated infections, and lower healthcare costs.2 Medical gloves and other hand-hygiene products are now available with integrated emollients and therapeutic agents. When considering these products, its important to review quantitative test data to ensure that agents are present in the right combination and in large enough amounts to truly provide benefits to the skin. Additionally, the formulas should be optimized to provide maximum benefit during typical clinical usage.
Q: Whats involved in a hand-care plan?
A: By undertaking a consistent, effective hand-care regimen, healthcare professionals will maintain the integrity of their skin as their first line of defense against the spread of bloodborne pathogens such as hepatitis B, C or even HIV and other potentially infectious microorganisms. An important challenge is to maximize the antimicrobial value of handhygiene practices while minimizing changes to skin health or microflora.
Strategies for meeting this challenge include:
- Reduce surgical scrub times
- Replace irritating hand hygiene products with preparations that are less damaging to the skin
- Develop and promote compliance with appropriate hand washing practices
- Educate clinical staff regarding the risks and prevention of irritant contact dermatitis and dry skin
- Provide caregivers with approved hand lotions/moisturizers
- Promote appropriate glove usage
Q: Wont washing my hands frequently and properly absolutely protect me from hospital-acquired infections?
A: Theres a bit of a conundrum when it comes to handwashing and infection control. The repeated use of hand-scrub and handwashing products, as recommended in the CDCs Guideline for Hand Hygiene in Healthcare Settings, can expose clinicians to substances such as iodophors, chlorhexidine, triclosan, and alcohol-based products all of which are commonly reported irritants. As a result, if you must wash your hands and change gloves between every patient or procedure, you are likely to become susceptible not only to dry skin, but also to skin irritations and acute or chronic irritant contact dermatitis. In addition to the increased risk of transferring infection to patients, broken skin puts employees at additional risk of exposure to infectious organisms such as hepatitis B or C, or even HIV. Damaged skin also provides a more direct route for contact organisms to enter the bloodstream.
Deborah Davis, PhD, MBA, MS is technical director for the gloves business unit of Cardinal Health. Her primary responsibilities include driving clinical research initiatives; coordinating various aspects of product development between the marketing, regulatory, manufacturing, and research and development organizations, and publication and presentation of technical information for customers and field sales personnel.
1. Boyce, J.M., Pittet, D. Guideline for hand Hygiene in Health-care Settings: Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. 23, 12 Suppl. Infect Control Hosp Epidem. 2002.
2. Larson, E. Skin hygiene and infection prevention: more of the same or different approaches? Clin Inf Dis. 1999; 29:1287-94.