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ByDeborah Davis, PhD, MBA, MS
There has been renewed emphasis placedon hand hygiene and skin wellness as a result of the Centers for Disease Controland Prevention (CDC)s Guideline for Hand Hygiene in Healthcare Settings.The guideline addresses issues that can result in higher incidence of nosocomialinfections among patients, and notes that a key reason clinicians do not adhereto recommended hand hygiene guidelines is skin irritation and dryness.1
Q:Isnt irritant dermatitis anallergy that only affects certain people?
A: Anyone, allergic or non-allergic, candevelop irritant contact dermatitis. Irritant dermatitis is usually due to a combination of areduced ability of the skin to resist injury, and exposure to a strongconcentration of irritating materials, such as soaps or chemicals. There are twotypes of irritant contact dermatitis: acute and chronic. Acute irritations havea rapid onset, may be severe in nature, and manifest for only a short period oftime. Typical symptoms include redness, burning, itching, and pain. Chronicirritant dermatitis symptoms persist for a longer duration and include drying,crusting, hard bumps, sores, fissures, and cracks.
Q: But isnt irritant contactdermatitis nothing more than dry and broken skin that can be treated with commonover-the-counter moisturizers and lotions (i.e., creams containing aloe vera)?
A: Although moisturizers and otherhand-care products can be effective in treating hand problems, manyover-the-counter hand-care products can become contaminated with infectiousmicroorganisms. Plus, consumer products often contain fragrances and otheradditives that might prove irritating or incompatible with clinical hand-hygieneproducts. As a clinician, you must ensure you are using skin-care products withclinically proven ingredients. Hand-hygiene products with glycerin have beenshown to attract moisture into skin, maintain skin lipids and oils, and reduceskin shedding. Gluconolocatone is known to minimize flakiness. Chitosan, which is widely used in wound dressings, helps toheal 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 toprevent dry skin since I have to wash my hands so often?
A: Studies demonstrate that hand lotionscan reduce skin scaling and cracking, which may reduce microbial shedding fromthe hands. Choosing an effective emollient and promoting its use by staffare of key importance. Purchasers should seek the advice of pharmacists andinfection control teams to ensure that hand-hygiene products are chosencarefully, in line with evidence-based recommendations.
Q: I barely have time practiceappropriate hand hygiene; how can I possibly keep my hands moisturized as well?
A: The continuing nursing shortage andheavy staff workloads make it difficult for healthcare workers to find time towash hands or use alcohol handrubs between patients, much less also apply amoisturizing product. Products and practices that make it easy for healthcareworkers to comply with recommendations regarding the use of moisturizers havethe potential to make a significant contribution to better hand hygiene, fewerhealthcare-associated infections, and lower healthcare costs.2 Medical glovesand other hand-hygiene products are now available with integrated emollients andtherapeutic agents. When considering these products, its important to reviewquantitative test data to ensure that agents are present in the rightcombination and in large enough amounts to truly provide benefits to the skin.Additionally, the formulas should be optimized to provide maximum benefit duringtypical clinical usage.
Q: Whats involved in a hand-careplan?
A: By undertaking a consistent, effectivehand-care regimen, healthcare professionals will maintain the integrity of theirskin as their first line of defense against the spread of bloodborne pathogenssuch as hepatitis B, C or even HIV and other potentially infectiousmicroorganisms. An important challenge is to maximize the antimicrobial value ofhandhygiene practices while minimizing changes to skin health or microflora.
Strategies for meeting this challenge include:
Q: Wontwashing my hands frequently and properly absolutely protect me fromhospital-acquired infections?
A: Theres a bit of a conundrum when itcomes to handwashing and infection control. The repeated use of hand-scrub andhandwashing products, as recommended in the CDCs Guideline for HandHygiene in Healthcare Settings, can expose clinicians to substances such asiodophors, chlorhexidine, triclosan, and alcohol-based products all of whichare commonly reported irritants. As a result, if you must wash your hands andchange gloves between every patient or procedure, you are likely to becomesusceptible not only to dry skin, but also to skin irritations and acute orchronic irritant contact dermatitis. In addition to the increased risk oftransferring infection to patients, broken skin puts employees at additionalrisk 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 enterthe bloodstream.
Deborah Davis, PhD, MBA, MS istechnical director for the gloves business unit of Cardinal Health. Her primaryresponsibilities include driving clinical research initiatives; coordinatingvarious aspects of product development between the marketing, regulatory,manufacturing, and research and development organizations, and publication andpresentation of technical information for customers and field sales personnel.
1. Boyce, J.M., Pittet, D. Guideline for hand Hygiene inHealth-care Settings: Recommendations of the Healthcare Infection ControlPractices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene TaskForce. 23, 12 Suppl. Infect Control Hosp Epidem. 2002.
2. Larson, E. Skin hygiene and infection prevention: more ofthe same or different approaches? Clin Inf Dis. 1999; 29:1287-94.