December 2021 – Repertoire Magazine
Hand hygiene is a critical aspect of patient safety1 and a task that is performed more than almost any other activity in healthcare settings. In fact, frontline healthcare workers (HCW) may have the opportunity clean their hands up to 100 times per shift, however not all of those opportunities are realized and skin irritation is often cited as the reason why.2 To maintain healthy skin and ensure proper hand hygiene compliance, it is essential that HCW take care of their hands.
The skin is the largest organ of the human body and is essential to providing a first line of defense from pathogens. HCW hands are one of the most important tools they have and can be negatively affected by dry or damaged skin. Lack of awareness of the true causes of skin damage is a significant contributing factor to improper hand hygiene. It is important for HCW to understand the behaviors that actually lead to skin damage and the steps they can take for prevention.
The first key step for HCW is knowing when to use soap and water. A soap and water handwash should be used:
- When hands are visibly dirty or contaminated
- If hands are soiled with blood or other body fluids
- Before eating and after using the restroom
- After caring for patients with C. diff if facility policy requires it
Second, both national and international hand hygiene guidelines recommend using an alcohol-based hand rub (ABHR) as the preferred method of cleaning hands in healthcare settings.3 The reason for this is that well-formulated ABHR products have superior efficacy over soap and water (even antimicrobial soaps) and offer other benefits, such as convenience and speed of use. Additionally, overexposure to hand washing with soap and water removes oils and lipids naturally present in the skin and disrupts the natural skin barrier. This can start the cycle of skin damage. Once the skin’s natural barrier has been disrupted it allows channels of exposure to nerves and tissues in the deeper layer of the skin. HCW then apply ABHR and get an immediate stinging sensation which is only a sign of skin damage that has already occurred. The stinging sensation often drives HCW to return to the use of soap and water as their primary means for hand hygiene, not knowing this is the source of the problem. The skin damage progresses with the continued overuse of soap and water making it extremely difficult for a HCW return to ABHR as their primary hand hygiene practice.
Skin irritation is often cited as a barrier to hand hygiene compliance.4 Therefore it is important for HCWs to be on the lookout for skin damage. Early warning signs of skin damage include dryness, tightness, flaking or itching of the knuckles, back of hands, and between fingers. To help prevent the cycle of skin damage it is essential for HCW to minimize handwashing with soap and water, except as required. Using lukewarm or cooler water (never hot) when washing hands, rinsing well and gently patting hands dry with a paper towel is another best practice. HCW should also be careful not to don gloves when hands are still wet. This can trap moisture underneath the gloves and irritate the skin.
Lotion is also essential for maintaining skin health. HCWs should use a facility-approved lotion frequently during their shift. Ideally this would be after every soap and water use, but at a minimum, applied twice per shift. HCW should never bring lotions from home into the clinical environment without approval. Non-approved lotions may not be compatible with other hand hygiene products, sterile gloves or may have levels of fragrance that are not appropriate.
Incorporating lotion into HCW routine is a good practice all of the time and especially during cold, dry weather or changes in climate. If a healthcare facility is switching from one hand hygiene product to another it is important to ensure lotion is used to support skin health during the transition period, or when hands feel dry for any reason.
HCW can continue to take care of their skin when they are not working, too. Wearing gloves in cold, dry weather, using a mild soap at home, and applying lotion as frequently as possible are all elements to keeping skin healthy. Thicker lotions and creams have a higher oil content and can be very beneficial outside of work when more greasiness can be tolerated. Look for a thicker lotion or cream that is fragrance-free for use at home. Applying this type of a lotion or cream on hands before going to sleep allows it to remain on the skin for an extend period of time and is another beneficial step that HCW can take to help keep hands healthy.
1 Centers for Disease Control and Prevention. 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. MMWR 2002;51:RR-16.
2 The Joint Commission. Measuring hand hygiene adherence: overcoming the challenges. 2009. Available from: http://www.jointcommission.org/assets/1/18/hh_monograph.pdf. Accessed February 7, 2019.
3 World Health Organization. WHO guidelines on hand hygiene in health care. First global patient safety challenge: clean care is safer care. http://whqlibdoc.who.int/publications/2009/9789241597906_eng.pdf. Published 2009. Accessed February 7, 2019
4 The Joint Commission. Measuring hand hygiene adherence: overcoming the challenges. 2009.