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Emollients in a propanol-based hand rub can significantly decrease irritant contact dermatitis
Abstract
The objective of this study is to determine the effect of emollients in a propanol-based hand rub on skin dryness and erythema. In this prospective, randomized, controlled, double-blind trial, 35 subjects participated; of them approximately half were atopic (modified Erlanger atopy score > or =8). 2 propanol-based formulations were tested in a repeated open application test, 1 contained a mixture of emollients (0.81%, w/w). 2 aliquots of 0.7 ml of each formulation were applied twice per day over 2 weeks to the cubital fossa of each subject after random assignment of the preparations. Treatment areas were assessed before each application and 3 days postfinal application by visual inspection for erythema and dryness according to a standard scale. The sum score over all assessment time-points served as primary parameter. The mean sum score for erythema and dryness was significantly lower for the hand rub with emollients (0.8 +/- 2.4) in comparison with that for the hand rub without emollients (1.5 +/- 3.5; P = 0.022; Wilcoxon signed rank test). A comparison of the atopic and non-atopic subjects revealed no significant difference for any of the products (P > 0.05; Mann-Whitney U-test). It is concluded that the addition of emollients to a propanol-based hand rub can significantly decrease irritant contact dermatitis under frequent-use conditions.
... Estimates for water usage are about 20 L for each surgeon unless motion-activated water taps are used and then estimates are 10 to 15 L per surgeon for each procedure (15). Under frequent-use conditions the general health of the skin is significantly improved with alcohol-based rubs compared to traditional scrubbing techniques (17) because of the lack of abrasive scrubbing, the lack of soap, and the presence of emollients (18). The emollients help to prevent the hands from becoming as dry as they would from soap and water washings (19). ...
... The cotton swabs were immediately immersed in 0.5 mL transport medium of Trypticase Soy Broth with a mixture of CHG neutralizing agents: 3% Tween 80, 0.3% lecithin, 0.1% histidine, 0.5% sodium thiosulphate, 3% saponin, 1% ether sulphate (18), and refrigerated until they were processed. The bacteriologist was blinded to the method of hand antisepsis. ...
... Due to the residual bacteriostatic or bactericidal activity of CHG, the use of effective neutralizing agents in the sampling fluids is important to avoid false positive efficacy assessments when testing products containing this molecule (18,29). As the hand rub tested has CHG in its formula the neutralizing agent was used and a false increased effectiveness can be excluded. ...
This prospective clinical study evaluates the effectiveness of an alcohol-based hand rub (Avagard") for pre-surgical hand antisepsis in an equine hospital and compares it with traditional scrubbing technique using 4% chlorhexidine gluconate sponges and water. Prior to elective surgery, 3 board-certified surgeons were randomly assigned to hand antisepsis with either technique. Culture samples of each hand were taken at 4 times: before and after neutral soap hand wash, after scrub or rubbing technique, and after surgery. There was no significant difference in mean bacterial colony forming units between scrub and rub techniques over the 3 time periods (P = 0.6), controlling for initial counts. One horse from the scrub group had a skin incision infection following stifle arthroscopy; this was resolved with medical treatment. The alcohol-based hand rub is equivalent in efficacy for pre-surgical hand antisepsis to traditional water-based scrubs in an equine hospital setting.
... A positive effect of glycerol in alcohol-based hand rubs on skin condition and user acceptability has been shown by some authors. 12,13 Kampf et al 13 found that the addition of a mixture of emollients containing 0.81% (wt/wt) glycerol to a propanol-based hand rub resulted in significantly less dryness and erythema after frequent application. However, the influence of glycerol on the bactericidal efficacy of the alcoholbased hand rubs tested here has, to the best of our knowledge, not been investigated before. ...
... A positive effect of glycerol in alcohol-based hand rubs on skin condition and user acceptability has been shown by some authors. 12,13 Kampf et al 13 found that the addition of a mixture of emollients containing 0.81% (wt/wt) glycerol to a propanol-based hand rub resulted in significantly less dryness and erythema after frequent application. However, the influence of glycerol on the bactericidal efficacy of the alcoholbased hand rubs tested here has, to the best of our knowledge, not been investigated before. ...
... A positive effect of glycerol in alcohol-based hand rubs on skin condition and user acceptability has been shown by some authors. 12,13 Kampf et al 13 found that the addition of a mixture of emollients containing 0.81% (wt/wt) glycerol to a propanol-based hand rub resulted in significantly less dryness and erythema after frequent application. However, the influence of glycerol on the bactericidal efficacy of the alcoholbased hand rubs tested here has, to the best of our knowledge, not been investigated before. ...
... A positive effect of glycerol in alcohol-based hand rubs on skin condition and user acceptability has been shown by some authors. 12,13 Kampf et al 13 found that the addition of a mixture of emollients containing 0.81% (wt/wt) glycerol to a propanol-based hand rub resulted in significantly less dryness and erythema after frequent application. However, the influence of glycerol on the bactericidal efficacy of the alcoholbased hand rubs tested here has, to the best of our knowledge, not been investigated before. ...
... Many participants (57.2 %) knew that glycerol is a humectant that serves to maintain the hydrated state of the skin. Such a positive effect may improve consumer's acceptability which has been demonstrated in previous studies (Kampf, Wigger-Alberti, Schoder, & Wilhelm, 2005;Houben, De Paepe, & Rogiers, 2006). ...
Purpose: Preventive measure has been a gold stone in reducing the spread of Coronavirus disease of
2019. These measures include quarantine, social distancing, face mask use, and most importantly hand
hygiene. Consequently, alcohol-based hand sanitizers have been used abundantly. The current study aimed
to assess the knowledge, preference, and practice toward hand sanitizers of the Lebanese community,
during the pandemic period.
Method: A cross-sectional questionnaire-based study was carried out from mid of May to mid of June
2020. Adult Lebanese residents from the 5 main Lebanese districts were invited to participate in the
study. The questionnaire included demographic data, 5 knowledge questions, practice during COVID-19,
and preferred characteristics of hand sanitizers. Data was analysed using SPSS-version 20. Results were
considered significant at p-value ≤0.05 with a confidence interval of 95%.
Results: Out of the 481 participants, 278 were unable to be quarantined, and accordingly 74.5% had to use
hand sanitizers regularly. Gel form, fast-drying, and low price were the main factors behind the choice of
hand sanitizers by percentages of 51.2%,40.2%, and 36.2%, respectively. Nevertheless, all types of hand
sanitizers have caused skin irritation in 43% of the respondents. The knowledge score revealed an average
score of 2.56±1.1 over 5 with a significantly higher means for medical workers and university degrees.
Conclusion: Consequently, educational campaigns should target common people for the proper choice and
use of hand sanitizers.
... Alcohols show a low potential for contact dermatitis although they may cause a burning sensation if they are applied to irritated or damaged skin [76,77]. The incorporation of emollients in an ABHS was reported to reduce contact dermatitis in a controlled, randomized, double-blind trial [78]. ...
The global use of alcohol-based hand sanitizers (ABHS) as an important means of controlling the transmission of infectious disease has increased significantly as governments and public health agencies across the world advocated hand hygiene as a preventative measure during the COVID-19 pandemic. Although the performance of these products is most commonly defined as a function of their alcohol concentration, they are multifaceted products in which an interplay of several factors is important in determining efficacy. This paper discusses the interplay between ABHS input (formulation) factors and output (product performance) factors in the context of a multidimensional perspective using a novel representative paradigm. In the model, represented in the form of a three-dimensional tetrahedron, each of the faces represents inputs in the manufacturing of the ABHS product, which are the type and amount of alcohol, the inactive ingredients, the formulation and the manufacturing practices. The four corners of the tetrahedron represent the product performance factors which include product efficacy, sensory characteristics, usage and compliance and product safety. The multidimensional approach to the formulation and evaluation of ABHS shows that several factors contribute to the effectiveness and utility of these products. The paradigm provides a useful framework for manufacturers of ABHS and related healthcare products.
... Alcohols show a low potential for contact dermatitis although they may cause a burning sensation if they are applied to irritated or damaged skin [76,77]. The incorporation of emollients in an ABHS was reported to reduce contact dermatitis in a controlled, randomized, double-blind trial [78]. ...
The global use of alcohol based hand sanitizers (ABHS) as a means of controlling the transmission of infectious disease increased dramatically in 2020 as governments and public health agencies across the world advocated hand hygiene as a preventative measure during the COVID-19 pandemic. Although the performance of these products is most commonly defined as a function of their alcohol concentration, they are multifaceted products in which an interplay of several factors is important in determining efficacy. The hand sanitizer tetrahedron, is a novel concept that considers both ABHS formulation factors and product performance factors from a multi-dimensional perspective. The four faces of the tetrahedron represent input/formulation factors: 1) the type and amount of alcohol, 2) inactive ingredients, 3) the type of formulation/delivery system and 4) manufacturing practices. The four corners of the tetrahedron represent output/product performance factors: 1) efficacy, 2) sensory characteristics, 3) usage, usability and compliance and 4) product safety/adverse effects. All factors are of importance to ensuring the effectiveness and utility of these products.
... 13,14,18,19 In addition, repeated application of ABHRSs might result in skin dryness. 20 According to the study by Kampf et al, 21 these adverse effects can be mitigated by adding a combination of emollients such as glycerol, dexpanthenol, levomenol, myristyl alcohol, and lanolin to these hand rubs with a lower incidence of erythema and dryness. Emollients can improve skin dryness by increasing water retention via stratum corneum occlusion. ...
In-hospital transmission is one of the main routes of the 2019 novel coronavirus (SARS-CoV-2) spreading among health care workers (HCWs) who are the frontline fighters. However, coming into contact with COVID-19-positive patients is unavoidable. Therefore, hand hygiene is of utmost importance for the prevention of COVID-19 among HCWs. This purpose can be achieved by applying alcohol-based hand rubs, washing hands properly with soap and water, and applying other antiseptic agents. Nevertheless, regular hand hygiene could also be challenging, because water, detergents, and disinfectants may predispose HCWs to hand dermatitis. The current article reviews the risk factors for the development of hand dermatitis, with further focus on the most common agents used among HCWs. In addition, the risk of occupational hand dermatitis for each agent is evaluated to increase awareness of this common condition. Finally, some recommendations are discussed to reduce the effect of hand dermatitis on HCWs.
... To reduce the harmful effects of hand washing, health professionals should apply alcoholbased handrubs whenever possible as this will help to reduce water and cleanser exposure (Royal College of Nursing (RCN), 2017). Handrubs containing emollients are recommended to help keep the skin hydrated (Kampf et al, 2005). ...
Health professionals' lack of compliance with hand hygiene is a problem in both hospitals and emergency medical services. The 2019 coronavirus disease (COVID-19), caused by SARS-CoV-2, is spreading around the world and practitioners must play their part to contain the outbreak. Hand hygiene is one of the most important measures to prevent the transmission of SARS-CoV-2 and stop the spread of COVID-19. A range of products (including alcohol-based handrub and personal and respiratory protective equipment), procedures and strategies can improve compliance with hand hygiene in emergency medical services. Incorporating hand-hygiene strategies into policy can help providers to improve compliance. Effectiveness of infection prevention and control measures should be assessed by audit. All health professionals should contribute to improving infection prevention and control, including in the prehospital environment and during transfer between settings.
... Именно поэтому так важно обучение с обратной связью для конкретного медицинского работника [52]. Обычно средства для обработки рук помимо активных компонентов содержат умягчающие добавки для снижения сухости кожи и ее раздражения [53]. Такие коммерческие препараты хорошо переносятся неповрежденной кожей в сравнении с водными растворами [54]. ...
Hand hygiene is an essential element to reduce the transmission of nosocomial pathogens in healthcare facilities. The WHO has launched a global campaign on hand hygiene with the aim to reduce healthcare-associated infections. Hand disinfection using alcohol-based hand rubs is the treatment of choice for clean hands according to the five indications for hand hygiene. The dermal tolerance is usually good when emollients are part of the formulation. Hand washing should be an exception, e.g. when hands are visibly soiled or contaminated with bacterial spores such as C. difficile. Use of plain liquid soap is usually sufficient, antimicrobial soaps do not provide a relevant advantage over plain soaps. Preoperative treatment of hands is ideally done with alcohol-based hand rubs. Additional biocidal agents with a persistent antimicrobial activity are not necessary and may cause skin irritation, allergic reactions or biocidal tolerance. Surgical scrubbing with antimicrobial soaps is more and more replaced by surgical hand rubbing which is faster (often 1.5 min application time) and more gentle to the skin. Following the WHO recommendations will help to prevent healthcare-associated infections and to reduce the occupational stress to the skin of healthcare workers.
https://www.fcm.kemsma.ru/currentissue
... Notably, the disinfectant (Sterilium) used by HCWs in this trial contained glycerol, which is a known moisturizer that prevents skin dryness. 20,21 As addition of a moisturizer to disinfectants has previously been shown to prevent skin irritation, 22 it might be speculated that the addition of glycerol to the disinfectants used in the present study diminished the need for hand creams. ...
Background
Healthcare workers (HCWs) are at high risk of developing hand dermatitis (HD). Current guidelines on HD prevention recommend the use of emollients; however, in practice, adherence is poor.
Objective
To assess whether the provision of creams, electronic monitoring and feedback on cream consumption can improve skin care in HCWs.
Methods
A cluster randomized controlled trial was conducted on 19 academic hospital wards, including 501 HCWs, for 12 months. The intervention wards (n = 9; 285 HCWs) were provided with hand cream dispensers equipped with an electronic system to monitor use, which was regularly communicated to the HCWs by the use of posters. The process outcomes were self‐reported cream consumption in both groups, and electronically measured consumption per ward in the intervention group (IG) vs the control group (CG).
Results
Self‐reported cream use at follow‐up was significantly higher in the IG than in the CG, before (odds ratio [OR] 2.27; 95%CI: 1.29‐3.97; P = 0.004) and during (OR 3.30; 95%CI: 1.80‐6.06, P < 0.001) the shift, whereas at baseline there was no difference between the groups. In the IG, electronically measured cream use was, on average, 0.4 events per shift per HCW.
Conclusion
The intervention improved hand cream use, and may therefore be considered as a practical strategy to promote skin care in HCWs. Notwithstanding this, the application frequency remained lower than recommended in the present study and current guidelines.
... 11 However, ABHRs are better tolerated and less irritating than detergents because they contain emollients that reduce their drying effect. 3,7,11,17 The World Health Organization's guidelines 11 specify that trials have shown that the regular, Increased skin hydration on dorsal and palmar surfaces of hands (ABHR did not dry skin) Slightly decreased pH and superficial sebum content on palmar surfaces but changes were within physiological range (so skin barrier function not affected) 73% reported good or excellent skin tolerance with less irritation and dryness with daily ABHR use compared with handwashing with soap and water Effectiveness of hand antisepsis was not significantly affected in any group using tested hand lotion ...
... Therefore, humectants are commonly added to alcohol-based rubs [8]. In commercial preparations, glycerol is often used and its positive effect on skin condition and user acceptability has been demonstrated [9]. However, the bactericidal efficacy of alcohol-based surgical rubs is negatively affected by glycerol, especially their 3-h effect [10]. ...
Background
Guidelines for hand hygiene recommend the use of alcohol-based hand rubs containing humectants in order to improve dermal tolerance. However, the bactericidal efficacy of pre-surgical hand rubs is negatively affected by the WHO-recommended humectant glycerol, especially the 3-h efficacy. The aim of this study was to investigate whether replacing glycerol as humectant increases the bactericidal efficacy of surgical hand rubs based on isopropanol (75%, wt/wt).
Material and methods
The efficacy of 3 and 5 min applications of a modified WHO II-formulation (containing lower glycerol concentrations) and the TPH 5766 hand rub which contains a new humectant (containing ethylhexylglycerin, dexpanthenol and a fatty alcohol) were compared to the European Norm 12,791 reference (n-propanol, 60%, vol/vol) immediately following and 3 h after application.
Results
Immediately after application both isopropanol-based surgical rubs approximated the performance of the reference. The 3-h effect of the modified WHO II-formulation was found to be less efficacious than the EN 12791, showing a 30% decrease in log10 reduction values. The 3-h post application effect for the TPH 5766 hand rub was found to not be different from EN 12791.
Conclusion
Based on our data, the bactericidal efficacy of isopropanol-based surgical hand rubs can best be obtained if glycerol is not used in the formulation. Unlike glycerol, a humectant comprised of ethylhexylglycerin, dexpanthenol and a fatty alcohol was found not to decrease hand rub effectiveness. Further investigation of the bactericidal efficacy of other humectants is necessary and may prove useful.
... 40 Studies proved that combined steroids with emollients could reduce the total high potency topical corticosteroid consumption, resulted in significantly greater improvement of disease severity, pruritus and skin dryness compared to corticosteroid treatment alone, decreased the risk of irritant contact dermatitis in AD and significantly improved skin dryness and enabled to maintain the achieved remission in the majority of patients. [41][42][43][44] In this study and based on the fore mentioned data, emerged the idea of combining all these drugs together to effectively control AD lesions in a six weeks twice daily treatment regimen. This guarded against the hazards of prolonged use of topical steroids; the mainstay of therapy in AD; and the emergence of resistant S. aureus strains. ...
Background Topical steroids are the mainstay of therapy in atopic dermatitis. However, as massive colonization of lesional and non-lesional skin of atopic dermatitis patients with Staphylococcus aureus has been proved to exist and aggravate the skin lesions, thus topical antibiotics seem necessary to be added. New combined topical antibiotics and steroid formula eliminate forcefully the organism. Moreover, as topical medication penetrates a moist stratum corneum more effectively than it will penetrate a dehydrated stratum corneum, thus combining an emollient to atopic dermatitis therapy seems of utmost importance. Objective To evaluate the effectiveness of combining two topical steroids, an antibiotic and an emollient as a single mixture in effectively controlling atopic dermatitis lesions in a six weeks treatment period. Subjects and methods Thirty one females with atopic dermatitis were enrolled in this study. Disease severity was measured using the Severity Score of Atopic Dermatitis (SCORAD) index at baseline, 3 weeks and 6 weeks of therapy. They were treated with a mixture of mometasone furoate, fusidic acid and betamethasone valerate twice daily for six weeks. Results Out of the 31 enrolled cases, 20 (64.5%) satisfied the inclusion criteria. They all completed the 6-week treatment regimen and evidenced no side effects from therapy. Statistical comparison between baseline and after three and six weeks interval using ANOVA and Tukey's multiple comparison tests revealed significant improvement of SCORAD index and its six clinical intensity signs with more effective improvement after the 6-week therapy. No correlation was ever detected by the Spearman test between index score and lesions' site or with allergic co-morbidities. Conclusion The combined topical therapy mixture was effective and safe in rapidly controlling treated lesions.
... 576,622 Disa hulumtime kanë treguar se përdorimi i rregullt i produkteve të tilla mund të ndihmojë në parandalimin dhe trajtimin e dermatitit të lëkurës të shkaktuar nga produktet për higjienën e duarve. [623][624][625][626][627] Në një hulumtim klinik nga McCormick dhe kolegët, 624 u dëshmua se kushtet e përmirësuara të lëkurës që rezultojnë nga një përdorim i shpeshtë dhe i planifikuar i një losioni me vaj, çoi në një rritje prej 50% të shpeshtësisë së pastrimit të duarve tek PSH. Këta kërkues theksuan nevojën për edukimin e PSH në lidhje me vlerën e përdorimit të rregullt dhe të shpeshtë të produkteve për kujdesin e duarve. ...
... Regarding the use of commercially available ABHRs on normal subjects using 20 applications on day 1 followed by 5 applications per day for the next 6 days, the products containing 75-80% alcohol were generally more drying compared with preparations with a lower alcohol content [32]. Moreover, use of emollients and humectants in the formulations has been shown to reduce skin problems [33][34][35]. However, there are no reported studies of the effects of these products at much higher frequencies of usage that are now advised for HHC. ...
Objectives:
The aim of this exploratory study was to investigate the effect of ethanol, isopropanol and n-propanol on stratum corneum (SC) enzymes and keratinocytes in vitro together with their effects on skin condition and function.
Methods:
Activities of kallikrein 5 (KLK5) and phospholipase A2 (PLA2) as well as keratinocyte metabolic activity, interleukin-1α (IL-1α) and tumor necrosis factor-α (TNF-α) were measured in vitro in the presence and absence of the different alcohols. We also measured transepidermal water loss (TEWL), skin capacitance, visual dryness and visual redness on the volar forearms of 25 Caucasian women following application of the alcohols 20 and 100 times per day over a period of 14 days in a clinical study.
Results:
Reduced activities of KLK5 and PLA2 were observed in the presence of the alcohols. The greatest denaturing effect was always observed for n-propanol (P < 0.001), and in the case of PLA2, the effect of isopropanol was greater than ethanol (P < 0.001). Equally, ethanol had the mildest effects on keratinocyte metabolic activity and cytokine secretion (P < 0.001) and n-propanol always produced the most severe changes in normal and differentiated keratinocytes. These in vitro findings supported the clinical results where the major effects were on the induction of skin irritation (increased dropout rates) and ranked the intolerance of the different alcohols as follows: n-propanol > isopropanol > ethanol. At the high application frequencies, the effect of the different alcohols on transepidermal water loss (TEWL) and skin capacitance was similar, but at the low application frequencies, n-propanol had a significant effect on TEWL and capacitance values (P < 0.05). Equally, n-propanol and isopropanol produced significantly more skin redness at the low application frequencies.
Conclusions:
Clearly, isopropanol and n-propanol caused significant SC and keratinocyte perturbation in vitro together with damage to skin condition and function in vivo whereas ethanol did not. As a result, we show that ethanol-based sanitizers are better tolerated by skin, particularly in high-use settings, than other alcohols and should be the active ingredient of choice.
... ABHR has been shown to be less irritating to skin than soap and water, despite perceptions to the contrary, and may significantly decrease dermatitis because of emollients in the product. [30][31][32][33][34] Therefore, health care workers should be instructed to use ABHR for most hand hygiene opportunities, unless contraindicated, and to use lotion before, during, and after their shift. Compatible supplementary lotion is required as part of the hospital's hand hygiene program. ...
This report summarizes our experiences planning and implementing the transition to a new commercial line of hand hygiene products and their dispensing systems in a large academic health care facility in Toronto, Canada. Our lessons learned are organized into a practical guide made available in 2 different formats: this article and an illustrated peer-to-peer guide (http://www.baycrest.org/wp-content/uploads/HCE-PROG-HH_HighQuality.pdf). © 2016 Association for Professionals in Infection Control and Epidemiology, Inc.
Alcohol-based hand rubs are usually based on ethanol, propan-2-ol or propan-1-ol. Some contain additional non-volatile biocidal active substances such as chlorhexidine digluconate, triclosan, benzalkonium chloride, hydrogen peroxide, DDAC, polihexanide, peracetic acid or octenidine dihydrochloride. For the additional biocidal active substances, almost all studies show a lack of efficacy on the skin and a lack of any health benefit (prevention of infection). The focus is therefore on the risks of these substances. Benzalkonium chloride, triclosan, chlorhexidine digluconate and DDAC can cause a strong and stable MIC increase in a wide range of mainly Gram-negative bacterial species. Cross-tolerance between benzalkonium chloride, triclosan and chlorhexidine digluconate is common. Horizontal gene transfer can be successfully induced by ethanol, chlorhexidine digluconate, polihexanide and triclosan in E. coli. The expression of antibiotic resistance gene can be increased by chlorhexidine digluconate in a vanA E. faecium. And efflux pump genes can be upregulated by benzalkonium chloride, chlorhexidine digluconate, triclosan, octenidine dihydrochloride and ethanol in some species. The overall balance is that there is evidence of a number of relevant risks, some of them potentially serious for the development of antibiotic resistance, but no convincing evidence of a health benefit. Alcohol-based hand rubs with additional biocidal active substances should therefore be replaced by formulations based on ethanol, propan-2-ol or propan-1-ol alone as active agents.
The consensus-based guideline “hand antisepsis and hand hygiene” for Germany has the following sections: Prevention of nosocomial infections by hygienic hand antisepsis, prevention of surgical site infections by surgical hand antisepsis, infection prevention in the community by hand antisepsis in epidemic or pandemic situations, hand washing, selection of alcohol-based hand rubs and wash lotions, medical gloves and protective gloves, preconditions for hand hygiene, skin protection and skin care, quality assurance of the implementation of hand hygiene measures and legal aspects.
The guideline was developed by the German Society for Hospital Hygiene in cooperation with 22 professional societies, 2 professional organizations, the German Care Council, the Federal Working Group for Self-Help of People with Disabilities and Chronic Illness and their Family Members, the General Accident Insurance Institution Austria and the German-speaking Interest Group of Infection Prevention Experts and Hospital Hygiene Consultants.
Background
Alcohol‐based hand rub (ABHR) is widely used for hand disinfection in the health care sector. ABHR is, however, known to cause discomfort when applied on damaged skin emphasizing the unmet need for alternative and better tolerated types of disinfectants. Active chlorine hand disinfectants (ACHDs) are potential new candidates; however, the effect on the skin barrier function compared to ABHR remains to be assessed.
Materials and methods
In Study A, the forearm skin of healthy adults was repeatedly exposed to ACHD and ABHR. Skin barrier function was assessed by measurement of transepidermal water loss, electrical conductance, pH, and erythema at baseline and at follow‐up after 2 days, and subjective discomfort was likewise assessed. Study B was performed in the same way; however, in order to induce an experimental irritant contact dermatitis, sodium lauryl sulfate patch tests were applied to forearms before exposure to ACHD and ABHR.
Results
In both studies, the skin barrier function was unaffected after repetitive exposure to ACHD and ABHR, and with no significant differences between the products. Subjective discomfort was reported as sporadic or very mild in relation to both products.
Conclusion
Our results illustrate that use of ACHD does not affect the skin barrier function negatively, neither in intact skin nor in skin with experimentally induced contact dermatitis. Future studies should include real‐life evaluation of skin barrier function and subjective discomfort following ACHD use in individuals with and without hand eczema.
Background
The use of alcoholic‐based hand rubs (ABHRs) is an important tool for hand hygiene, especially in times of the COVID‐19 pandemic. Possible irritant effects of ABHR may prevent their use by persons at risk of infection.
Methods
This systematic review is based on a PubMed search of articles published between January 2000 and September 2019 in English and German, and a manual search, related to the irritation potential of alcohol‐based disinfectants restricted to n‐propanol (1‐propanol) and its structural isomer isopropanol (isopropyl alcohol, 2‐propanol).
Results
The majority of the included studies show a low irritation potential of n‐propanol alone. However, recent studies provide evidence for significant barrier damage effects of repeated exposure to 60% n‐propanol in healthy, as well as atopic skin in vivo. The synergistic response of combined irritants, (ie, a combination of n‐propanol or isopropanol with detergents such as sodium lauryl sulfate) is greater, compared with a quantitatively identical application of the same irritant alone.
Conclusion
While recent studies indicate a higher risk of skin irritation for n‐propanol and isopropanol than reported in the past, this risk still seems to be lower than that for frequent handwashing with detergents, as recommended by some to prevent COVID‐19 infections.
Background:
The use of disinfectants is crucial to preventing the spread of nosocomial infections in health care workers. As many as 25 applications of hand disinfectants is a realistic default value during a working day. However, alcohol-based hand disinfectants may weaken skin barrier function and induce dryness and eczema, which decrease their acceptance.
Objective:
To evaluate the effect of ethanol-containing disinfectants with 5% urea on skin barrier function and on sensitivity to an irritant soap (sodium lauryl sulfate [SLS]).
Methods:
Twenty healthy volunteers treated one of their forearms twice daily for 17 days with an ethanol-containing gel with 5% urea. Two types of gels with urea were tested. Treatment was randomized to left or right forearm, and the contralateral forearm served as untreated control. Transepidermal water loss, skin capacitance (dryness), and sensitivity to SLS were evaluated.
Results:
Twice-daily application of the urea-containing ethanol gels lowered transepidermal water loss, prevented dryness, and reduced sensitivity to SLS compared with the untreated control skin.
Conclusions:
Improved barrier function using this ethanol gel with urea may have relevance in daily disinfectant procedures.
Background
Hand hygiene is considered as the most important strategy for preventing healthcare infections.
Objective
In this single-arm study, skin tolerance, effectiveness and prolonged efficacy, and adherence to use an alcohol-based hand rub (ABHR) solution among hospital nurses was evaluated.
Methods
Nurses were recruited in the main hospital of Molise Region, Central Italy. Skin reactions during 12-week follow-up were self-reported by nurses and, when occurring examined by hospital dermatologist. Samples were collected from palms and fingertips before and after ABHR, also at random times during work.
Results
Dermatological reactions were not reported by 20 nurses (15 female and 5 male, aged 30–59 years) after product use. Microbial counts decreased by 99% (2Log 10 ) in 75%, with higher reduction in palm than fingertips (99% vs 70% respectively). Analysis of six randomly collected samples after 10–20 and 30–40 min from the last use showed a satisfactory prolonged efficacy.
Discussion
Beyond high effectiveness to reduce transient microbiota, no skin reactions were observed, likely due to the camomile, thyme and eucalyptus extracts contained within the gel. This study, addressing technical questions of a commercialised product, provides useful information for public health authorities faced with a choice of hand disinfectants, evaluating cost-effectiveness and cost-benefit in the light of the huge amount of these products needed at hospital level.
Alcohol-based hand rubs are usually based on ethanol, propan-2-ol or propan-1-ol. Some of them contain additional non-volatile biocidal agents such as chlorhexidine digluconate, triclosan, benzalkonium chloride, hydrogen peroxide, DDAC, polihexanide, peracetic acid or octenidine dihydrochloride. For the additional biocidal agents, almost all studies indicate a lack of efficacy on the skin and a lack of any health benefit (prevention of infection). Therefore, the risks of these biocidal agents come into the focus. Benzalkonium chloride, triclosan, chlorhexidine digluconate and DDAC can cause a strong and stable MIC increase in numerous mainly Gram-negative bacterial species. Cross-tolerance is frequently found between benzalkonium chloride, triclosan and chlorhexidine digluconate. They can also enhance antibiotic resistance development. Horizontal gene transfer can be successfully induced by chlorhexidine digluconate and triclosan in E. coli. Antibiotic resistance gene expression can be increased by chlorhexidine digluconate in a vanA E. faecium. And efflux pump genes can be up-regulated in some species by benzalkonium chloride and chlorhexidine digluconate. The overall balance provides evidence for a number of relevant risks for additional biocidal agents but no convincing evidence for a health benefit. Alcohol-based hand rubs with additional biocidal agents should therefore be replaced by formulations based on alcohol(s) alone as active agent(s).
Background:
Facial dermatitis can result from various conditions, some of which are of a chronic and relapsing nature. The use of topical corticosteroid therapy may lead to additional adverse effects.
Objective:
To compare the efficacy of moisturizer containing 4-t-butylcyclohexanol, which acts as a sensitivity regulator, and licochalcone A, an anti-inflammatory agent from the licorice plant Glycyrrhiza inflata, with that of 0.02% triamcinolone acetonide (TA) for the treatment of facial dermatitis.
Methods:
This was a randomized, prospective, investigator-blinded study. Eighty participants with mild to moderate facial dermatitis were randomly treated with either the test facial moisturizer or 0.02% TA twice daily for the first 2 weeks. For the subsequent 2 weeks, all patients used only the test moisturizer. Clinical assessment by investigators, bioengineering measurements, patients' subjective evaluation, and clinical photography were performed at baseline, week 2, and week 4.
Results:
Both treatments showed a statistically significant improvement with regard to physician clinical assessment, skin hydration, transepidermal water loss, and patient-assessed visual analog scale after 2 and 4 weeks of treatment compared with baseline. The test facial moisturizer produced better skin hydration than TCS. The improvement in TEWL after 4 weeks of using the test moisturizer was comparable with 2-week treatment with 0.02% TA cream. However, subjective evaluation by patients indicated that TA more rapidly improved sensation sensitivity.
Conclusion:
The test facial moisturizer was slower than 0.02% TA in improving facial dermatitis, but showed greater benefit in erythema control and skin hydration.
Die Prävention nosokomialer Infektionen einschließlich Surgical-site-Infektionen und die Ausbreitung multiresistenter Bakterien (MRE) erfordern ein evidenzbasiertes Qualitätsmanagement der Hygiene. Dargestellt werden die Voraussetzungen der Struktur- und Prozessqualität, die Evaluierung der Ergebnisqualität durch Infektionssurveillance, die Erfassung des Verbrauchs an Händedesinfektionsmitteln, Antibiotika Stewardship und innerbetriebliche Eigenüberwachung. Händehygiene, Aufbereitung, Antiseptik, Desinfektion, Berufs-, Schutz- und Bereichskleidung, Wassersicherheit und Abfallentsorgung werden als Maßnahmen der Standardhygiene erläutert, flankiert durch Schutzimpfungen, Personalschutz und bauliche Voraussetzungen. Speziell berücksichtigt werden die Aufbereitung vor Urethrozystoskopen, der Infektionsschutz bei Harninkontinenz und Urostomapflege sowie das Screening zur Identifizierung von Trägern von MRE. Nicht zuletzt soll der Blick für die Eigenkontrolle urologischer Praxen geschärft werden.
Even before the discovery of germs, the practice of hand hygiene had revealed itself as a crucial element in the fight against infectious diseases. In fact, supported by the historical discoveries and more recent evidence based data, the World Health Organization considers hand hygiene as the pillar of infection control, particularly when related to nosocomial infections. Therefore, the World Health Organization has a strong focus on “Clean Hands Save Lives” campaigns, a principle that is easily translatable into “Clean Hands Save Horses”. Considering the recognised importance given to skin health and integrity as the first principle of good hand hygiene, using decontamination methods and products that are the least harmful to the skin is mandatory. This is why the currently accepted presurgical hand preparation methods do not involve aggressive brushing and disinfecting soaps anymore. Rather, hands should be washed with a neutral pH friendly soap first before a hydroalcoholic solution is applied. Although the principles and benefits of proper hand hygiene have been recognised in the healthcare world, one of the major drawbacks remains the lack of compliance with established protocols. To increase compliance, equine clinics should work on improving product accessibility, enhancing staff and client education as well as helping each other to remember to actually do it. This article reviews historical and current facts on hand hygiene and relates it to equine practice. Clean equine care is safer equine care: it's all in your hands!
WHO recommends the use of hand rubs with “sustained activity” for surgical hand preparation. This structured narrative review aims to verify if any of the alcohol-based hand rubs containing non-volatile “active ingredients” such as chlorhexidine digluconate (CHG), mecetronium etilsulfate (MES) or ortho-phenylphenol (OPP) provide such sustained efficacy for surgical hand disinfection. Literature was searched to find studies according to EN 12791. Published data sets were analysed to verify if any of the formulations has a superior efficacy (p < 0.01) after 3 h in comparison to the reference procedure. Formulations with 0.5 and 1% CHG in 70% iso-propanol or 61% ethanol were not superior after 3 h. Formulations with 0.2% MES in 45% iso-propanol and 30% n-propanol were also not superior when applied for 1 min (1 data set), 1.5 min as currently recommended for use (14 data sets) and 2 min (1 data set). When applied for 3 min the formulations were superior in 3 out of 7 data sets. The hand rub with 0.1% OPP in 78.2% ethanol was also not superior to the reference treatment when applied as recommended for 1.5 min. It appears to be reasonable and responsible to limit the dermal exposure and environmental input to biocidal agents with a clear benefit such as the alcohols. In analogy to avoiding dyes and fragrances in hand rubs, formulations containing “active” substances without a clear benefit but with potential risks should be avoided when alternative formulations with the same level of antimicrobial activity, dermal tolerance and user acceptability are available.
Background:
Contact dermatitis (CD) has been assessed by numerous disease severity indices resulting in heterogeneity across published research.
Objective:
This study aims to evaluate published CD severity scales and identify a criterion standard for assessment.
Methods:
Scopus and Ovid MEDLINE were searched for human randomized controlled trials (RCTs) on CD severity measures published during a 10-year period. Eligible studies were English-language RCTs reporting disease severity outcome measures for CD in humans. Studies were excluded if they were duplicates, not available in English, not related to CD, not RCTs, not conducted on human subjects, or did not report relevant outcome measures.
Results:
A total of 22 disease outcome measures were used in 81 included RCTs. Instrument-based measures were used in 40 (49.4%) studies, and visual assessments were used in 66 (81.5%) RCTs. Only 5 (6.2%) studies reported quality of life (QoL) outcomes. Two (2.5%) studies used a clinical severity scale, which combined both QoL and visual assessments.
Limitations:
This study was limited by the exclusion of non-RCTs and gray literature.
Conclusions:
Wide variation in CD outcome measures exists including instrument-based measures, visual assessments, and QoL outcomes. A standardized outcome measure must be generated to reduce heterogeneity.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
Dermatitis tangan merupakan masalah klasik okupasional para petugas kesehatan di berbagai negara, 80% kasus adalah dermatitis kontak iritan (DKI). Faktor risiko utamanya adalah paparan terhadap iritan, seperti air, detergen dan alcohol-based hand rubs (AHRs). Tujuan penelitian ini untuk membandingkan tingkat iritasi kulit akibat penggunaan disinfektan tangan formula-1 WHO, kombinasi etanol dengan n-propanol dan chlorhexidine gluconate (CHG) pada petugas kesehatan. Dermatitis kontak iritan yang ringan diinduksi dengan uji tempel menggunakan sodium lauryl ether sulfate (SLES) 0.5% selama 24 jam pada lengan atas 21 orang subjek, diikuti dengan repeated open application test (ROAT) menggunakan disinfektan tangan formula-1 WHO [80%(v/v) etanol, 1.45%(v/v) gliserol, 0.125%(v/v) H 2 0 2 ]; kombinasi 45% etanol dan 18% n-propanol (Sofia-Man®); CHG 0.5%(w/v) dalam 70%(v/v) etanol (3M Antiseptic®); dan air sebagai kontrol basah. Iritasi pada kulit dianalisa 15 menit setelah aplikasi masing-masing siklus atau 10 kali paparan dari total tiga siklus menggunakan penilaian DKI dari Japanese Society of Contact Dermatitis. Seluruh data dianalisa dengan uji Marginal Homogeneity. Reaksi positif ROAT terhadap disinfektan tangan formula-1 WHO muncul pada 10 subjek (47.62%), kombinasi etanol dan n-propanol 4 subjek (19.05%), CHG 12 subjek (57.14%) dan air 2 subjek (9.52%). Disinfektan tangan formula-1 WHO dan CHG lebih iritatif dibandingkan air (p<0.001), sedangkan kombinasi etanol dan n-propanol tidak berbeda bermakna (p=0.102). Tingkat iritasi kulit akibat penggunaan disinfektan tangan formula-1 WHO dan CHG tidak berbeda bermakna (p=0.050). Tidak terdapat korelasi bermakna antara riwayat atopi dengan tingkat iritasi pada kulit (p=0.863). Disinfektan tangan formula-1 WHO dan CHG lebih iritatif dibandingkan dengan air, sedangkan kombinasi etanol dan n-propanol tidak berbeda bermakna. (MDVI2013; 40/s:16s-22s) Kala kunci: dermatitis kontak iritan, formula-1 WHO, etanol, n-propanol, chlorhexidine gluconate, disinfektan tangan ABSTRACT Hand dermatitis is a classic occupational health problem for healthcare workers (HCWs) in many countries, 80% of cases are irritant contact dermatitis (1CD). The most important risk factor's the exposure to irritants: water, detergents and alcohol-based hand rubs (AHRs). The aim of the study is to compare the skin irritation level of WHO formulation-1, ethanot with n-propanol combination and chlorhexidine gluconate (CHG) containing hand disinfectants among HCWs. A low-grade ICD's induced by 0.5% sodium lauryl ether sulfate (SLES) patch over 24hours on the upper arm of 21 subjects, followed by repeated open application test (ROAT) with WHO formulation-1 hand rub [80%(v/v) ethanol, 1.45%(v/v) glycerol, 0.125%(v/v) H 2 0 2 J; combination of 45% ethanol and 18% n-propanol (Sofia-Man®); CHG 0.5%(w/v) in 70%(v/v) ethanol (3M Antiseptic®); and water as wet control. The skin irritation's examined 15minutes after each cycle of application/10 exposures of total three cycles by ICD score ofJapanese Society of Contact Dermatitis. The data's analyzed using Marginal Homogeneity test. The positive ROAT reaction to WHO formulation-1 was seen in 10 subjects (47.62%), ethanol and n-propanol 4subjects (19.05%), CHG 12subjects (57.14%) and water 2subjects (9.52%). WHO formulation-! and CHG hand disinfectants were more irritative compare to water (p<0.001), while ethanol and n-propanol combination wasn't significantly different (p=0.102). Irritancy level between WHO formulation-1 and CHG hand disinfectants was not significantly different (p=0.050). No significant correlation between atopy history and skin irritation level of AHRs (p=0.863). WHO formulation-1 and CHG containing hand disinfectants were more irritative compare to water, while ethanol and n-propanol combination was not significantly different. (MDVI2013; 40/s: 16s-22s)
Die Prävention nosokomialer Infektionen einschließlich Surgical-site-Infektionen und die Ausbreitung multiresistenter Bakterien (MRE) erfordern ein evidenzbasiertes Qualitätsmanagement der Hygiene. Dargestellt werden die Voraussetzungen der Struktur- und Prozessqualität, die Evaluierung der Ergebnisqualität durch Infektionssurveillance, die Erfassung des Verbrauchs an Händedesinfektionsmitteln, Antibiotika Stewardship und innerbetriebliche Eigenüberwachung. Händehygiene, Aufbereitung, Antiseptik, Desinfektion, Berufs-, Schutz- und Bereichskleidung, Wassersicherheit und Abfallentsorgung werden als Maßnahmen der Standardhygiene erläutert, flankiert durch Schutzimpfungen, Personalschutz und bauliche Voraussetzungen. Speziell berücksichtigt werden die Aufbereitung vor Urethrozystoskopen, der Infektionsschutz bei Harninkontinenz und Urostomapflege sowie das Screening zur Identifizierung von Trägern von MRE. Nicht zuletzt soll der Blick für die Eigenkontrolle urologischer Praxen geschärft werden.
Emollients are topical agents with moisturizing, lubricating and smoothing properties. The most important action of emollients is restoring the disturbed epidermal barrier. This effect is achieved by various mechanisms: occlusive properties, attraction and keeping the water within the stratum corneum and supplying the physiological lipids and peptides, that lack in the disturbed epidermis. The final effects of emollients are reduction of inflammation, decrease of pruritus and better appearance of the skin. Emollients are the essential part of the therapy of many inflammatory skin diseases with disturbed epidermal barrier. They are used in the treatment of atopic dermatitis, psoriasis, keratinization disorders, chronic eczema, pruritic diseases and many other dermatoses. Emollients are often the adjuvant therapy, which is used together with topical corticosteroids or calcineurin inhibitors. There are several possible types of therapy: continuous, intermittent or proactive. This paper summarizes the knowledge about emollients, their mechanisms of action, the indications and proper way of application.
Objective: To describe the underpinning principles involved in central venous access device (CVAD) securement and dressing products to prevent CVAD failure and complications through a synthesis of research studies. Background: Functional, dependable CVADs are a necessary part of patient care. Dressing and securement products are used to prevent CVAD failure and complications, but there is a large variety of products available for clinicians to access, with variable effectiveness. Methods: A narrative review of studies describing the mechanisms for CVAD securement and dressing products to prevent failure and complication was undertaken. After a systematic search, 20 clinical and laboratory studies were included in the review. Discussion: The major mechanisms by which CVAD dressing and securement products prevent failure are providing a barrier to microbial contamination and motion reduction. CVAD securement and dressing products provide these functions using coating, adhesion, antimicrobial properties, absorbency, and moisture vapor transmission without causing irritation to skin and maintaining visibility of the insertion site. The complexity of patients requiring CVAD securement and dressing means that universal recommendations across CVAD populations and broad generalization of studies from single populations (eg, intensive care) or devices (eg, peripherally inserted central catheters) are ill advised. Conclusions: CVAD securement and dressing products provide important, multifaceted functions to prevent CVAD failure and complication.
The aim of this study was the evaluation susceptibility of multidrug resistance microorganism to Nanosilver by comparing it with Deconex 5% disinfectant substances. Nanosilver is nanoparticle of silver that is recently being used as antibacterial substance in medicine. This is a cross-sectional study that involved 210 multi drugs resistance microorganism and two type of standard references bacterial as Escherichia coli (ATCC-35218 and S. aurous (ATCC 25923) assayed for Nanosilver and Deconex 5% antibacterial susceptibility. Antibiotic susceptible test was done in laboratory of Baqiyatallah Hospital in capital city of Iran. Nanosilver colloid solution brand commercial name 2000sl nanosilver manufactured in Pars Nonacid Company and Deconex 5% (Sterillium) manufacture in Bode-Germany was used. Here 100 g negative and 110 g positive microorganism samples were evaluated. The most common microorganisms were staphylococci, acinetobacter and the most common site of infection was bronchial from ICU admission patients. Staphylococci aurous (ATCC 25923), Escherichia coli (ATCC-35218) and some hospital microorganism were evaluated to susceptibility of Nanosilver, Deconex 5% and antibacterial drugs. This study showed Nanosilver and Deconex can eradicate more than 96 and 100% of multi drug resistance microorganisms, respectively therefore, more evaluation was needed about consumption of Nanosilver for hand washing and hospital environment disinfectant.
Hand hygiene prevents cross-infection in hospitals, but health-care workers' adherence to guidelines is poor. Easy, timely access to both hand hygiene and skin protection is necessary for satisfactory hand hygiene behavior. Alcohol- based hand rubs may be better than traditional handwashing as they require less time, act faster, are less irritating, and contribute to sustained improvement in compliance associated with decreased infection rates. This article reviews barriers to appropriate hand hygiene and risk factors for noncompliance and proposes strategies for promoting hand hygiene.
To compare skin condition and skin microbiology among intensive care unit personnel using one of two randomly assigned hand hygiene regimens: a 2% chlorhexidine gluconate (CHG)-containing traditional antiseptic wash and a waterless handrub containing 61% ethanol with emollients (ALC).
Prospective, randomized clinical trial.
Two critical care units (medical and surgical) in a large, metropolitan academic health center in Manhattan.
Fifty staff members (physicians, nurses, housekeepers, respiratory therapists) working full time in the intensive care unit.
One of two hand hygiene regimens randomly assigned for four consecutive weeks.
The two outcomes were skin condition (measured by two tools: Hand Skin Assessment form and Visual Skin Scaling form) and skin microbiology. Samples were obtained at baseline, on day 1, and at the end of wks 2 and 4. Participants in the ALC group had significant improvements in the Hand Skin Assessment scores at wk 4 (p = 0.04) and in Visual Skin Scaling scores at wks 3 (p = 0.01) and 4 (p = 0.0005). There were no significant differences in numbers of colony-forming units between participants in the CHG or ALC group at any time period. The ALC regimen required significantly less time than the CHG regimen (mean: 12.7 secs and 21.1 secs, respectively; p = 0.000) and resulted in a 50% reduction in material costs.
Changes in hand hygiene practices in acute care settings from the traditional antiseptic wash to use of plain, mild soap and an alcohol-based product should be considered. Further research is needed to examine the association between use of antiseptic products for hand hygiene of staff and reductions in nosocomial infection rates among patients.
Non-invasive methods to evaluate skin hydration by measuring electrical properties are widely used in the cosmetic industry. However, there is still some controversy about factors that affect measurement. For example, concerns have often been expressed about the possible confounding effect of salts, either in the formulation or on the skin. Ionized salts on the skin may increase electrical conductivity and may lead to changes in electrical properties that are not related to increased water content. We have performed a systematic study of the effects of salt, i.e., sodium chloride, and glycerin on the electrical properties of skin as measured by the three most commonly used instruments, the Nova DPM 9003, the Corneometer CM 825, and the Skicon 200. Formulations containing salt from 0-3% and glycerin from 0-10% were tested for their effects at one and two hours after a single application. Salt lowered the readings in the absence of glycerin and increased the reading in the presence of glycerin. For all three instruments, there was a linear correlation between the measurement and the glycerin level in the presence or absence of salt.
Pantothenic acid is essential to normal epithelial function. It is a component of coenzyme A, which serves as a cofactor for a variety of enzyme-catalyzed reactions that are important in the metabolism of carbohydrates, fatty acids, proteins, gluconeogenesis, sterols, steroid hormones, and porphyrins. The topical use of dexpanthenol, the stable alcoholic analog of pantothenic acid, is based on good skin penetration and high local concentrations of dexpanthenol when administered in an adequate vehicle, such as water-in-oil emulsions. Topical dexpanthenol acts like a moisturizer, improving stratum corneum hydration, reducing transepidermal water loss and maintaining skin softness and elasticity. Activation of fibroblast proliferation, which is of relevance in wound healing, has been observed both in vitro and in vivo with dexpanthenol. Accelerated re-epithelization in wound healing, monitored by means of the transepidermal water loss as an indicator of the intact epidermal barrier function, has also been seen. Dexpanthenol has been shown to have an anti-inflammatory effect on experimental ultraviolet-induced erythema.
Beneficial effects of dexpanthenol have been observed in patients who have undergone skin transplantation or scar treatment, or therapy for burn injuries and different dermatoses. The stimulation of epithelization, granulation and mitigation of itching were the most prominent effects of formulations containing dexpanthenol. In double-blind placebo-controlled clinical trials, dexpanthenol was evaluated for its efficacy in improving wound healing. Epidermal wounds treated with dexpanthenol emulsion showed a reduction in erythema, and more elastic and solid tissue regeneration. Monitoring of transepidermal water loss showed a significant acceleration of epidermal regeneration as a result of dexpanthenol therapy, as compared with the vehicle. In an irritation model, pretreatment with dexpanthenol cream resulted in significantly less damage to the stratum corneum barrier, compared with no pretreatment. Adjuvant skin care with dexpanthenol considerably improved the symptoms of skin irritation, such as dryness of the skin, roughness, scaling, pruritus, erythema, erosion/fissures, over 3 to 4 weeks. Usually, the topical administration of dexpanthenol preparations is well tolerated, with minimal risk of skin irritancy or sensitization.
The etiology of nosocomial infections, the frequency of contaminated hands with the different nosocomial pathogens, and the role of health care workers' hands during outbreaks suggest that a hand hygiene preparation should at least have activity against bacteria, yeasts, and coated viruses. The importance of efficacy in choosing the right hand hygiene product is reflected in the new Centers for Disease Control and Prevention guideline on hand hygiene (J. M. Boyce and D. Pittet, Morb. Mortal. Wkly. Rep. 51:1-45, 2002). The best antimicrobial efficacy can be achieved with ethanol (60 to 85%), isopropanol (60 to 80%), and n-propanol (60 to 80%). The activity is broad and immediate. Ethanol at high concentrations (e.g., 95%) is the most effective treatment against naked viruses, whereas n-propanol seems to be more effective against the resident bacterial flora. The combination of alcohols may have a synergistic effect. The antimicrobial efficacy of chlorhexidine (2 to 4%) and triclosan (1 to 2%) is both lower and slower. Additionally, both agents have a risk of bacterial resistance, which is higher for chlorhexidine than triclosan. Their activity is often supported by the mechanical removal of pathogens during hand washing. Taking the antimicrobial efficacy and the mechanical removal together, they are still less effective than the alcohols. Plain soap and water has the lowest efficacy of all. In the new Centers for Disease Control and Prevention guideline, promotion of alcohol-based hand rubs containing various emollients instead of irritating soaps and detergents is one strategy to reduce skin damage, dryness, and irritation. Irritant contact dermatitis is highest with preparations containing 4% chlorhexidine gluconate, less frequent with nonantimicrobial soaps and preparations containing lower concentrations of chlorhexidine gluconate, and lowest with well-formulated alcohol-based hand rubs containing emollients and other skin conditioners. Too few published data from comparative trials are available to reliably rank triclosan. Personnel should be reminded that it is neither necessary nor recommended to routinely wash hands after each application of an alcohol-based hand rub. Long-lasting improvement of compliance with hand hygiene protocols can be successful if an effective and accessible alcohol-based hand rub with a proven dermal tolerance and an excellent user acceptability is supplied, accompanied by education of health care workers and promotion of the use of the product.
The Guideline for Hand Hygiene in Health-Care Settings provides health-care workers (HCWs) with a review of data regarding handwashing and hand antisepsis in health-care settings. In addition, it provides specific recommendations to promote improved hand-hygiene practices and reduce transmission of pathogenic microorganisms to patients and personnel in health-care settings. This report reviews studies published since the 1985 CDC guideline (Garner JS, Favero MS. CDC guideline for handwashing and hospital environmental control, 1985. Infect Control 1986;7:231-43) and the 1995 APIC guideline (Larson EL, APIC Guidelines Committee. APIC guideline for handwashing and hand antisepsis in health care settings. Am J Infect Control 1995;23:251-69) were issued and provides an in-depth review of hand-hygiene practices of HCWs, levels of adherence of personnel to recommended handwashing practices, and factors adversely affecting adherence. New studies of the in vivo efficacy of alcohol-based hand rubs and the low incidence of dermatitis associated with their use are reviewed. Recent studies demonstrating the value of multidisciplinary hand-hygiene promotion programs and the potential role of alcohol-based hand rubs in improving hand-hygiene practices are summarized. Recommendations concerning related issues (e.g., the use of surgical hand antiseptics, hand lotions or creams, and wearing of artificial fingernails) are also included.
Repeated open application tests (ROATs) were performed with common ingredients of vehicles in 86 patients with contact dermatitis. The substances were applied twice daily for 7 days to the flexor aspect of the forearm near the cubital fossa, unless dermatitis appeared earlier. Of the patients with a questionable (?+) patch test result, 44% were positive in ROATs. The corresponding figure was 80% in the patients with B positive (+ or ++) response in the patch lest, when the results of ROAT with propylene glycol were excluded. Only 5 of 14 patients reacting lo 30% or to 10% propylene glycol but not in 15 in water in patch testing, showed a positive result to a cream containing 5% propylene glycol in ROAT. All 5 patients with a positive patch test reaction to 1% propylene glycol reacted to 5% propylene glycol in ROAT.
The results suggest that ROATs should be performed more often, especially in patients in whom little known or new allergens are suspected as being the cause of allergic contact dermatitis.
Suppose that a test formulation and a standard formulation are to be compared in an experiment with a two period crossover design. Suppose that it is desired to obtain a confidence interval for the ratio of the test formulation mean to the standard formulation mean for some variable. Suppose that the measurements on the variable will themselves be analyzed rather than analyzing the logarithms of the measurements. A method for obtaining an exact confidence interval for a rather general model is described. A method has previously been given for obtaining an exact confidence interval under a more restrictive model. The two models are contrasted.
Modern medicine still has to contend with the major problem of infections resulting from patient care. Despite considerable evidence that appropriate hand hygiene is the leading measure to reduce cross-infection, compliance with recommendations remains notoriously low among healthcare workers. In high-demand situations, such as in most critical-care units, or at times of overcrowding or understaffing, promoting hand cleansing with an alcohol-based handrub solution seems to be the most practical means of improving compliance. It requires less time, acts faster, irritates hands less often, and is superior to traditional handwashing or medicated hand antiseptic agents. Furthermore, it was used in the only programme that reported a sustained improvement in hand-hygiene compliance associated with decreased infection rates. Although easy access to fast-acting hand-hygiene agents is the main tool of any campaign to obtain sustained improvement with hand-hygiene practices, a multidisciplinary approach is necessary to produce behavioural change.
Water is a skin irritant which deserves attention because of its ubiquity. During the Vietnam war, soldiers suffered from painful swollen feet, so-called tropical immersion foot. In occupational dermatology, the importance of water as a skin irritant is especially appreciated. The irritancy of water has been demonstrated by occlusion experiments; occlusion with either closed chambers or water-soaked patches has been shown to produce clinical and histopathological inflammation. Functional damage, as revealed by increased transepidermal water loss, has also been shown. Repeated water exposure without occlusion caused an increase in blood flow on irritated skin; however, clinical evaluation did not show a difference in dryness or scaling. Several mechanisms such as osmolarity, pH, hardness and temperature might account for the irritancy of water. Extraction or dilution of natural moisturizing factors in the stratum corneum is another possible explanation. Occlusion per se also changes the physiology of skin and may trigger the activation of potentially active substances. However, much remains to be done to clarify the risk factors and mechanisms of water-induced irritation.
Objective: To compare skin condition and skin microbiology among intensive care unit personnel using one of two randomly assigned hand hygiene regimens: a 2% chlorhexidine gluconate (CHG)-containing traditional antiseptic wash and a waterless hand-rub containing 61% ethanol with emollients (ALC), Design: Prospective, randomized clinical trial. Setting: Two critical care units (medical and surgical) in a large, metropolitan academic health center in Manhattan. Subjects: Fifty staff members (physicians, nurses, housekeepers, respiratory therapists) working full time in the intensive care unit. Interventions: One of two hand hygiene regimens randomly assigned for four consecutive weeks. Measurements and Main Results: The two outcomes were skin condition (measured by two tools: Hand Skin Assessment form and Visual Skin Scaling form) and skin microbiology. Samples were obtained at baseline, on day 1, and at the end of wks 2 and 4. Participants in the ALC group had significant improvements in the Hand Skin Assessment scores at wk 4 (p = 0.04) and in Visual Skin Scaling scores at wks 3 (p = 0.01) and 4 (p = 0.005), There were no significant differences in numbers of colony-forming units between participants in the CHG or ALC group at any time period. The ALC regimen required significantly less time than the CHG regimen (mean: 12.7 sees and 21.1 sees, respectively; p 0.000) and resulted in a 50% reduction in material costs. Conclusions: changes in hand hygiene practices in acute care settings from the traditional antiseptic wash to use of plain, mild soap and an alcohol-based product should be considered. Further research is needed to examine the association between use of antiseptic products for hand hygiene of staff and reductions in nosocomial infection rates among patients.
A prospective, randomized double-blind study with intra-individual comparison of the results was undertaken with 20 volunteers to assess the influence of cosmetic additives on the acceptability of a mixture of n-propanol (50% v/v) and isopropanol (30% v/v) for hand disinfection. Three to 5 ml of antiseptic was rubbed into the hands until dry 15 times a day, 5 days a week and for 2 weeks per preparation. For self-assessment the parameters 'appearance', 'intactness', 'turgor' and 'sensation' were evaluated weekly by visual analogue; for assessment by a dermatologist the same parameters except 'sensation' were used. Each score was compared before and after treatment. The antimicrobial efficacy of the alcoholic mixture was equivalent to or better than the standard (isopropanol 60% v/v, 1 min). The frequent application of these antiseptic preparations caused a slight but significant deterioration of the skin condition as judged by both self-assessment and dermatologist; however, this was significantly less when the antiseptic contained cosmetic additives. It is concluded that the addition of suitable emollients can significantly increase the acceptability of alcoholic disinfectants.
We evaluated the effects of an antimicrobial hand gel (containing 60% ethanol plus emollients) on skin condition when used as a supplement to handwashing. Volunteers washed their hands 10 times per day for 5 days with a bar soap. Between washings one hand was treated with 1.0 ml of the gel while the other hand was untreated. By the conclusion of the study the gel-treated hands exhibited significantly lower (p less than 0.05) photographic scores for cracking, scaling, and erythema (redness), the major symptoms of dry, irritated skin. The gel treatment also helped to maintain normal skin hydration levels as measured by transepidermal water loss and skin impedance. By reducing soap-induced irritation, an alcohol gel with the appropriate emollients can help eliminate a major deterrent to handwashing among health care personnel.
Suppose that a test formulation and a standard formulation are to be compared in an experiment with a two period crossover design. Suppose that it is desired to obtain a confidence interval for the ratio of the test formulation mean to the standard formulation mean for some variable. Suppose that the measurements on the variable will themselves be analyzed rather than analyzing the logarithms of the measurements. A method for obtaining an exact confidence interval for a rather general model is described. A method has previously been given for obtaining an exact confidence interval under a more restrictive model. The two models are contrasted.
An attempt is made to formulate some kind of working hypothesis concerning the pathophysiology, clinical appearance and treatment of irritant contact dermatitis.
Acute irritant dermatitis may he caused by one single overwhelming external exposure of comparatively short duration. It is usually accidental and therefore recognized early as cause and effect.
Chronic irritant dermatitis may be the result of a too early repetition of one impairing factor (chronic irritant dermatitis ‘traumiteration’ type), but is more commonly the result of the influence of a variety of stimuli, each starting to be active before recovery from the foregoing stimuli has been completed (chronic irritant dermatitis ‘summation’ type). By repetition of the same stimulus, or by a combination of varying stimuli, the degree of impairment surpasses a critical level, in consequence of which a clinical disease (irritant contact dermatitis) ensues. This clinical disease, however, is only ‘the tip of the iceberg’.
Such stimuli may be chemical, mechanical and/or climatic. To find out which are the harmful factors requires a detailed case history about the patient's work, habits and hobbies, thus enabling him to avoid as many damaging exposures as is practical, and hence reducing the sum of causative factors. A number of causative factors are enumerated.
The article is intended to be a catalyst to promote discussion on this subject.
Development of irritant contact reactions in a wash test, in a repeated open application test (ROAT) and in chamber tests were compared with each other in 14 atopic and 14 non-atopic Caucasian medical students. In the wash test, the students washed their upper arm skin with 10% dishwashing liquid for 1 min 2 x a day for 1 week. In the ROAT, they applied the same detergent solution to 1 antecubital fossa 2 x daily for 1 week. Chamber tests were performed with the same detergent using 8 mm, 12 mm and 18 mm Finn Chambers applied to the upper back skin for 48 h. Additional 4 h and 24 h occlusion times were used with the 12 mm Finn Chambers. Test results were evaluated on days 0, 2, 4 and 7 by eye and by using an Evaporimeter EP1 for transepidermal water loss and a Minolta Chroma Meter CR-200 for skin colour. No statistically significant differences between atopics and non-atopics were found in any of the tests. The results of the tests did not correlate with each other, with the exception of the 12 mm/48 h chamber test and the wash test in atopics (R = 0.61, p = 0.02). It seems that other individual factors in addition to atopy influence the development of irritant contact dermatitis. The results of the chamber test and ROAT predicted poorly the result of the wash test.
Cinnamic aldehyde is an important fragrance material and contact allergen. The present study was performed to provide quantitative data on the eliciting capacity of cinnamic aldehyde, to be considered in assessment of clinical relevance and health hazard. The skin response to serial dilution patch tests and 6-week graded use tests with 0.02, 0.1 and 0.8% cinnamic aldehyde in ethanol was studied in a group of cinnamic-aldehyde-sensitive eczema patients. The minimum effect level demonstrated was 0.02% cinnamic aldehyde on patch testing and 0.1% cinnamic aldehyde on use testing, which are allowed usage concentrations in different kind of cosmetics. 72% (13/18) developed eczema in the use test performed with an alcoholic solution of cinnamic aldehyde on healthy upper arm skin. 6 of the 13 use-test-positive subjects (46%) reacted later than day 7, indicating that the standard exposure period of 7 days in use testing may not be sufficient, if low concentrations or volatile substances are used. A significant correlation between patch test sensitivity and the outcome of use testing was found (1,<0.001), which should be considered in designing future use test studies and advising patients. Detailed exposure information is needed to evaluate more fully the consequences of cinnamic aldehyde sensitivity.
The aim of the study was to test the irritancy of 6 antiseptics in an open exposure model. The following agents were tested in their normal use concentrations using open exposures, 2x daily for 4 days in 20 subjects: chlorhexidine 4% (CH), chlorhexidine 0.5% in ethanol 70% (CE), ethanol 70% (ET), iodine 1% in ethanol 70% (IE), povidone-iodine 10% (PI) and sodium hypochlorite 0.25% (SH). Responses were evaluated by visual scoring, subjective irritancy scoring, stratum corneum hydration (Corneometer), transepidermal water loss and laser Doppler flowmetry. Exposure to SH had to be discontinued after 4 applications because of severe subjective irritation. The same held true for IE (7 applications), whereas the other agents were exposed 8x. All evaluation methods showed SH to be significantly more irritating than IE, which was in turn more irritating than CH, CE, ET and PI. Thus, it can be concluded that CH, CE, ET and PI were non-irritating in this open exposure model.
Application of water and glycerin is known to influence skin mechanics. The kinetics of these processes are of great interest. A study was performed to show the immediate changes in skin-mechanics. A Dermaflex machine (R) was used to study 23 healthy volunteers. Water or glycerin was applied to the flexorside of the forearm, and readings were made after 3, 6, 9, 12 and 15 min. Regional untreated skin served as baseline. In agreement with earlier studies both substances influenced hysteresis. Water caused a significant increase in hysteresis after 12 and 15 min of hydration (P<0.01). Glycerin caused significantly increased hysteresis after 3 min (P<0.05) and the effect continued to the end of the observation period. No significant differences were seen in the distensibility. The onset of action is rapid for both substances, and the effects are therefore supposed to take place in the outermost layers of epidermis. The effect of glycerin on the hysteresis is more rapid in onset than that of water. Comparing the permeability coefficients, the effect on the mechanical properties of the skin does not appear to be determined by the permeability coefficients as water has a higher permeability coefficient but induces smaller changes than glycerin. Water alone does not appear to be the optimal plasticiser of human skin and other substances soluble in both water and lipids may have an even greater influence on skin mechanics in vivo.
The aim of this study was to compare the irritancy potential of 2 industrial hand cleansers with a brand leader of "mild" children's hand cleanser and with an emollient. The products were tested using repeated open application tests (ROATs) on the forearms of 40 subjects. Scoring of signs and symptoms (itching or burning), transepidermal water loss (TEWL) and stratum corneum hydration (Corneometer) evaluated responses. On all assessments, the children's hand cleanser was more irritant than the 2 industrial hand cleansers. The children's hand cleanser and industrial hand cleansers were more irritant than the emollient. The finding that a hand cleanser for children was more irritant than 2 industrial hand cleansers was surprising, and one which might hold serious implications for inducing or exacerbating atopic eczema in children. The combination of visual scoring, TEWL and Corneometer readings on ROATs is a potentially useful way of assessing irritancy strength of soap products on human skin.
Hand hygiene is one of the basic components of any infection control program and is frequently considered synonymous with
hand washing. However, health care workers frequently do not wash their hands, and compliance rarely exceeds 40%. Hand rubbing
with a waterless, alcohol-based rub-in cleanser is commonly used in many European countries instead of hand washing. Scientific
evidence and ease of use support employment of a hand rub for routine hand hygiene. It is microbiologically more effective
in vitro and in vivo, it saves time, and preliminary data demonstrate better compliance than with hand washing. Therefore,
a task force comprising experts from the Centers for Disease Control and Prevention and from professional societies is designing
guidelines for the use of a hand rub in the United States. Today, most countries of Northern Europe recommend a hand rub for
hand hygiene unless the hands are visibly soiled. Side effects are rare and are mainly related to dryness of the skin. This
review evaluates the scientific and clinical evidence that support the use of alcohol-based hand rubs in health care facilities
as a new option for hand hygiene.
Objective:
To compare the frequency of skin irritation and dryness associated with using an alcoholic-hand-gel regimen for hand antisepsis versus using soap and water for hand washing.
Design:
Prospective randomized trial with crossover design. Irritation and dryness of nurses' hands were evaluated by self-assessment and by visual assessment by a study nurse. Epidermal water content of the dorsal surface of nurses' hands was estimated by measuring electrical capacitance of the skin.
Setting:
Miriam Hospital, a 200-bed university-affiliated teaching hospital.
Participants:
Thirty-two nurses working on three hospital wards participated in the trial, which lasted 6 weeks.
Results:
Self-assessment scores of skin irritation and dryness decreased slightly during the 2 weeks when nurses used the alcoholic-hand-gel regimen (mean baseline score, 2.72; mean final score, 2.0; P=.08) but increased substantially during the 2 weeks when nurses used soap and water (mean baseline score, 2.0; mean final score, 4.8; P<.0001). Visual assessment scores by the study nurse of skin irritation and dryness did not change significantly when the alcoholic-hand-gel regimen was used (mean baseline and final scores were both 0.55), but scores increased substantially when nurses used soap and water (baseline score, 0.59; mean final score, 1.21; P=.05). Epidermal water content of the dorsal surface of nurses' hands changed little when the alcoholic-hand-gel regimen was used (mean+/-standard deviation baseline electrical capacitance reading, 24.8+/-6.8; mean final reading, 25.7+/-7.3), but decreased significantly (skin became dryer) with soap-and-water hand washing (mean baseline, 25.9+/-7.5; mean final reading, 20.5+/-5.4; P=.0003).
Conclusions:
Hand antisepsis with an alcoholic-hand-gel regimen was well tolerated and did not result in skin irritation and dryness of nurses' hands. In contrast, skin irritation and dryness increased significantly when nurses washed their hands with the unmedicated soap product available in the hospital. Newer alcoholic hand gels that are tolerated better than soap may be more acceptable to staff and may lead to improved hand-hygiene practices.
In a randomized, double-blind, placebo-controlled study the effect of topical dexpanthenol (CAS 81-13-0) formulated in two different lipophilic vehicles on epidermal barrier function in vivo was carried out. Seven days' treatment with dexpanthenol improved stratum corneum hydration and reduced transepidermal water loss. Active treatment was statistically different from the vehicle control on both measures. Our results suggest that topical dexpanthenol formulated in either lipophilic vehicle stabilizes the skin barrier function.
In clinical practice, cutaneous exposure to a variety of irritants such as surfactants and solvents is frequent. Although the induction of irritant dermatitis by single irritants has been extensively studied in recent years, our knowledge of the effects of simultaneous application of different irritants is limited. Using non-invasive techniques for measurements of transepidermal water loss (TEWL) and skin colour reflectance, we quantified the irritant effects of single and concurrent application of 0.5% sodium lauryl sulphate (SLS) and undiluted toluene (TOL) in vivo. The irritants were applied twice daily for 30 min to the volar forearms of 20 volunteers. Repeated application of SLS and TOL induced an irritant reaction, as indicated by an increase in TEWL and skin redness. In contrast to SLS alone, the application of TOL alone induced only a moderate increase in TEWL, confirming previous results. Concurrent application of SLS/TOL and TOL/SLS induced significantly stronger reactions than those caused by twice daily application of each irritant on its own. Our results demonstrate that a mixed application of an anionic detergent and an organic solvent has an additive effect on skin irritation. It is suggested that pretreatment with SLS causes an increased susceptibility to TOL irritation and vice versa. Thus, the necessity for special precautions against skin absorption of TOL when handling detergents such as SLS is emphasized.
Hand decontamination is crucial to control nosocomial infections. The utility of hand decontamination is related not only to its antimicrobial effectiveness, but also to its acceptability by hospital staff.
We aimed to assess skin tolerance and antimicrobial effects of two widely accepted hand hygiene measures under in-use conditions.
Fifty-two nurses were randomly assigned for an 8-day period to either an alcohol-based disinfectant or a hand wash with a non-antiseptic soap. At baseline and at the end of the test period, microbiological hand samples were obtained both before and after a hand hygiene procedure, and skin tolerance was assessed using clinical scores and measurement of transepidermal water loss.
Self-assessment of skin condition and grade of skin damage worsened significantly more in the group using soap than in the group using alcoholic disinfectant (P = 0.004 and P = 0.01, respectively). The alcohol-based rinse was significantly more effective than liquid soap in removing transient contaminant micro-organisms (P = 0.016). Twenty of 50 hand washes with non-antiseptic soap apparently resulted in bacterial contamination of the hands. At the end of the study, the total bacterial count increased with the increasing number of hand washes in the soap group (P = 0.003), and with the degree of skin damage (P = 0.005) in the antiseptic group.
In everyday hospital practice, alcohol-based disinfectant is more effective and better tolerated than non-antiseptic soap; soap is at risk of spreading contamination; and skin comfort strongly influences the number and the quality of hand hygiene procedures.
Hand hygiene prevents cross infection in hospitals, but compliance with recommended instructions is commonly poor. We attempted to promote hand hygiene by implementing a hospital-wide programme, with special emphasis on bedside, alcohol-based hand disinfection. We measured nosocomial infections in parallel.
We monitored the overall compliance with hand hygiene during routine patient care in a teaching hospital in Geneva, Switzerland, before and during implementation of a hand-hygiene campaign. Seven hospital-wide observational surveys were done twice yearly from December, 1994, to December, 1997. Secondary outcome measures were nosocomial infection rates, attack rates of methicillin-resistant Staphylococcus aureus (MRSA), and consumption of handrub disinfectant.
We observed more than 20,000 opportunities for hand hygiene. Compliance improved progressively from 48% in 1994, to 66% in 1997 (p<0.001). Although recourse to handwashing with soap and water remained stable, frequency of hand disinfection substantially increased during the study period (p<0.001). This result was unchanged after adjustment for known risk factors of poor adherence. Hand hygiene improved significantly among nurses and nursing assistants, but remained poor among doctors. During the same period, overall nosocomial infection decreased (prevalence of 16.9% in 1994 to 9.9% in 1998; p=0.04), MRSA transmission rates decreased (2.16 to 0.93 episodes per 10,000 patient-days; p<0.001), and the consumption of alcohol-based handrub solution increased from 3.5 to 15.4 L per 1000 patient-days between 1993 and 1998 (p<0.001).
The campaign produced a sustained improvement in compliance with hand hygiene, coinciding with a reduction of nosocomial infections and MRSA transmission. The promotion of bedside, antiseptic handrubs largely contributed to the increase in compliance.
The aim of the study was to demonstrate that the introduction of rub-in hand disinfection (RHD) in hospital units, with the implementation of suitable equipment, drafting of specific protocols, and training users, improved compliance of hand disinfection and tolerance of user's hands. In four hospital units not previously using RHD an external investigator conducted two identical studies in order to measure the rate of compliance with, and the quality of, disinfection practices, [rate of adapted (i.e., appropriate) procedures, rate of correct (i.e., properly performed) procedures, rate of adapted and correct procedures carried out] and to assess the state of hands (clinical scores of dryness and irritation, measuring hydration with a corneometer). Between the two studies, the units were equipped with dispensers for RHD products and staff were trained. Compliance improved from 62.2 to 66.5%, quality was improved (rate of adapted procedures from 66.8% to 84.3%, P > or = 10(-6), rate of correct procedures from 11.1% to 28.9%, P > or = 10(-8), rate of adapted and correct procedures from 6.0 to 17.8%, P > or = 10(-8)). The tolerance was improved significantly (P > or = 10(-2)) for clinical dryness and irritation scores, although not significantly for measurements using a corneometer. This study shows the benefit of introducing RHD with a technical and educational accompaniment.
Score concepts have been suggested for the standardised diagnosis of atopic dermatitis, incorporating various anamnestic and clinical minor criteria of atopy, including the 'Erlangen Score', developed in the hospital-based setting of a dermatitis clinic.
To evaluate the properties of this score in the context of a population-based epidemiological study.
The association between relevant atopic criteria and previous or current flexural eczema was evaluated in 2,352 hairdressing apprentices.
The association was not as strong as in the patient-based studies, comparing the respective odds ratios. Accordingly, the discriminating power of the Erlangen Score was poor, resulting in low sensitivity (55.7%) and specificity (73.8%) for, e.g., 8 points as cutpoint.
While the score appears useful to summarise minor criteria, the individual relevance of its point values should not be overestimated in view of a low positive predictive value in a population (compared to a clinical) setting.
Hand disinfection with short-chain aliphatic alcohols, so-called "rub-ins" is the method of choice for cross-infection prevention in health care environments, but their irritant potential is not well known. Skin tolerance is a major compliance factor, and a high proportion of health care workers suffer from low-grade irritant contact dermatitis. Therefore, assessment of the irritancy of the skin disinfectant n-propanol 60%, and comparative 100% and 0% solutions, was performed in the setting of experimental low-grade ICD. ICD was induced by overnight patch exposure to H2O, and to 0.3% sodium dodecyl sulfate (SDS), in 12 probands, followed by repeated open exposure to the test substances. Outcome variables were transepidermal water loss (TEWL), and skin surface capacitance. On skin sites pre-irritated by SDS, all n-propanol concentrations (100%, 60%, 0%) increased TEWL. However, a clear divergence appeared between pure n-propanol, and the lower concentrations. In contrast to pure n-propanol, n-propanol 60% and 0% had no significant effect on TEWL on H2O-pre-irritated skin sites. Capacitance of pre-irritated skin sites was increased by exposure to H2O-containing n-propanol solutions (60% and 0%). These results show a clear difference between the irritant potential of n-propanol 100% on one side, and n-propanol 60% and 0% on the other side. The level of pre-existent skin irritation is a pertinent factor in susceptibility to irritation, as the irritant potential of n-propanol 60%, the concentration used in daily practice, and n-propanol 0% (water) became significant only on detergent-irritated skin. Thus, preventive skin care may be a constructive approach in increasing tolerance of modern hand disinfection practices.
Irritant contact dermatitis has a broad spectrum of clinical features and is a leading cause of occupational disease worldwide. It has been shown previously that a combination of chemically different irritants may cause an additive effect compared to single application of these substances. In this study, tandem application of sodium lauryl sulfate and n-propanol was investigated in 20 human volunteers using non-invasive bioengineering methods, such as measurement of transepidermal water loss and chromametry. N-propanol did not enhance cumulative skin irritation when used with sodium lauryl sulfate, as has been reported for toluene. As n-propanol is the active ingredient in many disinfectants, this is of particular interest regarding occupational skin irritation in health care workers.
Six commercially available alcohol-based hand rubs [AHD 2000, Desderman, Mucasept A, Manorapid (Poly-Alkohol, Spitacid, and Sterillium] were investigated in a clinical double-blind trial involving 10 participants who had no previous experience of using hand rubs (Group 1), and seven who had substantial professional experience of using hand rubs (Group 2; virology laboratory staff). Group 1 was studied for one week with 20 applications on day 1 and then five applications per day for six days. Transepidermal water loss, dermal water content and superficial sebum content of the skin were measured before and after the seven-day application of the products, as well as user acceptability (self-assessment of smell, speed of drying, emolliant effect, skin dryness). Group 2 used each preparation twice for two weeks in a random sequence, and carried out self assessment at the end of each fortnight. Transepidermal water loss (mean baseline: 18.7 g/m(2)h), dermal water content (mean baseline dorsum: 75.6) and superficial sebum content (mean baseline dorsum: 4.8 microg/cm(2)) did not change significantly. In both groups assessments of the smell and the speed of drying did not reveal any significant differences between the six products. Sterillium had the best emollient effect of all products (P<0.05; Wilcoxon test and Mann-Whitney-U test) and was significantly better than Desderman, AHD 2000, and Mucasept A, causing less skin dryness after seven days use in Group 1 (P<0.05; Mann-Whitney-U test). Manorapid caused significantly less dryness than Spitacid, AHD 2000, and Mucasept A in Group 2 after the first use, but no significant difference was observed after the second use. Thus alcohol-based hand rubs that contain emolliants, irrespective of the type of alcohol (n-propanol, iso-propanol or ethanol), are well tolerated and do not dry out or irritate the skin. Personal assessments showed significant differences for the emolliant effect and the extent of dryness. Both factors are very important, as user acceptability has an impact on compliance. Sterillium is the only hand disinfectant containing mecetronium etilsulphate which has been shown to have an emolliant effect. Future research should focus on user acceptability in order to improve compliance.
To evaluate the effects of the introduction of an alcohol-based hand gel and multifaceted quality improvement (QI) interventions on hand hygiene (HH) compliance.
Interventional, randomized cohort study with four study phases (baseline; limited intervention in two units; full intervention in three units; washout phase), performed in three intensive care units at a pediatric referral hospital.
During 724 thirty-minute daytime monitoring sessions, a nonidentified observer witnessed 12,216 opportunities for HH and recorded compliance.
Introduction of an alcohol-based hand gel; multifaceted QI interventions (educational program, opinion leaders, performance feedback).
Baseline compliance decreased after the first 2 weeks of observation from 42.5% to 28.2% (presumably because of waning of a Hawthorne effect), further decreased to 23.3% in the limited intervention phase and increased to 35.1% after the introduction of a hand gel with QI support in all three units (P < 0.001). The rise in compliance persisted in the last phase (compliance, 37.2%); however, a gradual decline was observed during the final weeks. Except for the limited intervention phase, compliance achieved through standard handwashing and glove use remained stable around 20 and 10%, respectively, whereas compliance achieved through gel use increased to 8% (P < 0.001). After adjusting for confounding, implementation of the hand gel with QI support remained significantly associated with compliance (odds ratio, 1.6; 95% confidence interval, 1.4 to 1.8). In a final survey completed by 62 staff members, satisfaction with the hand gel was modest (45%).
We noted a statistically significant, modest improvement in compliance after introduction of an alcohol-based hand gel with multifaceted QI support. When appropriately implemented, alcohol-based HH may be effective in improving compliance.
The Guideline for Hand Hygiene in Health-Care Settings provides health-care workers (HCWs) with a review of data regarding handwashing and hand antisepsis in health-care settings. In addition, it provides specific recommendations to promote improved hand-hygiene practices and reduce transmission ofpathogenic microorganisms to patients and personnel in health-care settings. This report reviews studies published since the 1985 CDC guideline (Garner JS, Favero MS. CDC guideline for handwashing and hospital environmental control, 1985. Infect Control 1986;7:231-43) and the 1995 APIC guideline (Larson EL, APIC Guidelines Committee. APIC guideline for handwashing and hand antisepsis in health care settings. Am J Infect Control 1995;23:251-69) were issued and provides an in-depth review of hand-hygiene practices of HCWs, levels of adherence of personnel to recommended handwashing practices, and factors adversely affecting adherence. New studies of the in vivo efficacy of alcohol-based hand rubs and the low incidence of dermatitis associated with their use are reviewed. Recent studies demonstrating the value of multidisciplinary hand-hygiene promotion programs and the potential role of alcohol-based hand rubs in improving hand-hygiene practices are summarized. Recommendations concerning related issues (e.g., the use of surgical hand antiseptics, hand lotions or creams, and wearing of artificial fingernails) are also included.
Though the skin permeation enhancement effect of chemical penetration enhancers has been studied extensively, their skin irritation potential has not been adequately investigated. The objective of this study was to evaluate the skin permeation enhancement effect and skin irritation of saturated fatty alcohols using melatonin as a model compound. A saturated solution of melatonin in a mixture of water and ethanol (40:60) containing 5% w/v of saturated fatty alcohol was used in the skin permeation studies using Franz diffusion cells. For skin irritation studies, 230 microl of fatty alcohol solution was applied on the dorsal surface of the hairless rats using Hill top chamber. The skin irritation was evaluated by visual scoring method and bioengineering methods such as measurement of transepidermal water loss (TEWL) and skin blood flow. The flux of melatonin across hairless rat skin was found to be dependent on the carbon chain length of the fatty alcohols, with decanol showing the maximum permeation of melatonin. All fatty alcohols increased the TEWL and skin blood flow significantly compared with the vehicle. The fatty alcohols (decanol, undecanol and lauryl alcohol), which showed greater permeation of melatonin, also produced greater TEWL, skin blood flow and erythema. Tridecanol and myristyl alcohol showed lower permeation enhancement effect but caused greater skin irritation. Octanol and nonanol may be the most useful enhancers for the transdermal delivery of melatonin considering their lower skin irritation and a reasonably good permeation enhancement effect. However, further studies are needed to ascertain their safety as skin penetration enhancers. Skin permeation and skin irritation in experimental animals such as rats are generally higher compared with human skin. Further studies in human volunteers using fatty alcohols at the concentrations of 5% or lower may provide useful information on the utility of these fatty alcohols as permeation enhancers.
We studied the dermal tolerance (repetitive occlusive patch test; ROPT) and the skin hydrating properties of a new ethanol-based gel [85% (w/w)], Sterillium Gel. For the ROPT, 53 participants were studied. Gel was applied to one site on the back under an occlusive patch during an induction phase (nine applications over three weeks) and two weeks later to a virgin site on the back during a challenge phase (one application). Twenty-four hours after the removal of the patches (induction phase and challenge phase), then 48 and 72 h later (challenge phase) sites were graded for skin reactions using a standardized scale. In the induction phase none of the 53 participants had a skin reaction. In the challenge phase one participant had a barely perceptible skin reaction, and one had mild erythema at one time point. To evaluate skin hydrating properties of the gel, treated skin of 21 participants was compared to untreated skin. The gel was applied twice a day to the forearm for 14 days. Control corneometer values were taken before application of the gel (mean: 32.7 +/- 5.0) and after one (36.3 +/- 4.4) and two weeks (36.1 +/- 5.4). Relative skin hydration on treated skin in comparison with an untreated control field was significantly higher after one week by 6.85% (P = 0.0031; paired t -test for dependent samples) and after two weeks by 4.47% (P = 0.0153). Sterillium Gel did not demonstrate a clinically relevant potential for dermal irritation or sensitization, and significantly increased skin hydration after repetitive use, and so could enhance compliance with hand hygiene among healthcare workers.
The Guideline for Hand Hygiene in Health-Care Settings provides health-care workers (HCWs) with a review of data regarding handwashing and hand antisepsis in health-care settings. In addition, it provides specific recommendations to promote improved hand-hygiene practices and reduce transmission of pathogenic microorganisms to patients and personnel in health-care settings. This report reviews studies published since the 1985 CDC guideline (Garner JS, Favero MS. CDC guideline for handwashing and hospital environmental control, 1985. Infect Control 1986;7:231-43) and the 1995 APIC guideline (Larson EL, APIC Guidelines Committee. APIC guideline for handwashing and hand antisepsis in health care settings. Am J Infect Control 1995;23:251-69) were issued and provides an in-depth review of hand-hygiene practices of HCWs, levels of adherence of personnel to recommended handwashing practices, and factors adversely affecting adherence. New studies of the in vivo efficacy of alcohol-based hand rubs and the low incidence of dermatitis associated with their use are reviewed. Recent studies demonstrating the value of multidisciplinary hand-hygiene promotion programs and the potential role of alcohol-based hand rubs in improving hand-hygiene practices are summarized. Recommendations concerning related issues (e.g., the use of surgical hand antiseptics, hand lotions or creams, and wearing of artificial fingernails) are also included.
Mice deficient in the epidermal water/glycerol transporter aquaporin-3 (AQP3) have reduced stratum corneum (SC) hydration and skin elasticity, and impaired barrier recovery after SC removal. SC glycerol content is reduced 3-fold in AQP3 null mice, whereas SC structure, protein/lipid composition, and ion/osmolyte content are not changed. We show here that glycerol replacement corrects each of the defects in AQP3 null mice. SC water content, measured by skin conductance and 3H2O accumulation, was 3-fold lower in AQP3 null vs. wild-type mice, but became similar after topical or systemic administration of glycerol in quantities that normalized SC glycerol content. SC water content was not corrected by glycerol-like osmolytes such as xylitol, erythritol, and propanediol. Orally administered glycerol fully corrected the reduced skin elasticity in AQP3 null mice as measured by the kinetics of skin displacement after suction, and the delayed barrier recovery as measured by transepidermal water loss after tape-stripping. Analysis of [14C]glycerol kinetics indicated reduced blood-to-SC transport of glycerol in AQP3 null mice, resulting in slowed lipid biosynthesis. These data provide functional evidence for a physiological role of glycerol transport by an aquaglyceroporin, and indicate that glycerol is a major determinant of SC water retention, and mechanical and biosynthetic functions. Our findings establish a scientific basis for the >200-yr-old empirical practice of including glycerol in cosmetic and medicinal skin formulations.
With the new Centers for Disease Control and Prevention (CDC) guideline on hand hygiene, hospitals often introduce alcohol-based hand rubs for hand disinfection. Healthcare workers, however, may reject the new products because of skin irritation or other skin-related problems, which they experience after years of handwashing. In order to facilitate a successful introduction and continued use of alcohol-based hand rubs in hospitals, we have reviewed and summarized the major studies on the topic. Occupational hand dermatitis may occur in up to 30% of healthcare workers. It is mainly described as an irritant contact dermatitis caused by detergents. The diagnosis is usually clinical. Allergic reactions are very rare. After using an alcohol-based hand rub for the first time, healthcare workers may have a burning skin sensation that can be explained by pre-irritated skin. In this case the skin barrier has usually been impaired by frequent handwashing or occlusive gloves. This may result in a vicious circle whereby the healthcare worker increases the frequency of handwashing and reduces the frequency of hand disinfection. Prevention of irritant contact dermatitis is possible by selection of a low-irritating hand rub, which contains emollients, the correct use of the hand rub and a clear guideline when to disinfect and wash hands in the clinical setting. Common mistakes in the use of alcohol-based hand rubs are application to pre-irritated skin and washing hands before hand disinfection, which is, in general, not necessary, or after hand disinfection, which results in washing off the emollients. Clear preparation and guidance of healthcare workers before the introduction of alcohol-based hand rubs can help to enhance compliance in hand hygiene. The switch from handwash to alcohol-based hand rub will improve healthcare workers skin if mistakes are avoided and hand rinses are used correctly.
Alcohol-based hand rubs have been used for hygienic hand disinfection in hospitals for decades. In order to achieve good compliance with hand hygiene practices in the healthcare setting, dermal tolerance of a hand rub product is crucial. Sterillium, which is used in many European countries for hygienic hand disinfection, is based on iso-propanol, n-propanol and mecetronium etilsulphate. The potential for dermal irritation and sensitization of commercially available propanol-based hand rubs containing emollients has not been studied systematically. We therefore studied the dermal tolerance of Sterillium in a repetitive occlusive patch test on 55 subjects. Sterillium was applied to one site on the back under an occlusive patch during an induction phase (total of nine applications over a three-week period) and two weeks later to a virgin site on the back during a challenge phase (one application). Twenty-four hours after removal of the patches (induction phase and challenge phase), and in addition, after 48 and 72 h (challenge phase), the sites were graded for skin reactions using a standardized scoring scale. In the induction phase, two of the 55 subjects had a barely perceptible minimal erythema at one of nine time points. The remaining 53 subjects had no skin reaction at any time. In the challenge phase, all 55 subjects had no skin reaction at all. The absence of significant reactions with respect to severity and frequency demonstrates the favourable dermal tolerance of the hand rub product. The lack of irritation or sensitization potential could enhance compliance with hand hygiene among healthcare workers.
Dexpanthenol is popular in treating various dermatoses and in skin care, but few controlled clinical trials have been performed. We investigated the efficacy of dexpanthenol in skin protection against irritation in a randomized, prospective, double-blind, placebo-controlled study. 25 healthy volunteers (age 18-45 years) were treated for the inner aspect of both forearms with either Bepanthol Handbalsam containing 5% dexpanthenol or placebo x2 daily for 26 days. From day 15-22, sodium lauryl sulfate (SLS) 2% was applied to these areas x2 daily. Documentation comprised sebumetry, corneometry, pH value and clinical appearance (photographs). 21 volunteers completed the study, 3 were excluded because of non-compliance and 1 experienced a non-study-related, severe, adverse event. Only corneometry yielded a statistically significant difference, with decreased values following SLS challenge at the placebo sites (P < 0.05). Intraindividual comparisons showed superior results at the dexpanthenol-treated sites in 11 cases and in only 1 case at the placebo site. 6 volunteers experienced an irritant contact dermatitis, with more severe symptoms at the placebo site in 5 cases. In conclusion, dexpanthenol exhibits protective effects against skin irritation. The initiation of a study to evaluate the efficacy of dexpanthenol in preventing irritant occupational contact dermatitis under real workplace conditions is validated.
The principles of humectancy, emolliency, and occlusion, all central to stratum corneum (SC) maintenance, continue to drive the development of novel moisturizing technologies. Humectants promote water retention within the SC, whereas occlusives generally minimize water loss to the external environment. The complementary occlusive activity of emollients contributes to SC hydration as well. Moisturization technologies, ranging from face care to hand and body care, vary in the types and levels of humectants, emollients (including lipids), and occlusives; accordingly, their therapeutic effects differ as well. Emulsification of these components into a single formulation-the technologies of which are as varied as their individual components-is thought to enhance the aesthetics of the moisturizer and its overall moisturization efficiency. The present article reviews the current approaches to SC moisturization, increasingly viewed as critical to its structural and functional integrity, and to fundamental skin care.
Improvement of compliance in hand hygiene is probably the most effective step in reducing the incidence of nosocomial infections (NI). But improvement of compliance is known to be complex. Six possibilities for improving compliance are available although some of them may be difficult to carry out. Rule 1: Select an alcohol-based hand rub which has a good skin tolerance and is acceptable to health care workers to use. This has been shown to improve compliance. Rule 2: The hand rub shall be easily available. Wall dispensers near the patient and pocket bottles may well help. Other possibilities should be assessed locally. Rule 3: Implement teaching and promotion of hand hygiene, which has been shown to be very effective. This is may be the most effective tool but will cost time and money. If money is a problem, rule 4 may be the solution. Rule 4: Create a hospital budget which covers all costs involved with preventable nosocomial infection. Combine it with the budget for hand hygiene products. Even a small number of prevented NI largely outweighs the cost of effective hand hygiene products. Rule 5: Get senior staff to set a good example in order to motivate junior staff, because negligence in hand hygiene appears to correlate with the number of professional years. Rule 6: Have the patient-staff ratio well balanced. It has been shown that staff shortage decreases hand hygiene compliance. Other factors may be important as well, but implementation of these 6 golden rules could be an effective step into the right direction.
The most important risk factor for occupational contact dermatitis in hospital personnel is the exposure to irritants such as water, detergents and alcohol-based solutions. This study was undertaken to evaluate the short-term effects of repeated exposure to an alcohol-based disinfectant, to a detergent and to an alcohol-based disinfectant/detergent alternately. The hardening effect in preirritated skin after a 4-week interval was also evaluated. Detergent, disinfectant and disinfectant/detergent alternately were applied daily every 15 min for 6 h for 2 days to the flexor upper arms and forearms of 15 volunteers. A control area was included. After 4 weeks, a sodium lauryl sulfate patch was applied to each area. Irritant reactions were quantified by visual score, transepidermal water loss (TEWL) and skin colour at baseline, D3, D8, D35 and D37. As evaluated by clinical assessment, detergent caused more redness of the skin than both disinfectant applied alone and disinfectant/detergent alternately at D3 and D8, P < 0.001 and P < 0.001, respectively. An increased irritant response for detergent as compared to disinfectant alone and disinfectant/detergent was confirmed by TEWL and colour evaluations, P = 0.001 and P = 0.001 and P = 0.006 and P = 0.009, respectively. No hardening effect in preirritated skin was found after a 4-week interval. In conclusion, hand disinfection with alcohol-based disinfectant or alternate use of disinfectant/detergent causes less skin irritation than hand disinfection with a detergent. This study evaluated the short-term effects of disinfectant and detergent exposure only, and more long-term studies are necessary before recommendations can be made.
Scientific Affairs Melanchthonstr
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- Gu¨nter Pd
- Chemie Kampf
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Address: PD Dr Gu¨nter Kampf Bode Chemie GmbH & Co. Scientific Affairs Melanchthonstr. 27 22525 Hamburg Germany Tel.: +49 40 54006-0
Protection of human skin against the effects of the sunburn ultraviolet (290–320 nm) In: Sunlight and Man, Normal and Abnormal Photobiological Responses
- T B Fitzpatrick
- M Pathak
- J A Parrish
- Fitzpatrick T B
- M A Pathak
- L C Harber
- M Seiji
- Kukita
Fitzpatrick T B, Pathak M, Parrish J A. Protection of human skin against the effects of the sunburn ultraviolet (290–320 nm). In: Sunlight and Man, Normal and Abnormal Photobiological Responses. Fitzpatrick T B, Pathak M A, Harber L C, Seiji M, Kukita A (eds): Tokyo: University of Tokyo Press, 1974: S751–755.
Fax: +49 40 54006-128 e-mail: guenter.kampf@bode-chemie
- Benefit Of Emollients In A Propanol-Based Hand Rub
Fax: +49 40 54006-128 e-mail: guenter.kampf@bode-chemie.de Contact Dermatitis 2005: 53: 344–349 BENEFIT OF EMOLLIENTS IN A PROPANOL-BASED HAND RUB 349
- Pittet D
Kriterien zur Beurteilung der atopischen Hautdiathese
- Diepgen T L