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Less skin irritation from Alcohol based disinfectant than from detergent used for hand disinfection
Abstract
The benefit of alcohol-based disinfectant used on normal skin has been debated.
The objective of the present study was to compare the effects of repeated exposure to an alcohol-based disinfectant, a detergent and an alcohol-based disinfectant/detergent alternately for 10 days, including noninvasive measurements in the evaluation. Skin reactivity in irritated skin after a 4-week interval was also evaluated.
Detergent, disinfectant and alternate disinfectant and detergent were applied twice daily every 10 min for 1 h to the ventral upper arms and forearms of 17 healthy volunteers. A control area was included. After 4 weeks an SLS patch was applied to each area. Irritant reactions were quantified with a visual score recording and measurements of transepidermal water loss (TEWL) and skin colour were performed on days 1, 5, 11, 38 and 40.
On day 5 the detergent caused a higher visual score than either disinfectant applied alone or alternate disinfectant and detergent, P < 0.05. On day 11 detergent and alternate disinfectant and detergent caused a higher score than disinfectant, P < 0.05. An increased irritant response for detergent compared with disinfectant alone and alternate disinfectant and detergent was confirmed by TEWL evaluations on days 5 and 11, P < 0.001, while no significant difference was found by colour measurement. After 4 weeks, when evaluated by colour measurement, significantly less response to the SLS patch was found on the disinfectant-treated area compared with the control area and detergent area, and a similar trend was found for TEWL, although it was not statistically significant.
Alcohol-based disinfectant caused less visible skin irritation and less skin barrier disruption than the use of detergent. The alternate use of detergent and disinfectant caused less irritation than the use of detergent, and a possible interaction between the two irritants was not indicated. After 4 weeks there was a tendency for decreased skin reactivity in the skin areas which had 4 weeks previously been exposed to disinfectant.
... 1,2 In the health care sector, HE is most often induced by wet work, 3 currently defined as having wet hands for >2 h, hand washing >20 times, or wearing occlusive gloves for >2 h per working day. 4 Alcohol-based hand rub (ABHR) is another common exposure, which is recommended either in combination with hand washing, or in preference to hand washing, when the hands are not visibly dirty. 5 While frequent hand washings are known to cause impairment of skin barrier function leading to HE, due to the irritant effects of water and detergents, 3,6,7 ABHR has been assessed as harmless to the skin barrier function in numerous studies. 6,8,9 However, data are based on studies applying ABHR on dry skin, and results have recently been questioned in a study exploring the irritant effect of ABHR on wet skin indicating that the hydration of the skin may affect the damaging potential of ABHR. 10 Further, when ABHR is applied on skin with eczematous lesions or otherwise damaged skin, the alcohol causes a sensation of burning and stinging. ...
... 5 While frequent hand washings are known to cause impairment of skin barrier function leading to HE, due to the irritant effects of water and detergents, 3,6,7 ABHR has been assessed as harmless to the skin barrier function in numerous studies. 6,8,9 However, data are based on studies applying ABHR on dry skin, and results have recently been questioned in a study exploring the irritant effect of ABHR on wet skin indicating that the hydration of the skin may affect the damaging potential of ABHR. 10 Further, when ABHR is applied on skin with eczematous lesions or otherwise damaged skin, the alcohol causes a sensation of burning and stinging. 11,12 This subjective discomfort, which is difficult to tolerate, is anticipated to influence the compliance with hand disinfection in a negative direction. ...
... Regarding the sample size, approximately 20 healthy volunteers were considered sufficient in this study. 6 ...
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.
... 3 Despite this, there are studies questioning the use of TEWL measurement among nursing apprentices as a predictor of development of skin symptoms. 4 Because of the coronavirus disease 2019 (COVID-19) pandemic, there is increased strain on the skin, particularly among healthcare workers, due to the intense hand hygiene requirement (eg, longer hand washing durations, washing the hands more often, prolonged glove use). Frequent hand washing and skin occlusion under prolonged glove use seem to have a profound negative impact on skin barrier function noted by increases in TEWL values. ...
... Frequent hand washing and skin occlusion under prolonged glove use seem to have a profound negative impact on skin barrier function noted by increases in TEWL values. 4,5 In addition, occlusion significantly enhances the skin barrier damage caused by soaps in a dose-response manner. 6 By contrast, hand sanitizers on their own do not seem to disturb TEWL, 4 but they alter the SC pH. ...
Background:
Studies investigating simultaneous influence of personal and work-related factors on skin health during the COVID-19 pandemic are missing.
Objectives:
To investigate associations of skin hazards relevant for nursing apprentices with parameters of skin barrier function.
Patients and methods:
238 nursing apprentices (NA) attending the final year of education (median age 19 years) from vocational schools in the Zagreb, Croatia, were enrolled in the study performed in the schools and consisted of a questionnaire based on the Nordic Occupational Skin Questionnaire, clinical examination of skin on the hands, transepidermal water loss (TEWL) and stratum corneum (SC) pH measurement on the dorsum of the hand.
Results:
Around half of NA had compromised hand skin barrier function indicated with TEWL values >25 g/m2/h (48%) and SC pH >5.5 (57%). Skin barrier was compromised in around 40% of NA without clinically observed skin symptoms. Elevated SC pH was independently of ambient conditions associated with skin symptoms and female sex.
Conclusions:
Measurement of SC pH was shown to be less sensitive to field conditions than TEWL, and should be employed more in the field studies. Strengthening of skin health promotion in healthcare workers and apprentices is needed in pandemic conditions. This article is protected by copyright. All rights reserved.
... This study evaluated the impact of different hand hygiene procedures on the skin of the hands after a shift of 8 hours in HCWs, which is difficult to compare with other studies, which usually have this evaluation after longer periods and mostly in experimental settings, outside the regular work setting. 26,27 In our study we noticed that already after a single working day there were important differences between the three procedures of hand sanitation in almost all the parameters we evaluated (TEWL, CFU, and tolerability rates). 20 and is decreased by ABHS, 21 but it has been also stated that the skin barrier function is impaired by ABHS when applied on skin areas previously exposed to water immersion. ...
... 26 Moreover, in experimental settings, with a lower participants number, ABHS caused less skin irritation and less skin barrier disruption than detergents. 27,29,30 ABHS and disinfectant wipes contain additional skin care substances, such as glycerine, a moisturizing agent, which may replenish lipids and trap water, improving epidermal barrier. 31 Moreover, cleaning hands with soap and water removes skin lipids as they are rinsed off, whereas they remain on the skin when using ABHS. ...
Introduction
COVID-19 has increased the frequency of hand washing. There is scarce evidence regarding the impact of different hand hygiene procedures on skin barrier function in clinical practice.
Objective
To compare the impact on skin barrier function of different hand hygiene measures in health care workers in daily practice.
Methods
A randomized controlled clinical trial was conducted. Participants were randomized to sanitize their hands with water and soap, alcohol-based hand sanitizers (ABHS) or disinfectant wipes during their 8-hour work-shift. Epidermal barrier functional parameters, like transepidermal water loss (TEWL), and the microbial load were assessed before and immediately after the workday. Tolerance and acceptability of each product were recorded after work.
Results
Sixty-two participants were included and 20, 21 and 21 were randomized respectively to use water and soap, ABHS and disinfectant wipes. After the 8-hour shift, TEWL increase was higher with disinfectant wipes than with soaps or ABHS (+5.45vs + 3.87vs-1.46 g·h⁻¹·m⁻² respectively, P = .023). Bacteria and fungi colony-forming unit (CFU) count reduction was lower for water and soap group than for ABHS and disinfectant wipes. Disinfectant wipes were considered more difficult to use (P = .013) compared to water and soap and ABHS.
Conclusion
Daily hand hygiene with ABHS showed the lowest rates of skin barrier disruption and the highest reduction of CFU.
This article is protected by copyright. All rights reserved.
... (ICD) and eczema exacerbation compared with soap and water. 24,[27][28][29][30][31] Hence, ABHRs may be preferable for some HCPs. Many ABHRs are formulated to contain no or low allergen levels. ...
... Frequent hand cleaning (particular with soap and water [27][28][29] and the use of PPE can have a substantial impact on skin barrier function. [1][2][3][4][5][6][7][8] In a systematic review of 35 studies (including > 30,000 participants), the prevalence of skin damage caused by PPE for protecting against SARS-CoV-2 infection was estimated at 75.1%. ...
The severe acute respiratory syndrome coronavirus 2 pandemic has necessitated enhanced protection against viral transmission among healthcare professionals, particularly relating to handwashing and personal protective equipment. Some of these requirements may persist for years to come. They bring associated concerns around skin hygiene and general care, with damage to the face and hands now a well-documented consequence among healthcare professionals. This review assesses optimal skin care during the severe acute respiratory syndrome coronavirus 2 pandemic and in the “new normal” that will follow, identifies current knowledge gaps, and provides practical advice for the clinical setting. Regular, systematic hand cleaning with soap and water or an alcohol-based hand rub (containing 60%–90% ethanol or isopropyl alcohol) remains essential, although the optimal quantity and duration is unclear. Gloves are a useful additional barrier; further studies are needed on preferred materials. Moisturization is typically helpful and has proven benefits in mitigating damage from frequent handwashing. It may be best practiced using an alcohol-based hand rub with added moisturizer and could be particularly important among individuals with pre-existing hand dermatoses, such as psoriasis and eczema. Face moisturization immediately prior to donning a mask, and the use of dressings under the mask to reduce friction, can be helpful dermatologically, but more work is required to prove that these actions do not affect seal integrity. Nonetheless, such measures could play a role in institutional plans for mitigating the dermatologic impact of transmission control measures as we exit the pandemic.
... Because ICD does not require specific sensitization and can occur in a large percentage of the population, it presents a worrisome risk for groups required to perform numerous handwashings with potentially irritating solutions and therefore put individuals at risk of Ebola infection. ICD has been demonstrated in users of soap and water [16,22], ABHS [23,24], and chlorine solution [25][26][27][28]. However, this assessment of the impact of chlorine solutions on skin relies heavily on observational studies and case reports of accidental exposure to concentrations much higher than those recommended for handwashing in Ebola contexts [16,22,26,[29][30][31][32]. ...
... ICD has been demonstrated in users of soap and water [16,22], ABHS [23,24], and chlorine solution [25][26][27][28]. However, this assessment of the impact of chlorine solutions on skin relies heavily on observational studies and case reports of accidental exposure to concentrations much higher than those recommended for handwashing in Ebola contexts [16,22,26,[29][30][31][32]. The compounds commonly used to provide free chlorine in solution for disinfection in emergencies-sodium hypochlorite (NaOCl), calcium hypochlorite (HTH), and sodium dichloroisocynaurate (NaDCC)-also differ in their chemical properties and may differ in potential to cause ICD. ...
Trial registration:
International Standard Randomized Controlled Trial Registry ISRCTN89815514.
... Alcohol-based skin disinfectants are available to reduce the frequency of washing in nursing and medical settings. These attack the skin barrier less than detergents [188,189]. ...
As a widespread disease, contact dermatitis affects all age groups with a high prevalence and incidence. In addition to a reduction in the quality of life, it causes considerable health and socioeconomic costs. Essentially, five subtypes can be distinguished, namely irritant contact dermatitis, phototoxic contact dermatitis, allergic contact dermatitis with its two special forms of hematogenous and aerogenous contact dermatitis, photoallergic contact dermatitis, and protein contact dermatitis. The diagnosis is based on a detailed history and clinical skin findings as well as the exposure-related performance of allergological in vivo and in vitro tests. Once the contact substance—irritant or allergen—has been identified, the key to therapeutic success lies in its strict avoidance. Symptomatic therapy of contact dermatitis should always be individualized and based on the stage of eczema. Topical glucocorticoids are considered first-line therapy for both irritant and allergic contact dermatitis. The always accompanying basic therapy with skin care products plays a central role for sustainable therapeutic success. Systemic therapy is considered when topical therapy is ineffective or not feasible. In this context, the short-term use of systemic glucocorticoids should be limited to extensive or clinically severe acute contact dermatitis and exacerbations of chronic contact dermatitis. The efficacy of the use of newer biologics and Janus kinase inhibitors in contact dermatitis is currently being evaluated in several clinical trials.
... Different studies suggest alcohol and alcohol-based gel be superior to detergent-based soaps. Even when used repeatedly the effect on skin by alcohol was lesser than the effect on skin by detergents [71]. The alcohol-based disinfectant was found to be better at reducing the number of bacteria on hand than washing. ...
Soap and alcohol or alcohol-based cleansers have been used as hand disinfectants and
routine hand washing material for a long time. With the COVID-19 being pandemic,
there is an increase in the routine use of soap and sanitizers. No doubt washing hands
for 20 seconds with proper technique and proper soap could kill the Coronavirus but
the effect of regular use of soap on the skin is not addressed by the general public. It
has been shown by the in vitro as well as in vivo studies that the frequent use of soap
and detergents may harm the skin. The harsh surfactants in cleansers can damage skin
proteins and lipids and can cause dryness, irritation, barrier damage, and itching
problems. Furthermore, the use of soap can change the natural pH and deplete the
natural flora of the skin giving the pathogen an opportunity to transiently colonize the
skin surface. This paper explains the damages that may be caused to skin due to
excessive use of soap and detergents, the ways to mitigate those damages, and
potential alternative to detergent-based soaps.
... Zur Reduktion der Handwaschfrequenz in der Pflege und im medizinischen Bereich können alkoholbasierte Desinfektionsmittel verwendet werden. Diese greifen die Hautbarriere weniger an als Detergenzien [242,243]. ...
Zusammenfassung
Das Kontaktekzem ( syn. Kontaktdermatitis) ist eine durch äußere Einwirkungen ausgelöste Entzündung der Epidermis und der Dermis am Ort der Einwirkung. Die beiden Hauptformen sind das irritative und das allergische Kontaktekzem, die neben einer ausgeprägten Verminderung der Lebensqualität auch erhebliche gesundheits‐ und sozioökonomische Kosten verursachen. Wegweisend für die erforderlichen diagnostischen Maßnahmen sind die Anamnese und das klinische Bild. Eine möglichst genaue diagnostische Einordnung des Kontaktekzems mittels allergologischer Testung ist wichtig für das Krankheitsmanagement, da hier nicht nur die klassische Ekzemtherapie, sondern auch das Meiden der exogenen auslösenden Faktoren von großer Bedeutung sind. Die Wahl der Therapie sollte sich nach der Akuität, dem klinischen Schweregrad, der Morphologie der Läsionen und der Lokalisation des Kontaktekzems richten. Erforderlich ist eine bedarfsadaptierte Kombination aus Basistherapie, topischer, physikalischer und systemischer Therapie, wobei nicht alle Therapieformen gleichzeitig durchgeführt werden müssen, sondern variierend eingesetzt werden können. Primäre, sekundäre und tertiäre Präventionsstrategien zielen auf die Erkennung der auslösenden Noxen beziehungsweise der auslösenden Allergene mit nachfolgender Kontaktvermeidung oder ‐minimierung.
Die vorliegende S1‐Leitlinie zum Kontaktekzem soll vor allem Dermatologen, Allergologen sowie allergologisch und berufsdermatologisch tätigen Ärzten eine Entscheidungshilfe für die Auswahl sowie die Durchführung einer geeigneten und suffizienten Diagnostik, Therapie und Prävention zur Verfügung zu stellen.
... Alcohol-based disinfectants can be used to reduce the frequency of hand washing in nursing and in the medical sector. These have a less severe effect on the skin than detergents [242,243]. Again, products for hand cleansing and disinfection should not contain any potent allergens [244]. ...
Contact dermatitis is an inflammation of the epidermis and dermis at the site of exposure triggered by external agents. The two main forms are irritant and allergic contact dermatitis, which cause significant health and socioeconomic costs in addition to a marked reduction in quality of life. The anamnesis and the clinical picture are decisive for the necessary diagnostic measures. The most accurate possible diagnostic classification of contact dermatitis by means of allergological testing is important for disease management, since not only classical eczema therapy but also avoidance of the exogenous triggering factors are of great importance here. The choice of therapy should be based on the acuity, clinical severity, morphology of the lesions and localization of the contact dermatitis. A combination of basic therapy, topical, physical, and systemic therapy adapted to the patient’s needs is required, whereby not all forms of therapy must be carried out simultaneously but can be used in a varying manner. Primary, secondary, and tertiary prevention strategies aim at the recognition of the triggering noxae or allergens with subsequent contact avoidance or minimization.
The present S1‐guideline on contact dermatitis is primarily intended to provide dermatologists, allergologists and physicians working in allergology and occupational dermatology with a decision‐making aid for the selection and implementation of suitable and sufficient diagnostics, therapy, and prevention.
... Los alcoholes han sido usados para desinfectar superficies inanimadas, así como la piel (28). y se evapora en muy poco tiempo sin dejar rastros de residuos. ...
Interactions between the orthodontic office and the laboratory require protocols to avoid cross-infection when sending or receiving impressions and appliances. It is mandatory to know different disinfection methods since their incorrect use can damage, corrode or deform impression materials, prostheses, and appliances. In this work, our purpose is to review the most effective disinfection methods that help control SARS-CoV-2 infection during work in the orthodontic laboratory. Knowledge of these substances and their use protocols will avoid health problems in those who use them and harmful effects in the materials they handle. Keyword-SARS-CoV-2, COVID-19, orthodontic laboratory, dental office disinfection, orthodontics.
... However, the higher prevalence and severity of clinically observed and self-reported hand eczema found in finalyear apprentice nurses in comparison to final-year hairdressing apprentices,23,25 and the lack of association with atopic dermatitis, could indicate a certain degree of impact of pandemic preventive hygiene regimens.The apprentice nurses from this study showed in average good knowledge and behaviour regarding skin protection at work, rarely washing their hands more than 20 times per day and mostly using alcohol-based hand disinfectants. Alcohol-based hand disinfectants are considered less irritative than classical hand washing with soap and detergents in terms of OSD prevention.2,36,45 They were recommended as the first step of a good hand hygiene regimen in a recent position paper of European experts about the minimum standards in the prevention of occupational contact dermatitis.46 ...
Background/objectives
This study assessed the frequency and origin of hand eczema (HE), and work-related risk factors in apprentice nurses (AN), who are considered at high-risk to developing occupational skin diseases.
Subjects/Methods
The study involved 240 final-year ANs (females 75%, median age 19 years) from vocational schools in Zagreb, Croatia. The study was performed in 2020/2021 and included a questionnaire and clinical examination by means of the Osnabrück Hand Eczema Severity Index (OHSI). Skin prick test (SPT) with natural rubber latex (NRL) allergen, and patch test (PT) with basic series of allergens, and disinfectants, were performed in 42 ANs with HE that lasted >3 months.
Results
Clinically observed and self-reported HE was found in 49% and 46% of ANs, respectively. Those with observed changes were older and reported more days per month spent on practical work than those with healthy skin (p=0.001). Median OHSI was 4 (IQR 2-6). There were no positive SPTs to latex, and 11 (26%) ANs had positive PT reactions to ≥1 tested allergens, mostly nickel.
Conclusions
HE was common in final-year ANs during COVID-19 pandemic. It was mostly of irritative origin, associated with the duration of practical training, confirming cumulative effect of hazards on skin barrier.
This article is protected by copyright. All rights reserved.
... Additionally, previous studies have demonstrated that the efficacy and tolerance of alcohol are superior to that of soaps in achieving disinfection. 43,44 Accordingly, using alcohol-based disinfectants is recommended to HCWs to achieve adequate hygiene and to intervene against the potential adverse events that might result from frequent hand washing. 45 Applying guidelines or protocols for systemically managing the infection among HCWs can also increase the compliance among these workers, and reduce the rates of infections. ...
Methicillin-resistant Staphylococcus aureus (MRSA) is a common pathogen of clinical significance within the community and healthcare settings. It has been reported with a variety of infections, including endocarditis, bloodstream infections, pneumonia, joint and bone infections, and soft tissue and skin infections. Although many efforts have been exerted to eradicate the rates of infections and studies have reported a decreasing pattern in the prevalence rates over the years, it has been demonstrated that MRSA represents a significant challenge to the healthcare systems and the affected patients. In this literature review, we have provided a discussion regarding the risk factors, screening, and treatment of MRSA among healthcare workers (HCWs) based on the evidence obtained from the current relevant studies in the literature. HCWs are at increased risk of MRSA colonization, and many risk factors have been identified. These mainly include poor hygiene practices, chronic skin diseases, and having a history of working in an MRSA-endemic country. Decolonization practices are the main line of treatment of MRSA colonization among HCWs because antibiotic therapy is usually of limited use because of the increasing resistance to a wide range of antibiotics. Applying adequate interventions as taking care of hand hygiene and using alcohol-based disinfectants is recommended to achieve better outcomes. Increasing awareness among HCWs is also a potential approach to achieve better management.
... 29,28 Formal policies for monitoring staff compliance are often lacking. Alcohol-based hand rubs are a cost-effective way to improve HH compliance in NHs, 30 where their use is intended as a complement to staff education, 23 although they are not a substitute for handwashing when hands are visibly soiled. A study reported that the cost of purchasing and promoting hand rub was 100 times lower than the expected cost of the infections prevented. ...
Patients increasingly receive care from a large spectrum of different settings, placing them at risk for exposure to pathogens by many different sources. Each health care environment has its own specific challenges, and thus infection control programs must be tailored to each specific setting. High-turnover outpatient settings may require additional considerations, such as establishing patient triage and follow-up protocols, and broadened cleaning and disinfection procedures. In nursing homes, infection control programs should focus on surveillance for infections and antimicrobial resistance, outbreak investigation and control plan for epidemics, isolation precautions, hand hygiene, staff education, and employee and resident health programs.
... In experimental studies, AHDs have been found to be well tolerated by the skin barrier, and the irritant potential has been regarded as low (17)(18)(19). This has also been supported in epidemiological studies (7,9). ...
The COVID-19 pandemic has led to enhanced hygiene procedures and use of personal protective equipment, but also to increased attention to occupational skin disease in healthcare workers. The occurrence of hand and facial skin disease in > 5,000 Swedish healthcare workers was investigated in a questionnaire survey. Levels of skin exposure related to hygiene procedures and personal protective equipment were recorded. Caring for patients with COVID-19 entailed higher levels of wet work and face mask exposures, and was associated with higher 1-year prevalence of both hand eczema (36%) and facial skin disease (32%) compared with not being directly engaged in COVID-19 care (28% and 22%, respectively). Acne and eczema were the most common facial skin diseases; for both, a dose-dependent association with face mask use was found. Dose-dependent associations could be shown between hand eczema and exposure to soap and gloves, but not to alcohol-based hand disinfectants.
... 55 Using alcohol-based hand rub has been shown to be much less damaging to skin than handwashing with soap and water. 56,57 Still, alcohol is a solvent that can destroy the lipids surrounding the corneocytes in the stratum corneum. 58 Conceivably, it is essential for institutions to choose alcohol-based hand rubs with high acceptability and tolerability, such as those that contain emollients and humectants to avoid skin irritation. ...
Health-care-associated infections are the most prevalent adverse events of hospital care, posing a substantial threat to patient safety and burden on society. Hand hygiene with alcohol-based hand rub is the most effective preventive strategy to reduce health-care-associated infections. Over the past two decades, various interventions have been introduced and studied to improve hand hygiene compliance among health-care workers. The global implementation of the WHO multimodal hand hygiene improvement strategy and constant efforts to replace the use of soap and water with alcohol-based hand rub have led to a faster and more efficient hand cleaning method. These strategies have strongly contributed to the success of behaviour change and a subsequent decrease in health-care-associated infections and cross-transmission of multidrug-resistant organisms worldwide. The WHO multimodal behaviour change strategy requires a series of elements including system change as a prerequisite for behaviour, change, education, monitoring and performance feedback, reminders in the workplace, and an institutional safety climate. Successful adoption of the promotion strategy requires adaptation to available resources and sociocultural contexts. This Review focuses on the major advances and challenges in hand hygiene research and practices in the past 20 years and sets out various ways forward for improving this lifesaving action.
... Similar articles says about the natural sanitizers are free from harmful chemicals and its effectiveness against microbes. Hand sanitizers has to have alcohol be effective,In this present study 72% of population opted yes,In similar article 90% alcohol rules are more effective against viruses than most other forms of handwashes because alcohol based sanitizer restricts the viral growth by precipitating the surface proteins that that break the chain of transmission of virus,moreover the strength of alcohol is the key factor that determine the biocidal potentiality of the sanitizers 34 . ...
... Figure 6 represents there is a significant difference between the age groups knowledge about hand sanitizer-kill Coronavirus (p<0.05). 90% alcohol rubs are more effective against viruses than most other forms of hand washing 26,27 . Figure 7 shows 82% of people were aware of the forms of hand sanitizer and the remaining 14% was not aware of it. ...
... Repeated handwashing disrupts the skin barrier, while using a hand sanitizer containing glycerol instead is much gentler. 32 of 28.6% may raise concern for participation bias, the estimates of atopic dermatitis and hand eczema before the COVID-19 pandemic are similar to those from previous studies. 11,14,33 Another limitation is that the end points were self-reported (by parents). ...
Background
During the first wave of the COVID‐19 pandemic of Spring 2020, Denmark was one of the first countries to introduce lockdown measures, including closing of all daycare centers. Following the reopening of daycare centers, Danish Health Authorities implemented a mandatory intensive hand hygiene regimen.
Objectives
To examine the occurrence and point prevalence of hand eczema as a consequence of more intensive hand hygiene among Danish children attending daycare.
Methods
The heads of 1667 daycare centers in Denmark were contacted and asked to forward a link to a questionnaire to parents of the children attending the daycare center.
Results
Among 6858 children, 12.1% had hand eczema before reopening of daycare centers, whereas 38.3% reported hand eczema after the children returned to daycare. Of the children who never had hand eczema, 28.6% developed hand eczema after returning to daycare. The risk of hand eczema was significantly associated with atopic dermatitis, female gender, higher age, and frequency of handwashing.
Conclusion
Following the implemented hygiene regimen, a high proportion of young children rapidly developed hand eczema. Well‐established prophylactic skin care might have spared a proportion of the children from developing hand eczema.
... 44,45 However, it seems that irritant contact dermatitis due to chlorine solutions occurs in much higher concentrations than those considered by the reports on the Ebola outbreak. 17,46,47 Currently, there is no evidence to support the use of chlorine solutions for HH during the COVID-19 pandemic; however, administering these solutions with higher concentrations as hospital-level disinfectants has been introduced as an effective way of surface cleaning. However, the risk of work-related sensitivity to sodium hypochlorite is real and should be considered in hospital staff with regular exposure to this product. ...
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.
... There is also a recommendation to use hydro alcoholic solutions with glycerin. Alcohol-based hand solutions containing glycerin as moisturizer were studied intensively and are recommended to replace traditional soaps for hand washing within healthcare facilities 4,5 . Although these solutions are better tolerated than standard detergents 5,6 , the additional regular use of a fragrance-free 7 emollient after these procedures greatly improves its acceptance, as already stated by Wollenberg et al 8 . ...
Among the basic protective measures against COVID‐19, the need to wash hands frequently and in a prolonged way using soap, and to regularly use alcohol‐based hand sanitizers is well established for the whole population. Healthcare workers in general, and particularly those involved in the direct care of COVID‐19 patients, have to wear personal protective equipment (PPE) daily for many hours and also accomplish general preventive measurements outside their work. Cutaneous adverse reactions can develop that need to be prevented, identified and therapeutically managed. According to the data reported by Lin et al 1, based in the experience from healthcare workers in Wuhan, adverse skin reactions were reported in 74% of responders (n=376) to a general survey. The most commonly reported types of eruptions were skin dryness or desquamation (68.6%), papules or erythema (60.4%) and maceration (52,9%).
... Therefore, improvements in acceptability and tolerability can translate into fewer infections. Hand products, particularly those containing sodium laureth sulfates, irritate the skin and deplete skin lipids [14][15][16]. ABHRs seem to be better tolerated than detergents and are now recommended by the WHO as preferred hand sanitizers [17][18][19]. Because the skin tolerates ethanol better than n-propanol or isopropanol, ethanol is the preferred active substance in ABHRs (also included in the product tested in our study) [20,21]. ...
Abstract Background The effectiveness of alcohol-based hand rubs (ABHRs) depends substantially on their acceptability and tolerability. In this study, we assessed the acceptability and tolerability of a new ABHR (product EU 100.2018.02). Methods Among physicians, nurses, and cosmetologists who used the ABHR for 30 days, we assessed the product’s acceptability and tolerability according to a WHO protocol. Additionally, we used instrumental skin tests. Participants assessed the product’s color, smell, texture, irritation, drying effect, ease of use, speed of drying, and application, and they gave an overall evaluation. Moreover, they rated the tolerability, i.e. their skin condition, on the following dimensions: intactness, moisture content, sensation, and integrity of the skin. The tolerability was also assessed by an observer as follows: redness, scaliness, fissures, and overall score for the skin condition. Instrumental skin tests included transepidermal water loss, skin hydration, sebum secretion, and percentage of skin affected by discolorations. All assessments were made at baseline (visit 1), and 3–5 days (visit 2) and 30 days (visit 3) later. Results We enrolled 126 participants (110 [87%] women) with a mean age of 34.3 ± 11.65 years. Sixty-five participants (52%) were healthcare professionals (physicians, nurses), and 61 (48%) were cosmetologists. During visit 2 and visit 3, about 90% of participants gave responses complying with the WHO’s benchmark for acceptability and tolerability. Similarly, the ABHR met the WHO criteria for observer-assessed tolerability: on all visits, in more than 95% of participants, the observer gave scores complying with the WHO benchmark. Transepidermal water loss decreased from baseline to visit 3 (p
... The use of antibacterial (alcohol-based) hand rubs, with the addition of moisturisers for hand hygiene, reduces the drying and cracking of the skin that commonly results from repeated hand cleansing with soap and water. 33,34 This has the added benefit of also reducing rates of some health-care-associated infections, such as S. aureus bacteraemia and Clostridium difficile infections. 35 Moreover, antibacterial hand rubs have been associated with increased hand-hygiene compliance and reduced rates of nosocomial infection. ...
Background
Although strategies have been developed to minimise the risk of occupational hand dermatitis in nurses, their clinical effectiveness and cost-effectiveness remain unclear.
Objectives
The Skin Care Intervention in Nurses trial tested the hypothesis that a behaviour change package intervention, coupled with provision of hand moisturisers, could reduce the point prevalence of hand dermatitis when compared with standard care among nurses working in the NHS. The secondary aim was to assess the impact of the intervention on participants’ beliefs and behaviour regarding hand care, and the cost-effectiveness of the intervention in comparison with normal care.
Design
Cluster randomised controlled trial.
Setting
Thirty-five NHS hospital trusts/health boards/universities.
Participants
First-year student nurses with a history of atopic tendency, and full-time intensive care unit nurses.
Intervention
Sites were randomly allocated to be ‘intervention plus’ or ‘intervention light’. Participants at ‘intervention plus’ sites received access to a bespoke online behaviour change package intervention, coupled with personal supplies of moisturising cream (student nurses) and optimal availability of moisturising cream (intensive care unit nurses). Nurses at ‘intervention light’ sites received usual care, including a dermatitis prevention leaflet.
Main outcome measure
The difference between intervention plus and intervention light sites in the change of point prevalence of visible hand dermatitis was measured from images taken at baseline and at follow-up.
Randomisation
Fourteen sites were randomised to the intervention plus arm, and 21 sites were randomised to the intervention light arm.
Blinding
The participants, trial statistician, methodologist and the dermatologists interpreting the hand photographs were blinded to intervention assignment.
Numbers analysed
An intention-to-treat analysis was conducted on data from 845 student nurses and 1111 intensive care unit nurses.
Results
The intention-to-treat analysis showed no evidence that the risk of developing dermatitis was greater in the intervention light group than in the intervention plus group (student nurses: odds ratio 1.25, 95% confidence interval 0.59 to 2.69; intensive care unit nurses: odds ratio 1.41, 95% confidence interval 0.81 to 2.44). Both groups had high levels of baseline beliefs about the benefits of using hand moisturisers before, during and after work. The frequency of use of hand moisturisers before, during and after shifts was significantly higher in the intensive care unit nurses in the intervention plus arm at follow-up than in the comparator group nurses. For student nurses, the intervention plus group mean costs were £2 lower than those for the comparator and 0.00002 more quality-adjusted life-years were gained. For intensive care unit nurses, costs were £4 higher and 0.0016 fewer quality-adjusted life-years were gained.
Harms
No adverse events were reported.
Limitations
Only 44.5% of participants in the intervention plus arm accessed the behaviour change package.
Conclusion
The intervention did not result in a statistically significant decrease in the prevalence of hand dermatitis in the intervention plus group.
Future work
Participants had a high level of baseline beliefs about the importance of using hand moisturisers before, during and after work. Future research should focus on how workplace culture can be changed in order for that knowledge to be actioned.
Trial registration
Current Controlled Trials ISRCTN53303171.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment ; Vol. 23, No. 58. See the NIHR Journals Library website for further project information.
... 1,2 Compared with alkaline soaps and detergents, short-chain alcohols are considered to have a relatively low skin irritation potential. 3 However, in two recent studies, we found considerable and previously unknown negative effects of 60% n-propanol on the permeability barrier function and corneocyte surface topography in the healthy human skin in vivo. 4,5 Therefore, in the present study, we aimed to extend our previous findings by investigating the effects of the applied irritant con- 6 To be eligible for participation, the AD individuals had to be in a stage of clinical remission, defined as the absence of active eczema lesions within the test area or any other body site for at least 6 weeks prior to recruitment. ...
Background:
Recent studies provide evidence for significant and previously underestimated barrier damaging effects of repeated exposure to 60% n-propanol in healthy skin in vivo.
Objectives:
We aimed to investigate further the cumulative effects of a range of n-propanol concentrations relevant at the workplace in healthy and atopic dermatitis (AD) individuals, and study the modulation of the outcomes by co-exposure and host-related factors.
Methods:
Healthy adult and AD volunteers were exposed to n-propanol concentrations from 30% to 75% in occlusion-modified tandem repeated irritation test (om-TRIT) with measurements of erythema, transepidermal water loss, capacitance and the natural moisturising factors (NMF) levels at baseline and after 96 hours.
Results:
N-propanol significantly damaged the epidermal barrier even at the lowest concentration in both groups. Exposure to all n-propanol concentrations significantly reduced NMF levels. Preceding low-grade trauma by occlusion/water exposure reduced the skin irritation threshold in both groups. Moreover, the differences in the severity of the barrier function impairment after exposure to the same concentrations under the same conditions between the AD and control group were significant.
Conclusions:
The negative effects of cumulative exposure to n-propanol in healthy and atopic skin shown in the study suggest the need of critical re-evaluation of its irritant properties. This article is protected by copyright. All rights reserved.
... They do not require rinsing with water but can be spread over the surface of hands and rubbed until dry [17]. Health care setting prefer hand sanitizers to hand washing with soap and water [18] because it is more effective at killing microorganisms and better tolerated when compared to the use of soap and water [19]. Alcohol based sanitizers show antimicrobial activity against a variety of microorganisms except the spore formers and has been used as an antiseptic at least as early as 1363 though its use became evident in the 1800's. ...
The study identified the species of bacteria on the hands of undergraduate students of University of Agriculture, Makurdi. Susceptibility tests of the isolates to 5 different alcohol-based hand sanitizers (Lovillea®, Dettol®, Passion®, Y-Senses® and My care®) was done. 50 Hand swabs taken from the hands of male and female students were analyzed microbiologically. The most prevalent bacteria isolated were E. coli 47(94%), Staphylococcus epidermidis 42(84%), Proteus sp 32(64%), Klebsiella sp 31(62%), Shigella sp 25(50%), Staphylococcus aureus 18(36%) Pseudomonas aeruginosa and Salmonella typhi 15(30%) and Enterobacter aerogenes 11(22%) from males and females. Lovillea® and Y senses® hand sanitizers showed better efficacy against the isolates. Passion® sanitizer inhibited the growth of nine isolates with the highest zone of inhibition against Pseudomonas aeruginosa and Staphylococcus epidermidis (10 mm) and least against Salmonella sp. Dettol® inhibited growth E. coli (10 mm) and the least against S. aureus, P. aeruginosa and S. epidermidis were resistant. My care® hand sanitizer showed the least antimicrobial activity inhibited the growth of only 3 isolates, with the highest zone of inhibition against S. aureus and Enterobacter aerogenes (5 mm); E. coli, S. pyogenes, Salmonella sp, Klebsiella sp, Proteus sp, Pseudomonas spp, S. epidermidis were all resistant. The minimum inhibitory concentration (MIC) of the susceptible organisms was (0.5 ml) on Salmonella sp, E. aerogenes, Klebsiella sp and S. epidermidis. There was no significant difference in the antibacterial activity of the sanitizers.
... The most frequently used alcohols are ethanol, iso-and n-propanol. Although hand sanitizers seem to be less damaging for the skin barrier than soaps [52,53] it has been demonstrated that they have the ability to induce changes in the SC; for example, n-propanol has pronounced denaturing effects on the SC proteins, pro-filaggrin processing, and desquamatory SC enzymes [54]. Consistently, Soltanipoor et al. [46] showed that n-propanol caused remarkable changes in corneocyte surface topography, and that this effect was strongly associated with decrease in NMF and SC hydration. ...
Skin diseases represent one of the most common work‐related diseases and may have a detrimental effect on social, personal and occupational aspects of life. Contact dermatitis, which comprises predominately irritant contact dermatitis (ICD) and allergic contact dermatitis (ACD) accounts for vast majority of occupational skin diseases, especially in occupations associated with frequent skin contact with irritants and contact allergens. Although ICD and ACD have similar clinical manifestation, their pathophysiology and the role of the skin barrier is different. In ICD, perturbation of the skin barrier is the primary event which sets into motion diverse metabolic processes and triggers activation of innate immunity without involvement of adaptive immune system. In ACD, a type IV hypersensitivity reaction induced by contact allergens, the skin barrier impairment may evoke innate signaling pathways during the sensitization phase required for the activation of T‐cell adaptive response. Thus, skin barrier impairment may increase the risk of ICD or ACD not only because of enhanced permeability and ingress of irritants and allergens, but also by generation of innate immune signal needed for the induction of allergic response. Hence, an efficient way to prevent CD is to avoid skin barrier damage in the workplace. This review focuses on the skin barrier, how it is affected by skin irritants and how its impairment contributes to development of ICD and ACD.
This article is protected by copyright. All rights reserved.
... Parallèlement, notre travail a montré l'augmentation du taux d'hydratation cutanée sur les deux cotés de la main dominante après friction avec SHA. Cette augmentation de l'hydratation est un facteur de bonne tolérance cutanée(108,109,110).Nous avons identifié plusieurs facteurs de risque de diminution de la qualité de friction avec SHA.Les réservoirs de micro-organismes sont constitués par les ongles longs, les faux ongles, le vernis à ongles, les bijoux et les manches longues(14). Leur port est donc à proscrire lors des soins. ...
De nombreux travaux ont démontré que l'utilisation des SHA réduit le taux d'infections nosocomiales. Cependant, la qualité de friction avec SHA a été rarement évaluée. Un des objectifs de ce travail est d'évaluer la qualité de friction et la tolérance cutanée aux SHA sur le long terme. Lors d'une utilisation intensive en milieu hospitalier, les conséquences du passage systémique de l'éthanol par pénétration cutanée ou par inhalation restent encore un sujet de débat. Le second objectif est d'évaluer l'exposition aux SHA, dans des conditions expérimentales, et dans les conditions réelles de travail en milieu hospitalier. Ce travail a démontré une baisse de la qualité de friction à trois ans de la formation. L'utilisation des SHA augmente l'hydratation de la peau. Les SHA sont tolérées par les soignants. Les mesures réalisées en laboratoire, ont montré que l'exposition a l'éthanol des SHA est de brève durée mais à des concentrations importantes. La quantification d'éthanol dans l'air ambiant d'une chambre de patient, durant 8 heures d'utilisation intensive de SHA, a montré que le patient et le soignant sont exposés à la même quantité de vapeurs d'éthanol, cependant cette quantité est inférieure à la valeur limite d'exposition professionnelle française. L'étude réalisée au CHU, a montré que l'exposition des soignants aux SHA à court terme, ne conduit pas à une absorption décelable de l'éthanol et de ses métabolites. La concentration d'éthanol dans l'air inhalé, reste inférieure aux valeurs limites réglementaires françaises. L'ensemble de ce projet se déroule sur 10 ans, il permettra de vérifier les possibles effets secondaires liés à l'utilisation des SHA sur le long terme
... The hair filament anchored to the insulin needle can be sterilized by immersing the ampoule in a small gallipot or container filled with alcohol alone or a mixture of alcohol and betadine for 10 to 30 minutes. 8 It should be noted that the ampoule should be prepared in an infectioncontrolled environment to prevent infection. 9 ...
Background: Facial wounds are challenging for dermatologic surgeons, particularly traumatic facial wounds, because they can yield disfiguring scars. To obtain good results, narrow needles and sutures are needed. Hair filaments have a very small diameter (0.06-0.1 mm) and could serve as suture threads for facial wounds. Objective: To determine the aesthetic outcomes by using autologous hair to suture facial wounds. Patients and Methods: This case series study examined the aesthetic outcomes of all consecutive female patients with traumatic facial wounds who underwent autologous hair-based stitching in 2009-2016. Autologous hair ampoules were generated from an insulin needle. Micro instruments were used for wound stitching. Results: In total, 54 females (mean age, 10.8; range, 3-45) years had 56 traumatic wounds. Mean wound length was 3.6 (range, 1-12) cm. Injury depth varied from cutaneous-only to muscle involvement. Suturing yielded good edge coaptation, nice healing, and excellent aesthetic outcomes; the scars were often scarcely visible. Suture marks were not detected. Cutaneous reactions did not occur. Conclusion: Autologous hair can serve as a thread for closing facial wounds. It is low cost and thus suitable in settings characterized by facility and equipment limitations. It is also suitable for the battlefield.
... The microbes may be removed through washing practices and largely recommended by use of hand sanitizers. Hand sanitizers are well-adapted to the skin (Pedersen et al., 2005a;Boyce, 2000), work by stripping the outer layer of oil on the skin removing skin bacteria too (Axel et al., 2002), and their use is an important way to break bacterial transmission (Alex-Hart and Opara, 2011;Omogbai et al., 2011;Pedersen et al., 2005b). ...
Hands are the primary mode of transmission of microbes and infection. Hand hygiene is a simple and least expensive means of preventing infection. Various hygiene products are on the market in the form of sanitary, antimicrobial and alcohol-based hand sanitizers which are meant to reduce/remove microbial load of the skin. The antibacterial and antifungal activity of commonly used alcohol based hand sanitizers was assessed on microbes obtained from circulating currency notes and coins. Three hand sanitizer's; Sanitizer 1, Sanitizer 2, and Sanitizer 3 were analyzed in pure (P) and diluted (D) concentrations for their antimicrobial potential against the isolated thirty-one bacterial and thirty-eight fungal strains by disc diffusion method. Undiluted hand sanitizer HC was found to possess broad spectrum antibacterial and antifungal activity. The effect of sanitizer's on bacterial and fungal species was found in the order: Sanitizer 1P> Sanitizer 1D> Sanitizer 2P> Sanitizer 3P> Sanitizer 2D> Sanitizer 3D.
With the increasing global burden of skin cancer, the role of surgery in the armamentarium of the clinical dermatologist has never been so important. This chapter introduces the reader to the fundamentals of dermatological surgery. For the novice, the chapter outlines the basics of skin surgery including relevant anatomy, biopsy techniques and the simple elliptical excision. A comprehensive review and guide to common suturing techniques used during skin surgery is also provided. For the more experienced dermatologist, in addition to Mohs micrographic surgery, advanced cutaneous reconstructive techniques including full‐ and split‐thickness skin grafts, and one‐ and two‐stage flaps are also discussed. Important safety aspects and complications associated with skin surgery are dealt with. The chapter also provides a comprehensive guide to the essential equipment necessary prior to embarking upon cutaneous surgery.
Background:
Occupational hand eczema (OHE) is common among healthcare workers (HCWs), especially during the coronavirus disease 2019 (COVID-19) pandemic.
Aims:
Our study aimed to determine the prevalence of OHE among HCWs and to identify its associated risk factors.
Methods:
We conducted a cross-sectional study. A self-administered questionnaire study was done. It was followed by a clinical assessment of subjects with skin changes on their hands to determine the likely cause and its severity. Descriptive analysis and inferential analysis were performed to determine the prevalence of OHE and its associated risk factors.
Results:
A total of 1004 HCWs with a mean age of 34.58 years old were recruited. Of these, 50.1% were nurses, another 24.6% were doctors. A 1-year prevalence of 42.3% and a point prevalence of 16.5% were reported. Dry skin (n = 368, 86.6%) and itching (n = 274, 64.5%) were the common symptoms. Risk factors that were significantly associated with OHE were atopic eczema, allergic rhinitis, frequent hand washing and caring for children under four years old, whereas HCWs who frequently use alcoholic disinfectant and moisturizer hand cream showed lower odds of OHE. No significant association was found between age, gender, profession, involvement in COVID-19 care, number or duration of glove usage and occurrence of hand eczema.
Conclusions:
We report a high prevalence of OHE among HCWs during the current COVID-19 pandemic. Education and effective preventive measures are paramount to prevent and improve occupational dermatosis.
The bactericidal efficacy of stable sodium hypochlorite (s-SH, AirRish) was evaluated through in vitro testing against planktonic solutions of Staphylococcus aureus and Staphylococcus epidermidis. After an exposure time of 5 minutes viable colony forming units of both species fell below the limit of detection with both 100 ppm and 200 ppm s-SH, a greater than 6 log10 reduction (p< 0.001). Additionally, the antimicrobial effect of s-SH was also examined in hand sanitization applications. In a 60s hand rub, 200 ppm s-SH achieved a 96% reduction in hand CFUs, of similar effect as a typical alcohol sanitizer (p= 0.28). s-SH maintained considerable bactericidal efficacy at the tested concentrations.
Background
The focus on hand hygiene during the pandemic has been reported to increase the hand eczema (HE) prevalence in healthcare workers (HCWs), however, detailed prospective data is missing.
Objectives to evaluate changes in HE prevalence, exposures, and health-related quality of life (HR-QoL) among HCWs during the pandemic.
Methods
In this prospective cohort study, HCWs employed at hospitals in Copenhagen responded to a digital questionnaire at the beginning of the pandemic and again 10 months later.
Results
Seven-hundred-and-ninety-five HCWs responded to both questionnaires (83.4% females). The calculated one-year HE prevalence decreased from 16.0% at baseline to 13.0% at follow-up. Number of hand washings decreased significantly, while use of alcohol-based hand rubs (ABHR) on wet skin increased significantly. In a logistic regression model, increased use of ABHR on wet skin was associated with HE at follow-up (OR 1.78, 95%CI [1.11-2.87]). HR-QoL worsened slightly at follow-up, with HE severity and frequent flares being risk factors for a reduced HR-QoL.
Limitations
Sample size
Conclusion
In contrast to previous studies undertaken during the pandemic, we found a relatively low and stable HE prevalence. Our findings suggest that the interaction between changed exposures and HE is complex and cannot be linked to a single factor.
Background
Hand eczema (HE) is common in healthcare workers (HCWs). During the last decade, new recommendations support increased use of alcohol-based hand rub (ABHR) to partially replace hand washings. Although this is expected to lower the HE prevalence, newer data is lacking.
Objectives
To assess current one-year prevalence of HE in HCWs. Moreover, to investigate exposures and the extent of subjective discomfort to hand washings and ABHR.
Methods
A digital questionnaire was sent to 4876 HCWs in April–May 2020.
Results
Out of 2125 respondents (1779 women, 346 men), 14.7% reported HE within the last year. In total, 9.1% reported >20 hand washings and 76.0% reported ABHR use >20 times/shift. HE was significantly associated with hand washings (adjusted OR 1.73 [95%CI 1.26–2.36]) and glove use on wet skin (adjusted OR 1.99 [1.27–3.12]). Subjective discomfort was reported significantly more often to ABHR than to hand washing (P < .001), and significantly more often in HCWs with HE than without HE (P < .001).
Conclusions
The current one-year HE prevalence in HCWs of 14.7% was lower than previously reported Scandinavian data. HE was related to frequent hand washings, as previously reported, and to glove use on wet skin, which is a possible risk factor for HE that should be further explored.
This article is protected by copyright. All rights reserved.
Coronavirus disease 2019 (COVID-19) is currently receiving the whole world's attention. It appeared first in Wuhan city of China and rapidly spread to the world, causing many mortalities and morbidities; the disease is mainly transmitted via respiratory droplets and has a long infectivity period of about 14 days.
Science shows that the virus is also transmitted via the skin if the virus by any means finds its way and land on the skin surface. Infection occurs when touching the face, eyes, or nose with the hand after the virus has landed upon it. This is the main reason for the widespread usage of skin antiseptics and disinfectants. We included the most commonly used skin antiseptics, sterilizing methods, and disinfectants, such as household bleach, hydrogen peroxide gas plasma, Formaldehyde, Glutaraldehyde, Alcohol, Chlorohexidine, Povidone-iodine, Chloroxylenol, and alcohol-based hand sanitizer (e.g. Sterlelium). We will discuss their role in preventing acquired infection of COVID-19, as well as discussing the efficacy, costs, and side effects of different sterilizers, including general health hazards, as well as skin affection as irritant contact dermatitis, which is the commonest side effect. After conducting this work, we summarized the results & started sending them to our patients & medical personnel, and we observed 60% decrease in the cases of disinfectants induced allergic contact dermatitis /month compared to the previous two months.
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.
Objective:
To determine the frequency of self-reported hand dermatitis and the factors influencing its prevalence among nursing students.
Methods:
Researchers collected demographic data and used a self-assessment form to identify dermatologic symptoms. The questionnaires were distributed to the students and collected again after the students completed the forms.
Results:
Hand dermatitis was present in 20.9% of nursing students. The most common symptoms were irritation/pruritus, redness/cracking, flaking/rash, swelling, and vesicles in hands. The grade of the student, the presence of allergy complaints, and medication used to treat dermatitis were statistically significantly associated with dermatitis prevalence. The use of gloves and cleansing agents used in handwashing were factors linked to hand dermatitis.
Conclusions:
Hand dermatitis increases in parallel with the increase of clinical practice hours among nursing students. Familial and environmental factors also increase the risk of hand dermatitis.
The external formulations applied on the skin for the purpose of occupational protection are collectively referred to as occupational skin products. These are part of the three-step program: • Pre-exposure, protective (barrier) creams or protective products • Cleansing products • Skin-care products or postexposure skin care (emollients, moisturizers) Such formulations may provide protection only against weak irritants and cannot replace the use of other protective means such as gloves. Studies show that some external products fail to provide the declared anti-irritant efficacy and may actually aggravate irritation. It is therefore recommended that occupational skin products within the three-step program should be tested experimentally against the relevant irritants from the occupations they are to be used in. The efficacy of the protective creams is based mainly on skin physiology studies with healthy volunteers; only one RCT demonstrated a benefit in a real occupational setting. Worker education is needed to provide optimal use and achieve the optimal protection from the three-step program.
Handekzeme können neben anlagebedingtem Ursprung auch Ausdruck eines beruflich oder außerberuflich bedingten irritativen oder allergischen Kontaktekzems sein. Dies bietet Ansatzpunkte für sich ergänzende Maßnahmen auf der Ebene der primären, sekundären und tertiären Prävention. Im Vordergrund steht dabei die Identifikation des/der Auslöser(s) mit nachfolgender Reduktion oder Elimination der entsprechenden Exposition. Wichtige Präventionsansätze sind gesetzliche Regelungen, technische und organisatorische Maßnahmen sowie die korrekte Verwendung einer adäquaten persönlichen Schutzausrüstung (z. B. Schutzhandschuhe). Gesundheitspädagogische Interventionen können dabei das individuelle Hautschutzverhalten verbessern. Auch wenn die Evidenz zur Effektivität von Präventionsansätzen beim Handekzem begrenzt ist, haben diese besonders bei beruflicher Verursachung eine große Bedeutung, da dadurch die Entstehung einer Berufskrankheit (BK-Nr. 5101) verhindert bzw. deren Folgen gemindert werden können. In Deutschland wurde daher ein komplexes, abgestuftes Präventionskonzept für Berufsdermatosen etabliert. In den letzten Jahren konnte gezeigt werden, dass insbesondere die daran beteiligten Maßnahmen der sekundären und tertiären Individualprävention einen hohen Stellenwert haben.
Background
Skin protection products should be used after washing hands with soap, during breaks, after work, and during leisure time. Aside from their beneficial effects, skin care products may also interact with alcohol-based hand disinfectants by reducing their efficacy. The aim of this study was to investigate the effect of a hand lotion on the effectiveness of hygienic hand antisepsis using an alcohol-based handrub.
Methods
The effect of a protective hand lotion against an isopropyl alcohol-based handrub was investigated in 20 healthy volunteers according to the European standard test procedure EN 1500 in the following combinations: handwashing and application of hand lotion, only application of hand lotion, and no washing and no hand lotion (control), each for 5 minutes or 1 hour before hand antisepsis. The difference in microbiologic before-and-after values were expressed as log reduction factor.
Results
The effectiveness of hand antisepsis was not significantly affected in any of the groups using the tested hand lotion.
Conclusions
Hand antisepsis may be delayed for 5 minutes after hand lotion application. Shorter time intervals might be possible but were not tested.
Background:
Hand eczema is more common in healthcare workers compared to the general population. The hands are subject to changing occupational exposures due to mandatory hygiene regulations for health care workers.
Objectives:
To describe the exposure due to hygiene procedures and investigate the associations between occupational hand washing, use of non-sterile gloves, and hand disinfectant and self-reported hand eczema.
Methods:
Cross-sectional study with an electronic questionnaire distributed to 28 762 hospital employees in southern Sweden. Respondents working as nurses, assistant nurses or physicians constituted the group of healthcare workers analysed. Adjustments were made for gender, age, wet work at home, life-style factors and atopic dermatitis.
Results:
12 288 (43%) responded including 9051 healthcare workers. In this group the 1-year prevalence of self-reported hand eczema was 21%. On a daily basis, 30% reported hand washing with soap >20 times at work, 45% used hand disinfectants >50 times, and 54% used non-sterile gloves > 2 hours. After adjustment for confounding factors, a dose-dependent association with self-reported hand eczema was found for the daily number of hand washes with soap at work and time working with disposable gloves, but not for alcoholic disinfectant use. Hand washing outside work was not associated with self-reported hand eczema in the adjusted multivariate analysis.
Conclusions:
In this study, we found a higher 1-year prevalence of self-reported hand eczema among Swedish healthcare workers than reported in the general population. Hand washing with soap and use of disposable gloves were associated with the occurrence of self-reported hand eczema in a dose-dependent way. Use of hand disinfectant was not associated with self-reported hand eczema. This article is protected by copyright. All rights reserved.
Background:
Skin diseases constitute up to 40% of all notified occupational diseases in most European countries, predominantly comprising contact dermatitis, contact urticaria, and skin cancer. While insufficient prevention of work-related skin diseases (WRSD) is a top-priority problem in Europe, common standards for prevention of these conditions are lacking.
Objective:
To develop common European standards on prevention and management of WRSD and occupational skin diseases (OSD).
Method:
Consensus amongst experts within occupational dermatology was achieved with regard to the definition of minimum evidence-based standards on prevention and management of WRSD/OSD.
Results:
By definition, WRSDs/OSDs are (partially or fully) caused by occupational exposure. The definition of OSD sensu stricto additionally includes diverging national legal requirements, with an impact on registration, prevention, management, and compensation. With the implementation of the classification of WRSD/OSD in the International Classification of Diseases (ICD) 11th Revision in future, a valid surveillance and comparability across countries will be possible. Currently, WRDS and OSD are still under-reported. Depending on legislation and regulations, huge differences exist in notification procedures in Europe, although notification is crucial to prevent chronic and relapsing disease. Facilities for early diagnosis, essential for individual patient management, should be based on existing guidelines and include a multidisciplinary approach. Patch testing is essential if contact dermatitis persists or relapses. Workplace exposure assessment of WRSD/OSD requires full labelling of product ingredients on material safety data sheets helping to identify allergens, irritants and skin carcinogens. Comparable standards in primary, secondary and tertiary prevention must be established in Europe to reduce the burden of WRSD/OSD in Europe.
Conclusion:
The adoption of common European standards on prevention of WRSD/OSD will contribute to reduce the incidence of OSD and their socio-economic burden.
Two virucidal hand rubs containing high concentrations of ethanol were evaluated for their irritating and sensitizing propensities in a Human Repeated Insult Patch Test (HRIPT). Whereas the numbers of responses elicited by Product A and an ethanol control were commensurately low and not significantly different (p<0.256), the number elicited by Product B was significantly higher than those elicited by either Product A or control (p<0.001). Product A was found to be devoid of clinically significant irritating propensities; Product B, a weak cumulative irritant. It was shown that it is possible to use high concentrations of ethanol in formulating highly effective virucidal hand disinfectants without compromising the skin compatibility of the product.
The external formulations applied on the skin for the purpose of occupational protection are part of the three-step program:
Pre-exposure protective (barrier) creams
Mild cleaners
Post-exposure skin care (emollients, moisturizers)
Such formulations may provide protection only against weak irritants and cannot replace the use of other protective means such as gloves.
Published examples show that some external products fail to provide the declared effectiveness and may actually aggravate irritation.
It is recommended that the topical preparations within the three-step program should be tested experimentally against the relevant irritants from the occupations they are to be used in.
The efficacy of the protective creams is backed up mainly by skin physiology studies with volunteers; only one RCT demonstrates benefit in a real occupational setting.
Education of the workers is needed to provide optimal use and achieve the optimal protection from the three-step program.
In 2 earlier studies, we found increased nickel re-test reactivity at earlier experimentally induced nickel eczema sites. The aim of this study was to investigate if earlier contact dermatitis caused by another allergen or earlier irritant contact dermatitis also influenced the reactivity when nickel was applied topically on earlier but healed dermatitis sites. Twenty-three females with contact allergy to both nickel and cobalt were involved in the study. Experimental contact dermatitis from nickel, cobalt and SLS was induced on the lower back. One month later, challenge patch testing with a serial dilution of nickel on the previous but healed dermatitis sites, and on a control area, was done. The tests were read blindly. Significantly higher test reactivity was found at the site with previous allergic contact dermatitis from nickel, and significantly lower test reactivity was observed at the previous SLS dermatitis site.
Two studies were performed to evaluate the influence of glycerol on the recovery of damaged stratum corneum barrier function. Measurements of transepidermal water loss and capacitance were conducted in a 3-day follow-up after tape stripping (study 1) and a 7-day follow-up after a barrier damage due to a repeated washing with sodium lauryl sulphate. In study 1 a faster barrier repair (transepidermal water loss) was monitored in glycerol-treated sites. Significant differences between glycerol open vs. untreated and glycerol occluded vs. untreated were observed at day 3. Stratum corneum hydration showed significantly higher values in the sites treated with glycerol+occlusion, compared with all other sites. In study 2 a faster barrier repair was seen in glycerol-treated sites, with significant differences against untreated and base-treated sites 7 days after the end of the treatment. Stratum corneum hydration showed highest values in the glycerol treated sites after 3 days of treatment. Glycerol creates a stimulus for barrier repair and improves the stratum corneum hydration; stratum corneum hydration is not strictly related to barrier homeostasis and can be optimized by different mechanisms and pathways. The observed effects were based on the modulation of barrier repair and were not biased by the humectant effect of glycerol. As the glycerol-induced recovery of barrier function and stratum corneum hydration were observed even 7 days after the end of treatment, glycerol can be regarded as a barrier stabilizing and moisturizing compound.
To evaluate the effect of implementation of an evidence based skin care programme for wet work employees as part of an occupational health and safety management system.
375 wet work employees were included in a prospective randomised controlled trial, allocated to either intervention (n = 207) or control (n = 168). The intervention group was exposed to a skin care programme during the five month study period. The intervention included an educational programme for a group of frontline employees, who underwent formalised training, and subsequently introduced the information to their colleagues. As part of the intervention a skin care policy including written instructions was established at each workplace. Both groups answered a test quiz, completed questionnaires on behaviour and symptoms, and underwent clinical examination of their hands before and after the five month period.
No difference between the intervention and the control group was found at baseline with respect to clinical symptoms or behaviour. Evaluation after the five months of intervention revealed a significantly higher information level on skin care in the intervention group compared to the control group, a significant change in behaviour in the intervention group but not in the control group, and significantly less skin symptoms as evaluated clinically in the intervention group but not in the control group. No significant difference was found for self reported skin problems.
The intervention was successful with respect to information level (knowledge), behaviour, and clinical symptoms. Implementation of a skin care programme as part of an occupational health and safety management system is recommended as a prophylactic measure for employees in wet occupations.
Ceramides are the major lipid constituent of lamellar sheets present in the intercellular spaces of the stratum corneum. These lamellar sheets are thought to provide the barrier property of the epidermis. It is generally accepted that the intercellular lipid domain is composed of approximately equimolar concentrations of free fatty acids, cholesterol, and ceramides. Ceramides are a structurally heterogeneous and complex group of sphingolipids containing derivatives of sphingosine bases in amide linkage with a variety of fatty acids. Differences in chain length, type and extent of hydroxylation, saturation etc. are responsible for the heterogeneity of the epidermal sphingolipids.
It is well known that ceramides play an essential role in structuring and maintaining the water permeability barrier function of the skin. In conjunction with the other stratum corneum lipids, they form ordered structures. An essential factor is the physical state of the lipid chains in the nonpolar regions of the bilayers. The stratum corneum intercellular lipid lamellae, the aliphatic chains in the ceramides and the fatty acids are mostly straight long-chain saturated compounds with a high melting point and a small polar head group. This means that at physiological temperatures, the lipid chains are mostly in a solid crystalline or gel state, which exhibits low lateral diffusional properties and is less permeable than the state of liquid crystalline membranes, which are present at higher temperatures.
The link between skin disorders and changes in barrier lipid composition, especially in ceramides, is difficult to prove because of the many variables involved. However, most skin disorders that have a diminished barrier function present a decrease in total ceramide content with some differences in the ceramide pattern.
Formulations containing lipids identical to those in skin and, in particular, some ceramide supplementation could improve disturbed skin conditions. Incomplete lipid mixtures yield abnormal lamellar body contents, and disorder intercellular lamellae, whereas complete lipid mixtures result in normal lamellar bodies and intercellular bilayers. The utilization of physiological lipids according to these parameters have potential as new forms of topical therapy for dermatoses. An alternative strategy to improving barrier function by topical application of the various mature lipid species is to enhance the natural lipid-synthetic capability of the epidermis through the topical delivery of lipid precursors.
Two studies were performed to evaluate the influence of glycerol on the recovery of damaged stratum corneum barrier function. Measurements of transepidermal water loss and capacitance were conducted in a 3-day follow-up after tape stripping (study 1) and a 7-day follow-up after a barrier damage due to a repeated washing with sodium lauryl sulphate. In study 1 a faster barrier repair (transepidermal water loss) was monitored in glycerol-treated sites. Significant differences between glycerol open vs. untreated and glycerol occluded vs. untreated were observed at day 3. Stratum corneum hydration showed significantly higher values in the sites treated with glycerol + occlusion, compared with all other sites. In study 2 a faster barrier repair was seen in glycerol-treated sites, with significant differences against untreated and base-treated sites 7 days after the end of the treatment. Stratum corneum hydration showed highest values in the glycerol treated sites after 3 days of treatment. Glycerol creates a stimulus for barrier repair and improves the stratum corneum hydration; stratum corneum hydration is not strictly related to barrier homeostasis and can be optimized by different mechanisms and pathways. The observed effects were based on the modulation of barrier repair and were not biased by the humectant effect of glycerol. As the glycerol-induced recovery of barrier function and stratum corneum hydration were observed even 7 days after the end of treatment, glycerol can be regarded as a barrier stabilizing and moisturizing compound.
Several factors, such as amount of allergen, vehicle, anatomic site, immunologic status and previous eczema, may influence delayed hypersensitivity reactions. In an extended model, we have studied the significance of previous allergic contact dermatitis for elicitation of delayed hypersensitivity to nickel in 25 nickel-allergic females. On 3 occasions, 8, 4 and 1 months before the final challenge patch testing, an experimental allergic contact dermatitis from nickel was induced on the lower back. At the challenge patch testing, 4 identical dilution series of nickel were tested on 4 areas on the lower back 3 with previous but healed dermatitis and I control area. The tests were read in a blind way. A significantly higher test reactivity was found at the areas with a previous allergic contact dermatitis, the shorter the time interval between the previous provocation and the challenge, the stronger the reaction. These results may be of importance for the understanding of factors contributing to chronicity of allergic contact dermatitis.
The chamber test for assessing the irritancy of soaps entails five weekday exposures to 8% solutions with readings of scaling, redness, and fissuring on the following Monday. Eighteen well-known toilet soaps were evaluated. Great differences were noted. Most had an appreciable irritancy potential. These results contrast with a number of studies which failed to show differences among soaps or which concluded that soaps were innocuous.
Delayed hypersensitivity retest reaction 3 and 6 weeks after induction of allergic and irritant inflammation, was studied in 13 females with known hypersensitivity to nickel. An increased retest reaction compared to controls was observed only in sites of earlier specific allergic inflammation. Also a general down-regulation of the degree of hypersensitivity was observed at retesting.
This report reviews individual-related variables, environment-related variables and instrument-related variables, with a focus on the Evaporimeter EP1 (ServoMed). Start-up and use is described, and guidelines for good laboratory practice given.
Despite the frequency of irritant contact dermatitis, very little is known about the duration of barrier function impairment following cumulative irritant contact dermatitis. We studied post-irritation irritant reactivity by assessing the response to SLS irritation in previously irritated sites. Cumulative irritant contact dermatitis was induced on the forearms of 15 volunteers aged 18 to 50 years by repeated occluded application of 0.5% SLS 1 h per day over 3 weeks. 3, 6 and 9 weeks later, previously irritated and unirritated control sites were challenged with 2% SLS under occlusion for 23 h. Irritation was assessed by visual scoring, transepidermal water loss (TEWL) as an indicator of epidermal barrier function, and capacitance as a parameter of epidermal water content. While no difference in irritant reactivity between pre-irritated and unirritated sites was observed 3 weeks following irritant contact dermatitis, there was a significant hyporeactivity of previously irritated skin as expressed by clinical scores, TEWL and capacitance at 6 and 9 weeks. Our results indicate that epidermal barrier function remains altered even 9 weeks after cumulative irritant contact dermatitis. With regard to patch testing, post-irritation hyporeactivity might be a cause of false-negative tests on previously irritated sites.
This report reviews individual-related variables (age, sex, race, anatomical site, skin surface properties), intra- and interindividual variation (temporal, physical and mental activity, orthostatic effect, menstrual cycle/menopause), environment-related variables (light conditions, temperature) and various instrument-related variables that influence skin colour. CIE colorimetry (Minolta Chroma Meter) and spectrophotometric measurement (Derma Spectrometer) are considered. The guidelines give recommendations for measuring conditions and procedures.
Several factors, such as amount of allergen, vehicle, anatomic site, immunologic status and previous eczema, may influence delayed hypersensitivity reactions. In an extended model, we have studied the significance of previous allergic contact dermatitis for elicitation of delayed hypersensitivity to nickel in 25 nickel-allergic females. On 3 occasions, 8, 4 and 1 months before the final challenge patch testing, an experimental allergic contact dermatitis from nickel was induced on the lower back. At the challenge patch testing, 4 identical dilution series of nickel were tested on 4 areas on the lower back 3 with previous but healed dermatitis and 1 control area. The tests were read in a blind way. A significantly higher test reactivity was found at the areas with a previous allergic contact dermatitis, the shorter the time interval between the previous provocation and the challenge, the stronger the reaction. These results may be of importance for the understanding of factors contributing to chronicity of allergic contact dermatitis.
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.
EXCERPT I have taken the unusual step of requesting an editorial from an author of the article being discussed in order to offer an opportunity to place the issues addressed herein in a larger context. A dispute has simmered for more than a decade as to the appropriate role (if any) of waterless hand cleansers, with most American authorities skeptical and European authorities supportive. However, considerable evidence has accumulated in the past few years, as reviewed below by an American expert, and there may no longer be room for dispute—ED. Alcohol has been used as an antiseptic since ancient times. However, the first systematic in vitro studies of the germicidal activity of ethyl alcohol against pure cultures of bacteria were performed by Koch in the early 1880s.1 In the 1890s and early 1900s, alcohol was proposed for use as a skin antiseptic.1 Early investigators discovered that alcohols must be diluted with water for maximal antimicrobial activity and that preparations containing 50% to 70% alcohol were more effective than 95% alcohol.1,2 In 1922, studies in Germany demonstrated the efficacy of an isopropyl alcohol hand rub in reducing bacterial counts on contaminated hands.3 In 1935, isopropyl alcohol was added to the American Medical Association Council on Pharmacy and Chemistry’s list of new and nonofficial remedies, and disinfection of the skin was listed as one of its recommended uses.4 Using more quantitative methods, Price showed in the late 1930s that 65.5% alcohol was effective in reducing the number of bacteria on the skin.1 He subsequently recommended the use of a 3‐minute wash with 70% alcohol as a preoperative hand scrub and that 70% alcohol should be used for disinfecting contaminated hands.1
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.
Prevalence studies generally find nosocomial urinary tract infections to be the most common type of nosocomial infection, accounting for between 21% and 45% of all HAIs. The main risk factor appears to be the presence of a urinary catheter, with an estimated 80% of these infections being associated with their use. This paper describes a model which quantifies the extent of the burden of these infections in terms of the number of patients affected and the costs incurred by the hospital sector; and identifies the potential benefits of the routine use of silver alloy coated catheters, as a means of reducing the incidence of this type of infection. An illustrative model of the annual costs and benefits associated with the routine use of this intervention in adult, non-day case patients admitted to the medical and surgical specialties of NHS hospitals throughout England is presented. The results suggest that a 14.6% reduction in the incidence of urinary tract infections in catheterized medical patients, and a 11.4% reduction in catheterized surgical patients, would cover the cost of the intervention. Any further reduction in incidence would result in net positive benefits.
This report describes three different investigations undertaken to demonstrate the advantage of fluid alcoholic hand disinfectants. In the first study, the skin compatibility of Sterillium, a liquid alcoholic rub-in hand disinfectant was compared with that of Hibiscrub, a water-based handwashing antiseptic. Using various parameters such as image analysis of removed squames (D-squames), skin roughness or transepidermal water loss, Hibiscrub was found to be significantly inferior to Sterillium. Hibiscrub caused skin irritation in 15 volunteers who could not complete the test. In a second study, the microbicidal efficacy of Sterillium and Hibiscrub was tested in surgical hand disinfection. The microbial reduction by Sterillium was significantly greater than that of Hibiscrub, immediately after application as well as after the surgical procedure. In a third study, certain alcoholic gels were tested according to the EN 1500 'hygienic hand disinfection'. None of the gels tested passed the EN 1500 within 30s. However, Sterillium met the EN 1500 requirement within 30s. We conclude that Sterillium is superior to Hibiscrub in terms of skin tolerance and microbicidal efficacy in surgical hand disinfection. It is also superior to alcoholic gels.
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 compare the efficacy of handrubbing with an alcohol based solution versus conventional handwashing with antiseptic soap in reducing hand contamination during routine patient care.
Randomised controlled trial during daily nursing sessions of 2 to 3 hours.
Three intensive care units in a French university hospital.
23 healthcare workers.
Handrubbing with alcohol based solution (n=12) or handwashing with antiseptic soap (n=11) when hand hygiene was indicated before and after patient care. Imprints taken of fingertips and palm of dominant hand before and after hand hygiene procedure. Bacterial counts quantified blindly.
Bacterial reduction of hand contamination.
With handrubbing the median percentage reduction in bacterial contamination was significantly higher than with handwashing (83% v 58%, P=0.012), with a median difference in the percentage reduction of 26% (95% confidence interval 8% to 44%). The median duration of hand hygiene was 30 seconds in each group.
During routine patient care handrubbing with an alcohol based solution is significantly more efficient in reducing hand contamination than handwashing with antiseptic soap.
EXCERPT During the past four decades, methicillin‐resistant Staphylococcus aureus (MRSA) has spread throughout the world and has become highly endemic in many geographic areas. Recent studies of methicillin‐sensitive S. aureus (MSSA) and MRSA isolates collected over many years and analyzed by multilocus sequence typing (MLST), staphylococcal cassette chromosome mec (SCCmec) typing, and use of a computerized algorithm based on related sequence types (BURST) have revealed that the evolution and spread of MRSA occurred because of the introduction of the mobile SCCmec element into several different clones of MSSA.1 Early MRSA strains appear to have developed from a MSSA strain (ST250‐MSSA) that was prevalent in European countries, including Denmark, in the 1950s.1,2 Of interest, this MSSA ancestor to early MRSA strains is no longer prevalent among disease‐associated isolates. More recent epidemic strains of MRSA (EMRSA‐2, ‐6, ‐7, ‐12, ‐13, and ‐14) that spread effectively in hospitals during the 1980s and 1990s are indistinguishable by MLST, suggesting that a relatively small number of MRSA clones have unique qualities that facilitate their transmission over wide geographic areas. For example, EMRSA clones ST8‐MRSA‐III and ST239‐MRSA‐III have been recovered from patients in Finland, France, Germany, the Netherlands, Sweden, the United Kingdom, and the United States.1 One can conclude from the above findings that the occurrence of epidemics or high levels of endemicity observed in a given geographic area can be explained, at least in part, by whether strains with epidemic potential are circulating in healthcare facilities.
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.
Patch testing with chemical irritants almost always produces a striking variability in the intensity of reaction between individuals, even amongst normal, healthy subjects. Whilst there have been many attempts to define factors which predispose to heightened or, conversely, to diminished reactivity, the underlying cellular mechanisms responsible for the variability remain poorly understood. In this review, a number of possible explanations are proposed, with a particular emphasis on those which relate to the influence of pre-existing disease or to the genetic regulation of certain immunological and inflammatory processes.
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.
Wet work is the main cause of occupational contact dermatitis in the cleaning industry. Dermatologists and occupational physicians need to base their primary and secondary prevention for workers in the cleaning industry on the characteristics of wet work exposures. We quantified the burden of wet work in professional office cleaning activities with a continuous standardized observation by trained observers of 41 office cleaners. Duration and frequency of wet work exposure and of different cleaning activities were assessed. Wet work made up 50% of such cleaning work. Within a typical 3-hr shift, a mean frequency of 68 episodes of wet work was observed, which classifies office cleaning as wet work. Skin exposure to irritants was markedly different among cleaners who did the same cleaning activities. Reduction in skin irritation can be achieved by training the workers. Because this group of workers, who have a low level of education, has a high risk of developing irritant hand dermatitis, a special effort on training and instruction should be made. A reduction of exposure can be achieved by: using gloves more often; using gloves for a shorter period of time; using gloves while doing activities that otherwise cause the skin to be in contact with water and cleaning substances and washing hands with water only, reserving soap for when the hands are visibly dirty.
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.