Effect of hand hygiene regimens on skin condition in health care workers

Intern J of Cosmetic Sci

Wickett

2012

Synopsis Reduction and prevention of health care‐associated infections is a worldwide priority with emphasis on increasing hand hygiene compliance. Repetitive exposure to hand hygiene products and procedures is a significant factor in the development of occupational irritant hand dermatitis. Compliance has been difficult to achieve often due to skin irritation. The introduction of alcohol hand rubs has positively influenced compliance but rates remain lower than required. Genetic and environmental factors to the frequency and severity of irritant contact dermatitis have been identified. Because of the skin's role in innate immunity, maintenance of epidermal integrity is a key strategy for reducing health care‐associated infections. In this review, we examine the interdependence of the two issues and the challenges of simultaneously accomplishing both goals. We emphasize research conducted among healthcare workers in their clinical settings. The factors that influence skin integrity and the challenges in meeting both goals simultaneously are explored. Cosmetic scientists have played key roles in the development of improved skin care products, and the issues present an excellent opportunity for them to provide potentially life‐saving contributions to health care.

Section: Healthcare Workers and Hand Hygienesupporting

confidence: 90%

Section: Healthcare Workers and Hand Hygienementioning

confidence: 96%

Section: Healthcare Workers and Hand Hygienementioning

confidence: 99%

See 1 more Smart Citation

Hand hygiene compliance and irritant dermatitis: a juxtaposition of healthcare issues

Intern J of Cosmetic Sci

Wickett

2012

“…In an earlier study, we found TEWL to be higher on the HCW dorsum than the forearm (21). The reduction in keratin 1, 10, 11 (dorsum) with hand hygiene is consistent with the negative relationship between keratin 1, 10, 11 levels and xerosis (24) and with chronic hyperproliferation in the mutant cpdm/cpdm mouse (15).…”

Section: Discussionmentioning

confidence: 72%

Stratum corneum cytokines, structural proteins, and transepidermal water loss: effect of hand hygiene

Skin Research and Technology

Said

Wickett

2010

Self Cite

This preliminary study showed significantly lower SC biomarker levels in HCW compared with controls and regional differences between the hand and forearm. Exposure to repetitive hand hygiene results in substantial chronic skin irritation without time for barrier recovery between work periods. The impact on SC structural proteins and cytokines has many commonalities with chronic inflammation, although mechanistic questions remain.

“…Larson et al reported a significant increase in severity of itching and burning after repetitive hand washing (laboratory) or hand hygiene (hospital) [49,50]. Our laboratory reported that HCWs with irritant contact dermatitis also experience sensory irritation as itching, stinging and burning [9]. Paye et al [51] found that subjects with self-perceived sensitive hands had significantly higher erythema, greater loss of inter-corneocyte cohesion after tape stripping and lower skin hydration and concluded that hand sensitivity could be confirmed through measurable skin changes.…”

Section: Discussionmentioning

confidence: 86%

Role of TNF‐α polymorphism ‐308 in neurosensory irritation

Davis

Intern J of Cosmetic Sci

Wickett³

et al. 2011

Neurosensory cutaneous discomfort in response to topical products is common, yet the relationship between symptoms such as stinging and visible irritation is currently unclear. The presence of a polymorphism at position -308 on the TNF-α gene has been associated with skin irritation, i.e., erythema, dryness. Individuals with a G to A transition (AA/GA genotypes) have a lower threshold to experimentally induced irritation than those with the wild type (G allele, GG genotype). We investigated the effect of this polymorphism on neurosensory irritation (NSI). DNA genotyping was used to determine the allele type amongst a population of health care workers. The neurosensory response to lactic acid and water on the nasolabial folds and hands was assessed using a quantitative lactic acid sting test. Both genotypes had a more intense response to lactic acid compared with water on the face. The AA/GA genotypes had directionally higher scores from lactic acid (P = 0.1) and significantly higher stinging intensities from water (P = 0.001) on the face. For the hands, stinging intensities were higher for lactic acid and water amongst the AA/GA genotypes (P = 0.03 and 0.006 respectively). NSI to lactic acid was significantly higher on the face than on the hands (P < 0.05). Our findings indicate that subjects with the A transition at position -308 on the TNF-α gene experience more intense NSI with common ingredients, i.e., lactic acid and water, than those with the wild type. TNF-α polymorphism -308 may account for some of the inter-individual variability in response to skin care practices.