Healthy hands: Products provide relief for HCWs

Contact dermatitis remains a problem with gels

Alcohol-based hand gels have been an infection control success story. Health care workers are more likely to comply with hand hygiene and less likely to suffer from broken or raw skin from hand washing.

Yet the increased use of hand hygiene means a greater opportunity for skin irritation. For the minority of health care workers who still suffer from contact dermatitis, a number of products are available that provide relief.

The most obvious is simply moisturizer. "Alcohol, per se, is drying to the skin, but the new products have emollients in them," says Elaine Larson, PhD, RN, associate dean for research at Columbia University School of Nursing in New York City and a hand hygiene expert. "The new [Centers for Disease Control and Prevention] guideline [on hand hygiene] does recommend that health care facilities provide some kind of moisturizer."

Some hospitals provide a moisturizer alongside the gel, or purchase a gel that is combined with a lotion. But if the hospitalwide product isn't protective enough for some employees, they may need something stronger.

At the University of Washington Medical Center, nurse practitioner Barbara Dailey, MN, ARNP, discovered the Remedy products by Medline Industries in Mundelein, IL, (www.medline.com) which use olive oil and amino acids to provide nutrients to the skin. In a trial with other moisturizers, nurses raved about the healing properties.

The goal, Dailey says, is to renew the hands so "the skin's well moisturized and has the natural protectants on it."

But not every moisturizer is acceptable. If employees bring lotions from home, they may not be compatible with the gels or gloves used by the hospital and could harbor pathogens if they are in bottles that have been refilled, Dailey notes.

One other cautionary note: "Soaps that contain chlorhexidine are neutralized by most moisturizers," says Larson. That should be a consideration in choosing a moisturizer, she adds.

Protection from perspiration

Dig a little deeper into the cause of dermatitis and you'll find that some workers are not reacting to the gloves or gel but to perspiration on their hands under their gloves. "If you're sweating under your gloves, you have bacteria growing there," says Bruce E. Cunha, RN, MS, COHN-S, manager of employee health and safety at the Marshfield (WI) Clinic. The clinic is conducting a trial of GloveAid, a hand cream produced by Provectus Pharmaceuticals, of Knoxville, TN, (www.pvct.com/pureific.html) that contains an antiperspirant and an antibacterial agent.

Hand sealants, such as DermaMed, produced by Benchmark Medical of Salt Lake City, provide a barrier that protects the skin for about four hours, throughout regular hand hygiene. A study by Larson and colleagues found that a skin protectant did not cause more bacterial growth or adversely affect gloves.1 Sealants may help employees tolerate long-term glove use, says Larson.

Cotton glove liners also help some health care workers by keeping hands dry and acting as a barrier between the glove and hand. A new glove liner must be used each time the gloves are changed, notes Dailey. Medline also makes powder-free latex, vinyl, and nitrile gloves that are coated on the inside with aloe vera, providing a moisturizing effect.

Finding the right product may be a matter of trial and error, Cunha says. "We work hard to come up with an individual solution."

It's also important to talk to employees about how they treat their hands outside of work. "I tell our folks, 'Never put your hands in water without having gloves on. If you're washing dishes, make sure you're wearing gloves,'" says Dailey.

Some health care workers may suffer in silence with contact dermatitis, believing it's just part of the job, says Dailey.

"For every one who comes down to my office because their hands are hurting so badly, they say there are five or six on the floor just like them," she says. "I don't think we know the extent of the problem."

Reference

1. Larson E, Anderson JK, Baxendale L, et al. Effects of a protective foam on scrubbing and gloving. Am J Infect Control 1993; 21:297-301.