Dermatitis culprit: Water for hand washing too hot

Fixing one water problem led to another

When cases of dermatitis suddenly spiked at Gundersen Lutheran Medical Center in La Crosse, WI, puzzled infection control and employee health professionals began to investigate. The culprit, they discovered, was hot water. The problem began after the hospital resolved a seemingly unrelated concern. Legionella bacteria had been growing on rust surfaces in the hospital’s galvanized pipes.

"We tried to isolate those areas from patient areas, but still legionella would rear its head in cultures of the water system," explains Larry Lindesmith, MD, FACOEM, FCCP, medical director of employee health and safety. "We increased our water temperature to 140 [degrees], and to a great extent, we got rid of legionella."

Some time after that, infection control specialists surveyed nurses about their incidence of dermatitis. About 60% of them complained of the problem, says Marilyn Michels, MSN, CIC, CRRN, nurse epidemiologist in infection control. "We thought that was a bit excessive," says Michels. "We gathered a group of nurses together and asked them what they thought were some contributing causes. The water temperature was one issue."

The problem was especially acute in units in which nurses and other staff must perform frequent hand washing. "It’s the combination of the heat plus the trauma of scrubbing that irritates the skin and makes it more susceptible to developing irritative dermatitis," says Lindesmith.

The solution: Gundersen Lutheran replaced the older galvanized pipes and lowered the water temperature to 120 degrees. Cases of dermatitis went down. The hospitals also sent teaching carts into units to instruct on hand-washing technique to prevent dermatitis. Health care workers with symptoms of dermatitis were reminded to go to employee health.

Meanwhile, Lindesmith took other steps: The hospital switched from latex to vinyl exam gloves and reviewed its choice of soaps. Michels has not repeated the survey, but she says, "Nurses tell me their hands are a little better."

Lindesmith has a list of alternative soaps, including alcohol-based foam, for those who develop an irritation from the main product. "We’re constantly finding somebody who develops a contact dermatitis related to the soap we use," he says. "We always have to have an alternate system for some people."