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Health care workers may be suffering in silence from work-related dermatitis, much of it linked to frequent hand washing. Cases of work-related dermatitis are about 100 times greater than the rate reflected in federal data, and health care workers are at greater risk than most other occupations, according to an analysis of the National Health Interview Survey.(1)
Healthy People 2020 sets a goal of reducing occupational skin dermatitis by 10%. But that may be a particular challenge in health care because of frequent hand washing and donning and doffing of gloves, says Marty Visscher, PhD, director of the skin sciences program at the Cincinnati Children’s Hospital.
“If people comply with the hand hygiene guidelines, they’re going to have skin damage,” she says.
Some parts of the hospital and some occupations have a much higher risk. In the neonatal ICU, for example, Visscher sees employees with erythema on their knuckles, small fissures and cracks on the knuckles and even around the cuticles, and flaking on the palms. “They’ll say, ‘You should have been here last night. My hands were bleeding into the chart,’” she says.
Depending on the patient load, a nurse on a 12-hour shift may perform hand hygiene 70 to 200 times, says Visscher. If that includes frequent hand-washing with soap, the outer barrier of the skin is compromised, she says.
“Soap wears away some of the structural materials in the top layer of the skin,” she says. “That opens up channels for irritation… The number one reason people will give you for not doing hand hygiene is the irritation. It is a factor.”
Hand sanitizers are designed to enable repetitive hand hygiene without damaging the skin. But if the skin is already damaged, the alcohol-based rubs can cause additional irritation, says Visscher.
“When the skin is damaged enough, it has tiny cracks. When people use alcohol hand rubs, they get stinging and burning,” she says. “We can’t ignore health care workers when they’re saying this hand sanitizer stings.”
Visscher advises health care workers to have “proactive use of skin repair” – to put moisturizing cream on their hands frequently throughout the day. Lotion can be provided in break rooms and bathrooms, she says. “If they can carry a hand sanitizer in their pocket, they can carry a small tube of lotion in their pocket,” she says.
Lotions or creams should be free of petroleum-based products, such as petrolatum, or petroleum jelly, and mineral oil, because they can compromise the integrity of the gloves, Visscher says. As much as 80% of the lotions or creams typically used by health care workers contain petrolatum or mineral oil, she says.
In fact, glove use itself is irritating because of the friction of pulling them on and off and the potential for moisture to build up on the skin beneath the glove, she says.
--Michele Marill, Hospital Employee Health
1. Luckhaupt SE, Dahlhamer JM, Ward BW, et al. Prevalence of dermatitis in the working population, United States, 2010 National Health Interview Survey. Am J Ind Med 2012; epublication DOI: 10.1002/ajim.22080.