Major article
A prospective multicenter study evaluating skin tolerance to standard hand hygiene techniques

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We performed a prospective multicenter study to assess the dryness and irritation of the hands in health care facilities, and to evaluate whether that disinfection with an alcohol-based hand rub (ABHR) is better tolerated than classic handwashing with mild soap and water. Our study was conducted in 9 sites in the summer and winter. A team of investigators evaluated dryness and irritation. This study takes into account most of the individual and environmental risk factors (age, sex, use of a protective agent, constitutional factors, personal factors, external factors, institution, function, and number of consecutive working days). The results from the 1932 assessments collected show that traditional handwashing is a risk factor for dryness and irritation, whereas the use of ABHR causes no skin deterioration and might have a protective effect, particularly in intensive use. These results provide a strong argument to counter the rear-guard resistance to the use of ABHRs.

Section snippets

Study population

This French prospective study was conducted in a large population in 9 health care facilities. Staff were surveyed and assessed during their day-to-day work in two distinct periods, winter and summer. The study was conducted in staff comprising about two-thirds health care workers (HCWs) (eg, nurses, medicotechnical staff, doctors, students) and one-third non-HCW personnel (eg, secretaries, biomedical services, administration, laundry, hostesses, dieticians). The variables collected for each

Population characteristics

The study yielded a total of 1932 observations collected in the participating institutions: 1175 (60.8%) evaluations for the winter investigation (mean temperature, 10.1°C; mean precipitation, 72 mm) and 757 (39.2%) evaluations for the summer investigation (mean temperature, 24.2°C; mean precipitation, 16 mm). The Cannes General Hospital collected 885 cases (46%), the Antoine Lacassagne Cancer Center in Nice collected 257 cases (13%), the University Hospital of Nice collected 252 cases (13%),

Discussion

This prospective multicenter study evaluated the cutaneous adverse reactions induced by hand hygiene techniques. To the best of our knowledge, no wide multicenter study taking into account most of the individual and environmental risk factors for skin conditions has proven the benefits of ABHR.5, 16, 17, 18, 19 In univariate analysis, the use of an ABHR appeared to cause less dryness and less irritation than soap. This trend in favor of ABHR was confirmed by multivariate analysis, which even

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    All of the authors belong to AzurCLIN and Riviera-CLIN, two networks devoted to combating nosocomial infections in the Alpes-Maritimes region of France.

    Conflicts of interests: None to report.

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