Major Article
Skin reactions related to hand hygiene and selection of hand hygiene products

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Background

In October 2004, The World Health Organization (WHO) launched the World Alliance for Patient Safety. Within the alliance, the first priority of the Global Patient Safety Challenge is to reduce health care-associated infection. A key action within the challenge is to promote hand hygiene in health care globally as well as at the country level through the campaign “Clean Care is Safer Care.” As a result, the WHO is developing Guidelines on Hand Hygiene in Health Care, designed to be applicable throughout the world.

Methods

This paper summarizes one component of the global WHO guidelines related to the impact of hand hygiene on the skin of health care personnel, including a discussion of types of skin reactions associated with hand hygiene, methods to reduce adverse reactions, and factors to consider when selecting hand hygiene products.

Results

Health care professionals have a higher prevalence of skin irritation than seen in the general population because of the necessity for frequent hand hygiene during patient care.

Conclusion

Ways to minimize adverse effects of hand hygiene include selecting less irritating products, using skin moisturizers, and modifying certain hand hygiene practices such as unnecessary washing. Institutions need to consider several factors when selecting hand hygiene products: dermal tolerance and aesthetic preferences of users as well as practical considerations such as convenience, storage, and costs.

Section snippets

Skin reactions related to hand hygiene

There are 2 major types of skin reactions associated with hand hygiene. The first and most common is irritant contact dermatitis with symptoms that include dryness, irritation, itching, cracking, and bleeding. The second, allergic contact dermatitis, is rare and results from an allergy to an ingredient in the hand hygiene product. Symptoms of allergic contact dermatitis can be mild and localized or severe and generalized. In the most serious form, there may be respiratory distress and other

Methods to reduce adverse effects of agents

There are 3 primary strategies for minimizing hand hygiene-related irritant contact dermatitis among health care personnel: selection of less irritating hand hygiene products; education regarding proper skin care management, and routine use of moisturizing skin care products.

Factors to consider when selecting hand hygiene products

The selection of hand hygiene agents requires a multidisciplinary team effort (eg, infection control professionals, both clinical and administrative staff, pharmacists, behavioral scientists) to evaluate factors related to handcleansing agents and to conduct clinical pilot projects to test these factors.20, 54, 76, 77, 78, 79 Therefore, pilot studies to help select products at the local level should mainly address user acceptability issues. Other aspects such as tolerance, availability,

Summary and recommendations

Because of the necessity for frequent hand hygiene during patient care, health care professionals have a higher prevalence of skin irritation than seen in the general population. Damaged, irritated skin is undesirable, not only because it causes discomfort and even lost workdays for the professional but also because hands with damaged skin may in fact increase the risk of transmission of infections to patients. Ways to minimize the possible adverse effects of hand hygiene include selecting less

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    On behalf of the World Health Organization Global Patient Safety Challenge (Lead, Professor D. Pittet, World Alliance for Patient Safety, WHO Headquarters, Geneva, Switzerland).

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    Copyright © 2006 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.