hand hygiene
By Paul Alper
Moisturizers: An Essential Component of Proper
Hand Hygiene and Skin Health
J
ust as important as proper cleaning and sanitizing of
hands is proper moisturizer use. We will address when
and why to use moisturizers as an essential element of
your overall hand hygiene and skin health strategy and
ultimately, part of your facility’s infection prevention and
control approach. For purposes of simplicity, we will use
the term “moisturizer” here to mean collectively lotions,
creams, moisturizers and other similar names.
The CDC states that to maintain skin health: 1
● ● “Lotions and creams [aka moisturizers] can prevent
and decrease skin dryness that happens from cleaning
your hands
● ● “Use only hand lotions approved by your healthcare
facility because they won’t interfere with hand
sanitizing products”
Why is overall skin health vital to a successful hand
hygiene program? Contact dermatitis is extremely common
among nurses, ranging in prevalence surveys from 25
percent to 55 percent. Actually, as many as 85 percent
relate a history of having skin problems. 2,3 High-frequency
hand hygiene, especially in today’s pandemic environment,
can lead to chronic contact dermatitis among healthcare
workers, no matter how mild the soaps and sanitizers
they use are.
Hand hygiene products, along with household detergents
and cleaners, can damage the skin by causing denaturation
of stratum corneum proteins, changes in intercellular lipids,
decreased corneocyte cohesion and decreased stratum
corneum water-binding capacity. 4
Among these, the main concern is the depletion of the
lipid barrier that may result from contact with lipid-emul-
sifying detergents and lipid-dissolving alcohols. 4 Frequent
handwashing can lead to depletion of surface lipids with
resulting deeper action of detergents into the superficial
skin layers. During dry seasons and in individuals whose
skin is typically dry, this lipid depletion occurs more quickly. 4
When the natural barrier of the skin breaks down drying
and even cracks in the skin can occur which may allow
bacteria an entry point and increases risk of infection.
Applying a moisturizer can prevent those effects along with
the itching, redness, flaking, and pain that can accompany
skin breakdown. It also helps to avoid chronic damage and
changes in the normal skin flora. 5
Using a moisturizer will help promote and maintain healthy
skin, reduce transepidermal water loss (TEWL), increase skin
hydration, and improve overall skin tolerance. Moisturizing
hands with the right product reduces microbial shedding
from the skin and will protect people from picking up viruses
and reduce the likelihood of transmission. 6
44
Selecting a product that is non-sensitizing, non-irritating,
and compatible with gloves, sanitizers and CHG based
products if they are used in the facility (for example for skin
decolonization) is essential. It should be an emollient rich
product that is free of alcohol, artificial fragrances, and dyes.
Staff should use only the moisturizers provided by the facility
to ensure glove and CHG compatibility. Personal products
should only be used after a shift ends and at home -- never
during the work day.
Healthcare workers should use a moisturizer:
● ● At the start of a shift after washing hands with soap
and water and drying them thoroughly
● ● After washing and drying hands throughout the day
to keep the skin well hydrated
● ● At the end of the shift, again after washing and
drying hands
There has been a dramatic increase in clinician hand
hygiene due to the COVID-19 pandemic. It is more important
than ever to protect the skin’s natural barrier. Cracks and
fissures can allow easy access to microorganisms. Clinicians
should be applying a moisturizer routinely during the day
after soap-and-water handwashing to protect from the risk of
infection, discomfort, and potentially chronic skin issues. 7
Paul Alper, BA, led the launch of PURELL®, invented the
first electronic hand hygiene monitoring system proven to
reduce infections while improving behavior and eliminating
costs and is now the VP Patient Safety Innovation for Medline
Industries, Inc. through an exclusive engagement with his
consulting practice, Next Level Strategies, LLC.
References:
1. https://www.cdc.gov/handhygiene/providers/index.html
2. Larson E, et al. Prevalence and correlates of skin damage on the hands
of nurses. Heart & Lung. 1997;26:404-412.
3. Lampel HP, et al. Prevalence of hand dermatitis in inpatient nurses at
a U.S. hospital. Dermatitis. 2007;18:140-142.
4. Skin Reactions Related to Hand Hygiene. WHO Guidelines on Hand
Hygiene in Health Care: First Global Patient Safety Challenge Clean Care Is
Safer Care., U.S. National Library of Medicine, Jan. 1,1970, www.ncbi.nlm.
nih.gov/books/NBK144008/.
5. Diamond F and Popescu S. Hand Hygiene and Infection Control: Skin
Care Supports Patient Care. Infection Control Today. May 19, 2008. www.
infectioncontroltoday.com/hand-hygiene/hand-hygiene-and-infection-control-
skin-care-supports-patient-care.
6. Gale R. Don’t Just Wash Your Hands to Prevent Coronavirus. Moisturize
Them, Too. The Washington Post. March 6, 2020, www.washingtonpost.
com/lifestyle/wellness/hand-washing-coronavirus-moisturizer-dry/2020/03/06/
ede43874-5fcb-11ea-b014-4fafa866bb81_story.html.
7. Gajanan M. COVID-19: How to Avoid Dry Skin After Washing Your
Hands. Time. March 11, 2020, time.com/5800275/covid-19-wash-hands-
dry-skin-tips/.
april 2020 • www.healthcarehygienemagazine.com