Happy hands: hand care for healthcare workers

Stories from the field

I have been carrying out infection control training over the last few weeks, which includes practical activities on hand hygiene. A standard question I ask the trainees is how often they moisturise their hands. I was surprised when several trainees, mostly the men, said they never use a hand lotion or moisturiser!

The NHMRC’s Australian Guidelines for the Prevention and Control of Infection in Healthcare (2019) states: “Appropriate use of hand lotion or moisturisers added to hand hygiene preparations is an important factor in maintaining skin integrity, encouraging adherence to hand hygiene practices, and assuring the health and safety of healthcare workers.”

Unfortunately, it seems that when we are teaching our healthcare workers about hand hygiene, we are clearly not including the importance of using hand lotions/moisturisers. This puts them at a higher risk of contact dermatitis and other skin issues!

What’s the damage?

According to Hand Hygiene Australia, “There are two common types of skin reactions associated with hand hygiene. Irritant contact dermatitis, which includes symptoms that can vary from mild to debilitating, including dryness, irritation, itching, and even cracking and bleeding. The other being allergic contact dermatitis, which is rare and represents an allergy to some ingredient in a hand hygiene product.”

The vast majority of hand hygiene–related skin problems among healthcare workers are irritant contact dermatitis. This is primarily caused by frequent, repeated use of hand hygiene products – especially soaps and other detergents – and paper towel use, which result in skin drying. Dry, cracked skin can also create risk of infection, and increase the risk of transmission to others. Don’t forget that your skin barrier is one crucial to safeguarding against infections. Cracked hands can be as much of an infection hazard as cuts or open sores.

Getting the right ABHR

Recent studies have suggested that the ongoing use of emollient-containing (i.e. moisturising) alcohol-based hand rubs. They can improve irritant contact dermatitis in approximately 70% of affected healthcare workers. Also, the use of an oil-containing lotion or barrier cream three times a shift can substantially protect against drying and chemical irritation, which can cause skin breakdown.

The short version? Make sure you moisturise!

Taking skin health into your own hands

To properly look after your hands, you need to be aware of factors that may led to dermatitis and dry skin. Hand Hygiene Australia have some great tips for improving your skin health, which include:

1. Minimising fragrances and preservatives in ABHRs. Commonly the cause of contact allergies, these should be kept to a minimum or eliminated when selecting an ABHR.
2. Washing hands frequently with soap and water immediately after or before using an ABHR. Not only is this unnecessary, but it can lead to dermatitis.
3. Not donning gloves while your hands are still wet from either handwashing or ABHR. This also increases the risk of skin irritation.
4. Using hot water for handwashing.
5. Failing to use supplementary/compatible hand moisturisers (more on this shortly).
6. The quality of the paper towel used to dry hands after hand washing.

So, to minimise the development of occupational hand dermatitis, we need to use multiple strategies. Hand Hygiene Australia suggest:

1. Using a hand hygiene product that contains skin emollient (i.e. a moisturiser).
2. Educating staff on the correct use of hand hygiene products.
3. Educating staff on caring for their hands, including regular use of skin moisturisers both at work. You should moisturise your hands 3 times during your shift), and at home.
4. Management providing a supportive attitude and ensuring staff have the correct products to perform effective and safe hand hygiene.
5. Providing a supportive attitude towards staff with skin problems.

It is also important to ensure that the selected ABHR, soaps and moisturising lotions are chemically compatible to minimise skin reactions amongst staff. Moisturising hand lotions/creams and hand hygiene products made by chemical companies are made to be used together.

How much is enough?

The question now is ‘How often should I use a hand lotion/moisturiser?’ To this I say, there is no hard and fast rule in any of the literature I have read. Once again, the NHMRC advises, “An emollient hand cream should be applied regularly, such as after performing hand hygiene before a break and before going off duty and when off duty.”

Hand Hygiene Australia state that “educating staff on caring for their hands, including the regular use of skin moisturisers both at work and at home-such moisturising skin-care products need to be compatible with alcohol-based hand rubs,” is an important part of risk minimisation.

Personally, I moisturise my hands after performing hand hygiene before I start work!

As healthcare workers our hands are essential to what we do every day, they are really one of our greatest assets, so don’t take them for granted. Encourage them to look after themselves, choose their hand hygiene products carefully and moisturise, moisturise, MOISTURISE!!!

Hand hygiene should be at the top of every facility’s list of priorities. As well as making sure your facility has happy hands, you should also make sure that their hand hygiene is doing its job. Bug Control’s hand hygiene training kits show your staff the areas that they’re missing during regular hand hygiene. Don’t have cracked hands for nothing! Make sure your hand hygiene is effective with our training kits.