Hand Hygiene

Hand Care Protocols/What's Out There The products that HCWs may encounter in the hospital are many. For ease of discussion they are split into two categories: skin care products and hand hygiene products. Hand Hygiene Products Any product that is used in handwashing: Antiseptic handwash Antiseptic hand rub Surgical hand antisepsis products Skin Care Products Provide for the hydration and improved water retention of skin Hand Hygiene Products Handwashing products used by HCWs are regulated by the FDA and are outlined in the Tentative Final Monograph for Healthcare Antiseptic Drug Products (TFM). There are specific test protocols, procedures and log reductions that must be achieved for the products to be available in the marketplace. This is also true of surgical hand antisepsis products. The following are some of the preparations used for hand hygiene: Plain (non-antimicrobial) soap Alcohols – isopropanol, ethanol, n-propanol, or combination of any to the two N-propanol – is not listed in the TFM for products in USA Chlorhexidine Chloroxylenol – parachlorometaxylenol (PCMX) Hexachlorophene – since 1972, the FDA has warned against use of this in routine bathing of infants Iodines and iodophors Quaternary ammonium compounds Triclosan Other – (efficacy of these have not been established) Hypochlorite hand rinse Products with different concentrations of previously listed agents Skin Care Products One has only to look in any grocery store to see the number of products available for improving the skin. These products do not necessarily work well in the healthcare facility, but they do find their way through the door. The products that should be provided by the healthcare facility should meet the needs of HCWs to help minimize irritant contact dermatitis that may be associated with their hand hygiene practices. Additionally, skin care products in the healthcare environment must not negate the effects of antimicrobial soaps and rubs used in the facility. Some of the following ingredients can be found on the labels of skin care products: glycerin/glycerol/glycerine, citric acid, sorbitol, gluconolactone, chitosan, panthenol and others. Glycerin is noted as being one of the best moisturizers. It hydrates the dermis due to its water-retaining abilities. Citric acid is a pH adjuster that balances acidity and alkalinity. Sorbitol is also used as a moisturizer. Gluconolactone helps to minimize skin flaking. Chitosan helps to retain moisture, and panthenol is a vitamin with moisturizing effects. A review of products containing aloe vera does not list it as a significant cosmetic ingredient or moisturizer. The research is limited to stories and studies that may not hold up to close scrutiny. Skin care ingredient Ingredient proven to moisturize? Glycerin/glycerol/glycerine Yes Citric acid No Sorbitol Yes Gluconolactone Yes Chitosan Yes Panthenol Yes Aloe No Barrier protection materials with enhanced skin care properties The newest innovations for HCWs have come in the form of protective hand-healthy coatings applied to the inside of surgical and exam gloves used in the healthcare setting. These coatings offer a means to help keep skin moist and intact. Not all skin care product ingredients translate into formulations that can be used by a glove manufacturer as a hand-friendly coating. Some of the products are volatile liquids that evaporate quickly from the skin or may crystallize on the skin once any water evaporates. (Bissett) A number of additives may work well for skin that is not covered with a glove barrier but in the closed glove system could be potentially irritating. Glycerin, on the other hand, a product found in numerous skin care lotions, has made the transition into a coating for gloves in healthcare. Glycerin is a proven moisturizer. The other ingredients listed may be used in combination with glycerin to assist in the overall goal of moisturizing the hand. Aloe has come under scrutiny, as the research does not show that aloe can actually be identified on the finished product. Due to the high temperature in the vulcanizing ovens and other manufacturing No processes, such as washing and leaching that can expose the glove to high temperatures, the aloe may be ineffective. There is a “Dry Skin Model” (Dermatology Foundation) that describes the path to dry skin and further describes that if there are interventions along this path then this cycle can be broken. Prudent use of proper skin care products and gloves enhanced with skin care ingredients may be of significant help, especially to those HCWs who have skin prone to drying.

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