In research regarding the hand hygiene practices of healthcare workers—who have a professional need to frequently perform hand hygiene—the repeated use of alcohol-based hand rubs (ABHRs) or hand sanitizers was shown to cause less skin irritation and dryness than frequent washing with soap and water.1-2 In fact, concerns surrounding ABHRs and skin damage have been repeatedly disproven through an overwhelming amount of scientific data.
Proper hand hygiene in healthcare setting is an important tool in preventing the transmission and acquisition of healthcare-associated infections (HAI), and compliance at critical moments during patient care makes mildness as important as antimicrobial efficacy.1-2 Due to their skin tolerability, antimicrobial efficacy, availability/placement and time-savings, ABHRs are the best hand hygiene solution for these high frequency settings.
As Many as Sixty Hand Hygiene Opportunities an Hour
Washing with soap and water was the standard hand hygiene practice until the Centers for Disease Control and Prevention (CDC) revised the guidelines for hand hygiene in healthcare settings. The updated guidelines, published in 2002 and still current today, recommend ABHRs for routine decontamination when hands aren’t soiled and handwashing when hands are visibly dirty or contaminated. If soap and water is not available, the use of an alcohol-based hand sanitizer that contains at least 60% alcohol is recommended.
Studies have estimated that healthcare workers encounter between about seven and 60 hand hygiene opportunities per hour, so it’s not surprising that 69 percent of healthcare workers surveyed experienced skin irritation lasting more than three weeks, or skin irritation incidents more than once a year. 3-6
Despite the evidence of the damaging nature of handwashing, and education regarding the benefits of ABHRs, healthcare workers remain concerned about the effects of ABHRs on skin condition and health. In fact, a study including over 1,800 nurses found that 69.5% believed ABHRs to be more damaging than handwashing, compared to 30.5% who believed handwashing to be the more damaging practice.7
Handwashes, which are mixtures of detergents, surfactants, and antiseptic agents, require elements of friction, lathering, water rinsing and towel drying, all of which can have considerable effects on the skin’s epidermal barrier. One study reported significant skin damage occurring due to soap use within the five-day survey period (24 handwashes/day), including damage to the outer membrane of skin—the stratum corneum—and negative changes in self-assessed skin condition.8
No Increased Risk
Numerous studies have directly compared the effects of handwashing vs. sanitizing with ABHRs. The most noteworthy, published by Boyce et al., was a randomized trial that compared the frequency of skin damage associated with hand washing and ABHRs.9 Skin irritation and dryness, as self-reported by participants and by a study nurse and objective measurements, increased significantly when nurses washed their hands with soap and water. Alternatively, hand antisepsis with an AHBR was well tolerated and not associated with increased skin irritation or dryness.
In conclusion, healthcare workers should follow the CDC guidelines and use ABHRs as the primary means for hand hygiene, and can do so without an elevated risk of skin irritation or dryness. A white paper was created based on this topic and is available at Infection Control Today.10