Raw facts of hand hygiene

Due to continued high incidence and prevalence of skin problems among healthcare workers, a questionnaire-based investigation into the cause was conducted by the NHS. Responses concluded it was the increased use of alcohol-based sanitising rubs (ASRs) causing the skin problems and, as a result, proposals were made to introduce nonalcohol- based sanitising rubs to eliminate, or at least reduce, the problem. This approach raises two important questions. Firstly, is the problem really due to the increased use of ASRs or is this a perception, with the real causes of the problem lying elsewhere? Secondly, will the introduction of non-alcohol-based sanitising rubs resolve the problem, or could this actually result in an increased incidence and severity of skin problems?

Use of alcohol-based sanitising rubs

There is a considerable body of evidence that ASRs, if correctly buffered, do not cause damage to the skin.1-5 In a poster presentation at the American Academy of Dermatology 66th Annual Meeting, February 2008, Eugene Kirkland concluded: “The use of an alcohol-based cleanser was not associated with dermatitis.” Indeed, studies have shown that, correctly buffered, ASRs can actually improve skin condition. Figure 1 shows how the residual hydration of the stratum corneum was improved, indicating an improvement in skin condition, following the use of an ASR, whereas hand washing resulted in a deterioration in skin condition.6 Irritant contact dermatitis is almost always chronic and multi-factorial – i.e. the result of repeated exposures to many different irritant substances over a potentially extended period. Figure 2 illustrates the process, as first described by Malten in 1981.7 This states that every time the skin is exposed to an irritant some damage will occur