Hand dermatitis is a common problem for healthcare professionals. In this issue, Dr Nurcan Özyazicioğlu and colleagues surveyed third- and fourth-year nursing students regarding hand dermatitis. The authors documented a 20.9% overall hand dermatitis incidence that was more common with increasing hours of clinical exposure. The most common symptom was itch, which can lead to scratching and rubbing the skin, further breaking down the cutaneous barrier to infectious disease spread. Factors contributing to hand dermatitis included more frequent exposure to water, repeated soap or alcohol hand rinse exposure, and sweating under gloves. Although interesting, these findings should not discourage health professionals from proper hand hygiene, regardless of their hours of clinical exposure.
Our hands are often the first part of the body to come in direct contact with our patients. In some cultures, we greet colleagues or other members of the healthcare team by shaking our hands. The recent outbreak of coronavirus (COVID-19) is another potent reminder to healthcare professionals about the importance of regular hand hygiene with soap and water or alcohol hand rinses.
Although information about this virus continues to emerge, the World Health Organization has an introductory training video available online that highlights the importance of handwashing in controlling the spread of this disease.1 Coronaviruses obtained their name from their circular structure with spike-like projections resembling a crown. The virus mutates in various animal species and with close contact can spill over into humans. This has now happened three times in the recent past, most notably with the severe acute respiratory syndrome coronavirus. COVID-19 often presents as a mild illness but can cause shortness of breath, pneumonia, and kidney failure in susceptible individuals. It is transmitted not only by droplets from coughing and sneezing but also from contaminated surfaces. The virus can live on many surfaces, such as banisters, door knobs, elevator buttons, and more. Healthcare workers are very susceptible to catching this infection, and the use of properly fitting masks/personal protective equipment and frequent handwashing are paramount for all healthcare professionals. For the latest updates on the virus, visit www.who.int/emergencies/diseases/novel-coronavirus-2019.
The CDC reminds us about several day-to-day activities that should involve washing our hands.2 In the work environment, handwashing should occur before and after each patient contact, especially when looking after wounds and changing diapers. In any environment, handwashing should be prioritized after using the toilet, blowing our nose, coughing and sneezing, or before preparing and eating food. Touching animals, contact with animal food or waste, or handling garbage should also trigger handwashing.
The CDC website recommends 5 steps for effective handwashing with water:2
- WET your hands, turn off the tap, and apply soap
- LATHER by rubbing your hands and fingers together with soap including between the fingers and under the nails
- SCRUB for at least 20 seconds
- RINSE under clean running water
- DRY using a clean towel
However, it is often time-saving and more convenient to use alcohol hand sanitizers. The CDC recommends gels that contain at least 60% alcohol.2 The product should be applied to the palm of one hand and then rubbed over the surface of both hands including fingers for approximately 20 seconds until the hands are dry. Alcohol hand rinses can decrease hand bacterial counts and the risk of spreading infection to our patients and colleagues. Keep in mind that alcohol hand rinses do not kill all organisms, and they are less effective if you have a lot of debris or particulate matter on your hands (including feces). After several alcohol hand rinses, a residual film may develop that should be removed with handwashing. Regardless of the method of hygiene, healthcare workers, especially those with atopy, are very susceptible to hand dermatitis and need to protect their hands by moisturizing regularly and adhering to topical and systemic treatment programs.3
Hand hygiene has taken on new urgency. Handwashing is a critical action that healthcare professionals and all persons must do every day and frequently.
R. Gary Sibbald, MD, DSc (Hons), MEd, BSc, FRCPC (Med Derm), FAAD, MAPWCA, JM
Elizabeth A. Ayello, PhD, MS, BSN, RN, CWON, ETN, MAPWCA, FAAN
1. World Health Organization. Coronavirus. 2020. www.youtube.com/watch?v=mOV1aBVYKGA&t
. Last accessed February 23, 2020.
2. Centers for Disease Control and Prevention. When and how to wash your hands. 2019. www.cdc.gov/handwashing/when-how-handwashing.html
. Last accessed February 23, 2020.
3. Maliyar K, Sibbald C, Pope E, Gary Sibbald R. Diagnosis and management of atopic dermatitis: a review. Adv Skin Wound Care 2018;31(12):538–50.