Hand Hygiene Compliance Increases Healthcare Worker Dermatitis

A new study reveals that increased hand hygiene observance among health care workers (HCWs) has dramatically increased the incidence of irritant contact dermatitis (ICD).

Researchers at the University of Manchester (United Kingdom) conducted a quasi-experimental study to compare trends in incidence of ICD in HCWs that was attributed to hand hygiene, both before and after interventions to reduce healthcare-associated infections (HCAIs). The researchers studied reports voluntarily submitted by dermatologists to a UK national database between 1996 and 2012; they found that out of 7,138 cases of ICD reported, 1,796 were in HCWs.

When the researchers examined trends during the same periods in control groups, on a year-by-year basis, they found that HCWs were 4.5 times more likely to suffer from ICD in 2012 as in 1996. The increase was attributed to hand hygiene compliance measures initiated by the UK National Health Service (NHS; London) in 1999 to prevent HAIs such as C. difficile and methicillin-resistant Staphylococcus aureus (MRSA). The study was published on February 5, 2014, in the British Journal of Dermatology.

“Campaigns to reduce these infections have been very successful and many lives have been saved. However, we need to do all we can to prevent skin irritation among these frontline workers,” said lead author Jill Stocks, PhD, of the Institute of Population Health. “Obviously we don't want people to stop washing their hands, so more needs to be done to procure less irritating products and to implement practices to prevent and treat irritant contact dermatitis.”
Detergents, surfactants, extremes of pH, and organic solvents all have the common effect of directly affecting the barrier properties of the epidermis. These effects include removing fat emulsion and dermal lipids, inflicting cellular damage on the epithelium, and increasing trans-epidermal water loss by damaging the horny layer water-binding mechanisms and damaging DNA, which causes the layer to thin. Common chemical irritants implicated include solvents, latex, kerosene; sodium lauryl sulfate and other surfactants, and alkalies such as drain cleaners.

Related Links:
University of Manchester
UK National Health Service