Comité SST

Dermatoses in the care settings: don’t wash your hands of it!

Dermatoses in the care settings [ 1 ]: don’t wash your hands of it!

Every year, a number of workers are compensated by the Commission de la santé et de la sécurité du travail (CSST) for dermatoses mainly caused by frequent hand washing and wearing gloves. These skin diseases, most of which are irritating contact dermatitis, affect the hands in more than 80% of cases. According to the statistics from the Commission, nearly a third of the recognized cases of dermatoses affecting the personnel in the care settings, cause them to be absent from work and above all to suffer a lot. What are the risk factors and how to prevent them?

Without a doubt, one of the main causes of dermatosis is frequent handwashing. Products, such as soap and rough paper used several times a day, dry out the hands and could lead to skin irritation. Since handwashing is the most important preventive measure to combat the transmission of infections, there is certainly no question of eliminating it from practices in the care setting. Nevertheless, the healthcare professionals face a double bind, that of applying this universal precaution measure to prevent the spread of infectious diseases, while trying to limit the number of times they wash their hands every day in order to avoid suffering from a dermatosis.

The care personnel must also deal with the paradoxical effect of handwashing. Although this measure is aimed at reducing the presence of bacteria, too high a frequency of handwashing results in the opposite, an increase in these microorganisms on the hands. This phenonomen can also be explained. The antibacterial qualities of the skin are associated with its normal acidity [ 2 ]. So, handwashing with ordinary soap does not only remove the microorganisms on the skin, but also the oil that it contains, thereby reducing its level of humidity and acidity, which by the same token, increases its pH and results in a loss of water. It can take up to a few hours after handwashing before the acid pH and the antibacterial properties return to normal.

Wearing gloves, particularly for extended periods, is the second risk factor for dermatosis. Gloves keep the humidity inside the glove, which leads to the maceration of the skin on the fingers and can eventually cause eczema. In addition, wearing gloves increases perspiration and dries out the skin because of the powder. Therefore, it is advised to completely dry the hands before putting on gloves and to remove any excess powder after having removed the gloves. The relevancy and necessity of using or not using gloves needs to be assessed. When they are recommended, it is important to choose the appropriate type of gloves (latex, vinyl or nitrile), because their resistance varies depending on the task to be performed.

The third risk factor is linked to the material used in making the gloves. Depending on the material used in making them, such as the sap from a rubber tree called natural latex [ 3 ], wearing gloves can cause reactions from skin irritation or urticaria to the development of an allergy or allergic contact dermatitis [ 4 ]. You have no doubt heard of latex allergies contracted at work by the healthcare professionals. This type of allergy has such major repercussions in human and financial terms that the institutions have decided to banish all products containing latex from their environment and to install a latex-free purchasing policy.

What are the solutions? The three levels of prevention of professional dermatosis are hydration, protection and early treatment. In 1994, they were presented as a triangular diagram by Dr. Louis-Philippe Durocher, a recognized dermatologist on the subject. Studies have shown that the use of hydrating creams or lotions act both in the prevention and treatment of skin dryness. To be effective, they need to be used regularly and frequently, at least four times a day, every day, including holidays and the weekends. The application of a hydrating product protects the hands from irritants, prevents fissures and preserves skin integrity, even with frequent handwashing. Moreover, it’s an excellent habit to have!

Thus, to avoid her flawless skin becoming like a toad’s skin, or that a dermatosis compromises her pursuing her career, the healthcare professional has no other choice than to face the constant challenge of maintaining a good hydration balance of her skin while protecting them from aggressors, to wash them without going overboard, to wear gloves when required and to take them off as soon as possible, and to have any sign of altered skin of the hands treated right away.

Lastly, the essential thing concerning dermatosis in the care setting is to never wash your hands of it!

Notes

Note 1 – The authors of this OHS editorial were mostly inspired by the articles in the “Les dermatoses au travail : prévenir pour ne pas y laisser sa peau!” file, written by Rose-Ange Proteau, consultant at the ASSTSAS, that appeared the Objectif Prévention magazine, Vol. 25, No 3.

Note 2 – The normal pH of the skin is about 5. The acidity or alkalinity of a solution is indicated by its pH. A solution with a pH=7 is said to be neutral. A solution with a pH<7 is said to be acidic and the lower the pH, the more acidic. A solution with a pH>7 is said to be alkaline. The higher the pH is, the more alkaline.

Note 3 – Some people are not allergic to natural latex itself, but to the chemical agents added to the natural or synthetic rubber in the glove manufacturing process.

Note 4 – Dermatitis is a dermatosis which results in an inflammation of the skin.

Do you know ?

Cream, lotion or moisturizing barrier cream: all of these products are effective for hydrating your skin and preventing dermatosis, providing you use them every day, even during your vacation. The important thing is the regularity. You can choose the moisturizing product that you prefer.

The aloe in many creams and lotions keeps the hands well moisturized.

As antiseptic soaps are more irritating for the skin than regular soaps, their use should be minimized. Alcohol gels contain emollient products that reduce the risk of drying out the skin.

When it is appropriate to do so, the use of alcohol gel is preferable in preventing dermatosis. In some situations when hands not visibly dirty need to be disinfected, like before entering the room of a patient, alcohol gel can replace soap and is also effective for controlling the transmission of infections.

Skin that is damaged or altered by a dematosis can absorb products or contaminants on its surface more quickly, which can spread to the systemic circulation and cause serious health problems.

The nurses specialized in prevention of infections can help you to identify the appropriate gloves for the tasks that you have to perform in the care setting. Don’t hesitate to consult them!!

According to the dermatologist, Louis-Philippe Durocher, the wearing of gloves on skin that is already damaged or with a dermatosis should be avoided, as this will aggravate the condition and prevent it from healing.