Good Skin Health: The Hidden Factor in Hand Hygiene Compliance

By Lars Wulff-Nilsen and Peter Teska

Even if they appear clean, your hands can be a vehicle for spreading potentially deadly foodborne illnesses and healthcare-associated infections (HAIs). To reduce the transmission of pathogens, proper and regular hand care is key. Equally important is creating accountability around hand hygiene among employees. 

But are we focusing too much of the discussion on which pathogens are killed and in how many seconds?  Are these facts convincing employees to increase handwashing and the use of hand sanitizer at critical moments? Unfortunately, the current approach isn’t as effective as it could be. And without compliance, these disease-causing microorganisms remain on hands. Uncovering factors that increase compliance can help protect employees, building visitors and an organization’s brand.

Awareness doesn’t guarantee compliance. Compliance monitoring systems of various sophistications are being used with increasing frequency around the world, yet hand hygiene compliance levels are nowhere near where they should be. With hand hygiene awareness at an all-time high, why is it that workers do not wash their hands enough, at the right time and in the right way?

Too often, organizations focus on product efficacy and kill claims rather than the lives at stake and the importance of employee compliance.  While it’s essential for facilities to make effective hand care product available, if employees aren’t using the product when and where it is required, product selection doesn’t matter. But why is compliance low in many industries and organizations? 

The answer is skin health.

Skin health barriers
Skin health can greatly impact whether or not employees perform hand hygiene. There are several reasons why site managers, team leaders and infection preventionists should consider skin health when developing a hand hygiene program, including:

1. Cracked, dry, irritated and allergy-prone skin is a common reason that workers do not perform hand hygiene.
Some workers are concerned that handwashing agents will cause irritation and dryness. Others have existing skin issues such as dermatitis, and fear that it will worsen with frequent handwashing. However, skin irritation results in more than just discomfort. It can cause cracks in the skin on hands, and according to the Centers for Disease Control and Prevention (CDC), these cracks are believed to reduce the effectiveness of the skin as a protective barrier. Cracks on hands are also likely to contribute to higher numbers of bacteria on the hands. In fact, the World Health Organization (WHO) notes that damage to the skin changes skin flora, resulting in more frequent colonization by staphylococci and Gram-negative bacilli which are responsible for numerous diseases.

2. Lack of education and knowledge around correct procedure and precautions can lead to misuse and health issues.
Procedures and precautions that can protect skin health include:
• Rehydrating the skin at regular intervals. This helps to reduce the risk of skin shedding, which can cause additional irritation.
• Performing hand hygiene even when gloves are worn. The use of gloves does not replace the need for hand hygiene. Hands should be washed before putting gloves on and after they have been removed.
• Safety around chemicals and other potential irritants. The CDC estimates that more than 13 million workers in the U.S. are potentially exposed to chemicals that the skin can absorb. Detergents and other materials can denature the outer layers of skin, removing lipids. This ultimately reduces skin health, making it harder for the skin to function as a protective layer against pathogens.

3. Every person is unique, and every skin profile is different.
With so much differentiation from person to person, how can organizations expect uniform results? The answer is simple: use milder, certified products and conduct trials among staff.

When manufacturers develop hand care products, there are standardized tests that can be performed to determine the likely impact of frequent hand hygiene on the skin. The most common, the trans epidermal water loss test (TEWL), measures the rate at which water is removed from the skin, reducing the barrier function of the skin. Facilities should run trials before introducing new hand-care products to see what impact they have on hand health and to evaluate factors such as overall efficacy and acceptance by staff.

According to the WHO, certain environments, such as those with lower temperatures, low humidity or frequent changes in either, can increase the risk of dermatitis. It is therefore important to try to maintain consistent temperatures and humidity levels throughout the working environment to reduce the likelihood of occupational dermatitis.

Hand hygiene compliance is ultimately about personal choices and employee behavior. However, even when knowledge exists, action does not always occur. Encouraging proper hand hygiene should be a high priority for any organization. This begins with a discussion about skin health and how frequent hand care can improve hand hygiene. Hand hygiene is not just about killing germs. It is about protecting workers, guests, patients, students and society as a whole. It also about protecting an organization’s brand – and its bottom line.

Lars Wulff-Nilsen is the global marketing lead, personal care for Diversey Care; and Peter Teska is the infection prevention application expert for Diversey Care.