Skin Irritation and Dryness Associated With Two Hand-Hygiene Regimens: Soap-and-Water Hand Washing Versus Hand Antisepsis With an Alcoholic Hand Gel

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Abstract
Objective: To compare the frequency of skin irritation and dryness associated with using an alcoholic–hand-gel regimen for hand antisepsis versus using soap and water for hand washing.Design: Prospective randomized trial with crossover design. Irritation and dryness of nurses' hands were evaluated by self-assessment and by visual assessment by a study nurse. Epidermal water content of the dorsal surface of nurses' hands was estimated by measuring electrical capacitance of the skin.Setting: Miriam Hospital, a 200-bed university-affiliated teaching hospital.Participants: Thirty-two nurses working on three hospital wards participated in the trial, which lasted 6 weeks.Results: Self-assessment scores of skin irritation and dryness decreased slightly during the 2 weeks when nurses used the alcoholic–hand-gel regimen (mean baseline score, 2.72; mean final score, 2.0; P=.08) but increased substantially during the 2 weeks when nurses used soap and water (mean baseline score, 2.0; mean final score, 4.8; P<.0001). Visual assessment scores by the study nurse of skin irritation and dryness did not change significantly when the alcoholic–hand-gel regimen was used (mean baseline and final scores were both 0.55), but scores increased substantially when nurses used soap and water (baseline score, 0.59; mean final score, 1.21; P=.05). Epidermal water content of the dorsal surface of nurses' hands changed little when the alcoholic–hand-gel regimen was used (mean ± standard deviation baseline electrical capacitance reading, 24.8±6.8; mean final reading, 25.7±7.3), but decreased significantly (skin became dryer) with soap-and-water hand washing (mean baseline, 25.9±7.5; mean final reading, 20.5±5.4; P=.0003).Conclusions: Hand antisepsis with an alcoholic–hand-gel regimen was well tolerated and did not result in skin irritation and dryness of nurses' hands. In contrast, skin irritation and dryness increased significantly when nurses washed their hands with the unmedicated soap product available in the hospital. Newer alcoholic hand gels that are tolerated better than soap may be more acceptable to staff and may lead to improved hand-hygiene practices.