There are three main types of hand dermatitis in the healthcare setting; irritant, allergic non-latex, and latex allergy. The symptoms are dry, red hands with cracks and fissures when the dryness is severe. Rash, either hives or red streaks or papules may be present, particularly if the rash is allergic in nature.
Frequent use of moisturizers is essential to avoiding dermatitis or healing rough hands. Moisturizers must be used in approved containers to avoid contamination. Containers must be 16 oz or less and either a pump container or single person containers must be used.
When hands are affected with dermatitis, compliance with hand washing regulations can be decreased due to avoidance of exposure to the irritants causing the problem. Hand dermatitis affects the integrity of the skin as a barrier to bodily fluids and pathogens. Inflamed hands can be colonized with more bacteria and be a potential source of pathogens. The compromise of the skin barrier in addition to the increased bacteria can result in occupationally acquired infections and the possible spread of infection to other coworkers or patients.
Water is the primary cause of dermatitis. The constant wetting and drying removes protective substances from the skin making it less pliable and more prone to cracks and fissures. When soap/cleansing agents are added, these agents act as secondary irritants, resulting in a change in the pH of the skin and removal of protective lipids from the skin.
Most moisturizers manufactured and distributed through medical supply companies for healthcare settings are latex glove and CHG compatible. Healthcare facilities may supply these moisturizers for their employees. Some facilities have policies in place to prevent the use of personal moisturizer products in the workplace. If employees are allowed to bring their own supply of moisturizer to work they should: use a product that is water-based, use a pump bottle, flip-top capped container or squeeze tube to prevent contamination of the product, and not share moisturizers with coworkers to decrease the possibility of contamination of the product.
The prevention of hand dermatitis is a matter of replacing the moisture lost from the skin due to constant exposure to water and soothing the irritant effect of soap/cleansing agents. Follow hand washing guidelines to use warm water, the least harsh soap for routine hand washing and dry hands thoroughly after washing. If possible, use alcohol emollient gels when hands are not soiled: Use water-based moisturizers after washing hands, use a heavier, oil-based moisturizer under cotton gloves at home or away from work to help heal severely dry skin.
If the skin on the hands is red, inflamed or severely cracked, despite using moisturizers, medical attention should be sought to clear the skin. This may require the use of topical steroids, soaks, antibiotics (if there is evidence of infection) or removal from the job environment on a temporary basis. The longer hand dermatitis is present, the more difficult it is to treat and the more chronic it may become. Health care personnel with active hand dermatitis, regardless of cause, can develop secondary irritation and aggravation of dermatitis by wearing gloves. The use of latex gloves should be minimized to reduce the risk of sensitization and potentially life-threatening allergic reactions.
It is less common that occupational hand dermatitis is caused by an allergy instead of irritation from water and soap. • If hand dermatitis is persistent a person may need to be checked by a dermatologist or allergist for an allergic component to their rash. Employee health services can do a latex risk assessment, which is a screening questionnaire for latex sensitivity risk factors. If the assessment is positive, a referral to a specialist to confirm the diagnosis may be needed. Some allergies may be due to contact with rubber additives, latex proteins, antibacterial agents in hand washing products, and/or preservatives or fragrances in moisturizers, etc. A history of eczema in childhood has been shown to increase one’s susceptibility to hand dermatitis from chronic exposure to water and cleansing agents.
Frequent hand washing is a mandatory requirement in health care settings to prevent the spread of infection from organisms on the hands. The continual use of water and soap can potentially result in hand dermatitis. Protection from this problem requires the maintenance of the natural skin barrier. To prevent hand dermatitis: Wash with warm, not hot water, use the least harsh soap or lowest concentration of antibacterial soaps, use alcohol sanitizing emulsion gels if feasible, use water-based moisturizers liberally, use non-latex gloves, and protect and treat the hands when away from the work environment. Also, use a moisturizer such as dermaglove® HAND RECOVERY to replenish the skin while also fighting germs.