Though they are recognized as having increased compliance and adherence in routine hand hygiene, there are also reports of clinicians experiencing irritant dermatitis to these products as well. The Centers for Disease Control and Prevention (CDC) stated that it anticipates an increase in reports of irritant and even allergic contact dermatitis as more of these products are made available.iii

All surgical scrub solutions have been known to cause irritant dermatitis. The frequency of skin irritation is concentration-dependant. Products containing 4% chlorhexidine gluconate are most likely to cause dermatitis when used frequently for antiseptic hand washing.

Gloves may also be the source of an irritant reaction. Glove powder is a common cause of irritant reactions, especially in exam glove wearers. The simple practice of donning and removing gloves, especially if not properly sized, may cause friction across the dorsum of the hand (knuckles) and develop into a reddened irritant reaction.

It is common practice for clinicians to use over-the counter hand lotions and moisturizers in the clinical environment. From an infection-prevention standpoint, this is an unacceptable practice since these products may harbor and grow infectious microorganisms and are not approved for use in the health-care setting. Most of these products are highly fragranced, are not compatible with other hand hygiene products and can be the source of either an acute or chronic irritation.

A more delicate issue to address with clinicians is that related to age. It is well documented and has been profoundly recognized that the nursing population is aging. The majority of practicing nurses today are over 40 years old and the average age of an operating room nurse is 48.7 years old. This population is at greater risk for dry skin. Another recently recognized phenomena is that the younger populations, the 20- to 30-year-olds, are experiencing an increase in dermal reactions as well. The research and causality behind this is still evolving.

Sources/Cause		Issue		Solution
Alcohol-based products including gels, rinses, rubs and foams		Frequent use can cause drying of the skin		Use products with added emollients, humectants or other skin-conditioning agents
Surgical scrub solutions		Can cause irritant dermatitis (frequency of skin irritation is concentration-dependent)		Products containing 4% chlorhexidine gluconate are most likely to cause dermatitis when used frequently for antiseptic hand washing – avoid these if possible
Gloves, including glove powder, chemicals and accelerants used during manufacture and glove pH		Common sources of irritant reactions		Select gloves that conform to individual clinician needs
Glove donning/removal		Can cause friction across the dorsum of the hand (knuckles) resulting in a reddened irritant reaction, especially if not properly sized		Ensure correct glove sizing for clinicians, don and remove gloves carefully
Use of over-the-counter hand lotions and moisturizers		Because most products are highly fragranced, they are not compatible with other hand hygiene products and can be the source of either acute or chronic irritation		Discontinue use. Note: because these products may harbor and grow infectious microorganisms, they are unacceptable from an infection-prevention standpoint

References
i NIOSH and Project Nora.(1996).Latex Allergy News . 11(5),1084-1121.
ii Prevalence and Correlates of Skin Damage on the Hands of Nurses.(1997 September/October). Heart &Lung .(Vol.26, No.5), 404-412.
iii Boyce, J.M., Pittet, D.(2002).Guideline for Hand Hygiene in Health-Care Settings: Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand
Hygiene Task Force.Infection Control and Hospital Epidemiology. (Vol.23, No.12).
iv Larson, E., et al.(1998).Changes in bacterial flora associated with skin damage on hands of health-care personnel.Am J Infection Control. (Vol.26),513-521.
v Ibid.
vi Boyce, J.M., Pittet, D.(2002).Guideline for Hand Hygiene in Health-Care Settings: Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand
Hygiene Task Force.Infection Control and Hospital Epidemiology. (Vol.23,No.12).
vii Ibid.
viii Ibid.
ix Grove, G.L.,et al.(2001).Methods for Evaluating Changes in Skin Condition Due to the Effects of Antimicrobial Hand Cleansers: Two Studies Comparing a New Waterless Chlorhexidine Gluconate/Ethanol
Emollient Antiseptic Preparation with a Conventional Water-Applied Product.Am J Infection Control. (Vol.29,No.6),361-369.
x Menne,T. and Maibach, H.(2002).Hand Eczema (2nd ed.).CRC Press.Boca Raton,FL.
xi Ibid.