Hand care protocol

by Diane M. Sosovec, RN, MS, CNAA

Increased glove usage and associated behaviors may result in some individuals experiencing an increase in skin irritations or even contact dermatitis. By undertaking a consistent, effective hand care regime, health-care professionals will maintain the integrity of their skin and their first line of defense against bloodborne pathogens and other infectious material.

A hand care protocol should address the following:

  • Hand washing
  • Use of lotions/moisturizers
  • Appropriate glove usage

Hand Washing. The purpose of hand washing is to remove soil and transient microorganisms. After glove removal, hand washing rids the hands of powder and other debris. Wash hands thoroughly with an appropriate hand soap or antiseptic. Rinse hands thoroughly to remove residual soap. Dry hands appropriately with single-use towels or warm-air dryers.

Concerns

  • Frequent hand washing may dry skin.
  • Some hand soaps may contain harsh detergents.
  • Residual soap may become an irritant.
  • Aggressive use of paper or other single-use towels may be irritating.


Recommendations

  • Wash hands prior to donning and immediately after removing gloves.
  • Use a good-quality soap or antiseptic that is not harsh or caustic.
  • Thoroughly rinse hands.
  • Gently dry hands, pat dry or air dry.

Use of Lotions/Moisturizers. Hand lotions will prevent dry skin and reduce the risk of developing skin irritations and contact dermatitis. Frequent and consistent use of an appropriate lotion is an integral component of a hand care regime.

Concerns

  • Not all lotions are compatible with antiseptic products.
  • Hydrocarbon-based products are NOT compatible with latex gloves.
  • Products containing mineral oil, petroleum or lanolin should not be used when wearing latex gloves.

Recommendations

  • Frequently apply appropriate hand lotion.
  • Water-based lotions, such as Amino+Derm lotion, are preferred when wearing latex gloves.

Appropriate Glove Usage. Some individuals may be sensitive to either the chemicals used in the manufacturing of gloves or the protein allergen in natural rubber latex. These sensitivities may be manifested as irritations, contact dermatitis or allergic reactions defined as either Type IV or Type I hypersensitivity. Most skin reactions are irritations, and most irritations can be managed by improved hand care and appropriate gloving practices.

Dermal Reactions

Irritations (Non-Allergic)
Signs & Symptoms
: Acute: Redness, burning, itching, pain. Chronic: Dry, crusty, hard bumps, sores, fissures, cracks.
Signs and symptoms typically stop at the wrist where glove contact ceases.

Potential Causes:
Hand soaps, antiseptics, scrub solutions, glove chemicals. Glove powder, if not thoroughly washed off hands; Climate - cold, windy, or hot and arid; Emotional stress; Inappropriate hand care; Inappropriate glove usage.

Management:
Identify and remove causative agent. Allow hands to heal. Undertake a consistent hand care regime.

Recommendations: Do not assume that the glove is the causative agent. Consider changing hand soaps. If the glove is determined to be the irritant, do not conduct a trial with another brand or glove type until hands are completely healed. Glove liners may be beneficial. Use of water-based hand lotions is encouraged. With powder-related irritations, powder- free gloves may be considered. Synthetic gloves may be indicated since they do not contain the same chemicals as latex gloves.

Chemical Allergy - Type IV Hypersensitivity
Signs & Symptoms: Itching, drying, redness, crusting, thickening of skin, hard bumps, sores, papules, vesicles. Signs and symptoms may spread up the arm beyond the border of the glove.

Potential Causes or Predisposers: Glove chemicals: accelerators, preservatives, colorants, other additives. Poison ivy, poison oak. Soaps, detergents, disinfectants Individuals with chronic eczema Individuals who have other allergies.

Management: Identify and remove causative agent. Allow hands to heal. May seek intervention from a dermatologist or an allergist. Glove selection: Nitrile, synthetic or one that is designed to reduce concentrations of chemical accelerators.

NOTE: A chemical allergy, Type IV hypersensitivity will not progress systemically or to anaphylaxis.

Protein Allergy - Type I Hypersensitivity
Signs & Symptoms: Local: Moist, pink, raised hives, or urticaria, often blanched in center. Systemic: May produce swollen eyelids or face or respiratory distress; rarely progresses to anaphylaxis.

Potential Causes or Predisposers: Natural rubber latex protein allergen. Individuals who are atopic or have a history of allergy or clinical reactivity. Possible cross-reactivity to certain food allergies: avocado, banana, chestnut, kiwi and other fruits and vegetables.

Management: Identify and remove causative agent. Seek medical management from a physician. Glove selection: Synthetic or nitrile exam gloves; synthetic surgical gloves, such as neoprene or polyisoprene.

Recommendations: If you suspect that you may be sensitive to latex protein allergen, seek medical advice from your physician or employee/occupational health department. If you have been assessed as allergic to the protein allergen in latex and are currently wearing gloves labeled "hypoallergenic," take note. Most gloves in the market today labeled "hypoallergenic" DO CONTAIN natural rubber latex and are specifically formulated for chemical allergies, not latex allergies.

Hand Care Plan

Hand washing:

  • Routine hand washing should not exceed 15 seconds.
  • Hand washing for procedural aspects of patient care should not exceed 30 seconds.
  • Use tepid water
  • Use a mild hand soap or antimicrobial agent
  • Rinse hands thoroughly
  • Dry gently
  • Liberally apply a water-based lotion or moisturizer


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Note: Do not use over-the-counter hand care products in the clinical environment. Only products that have been evaluated and approved by the infection control department should be used.

Note: The information provided here is for general educational purposes and is not a substitute for specific medical advice by a physician. The information, programs and policies reviewed here are for illustrative purposes only. Each healthcare institution should tailor its policies, guidelines and approach to its unique circumstances, taking into account its facilities, employees and patient population.