Hand soaps and cleaning detergents rank second behind solvents in causing occupationally acquired dermatitis. Dermatitis is inflammation of the skin often characterized by reddening, cracking or scaling of the skin. Klauder attributed almost 25% of occupational dermatitis in a 20 year study to hand soap and cleaning detergents.
Soaps and detergents solubilize keratin and skin lipids, removing lipids and soil from the hands and changing the skin pH from acidic to alkaline. If the soap has abrasive agents, such as is found in mechanics hand soaps, it not only removes soils but also strips away the superficial layers of stratum corneum to which the soils have adhered. Dermatitis is caused by the removal of lipids from the skin (delipidization) and destruction of skin tissue cell walls. When it occurs, dermatitis is almost always caused by direct skin irritation, known as contact dermatitis, rather than a chemical allergy.
Allergic contact dermatitis from hand soap and cleaning detergents is relatively rare. Trace chemicals present in the detergent base or the perfumes used in the hand soaps are often the cause of allergic dermatitis. True contact allergy caused by the cleaning detergent base or hand soap almost never occurs. Mechanical friction, cutaneous trauma and the temperature of the wash solution all influence how irritating a cleaning detergent or hand soap is to the hands. Even if a cleaning detergent or hand soap does not cause inflammation following a single or a few exposures, repetitive low concentration exposures to the cleaning detergent or hand soap can cause increasing amounts of inflammation.
Excessively high concentrations of some cleaning detergents can cause inflammation, even with just one exposure. A “typical” person washing their hands three to four times per day seldom develops contact dermatitis. Workers washing their hands frequently, 10 to 20 times per day, may develop dermatitis through skin irritation. Once skin has become inflamed, it is even more susceptible to additional irritation. Irritant skin reactions can take up to 17 days before the skin is completely repaired.
With a high frequency (>25 times/day) of handwashing, an increase in bacterial counts on the hands of health care workers is likely to occur, due to dermatitic inflammation.
Repeated or excessive handwashing may cause excessive dryness, cracking and dermatitis. Bacterial counts on dermatitic skin cannot be reduced appreciably even with antiseptic hand soaps, because the bacteria get into the crevices of the skin and cannot be killed.
Effective hand washing programs strive to prevent this condition, as will be discussed later. Accumulated surveys report that irritant contact dermatitis caused by frequent handwashing occurs in between 10% and 45% of all health care workers. Damaged skin often harbors increased numbers of potential pathogens. As the hands become irritated, the skin develops cracks or fissures which allows microorganisms to penetrate the skin’s barrier and reproduce in larger numbers in these reservoirs. Washing damaged skin with either a plain or antiseptic soap is less effective in reducing the number of bacteria present than on healthy skin. The damaged skin no longer provides the protective barrier needed to control the growth of microorganisms and the soap cannot penetrate into all of the reservoirs to remove or kill the bacteria.
Personnel with dermatitis, which may be caused by frequent handwashing, may be a greater risk to patients than other personnel. Colonization by pathogenic organisms on dermatitic skin is common and handwashing will not appreciably reduce the bacteria counts. Efforts should be made to control dermatitis through the use of creams and lotions. However, if the creams and lotions are contaminated, they can also be the source of nosocomial outbreaks as has happened several times.
Food service workers should not use creams and lotions during their shifts to avoid the potential for contamination of food with the cream or lotion. If the dispenser of the cream or lotion is not equipped with a positive break, such as the Personal Hygiene System, the creams and lotions should only be applied while at home or during other nonworking hours. A positive break is a method of dispensing hand care products that prevents the accidental contamination of the dispenser, which in turn could contaminate the product 10 reservoir, by means of a gap through which discharged product falls before touching the employee’s hands.
Instances of product contamination have occurred which resulted in employees washing their hands and becoming contaminated with high levels of bacteria.