INTRODUCTION

Coronavirus disease 2019 (COVID-19) has increased the frequency of hand washing. There is scarce evidence regarding the impact of different hand hygiene procedures on skin barrier function in clinical practice.

For the required proper hand hygiene procedures, currently there are several hand hygiene products available, such as soaps, alcohol-based hand sanitizers (ABHS), and disinfectant wipes. ABHS reduce skin pathogens more efficiently and, therefore, frequent application of ABHS containing at least 60% alcohol or, if unavailable, hand washing with a soap and water for at least 30 seconds is recommended. Nevertheless, a frequent use of these products may induce dry hands and skin damage, resulting in irritant or allergic contact dermatitis.  Moreover, injured skin is a potential host for SARS-CoV-2.

This study evaluated the impact of different hand hygiene procedures on the skin of the hands after a shift of 8 hours in Healthcare Workers (HCWs).  In this study authors noticed that already after a single working day there were important differences between the three procedures of hand sanitation in almost all the parameters study evaluated (TEWL, CFU, and tolerability rates).

TAKE-HOME MESSAGE

Healthcare workers were randomized to hand washing with water and soap, applying alcohol-based hand sanitizer (ABHS), or using a disinfectant wipe to evaluate the effects of hand hygiene practices on the skin barrier.

Trans-epidermal water loss (TEWL) was greatest with the use of the disinfectant wipe and, interestingly, was reduced with the use of ABHS. Reduction of bacteria colony-forming unit (CFU) counts was greatest with the use of ABHS.

ABHS shows the least impairment in the skin barrier and most reduction in CFUs when used in the healthcare setting.

WHO guidelines on hand hygiene in healthcare recommend using ABHS instead of water and soap if hands are not visibly dirty.

CONCLUSION

According to study findings, daily hand hygiene with ABHS showed the lowest rates of skin barrier impairment, the highest rates of CFU reduction, and was considered the most convenient and easy method to use.

Disinfectant wipes showed the highest TEWL increase. Water and soap also led to increased TEWL values, similar to disinfectant wipes. ABHS showed the best results, as it was the only hand hygiene procedure that did not increase TEWL values, likely in relation to lower skin barrier impairment.

Regarding the antimicrobial power, water and soap showed the lowest reduction in bacterial and fungi CFU counts. ABHS and disinfect wipes had similar CFU reduction rates and both higher than water and soap. ABHSs kill microorganism by penetrating though their membrane and inducing cellular lysis, while soaps only remove debris from the skin. Therefore, ABHS and disinfectant wipes may be more effective in reducing live bacteria and fungi that are able to form colonies in culture (reduced CFU) than water and soap, as shown in our study.

Viruses are more difficult to study in vivo and there are scarce studies that compare the viral load reduction with different types of hand hygiene products. In vitro, both soaps and ABHS are effective in inactivating enveloped virus. ABHS also have a high activity against non-enveloped viruses. Regarding disinfectant wipes, previously it has been observed that they are noninferior to water and soap but less effective than ABHS in reducing bacteria from the hands.

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