Healthcare Workers and Compliance

Healthcare workers are exposed to a number of chemical irritants that can cause acute dermatitis and other skincare problems. The irritants in the institutional environment include everything from soaps and solvents to irritation from operating medical equipment. In fact, some of the best health and safety practices have unwanted consequences that can cause non-compliance with hand washing, which compounds hygiene problems. For example, too much hand washing and frequent glove use can cause adverse side effects like cracked and bleeding hands (McCormick, Buchanan & Maki, 2000). Exposure to solvents and cleansers can also cause cellular damage and remove the surface lipids from hands, causing cracking, bleeding, and sores (Nettis, Colanardi, Coccio, et al., 2002). Cracked and bleeding hands obviously open the healthcare worker to infections, and also allow that healthcare worker to spread infections in the workplace. Promoting skin care among healthcare workers is therefore critical evidence-based practice.

Protective gloves might help prevent some of the more severe skin problems linked with exposure to harsh chemicals but the gloves themselves can also be irritants that cause dry, cracked, and bleeding hands (McCormick, Buchanan & Maki, 2000; Nettis, Colanardi & Coccio, et al., 2002). Cracked and bleeding hands frequently lead to noncompliance with hand washing because the hand washing irritates the sore areas. Hand washing compliance remains critically low in the healthcare professions in spite of the fact that hand washing is "key to the prevention of hospital-acquired infection," (Naikoba & Hayward, 2001, p. 173). As hand washing compliance is already low in the healthcare professions, organizations and healthcare leaders need to prevent skin care problems from occurring, and encourage hand washing compliance in other ways.

In the healthcare setting, it is critical to prevent problems like cracking and bleeding to promote healthcare worker hygiene. One of the best solutions is a lotion or cream that is designed to be used on a regular preventative basis. McCormick, Buchman & Maki (2000) found that the majority of healthcare workers who used either a barrier cream or a lotion experienced improved hand condition and were washing their hands with 50% greater frequency after a four-week trial period. The lotion was preferred among most of the healthcare workers participating in the McCormick, Buchman & Maki (2000) study. This is probably due to the fact that moisturizers need to allow the skin to breathe, and some creams may be too heavy ("Skin Care," n.d.).

Therefore, offering a lotion in all hand washing areas is a simple step that organizations can take. I have personally worked in organizations that offer a medicated cream next to each sink. The cream needs to smell nice to encourage healthcare workers to use it. I would strongly suggest working with skin care companies to develop a highly effective cream or lotion that smells nice but that is strong enough to mitigate the specific problems associated with exposure to skin irritants. Products containing natural oils and silicones like dimethicone are recommended ("Skin Care," n.d.). Compliance with skin care and hygiene practices could improve if healthcare workers are offered higher quality and more effective products, and when those products are strategically placed throughout the institution to improve accessibility. For healthcare workers especially prone to skin irritations, lotions and creams could also be offered on a take-home basis to promote overall skin health and thus increase hand washing compliance.

When healthcare workers are experiencing barriers to compliance like the poor conditions of their hands, it may be essential to offer alternatives to soap such as alcohol-based hand sanitizers. Most institutions I have worked in do offer hand sanitizers but do not have any regulations requiring their use. Hand washing regularity is far more important overall, but hand sanitizer stations placed strategically throughout an institution do help remind the healthcare workers to use the product in case they have not washed their hands recently. Placing the hand sanitizer dispensers throughout the institution, in hallways and in rooms, helps to cut down on the spread of infections. While alcohol-based hand sanitizers certainly do not solve the problems with cracking and bleeding, they can decrease infection rates and need to be incorporated into institutional hygiene practices (Hilburn, Hammond, Fendler, et al., 2003). Skin care for healthcare workers can promote overall institutional hygiene and prevent the spread of infections.