Improved Skin Health in a One-Year Prospective Bioengineering Analysis of Healthcare Workers’ Hands in Long Term?Care

Abstract

BACKGROUND Compromised skin integrity is a known barrier to optimal hand hygiene (HH) practice and a contributing factor to decreased HH events amongst healthcare workers (HCWs). Because traditional sensorial assessments of skin health are subjective, skin evaluation an be difficult. Adding to the complexity, HCWs daily routines such as use of personal hygiene products, impacts in-use studies of skin responses that are typically conduced over short periods of time, days or weeks. Furthermore, while these results may conclude statistically, other variables such as seasonal changes, temperature and humidity variations, episodes of increased HH due to outbreaks during the year (i.e. norovirus), limits accuracy of the skin health evaluation and true skin status of HCWs hands. METHODS A prospective one-year tracking test protocol was designed to assess skin physiologic properties of thirty-six HCW's in a?skilled nursing facility every six to eight weeks between February of?2016 to January of 2017 in response to two test products: antimicrobial soap formulated with milder surfactants, conditioners and moisturizers and alcohol sanitizer that contained emollients and moisturizers. Due to work shift, turn-over, and medical absenteeism, 12 of the 36 HCW's participated in every skin bioengineering mea?surement. RESULTS Results indicated that skin barrier function by transepidermal water loss (TEWL) showed significant improvement compared to baseline and directional improvement for hydration. Data further revealed that seasonal changes reflect on skin hydration changes, warmer weather induced higher skin hydration levels than colder weather. Skin redness showed no sign of change both instrumentally and visually, while skin pH was directionally decreased and aligned with the TEWL trend, demonstrating improvement in skin health. CONCLUSIONS Soap and sanitizer formulation with moisturizers have accumulative benefits in maintaining skin health and should be considered when choosing products for HCW's to promote optimal HH practice. Compromised skin integrity is a known barrier to optimal hand hygiene (HH) practice and a contributing factor to decreased HH events amongst healthcare workers (HCWs). Because traditional sensorial assessments of skin health are subjective, skin evaluation an be difficult. Adding to the complexity, HCWs daily routines such as use of personal hygiene products, impacts in-use studies of skin responses that are typically conduced over short periods of time, days or weeks. Furthermore, while these results may conclude statistically, other variables such as seasonal changes, temperature and humidity variations, episodes of increased HH due to outbreaks during the year (i.e. norovirus), limits accuracy of the skin health evaluation and true skin status of HCWs hands. A prospective one-year tracking test protocol was designed to assess skin physiologic properties of thirty-six HCW's in a?skilled nursing facility every six to eight weeks between February of?2016 to January of 2017 in response to two test products: antimicrobial soap formulated with milder surfactants, conditioners and moisturizers and alcohol sanitizer that contained emollients and moisturizers. Due to work shift, turn-over, and medical absenteeism, 12 of the 36 HCW's participated in every skin bioengineering mea?surement. Results indicated that skin barrier function by transepidermal water loss (TEWL) showed significant improvement compared to baseline and directional improvement for hydration. Data further revealed that seasonal changes reflect on skin hydration changes, warmer weather induced higher skin hydration levels than colder weather. Skin redness showed no sign of change both instrumentally and visually, while skin pH was directionally decreased and aligned with the TEWL trend, demonstrating improvement in skin health. Soap and sanitizer formulation with moisturizers have accumulative benefits in maintaining skin health and should be considered when choosing products for HCW's to promote optimal HH practice.