Getting Under Your Skin
Why your epidermis is important to infection control
By Nancy Andrews, RDH, BS
What’s on the outside matters a great deal when it comes to infection control. Intact epidermis (outer skin) is a vital personal barrier against infection. Contaminated hands are considered the greatest factor in disease transmission. Injured, broken skin lets in pathogens, causing infections. Open wounds, broken skin and injuries expose people to deadly diseases such as hepatitis or MRSA (methicillin-resistant Staphylococcus aureus), and troublesome infections such as herpes, pink eye, mumps, measles, meningococcal infections or chicken pox. Human pathogens can remain viable on contaminated surfaces for hours, days, weeks or even months.
As such, effective hand hygiene is critical for reducing the risk of transmitting organisms to patients and healthcare workers. Your customers know this to an extent - they buy products that protect, preserve and heal skin every day. However, are your customers getting all the products they need to protect their skin? Are they using them correctly? The more you know, the more you can empower them, protect them and sell.
Customers’ most important skin challenges
Non-intact skin that may allow pathogens, irritants or allergens to enter their bodies. The risks are:
- Percutaneous injury at work with contaminated objects
- Existing cuts / openings in skin
- Dry, cracked skin
- Irritant contact dermatitis (non-allergic local skin reaction to physical or chemical irritant).
Allergies that affect skin
- Allergic contact dermatitis (type IV hypersensitivity) is usually a rash, confined to the area of contact, starting hours after exposure, caused by latex, glove accelerators and chemicals such as methacrylates and glutaraldehyde.
- Latex allergic reactions usually begin minutes after exposure, but varied symptoms may be delayed for hours. Symptoms are: itchy, burning rashes; watery, itchy eyes; runny noses and sneezing; hives; asthma; coughing; wheezing; difficulty breathing; and death.
- Conditions that increase risk: eczema, psoriasis, herpes, acne, diabetes, and colonization with a resistant organism such as MRSA.
Products that fail to protect and preserve skin
- Over-the-counter products may be too drying, lacking in emollients, and may have petroleum ingredients that compromise some gloves. Professional products are more likely to have the correct kind and amount of emollients and be most effective.
- Workers may choose harsher, irritating antimicrobial soaps to counteract their (too) fast handwashing routines.
- Gloves may be selected poorly, worn too long, damaged without detection, or used without proper hand hygiene. Workers must be aware of the limitations of gloves.
Lack of awareness of products available
Many customers do not know the difference between an FDA-approved professional skin-care product and the latest special at the supermarket. This is a great opportunity to help them.
Failure to get medical diagnosis of skin conditions Many conditions have similar symptoms. If workers don’t know what is wrong, finding the right products for them is a guessing game.
How reps can help
Reps should know the benefits of professional products compared to the disadvantages of domestic products and be readily available to explain the differences to customers. The following are tips to pass on to customers on how to keep their hands healthy:
- Protect skin inside and outside of dentistry - keep skin intact.
- Always rinse and dry hands thoroughly after handwashing. Soap residue is irritating.
- If alcohol hand sanitizers are used along with handwashing in a combined protocol (recommended by the CDC), use gentle, plain soap for handwashing.
- Avoid bare-handed contact with irritating, toxic, and sensitizing chemicals such as disinfectants, acrylic monomers and antimicrobials.
- Know which chemicals can permeate gloves, and avoid handling them, or change gloves if exposed. Bonding agents, acrylics, bases and liners and glutaraldehyde can penetrate patient treatment gloves.
- Hand creams and lotions prevent dryness and maintain skin integrity, and should be used as often as possible: during breaks, at lunch, and during off-hours. However, only non-petroleum (water-based) products should be used during work hours, to avoid degradation of some gloves.
- Use protective gloves outside dentistry to handle household chemicals such as cleaning agents, glues and solvents and for other activities that may damage hands, such as gardening, plumbing, or car repair.
- Moisturize skin daily to avoid dryness, especially in harsh weather and dry climates.
- Avoid latex exposure and replace latex products with non-latex products.
The bottom line
Intact skin is vital to personal safety. Breaks in the skin create a portal of entry for pathogens, irritants and allergens. All hand care products should be effective, be compatible with gloves, and protect skin. Every office should have a complete line of hand asepsis and care products designed for professional use.
Sidebar:
Interesting skin facts
- Skin is the body’s largest organ: two square meters of ecosystem.
- Skin is covered with a variety of bacteria, viruses, fungi and mites: usually in harmony, but not always.
- Most are "friendly," keeping skin balanced and healthy - so the goal of hand antisepsis is not to kill all skin organisms, but to control the transfer of pathogens to others.
- We have "resident organisms" that occupy (colonize) the deeper skin layers, are unique to individuals, and are difficult or impossible to remove.
- We also have "transient organisms" that are more superficial, easier to remove, and are responsible for most hand-contact disease transmission.
- The most diverse ecosystems of the body, with typically 300 different species, are found on the inner forearm, skin between fingers, and hidden areas such as the belly button. (The mouth has over 600 species.) Women have greater diversity in microbes on their hands than men, possibly due to differences in pH (men are more acidic), or oil, sweat, cosmetics and lotions, skin thickness or hormones.
- Skin organisms multiply rapidly under gloves, doubling their number every 12 minutes.
- Inflamed, irritated skin contains high numbers of microorganisms, and handwashing will not remove bacteria from irritated skin.
- Mucosal tissue: "pink skin" is more vulnerable than epidermis because it absorbs and secretes, providing an easy pathway for microbes to enter the body. Mucosal tissue is also easily injured (torn, stretched, scratched or punctured), so dental workers depend on eye and face coverings as barriers against exposure.
Sidebar 2:
Hand hygiene product key features
Products - All should be compatible with gloves and other products used, have a well-designed dispenser, have reliable vendor support, be cost effective and be petroleum free.
Soaps - Plain soaps: Gentle, good surfactant. Antimicrobial soaps: FDA-approved broad spectrum, fast acting, persistence, emollients, least irritating agents.
Waterless hand rubs - FDA approved for medical use: 60 - 95 percent ethanol (avoid isopropyl) for best effectiveness and skin protection. For surgery: added antimicrobial ingredient for persistence.
Lotions - Non-greasy, hypo-allergenic.
Creams/protectants - Non-greasy, hypo-allergenic.
Scrub brushes - Disposable or sterilizable with rounded bristles to avoid cutting skin.
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