Jerry Newman

Intermittent use of an antimicrobial hand gel for reducing soap-induced irritation of health care personnel

We evaluated the effects of an antimicrobial hand gel (containing 60% ethanol plus emollients) on skin condition when used as a supplement to handwashing. Volunteers washed their hands 10 times per day for 5 days with a bar soap. Between washings one hand was treated with 1.0 ml of the gel while the other hand was untreated. By the conclusion of the study the gel-treated hands exhibited significantly lower (p less than 0.05) photographic scores for cracking, scaling, and erythema (redness), the major symptoms of dry, irritated skin. The gel treatment also helped to maintain normal skin hydration levels as measured by transepidermal water loss and skin impedance. By reducing soap-induced irritation, an alcohol gel with the appropriate emollients can help eliminate a major deterrent to handwashing among health care personnel.

Inactivation of chlorhexidine gluconate on skin by incompatible alcohol hand sanitizing gels

Incompatibility of leave-on products with an antimicrobial residual can negate the efficacy benefits of chlorhexidine gluconate (CHG) persistence. Two marketed alcohol products containing Carbomer were tested using a pigskin substrate model against Staphylococcus aureus. The CHG residual achieved a 4.22 log(10) reduction (standard deviation [SD] = 0.32) in this study, which was dramatically reduced to a 0.54 (SD = 0.50) and 0.46 (SD = 0.56) after subsequent treatment with incompatible alcohol gel products. A marketed alcohol product containing a nonionic thickener maintained the efficacy of the CHG chemical reservoir (log(10) reduction = 4.26, SD = 0.00). Similar findings were demonstrated when alcohol solutions containing the individual thickening agents were tested as simple formulations. An in vivo test using human forearms and Serratia marcescens similarly demonstrated that the activity of a CHG reservoir (log(10) reduction = 3.73, SD = 0.86) was not reduced by a nonionic thickened product (log(10) reduction = 3.98, SD = 0.72) but was significantly reduced by treatment with alcohol products containing anionic thickeners carbomer (log(10) reduction = -0.32, SD = 0.34) or acrylates/C10-30 alkyl acrylate crosspolymer (log(10) reduction = -0.20, SD = 0.32). The use of anionic thickeners or emulsifiers in leave-on products, including alcohol hand sanitizers, may inactivate the persistent antibacterial activity of CHG.

Factors affecting skin condition in two nursing populations: implications for current handwashing protocols.

Two different nursing populations--one from Phoenix, Arizona, and the other from Racine, Wisconsin--and a group of persons prone to dry skin from Racine were evaluated for the presence of scaling, cracking, and erythema, the major visible symptoms of hands with dry, chapped skin. The results provide insight into the effects of age, season, geographic locale, handwashing frequency, and work area on skin condition. Season (winter), geographic locale (northern locale), and age (over 30 years) were the most significant extrinsic factors influencing the manifestation of hands with dry, chapped skin. In the presence of these predisposing factors, a handwashing frequency of only one to two times per hour was sufficient to significantly increase the severity of dry skin. Among nurses those most susceptible to dry skin were over 30 years of age, were high-frequency (more than three washings per hour) hand washers, and were exposed to the winter climate of a northern locale.