The impact of an ultra-mild foaming hand cleanser on skin health of healthcare workers: Can laboratory findings be validated in a clinical healthcare setting?

BACKGROUND/OBJECTIVES: It is recognized that poor handwashing compliance is a key factor in the spread of infections in the healthcare environment. High-frequency, repeated handwashing can damage skin thus leading to irritant contact dermatitis. This in turn can become a major barrier to proper healthcare worker (HCW) handwashing. The objective of this study was to assess skin performance, both in a hospital and in a controlled clinical setting, to determine whether a foaming handwash can prevent skin irritation. Secondary objectives were to assess the wash with a moisturizing alcohol hand sanitizer to determine whether a regimen could have an even greater impact on HCW skin condition. METHODS: Based on a standard, published method, a forearm controlled application wash test (FCAT) with multiple objective measures was conducted in a clinical lab to assess handwash irritation potential. A washout period to mimic the cleanser induced dry, irritated skin of HCWs was performed prior to test articles being applied a total of 26 times over 5 days. The mildest foaming handwash was then placed in three units of an acute care hospital in northeastern Ohio for 4 weeks during the onset of the cold winter season. Skin condition was subjectively evaluated before and after by the HCWs and visual grading. Skin hydration was evaluated by Corneometera and barrier function by transepidermal water loss and desquamation measures. RESULTS: Using a marketed foaming healthcare handwash as a benchmark, the clinical FCAT study identified one foaming handwash as being ultramild (p < 0.05) and at parity with a baby wash and rinse water alone. This product was then evaluated in the 4-week hospital study. The change between baseline and the final evaluation was better for the test group versus control for perception of skin condition (p < 0.11) and objective skin hydration (p < 0.08). A combined regimen of mild wash and moisturizing hand sanitizer provided even greater improvement (desquamation index versus control, p < 0.04; subjectively, p < 0.05; and skin hydration, p < 0.05). Another interesting qualitative finding was HCW hand hygiene interest increased noticeably for all units involved. CONCLUSIONS: The hospital field test validated the clinical lab testing by demonstrating the ability to improve healthcare worker skin health relative to a control group by washing with a well formulated, ultra-mild cleanser. Additionally, a combined regimen provided an even greater improvement.