Bacterial Shedding and Desquamation from the Hands of Healthcare Workers Correlates with Skin Condition

BACKGROUND/OBJECTIVES: The outer layers of human skin are comprised of corneocytes which are constantly shed (desquamated) into the environment and replaced by fresh layers from underneath. Desquamated skin is laden with the same bacteria populating intact skin and has been documented to pose a significant risk of infection in the surgical setting. The risk of infection from bacteria shed from the hands is controlled in the surgical room through hand hygiene prior to surgery and the use of gloves. Little is known regarding the risk of infection transfer from bacteria shed from the hands in non-surgical settings. It is known that frequent handwashing often damages the skin of healthcare workers and can lead to colonization by pathogenic bacteria. The objectives of this study were to measure viable bacteria shed from the hands of healthcare workers (HCWʹs) in an acute care setting and determine whether levels of dispersed bacteria correlated with skin condition. METHODS: Data was collected from 3 units of an acute care hospital in Northeast, Ohio. Bacteria shed from the hands of the subjects were collected using a SAS Super 180 Microbial Air Sampler. Approximately 35 minutes after handwashing, HCWʹs were instructed to rub their hands in a wringing motion 15 cm above the sampler for 30 seconds while 100 L of air was collected. Airborne particles were collected onto RODAC plates containing trypticase soy agar and bacteria were quantified after incubating for 24 hours at 35°C. Skin hydration, transepidermal water loss and desquamation index were measured by standard methods. RESULTS: Bacterial dispersal and quantitative skin measurements were obtained from 86 HCWʹs over a 3 day period. The levels of bacteria shed from the hands of the HCWʹs was found to be negatively correlated to corneometer measurements (p < 0.01); and positively correlated to desquamation index (p < 0.02). No correlation was found between levels of shed bacteria and transepidermal water loss. As expected, corneometer measurements were found to be negatively correlated to desquamation index (p < 0.0001). CONCLUSIONS: The results of this hospital study demonstrate that the levels of bacteria shed from the hands of healthcare workers are influenced by the health of the individualʹs skin; i.e. dry skin sheds more bacteria. This increased bacterial dispersal from dry skin may increase the infection transfer risk for HCWʹs with poor skin condition in the acute care setting. All authors are employees of GOJO. All work was funded by GOJO. Our role in the Skin Care Science group is to understand end users skin condition and the performance / efficacy of our new products / technologies in order to help develop better products &/or position and thereby sell our hand hygiene products to professional markets like Healthcare.