A primary strategy for reducing the transmission of infectious agents through contact and feces to mouth is good hand hygiene. The widespread use of antimicrobial products has raised concerns regarding the development of antiseptic resistance and the harm to the skin barrier caused by frequent washing.
This article examines the evidence regarding the connection between infection and skin hygiene, the effects of washing on skin integrity, and skin care practices.
Does washing your skin lower your infection risk?
Washing and bathing oneself:
Improved health is clearly correlated with an improvement in society’s general cleanliness over time. Greene found a connection between better health and personal hygiene by employing causal inference and historical and cross-cultural evidence. However, other factors (such as improved public services, waste disposal, water supply, commercial food handling, and nutrition) have all changed at the same time, making it difficult to measure the role that personal cleanliness has played in the control of infectious diseases over the past century.
Hand Hygiene for the Public at Large:
Industrialized nations provide the majority of current evidence for a causal link between Skin hygiene and infection risk in community settings. Even though confounding by other variables may have limited many of these studies, there is strong evidence that hand washing plays a significant role in infection prevention
Hand Hygiene in Medical Facilities:
Healthcare skin hygiene practices have been the subject of extensive discussion, and they may be even more complicated than those of the general public. Unless patient care involves invasive procedures or extensive contact with blood and body fluids, current guidelines recommend plain soap for handwashing; however, the use of antiseptic products may further reduce infection rates during surgery or in adult or neonatal intensive care units.
The properties of skin barriers and the effects of hand hygiene practices:
The average adult has about 1.75 m2 of skin. There are five layers to the epidermis, the skin’s outermost layer. The stratum corneum, the outermost layer, is made up of dead cells that have been flattened (coenocytes, also called squames) and are attached to each other to form a tough, horny layer of keratin and a few lipids.
Professionals in the health care industry’s hand microbiology:
The prevalence of pathogens in damaged skin is higher. Additionally, the number of organisms shed from damaged skin is frequently higher than from healthy skin, and washing damaged skin is less effective than washing normal skin at reducing the number of bacteria. Several recent studies have reported the microbial flora on nurses’ clean hands (samples taken right after handwashing).Tetracycline resistance decreased and methicillin resistance among coagulase-negative staphylococcal flora on hands did not appear to increase from the 1980s to the 1990s.
When Does Clean Enough?
Even when antiseptic preparations are used, which significantly lower the count of hand flora, no further than an equilibrium level is reached. After some time, the number of organisms spread by nurses who frequently washed their hands with an antimicrobial soap actually increased; Skin health is deteriorating as a result of this increase.
A recent survey found that nurses with damaged hands were twice as likely to be colonized by S. aureus, S. hominis, gram-negative bacteria, enterococci, and Candida species. And the hands were colonized by a greater number of species.
Recommendations for the Public at Large:
- The skin is cleaned by mechanically removing bacteria shed by corneocytes during a bath or shower. After using regular soap for a bath or shower, the number of bacteria is at least the same or higher than before. Although frequent bathing serves little microbiological purpose, it has aesthetic and stress-relieving benefits.
- A single recommendation for general hand hygiene practices would not be sufficient. The potential benefit of prolonged antimicrobial activity for certain occupations, such as child care providers and food handlers.
- Alcohol hand rinses, which are now widely available over-the-counter, can be used in place of detergent-based antiseptics. Their advantages include a lack of resistance potential, excellent microbicidal properties, and rapid and broad-spectrum activity.
- Antiseptic hand products should only be used by people who are in close physical contact with people who are at a high risk for infection, such as newborns, the elderly, or immunosuppressed, because hands are the primary mode of fecal-oral and respiratory transmission. Close physical contact with people who are infected;diarrhoea, upper respiratory infections, and skin infections caused by an organism that can be spread through direct contactor work in an environment where infectious disease transmission is likely (food preparation, crowded living quarters like prisons, child care centers, and preschools, and chronic care residences).
Guidelines for Healthcare Professionals:
Finnish researchers found that patient care workers’ hands became damaged and posed a greater risk to themselves and their patients when they were washed more frequently than when they were washed less frequently.
Use of Moisturizers and Lotions:
Regardless of whether a product contains an antibacterial ingredient, moisturizing is beneficial for skin health and reduces microbial dispersion. The effectiveness of lotions and creams varies greatly due to differences in their contents and formulations.
The following measures are recommended to improve the skin condition of healthcare professionals and decrease their likelihood of harboring and shedding skin microorganisms:
1) Dirt and debris can be removed from damaged skin with mild, non-antimicrobial skin cleansing products. A waterless, alcohol-based product may be used in situations where antimicrobial action is required, such as when handling patients who are highly susceptible or before invasive procedures.
2) Shorter, less abrasive washing regimens may be used in clinical areas like the operating room, neonatal and transplant units, as an alternative to lengthy scrub protocols with brushes or other harsh mechanical action.
3) Staff (and possibly patients as well) skin care regimens and procedures may include the application of barrier creams or effective skin emollients.
4) The compatibility of skin moisturizing products with any topical antimicrobial products and their physiologic effects on the skin should be carefully evaluated.
Conclusions:
From a public health perspective, using current hygiene practices more frequently might not always be better (for example, clean might sometimes be “too clean”), and the same advice cannot be used for all users or situations. The role of the skin in the transmission of infectious diseases and the interaction between skin physiology, microbiology, and ecology will likely be better understood in future research.