Hand Washing: How Much Is Too Much?

“Wash your hands!” your mom exhorted. And now you, as a safety professional, probably preach that to your workforce – you know that good hand hygiene is a fundamental of workplace safety. But where do you draw the line?

In the healthcare setting, frequent hand washing is essential to prevent the spread of potentially serious infections, such as staphylococcus and clostridium. And in other work environments, hand washing not only helps prevent the spread of infection, but also guards against irritation and inflammation from any number of commonly found workplace chemicals.

But, as the saying goes, you can have too much of a good thing.

Findings presented earlier this year at the annual meeting of the American Academy of Dermatology (AAD) showed a strong connection between frequent hand washing and contact dermatitis (also called hand dermatitis), a common skin condition marked by scaling, redness, itching, and burning due to a chemical substance on the skin. 

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Dermatologist Susan T. Nedorost, associate professor of dermatology at University Hospitals Case Medical Center in Cleveland, studied healthcare workers who washed their hands at least eight times daily.

The Rule of 10

Data from 60 subjects who completed the study showed that 63 percent of participants developed hand dermatitis. Specifically, 22 percent of participants who washed their hands more than 10 times per day developed hand dermatitis compared to only 13 percent of those who washed their hands fewer than 10 times daily.

The researchers determined that neither the use of an alcohol-based cleanser nor the use of gloves significantly influenced the development of hand dermatitis (however, see recommendations below).

“We demonstrated that some people are predisposed to skin reactions to irritant detergents, and those who do ‘wet’ work in low humidity conditions where frequent hand washing is an essential part of the job are very susceptible to hand dermatitis,” Nedorost told the AAD. “Our findings confirm that health care workers who wash their hands repeatedly are at an increased risk of developing hand dermatitis, which can take months to heal.

“This knowledge can help workers at risk for the condition to practice good hand care and follow preventative tips to decrease their risk factors on the job,” she said.

Genetic factors play a role

Some study participants had reactions to even low concentrations of detergent, indicating that they were at increased risk for hand dermatitis likely due to genetic factors, according to a report on the AAD website.

Nedorost also determined that the most important factor in predicting those at risk for hand dermatitis was a reaction to the detergent sodium lauryl sulfate (SLS). The large percentage of participants who reacted positively to SLS and developed hand dermatitis far outweighed the number of participants who did not react positively to SLS, but who later developed hand dermatitis.

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Because environmental factors such as humidity and the need for good hand hygiene at work are beyond workers’ control, prevention is the key to warding off hand dermatitis. Nedorost recommended the following tips to help prevent hand dermatitis:

  • Cotton gloves should be worn under rubber or vinyl gloves for wet work to prevent perspiration from dampening the skin. The cotton gloves should be changed frequently if wet work is prolonged.
  • When appropriate, alcohol-based hand cleansers should be substituted for hand washing. These cleansers are well tolerated, but may cause temporary stinging when in contact with cracks in the skin.
  • A cream or ointment-based emollient should be applied immediately after water exposure before the skin is completely dry. The goal is to prevent rapid drying and cracking, so applying the emollient after the skin is dry is not nearly as beneficial.

Although contact dermatitis patients often receive prescriptions for topical corticosteroids to treat their symptoms, Nedorost warned that chronic use of topical steroids may reduce the skin’s ability to tolerate irritants, thin the skin, and increase the risk of bruising and tearing.

In tomorrow’s Advisor, we’ll look at the larger topic of skin protection in general, and at a resource that explains your legal obligations as well as best practices for limiting occupational skin diseases.