Frequent Hand Washing May Increase Risk for Contact Dermatitis in Healthcare Workers

Martha Kerr

February 06, 2008

February 6, 2008 (San Antonio) — Frequent hand washing by healthcare workers may be counterproductive if performed too frequently, a study from University Hospitals Case Medical Center in Cleveland, Ohio, shows. The study was presented here this week at the American Academy of Dermatology 66th Annual Meeting.

Led by Eugene B. Kirkland, MD, professor of dermatology, the study involved 111 healthcare workers who washed their hands at least 8 times a day. Participants completed questionnaires about their medical and family histories, including allergies, asthma and eczema, frequency of hand washing, and use of hand sanitizers.

The investigators conducted patch testing in the participants, testing sensitivity to various concentrations of sodium lauryl sulfate, sodium hydroxide, and benzalkonium chloride. They assessed the healthcare workers monthly for 6 months.

Of the 111 healthcare workers, 58% developed hand dermatitis to soaps, but use of an alcohol-based cleanser was not associated with dermatitis. A total of 79% of healthcare workers used gloves and wore them approximately 3.45 hours a day. Use of gloves also was not associated with contact dermatitis.

Other variables not associated with contact dermatitis were asthma, allergic rhinitis, atopic dermatitis, family history of atopic dermatitis, psoriasis, and skin that was quick to sunburn.

The researchers found a suggestion that sensitivity to the detergents on patch testing may have been linked to a somewhat increased risk for contact dermatitis.

Overall, 3% of participants developed hand contact dermatitis. All of the severe cases occurred during between November and April, and 79% of the milder cases occurred during the winter months.

A similar study was presented by Kathleen Garvey, MD, and Virginia Hall, MD, dermatologists at the Mayo Clinic in Jacksonville, Florida. They presented findings on 43 physicians and 161 registered nurses practicing at 1 of the Mayo Clinic's 3 sites.

Participants in this study underwent patch testing to a wide array of substances. Among the most common sensitivities seen were those to diphenylguanidine, fragrances, thimerosal, cobalt, nickel, and gold.

"Results from our data suggest that the most frequent positive patch reactions were not occupationally related in these physicians and nurses," Dr. Garvey and Dr. Hall reported. "We conclude this due to the fact that the most common allergens causing a positive patch reaction are not typically encountered in the workplace (fragrance mix, cobalt, nickel, gold, and dermatophagoides).

"Thimerosal...could theoretically be occupationally related," the investigators said during their presentation. "[It is] used as an antiseptic and antifungal agent as well as a preservative in vaccines, immune globulin preparations, and ophthalmic and nasal products. However, it can also be found in numerous nonmedical products such as cosmetics (mascara, eye shadow, make-up remover, etc).

"Interestingly, the physician group had a fair number of positive patch reactions to diphenylguanidine and N-cyclohexylthiophthalmide whereas the nurse group did not," the researchers observed. "Both of these antigens could potentially be occupationally related to the use of rubber gloves."

The Mayo Clinic team's conclusions are somewhat at odds with those of Dr. Kirkland's team. "With patch testing, determining true clinical relevance is always a problem, not only clinically but with research data as well. True relevance is the largest limitation of our data," Dr. Garvey and Dr. Hall asserted.

Susan Nederost, MD, associate professor of dermatology at University Hospitals Case Medical Center in Cleveland and coinvestigator with Dr. Kirkland, told Medscape Dermatology that "it is important to sort out irritant from allergic dermatitis. That's why patch testing is important."

Dr. Nederost added, "Steps to take to minimize contact dermatitis are to avoid hand washing with soap and [to avoid] washing when feasible, use alcohol-based hand sanitizers more often and use cream-based lotions. Using cotton gloves under rubber occlusive gloves may be helpful for those tasks that are amenable to it."

None of the authors have disclosed any relevant financial relationships.

American Academy of Dermatology 66th Annual Meeting: Posters P700 and P709. Presented February 1, 2008.

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