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Letters to the editor re: hand gel and skin care

Dear Editor

I am writing in relation to the Nursing Review edition dated Feb/Mar 2015. On page 19 you had an article on basic skin care tips. Under hand care, in the first bullet, there was an advice to try and avoid using alcohol hand gel as it dries out your skin. If possible use soap and water instead.

The national hand hygiene programme (Hand Hygiene NZ) in New Zealand and all the district health board-based programmes promote the use of alcohol-based hand gel as it is actually more effective in killing microorganisms on the hands, as well as it is readily available at the point of care.

It is impossible to provide a sink in each patient cubicle. Also, while I understand that alcohol can act as a solvent dissolving lipids in the skin, all alcohol-based products have emollients and moisturisers in them, so they actually end up harming the skin less than washing with soap and water. All this info can be referenced if need be.

Another very important point is that preferring to use soap and water means that staff may not be able to clean their hands as per the best evidence-based practices; for example,

immediately before a procedure. I would like to raise my concern around publishing this advice. It has its drawbacks on our efforts to improve hand hygiene practices. Nurses compose the main healthcare workforce that we work with.

I am looking forward to receiving your feedback on this issue. Much appreciated.

Kind regards
Eman Radwan MPH, MSc. Public Health, MBBCh
Quality Lead – Infection Prevention & Control
Waitemata DHB

Dear Editor

I concur with Eman’s comments. District health board healthcare workers are actively encouraged to use alcohol-based hand rub (ABHR) as their main hand sanitiser product due to its quickness and point of care availability.

As you know from my previous contributions to Nursing Review, changing healthcare worker hand hygiene behaviour is challenging and unfortunately deriding ABHR as causing dry skin is not helpful and somewhat misinformed.

We do advocate for soap and water when hands are visibly soiled or after dealing with certain microorganisms. However, ABHR purchased by healthcare facilities and used by healthcare workers usually contains moisturisers, emollients and are better for hands long term than most healthcare associated soap and water-based products.

Your ‘tips’ do say that if ABHR is unavoidable to make sure that hands are well cared for; we would agree with this regardless of what hand sanitation is used. I am surprised that you offer several branded and named products to use – unless this is an advertorial as opposed to independent editorial/advice?

Kind regards
Louise Dawson RN
HHNZ Hand Hygiene Coordinator
Auckland District Health Board

Editor’s response and correction

The hand care tips included in the Skin Care article were most definitely not intended to discourage nurses from following good hand hygiene practice.

The tips were drawn up from the advice and opinion provided by the cosmetic nurse interviewed for the article. Since receiving the letters, I have looked at the recent research on the issue and understand that particular tip was no longer accurate or helpful for nurses using hand rubs containing moisturisers and emollients.

As a result, that tip has been withdrawn from the online version of this article and this correction has been published for our print readers. Regarding the naming of several products, these were just examples given of common products that the reader might be familiar with. The article was definitely not advertorial and Nursing Review approached the cosmetic nurse in question for information on cosmetic skin care for our edition focusing on nurses’ own wellbeing.

For more information on hand hygiene and hand care tips for nurses, go to:

www.hha.org.au/About/ABHRS/abhr-limitations/hand-care-issues.aspx

See also www.handhygiene.org.nz to find out more about Hand Hygiene New Zealand (HHNZ).