NursesHands University of Pittsburghnurseshands 匹兹堡大学.pptVIP

Hand Hygiene: A Look at the New Guideline Elaine Larson, RN, PhD, FAAN, CIC Hand Microbial Ecology Background: Where Did the Recommendations Come From? Skin As A Barrier Stratum corneum composed of ~15 layers of flattened dead cells New layer formed daily Completely replaced every 2 wks Horny protective layer of bricks and mortar From healthy skin…. 107 particles shed daily 10% contain viable bacteria Acidic pH is antibacterial Lipids prevent dehydration Effects of Soap on Skin Increased pH Reduced lipids Increased transepidermal water loss Increased shedding of squamous cells Effect of Scrubbing on Skin Shedding CFU reduced satisfactorily with either surgical scrub or alcohol No increase in shedding after alcohol 18-fold increase in shedding after scrub Meers Yeo, 1978 Studies of Hand Flora Factors affecting skin condition(Seitz, Newman, AJIC, 1988) Nurses in Arizona and Wisconsin Winter, northern locale, age 30 yrs increased risk of dry, chapped hands Washing only 1-2 times/hour increased severity of dry skin Survey 1 To describe prevalence and correlates of skin damage on hands of nurses Four hospitals: two in mid-Atlantic, two in northern U.S. 410 nurses working 30+ hr/week in acute care Assessing Skin Damage:Irritant Contact Dermatitis Visual exam at 30X magnification by trained investigators Self-report questionnaire Reliability and validity confirmed with dermatologist assessment Diagnosed conditions (eczema, atopic dermatitis, psoriasis) excluded Results Approximately one-fourth (106/410) had measurable, current skin damage 85.6% reported ever having problems Damage not correlated with age, sex, skin type, soap used at home, duration of handwashing, glove brand Correlates of Damage Type of soap used at work (CHGplain soapother antimicrobial soap, p=.01) Frequency of handwashing (p=.0003) Frequency of gloving (p=.008) Study site (both community hospitals both academic health