Hand hygiene.pdf

particularly when resources are limited, cannot be recommended at present. Whether the
use of basic, oil-containing products, not specifically manufactured for hand skin protection,
would have similar efficacy as currently available manufactured agents remains to be
determined.
Frequent wearing of gloves can increase the risk of skin problems. In a study among
healthy volunteers, when a moisturizer was applied prior to wearing occlusive gloves there
was a statistically significant improvement in skin hydration 473 . More recently, an examination
glove coated with aloe vera resulted in improved skin integrity and decreased erythema
in 30 women with occupational dry skin 474 . Nevertheless, such products cannot yet be
recommended because field trials, larger sample sizes and cost analyses are needed.
In addition to evaluating the efficacy and acceptability of hand-care products, product
selection committees should inquire about potential deleterious effects that oil-containing
products may have on the integrity of rubber gloves and on the efficacy of antiseptic agents
used in the facility 13,417 , as well as the fact that, as previously mentioned, most of these
products are not sterile and can easily become contaminated.
13. FACTORS TO CONSIDER WHEN SELECTING HAND
HYGIENE PRODUCTS
To achieve a high rate of hand hygiene adherence, HCWs need education, clear guidelines,
and some understanding of infectious disease risk, and acceptable hand hygiene
products 134,262,454,455,459,475-477 . The selection of hand cleansing agents is a key component of
hand hygiene promotion, and at the same time a difficult task. The selection strategy requires
the presence of a multidisciplinary team (e.g. infection control professionals, administrative
staff, pharmacists and behavioural scientists) and efforts to evaluate factors related to hand
cleansing agents and to conduct clinical pilot projects to test these factors 1,7,16,277,456,478 The
major determinants for product selection are antimicrobial profile and user acceptance. The
antimicrobial efficacy of hand hygiene agents is provided by in vitro and in vivo studies (see
Part I, Section 8) which are reproducible and can be generalized. Pilot studies aiming to help
select products at the local level should mainly concentrate on user acceptability issues.
Other aspects such as tolerance, availability, storage and costs should also be addressed on
a local basis to guarantee feasibility and sustainability.
13.1 PILOT TESTING
Pilot testing to assess acceptability is strongly recommended before final selection.
Characteristics that can affect HCWs’ acceptance of a hand hygiene product include dermal
tolerance and skin reactions to the product, and its fragrance, consistency and colour 155,445,456 .
Structured self-administered questionnaires may be useful tools to assess HCWs’ acceptability
of hand hygiene products. Such tools should be adapted to the local setting because of
differences in sociocultural backgrounds, climate and environmental conditions, and clinical
practices among users. For an efficient comparison, each product should be tested by
different users for at least two to three weeks. Skin reactions to hand hygiene products may
be increased by low relative humidity. Therefore, dry weather, e.g. during winter months in
the northern hemisphere, should be taken into account during pilot testing; the introduction
of new products during dry periods, with low relative humidity, should be avoided. Dryness
and irritation should be assessed with sufficient numbers of HCWs to ensure that the results