Under normal circumstances, nurses and all healthcare providers wash their hands dozens of times throughout the workday. Today, with the need to wash hands even more frequently, there is concern about stripping hands of their healthy oils and good bacteria. Without these, germs can more easily enter the body. It is important for nurses to combat raw, itchy and painful hands.
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The following are recommendations from Cleveland Clinic Dermatology Chief Resident Katherine Glaser, MD, and Nursing Wellness Director Holli Blazey, CNP.
- If you have a lot of cracks in the skin on your hands or have dry chapped hands, be careful about how often you use alcohol-based hand sanitizers, which can further dry out your skin. When given a choice, use mild, fragrance-free cleansers to wash your hands. These soaps are more gentle than hand sanitizer foams, and they can be more effective when proper handwashing techniques are used.
- Use warm (not hot water) and gently pat your hands dry with a clean paper towel.
- When you can, use a gentle moisturizer on the hands after each washing and apply it to damp hands. Thick creams and ointments are better than thin lotions. Plain Vaseline works well too.
- Keep your fingernails short to prevent dirt and germs from collecting and causing skin tears when itching.
- Wet glove treatments can be utilized at night for severe dryness. Before going to sleep, apply a thick ointment such as plain Vaseline, then put on a pair of damp white cotton gloves or socks, and cover with a dry pair of white cotton gloves or socks. In the morning remove the gloves or socks and apply a new layer of moisturizer.
- Minimize irritation to the skin by avoiding wool or synthetic fabrics, fabric softener sheets, and scented laundry detergents. Use hypoallergenic unscented laundry detergent.
- Avoid common allergens, especially if you have a known allergic reaction. Most common allergens include fragrances, latex, nickel and topical antibiotics, such as neomycin or polymyxin which are common in over-the-counter antibacterial products. If an eczematous rash develops, a topical steroid may be required from a dermatologist.
Handwashing at Cleveland Clinic
Cleveland Clinic uses hand sanitizers with at least 60% alcohol, which is effective in killing germs. In general, soap and water are more effective than hand sanitizers in removing certain germs from your hands, but alcohol-based hand sanitizers can actually kill certain types of germs. The policy for Cleveland Clinic healthcare providers is as follows:
Use soap and water:
- When hands are visibly dirty or contaminated with blood/body fluids.
- Before eating.
- After using the restroom.
- After caring for patients with Clostridium difficile (C diff).
Alcohol rub or gel is fine for the following:
- When hands are not visibly soiled.
- Upon entering and exiting a patient room. (“Foam In/Foam Out” time.)
- Before and after patient contact.
- After contact with items in the environment.
- Before and after glove use.
Do the ABC’s
During this high-volume patient time time, Nursing Wellness recommends using the time you wash your hands to take a moment for yourself to do the ABC’s while you “Foam In/Foam Out” before and after seeing patients.
- Acknowledge: I have done all that I can. I leave the patient in the care of the team.
- Breathe: Inhale a comfortable, full breath. Exhale slowly, releasing tension.
- Clear: Clear, Center and Refocus.