Effect of Hand Hygiene Procedures on Skin Biomarkers

Skin cleansing is an essential part of skin care. Its primary function is to remove dirt, oil, other environmental pollutants, and bacteria from skin. However many cleansers are based on surfactants that interact with the proteins and lipids of the Stratum Corneum (SC). Frequent, repetitive exposure to soap and water negatively affects the structure and function of the skin barrier and may lead to inflammation, barrier lipid disruption, and increased permeability. Additionally, the skin repair process results in hyperproliferation, insufficient hydration, and inadequate desquamation. Damaged skin has increased levels of bacteria, therefore, hand hygiene compliance results in damaged skin and thereby an increased bacterial load. Minimizing damage caused by cleansers is the first step toward cleansing without damaging the surface of the skin. The second step is to provide moisturizing benefits during wash to compensate for the damaging effect of washing. Moisturizing the skin maintains an optimal level of hydration and plasticization that allows the skin to retain its normal viscoelasticity. This study investigated wither skin inflammation resulted from the repeated hand hygiene usage, will influences keratins and cornified envelope proteins as major structural keratinocyte protein from the outermost layer of the (SC), and will effect the production of epidermal cytokine as major mechanisms used by epidermal cells to participate in immune and inflammatory skin reactions. We hypothesized that a synergistic hand hygiene regimen (TP) based on minimally disruptive surfactants for water washing, alcohol hand rubs with emollient, and compatible lotion would minimize damage and help maintain an effective skin barrier. The hand skin was evaluated with high-resolution quantitative digital imaging, visual grading, self-assessment, measurements of hydration and barrier integrity, and Quantifying different Cytokines, structural proteins and selected biomarkers on the skin surface of health care worker hands. One group of HCW used the (TP) and the other continued with the Current Hospital Products (CHP). The hands were assessed at the start and end of work cycles, i.e., typically 2 to 3 consecutive 12-hour shifts with 2 to 4 days off work. The skin effects were evaluated over 6 cycles during fall/winter. In the winter, the initial assigned products (TP or CHP) were used for 3 to 4 weeks and the skin was assessed over 3 cycles. The HCW’s then changed to the other product for 3 cycles to determine the effects of both sets within one season. D-Squame® tapes were used to recover skin surface samples. These samples were then extracted into buffer solution for analysis. Utilizing the Luminex-Based bead arrays we had quantitativly determined the amount of different skin biomarkers such as Cortisol, Fibronectin, Keratins 1, 10, and 11, Involucrin, Keratin 6 (skin map Kit), IL-8, TNF-α, IL-α, IL-10, and IL-1ra. We found that Dryness and Erythema for the knuckles and dorsum were significantly higher at the end of a cycle than the beginning, and the skin hydration was significantly reduced. The TP group generally experienced significantly lower levels of damage over the cycles than the CHP group. The skin condition at the beginning of the winter study was significantly poorer than at the end of the spring phase, particularly for dryness/scaling and self-assessment (appearance, intactness, moisture, sensation). Erythema was relatively constant across seasons. Regimens designed to minimize irritation from repeated washing, protect the skin during subsequent hand hygiene procedures, and to facilitate skin repair, which improves hand skin condition while achieving skin disinfections. We compared our findings regarding the correlation between traditional clinical skin measurements (evaporimetry and erythema) and the epidermal biomarkers. Additionally, we examined the role of Hand Hygiene products for changes to the epidermal biomarkers of the stratum corneum using the same D-Squame® tape method. The biomarker we identified showed significant difference pattern between HCWs and non-HCWs (control subjects).