Skin care protocol: for discussion

There are twin risks involved in skin care; the need to reduce risk of infection and isk of dermatitis.

The main methods of preventing infection involve use of disposable gloves and hand-washing. The risk of dermatitis from using gloves can be reduced by use of natural rubber latex-free gloves. However the frequent hand-washing with use of aggressive antiseptic soaps and alcohol based handrubs is a common cause of irritant dermatitis in health care workers. The risk is reduced by careful drying and use of emollients but still remains.

The NICE guideline on infection control in primary care is intended to cover a wide range of community and primary care situations where there are very large differences in level of risk, from pulse-taking to district nurse care. Taken at face value they leave no room for doubt about the use of gloves, washing hands after skincontact, use of soaps, handrubs and emollients.

A more measured approach would take account of the inconsistencies that arise; when taking blood pressures, the cuffs are not sterilised between patients; skin contact with the patient can be minimised or eliminated in some procedures; hand-contact with skin carries a much lower risk than contact with body fluids; it seems inconsistent to wash hands before and after use of single-use gloves if they are powder-free; and so on.

The aim of dermatitis prevention measures should be to reduce unnecessary washing, and unnecessary use of soaps and hand rubs as long as these are consistent with infection control.

A start could be made by

• Reducing hand washes after taking gloves off –as long as good glove removal technique is used.
• Using gloves for a wider range of contacts
• Reducing skin-skin contact where procedures allow