How to I look after my skin - University of Exeter



LOOKING AFTER YOUR SKIN

Advice for health care workers

We want to minimise the risk of your work affecting your skin. This advice on skin care will help you to keep your skin in good condition and reduce the risk of your work causing skin problems on your hands.

Frequent hand washing and wearing impervious gloves for long periods can cause irritation to the skin and increase the risk of developing dermatitis. This is why health care workers are at risk from dermatitis.

Skin affected by dermatitis is more likely to carry bacteria, which is a risk to patients, so keeping your skin healthy will benefit you and your patients.

What is dermatitis – what do I look out for?

Have a look at the pictures on this web page or at the following web link:



Dermatitis is a skin condition caused by contact with something that irritates the skin or causes an allergic reaction. It usually occurs where the irritant touches the skin.

Many people will have mild problems from time to time, with skin that looks dry and may be slightly itchy, particularly in the winter months when the air is dry. This is the time to take action to avoid the problem becoming worse.

If the problem becomes worse you could see one or all of these signs on your skin: Redness - Scaling/flaking - -Blistering - Weeping - Cracking – Swelling.

Someone who has dermatitis may experience symptoms of itching and pain.

Health care workers in clinical areas are most likely to be affected from repeated contact with soap and water which are mild skin irritants. Dermatitis can develop quickly after contact with strong irritants, such as some chemicals. Employees doing domestic or maintainance work may come across strong irritant chemicals.

Allergy to a substance can also cause dermatitis. Once someone is ‘sensitised’, it is likely to be permanent and any skin contact with that substance will cause allergic contact dermatitis. Often skin sensitisers are also irritants. This is less likely to be a problem to health care workers, but there is a small risk they may become allergic to the chemicals used in the manufacture of impervious gloves, or other substances found in a health care environment. If this occurs they would need to avoid certain gloves or chemical substances.

How should I look after my skin?

Use a good hand hygiene technique (see “How to wash my hands” below).

Wear gloves for wet work and when you are advised to do so for infection control reasons, but wear them for as short a time as possible.

Look after hands outside of work too. Wear gloves for wet work or rough work that may abrade the skin particularly if your skin is dry. In the winter wearing gloves to protect your hands form the cold outside can help. When you get dry hands there will be other factors than just work affecting skin.

Use the moisturising product supplied in your work area regularly. If the moisturiser at work does not suit your skin or your doctor has advise you to use a specific moisturiser, check with your manager that you can use this in the work area. Use a moisturiser at home as well.

Do use alcohol gel in place of hand washing when you can. This is less damaging to the skin than frequent hand washing.

Consider not wearing rings at work, or only a single plain ring. For infection control reasons, clinical staff are only permitted to wear a single plain ring.

Inspect your hand skin regularly. If you see any early signs of dermatitis (dry skin, or sometimes small lumps between the fingers) check you are using a good hand hygiene technique, and apply moisturiser regularly (every 2-3 hours). Reduce or avoid wet work at home and at work as far as possible.

If you develop dermatitis on your hands that is more than mild you may need to avoid frequent hand washing for a while to allow your hands to recover. See “Should I stop working if I have dermatitis on my hands” below.

How do I wash my hands in a way that will minimise the risk of skin problems?

• Use luke-warm water to wash hands – NOT HOT!

Hot water melts away the natural fats found in the surface layer of the skin. When these fats are removed the surface layer of the skin dries out and becomes cracked and brittle. If you do not have mixer taps use cold water.

• Wet hands before applying the wash lotion to the skin.

Wetting hands first puts a layer of water between your hands and the soap, this helps with foaming but also means it is easier to rinse off the soap. Residues left on skin, can cause irritation, especially if your skin is already dry and cracked.

• Do not use more soap than you need.

Take care not to apply too much. One pump on the dispenser should give you enough soap.

• Following the 6 step technique

Follow the 6 step technique for washing to ensure all areas of the hands are free from dirt, and micro organisms.

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• Rinse thoroughly

Make sure you remove all soap residues. You can repeat the same 6 steps used for washing to ensure through rinsing.

• Do not disinfect hands with an alcoholic hand sanitizer directly after washing

To perform a hand hygiene episode you should either wash OR use alcohol sanitizer. It is not necessary to use the alcohol sanitizer after washing and if your hands are still wet and pores are open from washing with warm water, the alcohol can get into the living layers of the skin and will cause a stinging sensation.

• Dry hands thoroughly

Especially in winter if hands are not dried properly the weather outside and heating systems inside can cause extreme dryness of the skin.

• Moisturise regularly

Use a pea sized amount of hand cream at the start and end of your shift and in any breaks and at any other time you feel you need it.

• Use alcohol gel

In normal circumstances the gel can be used on visibly clean hands instead of hand washing. Try and reduce hand washing by using the gel as this will help will skin care. However, you may find that every several uses of the gel your hands feel sticky and you may want to wash with them with soap and water. The gel may sting on dry skin in which case increased use of the skin conditioner should help. There are occasions when for infection control reasons the gel can not be used in place of hand washing.

What do I do if I develop a rash on my hands?

Inform your manager.

Seek advice from Occupational Health if required or if advised to do so by your manager.

Review your hand care in line with the advice given here.

Should I stop working if I have dermatitis on my hands?

If you have a rash on your hands you should inform your manager, who may advise you to seek advice from Occupational Health.

If the dermatitis is mild, (dry skin with no large cracks, or breaks in the skin) you may be able to continue work if:

• you are able to use the normal hand hygiene technique

• the dermatitis is not getting worse

If your dermatitis is more severe and is getting worse, you will need to stop frequent hand washing/wet work. It may be possible for you to be temporarily redeployed to other work. If this is not possible or your problem is severe you may need to take time off work to allow your skin to recover.

You must not work with direct contact with patients if you have infected skin lesions, or weeping skin.

If your problem is more than mild and not improving with simple measures you may need further prescribed treatment in addition to regular moisturisers. Seek advice from your General Practitioner.

What about latex?

Latex is a natural product from a tree used to make latex rubber gloves and other latex items used in health care.

In a small number of people it can cause an immediate allergic reaction. Someone who has this allergy would usually develop symptoms within 5 – 10 minutes of latex contact:

• Urticaria (hives) on the skin

• Runny nose, runny and red eyes

• Wheezing / asthma

• Anaphylaxis

In most cases it is only the skin that is affected; the respiratory problems are much less common.

Latex rubber also contains other chemicals that can cause an allergic dermatitis and the wearing of the gloves on its own can cause irritation, so not all problems with latex gloves are due to latex allergy.

If you suspect you have problems with latex please refer to the Trust Prevention and Management of Staff Latex Allergy Policy, which gives a lot more detail. (see useful links for web reference).

You should tell your manager of your concerns and seek advice from Occupational Health.

The use of latex gloves is now greatly restricted in the Trust. You should only use latex gloves if it is really necessary.

I am a manager. What should I do if a member of staff has skin problems?

Encourage employees to follow this advice.

Ensure staff check the skin of their hands regularly and inform you if they have any skin problems.

If dermatitis is more than mild staff will need to stop work involving frequent hand washing until their skin is improving. Wherever possible the employee should be temporarily redeployed to other work or their job adjusted to avoid frequent hand washing and glove use; if this is not possible the employee will need to take some time off.

Seek advice from and arrange referral to Occupational Health for staff members who have more than mild dermatitis.

If latex or rubber allergy is suspected always refer to Occupational Health.

Staff who regularly use latex gloves should have annual health surveillance as required by the Control of Substances Hazardous to Health Regulations (COSHH). Health surveillance can be carried out locally by a line manager, or other responsible person. Refer to the Prevention and Management of Staff Latex Allergy Policy for full details of how to arrange health surveillance.

Health surveillance may also be needed where there are significant risks to the skin. For further advise see the Trust Health Surveillance Policy (see links below) and seek advise from Occupational Health, Risk Management or the COSHH advisor.

Useful links for further advice

Poster advising you to check your skin.



Health and Safety Executive advice on skin problems at work



Link to NHS Plus guidance documents on dermatitis



Prevention and Management of Staff Latex Allergy Policy



Health surveillance policy



Dr Tim May.

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