Understanding hand care

April 1, 2002
There has never been more awareness and discussion regarding the need for hand care, and yet it is a fact that most people within our industry know very little about the products they use.

By Andrew G. Whitehead

There has never been more awareness and discussion regarding the need for hand care, and yet it is a fact that most people within our industry know very little about the products they use.

Dentists, hygienists, assistants, and lab technicians ask the same questions about the same problems. Here are basic answers to frequently asked questions.

Why use an antimicrobial hand soap? Two types of microorganisms are found on the hands: resident skin flora, referring to the generally nonthreatening organisms that colonize the skin, and the more infectious transient flora, which reach hands through contact with contaminated objects. In his textbook, Infection Control and Management of Hazardous Materials for the Dental Team (2nd Ed., St. Louis; Mosby, 1998: 125), Chris Miller, PhD, of Indiana University School of Dentistry writes, "Although plain soap and water without antimicrobial activity performs well in removing dirt and some transient microorganisms from the hands, it has little effect on the resident flora. Frequent use of handwashing products containing low to medium levels of antimicrobial agents in 10- to 30-second routine handwashing procedures minimize the number of transient microorganisms on the hands and aid in reducing the number of resident bacteria."

What benefits do antimicrobial barrier creams provide? Antimicrobial barriers are formulated to inactivate bacteria and help prevent potential pathogens and other harmful substances from penetrating the skin's normally porous surface. They offer persistent skin protection – even with handwashing – and some may include vitamins and moisturizers that help keep skin intact.

Do I really need to use a moisturizer? According to Dentistry's Resource for Infection Control and Safety (OSAP Monthy Focus, 1999; No. 2: 2), while handwashing and protective gloves remain essential elements of an effective infection control program, "intact skin is the best barrier against infection. The goal of hand care is to manage factors that compromise the integrity of the skin ... Using a moisturizing lotion on the hands throughout the day, especially after washing hands, helps prevent drying and chapping."

What is Aloe Vera? The gel from the Aloe Vera Barbadensis plant contains high molecular weight polysaccharides (50,000-100,000mw) that have been scientifically shown to have a variety of biological activities that are beneficial to the skin. These include a variety of anti-inflammatory responses, stimulation of collagen, and incredible moisturizing properties that improve the skin's ability to hydrate itself and aid in the removal of dead skin cells.

Why are protein levels in latex gloves relevant? A true latex allergy (Type I Immediate Hypersensitivity) involves an immune response to one or more of the 256 proteins found in natural-rubber latex. It is believed that reducing exposure to latex proteins can lower the potential for development of latex allergy. In addition, a report released by the United States National Institute for Occupational Safety and Health (NIOSH Alert; Publication No. 97-135, June 1997: 3) notes that reductions in exposure to latex protein allergens are associated with decreased sensitization and symptoms.

"My hands are red and itchy from gloving. Am I latex-allergic? Reactions to gloves can involve allergic or nonallergic reactions. Irritant contact dermatitis, the most common complaint, is not an allergic reaction but physical irritation and cell damage that leads to inflammation. Careful hand care typically resolves the problem. Type IV delayed hypersensitivity, also known as allergic contact dermatitis, is an immune response to a chemical used in glove production, not to the latex.

Type IV skin reactions can appear hours after contact and can spread beyond the site of contact. Only Type I immediate hypersensitivity is a true allergy to latex. An immune response to the proteins in natural-rubber latex, Type I allergies can induce hives, itching, swelling of tissues, wheezing, difficulty in breathing, nausea, and, in rare instances, anaphylaxis. Type I latex allergic individuals should use gloves made from alternative material, such as nitrile or vinyl. Because of the variety and complexity of responses to different offending agents, classification of the different reactions can be difficult and confusing. As such, any recurrent conditions or dermal problems that are not readily resolved should be referred to a physician for proper diagnosis.

What type of material is nitrile? The term nitrile describes a synthetic polymer composed of acrylonitrile, butadiene, and a carboxylic acid. It is so named because many of the material's distinguishing features stem from the presence of acrylonitril – a monomer that imparts permeation resistance, determines the softness of the product, and permits the material to be made with either a high or low modulus. Nitrile gloves are suitable alternative for latex-allergic individuals, offering exceptional puncture-resistance and can withstand exposure to a wide variety of solvents and chemicals.

What about vinyl gloves? Vinyl is a synthetic material made by polymerizing small vinyl chloride monomers. Vinyl gloves contain no proteins or chemical accelerators that can induce allergic reaction; however, they have lower tensile strength and are not as elastic as latex, which may make the barrier more prone to fail with extended use. Vinyl can be a good nonlatex alternative for use in low-risk situations.

What does "low modulus" mean? The property that most impacts the comfort of a glove is its modulus of elasticity – modulus, for short. Modulus is the resistance of a material to stretch. The higher the modulus, the more force it takes to stretch the glove. Low modulus gloves are easy to stretch and therefore exert less stress on the hand.

For answers to any questions relating to hand-care liquids and gloves, call the OSAP Hotline at (800) 298-6927. Remember, no one can take care of your hands but you! Proper hand care leads to greater comfort, increased safety, and a longer, more fulfilling practice. At the end of the day, you, your health, and your safety are what count!

Andrew G. Whitehead is a vice president for Crosstex International, manufacturer of infection control and disposable products. He Is a founding member and board member of the Organization for Safety and Asepsis Procedures (OSAP), dentistry's resource for infection control and safety. Whitehead may be reached at (631) 582- 6777, by email at [email protected], or visit www.crosstex.com.

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