Actions Taken to Prevent Skin Irritation

Steps taken to introduce Prime Lotion

- What is the background that led you to consider introducing Prime Lotion?

We recognized that skin irritation can cause the colonization of bacteria and can also lead to lower hand hygiene compliance rates. However, until the introduction of Prime Lotion, hand care measures were left to individual discretion among the staff, and hand care products were prepared on their own, or bought using the ward's budget and shared with the ward staff. Although, when we had the hospital round and checked the ward, more than half of the wards did not have skin care products in the hand washing area, which we found inadequate to address skin irritation. At that time, we heard from other hospital staff that more and more facilities are supplying hand care products to staff these days. This made us consider preparing hand care products for staff in the hospital so that they can care for their hands as necessary.

We first talked to the head of the nursing department, and then the nursing department discussed it with higher management. As a result, we received the decision from management that the hospital should secure basic measures for staff, such as providing hand care products to prevent skin irritation, which is related to the hand hygiene practice for preventing infections.

	Ms. Nobuko Fukahori (Infection Control Team, Certified Nurse in Infection Control)	Mr. Kenichi Shimizu (Occupational Safety Team / Infection Control Team Assistant Manager)

- Why did you choose Prime Lotion?

We chose from three products, including Prime Lotion. We used each test sample for three months in a department and conducted a survey questionnaire on each product's usability. Prime Lotion was well-liked because of its smooth texture. Among the infection control team (ICT), Prime Lotion was highly rated in the following perspectives. Its usability did not leave stickiness, which is important because it does not affect consequent work; it did not obstruct the donning or removal of gloves, and it did not affect the strength of the glove. Also, it did not obstruct the hand disinfectant's persistent efficacy. In addition, Prime Lotion is dispensed from a container with a pump, which is preferable as it reduces the risk of contamination. Finally, the cost of the product was also taken into account, and Prime Lotion was chosen for use in our hospital.

After introducing Prime Lotion

- Where do you place Prime Lotion, and how do you train the staff to use it?

We have placed Prime Lotion in every area considered necessary, such as the ward, the outpatient area and the examination room. We have positioned it so that all staff, not just the ward's staff but also the hospital's administration staff and other staff, can use the product. As for usage, we have encouraged the staff to frequently use the product after hand washing or hand rubbing, and when the hands feel dry.

- Have there been any changes among the staff after the introduction of Prime Lotion?

We started using Prime Lotion in October of last year, and we received some feedback from the staff, such as there have been less chaps than previous year, and they are grateful with the supply of the hand care product. Especially, we received such voices from the assistant nurses who were often involved in wet work.

- How have you made the importance of hand care well known among the staff?

We have made it known through the link staff (people in charge of infection control and prevention in each department, including the co-medical staff). In our hospital, six or seven years ago, we started making the month of October as a hand washing strengthening month, since October 15th is Global Handwashing Day. One month prior to this period, we conduct an educational session on skin irritation, such as why skin irritation is a problem or why hand care is necessary, at the link staff meeting. Then, the link staff collaborates with the ICT team to train the hospital staff on effective hand hygiene practices during the hand washing strengthening month. The training consists of hand rubbing using an alcohol-based hand rub and hand washing. We use fluorescent lotion and black lighting as an educational tool to visibly identify the missed areas in hand washing. Since the staff changes periodically, we implement this education each year.

- Do you take any other measures to address skin irritation other than using hand lotion?

When washing hands, we tell staff not to directly apply soap to dry hands but to use soap only after wetting the hands with water. Since the residuals of soap can cause skin irritation, we encourage staff to rinse well with water. In addition, we do not recommend using hot water or rubbing the hands with a paper towel to dry; it is better to pat them gently. For those with serious skin irritation, we advise seeing a dermatologist.

This year, we are going to make a poster featuring the most important points, and we will promote the prevention of skin irritation.

- Is there anything you are currently focused on in addition to skin irritation?

We are currently focused on environmental cleaning, as it is important to maintain a clean environment in order to reduce the risks of transmission of pathogens from the environment to the hands. This year, we are evaluating environmental contamination using an ATP (Adenosine Triphosphate) measure. Currently, patients' surroundings, for example, bedrails and nurse call buttons, are being evaluated, and with these results, we will determine the places and devices that need to be improved. We will ask the link staff to propose measures and practices to improve the cleaning. After two months, we will again check the environmental conditions to evaluate the improvements. We have already discovered that the tourniquets are highly contaminated. We are planning a trial to study the efficacy of cleaning with environmental surface wipes compared with adopting heat-resistant tourniquets and applying hot-water disinfection once a day.

Next Step

- What is your next step?

In our hospital, thanks to the yearly hand wash strengthening month, most of our staff is knowledgeable about hand washing techniques. However, we believe knowing when to perform hand hygiene is still not fully understood. Thus, we plan on adding more information regarding when to perform hand hygiene in our infection control manual, and we would like to improve hand hygiene compliance rates.