Double-blind, randomized trial of scheduled use of a novel barrier cream and an oil-containing lotion for protecting the hands of health care workers

Abstract

Context: Many health care workers suffer severe hand irritation, with cracking and bleeding, as a consequence of frequent handwashing and glove use. Integumentary breakdown has major implications for nosocomial infection control and promotes the spread of bloodborne viruses. The potential benefits of scheduled use of hand-care agents-lotions or creams-in health care workers has not been established by controlled trial.

Objective: To compare the value of an oil-containing lotion with a novel barrier skin cream in health care workers with severe hand irritation.

Design: Prospective, randomized, double-blind trial.

Setting: University medical center.

Participants: Fifty-four health care workers from multiple departments with severe hand irritation, 74% with one or more full-thickness cracks or other integumentary breaks.

Main outcome measures: Objective and subjective parameters for scaling, cracking, weeping, bleeding, and pain were scored by two blinded investigators weekly for 4 weeks, and the hands of subjects were cultured quantitatively at the onset and after 2 weeks and 4 weeks.

Results: Subjects in both groups experienced marked improvement in overall hand condition (each, P <.02), particularly in scaling, cracking, and pain. Persons randomized to use of the oil-containing lotion showed greater improvement (mean score, from 6.5 to 2.7 vs 6.8 to 4. 7, P =.006). In 18 (69%) of 26 persons who used the control lotion, all full-thickness integumentary breaks were healed and pain was totally resolved, compared with 14 (52%) of 27 persons who used the barrier cream (P =.26). Use of the two agents in a scheduled fashion had no effect on the levels or profile of the transient hand flora. However, by the fourth week of use, handwashing frequency was 50% higher in subjects randomized to use the control lotion than it was in subjects randomized to use the barrier cream (17.8 vs 11.7 times per day, P =.04).

Conclusion: Use of an oil-containing lotion or a barrier cream on a scheduled basis can substantially protect the hands of vulnerable health care workers against drying and chemical irritation, preventing skin breakdown and promoting more frequent handwashing.