Emulsions, Microemulsions, and Lyotropic Liquid Crystals - Surface and Colloid Chemistry: Principles and Applications - page 196

For surgical or other high-risk patients, showering with antiseptic agents has been
tested for its effect on postoperative wound infection rates. Such agents, unlike plain
soaps, reduce microbial counts on the skin. Whole-body washing with chlorhex-
idine-containing detergent has been shown to reduce infections among neonates,
but concerns about absorption and safety preclude this as a routine practice. These
factors have led to suggestions that antimicrobial products should be more univer-
sally used, and a myriad of antimicrobial soaps and skin care products have become
commercially available. While antimicrobial-drug-containing products are superior
to plain soaps for reducing both transient pathogens and colonizing flora, widespread
use of these agents has raised concerns about the emergence of bacterial strains
resistant to antiseptic ingredients such as triclosan.
Some evidence indicates that long-term use of topical antimicrobial agents may
alter skin flora. Water content, humidity, pH, intracellular lipids, and rates of shed-
ding help retain the protective barrier properties of the skin. When the barrier is
compromised (e.g., by hand hygiene practices such as scrubbing), skin dryness, irri-
tation, cracking, and other problems may result. Although the palmar surface of the
hand has twice as many cell layers and the cells are >30 times thicker than on the rest
of the skin, palms are quite permeable to water.
Damaged skin more often harbors increased numbers of pathogens. Moreover,
washing damaged skin is less effective at reducing numbers of bacteria than wash-
ing normal skin, and numbers of organisms shed from damaged skin are often higher
than from healthy skin. The microbial flora on the clean hands of nurses (samples
taken immediately after handwashing) have been reported in several recent studies.
Methicillin resistance among coagulase-negative staphylococcal flora on hands did not
seem to increase during the 1980s to the 1990s, and tetracycline resistance decreased.
9.5.1.2 detergent-based antiseptics or alcohol
Because of increasingly vulnerable patient populations, the demand for hand hygiene
among healthcare professionals has never been greater. However, frequent handwash-
ing is not only potentially damaging to skin but also time consuming and expensive.
A mild emulsion cleansing rather than handwashing with liquid soap was associated
with a substantial improvement in the skin of nurses' hands.
Use of lotions and moisturizers: Moisturizing is beneficial to skin health and
reducing microbial dispersion from the skin, regardless of whether the product used
contains an antibacterial ingredient. Because of differences in the content and for-
mulations of lotions and creams, products vary greatly in their effectiveness. Lotions
used with products containing chlorhexidine gluconate must be carefully selected to
avoid neutralization by anionic surfactants. The role of emollients and moisturizers
in improving skin health and reducing microbial spread is an area for additional
research.
For improving the skin condition of healthcare professionals and reducing their
chances of harboring and shedding microorganisms from the skin, the following
measures are recommended:
1. For damaged skin, mild, nonantimicrobial skin-cleansing products may
be used to remove dirt and debris. If antimicrobial action is needed (e.g.,