The recent verdict by the FDA had the entire FMCG industry alarmed with its opinion that antibacterial soaps and body washes could actually cause health issues. A draft rule released earlier in September said makers of antibacterial soaps and body washes would have to prove their products are more effective than regular soap and water. If they can't, the products will have to be reformulated or relabeled.
The FDA said there is no evidence the anti-bacterial products kill germs better than traditional soap and that some of the ingredients could impact a users' hormone levels or increase the risk of drug-resistant bacteria. Such a ban will affect about 2,100 products, or roughly 40 per cent of the over-the-counter cleanser market. While the regulations would only cover soaps and body washes used with water, antibacterial hand sanitizers, wipes or products used in health care settings are not included in the regulations.
However, what needs to be noted here is the effect that anti-bacterial products can have on the skin and health. So, what about the cleaning operatives who are constantly trained in hand hygiene and in the use of products like anti-bacterial soaps, alcohol based hand rubs, etc?
Importance of hand hygiene
The hands are one of the main vehicles for spreading germs. In healthcare, this can result in patients acquiring hospitalassociated infections (HAIs), which are the most frequent adverse events in healthcare delivery worldwide, causing serious illness and even death. According to Paul Blount, Group Marketing Director, Deb Group, UK, in 2014, results of the HAI Prevalence Survey in the U.S. were published and showed that in 2011 there were a reported estimated 722,000 cases of HAIs in U.S. acute care hospitals, with about 75,000 deaths.
Proper hand hygiene is one of the most important lines of protection to reduce microbial infection transmission between people. It is generally accepted as the single most important measure in preventing the spread of infection. Washing with soap and water, complemented with use of an alcoholbased hand rub (ABHR), can be used to achieve proper hand hygiene. The World Health Organisation (WHO) has developed the ‘My 5 Moments for Hand Hygiene’ guideline with the purpose to aid in hand hygiene training, observation and performance measurement in all health care settings worldwide.
Nonetheless, compliance to these hand hygiene guidelines by health care personnel generally averages less than 40 per cent. Therefore, improving staff compliance to proper hand hygiene is most likely to be successful with a multimodal approach, using a combination of education, system change, motivation, and feedback on compliance rates.
The right product and care
There are several options when it comes to hand hygiene maintenance – antimicrobial hand soaps, hand gel sanitisers, or plain hand soap. Steve Teasdale, Managing Director & Vice President, Scientific Affairs, InnuScience, says, “Despite the fact that health care and food handling professionals face different realities and present different transmission risk levels when compared to regular facility maintenance professionals, it is well recognised that the simple operation of properly washing your hands with plain hand soap under running water is, in most situation, the best practice to adopt.” Blount adds that in higher risk areas, the use of an antibacterial soap will help support the hand hygiene practice, particularly where ABHRs are not available.
Several hand hygiene products, while serving to clean and disinfect, can also affect the user’s skin. Blount elaborates, “Skin condition can have an important impact on people’s willingness to engage with hand hygiene, whether in their professional or personal lives. When people have dry, sore hands they are naturally less inclined to either wash hands or apply an alcohol-based hand rub. In hygiene-critical environments, such as healthcare and the F&B industry, reluctance to wash and sanitise hands will increase the risk of spreading infections and result in the consequences outlined above. For example, nursing is one of the highest risk professions for occupational skin disorders and up to 15 per cent of nurses suffer from dermatitis, which is likely to impact on their hand hygiene compliance.”
Teasdale explains, “The skin is a complex and sensitive surface that shelters resident (commensal) safe microbial populations. Those microorganisms are essential to ensure skin balance and skin health as well as to prevent external microbial colonization of the skin. Skin also transports transitional microbes, some of which may represent health risk. In a proper and effective hand hygiene strategy, the goal is to wash away the transitional microorganisms while not hurting the resident beneficial ones.”
He adds that antimicrobial hand soaps and hand gels sanitizers don't have the ability to provide that selective desired effect. They hurt and try to kill all the microorganisms they meet! Their frequent use leads to a skin that is unbalanced and more prompt to colonization by unsafe external microorganisms. In addition, their active antimicrobial ingredients are irritants for the skin, making it dryer, less flexible and sometime, covered with micro crevices. This type of unhealthy and damaged skin is hard to wash and can easily shelter unsafe microorganisms.
Many of the chemical active ingredients found in antimicrobial hand soaps and hand gel sanitizers also present a health risk to population. Some of them are directly presenting health problems to people following direct and frequent skin exposure. Because of their generalized and excessive use, most of them are connected with antibiotics multiresistance of dangerous bacteria that are causing increasing concerns to community health. In response to this, InnuScience has developed its Nu-BioDermTM hand soaps. This line of high-quality hand soaps is proposed for safe and frequent use. It has no antimicrobial activity and has the ability to effectively remove dirt and transitional unsafe microbes from the skin while not damaging the resident beneficial microbial flora.
Alcohol-based hand rubs
In complete contrast to this, Blount actively recommends ABHR’s, which he says can be effective in replacing soaps and gel sanitisers. Alcohol-based hand rubs were first recommend by the WHO to increase hand hygiene compliance in hospitals as highly frequent hand washing with soap and water can be particularly damaging to the skin. Also, the speed at which ABHRs can be applied significantly impacts on rates of hand hygiene compliance. Nonetheless, where physical, organic soils are on the skin, soap and water must be used to remove them; ABHR are only effective on physically clean hands to kill germs.
Blount informs, “It is often thought that ABHR dry out skin. However, for well formulated products this is not true. Indeed, the use of products such as Deb’s InstantFOAM Complete, have been proven to improve skin condition in very high usage environments. However, when ABHRs are used on already dry and open skin, the effect of the alcohol can result in some soreness; therefore, the use of moisturizing creams is always recommended to ensure hands remain healthy and do not become dry.” While the jury is out on the right kind of product to use to ensure that hand hygiene and hand care go hand in hand (pun intended), what is important to observe is that while hand hygiene is important, it is also important to consider skin care!
Kishore Kumar Pemmasani, Executive Housekeeping, Hilton Dubai Jumeirah Resort and Hilton Dubai The Walk.
What is the importance of hand hygiene in housekeeping?
Hand hygiene is extremely important for our housekeeping staff because they are constantly in touch with the various surfaces in the hotel. By understanding the essentials of basic hygiene, we can ensure that all hazards that pose a risk to guest rooms / public areas are controlled, ensuring the safety of self, guests and colleagues. Hands are the primary route of many disease causing microorganisms and act as vehicles for cross contamination. Hence, education on hand hygiene is crucial to prevent infections and disease outbreaks.
What are Hilton’s standards when it comes to hand hygiene compliance?
As a part of our bio-hazard management programme, all team members are educated on the importance of hygiene and the effective methods of hand washing. Together with the partnership of our global cleaning and sanitisation partner, regular refresher programmes are conducted on hand hygiene and the correct methods of applying disinfection agents. We believe, continuous education, provision of fail-safe hygiene arrangements and surveillance programs to ensure our team is protected from the perils of hand transmitted pathogens. As a part of the bio-hazard management programs all risk spots are identified and appropriate controls are established to assist both our guests and team members. This includes frequent hand contact areas, like punching stations, elevator buttons, public telephones etc. We make sure our standards and provisions are equally available to all contractors and established in our staff accommodations as well.
Why it is important for housekeeping staff, who have strict requirements in hand hygiene, also take care of their skin/hand?
In hospitality, we deal with all kinds of risk groups, like infants, pregnant women, senior citizens and immune-compromised individuals and those with the history of allergies. Therefore utmost care and attention from our team is essential for infection control and ensure the stay of each guest is healthy. Since the housekeeping staff’s daily job brings them in direct contact with chemicals through touch and inhalation, it is important that they maintain their health. Cleaning technicians are the life lines of our industry. Considering their exposure to contaminated areas and objects stringent controls are necessary. Moreover, it is important for us to ensure that their skin is taken care of when it comes to hand hygiene compliance. Given that housekeeping staff works with their hands through the day, any abrasion, irritation or allergy can affect the person’s health as well as affect the day’s work.