key: cord-0896022-clnd5pe5 authors: Rundle, Chandler W.; Presley, Colby L.; Militello, Michelle; Barber, Cara; Powell, Douglas L.; Jacob, Sharon E.; Atwater, Amber Reck; Watsky, Kalman L.; Yu, Jiade; Dunnick, Cory A. title: Hand Hygiene During COVID-19: Recommendations from the American Contact Dermatitis Society date: 2020-07-22 journal: J Am Acad Dermatol DOI: 10.1016/j.jaad.2020.07.057 sha: fb71e58b2e74181a8a76eaa3d4ae828686da70fb doc_id: 896022 cord_uid: clnd5pe5 Abstract The recent coronavirus 2019 (COVID-19) pandemic has resulted in increased hand hygiene and hand cleansing awareness. To prevent virus transmission, the Center for Disease Control (CDC) recommends frequent hand washing with soap and water. Hand hygiene products are available in a variety of forms and while each of these formulations may be effective against COVID-19, they may also alter skin barrier integrity and function. As health care workers and the general population focus on stringent hand hygiene, the American Contact Dermatitis Society (ACDS) anticipates an increase in both irritant contact and allergic contact hand dermatitis. Alcohol-based hand sanitizers with moisturizers have the least sensitizing and irritancy potential when compared to soaps and synthetic detergents. This article provides an overview of the most frequently used hand hygiene products and their associations with contact dermatitis as well as recommendations from the ACDS on how to treat and prevent further dermatitis. • Hand hygiene is an accepted practice to prevent transmission of infectious disease. 42 • Increased hand washing related to Coronavirus 2019 may result in elevated rates of hand 43 dermatitis. 44 • American Contact Dermatitis Society recommends best practices for proper hand 45 hygiene, skin disease prevention, and skin restoration. Soaps are made of lye and natural fats. The term soap is used to refer to any cleanser; however, 111 this is incorrect as soap designates a specific chemical composition. 5 Soap is created when a fat 112 interacts with an alkali resulting in a fatty acid salt with cleansing properties. The typical pH of a 113 true soap is around 9-10. 6 Soap removes dirt and inactivates viruses by disrupting the lipid 114 membrane and intracellular lipids. There is evidence to support soap as a more effective method 115 of hand hygiene than hand sanitizer. 7 Hand washing with soap and water has the added benefit of 116 physically washing away debris and pathogens with running water. Although soaps are effective 117 in removing debris, they also remove beneficial intracellular lipids and damage proteins found in 118 the stratum corneum layer of the skin. 6 Removing these beneficial lipids and proteins 119 compromises the stratum corneum and increases skin sensitivity and irritation. 6 120 121 Synthetic detergents, derived from petrolatum mixed with surfactants, contain less than 10% 122 soap and have a pH of 5.5-7, which is similar to the pH of healthy skin. 6 Synthetic detergents Various antimicrobial ingredients were reviewed and rated for their relative efficacy as a 144 virucidal agent and potential allergenicity (Table 1) . Alcohols, bleach, and iodophor-containing 145 solutions are the most effective against viruses. 15 The antiviral activity of alcohol is attributed to 146 its ability to denature proteins. 16 The antiviral activity of povidone iodine is noted to rapidly Alcohol-based hand sanitizers work by penetrating the viral membrane to denature and 151 coagulate proteins, disrupt cellular metabolism, and induce lysis of the viral particle. 14 An extensive list of ACDS recommended hand hygiene practices is found in Table 3 . Table 3 . • Wash hands with lukewarm or cool water and soap for at least 20 seconds. • Avoid hot and very cold water. • Non-frictional, pat drying (don't rub). • Immediate application of moisturizer following cleansing practices is recommended. • Products with antibacterial ingredients are not necessary for proper hand hygiene. • Look for soaps or synthetic detergents that are devoid of allergenic surfactants, preservatives, fragrances, or dyes. • Look for synthetic detergents with added moisturizers. • Dry hands are common with frequent use of soaps or synthetic detergents. • At least 60% alcohol is recommended. • Look for hand sanitizers that are devoid of allergenic surfactants, preservatives, fragrances, or dyes. • Look for ABHS with added moisturizers. • Dry hands are common with frequent use. Application of a moisturizer following hand washing is recommended. • Avoid moisturizers in jars to prevent "double dipping" into and potentially contaminating the product. • Use moisturizers packaged in tubes, instead. • Look for pocket-sized moisturizers to keep on one's person for frequent reapplication. • At night, application of moisturizer followed by cotton or loose plastic gloves (e.g. plastic, clear, disposable food gloves) to create an occlusive barrier. • For healthcare workers, a moisturizer under gloves can also be effective. Moisturizers with a water base are safe under all gloves, however oil based moisturizers can break down latex and rubber by making the material swell or become brittle. • Latex, vinyl, and nitrile gloves are resistant to break down from ethanol or isopropyl alcohol. • Soak and smear: Soak the hands in plain water for 20 minutes and immediately apply moisturizer of choice to damp skin nightly for up to 2 weeks. • For glove ACD, accelerator-free gloves should be utilized, such as rubber-free neoprene or nitrile gloves. • Apply moisturizer after washing hands and before wearing gloves. • Consider a cotton glove liner or loose plastic gloves (e.g. plastic, clear, disposable food gloves). • Individuals with suspect hand ACD should be patch tested. 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Recommendations 499 for the Prevention, Detection and Management of Occupational Contact Dermatitis in Health Care 500 Settings Intactness of Medical Nonsterile Gloves on Use of Alcohol 502 Disinfectants Changes in Chemical Permeation of Disposable Latex, Nitrile, and 504 Vinyl Gloves Exposed to Simulated Movement • Hand hygiene is an accepted practice to prevent transmission of infectious disease. • Increased hand washing related to Coronavirus 2019 may result in elevated rates of hand 4 dermatitis. • American Contact Dermatitis Society recommends best practices for proper hand 6 hygiene, skin disease prevention, and skin restoration.