# Reducing the frequency of hand hygiene to maintain skin integrity among nurses in the growing care unit: A pilot study

## TL;DR

This pilot study explores whether reducing hand hygiene frequency among nurses can maintain skin health without increasing infection risks.

## Contribution

The study introduces a novel approach to reducing hand hygiene frequency while maintaining microbial control and skin integrity in a neonatal care setting.

## Key findings

- Reducing hand hygiene frequency did not significantly change microbial contamination levels.
- Skin barrier impairment remained unchanged after the intervention.
- Hand hygiene effects showed significant differences before and after the intervention.

## Abstract

Consistent hand hygiene practice is required to reduce the prevalence of healthcare-associated infections. However, frequent hand hygiene compromises the skin barrier, causing hand eczema. Consequently, compliance with this practice can be reduced. This study aimed to determine the safety of reducing the frequency of hand hygiene by nurses, focusing on the de-implementation of the current excessive hand hygiene protocol.

A single-group, pretest–post-test pilot study was conducted in three nurses at a growing care unit (level 2 neonatal intensive care unit) in a Japanese university hospital. The developed intervention was performed four times and the current hand hygiene protocol was performed six times in each nurse. The number of microbial contaminations on the hands at each time point was the primary outcome. Impairment of the skin barrier (changes in the stratum corneum water content, transepidermal water loss, and skin pH) was the secondary outcome.

The pre- and post-test residual bacterial contamination at each time point was not significantly different (p=0.99). The amount of change in skin physiology was also not significantly different between the pre- and post-tests.

Hand hygiene effects, such as a reduction in bacterial contamination and impairment of skin physiology, were significantly different between before and after the intervention of reducing the frequency of hand hygiene by nurses. To confirm this finding, we will focus on resistant bacteria and test this intervention in randomized, controlled trials.