Sharon A. Van Wicklin, MSN, RN, CNOR/CRNFA, CPSN, PLNC, is perioperative nursing specialist with the Association of periOperative Registered Nurses.
Q: Can you tell me if hand cream is allowed in the instrument reprocessing department?
Sharon A. Van Wicklin: According to AORN's 2011 Standards and Recommended Practices, "Recommended practices for hand hygiene in the perioperative setting,"
Recommendation 1: "All health care personnel should follow established hand hygiene practices for maintaining healthy skin and fingernail condition…
- Health care organization-approved hand lotions should be readily available and used frequently to maintain good hand skin condition following surgical hand hygiene. Skin irritation and dermatitis from frequent hand washing can increase the risk of infection for both the health care worker and the patient. Failure to follow practices that maintain intact skin may create breaks in intact epithelium, which compromises the barrier properties of the skin and presents the opportunity for microbial transmission into the tissues.
- Lotions selected for use in the perioperative setting should be evaluated and approved by an interdisciplinary group that has the designated authority to evaluate and select hand lotions.
- Hand lotions used in the perioperative setting should
- be compatible with antiseptics and barrier products in use,
- list water as the first ingredient on the label,
- contain no anionic-based materials or chemicals, and
- contain no petroleum or other ingredients with a demonstrated detrimental effect on the barrier properties of gloves in use.
Many lotions found in over-the counter products contain an anionic based ingredient that interferes with the residual effect of chlorhexidine gluconate and chloroxylenol. Chlorhexidine gluconate and chloroxylenol are in many hand antiseptic products used in health care organizations for their antiseptic properties. Petroleum may affect the barrier properties of latex gloves that may be worn by health care personnel. A study on latex glove compatibility has shown petroleum to have adverse effects on the integrity of latex gloves. Some gloves have been demonstrated to be compatible with some lotions" (pp. 74-75).
However, using hand lotion in the instrument reprocessing department may be problematic if it is transferred to surgical instruments during handling and subsequently prevents the sterilizing/disinfecting agents from penetrating and killing the microorganisms.
This situation should be approved by the facility infection prevention personnel. If lotion is determined to be acceptable, it should be stored away from designated instrument reprocessing areas and near areas where hand hygiene is performed. Many of the alcohol foams contain skin protective agents.
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