Why Nurses’ Cracked Hands Show Up Every Winter, and How to Stop It

There’s a pump of alcohol rub outside every patient room on your unit. There’s probably also a tube of drugstore hand cream in somebody’s locker, bought in November and squeezed flat by January. Between those two objects is the reason nurses’ cracked hands come back every winter, and the reason most of us treat the problem the wrong way.

How many times does a nurse clean their hands in one shift?

According to the CDC, a healthcare provider may need to clean their hands as many as 100 times in a 12-hour shift. Put that in time: at 20 seconds a cleaning, it’s more than half an hour a shift with hands wet with rub or soap. Then the hands go into gloves, come out damp and get cleaned again.

Alcohol does its job on germs. It also dissolves the oils that hold the outer layer of skin together. Do that 100 times, add a hot-water scrub at the sink, and the skin over the knuckles splits. That’s irritant hand dermatitis.

Why does winter make it so much worse?

Cold outside air holds little moisture, and the heated air inside a hospital holds even less. Skin that’s already short on oil loses water faster, so the small cracks you had in October are open and bleeding by December.

How common is it? The honest answer is that nobody agrees on one number. Studies of nurses and hospital staff put hand dermatitis anywhere from about 1 in 5 to more than half, depending on the country, the unit and how the question was asked. The studies vary on the number. They don’t vary much on the cause: frequent hand hygiene, wet work and gloves.

Cracked hands are an infection-control problem

Split skin is harder to get clean, and it hurts. And a nurse whose hands burn every time they hit the rub will use it less. The CDC’s own hand-hygiene guideline lists irritation and dryness among the reasons staff give for skipping it, and the CDC reports that some providers clean their hands less than half the times they should.

So the fix is not fewer hand cleanings. It’s putting back what each cleaning takes out.

Run this five-point check on your unit

1. Put moisturizer at the point of care, not in lockers. A pump on the unit, approved by infection control, gets used. A tube in a bag doesn’t.
2. Check that the lotion works with your gloves and your CHG. Many lotions staff bring from home are built on mineral oil, which can break down latex gloves, and some ingredients can blunt chlorhexidine. Ask the maker for compatibility data in writing.
3. Use lukewarm water at the sink and pat hands dry. The CDC advises against hot water for exactly this reason.
4. Moisturize at the start of the shift, at breaks and at the end. Three times a day beats a big dose once a week when the cracks already hurt.
5. Ask about skin in huddles, early. A crack caught in November is a small problem. The same crack in January is a nurse in employee health.

Where an alcohol-free sanitizing cream fits

We make I.C. Hand Sanitizing Cream for the part of this cycle that alcohol makes worse. Its active is benzalkonium chloride (BZK), an alcohol-free antiseptic that kills 99.99% of germs. Alcohol flashes off in seconds and takes your skin’s oils with it. There’s no alcohol in the cream, so it goes on with dimethicone, which helps hold moisture in, plus shea butter, sunflower butter and vitamins A, D and E, and every cleaning puts something back. It’s non-flammable and NSF E3 registered. And we’ve belonged to APIC, the association for infection-prevention professionals, for more than 20 years, so we build for the people who write your hand-hygiene policy.

For the moisturizer step, I.C. Lotion (fragrance-free) is compatible with CHG and safe to use before nitrile, latex or vinyl gloves.

Here’s the limit, and you should hear it from us. The CDC still prefers alcohol-based rub for most hand hygiene in patient care, and no sanitizer, ours included, replaces soap and water when hands are visibly dirty or when your policy calls for a wash, like a C. diff room. Your infection-control team decides where a BZK product belongs on your unit. Where it earns its place: staff whose hands are already cracked, units where alcohol can be swallowed or misused, like behavioral health and memory care, and anywhere flammable storage is a headache.

Want to try it on your unit? Request samples, or book a free 20-minute winter hand-care in-service for your nurse educators. Find a distributor or request samples.

Then go look in the lockers on your unit. Whatever’s in there tells you what your hand-care program is missing.

Related reading: Work-safe hand cream: what to use under nitrile gloves · Hand sanitizer and residents with dementia: why alcohol-free · Hand care for healthcare teams

Sources

• CDC, Clean Hands Count provider infographic (“as many as 100 times per 12-hour shift”; “less than half of the times they should”; avoid hot water): stacks.cdc.gov/view/cdc/39227
• CDC, Guideline for Hand Hygiene in Health-Care Settings, MMWR 2002;51(RR-16) (irritation and dryness as reported barriers; alcohol-based rub preferred unless hands are visibly soiled).
• Hand dermatitis prevalence range (about 18% to 72% across nurse and healthcare-worker studies in Germany, Denmark, Hong Kong, Korea, Turkey, Australia and Canada), as compiled in “Hand dermatitis among nurses at a university hospital in Saudi Arabia,” Biomedical Research: biomedres.info