Changes in bacterial flora associated with skin damage on hands of health care personnel

In a prospective observational study of 40 nurses (20 with diagnosed hand i rritation and 20 without), nurses with damaged hands did not have higher mi crobial counts (P = .63), but did have a greater number of colonizing speci es (means: 3.35 and 2.63, P = .03). Although numbers were small, nurses wit h damaged hands were significantly more likely to be colonized with Staphyl ococcus hominis (P = .03). Fifty-nine percent of S hominis isolates from nu rses with damaged hands were resistant to methicillin compared with 27% of isolates from those with healthy skin (P = .14). Twenty percent of nurses w ith damaged hands were colonized with Staphylococcus aureus compared with n one of the nurses with normal hands (P = .11). Nurses with damaged hands we re also twice as likely to have gram-negative bacteria (P = .20), enterococ ci (P = .13), and Candida (P = .30) present on the hands. Antimicrobial res istance of the coagulase-negative staphylococcal flora (with the exception of S hominis) did not differ between the 2 groups, nor did a trend toward i ncreasing resistance exist when compared with other studies during the past decade. Skin moisturizers and protectant products were used almost univers ally by nurses at work, primarily products brought from home. Efforts to im prove hand condition are warranted because skin damage can change microbial flora. Such efforts should include assessment or monitoring of hand care p ractices, formal institutional policy adoption and control of use of skin p rotectant products or lotions, and prudent use of latex gloves or more wide spread use of powder-free and nonlatex products.