Rose Gallagher on Skin Health

We caught up with Rose Gallagher, Professional Lead for Infection Prevention and Control at the Royal College of Nursing (RCN), to speak about skin health and hand hygiene among nurses, midwives and healthcare professionals during the pandemic and beyond.

From my perspective and from the conversations I have had with nurses, definitely. There has been an increased awareness of poor skin condition, because of the combined messages around glove use and skin health, which has been really successful over the past couple of years when it comes to getting people to think routinely about this.

However, the pandemic has really pushed this to the forefront. The concept of skin health is really applicable not only to nurses and midwives, but to all healthcare workers. We’re seeing increased glove use and everyone is much more aware of the need to clean their hands regularly, whether with sanitiser or soap and water. And with that, comes a heightened risk of sore hands. This is obviously happening at home for healthcare workers too – which makes the perfect storm. For me, it’s a real chance to tackle this issue once and for all.

Yes. What I am hearing when people talk about hand hygiene now, is that they are talking about hand cream too – this wasn’t so obvious before, but again this is down to the pandemic.

When it comes to hand hygiene now, there is a much stronger association with looking after your hands as well as keeping them clean, which is really positive. This behaviour is voluntary too - we’re not having to prompt nurses to think about moisturising.

It’s a shame that we don’t have any hard data at the moment on whether skin disease amongst healthcare workers is becoming more common. There is still a need to undertake skin checks, still a need to report dermatitis, but because we don’t collect routine data on the outcomes of skin disease, what we know from severe cases only represents the tip of the iceberg - without the data we really don’t know how badly staff are being affected or whether the measures being put in place by employers are helping or not.

Raising awareness will hopefully help nurses to recognise skin disease in their colleagues, too, and to prompt them to seek advice when needed. This isn’t just the responsibility of the Ward Manager for example, but also the individual. We each have a responsibility to not only report on our own health but to recognise symptoms in others too – this is where awareness raising will be most important.

I think they have in the past and that it has always generally been accepted - I can remember having very sore hands as a student nurse. This was down to popularity of harsh soaps, which was eventually stopped due to widespread poor skin health.

I believe that this attitude of acceptance is still commonplace though. When it comes to raising awareness we focus mostly on NHS settings, but we need to get this message through to care homes and independent healthcare providers too. It needs to go across the spectrum – it’s about protecting the profession on the whole.

It reminds me of the attitude to back injuries in the past – most nurses accepted that they would have sore backs by age of 50. Then, with introduction of Moving and Handling legislation and a focus on the prevention of injury, it became no longer acceptable. Over the next five years, I would like to see skin disease be viewed in the same way.

One of most important things relates to the products available. Users need to have a say in what they want in a product, such as texture, how it is dispensed and so on. Nurses are being far more vocal about what’s needed in their products. Scent is also a factor, and this can be quite individual, but being dermatologically acceptable is really important too.

In the past, workplace-provided creams were to share and might end up running out or not be your preferred format. So really, it wasn’t often down to preference – it could be that nurses had specific needs based on their skin disease for example.

I would say that if the cream provided in the workplace is not suitable, particularly if it has been sourced as the usual cream can not be supplied, we could see nurses start to bring in their own in again. As more and more nurses have sore hands, there is a risk that they will need higher levels of moisturisation than normal – this is something we need to monitor.

It has been great. We’ve had excellent feedback so far from across all regions in the UK. We’re still going through the process of disseminating this, and we’re actively trying to meet members to make sure they’re aware, which includes our branches and regions as well. This is very much an organisation-wide issue. I was recently speaking to my colleagues in France and they’re keen to hear about this phase of our work too. So there has been huge interest, and so far so good.

This is where the pandemic actually gives us an opportunity. There’s a strong message coming through on physical and mental health. Nurses in particular are really starting to challenge the wrongly held perception that self-care is selfish - it is becoming increasingly unacceptable not to look after yourself or to work when you are unwell – and this is extending to skin care too.

What’s really positive is that I’m seeing a lot more messaging around rest and hydration, talking to someone, taking exercise – this is really important. As nurses we always put our patients first, but there has to be balance. There is pressure to work at pace, which can mean shortcuts, which in reality often means nurses and midwives not caring for themselves. As the RCN continue to lobby for an increase in the nursing workforce, this will help generate time for more self-care.

The range is wide. It can be very mild to extreme. The lower levels are tolerated, and can include day-to-day discomfort and soreness, which can then result in issues with hand hygiene best practice. For example, either nurses are able to tolerate sanitisers, or they use them knowing they may be painful to the hands – obviously, if they are unable to perform hand hygiene properly, we have to look at redeployment until the skin heals and this has a knock-on effect on the rest of their team.

The impact also carries over into home life – avoiding washing the hands at home, not being able to carry out normal tasks and so on. Poor skin health can affect mental health - it has a knock on effect, and isn’t just something that happens on shift.

We’ve worked with two RCN members who have experienced severe skin disease – they represent the extreme end of the spectrum. One member had to leave nursing altogether, and you can hear Julie talk about the impact chronic dermatitis had on her life and what it meant to her on an RCN podcast. The important message is to act early, or it can result in severe skin disease - and we really can’t afford to lose nurses because of this.

Certainly ten to fifteen years ago, but products have really improved since then. In my conversations with staff, they are far more accepting of the products that are procured and they know they contain emollient. People are no longer questioning if they are present in hand sanitiser – some may think that alcohol dries out hands, and this may be more common outside the NHS because of the way we have pushed education on hand hygiene. We still need to challenge those myths around sanitiser, but certainly the situation is much better than it used to be.

Skin health is not just the responsibility of an individual nurse or midwife. The important message is that whilst we as individuals have a responsibility to take action to look after our skin, so does our employer – they need to provide the correct skin care products including sanitisers, soaps and creams to the nursing workforce.

It is really important that our members know that their employers have these responsibilities and what to do if they think that they are not meeting these responsibilities. During the pandemic, the RCN has released lots of advice on what to do if you don’t feel safe. We have information on what you can do as an individual, as it’s important that people know there are options, which the pandemic will be good in highlighting. The work that the RCN does is for all nurses and midwives, and not just for our members, which is why our resources on this are freely available.

Find out more about the RCN’s skin health campaign here:
https://www.rcn.org.uk/clinical-topics/infection-prevention-and-control/skin-health.