The most agents essential in reducing infection from the oral cavity and transfer to the upper and lower respiratory tract is hand hygiene. Centers for Disease Control recommends hand washing with soap and water can to prevent virus SARS-co-2 transmissions. Hand hygiene products may be effective against alter skin barrier integrity and COVID-19 .
According to the recommendations of World Health Organization (WHO) on using alcohol-base formulation for hand hygiene and it got used to among the general public because of the Covid-19 pandemic, this study was done with the aim of relationship between the type of hand hygiene method and the incidence of skin problems of alcohol-based hand rub with antiseptic and plain soap on hands of general public after the Covid-19 pandemic in Ahvaz, southwest Iran during 2020. The risk factors for the development of hand dermatitis, with further focus on the most common agents used among human.
The disease caused by the unprecedented novel coronavirus, spreads from country to country and quickly becomes a global crisis. Although governments have tried to stop or slow the outbreak of the emerging disease through various measures, the victims resulting from this disease are raising. Therefore, Hand hygiene education, Distribution of disinfectants among the people and low-income groups, high production of Hand hygiene, close contact among people should be avoided to reduce COVID-19 transmission [21-24, 9, 25]. Based on result different study, hand hygiene is of utmost importance for the prevention of COVID-19 among HCWs.
Abbasnia et al, in 2016 studied Evaluation of antibacterial effect of hand hygiene gel on different concentrations of bacteria. Based on their result the Hand hygiene gel was not effective when encountered with the highest concentration of bacteria in all four time-tested, and the entire surfaces of the plates were coated with bacteria, and with decreasing concentrations of bacteria and increasing the encounter duration, the number of bacteria reduced . This study showed that basic hand hygiene gel was only effective when the number of bacteria was lower than CFU per milliliter and the exposure time was at least 40 seconds .
Araghi et al in 2020 studied hand hygiene among health care workers during COVID-19 Pandemic. They reported that applying alcohol-based hand rubs, washing hands properly with soap and water, and applying other antiseptic agents .
Baloochi and Saleh Moghaddam in 2008 the comparison of skin complications of alcohol-based hand rub with antiseptic soap and plain soap on hands of nursing personnels . According to the result of skin complications in groups with four dimensions: appearance, intactness, moisture content and sensation. Among three groups, the alcohol-based hand rub in comparison with plain soap showed less skin complications in intactness (p=0.04) .
In a similar study by Masakini et al. the efficacy of hand washings due to used waterless hand hygiene was investigated in Iran . The findings showed that 30 samples were not grown on EMB medium، but 30 samples of Blood agar, before and after washing with soap and liquid hand rub, were grown and applying hand rub alcohol liquid is most effective than washing with soap. Identification of bacteria in manitol salt agar medium and coagulas test revealed %80 were coagulas negative staphylococcus and %20 coagulas positive staphylococcus . In this study washing with soap dose not effect on hand hygiene of nurses but disinfectant with liquid alcohol shows significant correlation in reducing microbial load on personnels’ hand that is revealed alcohol was more effective in reducing pollution .
Based on another study, Kampf and Löfflerin in 2003 evaluation of aspects a successful introduction and continuation of alcohol-based hand rubs for hygienic hand disinfection . They showed that hand washing with a solution containing ethanol 80% has a significant reduction on skin microorganisms .
Based on the study of Samadipour et al. (2008), in Sabzevar, adherence to hand hygiene practice in internists was 34.4% in the surgical staff 21.3% in the intensive group 15.65% and in doctors 16.59% . Out of 1356 situations of hand hygiene practice only in 306 cases hand hygiene was practiced. In general, the mean percentage for the four groups was 22.6%. According to their result, the hand hygiene practice while taking care of patients is low and unsatisfactory .
Keratin and lipids are the A famous component of a healthy skin barrier is the stratum corneum . Alkaline soaps and detergents, friction, dry skin, warm water, cold water, rough paper towels and use repeated glove are the most important cases that can negatively affect skin barrier function [20, 31]. Epidermal atrophy, reduced keratinocyte size, decreased free fatty acids are the most agents that increased infections. In a study performed by Lan et al in 2020 investigated of skin damage among health care workers managing during the COVID-19 outbreak in Hubei, China. They reported that 66.1% of health care workers washed their hands more than 10 times per day, but only 22.1% applied moisturizers after hand washing .
A research conducted by Głąbska et al in 2020 on the influence of the COVID-19 pandemic on hand hygiene behaviors in the Poland indicated that the majority of circumstances of washing hands, including those associated with meals, personal hygiene, leaving home, socializing, health, and household chores, the share of respondents declaring always washing their hands was significantly higher for the period during the COVID-19 pandemic than for the period before (p < 0.0001) .
Due to the cultural of Iranian such as visiting, to shake hands, participate in mourning and wedding ceremonies, increases the importance of preventive activity about this disease. Hand dermatitis prevention, products devoid of allergens, using products with added moisturizers and applying moisturizers after hand washing are the main actions that can decrease health skin risks to the people of the region and world. Therefore, continuous education about how correct use of hand washing, products detergent and use of moisturizing skin is a priority.
Limitations and strengths
The major limitations of this study include the limitations of ecological studies which is the use of aggregated data. We only studied hand hygiene factor, but some sites could be related to more than this factor.