To understand the goal of hand hygiene it is essential to know the normal characteristics of the skin.
The skin is normally colonized, and different areas of skin have different rates of bacterial colonies measured as: cfu / cm2; In the RN the areas of greatest colonization are: perineal-inguinal, umbilical, axillary, cervical, and lower limbs. In contrast, health workers are hands.
It was only in 1938, that the skin flora was categorized into:
FLORA TRANSITORIA: recently acquired (pollution); These bacteria can be acquired from colonized patients: E. coli, Cocos (+) MR, Candidas, MR Enterococci and Gram Bacilli (-) MR. They usually survive a limited period of time and are located in the superficial layers, for which they can be removed with hand washing by mechanical drag. It is more frequently associated with cross infection.
RESIDENT FLORA: they are persistent or permanent microorganisms in the skin of most people, include Staphylococcus C (-), corinebacterium, Diphteroids, these survive and multiply in deep layers. On some occasions Staphilococcus Aureus or Candidas spp are incorporated when the skin is injured, being difficult to eradicate and becoming an important source of contamination and transmission.
The skin is a dynamic structure with three important functions: a) reduce water loss, b) the body’s first protective barrier against infections and abrasions and c) act as a permeable barrier.
Its structure in premature RNs is not fully developed; in them we observe that the stratum corneum does not exist or is limited to 1 or 2 cell layers, preventing it from fulfilling the first two functions; the epidermis is thin and easily exposed to lacerations and irritating substances that alter its weak integrity; Only the dermis and the hypodermis are better developed in them.
The alteration of the integrity can be of nutritional cause, by disruption (puncture-laceration), by extraction of lipids and corneal layer (acetone-adhesives) or by irritating chemical substances (solvents-detergents); Not only does it affect the RN but also the personnel who sanitize their hands frequently and their normalization requires from 6 hours to 7 days.