WOUND CARE
SECTION EDITOR: Barbara Pieper, PhD, RN, CS, CETN, FAAN
Factors to Consider When Selecting Skin
Cleansing Products
Denise Henry Nix, RN, BAN, MS, CWOCN
The number of commercially marketed skin cleansing agents continues to grow, provid-
ing clinicians with an increasingly large variety of products from which to choose. This
variety may lead to confusion about which product to choose, particularly for persons
without expertise in the area of skin care. This article reviews common types of skin
cleansers, their formulation, ingredients, skin compatibility, pH, and related infection con-
trol issues. (J WOCN 2000;27:260-8)
W OC nurses highly value skin integri-
ty, and much of our practice is ded-
icated to the prevention of skin break-
down and the treatment of persons with
altered skin integrity. WOC nursing prac-
tice incorporates detailed knowledge of
the characteristics of wound and skin care
products; however, often it is persons with
less expertise in skin care who select the
products that many health care facilities
use for skin cleansing. Whether a skin
cleanser is intended for routine hand
washing or general bathing, an under-
standing of the various formulations and
ingredients of cleansers is essential for
appropriate product selection. These con-
siderations affect compliance with hand-
washing policies, nosocomial infection
rates, and the integrity of the skin of all
persons using the cleanser. This article
reviews the formulations of commonly
used skin cleansers and provides implica-
tions for their use in clinical practice.
BARRIER FUNCTION OF
NORMAL SKIN
The healthy epidermis provides an
effective barrier against noxious agents
and infectious organisms.1 Normal skin
provides a barrier that can be analogized
to brick and mortar, with the epithelial
cells acting as bricks and the skin lipids as
mortar. Any substance that comes into
contact with the skin and strips away its
lipids produces a defect within this barri-
er. Such defects may permit invasion by
pathogens or environmental irritants. The
260
integrity of the skins barrier function is
typically measured by its transepidermal
water loss (TEWL). TEWL is the evalua-
tion of changes in the rate of passive evap-
oration (moisture loss) through the skin.
Normal TEWL varies according to the area
of the body. TEWL values rise as the barri-
er function declines as the skin becomes
dryer, with less water content. A decrease
in TEWL values can be related to an
improvement in the ability of the skin to
act as a barrier against moisture loss.2
The typical or normal bacterial flora that
inhabits the skin is related to its barrier
function. Species of bacteria normally
found on human skin actually provide bac-
terial interference against the overgrowth of
pathogenic microorganisms. Examples of
species normally found on human skin
include Staphylococcus, Micrococcus, Neis-
seria, Peptococcus, Corynebacterium, Pro pioni-
bacterium, Streptococcus, and Acinetobacter.
Not all species are found on one person, but
most people carry at least 5 of these species
as normal bacterial flora.3
The ideal skin cleanser removes un-
Denise Henry Nix, RN, BAN, MS,
wanted microorganisms while maintain-
CWOCN, is Clinical Nurse Specialist,
ing the skins barrier function. The charac-
Vencor Hospital, Minneapolis,
teristics of the ideal skin cleanser will vary Minnesota.
according to the needs of those using the
Reprint requests: Denise Henry Nix,
product. For example, a nurse with fre-
RN, BAN, MS, CWOCN, 4101 Golden
quent exposure to contaminants will re-
Valley Rd, Golden Valley, MN 55422.
quire a different product for hand wash-
ing when compared with an elderly resi- Copyright 2000 by the Wound,
Ostomy and Continence Nurses
dent of a long-term care facility using a
Society.
cleanser for general body bathing.
Therefore, product selection decisions pri- 1071-5754/2000/$12.00 + 0
marily should be based on identification 21/1/107876
of intended users, clinical goals, and an doi:10.1067/mjw.2000.107876
JWOCN
Volume 27, Number 5
understanding of ingredients and formu-
lation concepts.
SOAP VERSUS DETERGENT
I have observed that many clinicians
make incorrect assumptions about cleans-
ing agents. For example, the terms soap
and detergent are commonly used inter-
changeably. Despite important differences
in these terms, they are often used as
generic words indicating any cleansing
product, including a laundry detergent or
a hand soap. A detergent is a cleansing or
purging surfactant.1 In contrast, a soap is a
natural surfactant made of sodium or
potassium salts. Detergents are often mis-
takenly perceived as harsh compared with
soap. In reality, the term detergent en-
compasses both soaps and synthetic deter-
gents; the synthetic detergents usually
represent milder alternatives to soaps. All
detergents contain some form of surfac-
tant. Surfactants are chemical substances
that adhere to the skin and induce changes
that facilitate the removal of dirt and
debris from the skin surface.
Soaps, which were developed as early as
1780, are made of alkali salts of fatty acids
and can be formulated as a liquid or solid
bar. Synthetic detergents were developed
in the late 1940s and early 1950s as a
milder alternative to soaps; these products
are also manufactured in liquid or bar
form. Contrary to popular myth, a liquid
formulation does not necessarily mean
that the product is nonirritating. Both nat-
ural soaps and synthetic detergents are
manufactured as liquids, and the nurse
should carefully evaluate the ingredients
and formulation when making product
decisions. Although a soap is considered a
natural detergent, it has disadvantages,
including a high pH, poor rinsing proper-
ties, and scum residue when rinsed with
hard water. These disadvantages led to the
development of milder detergents contain-
ing synthetic surfactants in the late 1940s
and early 1950s.1 Because of their synthet-
ic surfactants, liquid detergents avoid
these disadvantages associated with natur-
al soap. However, many products referred
to as soaps are actually synthetic deter-
gents, and it is possible to confuse a gentle
liquid cleanser with a relatively harsh liq-
uid soap unless the nurse remains aware of
the products ingredients and formulation.
In addition to differentiating soaps ver-
sus detergents, the nurse should identify
Nix 261
key ingredients when selecting a product
for routine skin cleansing (Box). For exam-
ple, persons with allergies may be harmed
when using a cleansing product that con-
tains one or more ingredients likely to pro-
duce a hypersensitive reaction. An under-
standing of the function of each ingredient
also helps the nurse achieve the intended
outcome. For example, if a cleanser is
needed that reduces pathogenic organ-
isms on the skin, a product with antimi-
crobial properties is selected.4-11
In addition to considerations of specific
ingredients, it is essential to understand
the total formulation and the combined
effect of individual ingredients. For exam- Both natural
ple, a highly effective cleanser (surfactant)
may achieve the goals of moving soil and soaps and
reducing bacteria counts, but it also tends
to strip away lipids and compromise cuta-
synthetic
neous barrier function. However, instead
of selecting a less effective cleanser, the
detergents
nurse may be able to combine the cleanser are
with a compatible moisturizer/condition-
ing product that restores the lipid content manufactured
of the skin.4
as liquids, and
KEY INGREDIENTS the nurse
Surfactants should
Surfactants (also known as surface act- carefully
ing agents) are chemical substances that
adhere to skin surfaces and decrease the evaluate the
amount of friction required to remove
unwanted materials (Table 1).1,12,13 Sur- ingredients
factants are incorporated into cleansing
agents because the dirt that collects with-
and
in the lipids of the skin is not effectively
removed by water alone, even with rea-
formulation
sonably vigorous mechanical washing.
The area of the surfactant molecule that
when making
provides the greatest detergent effect is product
its hydrophilic or polar region. Surfac-
tants are generally categorized into 4 decisions.
major groups based on their net charge.
Anionic surfactants have a net negative
charge, cationic surfactants have a net
positive charge, amphoteric surfactants
have both positive and negative charges,
and nonionic surfactants carry no electri-
cal charge.
Anionic surfactants include the natural
soap surfactants (eg, potassium cocoate)
and specific synthetic surfactants includ-
ing sodium lauryl sulfate (SLS), triethanol-
amine lauryl sulfate, ammonium lauryl
sulfate, and sodium stearate.1 Surfactants
such as SLS are also found in ointments
and creams as well as in cleansers. When
 JWOCN
262 Nix September 2000

Box
Glossary
Alkali salts: Strongly basic salt
Antimicrobial: An agent that kills or inhibits the growth and multiplication of microbes
Colonization: The formation of compact population groups of the same type of microor-
ganism when a bacterial cell begins reproducing
Decolonization: A procedure attempting to eradicate unwanted organisms by using antimi-
crobial agents
Detergent: Cleansing or purging agent; detergents allow fats to be suspended in water
Emollient: Any agent that softens the skin and renders it more pliant; soothes irritation in the
skin or mucous membrane
In vitro: In an artificial environment, referring to a process or reaction occurring therein, as in
a test tube or culture media
Fatty acids: Acids that occur in biologic material, particularly as esters in fats and phospho-
lipids
Irritant: An agent that causes an inflammatory response to tissue such as skin redness,
swelling, or itching
Humectant: An agent that brings about a moisturizing effect
Hydrophilic: Having an infinity for water; attracting or associating with water molecule
In vivo: In the living body, referring to a process or reaction occurring within
pH: An expression of the acidity or alkalinity of a solution; pH of 7 is neutral

Amphoteric Preservative: An agent that is added to a preparation to destroy or inhibit growth of

microorganisms
Reference: A standard against which techniques, measurements, and observations can be
surfactants compared, or upon which calculations can be measured
Reference irritant: A standard against which measurements and comparisons can be
such as made when measuring a potential irritant

cocamido- Data from references 16, 42, and 43.

propylbetaine
combine incorporated in ointments and creams, the
surfactant is used to keep the oil and the
anionic water from separating. In addition, when
applied to the skin, the surfactant helps lift
detergent dirt and oil.1,12,13
SLS is also commonly used as a gold
properties standard when demonstrating the irritat-
ing potential of detergent products. A one-
with cationic time occlusive test is typically used for
such comparisons. In this design, a sub-
disinfectant stance is placed in contact with the skin
properties. under an occlusive dressing for a given
time period (usually 24 hours). More
recently, some researchers have criticized
this method as limited because it fails to
adequately replicate the effects of cumula-
tive use in clinical situations.14,15
Cationic surfactants such as cetrimide
and benzalkonium play only a minor role
in routine skin cleansers because of their
incompatibility with anionic surfac-
tants.1,3,14 Cationic surfactants are report-
ed to be less irritating than anionic surfac-
tants, and they have some disinfect prop-
erties. Because of these limitations, cation-
ic surfactants are typically used as preser-
vatives based on their bactericidal activity.
For example, benzalkonium is widely
used as a preservative for ophthalmic
products.
Amphoteric surfactants such as cocami-
dopropylbetaine combine anionic deter-
gent properties with cationic disinfectant
properties. Activation of the surfactant
relies on the pH of the media used; most
amphoteric products have a pH of 7 or
higher. Amphoterics are often found in
baby products because of their reputation
for avoiding irritation of the eye. Never-
theless, a pH higher than 7 can disrupt
skin barrier function.1,12,13
Nonionic surfactants include polysor-
bate 20 and 60. Nonionic surfactants are
compatible with all other types of surfac-
tants. Pharmaceutical systems use nonion-
ic surfactants because they are minimally
affected by pH. They also have a low toxi-
city potential and are often used in cos-
metic and food products. Nonionic surfac-
tants are used for emulsifying, foam
boosting, and solubilizing (dissolution
of a substance within a solvent solu-
tion).1,12,13
Antimicrobials
Some cleansers combine an antimicro-
bial and surfactant to reduce bacterial col-
onization. Commonly used antimicrobials
include triclosan, chlorhexidine gluconate
(CHG), and para chloroxylenol (PCMX).
Products with CHG and PCMX are often
used in health care facilities. For example,
Hibiclens (ICA Americas, Inc, Wilming-
ton, Del) contains 4% CHG, and Sween
JWOCN
Volume 27, Number 5 Nix 263

Table 1. Common ingredients*

Product Ingredient Common uses
Surfactants
Anionicnatural Natural soap Skin cleansing
Potassium cocoate
Anionic-synthetic Sodium lauryl sulfate Ointments, creams
Triethanolamine lauryl sulfate Skin cleansing
Ammonium lauryl sulfate Toothpaste
Cationic Cetrimide Disinfectants
Benzalkonium chloride Antimicrobial
Preservatives
Amphoteric Cocamidopropylbetaine Baby shampoos
Foam boosters
Nonionic Polysorbate 20 Shampoo/cosmetic
Polysorbate 60 Food products
Laundry/dishwashing
Pharmaceuticals
Antimicrobials Triclosan
Chlorhexidine gluconate
Para chloroxylenol
Humectants/moisturizers Glycerin
Methyl glucose esters
Lactates
The addition
Lanolin derivatives of an
Mineral oil
Alcohols Isopropyl alcohol Antimicrobial antimicrobial
Benzyl alcohol
Cetyl or stearyl alcohol
Preservatives
Emollients, thickeners
agent for skin
in moisturizers and cleansing
lubricants

*Specific ingredients are less important than the effects of all the ingredients combined.
Some alcohols are emollients and are not drying to the skin.
Soft Touch (Coloplast Corp, North Man-
kato, Minn) contains PCMX. Triclosan is
also frequently used in skin cleansing
products for health care settings and com-
mercial use.2,9 Examples of the many
products containing triclosan in a health
care setting include Provon Medicated
Lotion Soap and Gentle Rain All Body
Cleanser by Coloplast Corp. Commercial
products containing troclosene include
Dial liquid soap (The Dial Corporation,
Scottsdale, Ariz) and Softsoap Gentle
Antibacterial Body Wash (Colgate-Palm-
olive Company, New York, NY).
The addition of an antimicrobial agent
for skin cleansing remains controver-
sial.8,16,17 Some researchers suggest that
the use of antimicrobial-based skin clean-
sers may be beneficial when manag-
ing patients who are colonized with
methicillin-resistant Staphylococcus aureus
(MRSA).18 However, others contend that
little convincing evidence exists that rou-
remains
controversial.
tine use of an antimicrobial cleanser is
effective or necessary. These researchers
also raise concerns that regular use of an
antimicrobial cleanser may increase the
risk of selecting for organisms that are
resistant to the agents used.16,17
The area of greatest agreement regard-
ing use of an antimicrobial agent occurs
in the context of hand washing among
health care personnel. Several studies
have compared the benefits of antimicro-
bial cleansers in hand washing among
health care personnel with cleansers with-
out an antimicrobials ingredient.6,18-20
Based on data from these studies, an an-
timicrobial cleanser is recommended for
health care providers with a high frequen-
cy of hand washing (8 or more times per
day). This advantage disappears among
persons with relatively low hand-washing
frequency (6 times or less per day).21
Current guidelines promulgated by the
Association for Professionals in Infection

264 Nix
Control state that the choice between an-
timicrobial and nonantimicrobial clean-
sers for hand washing should be based on
the degree of hand contamination and
whether it is important to reduce counts of
resident flora on the hands of health care
personnel.5
Humectants and moisturizers
Humectants may be added to a skin
cleanser because of their moisturizing
effects. Examples of humectants include
glycerin, methyl glucose esters, lactates,
lanolin derivatives, and mineral oil.
Humectants play an important role in
maintaining and restoring the skins barri-
er function. Frequent cleansing with any
soap or detergent can reduce the lipid con-
The area of tent of the stratum corneum. As a result,
the barrier function of the skin is compro-
greatest mised and its TEWL rises. This depletion
leads to dry, chapped hands and, in some
agreement instances, eczema.22 To avoid this adverse
outcome, a humectant or moisturizer may
regarding use be added to the skin cleansers to minimize
the loss of lipids. Nevertheless, these
of an ingredients only partially compensate
antimicrobial for lipid stripping during hand washing,
and an additional compatible moisturizing
agent occurs agent (a lotion or cream) should be applied
immediately following cleansing.22
in the context
Alcohols
of hand The term alcohol describes a diverse
group of products. Alcohols are available
washing as both solids and liquids and exert vary-
ing effects depending on their specific for-
among mulation. For example, isopropyl alcohol
health care acts as an antimicrobial agent, whereas
benzyl alcohol acts as a preservative. Cetyl
personnel. or stearyl alcohols serve as emollients
and thickening agents when added to
moisturizers or lubricants. When used in
this context, they safely enhance the total
formula of the product and do not dry the
skin.23
ADDITIONAL CONSIDERA-
TIONS
Acid-base Balance
Healthy skin is somewhat acidic with a
pH of 5.5.24,25 This acid mantle discour-
ages bacterial colonization and promotes
retention of moisture in the skin barrier.
The pH of a skin cleanser influences the
skins acid mantle. Because repeated
washings with an alkaline soap increase
the skins pH, a cleansing product with a
JWOCN
September 2000
pH of 4 to 7 is recommended.26 Selection
of a product with a pH between 4 and 7 is
particularly important for elderly patients
because their skin is dryer, more prone to
cracking, and slower to recover from the
effects of cleansing with a product that
alkalinizes the skin.
Most bar cleansers have a pH of 7 to 11.24
Fortunately, ingredients can be added to bar
cleansers to adjust or compensate for this
high pH. Common pH adjusters are citric
acid, phosphoric acid, sodium hydroxide,
and triethanolamine. Unfortunately, these
ingredients also tend to cause the bar to
form a gelatinous material on and below its
surface that serves as an excellent media
for bacterial growth. This disadvantage
may be alleviated by adding a filler such as
dextrin or starch. Drawbacks to fillers are a
rough surface texture and loss of slip (ie,
the bar does not slide or slip across the skin
as well). Unfortunately, the pH is not usual-
ly listed on the product package, and it is
often necessary to ask the company for the
pH of a particular product.
Bar Versus Liquid Cleansers
Much has been written and debated
regarding the use of bar versus liquid skin
cleansers in relation to infection con-
trol.5,18,27-35 Some infection control experts
contend that bar soaps are frequently mis-
used because they are typically stored in
contact with moisture. The resulting jelly
mass is unsightly, difficult to use effec-
tively, and may harbor live pathogenic
bacteria.35
Bar soap was included in one study of
objects in the health care setting that were
subjected to use by multiple persons.27
The researchers isolated several strains of
Pseudomonas from 45 of 353 environmental
samples used by multiple providers (13%)
and found that the 5 most common strains
were frequently found on patients. They
also affirmed that the hands are a major
vehicle for the transfer of Pseudomonas bac-
teria and implicated bar soap in its
spread.27,35 Other researchers have found
that bacteria survive on soap bars in con-
tinuous use in public lavatories, even
when cultured 48 hours following their
last use.28
The role of the soap dish in infection
control has also been studied.19 Swabs
were collected from soap dishes on 6
wards and from a bacteriology laboratory
on 4 consecutive days. The sludge of the
dish was found to be colonized with pre-
dominantly gram-negative bacteria. This
JWOCN
Volume 27, Number 5
colonization persisted, even when a med-
icated iodophor bar soap was used. Other
supplies used for hand washing can be
contaminated with gram-negative organ-
isms if they are not completely dried. For
example, bath oils may spill onto adjacent
surfaces, creating a medium for bacterial
growth. Furthermore, at least two studies
have shown that bathing with bar soap
does not eliminate colonization. Instead, it
may simply shift bacteria to adjacent sites
on the body.27,31
Researchers from the Dial Corporation
have disputed observations that bar soap
is likely to transfer bacteria.32-34 They
studied 16 adults who washed with
Escherichia coli-inoculated bars using their
normal hand-washing procedure.34 Even
after noncoached washing, none of the 16
subjects had detectable levels of the bac-
terium on their hands.32-34
Some researchers have concluded that it
would be prudent to encourage the use of
liquid skin cleansers rather than bar
soap.28 Samples obtained from bar and
liquid soaps from 26 public bathrooms
were investigated. Liquid soaps were
found to be negative for bacteria, while
100% of the 84 samples obtained from bar
soaps yielded positive cultures.28
In addition to choosing between a bar
and liquid format, skin cleanser quantity
affects bacterial colonization. Larson and
associates35 compared bacterial colony
counts on the hands of 40 subjects ran-
domly assigned to 1 of 4 products in
aliquots of 1 versus 3 mL. When compared
with those using 1 mL, subjects using 3
mL of cleanser had a significant reduction
in bacterial colonization. Liquid cleansers
have the potential to dispense a predeter-
mined amount of product (typically 1
pump = 1 mL), allowing some control
over the volume of cleanser dispensed.
This represents another possible advan-
tage over bar soap, because with bar soap
the volume of cleanser used cannot be
measured with any degree of accuracy.
When a liquid cleanser is used, the
Centers for Disease Control and Prevention
(CDC) recommends that dispensers remain
closed until they are replaced or cleaned
and filled with fresh product.20 Some dis-
pensers are designed to prevent access for
any purpose (such as topping off or a par-
tial refill) other than disposal of an empty
cartridge and replacement with a new,
full sealed unit. This technique is optimal
because it eliminates the need for cleaning
or opening the product, allowing potential
Nix 265
contamination.
When using a bar of soap, the CDC rec-
ommends placement on a drainable rack
between uses. Soap racks that promote
drainage of all water from the bar should
be installed. In addition, there should be
easy access to replacements when soap is
lost, dropped, melted, or consumed.
Others recommend that small soap bars
that can be changed be used in preference
to larger bars that are more likely to melt or
become colonized with bacteria.20,36
A final factor to consider when choosing
between a bar and liquid cleanser is the
need for education. When a soap bar is used
for routine cleansing of the skin, it is neces-
sary to educate staff and patients regarding
the use of drainable soap dishes. These
users typically include patients, staff, and
visitors who present a variety of teaching
Some
challenges such as language barriers, age
and developmental differences, varied edu-
infection
cational and literacy, as well as differing control
motivation. In contrast, education for the
proper installation and filling of liquid experts
cleansers can be limited to personnel in spe-
cific departments who are trained to per- contend that
form of this task. In addition, the proper use
of a pump skin cleanser dispenser may be bar soaps are
easier when compared with the use and
maintenance of a bar of soap.
frequently
Acceptability and
misused
Compliance because they
The accessibility and convenience asso-
ciated with hand washing is considered are typically
the most powerful determinant in ensur-
ing compliance and subsequent reduction stored in
of nosocomial infections.37 Health care
workers have been examined for factors
contact with
leading to compliance with hand-washing
policies. Persons who complied less fre-
moisture.
quently with hand-washing policies
placed significantly more value on the
detrimental effects of the products on their
own skin integrity. For example, persons
who report having dermatitis that is relat-
ed to skin cleanser use are less likely to
comply with hand-washing policies than
those without hypersensitivity.38 One
study documented higher levels of staff
satisfaction and lower incidence of skin
damage with a triclosan product com-
pared with a CHG product.6 An increased
emphasis on the use of products that min-
imize skin irritation may be more effective
in achieving compliance than mandatory
educational programs emphasizing the
importance of hand washing.38,39 In addi-
tion, ensuring that moisturizers are readi-
 JWOCN
266 Nix September 2000

Table 2. Examples of product tests

Test
Stability test
Potential for allergy
Dermal irritancy potential
Preservative challenge*
Feature(s) tested
Odor, pH, viscosity
Potential for allergy
Dermal irritancy potential
challenge test
Prevention from microbial
contamination
Basic description
An in vitro test that measures the
degree of resistance to chemical
changes of a formula43
Human repeat insult patch test in
vivo on healthy humans or ani-
mals40,41
In vivo on healthy humans40,41
14-day cumulative irritation with
Microorganisms are introduced in
vitro to the product and evaluated

This distinction over a period of 28 days43; preserva-

tives efficacy is 99.9% reduction of
is clinically viable bacterial within 14 days, and
maintenance at these levels for the
relevant remainder of the test period

because Time kill study Rapid microbial kill rate Measures the time that an antimi-
crobial product takes to reduce
clinicians microbial contamination of the skin
to an acceptable level
can easily *A product effective against methicillin-resistant Staphylococcus aureus does not necessarily mean it
misinterpret a removes methicillin-resistant Staphylococcus aureus from skin; it could simply meet the preservative chal-
lenge test.

product claim Celsis Laboratory Group, New Jersey Division, Edison, NJ 08837.

such as ly accessible for use after handwashing
may enhance compliance by minimizing
effective skin irritation associated with frequent
handwashing.
against MRSA
as implying Product Testing Data
Before marketing a skin cleanser, the
use of the product may be tested for safety and func-
tion40,41 (Table 2). If safety testing is not
cleanser done, a warning statement must be applied
to the package. Provided safety testing has
removes been completed, the manufacturer can sup-
ply a summary of the safety tests that have
MRSA from been performed on a specific product.
These tests should evaluate stability, poten-
skin. tial for allergy, dermal irritancy, and preser-
vative efficacy. Antimicrobial effectiveness
should also be demonstrated when indicat-
ed using an in vitro minimum inhibitory
concentration technique or an in vivo time
kill study technique using human subjects.
When reviewing product safety data, it
should be emphasized that a preservative
challenge test implies that a certain type of
microorganism is not likely to grow inside
the product. This test was not designed to
indicate the effect of the product on the
skin. This distinction is clinically relevant
because clinicians can easily misinterpret a
product claim such as effective against
MRSA as implying use of the cleanser
removes MRSA from skin. Instead, the cor-
rect interpretation of such as claim is limit-
ed to testing that demonstrated that MRSA
does not grow when placed in the product
package or on an object other than human
skin.
SUMMARY
The consequences of choosing an inap-
propriate cleansing product are significant
because this can lead to reduced compli-
ance with hand washing, increased noso-
comial infection, and an increased inci-
dence of dermatitis. The primary factors
the WOC nurse should consider when
offering advice for the selection of a skin
cleansing products must begin with the
purpose, the clinical goals, and the per-
sons expected to use the product. Clearly,
one product will not meet all of the needs
in a health care setting. Products pur-
chased for hand washing, for example,
can be inappropriate for general bathing.
Components such as surfactant type, pH,
humectants, and moisturizers can have a
significant impact on how skin cleansers
perform for health professionals and the
patients they serve.
JWOCN
Volume 27, Number 5
Acknowledgments
I thank Sharon Carlson, RN, CIC, for her
guidance and expertise in the area of infection
control. I thank Cathy Garvin, RN, CWOCN,
and Clark L. Thompson, BS, MS, for sharing
their knowledge related to formulations and
testing.
REFERENCES
1. Friedman M, Wolf R. Chemistry of soaps and
detergents: various types of commercial prod-
ucts and their ingredients. Clin Dermatol 1996;
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2. Thune P. The effects of detergents on hydration
and skin surface lipids. Clin Dermatol 1996;14:29-
33.
3. Wysocki A, Bryant R. Skin. In: Acute and chronic
wounds nursing management. St. Louis (MO):
Mosby-Year Book, Inc; 1992. p. 1-30.
4. Dooms-Goossens A, Blockeel I. Allergic contact
dermatitis and photoallergic contact dermatitis
due to soaps and detergents. Clin Dermatol
1996;14:67-76.
5. Larson E. APIC guideline for handwashing and
hand antisepsis in health care settings. Am J
Infect Control 1995;23:251-69.
6. Webster J. Handwashing in a neonatal intensive
care nursery: product acceptability and effec-
tiveness of chlorhexidine gluconate 4% and tri-
closan 1%. J Hosp Infect 1992;21:137-41.
7. Yamamoto K. Soaps and detergents in children.
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