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PubMed2000

Skin irritation and dryness associated with two hand-hygiene regimens: soap-and-water hand washing versus hand antisepsis with an alcoholic hand gel.

OBJECTIVE: To compare the frequency of skin irritation and dryness associated with using an alcoholic-hand-gel regimen for hand antisepsis versus using soap and water for hand washing. DESIGN: Prospective randomized trial with crossover design. Irritation and dryness of nurses' hands were evaluated by self-assessment and by visual assessment by a study nurse. Epidermal water content of the dorsal surface of nurses' hands was estimated by measuring electrical capacitance of the skin. SETTING: Miriam Hospital, a 200-bed university-affiliated teaching hospital. PARTICIPANTS: Thirty-two nurses working on three hospital wards participated in the trial, which lasted 6 weeks. RESULTS: Self-assessment scores of skin irritation and dryness decreased slightly during the 2 weeks when nurses used the alcoholic-hand-gel regimen (mean baseline score, 2.72; mean final score, 2.0; P=.08) but increased substantially during the 2 weeks when nurses used soap and water (mean baseline score, 2.0; mean final score, 4.8; P<.0001). Visual assessment scores by the study nurse of skin irritation and dryness did not change significantly when the alcoholic-hand-gel regimen was used (mean baseline and final scores were both 0.55), but scores increased substantially when nurses used soap and water (baseline score, 0.59; mean final score, 1.21; P=.05). Epidermal water content of the dorsal surface of nurses' hands changed little when the alcoholic-hand-gel regimen was used (mean+/-standard deviation baseline electrical capacitance reading, 24.8+/-6.8; mean final reading, 25.7+/-7.3), but decreased significantly (skin became dryer) with soap-and-water hand washing (mean baseline, 25.9+/-7.5; mean final reading, 20.5+/-5.4; P=.0003). CONCLUSIONS: Hand antisepsis with an alcoholic-hand-gel regimen was well tolerated and did not result in skin irritation and dryness of nurses' hands. In contrast, skin irritation and dryness increased significantly when nurses washed their hands with the unmedicated soap product available in the hospital. Newer alcoholic hand gels that are tolerated better than soap may be more acceptable to staff and may lead to improved hand-hygiene practices.

Antisepsis↗

PubMed1999

Fist position for skin grafting on the dorsal hand: I. Analysis of length of the dorsal hand surgery in hand positions.

In skin grafting for reconstruction of burns and contracture deformities of the dorsal hand, the hand is kept in a proper position to provide the greatest amount of skin and to avoid the secondary functional deformity. The safe position has been commonly used for immobilizing the hand, but this is to protect the hand function rather than to provide maximal surface for skin grafting. Split-thickness skin graft contracts up to 30 to 50 percent of the original size owing to secondary contraction. If insufficient skin is grafted, contracture deformity of the dorsal hand may occur. To graft the greatest amount of skin on the dorsal hand, the hand should be kept preoperatively in a position flexing all joints of the wrist, metacarpophalangeal joints, and interphalangeal joints and maximally stretching the dorsal hand (a fist position). We studied the surface length of the dorsal hand between the wrist, the metacarpophalangeal joint, and the eponychium in the anatomic, safe, and fist positions of the right hand in 60 adults. Difference of total length between the anatomic and safe positions was not statistically significant (p > 0.05). The total length in a fist position was significantly increased in comparison with the other two positions (p < 0.05). In a fist position compared with the safe position, the increase in length of the dorsal surface of the proximal hand was 11 to 20 percent except in the thumb, and the increase in length of the dorsal surface of the finger was 12 to 17 percent. The increase in total length of a fist position was about 9 mm (7 to 8 percent) in the thumb and 20 to 32 mm (14 to 18 percent) in the index to little fingers. It suggests that the safe position fails to provide an increased dorsal hand surface area for skin grafting compared with the anatomic position. The greatest amount of skin can be grafted in a fist position. Hand immobilization in a fist position for 7 to 9 days after skin grafting has not resulted in irrevocable joint stiffness in our experience. If injury of the deep structures is not present, the hand should be immobilized in a fist position before skin grafting on the dorsal hand.

Adult↗

PubMed2002

Joint protection and home hand exercises improve hand function in patients with hand osteoarthritis: a randomized controlled trial.

OBJECTIVE: To determine the effect of joint protection and home exercises on hand function of patients with hand osteoarthritis (OA). METHODS: Randomized, controlled, 3-month trial with a blinded assessor. Primary outcome parameter was grip strength; secondary parameters were Health Assessment Questionnaire and visual analog scales (VAS) for pain and global hand function. Forty patients with hand OA were randomly assigned to 2 groups: One group received instruction for joint protection and home hand exercises (JPE group), the control group received an information session about hand OA. RESULTS: Grip strength improved by 25% in the JPE group (right hand, P < 0.0001; left hand, P = 0.0005), but not in the control group. Global hand function (by VAS) improved in a larger proportion (65%) of patients in the JPE group (P < 0.05). CONCLUSIONS: Joint protection and hand home exercises, easily administered and readily acceptable interventions, were found to increase grip strength and global hand function.

Ambulatory Care↗

PubMed2006

Does a preceding hand wash and drying time after surgical hand disinfection influence the efficacy of a propanol-based hand rub?

BACKGROUND: Recently, a propanol-based hand rub has been described to exceed the efficacy requirements of the European standard EN 12791 in only 1.5 min significantly. But the effect of a 1 min preceding hand wash and the effect of one additional minute for evaporation of the alcohol after its application on the efficacy after a 1.5 min application time has never been studied. METHODS: We have investigated a propanol-based hand rub (Sterillium, based on 45% propan-2-ol, 30% propan-1-ol and 0.2% mecetronium etilsulfate) in three variations: with (A) and without (B) a 1 min hand wash before the disinfection of 1.5 min with immediate sampling after the disinfection; and (C) without a hand wash before the disinfection but with sampling 1 min after the disinfection. The efficacy of the three variations was compared to the reference treatment of EN 12791. All experiments were performed in a Latin-square design with 20 volunteers. Pre- and post-values (immediate and after 3 hr) were obtained according to EN 12791. RESULTS: The 3 min reference disinfection reduced resident hand bacteria on average by 1.8 log10 steps (immediate effect) and 1.4 log10-steps (sustained effect) respectively. Method A was equally effective as the reference (immediate efficacy: 1.5 log10-steps; sustained efficacy: 1.6 log10-steps). Method B seemed to be more effective (immediate efficacy: 2.3 log10-steps; sustained efficacy: 1.7 log10-steps). Method C revealed the best efficacy (immediate efficacy: 2.3 log10-steps; sustained efficacy: 2.0 log10-steps). A comparison of all three treatment variations and the reference treatment revealed a significant difference for the immediate efficacy (p = 0.026; Friedman test), but not for the sustained efficacy (p = 0.430). A post-hoc-test for the immediate efficacy indicated a significant difference between methods A and C (p < 0.05; Wilcoxon-Wilcox test). Hence, none of the treatment variations was significantly less effective than the reference treatment. CONCLUSION: An application of the propanol-based hand rub for 1.5 min after 1 min hand wash fulfills the efficacy requirements of EN 12791. The efficacy can be improved to some extent by omitting the preceding hand wash and by awaiting the evaporation of the alcohol which is clinical practice anyway. The preceding hand wash has the most negative effect on the immediate effect. Based on our data hands should not be routinely washed before the disinfection period unless there is a good reason for it such as visible soiling.

Anti-Infective Agents, Local↗

PubMed1990

Relationship of testosterone and nonverbal intelligence to hand preference and hand skill in right-handed young adults.

The relationship between serum testosterone level and nonverbal intelligence was studied in right-handed young adults with regard to handedness. Hand preference was assessed by the Edinburgh Handedness Inventory. Hand skill was measured by a peg moving task. Serum testosterone level was determined using tritium-marked-radioimmunoassay. Visual-spatial performance (nonverbal intelligence) was measured by Cattell's Culture Fair Intelligence Test. In men with consistent right-hand preference (GSs: 80 to 100), IQ was found to be positively linearly related to serum testosterone, which exhibited two regression lines belonging to low and high difference in skill between hands. In females with consistent right-handedness, there was a negative linear correlation between IQ and serum testosterone, which also exhibited two different regression lines according to difference in skill between hands. In males with moderate right-hand preference (GSs 50 to 75), IQ was found to be positively linearly related to serum testosterone, exhibiting two different (same slopes) regression lines according to difference in skill between hands. In females with moderate right-hand preference, IQ first increased and then decreased with serum testosterone, exhibiting a quadratic relationship. These results suggested that serum testosterone in young adults may be associated with visual-spatial performance depending upon sex, hand preference, and hand skill.

Adolescent↗

PubMed1992

Testosterone and estradiol in right-handed men but only estradiol in right-handed women is inversely correlated with the degree of right-hand preference.

Relations of sex hormones to the degree of right-hand preference was studied in right-handed male and female adult subjects. Hand preference was assessed by the Edinburgh and Waterloo Handedness Questionnaires. Males consisted of weakly, moderately, and strongly right-handed subjects. Females comprised only moderately and strongly right-handed subjects. In females, only serum estradiol was found to be negatively linearly and significantly correlated with the degree of right-hand preference. In males, testosterone, as well as estradiol, showed a significant negative linear correlation with the degree of right-hand preference. Sex hormone binding globulin also showed a similar relation to hand preference in males. Thus, nearly all sex hormones caused a decrease in the degree of right-hand preference in males, whereas only estradiol had the same effect on hand preference in females. This would be the cause of stronger right-hand preference in females than males and vice versa.

Adolescent↗

PubMed1993

Sensory nerve conduction velocities are higher on the left than the right hand and motor conduction is faster on the right hand than left in right-handed normal subjects.

Lateralization in the sensory and motor nerve conduction velocities was studied in right-handed normal subjects. The nerve conduction velocities (NCVs) were measured in hands. Sensory NCVs were found to be higher on the left hand than the right hand. The motor NCVs did not show a statistically significant difference between the right and left hands. However, the motor conduction velocity measured from median nerve to the action potential from abductor pollicis brevis muscle was found to be significantly higher in the right hand than the left hand. It was concluded that fast conducting neuromuscular junctions on the right hand muscles would contribute to relatively fast right hand in right-handers. Relatively fast conducting sensory nerves in the left hand may contribute to a relatively better perception by the right cerebral hemisphere in right-handers.

Brain↗

PubMed1979

Cerebral potentials during smooth goal-directed hand movements in right-handed and left-handed subjects.

During smooth goal-directed hand movements a negative potential shift can be recorded from the human scalp. This goal-directed movement potential (GDMP) is preponderant over central areas with a maximum at the vertex and, over the motor cortex, contralaterally larger than ipsilaterally to the moving hand. In 11 right-handed and 6 left-handed subjects, the morphology and distribution of these potential shifts were studied in relation to task differences, moving hand and handedness. The results show a functional differentiation of two components of the GDMP: (1), a lateralized, slow negative wave, restricted to the precentral area and selectively varying with the hand used, and (2), a widespread, bilateral symmetrical component, selectively influenced by task-specific and individual factors. Two effects reflect an influence of the subject's handedness on the GDMP: (A) averaged for both hand conditions, there are larger amplitudes over the hemisphere contralateral to the dominant hand, and (b), averaged for both hemispheres, larger amplitudes result from using the non-dominant hand.

Adolescent↗

PubMed2006

The effects of the diabetes related soft tissue hand lesions and the reduced hand strength on functional disability of hand in type 2 diabetic patients.

OBJECTIVES: The aim of the present study is to examine the effects of diabetes related soft tissue hand lesions such as Dupuytren's disease, trigger finger and limited joint mobility (LJM) and the reduced hand strength on the functional disability of the hand in type 2 diabetic patients. METHODS: Forty-four type 2 diabetic patients and 60 age and sex matched controls were included in the study. Subjects were examined for the presence of Dupuytren's disease, trigger finger and LJM. Grip strength was tested first with Jamar dynamometer followed by pinch strength measurements using by a manual pinchmeter. Electrophysiological studies were performed in both groups. Duruöz Hand Index (DHI) was used to assess the functional hand disability. RESULTS: The mean DHI score of the diabetics was significantly higher than controls (p<0.0001). Dupuytren's disease, trigger finger or LJM was not correlated with DHI in diabetic patients (p>0.05). The grip and pinch strengths were significantly lower in diabetic patients than the non-diabetic controls (p<0.05) and the grip and pinch strengths were negatively correlated with DHI in type 2 diabetic patients (p<0.001). CONCLUSION: Dupuytren's disease, trigger finger and LJM did not cause to functional disability of hand but low hand strength was found to cause functional disability of hand in our type 2 diabetic patients.

Aged↗

PubMed2002

Influences of hand posture and hand position on compatibility effects for up-down stimuli mapped to left-right responses: evidence for a hand referent hypothesis.

Unimanual left-right responses to up-down stimuli show a stimulus-response compatibility (SRC) effect for which the preferred mapping varies as a function of response eccentricity. Responses made in the right hemispace and, to a lesser extent, at a midline position, are faster with the up-right/down-left mapping than with the up-left/down-right mapping, but responses made in the left hemispace are faster with the up-left/down-right mapping. Also, for responses at the midline position, the preferred mapping switches when the hand is placed in a supine posture instead of the more usual prone posture. The response eccentricity effect can be explained in terms of correspondence of asymmetrically coded stimulus and response features, but it is not obvious whether the hand posture effect can be explained in a similar manner. The present study tested the implications of a hypothesis that the body of the hand provides a frame of reference with respect to which the response switch is coded as left or right. As was predicted by this hand referent hypothesis, Experiment 1 showed that the influence of hand posture (prone and supine) on orthogonal SRC was additive with that of response location. In Experiment 2, the location of the switch relative to the hand was varied by having subjects use either a normal grip in which the switch was held between the thumb and the index finger or a grip in which it was held between the little and the ring fingers. The magnitudes of the mapping preferences varied as a function of the grip and hand posture in a manner consistent with the hand referent hypothesis.

Functional Laterality↗

PubMed2003

Hand function tests and questions on hand symptoms as related to the Stockholm workshop scales for diagnosis of hand-arm vibration syndrome.

The severity of hand-arm vibration syndrome (HAVS) is usually graded according to the Stockholm workshop scales. Although the Stockholm workshop scales are regarded the gold standard for assessing the severity of HAVS, they are based primarily on subjective symptoms. The aim of the present study was to explore the agreement between Stockholm workshop scales and the outcome from ten well-defined clinical tests commonly used in hand rehabilitation for assessment of hand function. One hundred and eleven vibration-exposed workers participated in the study. Ten objective tests of hand function and four questions on subjective hand symptoms were included. The results indicated that, out of these tests, perception of vibration, perception of touch/pressure and dexterity showed a moderate agreement with Stockholm workshop scales. Among specific questions on hand symptoms, cold intolerance and pain showed a high agreement with Stockholm workshop scales. It is concluded that defined objective tests combined with directed questions on specific hand symptoms, together with the Stockholm workshop scales, may be helpful for diagnosing HAVS.

Adult↗

PubMed1996

Alien hand syndrome of the dominant hand and ideomotor apraxia of the nondominant hand.

Following an extended infarction in the territory of the left anterior cerebral artery including the anterior corpus callosum, a 66-year-old right-handed man exhibited an alien hand syndrome on the right side and an ideomotor apraxia of the left hand. In addition to other typical symptoms of frontal lobe lesions, he presented with an interesting difference in the manifestation of perseveration in either hand. In the right hand, the perseveration was part of the alien hand syndrome, whereas in the left hand perseveration showed in the inability to switch promptly from one movement to another on instruction during praxis testing.

Aged↗

PubMed2006

Comparison of a waterless hand-hygiene preparation and soap-and-water hand washing to reduce coliforms on hands in animal exhibit settings.

Outbreaks of enteric disease associated with exposure to live animals on exhibit have occurred with increasing frequency in recent years. Possibly the most important pathogen causing such outbreaks is Escherichia coli O157:H7, because of the serious illness it can cause. Hand hygiene is consistently protective against disease among persons exposed to animals implicated in these outbreaks. Livestock barns have limited hand-washing facilities, therefore a waterless hand-sanitizing gel would be a potentially preventive measure readily available to visitors and animal exhibitors. This study compared the reduction of bacterial counts on hands of animal exhibitors when soap and water was used or when an ethanol-based hand gel was used after animal handling. Participants were youth and adults involved with showing livestock. The sanitation methods were similar in reducing the total bacteria and coliform counts on the hands of the participants (Wilcoxon rank sum test P values 0.12 and 0.69 respectively).

Animals↗

PubMed1988

Jebsen Hand Function Test: performance of the uninvolved hand in hemiplegia and of right-handed, right and left hemiplegic persons.

The Jebsen Hand Function Test was administered to 50 hemiplegic patients within three weeks of their admission to a rehabilitation center. Participants in the study demonstrated significantly slower performance on all items of the test for both the nonparetic and paretic hands when comparisons of scores were made with previously published norms. A further analysis of test results was made among all right-handed subjects. The left hemiplegic group performed all subtest items more slowly than right hemiplegic subjects with the weak hand. Performance with the nonparetic hand was significantly different between left and right hemiplegic subjects only on the writing subtest. These differences cannot be exclusively explained by either hand dominance or hemispheric specialization.

Aged↗

PubMed1984

Differential laterality of hand function in right-handed and left-handed boys.

This study was designed to investigate differences in the degree of manual lateralization between right-handed and left-handed normal boys. Sixty-three 5, 7, and 9 year olds were tested on the Minnesota Rate of Manipulation Test (displacing subtest and turning subtest), the Finger Tapping Test, the Purdue Pegboard (placing subtest and assembly subtest), and the Southern California Motor Accuracy Test--Revised. Significant differences between right- and left-handed subjects were obtained on two of the six measures, and a third measure approached significance, with less lateralization among the left handers than among the right handers. Subsequent analyses indicated that differences in lateralization were significant or near-significant in the 5 and 7 year olds. By 9 years of age, right- and left-handed subjects no longer differed in the degree of laterality. Differences in degree of laterality, or the lack of such differences, between young right- and left-handed boys might be a function of the nature of the fine motor task or a function of the child's previous experience with the task.

Age Factors↗

PubMed1986

Bimanual hand writing in right-handed and left-handed stutterers and nonstutterers.

Right-handed stutterers performed more poorly with their nondominant hand when writing digits and letters bimanually, and also made more nondominant hand mirror reversals than did nonstutterers. Left-handed stutterers and nonstutterers differed only in the incidence of mirror reversals with the nondominant hand. The results support the hypothesis that disorganization in the integration of left- and right-hemisphere inhibitory and excitatory processes may be an integral component of stuttering.

Adolescent↗

PubMed1989

Hand protection and protection from hands: hand-washing, germicides and gloves.

A variety of soaps, detergents, germicides, and protective gloves are available for use by health care workers. Appropriate hand-washing and glove use will reduce the possibility of spread of infectious organisms from patient to staff, from patient to patient, and from staff to patient. Both hand-washing and glove use can have adverse effects. Excessive hand-washing, mechanical irritation from scrubbing, use of germicides, and wearing of gloves can result in irritant and allergic dermatitis. Dermatitis will result in an increased risk of infection to both the worker and the patient.

Cross Infection↗

PubMed2006

Dissociated small hand muscle atrophy in aging: the 'senile hand' is a split hand.

The term 'split hand' refers to a pattern of dissociated atrophy of hand muscles and was first described in ALS. We hypothesize that this phenomenon also occurs in 'normal' aging. We investigated healthy subjects of different ages and found a progressive dissociation in atrophy of the hand muscles, as measured with compound muscle action potential amplitudes, with increasing age. Different possible causes of this progressive dissociation are discussed. It might be related to preferential use of thenar muscles in humans, which render these muscles and their motor neurons more susceptible to oxidative stress. In addition, a difference in intrinsic susceptibility to oxidative stress might be involved. The relation between normal age-related muscle loss (sarcopenia) and the pathologic loss in motor neuron disease is discussed.

Adolescent↗