Alcohol-based hand sanitizer’s effect on hand barrier function induced Staphylococcus lugdunensis aortic and mitral valve endocarditis: a case report

Abstract

Background: The World Health Organization (WHO) and national disease control agencies emphasized the importance of hand hygiene to reduce the spread of the virus during COVID-19 pandemic to curb the spread of the virus coupled with vaccination. Alcohol-based hand sanitizer (ABHS) formulation is effective to reduce or eliminate bacterial or viral load, and commonly applied in the form of hand rub rinses, gel and foam, but it may impair skin barrier integrity and function, increasing the risk of hand dermatitis resulting local and/or systemic infections. Case Description: A 75-year-old woman used ABHS excessively without skin moisturizer resulted in bilateral dry skin-crack hands. Two weeks prior to hospital admission, she experienced progressive generalized fatigue, shortness of breath with moderate exertion, bilateral lower leg edema, orthopnea and paroxysmal nocturnal dyspnea associated with fever and chills. She was diagnosed with Staphylococcus lugdunensis (S. lugdunensis) aortic and mitral valve endocarditis. Intravenous (IV) antibiotics coupled with urgent cardiac surgery to replace the aortic valve, debridement and reconstruction of the left ventricular outflow track followed by a complex mitral valve repair. Her post-operative course complicated by requiring intra-aortic balloon pump (IABP), veno-venous extracorporeal membrane oxygenation (VV-ECMO) and continuous venous-venous hemodialysis (CVVHD). Despite decannulation of all three mechanical supports, the patient continued to have multiple intensive care unit (ICU) related medical and surgical complications, resulted in her mortality. Conclusions: Excessive use of ABHS without moisturizer can induce dry hands and skin damage, resulting in irritant or allergic contact dermatitis. The injured skin is a potential host for local and systemic infections such as the described case of S. lugdunensis endocarditis.