[Quality management in occupational dermatology]

BACKGROUND

Health care of patients with occupational dermatitis (OD) in the sense of suspected "BK 5101" is carried out in Germany within the optimized dermatologist's procedure and the "dermal intervention" (formerly: hierarchical multistep intervention approach) of the statutory accident insurance (UVT), respectively.

OBJECTIVES AND METHODS

Dermatologists and UVT administrators are obliged to improve OD patient care by continuous quality management measures. Essential quality management elements include the research projects EVA_Haut and VVH, the clearing procedure of the Task Force on Occupational and Environmental Dermatology (ABD), training of dermatologists to receive the CME certificate "Occupational Dermatology (ABD)", the establishment of processing standards for administrators and optimized dermatologist's report forms (based on the results of all the above steps taken).

RESULTS

It was shown that the optimized dermatologist's procedure and "dermal intervention" are established in Germany. Also, the available preventive and therapeutic measures for OD patients are effective. Despite the increase of cases with suspected OD, the number of cases in which a career change was required is almost constant (3 %); at the same time the percentage of notified cases which, as a result, are covered within the dermatologist's procedure by the UVT is rising (86 %). The measures recently taken have continuously increased quality of health care in occupational dermatology.

[Allergic contact dermatitis to metals over a 20-year period in the Centre of Portugal: evaluation of the effects of the European directives]

INTRODUCTION

Metals are a common cause of allergic contact dermatitis. After the introduction of the EU Nickel Directive (1994/27/CE; 2004/96/EC) and, more recently, the Cement Directive (2003/53/EC) there has been a significant decrease in sensitization to metals mainly in the Nordic countries. The applicability of these directives and their impact in the Portuguese population is unknown.

MATERIAL AND METHODS

A retrospective study (1992-2011) was carried out in our patch test clinic to assess the temporal trend of metal sensitization (nickel [Ni], cobalt [Co] and chromium [Cr]) along the last 20 years, particularly considering age, sex and its relation with occupational activity.

RESULTS

Out of 5 250 consecutively patch-tested patients, 1 626 (31%) were reactive to at least one metal (26.5% to Ni; 10.0% to Co and 7.9% to Cr). Women had a higher prevalence of sensitization to Ni (34.4% vs 8.9%) whereas men were more reactive to Cr (11.5% vs 5.0%). Nickel sensitization did not decrease significantly over the years, although in recent years among women sensitized to nickel the percentage of younger patients (16-30 years-old) is significantly lower (p < 0.001). Chromium sensitization significantly decreased, particularly in men (r = -0.535), and mainly in the construction workers (r = -0.639). Chromium reactivity associated with the shoe dermatitis has remained stable.

DISCUSSION

We emphasize the higher and stable percentage of nickel sensitized individuals suggesting, so far, a low impact from the EU Ni directive, although a decreasing percentage in the the younger group among Ni sensitized women may suggest a beneficial effect is becoming evident is this age group. On the contrary, the impact of the directive regarding the modification of Cr in cement seems to be effective. There is now a need to regulate chromium content in leather products, namely in shoes.

CONCLUSIONS

The regulation of interventional measures related either to the manufacture and trade of adornments or professional use will better protect the population of allergy to metals.

[Barrier creams in prevention of hand dermatoses]

Contact dermatitis is a common skin disease in the workplace and at home. Due to the high incidence of skin diseases the European Union countries have taken the activity to reduce or minimize this problem by the promotion of skin protection program, based on the application of skin protection measures - barrier creams and moisturizers. Definitions, reasons, mechanism of action and duration, application of methods, as well as the efficacy of using skin protection products in different workplaces are extensively reviewed in this article. Correctly matched barrier preparations protect against harmful factors and irritants, facilitating at the same time hand washing at the end of the working day, and together with the use of suitable non-irritating detergents and skin care products are important elements contributing to the prevention of occupational skin diseases. They shouldn't be used as a primary protection against high-risk substances. Numerous creams declared as the skin protection measures are on the market, so a careful selection of appropriate effective skin protecting barrier cream for the specific situations/environments is recommended.

Latex allergy in women's health care

Latex allergy in midwifery and women's health care is not a new concept, with numerous case reports documenting adverse reactions in pregnant women to natural rubber latex in the birthing room. The practising midwife, nurse and sonographer need to be aware of the signs and symptoms of latex allergy and the implications of a severe reaction to latex not only to the woman but also the unborn child.

[Prevention of occupational dermatitis in an international perspective]

Occupational dermatitis (OD) have always been a significant part of the occupational disease with huge social and economic costs. Traditionally, the standard program of OD prevention takes place in the three phases of protection, cleansing and use of emollient creams and other products able to improve the cutaneous trophism (skincare) at the end of the shiftwork. However, in countries like Germany where protection measures and skincare were widespread, there was not a simultaneous decrease in the OD. In recent years pilot programs for the prevention of OD have been implemented with positive results. In particular the integrated approach that includes three steps of primary, secondary and tertiary prevention (Osnabrueck model) is of great interest. Primary prevention is represented by introduction of technical regulations, pre-employment counselling and specific initiatives to promote health (healthy skin campaign). In the case of initial/minor OD, secondary prevention is accomplished through the dermatological treatment of the patient and 1-2 days outpatient education initiatives/skin protection training. In severe cases of individual OD, tertiary prevention involves the hospitalization of the patient in a dermatology department. In 2009 the European network EPOS (European Initiative for the Prevention of Occupational Skin Diseases) of preventive dermatology has been organized basing on the integrated approach of primary, secondary and tertiary prevention.

Recent advances in research on lacquer allergy

Allergic contact dermatitis caused by contact with lacquer sap and lacquerware affects the welfare of lacquer workers and the lacquerware industry. Many studies of the mechanism of urushiol allergy, including animal models, have been carried out and have established several hypotheses. In order to provide a comprehensive understanding of lacquer allergy, we review recent advances in the research on lacquer allergy including the chemical properties of lacquer lipid components, allergic mechanism analyses, immunological explanations, allergy medications, and the prevention combined with the research results from our laboratory.

Epoxy pipe relining - an emerging contact allergy risk for workers

BACKGROUND

Epoxy pipe relining is a method of repairing old and worn water pipes supplying households. The method, using epoxy resin systems (ERSs), involves creating a new pipe inside an existing pipe. Large amounts of epoxy are normally handled at small, temporary worksites.

OBJECTIVES

To describe working conditions and contact allergies to ERSs in 8 patients with occupational contact dermatitis related to their work in the relining trade.

METHODS

Eight patients with suspected work-related eczema in the relining trade were referred to our Occupational and Environmental Dermatology outpatient unit. They were examined and patch-tested between August 2010 and May 2011.

RESULTS

Seven patients were patch test-positive to ERSs, and 6 of 8 reacted to the epoxy resin (MW 340) in the baseline series. Five of the patients were patch test-positive to their own work products. Seven of the cases had to leave the relining trade because of skin problems.

CONCLUSIONS

Relining is a widely used alternative to replacing old pipes, and entails a risk of massive skin exposure to ERSs and consequently a high risk of developing allergic contact dermatitis. Further mapping of working methods and use of personal protective equipment (PPE) is crucial to reduce hazardous skin exposure.

[Laboratory animal; allergy; asthma]

Laboratory animal allergy (LAA) may develop when susceptible persons are exposed to allergens produced by laboratory animals. LAA is associated with exposure to urine, fur, and salivae of rats, guinea pigs, dogs and rabbits. Approximately 30% of persons who are exposed to laboratory animals may develop LAA and some will also develop asthma. LAA is most likely to occur in persons with previously known allergies, especially to domestic pets. The majority of LAA sufferers experience symptoms within six months their first exposure to laboratory animals; almost all develop symptoms within three years. The most common symptoms are watery eyes and an itchy, runny nose, although skin symptoms and lower respiratory tract symptoms may also occur. Feeding and handling laboratory animals or cleaning their cages generates ten times the amount of allergens compared with undisturbed conditions. Prevention of animal allergy depends on control of allergenic material in the work environment and on organizational and individual protection measures. Pre-placement evaluation and periodic medical surveillance of workers are important pieces of the overall occupational health programme. The emphasis of these medical evaluations should be on counselling and early disease detection.

Helping hands

Hand eczema can seriously affect nurses' lives, but new treatments are available.

Teaching interventions in contact dermatitis

Prevention of occupational contact dermatitis is of utmost significance for both insurers and legislators because it can preserve the individual's ability to work and result in decreased costs for public health. In the last 20 years, many concepts for educational interventions and a multitude of teaching aids have been developed by insurance associations and public institutions from different countries (eg, the United States, Sweden, Denmark, Switzerland, and Germany). For didactic purposes, terms of different levels of prevention have been inaugurated in northern Europe in the context of occupational dermatology. This review presents different educational interventions in the fields of primary, secondary, and tertiary prevention as well as evaluation studies of these measures, especially among health care workers, hairdressers, metalworkers, and bakers' apprentices. Special emphasis is put on the prevention of allergic contact dermatitis.

Prevention of occupational dermatitis

Occupational dermatitis is among the most frequent occupational diseases. Dermal exposure risk affects many professional categories such as healthcare workers, hairdressers, bakers, cleaning and kitchen employees. The economical burden of occupational dermatitis (OD) is huge (greater than 5 billion Euro per year in Europe), comprising direct costs (treatment, compensation), as well as indirect costs due to sick leave and lack of productivity. A scientifically based preventive program consisting of skin protection during work, cleaning and skin care after work has generally been recommended to prevent occupational contact dermatitis. However the rate of reported occupational skin diseases seems unchanged in the recent years. In cases of impaired skin condition the secondary prevention (i.e. therapeutic treatment by dermatologists and health-educational intervention seminars) is fundamental. For cases of occupational dermatoses in which these outpatient prevention measures are not successful, interdisciplinary inpatient rehabilitation measures have been developed (tertiary individual prevention). In the past years, various pilot-concepts to improve occupational dermatitis prevention have been successfully put into practice focussing on interdisciplinary (dermatological and educational) skin protection training programmes for high-risk professions. Currently a multi-step intervention approach is implemented which is aiming at offering quick preventive help at all levels of severity of occupational contact dermatitis. Recent data reveals that there are reliable evidence-based options for multidisciplinary prevention and patient management of occupational dermatitis using a combined approach by a network of clinics, practices and statutory social insurance bodies. At this stage, it seemed reasonable to form a European joint initiative for skin prevention. Recently a European network of preventive dermatology (European Initiative for the Prevention of Occupational Skin Diseases-EPOS) has been organized based on the German experience in the specific field.

[Etiology, determinants, diagnostics and prophylaxis of occupational allergic respiratory diseases in hairdressers]

Hairdressers are occupationally exposed to many substances both, allergizing and irritating. The continuous development of hairdressing services brings about new risks. The most important allergens are: persulfates (ammonium and potassium), paraphenylenediamine, and latex. A growing number of occupational allergens in the work environment of hairdresses, providing that most of them are low weight allergens, may cause some diagnostic problems. Health risks related with haidressing occupation, have prompted the researchers to pay more attention to risk factors of occupational allergy. Owing to the fact, that first morbid symptoms may occur very early, even during the apprenticeship in a hairdressing school, it is very important to indentify health risks, which can be useful in predicting the onset of occupational allergy and in developing effective prevention methods. The most common allergens at the hairdressers' workplace, risk factors, diagnostics of occupational asthma and rhinitis, as well as the prevention of these diseases are reviewed in this publication.

[Surgical team satisfaction levels between two preoperative hand-washing methods]

INTRODUCTION

Recently, there have been new antiseptics for surgical scrub that do not require brushing. One of them contains 1% chlorhexidine gluconate and 61% ethyl alcohol; within its benefits, it may offer a low potential for skin sensitization, as well as cost savings and less use of water.

OBJECTIVES

To evaluate satisfaction levels, washing time, safety, cost and amount of water between the traditional surgical scrub technique (group A) and brush-free surgical scrub procedure (group B).

MATERIAL AND METHODS

One hundred clean and clean-contaminated surgeries with four hundred members of surgical teams were included. Satisfaction levels, hand-washing time, skin disorders and problems associated with placement of gloves were evaluated. Hands cultures were taken in 20% of the population and the amount of water used by patients in group A was measured. Total costs and wound infections were analyzed.

RESULTS

Satisfaction scale in group A was 9.1 +/- 1.39 and 9.5 +/- 1.54 in group B (p = 0.004). The mean hand-washing time was 3.9 +/- 1.07 min in group A and 2.0 +/- 0.47 min in group B (p = 0.00001). Thirteen patients had dry skin in group A and four in group B (6.5% vs. 2%; p = 0.02). There were ten positives cultures in group A and five in group B (25% vs. 12.5%, p = 0.152). Wound infection rate was 3%. On average, five-hundred eighty liters of water were used by the former group, and the estimated hand-washing cost was lower in the second group.

CONCLUSIONS

The handwashing technique with CGEA is as effective as traditional surgical scrub technique, and it is associated with less washing time, dry skin, cost and use of water.

Concise guidance: diagnosis, management and prevention of occupational contact dermatitis

Occupation is an important risk factor for contact dermatitis that presents in adulthood. Occupational contact dermatitis often has significant adverse effects on quality of life and the long-term prognosis is poor unless workplace exposures are addressed. The condition often presents to general practitioners, physicians or dermatologists who will be responsible for facilitating management of the workplace issues in the event that an occupational health service is not accessible. This concise guidance summarises three sets of guidance from the Occupational Health Clinical Effectiveness Unit, the British Occupational Health Research Foundation and the British Association of Dermatologists respectively. It is aimed at physicians in primary and secondary care, covering the clinical aspects of case management but also drawing attention to the important actions they should take to address the workplace issues, either in liaison with an occupational health provider or in the absence of occupational health input.