Self-reported skin exposure--validation of questions by observation

The association between wet work and hand eczema in the Dutch general population: Application of a job exposure matrix to the lifelines cohort study

BACKGROUND

Studies on wet work and hand eczema (HE) frequently rely solely on self-reports regarding wet work.

OBJECTIVES

To assess the association between wet work and moderate-to-very-severe HE, within the Dutch general population, by using a (sex-specific) job exposure matrix (JEM).

METHODS

Within the Lifelines Cohort Study, participants with self-reported moderate-to-very-severe HE at worst in the past year were linked to data from the Danish (sex-specific) wet work JEM, a tool that links occupations with wet work indices (including duration and probability of glove use, wet hands and total wet work for at least 2 and 4 h/working day).

RESULTS

In total, 56 978 (41.9%) participants were included. The multivariate binary logistic regression analyses showed significant associations between all facets of wet work and moderate-to-very-severe HE. When using the sex-specific JEM, significant associations were found in females, but not in males.

CONCLUSIONS

This study is the first to use a wet work-specific JEM in a general population sample, and found positive associations between wet work and HE. The sex-specific findings should be interpreted with caution, due to limitations inherent in using a JEM, and should be further explored with observational studies, with a focus on duration, frequency, and exposure type.

Characterization of Cleaning and Disinfection Product Use, Glove Use, and Skin Disorders by Healthcare Occupations in a Midwestern Healthcare Facility

Healthcare facility staff use a wide variety of cleaning and disinfecting products during their daily operations, many of which are associated with respiratory or skin irritation or sensitization with repeated exposure. The objective of this study was to characterize the prevalence of cleaning and disinfection product use, glove use during cleaning and disinfection, and skin/allergy symptoms by occupation and identify the factors influencing glove use among the healthcare facility staff. A questionnaire was administered to the current employees at a midwestern Veterans Affairs healthcare facility that elicited information on cleaning and disinfection product use, glove use during cleaning and disinfection, skin/allergy symptoms, and other demographic characteristics, which were summarized by occupation. The central supply/environmental service workers (2% of the total survey population), nurses (26%,), nurse assistants (3%), and laboratory technicians (5%) had the highest prevalence of using cleaning or disinfecting products, specifically quaternary ammonium compounds, bleach, and alcohol. Glove use while using products was common in both patient care and non-patient care occupations. The factors associated with glove use included using bleach or quaternary ammonium compounds and using cleaning products 2-3 or 4-5 days per week. A high frequency of glove use (≥75%) was reported by workers in most occupations when using quaternary ammonium compounds or bleach. The use of alcohol, bleach, and quaternary ammonium compounds was associated with skin disorders (p < 0.05). These research findings indicate that although the workers from most occupations report a high frequency of glove use when using cleaning and disinfection products, there is room for improvement, especially among administrative, maintenance, and nursing workers. These groups may represent populations which could benefit from the implementation of workplace interventions and further training regarding the use of personal protective equipment and the potential health hazards of exposure to cleaning and disinfecting chemicals.

Causes of irritant contact dermatitis after occupational skin exposure: a systematic review

PURPOSE

Irritant contact dermatitis (ICD) is a major cause of occupational disease. The aim was to review the relation between exposure to occupational irritants and ICD and the prognosis of ICD.

METHODS

Through a systematic search, 1516 titles were identified, and 48 studies were included in the systematic review.

RESULTS

We found that the evidence for an association between ICD and occupational irritants was strong for wet work, moderate for detergents and non-alcoholic disinfectants, and strong for a combination. The highest quality studies provided limited evidence for an association with use of occlusive gloves without other exposures and moderate evidence with simultaneous exposure to other wet work irritants. The evidence for an association between minor ICD and exposure to metalworking fluids was moderate. Regarding mechanical exposures, the literature was scarce and the evidence limited. We found that the prognosis for complete healing of ICD is poor, but improves after decrease of exposure through change of occupation or work tasks. There was no substantial evidence for an influence of gender, age, or household exposures. Inclusion of atopic dermatitis in the analysis did not alter the risk of ICD. Studies were at risk of bias, mainly due to selection and misclassification of exposure and outcome. This may have attenuated the results.

CONCLUSION

This review reports strong evidence for an association between ICD and a combination of exposure to wet work and non-alcoholic disinfectants, moderate for metalworking fluids, limited for mechanical and glove exposure, and a strong evidence for a poor prognosis of ICD.

The Prevalence and Clinical Features of Skin Irritation Caused by Infection Prevention Measures During COVID-19 in the Mecca Region, Saudi Arabia

PURPOSE

Due to the COVID-19 pandemic, recommendations to prevent infection suggest increasing the frequency of handwashing and disinfection; however, these measures can have negative implications on our skin. This study aims to evaluate whether these measures correlate with new-onset skin damage or can exacerbate hand eczema among the general population.

MATERIALS AND METHODS

This was a descriptive, cross-sectional, survey-based study, including the general population of Mecca region, Saudi Arabia. To achieve the study's aim, an online questionnaire to the general population comprising 25 items was distributed via social media apps during the pandemic between October 23 and November 21, 2020. Data were automatically collected in Excel and entered into SPSS for analysis.

RESULTS

A total of 783 participants were included in this study, of whom 695 (88.8%) were female. A history of hand eczema was reported among 123 (15.7%) participants, and 270 (34.5%) had a history of atopy. During the COVID-19 pandemic, 86 (13.0%) participants noticed new-onset skin irritation, while 81 (31.3%) of the participants reported exacerbation of earlier hand allergic dermatitis. The most frequent symptoms were dryness and feeling of tightness. Additionally, most participants among both groups noticed that skin lesions appeared for less than 10 days. The frequent handwashing statistically increased following the onset of the pandemic (p=0.001), there is association between new-onset symptoms and more frequent handwashing, as well as the use of hand disinfectants, during the pandemic (p=0.001).

CONCLUSION

Our study suggests that the general population's skin was negatively affected by COVID-19 precautions, particularly those with a history of hand eczema. We recommend spreading awareness of skin protective modalities and the use of new infection prevention measures, such as regular skin moisturization for hand protection and possibly using less damaging skin disinfectants like ozonized water provided it is scientifically proven effective in disinfecting COVID-19 virus.

Wet work exposure: comparison of observed and self-reported data

PURPOSE

Wet work is the most important exposure leading to occupational hand eczema; however, the prevalence and character of wet work in various wet work professions remain not fully covered. Self-reported data are widely used in studies of wet work although the validity of these remains uncertain. The objective of the present study is to provide information on validity of self-reported wet work exposure in different professions by comparing work place observations with self-reported data.

METHODS

114 workers from 15 various wet work professions were observed. The observations covered duration and frequency of wet work activities. The observed population as well as a non-observed population from each work place were given a questionnaire covering the same wet work activities.

RESULTS

Correspondence analysis between self-reported and observed wet work showed that misclassification was larger regarding duration than frequency. 29.2% overestimated and 23.9% underestimated total wet work with more than 2 h/day. Professions with high wet work prevalence overestimated duration of wet work activities, but underestimated frequency. Females overestimated frequency, but not duration. The observed group (45%) significantly more often, than the non-observed group (32%), reported having more than 2 h of wet work/day (OR 2.8, 95% CI 1.6-4.9). Sensitivity and specificity of the questionnaire regarding total wet work in the observed population showed 51% sensitivity and 59% specificity.

CONCLUSION

Over- and underestimation of wet work were found to be equally distributed. The correspondence analyses illustrate a noticeable misclassification between the estimations and the observations on all wet work variables, but largest for total wet work.

Usage of gloves for hair shampooing in German hairdressing salons

Background

Occupational skin disease caused by wet work is particularly common in employees in hairdressing salons. The objective of this paper was to determine the frequency of glove use for hair shampooing.

Methods

Data on the usage of gloves for hair shampooing were collected by covert observations in four cross-sectional surveys of newly opened hairdressing salons located in Cologne. Measurements were conducted between 2009 and 2012. A team of five trained observers were involved in the measurements. As a second assessment method, salon owners of other newly opened salons from five districts of Germany were interviewed by telephone at three of the four measurement points. Trend analysis was performed with the Mantel-Haenszel test for trends and simple linear regression. Differences in proportions of glove use between the two assessment methods were compared by chi-squared tests.

Results

In total, 435 hair shampoos were observed and 630 salon owners interviewed. Gloves were worn in 14 % of the observed hair shampoos. Proportions of glove use differed significantly according to assessment measurement. Proportions of glove use assessed by covert observation increased from 10.5 % to 18.5 % (p_trend = 0.044) whereas the proportions obtained by telephone interview decreased over the study period from 84 % to 76 % (p_trend = 0.037). No trend was found for the intensity of glove use (p_trend = 0.204).

Conclusions

Gloves were worn in less than 20 % of hair shampoos. This rate is much lower than values reported from other written or verbal surveys. Future measures for skin protection in hairdressing salons should take this into account.

Electronic supplementary material

The online version of this article (doi:10.1186/s12995-015-0089-y) contains supplementary material, which is available to authorized users.

Characterization of cleaning and disinfecting tasks and product use among hospital occupations

BACKGROUND

Healthcare workers have an elevated prevalence of asthma and related symptoms associated with the use of cleaning/disinfecting products. The objective of this study was to identify and characterize cleaning/disinfecting tasks and products used among hospital occupations.

METHODS

Workers from 14 occupations at five hospitals were monitored for 216 shifts, and work tasks and products used were recorded at five-minute intervals. The major chemical constituents of each product were identified from safety data sheets.

RESULTS

Cleaning and disinfecting tasks were performed with a high frequency at least once per shift in many occupations. Medical equipment preparers, housekeepers, floor strippers/waxers, and endoscopy technicians spent on average 108-177 min/shift performing cleaning/disinfecting tasks. Many occupations used products containing amines and quaternary ammonium compounds for >100 min/shift.

CONCLUSIONS

This analysis demonstrates that many occupations besides housekeeping incur exposures to cleaning/disinfecting products, albeit for different durations and using products containing different chemicals.

Is skin exposure to water mainly occupational or nonoccupational? A population-based study

BACKGROUND

Skin exposure to water is considered to contribute to hand eczema. Knowledge about total water exposure during a day is scanty.

OBJECTIVES

To investigate self-reported water exposure at work as well as throughout the day.

METHODS

Skin exposure to water was assessed from two questionnaire-based health surveys: the nationwide Environmental Health Survey 2007 (EHS), which enquired about water exposure throughout the day, and the Stockholm Public Health Survey 2006 (PHS), which probed water exposure at work. Answers from 19,667 individuals (EHS) and 18,318 individuals (PHS) were available for analysis.

RESULTS

In total, 22% of respondents (women 30%, men 12%) reported skin exposure to water more than 20 times during an entire day (EHS) compared with 6% (women 8%, men 4%) at work (PHS). In a univariate analysis, using a merged file comprising data from the EHS and the PHS, water exposure more than 20 times a day was more common in the EHS (prevalence proportion ratio 3·570, 95% confidence interval 3·353-3·802). In multivariate models the variables studied did not fulfil the criteria for being confounders. Water exposure at work declined with increasing age in both women and men (P < 0·0001) as did water exposure during the entire day in men (P < 0·0001). However, women were equally exposed during the entire day across age groups (P = 0·205).

CONCLUSIONS

High water exposure over the entire day was found to be considerably more frequent than exposure at work. Thus, a significant proportion of water exposure seems to occur outside work. This should be considered in prevention of hand eczema and when counselling patients with hand eczema in clinical practice.

Prevalence, incidence and predictive factors for hand eczema in young adults - a follow-up study

BACKGROUND

Hand eczema is common in the general population and affects women twice as often as men. It is also the most frequent occupational skin disease. The economic consequences are considerable for society and for the affected individuals.

METHODS

To investigate the prevalence and incidence of hand eczema and to evaluate risk factors for development of hand eczema in young adults. Subjects and methods; This is a prospective follow-up study of 2,403 young adults, 16 - 19 years old in 1995 and aged 29 - 32 years, 13 years later, in 2008. They completed a postal questionnaire that included questions regarding one-year prevalence of hand eczema, childhood eczema, asthma, rhino-conjunctivitis and factors considered to affect hand eczema such as hand-washing, washing and cleaning, cooking, taking care of small children and usage of moisturisers. These factors were evaluated with the multinominal logistic regression analysis.

RESULTS

The one-year prevalence of hand eczema was 15.8% (females 20.3% and males 10.0%, p < 0.001). The incidence was 11.6 cases per 1000 person-years (females 14.3 and males 5.2, p < 0.001). Childhood eczema was the most important risk factor for hand eczema. The odds ratios were 13.17 when having hand eczema 1995 and 2008 compared to 5.17 in 2008 (p < 0.001). A high frequency of hand washing was important in predicting hand eczema only when having 1-year prevalence 2008, OR 1.02 (p = 0.038).

CONCLUSIONS

After 13 years an increased 1-year prevalence of hand eczema was found. The significant risk factors for hand eczema changed over time from endogenous to exogenous factors.

Exposures related to hand eczema: a study of healthcare workers

BACKGROUND

Hand eczema is common in healthcare workers, owing to intensive exposure to wet work and skin irritants. Targeted interventions and vocational guidance based on documented exposures and risk factors are needed.

OBJECTIVES

The aims of the study were to investigate the relationship between exposures (domestic and at work) and prevalence and severity of hand eczema.

METHODS

Self-administered questionnaires were sent to 3181 healthcare workers in Denmark.

RESULTS

Two thousand two hundred and sixty-nine (71%) workers responded to the questionnaire. Frequent hand washing was significantly related to the presence of hand eczema. Having children < 4 years old in the household was also related to the presence of hand eczema. A lower prevalence of hand eczema was found among those using moisturizers at work, and a higher prevalence was found among those using moisturizers at home.

CONCLUSIONS

Although healthcare workers are recommended to use disinfectants when the hands are not visibly dirty, hand washing is still significantly related to hand eczema. Frequent hand washing may be a question of behavioural habits, and a focus for future guidance should be on changing hand washing habits. Attention should also be paid to healthcare workers with small children at home. The preventive effect of moisturizers used during working hours should be tested in future follow-up studies.

Skin exposure to epoxy in the pipe relining trade - an observational study

BACKGROUND

Epoxy resin systems (ERSs) are frequent causes of occupational allergic contact dermatitis. Epoxy pipe relining has become a widely used alternative to replacing old and worn drain pipes in housing, and involves a high risk of skin exposure to ERSs.

OBJECTIVES

To map out work methods, protective measures and skin and surface contamination among workers involved in epoxy pipe relining, as a basis for prevention of occupational skin disease.

METHODS

Twenty-one employees in eight relining companies in Stockholm County were observed. Contact and contamination with ERSs and the use of personal protective equipment during relining work were noted.

RESULTS

Contamination by uncured ERSs on gloves, personal and shared tools and work areas was identified during mixing, wetting, installation, and cleaning. The gloves used were often inadequate for handling ERSs.

CONCLUSIONS

Relining pipes poses an extensive risk of uncured ERS exposure, and contamination was identified during the whole work process. Shared and personal tools and work areas were extensively contaminated. Changes in work routines and logistics for handling ERSs are essential, and knowledge among both employers and employees regarding the risks caused by ERS exposure is vital to create a safe work environment and prevent contact allergies.

Occupational health risks of barbers and coiffeurs in Izmir

The objective of this study was to examine self-reported occupational health risks and health complaints of barbers and hairdressers. A total of 1284 individuals from 300 workplaces in Izmir participated in this study. The workers completed the questionnaires during their training in occupational health. Self-reported symptoms were allergy: 35% and musculoskeletal symptoms: 32%. The frequency of allergy complaints was found to be significantly higher in older individuals and in women. Allergic complaints were more frequent in i) those having history of allergy, ii) in the group where the use of protective clothing and gloves was lower, iii) in smokers and in those who found ventilation in the workplace to be inadequate. Only 41.2% reported that they used gloves and 15.2% reported the use of protective clothing within the last month. It appears that poor occupational factors in barbers' salons and exposure to hairdressing chemicals bring about health problems of the hairdressers.

Dermatology in public health - a model for surveillance of common skin diseases

Aims: The aim was to establish a baseline prevalence of skin conditions of public health importance in the general population and taking the validity of the questions into account. Our model is intended for future surveillance of skin conditions. Methods: The suggested questions have for the first time been used in Swedish population surveys. A random sample was taken from the general population aged 16 to 84 years of the participating areas. Results: During the past 12 months, hand eczema was reported by 9.4%, childhood eczema by 15.7% and nickel allergy by 13.7% of the population. Hand and childhood eczema questions have previously been validated. Taking the validity into account, the actual population prevalence of hand eczema (11.7%) is underestimated, and the prevalence of atopic childhood eczema (10.0%) is overestimated based on the results of the questionnaire. In addition to presenting prevalence, population survey results can be used for risk analyses. A 10-fold risk of hand eczema in individuals with childhood eczema and self-reported nickel sensitivity is shown in our study. Conclusions: Questionnaires can be used for epidemiologic surveillance so long as the questions are validated and that the validity is taken into account when estimating the occurrence of the conditions. Public health surveys such as this one lay the basis for future epidemiological surveillance of skin conditions that can be subject to interventions. We propose that these, or similar, questions should be used regularly in population surveys and supplemented by questions on skin exposure.

Validation of self-reported occupational exposures in meatpacking workers

OBJECTIVE

The ability of workers to accurately recall exposures that occur on the day of their injury is considered a potential limitation of case-crossover studies. This study assessed validity of occupational exposures reported by uninjured workers at a Midwestern meatpacking plant.

METHODS

One hundred thirty-six workers were observed for 60 min while working and then interviewed within 8 days (median 3 days) about exposures during the observation period. The level of agreement between self-reports and direct observations was assessed using kappas and intraclass correlation coefficients.

RESULTS

Excellent agreement was found between observed and reported work location (kappa = 0.97, 95% CI: 0.92-1.0), task (kappa = 0.83, 95% CI: 0.76-0.91) and tools used (kappa = 0.88, 95% CI: 0.81-0.95). Personal protective equipment varied by work type and location, and agreement between observed and reported usage varied from excellent to poor for various items. Excellent agreement was found for tool sharpening (kappa = 0.89, 95% CI: 0.82-0.97); good agreement for occurrence of break during the observation period (kappa = 0.60, 95% CI: 0.45-0.74); and poor agreement for equipment malfunction, line stoppages, being tired, unusual task, unusual work method, being distracted, rushing, slipping, or falling.

CONCLUSIONS

Agreement between observed and reported occupational exposures varied widely. Self-reported exposures are utilized in many occupational studies, and future exposure validity assessment studies should continue to improve retrospective study methods. Valid exposures will allow researchers to better understand injury etiology and ultimately prevent injuries from occurring.

Legionella antibodies in a Danish hospital staff with known occupational exposure

Although legionnaires' disease frequently is acquired in health care institutions, little is known about the occupational risk of Legionella infection among health care workers. The aim of the present cross-sectional study was to analyse antibody levels among exposed hospital workers and to determine the correlation between antibodies to Legionella and self-reported symptoms. The study included 258 hospital employees and a reference group of 708 healthy blood donors. Hospital workers had a higher prevalence of Legionella antibody titres (>/=1 : 128) than blood donors (odds ratio 3.4; 95% CI 2.4-4.8). Antibody levels were not higher among staff members at risk of frequent aerosol exposure than among less exposed employees. There was no consistent association between a history of influenza-like symptom complex and the presence of antibodies. The results indicate that hospital workers have a higher risk of Legionella infections than the general population. However, since no excess morbidity was associated with seropositivity, most Legionella infections may be asymptomatic.

Occupational skin exposure to water: a population-based study

BACKGROUND

Occupational exposure to skin irritants, in particular to water, is an important risk factor for hand eczema.

OBJECTIVES

To assess occupational skin exposure to water in the general population.

METHODS

As part of a public health survey in Stockholm, Sweden, 18,267 gainfully employed individuals aged 18-64 years completed a questionnaire with previously validated questions regarding occupational skin exposure to water.

RESULTS

Altogether 16% reported exposure to water for (1/2) h or more a day, and 13% reported exposure to water more than 10 times a day. Furthermore, 7% reported water exposure of more than 2 h and 6% of more than 20 times a day. Women reported more water exposure than men and many female-dominated occupations were seen to comprise water exposure. Women were also more exposed than men within the same jobs. Young adults were more exposed than older. A total of 18% were employed in high-risk occupations for hand eczema. Fifty-nine per cent of individuals employed in high-risk occupations reported water exposure at work, compared with 11% in low-risk occupations.

CONCLUSIONS

A total of 20% of the population of working age acknowledged occupational skin exposure to water, which was found to be more common in young adults and women. Using job title as a proxy for water exposure gives an underestimation due to misclassification. In assessing occupational skin exposure to water, both exposure time and frequency should be considered.

Skin exposure in geriatric care ? a comparison between observation and self-assessment of exposure

The aim of this study was to compare observation and self-assessment of skin exposure to irritants during a working day in nursing in geriatric care. The study group consisted of 40 volunteers, 13 nurses, and 27 assistant nurses. Before the start of a working day, the participants completed a questionnaire regarding skin exposure to water, gloves, hand disinfection, and moisturizers. Observers subsequently used a hand-held computer to register the time and frequency of each exposure. The total mean skin exposure time was 96 min per working day, including glove use. The mean exposure time to water was 9 min per working day. A tendency to overestimate was found for all exposures. A strong correlation between self-reports and observations was found for hand disinfection and moisturizers, while a moderate correlation was found for gloves and number of water exposures and a weak correlation for total time of water exposure. Despite the differences between self-assessment and observation of the exposure, we consider the questionnaire to be useful for surveying skin exposure in nursing. Furthermore, the observations in this study suggest that nursing work in geriatric care may comprise limited exposure to water.

Nickel allergy and hand eczema ? a 20-year follow up

The aim of this study was to investigate the occurrence of hand eczema after 20 years in women patch tested to nickel during childhood. In 1982-1983, 960 schoolgirls were patch tested for nickel allergy; its prevalence was found to be 9%. 20 years later, the same individuals received a questionnaire regarding hand eczema and factors of importance for the development of hand eczema. 735 of 908 women (80.9%) answered the questionnaire. In total, 17.6% of respondents reported hand eczema after the age of 15 years, and the 1-year prevalence was 12.8%. There was no statistically significant difference in the occurrence of hand eczema between the groups who had previously tested positive and negative for nickel allergy. 38.3% of the respondents considered themselves to be nickel sensitive at the time they answered the questionnaire; in this group, the reported prevalence of hand eczema after age 15 was 22.5%. 31.4% of those with a history of atopic dermatitis reported hand eczema after age 15, compared with 10.6% of those without (P < 0.001). In conclusion, contact allergy to nickel in childhood did not seem to increase the prevalence of hand eczema later in life.