Incidence of occupational contact dermatitis in healthcare workers: a systematic review

The prevalence of hand dermatitis among intensive care unit nurses

BACKGROUND

Healthcare workers are at high risk of developing occupational hand dermatitis (HD) due to their frequent exposure to wet-work and use of gloves. Complaints of HD may interfere with work and cause loss of work productivity, or sick leave, and may have impact on job pleasure and performing daily activities. The prevalence of HD among intensive care unit (ICU) nurses is unknown.

OBJECTIVES

To investigate the point prevalence and the 1-year prevalence of HD among ICU nurses, and to determine the impact of HD on work and daily activities.

METHOD

A questionnaire-based cross-sectional study was performed among ICU nurses. Participants were recruited in the Amsterdam University Medical Centre. A symptom-based questionnaire was used to determine HD and atopic predisposition, and an additional questionnaire was used concerning the influence of HD. ICU nurses with an atopic predisposition or symptoms suiting HD were invited for the hand dermatitis consultation hour (HDCH). Data were analysed with logistic regression.

RESULTS

A total of 184 ICU nurses were included. The point prevalence of HD was 9.8% (95% CI: 5.9-15.0) and the 1-year prevalence was 26.6% (95% CI: 20.4-33.6). Sick leave was reported by 0.5%. HD seemed to have more impact on job pleasure than on work productivity.

CONCLUSION

The high prevalence rate of HD resulting from our study highlights the need for the prevention of occupational HD among healthcare workers.

The effects of an educational intervention based on the protection motivation theory on the protective behaviors of emergency ward nurses against occupational hazards: a quasi-experimental study

BACKGROUND

Emergency ward nurses face a variety of occupational hazards due to the nature of their occupational and professional duties, which can negatively affect their health. Therefore, this study aimed to evaluate the effects of an educational intervention based on the protection motivation theory on the protective behaviors of emergency ward nurses against occupational hazards in Tehran, Iran, in 2023.

METHODS

The present quasi-experimental study was conducted with two intervention and control groups, using a pretest-posttest design. A total of 124 nurses working in the emergency wards of four hospitals (two hospitals for the intervention group and two hospitals for the control group by random assignment) were selected by multistage sampling method. The educational intervention based on the protection motivation theory was implemented for the intervention group for three weeks. The nurses of both groups completed a demographic questionnaire and the scale of emergency ward nurses' protective behaviors against occupational hazards before, immediately, and one month after the intervention. Data analysis was performed using descriptive and inferential methods.

RESULTS

The two groups were similar in terms of demographic characteristics at the baseline (p > 0.05). Protective behaviors of emergency nurses against occupational hazards and their sub-scales (physical, chemical, biological, ergonomics, and psychosocial hazards) were higher in the intervention group than in the control group immediately and one month after the educational intervention. In addition, the measurement over time also showed the positive effect of time and educational intervention on the protective behaviors of emergency nurses against occupational hazards and their sub-scales in the intervention group.

CONCLUSION

These findings showed that the educational intervention based on the protection motivation theory can be effective and helpful in improving the protective behaviors of emergency ward nurses against occupational hazards and their sub-scales. Future studies can focus on a more specific design of this kind of intervention based on the type of occupational hazards and needs of nurses in different wards.

Preservative contact allergy in occupational dermatitis: a machine learning analysis

Occupational dermatoses impose a significant socioeconomic burden. Allergic contact dermatitis related to occupation is prevalent among healthcare workers, cleaning service personnel, individuals in the beauty industry and industrial workers. Among risk factors, the exposure to preservatives is frequent, since they are extensively added in products for occupational use. The goal of this study is to investigate the contact allergy patterns in order to understand the linkage among hypersensitivity to preservatives, occupational profiles, patients' clinical and demographic characteristics. Patch test results were collected from monosensitized patients to Formaldehyde 2%, KATHON 0.02%, thimerosal 0.1%, and MDBGN 0.5%; information was also collected for an extended MOAHLFA (Male-Occupational-Atopic-Hand-Leg-Face-Age) index. To assess the relationship between allergen group and occupational-related ACD, the chi-square test for independence was utilized. To uncover underlying relationships in the data, multiple correspondence analysis (MCA) and categorical principal components analysis (CATPCA), which are machine learning approaches, were applied. Significant relationships were found between allergen group and: occupation class, atopy, hand, leg, facial, trunk, neck, head dermatitis, clinical characteristics, ICDRG 48 h and ICDRG 72 h clinical evaluation. MCA and CATPCA findings revealed a link among allergen group, occupation class, patients' demographic and clinical characteristics, the MOAHLFA index, and the ICDRG scores. Significant relationships were identified between the allergen group and various manifestations of dermatitis. The utilization of machine learning techniques facilitated the discernment of meaningful patterns in the data.

Global Guidelines in Dermatology Mapping Project (GUIDEMAP)-A systematic review of the methodological quality of contact dermatitis clinical practice guidelines

The Global Guidelines in Dermatology Mapping Project (GUIDEMAP) assesses the methodological quality of clinical practice guidelines (CPGs) for high-burden skin diseases. This review focuses on contact dermatitis. We searched MEDLINE, Embase, PubMed, Web of Science, Cochrane Library, Emcare, Epistemonikos, PsycINFO and Academic Search Premier for CPGs published between 1 November 2018 and 1 November 2023. Prespecified guideline resources were hand searched. Two authors independently undertook screening, data extraction and quality assessments. Instruments used were the Appraisal of Guidelines for Research and Evaluation (AGREE) II Reporting Checklist, the U.S. Institute of Medicine's (IOM) criteria of trustworthiness, The Agency for Healthcare Research and Quality's National Guideline Clearinghouse Extent Adherence to Trustworthy Standards (NEATS) Instrument and Lenzer's Red Flags. Twenty five CPGs were included, exhibiting heterogeneity in both the topics they addressed and their methodological quality. Whereas the CPGs on management of hand eczema from Denmark, Europe and the Netherlands scored best, most CPGs fell short of being clear, unbiased, trustworthy and evidence-based. Disclosure of conflicts of interest scored well, and areas needing improvement include 'strength and wording of recommendations', 'applicability', 'updating' and 'external review'. Adhering to AGREE II and Grading of Recommendations, Assessment, Development and Evaluations (GRADE) enhances methodological quality.

Recognized Occupational Diseases in Italy's Friuli-Venezia Giulia and Liguria Regions (2010-2021)

BACKGROUND

The study of recognized occupational diseases trend is important to understand the preventive approach needed in the future, however, while numbers of occupational diseases are available on web, data on incidence are missing. The aim of our study was to analyze the trend and the incidence rate ratio (IRR) of recognized occupational diseases in Italy, in Friuli-Venezia Giulia region (FVG) and Liguria region from 2010 to 2021.

METHODS

Numbers of recognized occupational diseases by the Italian National Insurance for Occupational Diseases (INAIL) were analyzed and incidence were calculated considered the total number of workforces in the area. A Poisson regression model was used to estimate incidence trends.

RESULTS

FVG region presented a higher incidence of all occupational diseases compared to Italy and to Liguria in the period considered. The overall incidence in 2019 was 175, 91.8 and 108 cases for 100,000 workers, for FVG, Liguria and Italy respectively. Musculoskeletal disorders (MSDs) were the majority of occupational diseases with 100, 51 and 82.8 cases per 100,000 workers, in FVG, Liguria and Italy, respectively. Incidence of occupational cancers was 16, 10 and 4.9 cases per 100,000 workers, in FVG, Liguria and Italy, respectively. The annual change of incidence from 2010 to 2019 was positive for MSDs (IRR 1.06; 95%CI 1.06 to 1.07) and decreasing for the other causes in Italy. In FVG region the trend was positive for MSDs (IRR 1.05;95%CI 1.04 to 1.06), for respiratory diseases (IRR 1.03; 95%CI 1.00 to 1.05) and pleural plaques (IRR 1.03; 95%CI 1.00 to 1.06). In Liguria the trend was positive for MSDs (IRR 1.17; 95% CI 1.15-1.19) and for pleural plaques (IRR 1.07; 95%CI 1.03-1.12). Stable trends were found for cancers. Declining trend was shown for noise induced hearing loss and skin diseases.

CONCLUSIONS

FVG region presented a higher incidence of recognized occupational diseases compared to Liguria region and Italian data. Results that can be explained by a higher propensity of claiming for occupational diseases in workers, mainly for MSDs disorders. For cancers and asbestos-related diseases the higher incidence can be attributable to high exposure to asbestos in FVG and Liguria workers mainly in shipyard and dock activities.

Awareness, Attitude, and Knowledge Among the Healthcare Workers in China at the Onset of the Oversea Monkeypox Outbreak

BACKGROUND

The outbreak of monkeypox in several nonendemic countries has been reported since May 2022. In the context of the COVID-19 pandemic, it is important to examine how healthcare workers (HCWs) respond to the monkeypox epidemic. Having been involved in the fight against COVID-19 resurgence for nearly 3 years, how HCWs in China respond to the oversea monkeypox outbreak remains unclear.

OBJECTIVE

To investigate the awareness, perceived risk, attitude and knowledge about monkeypox among HCWs in China.

DESIGN

A cross-sectional survey.

PARTICIPANTS

Physicians and nurses from 13 hospitals in Suizhou, China, were contacted through membership of the Physicians' and Nurses' Association.

MAIN MEASURES

Responses regarding their awareness, risk perception, attitude, behavior, and knowledge about the outbreak of monkeypox were collected anonymously during the second month of the outbreak between 15 and 21 June 2022.

KEY RESULTS

Of the 395 physician and 1793 nurse respondents, most had heard of the oversea monkeypox outbreak (physicians 93%, nurses 88%). More than 30% thought there existed an infection risk for themselves or family members (physicians 42%, nurses 32%). Most agreed that HCWs should pay attention to the outbreak (physicians 98%, nurses 98%). More than half had actively sought expertise (physicians 62%, nurses 52%). Approximately half believed that monkeypox may be transmitted through sexual activity or respiratory droplets, or from mother to fetus in utero (physicians 50%, 62%, 55%; nurses 40%, 60%, and 48%, respectively). Some believed that mask-wearing, hand-washing, and glove-wearing can prevent monkeypox transmission (physicians 78%, 89%, 83%; nurses 77%, 86%, 76%, respectively).

CONCLUSIONS

This study identified high awareness, high perceived risk, and pro-prevention attitudes among HCWs in China at the onset of the oversea multi-country monkeypox outbreak, but low levels of monkeypox-related knowledge. Immediate efforts are needed to fill in their knowledge gap, particularly regarding the transmission routes and prevention measures.

Trends in Occupational Diseases in Italian Industry and Services From 2006 To 2019

BACKGROUND

There is a paucity of data on occupational disease incidence in Italy, and we analyzed the trend on time as an incidence rate ratio (IRR).

METHODS

Occupational diseases reported to the Italian National Insurance for Occupational Diseases (INAIL) in industrial and services sectors from 2006 to 2019 were considered and analyzed. Annual case counts were analyzed using a Poisson regression model to estimate incidence trends.

RESULTS

The incidence of occupational diseases in the industrial and services sectors in 2019 was 261 cases for 100,000 workers, with musculoskeletal disorders (MSDs) representing 65% of the total cases, their incidence being 169.5 cases per 100,000 workers. The incidence of ear diseases (ED) decreased to 20.8 cases for 100,000 workers. The annual change in incidence (IRR) was 1.08 (CI 95% 1.07-1.11) for MSDs, 1.08 (CI 95% 1.06-1.10) for cancers, and 1.04 (CI 95% 1.03-1.06) for respiratory diseases. The trend was significantly negative for ear diseases, 0.96 (CI 95% 0.96-0.97), and skin diseases 0.93 (CI 95% 0.92-0.93). No changes were found for asbestos and mental diseases.

CONCLUSIONS

During the study period, occupational diseases increased in Italy, mainly for MSDs, due to a changeover in eligibility criteria from 2008. However, the overall incidence was lower than in other EU Countries. More efforts are needed to harmonize the legislation for joint action in the prevention and recognition of occupational diseases.

Self-Reported Allergic Occupational Contact Dermatitis among Dental Healthcare Professionals in United Arab Emirates -A Cross Sectional Study

In dentistry, occupational contact dermatitis may affect dental professionals along with technicians, nurses, and patients. Changes to dental practice in recent years have altered the reported frequencies of allergens causing contact dermatitis in both dental professionals and dental patients. In the current cross-sectional study, we used a structured questionnaire and clinical examinations to examine the prevalence of self-reported hand eczema among United Arab Emirates (UAE). The relationship between subjective skin discomfort and latex, composite/bonding, or other dental materials also was explored. A structured questionnaire was designed to analyze the prevalence of skin conditions among dental professionals and study its implication in gender, occupation, and age groups. The questionnaire included information about skin symptoms, atopy, occupational experience, and other background factors like respiratory symptoms, work history and methods, and exposure at work. It was distributed to 550 randomly selected dental healthcare professionals. Out of 550 dental healthcare workers contacted, 434 responded giving a response rate of 79%. The prevalence of dry and rough skin on the hands was highest (45%). There was a total of 29 cases of allergic contact dermatitis, 15 cases of contact urticaria, 12 cases of irritating contact dermatitis, and 1 incidence of onychomycosis among the 100 dental healthcare professionals who reported having dermatitis on their hands, forearms, or faces due to their daily dental chores. Rubber chemicals and natural rubber latex (NRL) in protective gloves used by dentists, as well as dental-restorative plastic materials (methylacrylates), were the most common causes of allergy. Dry skin and hand eczema were more common among dental healthcare professionals. Plastic gloves or NRL gloves with a low protein content are recommended for dental work. Skin exposure to methylacrylates or latex should be avoided.

[Hand eczema or psoriasis: update on the FB 323 study occupational dermatology cohort]

In daily dermatological practice, the distinction between eczema and psoriasis in dermatoses of the hands can be difficult. However, a clear diagnosis is necessary to initiate optimal therapy and management. In recent years, the so-called molecular classifier has been developed for optimized differentiation of eczema and psoriasis. An occupational dermatological cohort has been established at Heidelberg University Hospital since 2020. It is funded by the German Statutory Accident Insurance. The aim is to follow-up patients over 3 years where this new diagnostic method is used and to compare the results with a retrospective occupational dermatological cohort. Recruitment ended in December 2022. The current analysis reports participants' occupational activity, insurance status, disease progression, and number of sick days. A total of 287 patients were included; mean age was 50.4 years and 63.5% (n = 181) were undergoing treatment at the expense of the liable statutory accident insurance at the start of the study. About 50% of the patients worked in health professions, metal industry, or construction. The average duration of occupational dermatosis was 6.5 years. In 38.9% of the patients, the clinical diagnosis had been classified as unclear by the treating dermatologist. By using the molecular classifier, the diagnosis could be clarified in 98% of the cases (eczema vs. psoriasis). The first analyses demonstrate that the molecular classifier contributes to improving therapy by optimizing the diagnosis.

Illness Perceptions of Patients with Occupational Skin Diseases in a Healthcare Centre for Tertiary Prevention: A Cross-Sectional Study

Objectives: To investigate the illness perceptions of patients with occupational skin diseases (OSDs). Design: Cross-sectional study. Setting: Specialised healthcare centre for inpatient and outpatient individual prevention in occupational dermatology in Germany. Participants: A total of 248 patients with hand eczema (55.2% female; average age: 48.5 years, SD: 11.9) were included in the final analyses. Measures: A modified and recently validated version of the 'Revised Illness Perception Questionnaire' (IPQ-R) was used to assess illness perceptions. Severity of skin disease was evaluated with the Patient-Oriented Eczema Measure (POEM), the Osnabrueck Hand Eczema Severity Index (OHSI), and a single, self-reported global item. The Erlangen Atopy Score (EAS) was used for atopy screening. Results: We found strong illness identity, high emotional impact, and long timeline beliefs, meaning that study participants perceive their OSD on the hands as a highly symptomatic, emotionally burdening, and chronic condition. Results suggest that hand eczema has a major impact on how participants manage their own lives, particularly during everyday life and occupational activities. Study participants predominantly identified irritant or sensitising substances and activities at work as well as skin protection regimes as causes of their disease. Conclusions: Healthcare workers should consider the illness perceptions as well as the disease burden of patients with an OSD on the hands in clinical practice. Multi-professional approaches to patient care should be sought. Illness perception in (occupational) dermatological patients should be the subject of further research.

A Critical Review on the Current State of Antimicrobial Glove Technologies: Advances, Challenges, and Future Prospects

Following recent viral outbreaks, there has been a significant increase in global demand for gloves. Biomedical research increasingly focuses on antimicrobial gloves to combat microbial transmission and hospital-acquired infections. Most antimicrobial gloves are manufactured using antimicrobial chemicals such as disinfectants, biocides, and sanitizers. The design of antimicrobial gloves incorporates advanced technologies, including colloidal particles and nanomaterials, to enhance antimicrobial effectiveness. A category of antimicrobial gloves also explores and integrates natural antimicrobial benefits from animals, plants, and microorganisms. Many types of antimicrobial agents are available; however, it is crucial that the selected agent exhibits a broad spectrum of activity and is not susceptible to promoting resistance. Additionally, future research should focus on the potential effect of antimicrobial gloves on the skin microbiota and irritation during extended wear. Careful integration of the antimicrobial agent is essential to ensure optimal effectiveness without compromising the mechanical properties of the gloves.

Work-related and personal risk factors for occupational contact dermatitis: A systematic review of the literature with meta-analysis

The objective of this review is to identify work-related and personal risk factors for contact dermatitis (CD), and assess their association with this frequently occurring occupational disease. A systematic review of the literature from 1990 to June 2, 2020, was conducted using Medline and Embase. Prospective cohort and case-control studies were included, and meta-analyses were conducted when feasible. Quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation. Twenty-nine studies were identified, comprising 26 study populations and with a total of 846 209 participants investigating 52 risk factors for CD. Meta-analyses were performed for five risk factors, all of them for irritant contact dermatitis (ICD). Moderate-quality evidence was found for associations between wet work and ICD (OR: 1.56, 95%CI: 1.21-2.01). High-quality evidence was found for the association between atopic dermatitis and ICD (OR: 2.44, 95%CI: 1.89-3.15). There was no evidence for an association between ICD and sex or history of hand dermatitis, respiratory and mucosal atopy. In conclusion, several work-related and personal risk factors associated with CD were identified. Our data emphasize the need for the assessment of both, work-related and personal, risk factors to prevent occupational CD.

Hand Eczema in Apprentice Nurses during the COVID-19 Pandemic after a Skin Prevention Program

BACKGROUND

Healthcare workers, particularly nurses and apprentice nurses, are at high risk of the development of hand eczema due to daily exposure to wet work. This study aimed to assess the occurrence of hand eczema in a group of first-, second-, and third-year apprentice nurses at the University Hospitals of Trieste (northeastern Italy) during the COVID-19 pandemic.

METHODS

Two hundred forty-two Nursing School students were recruited. Data were collected using a standardized questionnaire based on the Nordic Occupational Skin Questionnaire, and all patients underwent a medical examination to evaluate their skin condition based on standard scores. Transepidermal water loss was also measured. The factors associated with hand eczema were investigated using univariate and multivariate logistic regression analyses.

RESULTS

The prevalence of hand eczema was low in students both before and after the traineeship (17.9 and 21.5%, respectively), but clinical signs of mild skin damage, mainly skin dryness, were present in 52.3 and 47.2%, respectively. The factor associated with hand eczema was a personal history of atopic eczema (odd ratios 2.61, 95% confidence intervals 1.18-5.80), while exposure to irritants and glove use did not reach statistical significance.

CONCLUSIONS

Our findings might be explained by the preventive measures adopted for skin protection among healthcare workers in Trieste since the apprenticeship.

Occupational Skin Dermatitis among Healthcare Workers Associated with the COVID-19 Pandemic: A Review of the Literature

The skin is the outermost layer of the human body and is continually exposed to numerous external stimuli, which can cause unwanted skin irritation. Occupational skin diseases are the most prevalent form of work-related illness and are found in a variety of sectors, particularly healthcare. During the recent COVID-19 pandemic, healthcare professionals experienced a variety of unexpected, unusual occupational skin diseases associated with COVID-19-engaged employment. Because the clinical characteristics of these types of skin inflammation are unique, this review focuses on the characteristics of a large category of occupational workers, namely COVID-19-engaged healthcare professionals. Furthermore, we examined the potential pathogeneses of occupational skin disorders associated with COVID-19-engaged labor, as well as different preventative methods.

Illness perceptions of occupational hand eczema in German patients based on the common-sense model of self-regulation: A qualitative study

BACKGROUND

Occupational skin diseases (OSD) in the form of hand eczema (HE) are a common work-related disease. Illness perceptions as presented in Leventhal's Common-Sense Model (CSM) are important for patients' self-management of diseases. Understanding these illness perceptions is essential for patient communicating. No quantitative or qualitative studies which investigated subjective illness perceptions in patients with occupational HE utilized the CSM as theoretical framework. The Objective of this study is to investigate illness perceptions of patients with occupational hand eczema (HE) using the CSM.

METHODS

We applied an exploratory qualitative approach and conducted purposive sampling. Thirty-six patients with occupational HE were interviewed using an interview guide based on the dimensions of the CSM, including coherence and emotional representation. All participants participated in a three-week inpatient program at a clinic specialized on occupational dermatology. One interview had to be excluded before analysis, since one participant's diagnosis was retrospectively changed from ICD to tinea and hence did not match the inclusion criteria. Thirty-five interviews were transcribed verbatim and analyzed. Data was analyzed deductively and inductively using qualitative text analysis. MAXQDA 2018 (Verbi, Berlin, Germany), a software for qualitative data analysis, was applied for coding and summarizing of results. All dimensions of the CSM were explored for occupational HE.

RESULTS

Several sub-categories could be identified. Participants named a variety of causes in different areas (e. g. external irritants and other hazardous factors, psycho-social factors, allergies, having a 'bad immune system' or lifestyle). The great impact of the disease on the participants' life is shown by the wide range of consequences reported, affecting all areas of life (i. e. psychological, physical, occupational, private). Considering coherence, an ambivalence between comprehensibility and non-comprehensibility of the disease is apparent.

DISCUSSION

The complexity of illness perceptions presented in this paper is relevant for those involved in HE patient education and counseling, e. g, health educators, dermatologists, and, occupational physicians. Future research might further investigate specific aspects of illness perceptions in patients with occupational HE, especially considering the complexity of coherence and overlapping dimensions (i. e. emotional representation and psychological consequences).

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.

Incidence of skin diseases in healthcare workers before and during the COVID-19 pandemic at Trieste Hospitals (northeastern Italy)

BACKGROUND

Occupational skin diseases (OSDs) are common in healthcare workers (HCWs).

OBJECTIVES

To investigate and compare the incidence and clinical features of OSDs amongst HCWs before and during the COVID-19 pandemic.

MATERIALS & METHODS

Incident cases of OSDs were investigated in the cohort of HCWs at Trieste Hospitals from July 1, 2018 (3340 workers) to October 31, 2021 (137,532 person-months).

RESULTS

The monthly incidence was ranging from 0 to 11.90 cases per 10,000 person-months in pre-COVID-19 period (cumulative incidence 4.22; 95%CI 2.9-6.0) and from 0 to 13.61 cases per 10,000 person-months in COVID-19 period (cumulative incidence 5.06; 95%CI 3.6-6.9). The incidence rate ratio (IRR) between COVID-19 and pre-COVID-19 period was 1.22 (95% CI 0.73-1.98). The incidence of OSDs in the COVID-19 period was 6.1 (4.2-8.6) and 2.7 (95%CI 1.1-5.6) cases * 10,000 person-months for women and men, respectively with an IRR of 2.25 (95%CI 0.98-5.9). Incidence in nurses in the COVID-19 period was 6.7 (95%CI 4.2-10.2) cases * 10,000 person-months.

CONCLUSIONS

Incidence of OSDs was a little bit higher during the COVID-19 pandemic compared to the previous period but fluctuation of numbers were mainly related to calendar period, with higher incidence in winter and spring. Incidence data were higher than that observed in 2004-2013 in the same cohort. Face dermatitis cases doubled after the start of COVID-19 pandemic. Overall data demonstrated a non-significant increase of OSDs in HCWs during the pandemic, probably due to the preventive strategies set up in our cohort over the years. This article is protected by copyright. All rights reserved.

Prevention of occupational hand eczema in healthcare workers during the COVID-19 pandemic: a controlled intervention study

BACKGROUND

Occupational hand eczema (HE) is common among healthcare workers (HCWs) and has - in some regions of the world - increased during the COVID-19 pandemic due to related hygiene measures.

OBJECTIVES

To evaluate the efficacy of an intervention for HE prevention in HCWs during the pandemic.

METHODS

A prospective, controlled, unblinded interventional trial was conducted in 302 HCWs. The intervention group (IG) (n = 135) received online-based health education and free access to hand cleansing and hand care products. The control group (CG) (n = 167) did not receive any intervention within the study. At baseline (T0), after three (T1) and six (T2) months, participants completed standardised questionnaires. The Osnabrueck Hand Eczema Severity Index (OHSI) was assessed at T0 and T2.

RESULTS

During the observation period, there were no new HE cases in the IG (n = 115) and 12 cases (8.8%) in the CG (n = 136). OHSI values at T2 were lower in the IG (b = -1.44, P < 0.001). Daily use of emollients was higher at work (b = 1.73, P < 0.001) and at home (b = 1.62, P < 0.001) in the IG at T2.

CONCLUSIONS

The intervention was effective in HE prevention and improving skin care behaviour during the COVID-19 pandemic. This article is protected by copyright. All rights reserved.

Prevalence and incidence of hand eczema in hairdressers - a systematic review and meta-analysis of published literature from 2000-2021

BACKGROUND

Hairdressers are commonly affected by hand eczema (HE), due to skin hazardous exposure such as irritants and allergens in the work environment.

OBJECTIVE

To give an overview of the current prevalence, incidence, severity as well as the pattern of debut and the contribution of atopic dermatitis on HE in hairdressers.

METHODS

A systematic review according to the PRISMA guidelines was performed. Studies published from 2000 to April 2021 that fulfilled predefined eligibility criteria were retrieved.

RESULTS

A pooled lifetime prevalence of 38.2% (95%CI 32.6-43.8), a pooled 1-year prevalence of 20.3% (95%CI 18.0-22.6) and a pooled point prevalence of 7.7% (95%CI 5.8-9.6) of HE was observed in hairdressers. The lifetime prevalence in fully trained hairdressers and hairdressing apprentices was almost identical. The pooled incidence rate of HE was 51.8 cases/1000 person-years (95%CI 42.6-61.0) and the pooled prevalence of atopic dermatitis was 18.1% (95%CI 13.6-22.5).

CONCLUSION

HE is common in hairdressers and most have debut during apprenticeship. The prevalence of atopic dermatitis in hairdressers is comparable with estimates in the general population, indicating that occupational exposures are the main factor in the increased prevalence of HE in hairdressers. This warrants a strategic and collective effort to prevent HE in hairdressers. This article is protected by copyright. All rights reserved.

Characteristics of hand eczema in final-year apprentice nurses during the COVID-19 pandemic

BACKGROUND

Apprentice nurses are considered at high risk to developing occupational skin diseases.

OBJECTIVES

This study assessed the frequency and origin of hand eczema, and work-related risk factors in apprentice nurses.

METHODS

The study involved 240 final-year apprentice nurses (females 75%, median age 19 years) from vocational schools in Zagreb, Croatia. The study was performed in 2020/2021 and included a questionnaire and clinical examination by means of the Osnabrück Hand Eczema Severity Index (OHSI). Skin prick test (SPT) with natural rubber latex (NRL) allergen, and patch test with the basic series of allergens, and disinfectants, were performed in 42 apprentice nurses with hand eczema that lasted more than 3 months.

RESULTS

Clinically observed and self-reported hand eczema were found in 49% and 46% of apprentice nurses, respectively. Those with observed changes were older and reported more days per month spent on practical work than those with healthy skin (P = .001). Median OHSI was 4 (interquartile range 2-6). There were no positive SPTs to latex, and 11 (26%) apprentice nurses had positive patch test reactions to one or more tested allergens, mostly nickel.

CONCLUSIONS

Hand eczema was common in final-year apprentice nurses during the COVID-19 pandemic. It was mostly of irritative origin, associated with the duration of practical training, confirming cumulative effect of hazards on skin barrier.

Occupational hand dermatitis web survey in a university hospital during COVID-19 pandemic: the SHIELD study

BACKGROUND

Occupational hand dermatitis (OHD) is a skin disease occurring on employees' hands in certain jobs. Little is known about prevalence, incidence and characteristics of this adverse skin reaction and its associated risk factors during COVID-19 pandemic. To evaluate both prevalence and incidence of OHD and associated risk factors in Italian clinicians.

METHODS

A cross-sectional study was performed using a self-report questionnaire.

RESULTS

Two hundred and thirty clinicians responded to the survey and 82% of responders did not report previous OHD history before the COVID-19 pandemic. Daily use of gloves was reported by 80% of responders. OHD prevalence was 18%, while incidence was 80%. We found a protective effect on symptom occurrence for vinyl/nitrile gloves if the time with gloves was ≥ 6 hours per day.

CONCLUSIONS

This survey reveals a high OHD incidence in an Italian population of clinicians. Furthermore, wearing vinyl/nitrile gloves for at least 6 hours a day had a protective effect on symptom onset.

Acceptance of semipermeable glove liners compared to cotton glove liners in health care workers with work-related skin diseases: Results of a quasi-randomized trial under real workplace conditions

BACKGROUND

Glove liners (GLs) made of cotton (COT) are worn under impermeable gloves to prevent occlusion effects. Semipermeable GLs made of Sympatex (SYM) might be an alternative.

OBJECTIVES

To evaluate the acceptance of GLs (COT/SYM) in health care workers (HCWs) with work-related skin diseases (WRSDs).

METHODS

One hundred sixty-one HCWs with WRSDs were asked to wear GLs in combination with occlusive gloves for 10 ±2 weeks under workplace conditions. A questionnaire was applied to compare acceptance and usability of the respective glove combinations and previously used protective gloves (PUGs).

RESULTS

A total of 120 data sets were available (SYM: n = 65, 77.4%; COT: n = 55, 71.4%). Both GLs provided a significantly lower sweating sensation, more pleasant climate, comfortable wearing experience, and moist or dry feeling on the skin compared to PUGs. SYM-GLs performed significantly better than COT-GLs regarding mobility of hands, sensitivity, and sense of touch. COT-GLs were significantly better than SYM-GLs in the categories fit, donning and doffing, and material contact.

CONCLUSIONS

Both GLs did not impair work performance, were applicable in various areas of health care activities, and were preferred over PUGs. Our results indicate that SYM-GLs are an alternative to COT-GLs and thus may contribute to current prevention strategies.