Occupational skin diseases in Washington State, 1989 through 1993: using workers' compensation data to identify cutaneous hazards

The dermal toxicity of cement

Cement and concrete are products used widely in the construction sector, with a traditional perception that any hazards that they have are limited to dermatitis in a small number of workers. In some cases, employers and builders do not think that concrete is a chemical. However, contact dermatitis is one of the most frequently reported health problems among construction workers. A review of the available literature suggests that cement has constituents that produce both irritant contact dermatitis and corrosive effects (from alkaline ingredients such as lime) and sensitization, leading to allergic contact dermatitis (from ingredients such as chromium). These findings indicate that cement and concrete should be treated as hazardous materials, and that workers handling such products should reduce exposure wherever possible. Initiatives to reduce the chromium content of cement have been shown to be successful in reducing the incidence of allergic dermatitis, although the irritant form remains.

Assessment of Health Consequences of Steel Industry Welders' Occupational Exposure to Ultraviolet Radiation

BACKGROUND

Welding is among the most important frequently used processes in the industry with a wide range of applications from the food industry to aerospace and from precision tools to shipbuilding. The aim of this study was to assess the level of steel industry welders' exposure to ultraviolet (UV) radiation and to investigate the health impacts of these exposures.

METHODS

In this case-control study, we measured the intensity of UV at the workers' wrist in Fars Steel Company through manufacture of different types of heavy metal structures, using UV-meter model 666230 made by Leybold Co., from Germany.

RESULTS

The population under the study comprised 400 people including 200 welders as the exposed group and 200 nonwelders as the unexposed group. The results of the questionnaire were analyzed using SPSS software, version 19. The average, standard deviation, maximum and minimum of the UV at the welders' wrist were 0.362, 0.346, 1.27, and 0.01 μW/cm(2), respectively. There was a significantly (P < 0.01) higher incidence of cataracts, keratoconjunctivitis, dermatitis and erythema in welders than in their nonwelders.

CONCLUSIONS

This study showed that the time period of UV exposure in welders is higher than the permissible contact threshold level. Therefore, considering the outbreak of the eye and skin disorders in the welders, decreasing exposure time, reducing UV radiation level, and using personal protective equipment seem indispensable. As exposure to UV radiation can be linked to different types of skin cancer, skin aging, and cataract, welders should be advised to decrease their occupational exposures.

Occupational dermatitis in hairdressers: do they claim workers' compensation?

BACKGROUND

Hairdressers are one of the largest occupational groups attending our Occupational Dermatology Clinic. However, few seek workers' compensation for their occupational dermatitis.

OBJECTIVES

To retrospectively analyse and compare workers' compensation claims data and diagnosed disease data for occupational contact dermatitis in hairdressers from 1993 to 2009, for the state of Victoria, Australia.

PATIENTS/MATERIALS/METHODS

Data from the Occupational Dermatology Clinic database, the Compensation Research Database and the Australian Bureau of Statistics were used in this study.

RESULTS

The clinic database identified 157 hairdressers and apprentices with a confirmed diagnosis of occupational contact dermatitis assessed between 1993 and 2009. Forty-six unique claims for occupational contact dermatitis from 46 individuals were identified from the Compensation Research Database over the same time period. Hairdressers in the 15-24-year age group were significantly over-represented in the claims data relative to the diagnosed disease data (p < 0.01). The median cost per claim was AU$1421, and the median time off work per claim was 20 days.

CONCLUSION

Increased efforts are needed to reduce the incidence of occupational contact dermatitis in hairdressers in Australia, and to ensure that hairdressers with occupational contact dermatitis are aware of their compensation entitlements. Reliance on workers' compensation data for disease surveillance may lead occupational health and safety regulators to underestimate the magnitude of the problem of occupational contact dermatitis in the hairdressing profession.

Evidence-based guidelines for the prevention, identification and management of occupational contact dermatitis and urticaria

BACKGROUND

Occupational contact dermatitis is the most frequently reported work-related skin disease in many countries. A systematic review was commissioned by the British Occupational Health Research Foundation in response to a House of Lords Science and Technology Committee recommendation.

OBJECTIVES

The systematic review aims to improve the prevention, identification and management of occupational contact dermatitis and urticaria by providing evidence-based recommendations.

METHODS

The literature was searched systematically using Medline and Embase for English-language articles published up to the end of September 2009. Evidence-based statements and recommendations were graded using the Royal College of General Practitioner's three-star system and the revised Scottish Intercollegiate Guidelines Network grading system.

RESULTS

Three thousand one hundred and fifty-five abstracts were identified and screened. From these, 786 full papers were obtained and appraised. One hundred and nineteen of these studies were used to produce 36 graded evidence statements and 10 key recommendations.

CONCLUSIONS

This evidence review and its recommendations focus on interventions and outcomes to provide a robust approach to the prevention, identification and occupational management of occupational contact dermatitis and urticaria, based on and using the best available medical evidence.

Workers' compensation experience of Colorado agriculture workers, 2000-2004

BACKGROUND

Agriculture is among the most hazardous of occupations. The lack of information regarding agriculture injuries or fatalities has been recognized as an obstacle for effective injury prevention. Workers' compensation claims data for non-fatal injuries among agriculture and agri-business workers in the State of Colorado between the years of 2000 and 2004.

METHODS

Workers' compensation claims are utilized to estimate injury claim incidence rates, determine the distributions of sources, causes, types and body locations of injuries, and estimate the costs of these injuries.

RESULTS

Colorado agriculture and agri-business workers (e.g., cattle dealers, cattle or livestock raisers, dairy farmers) have high rates of injury claims, especially in sectors that involve interaction with animals or livestock. Grain milling operations had a high rate of injury claims among agri-business operations. Injuries related to animals, strains, machinery, and falls or slips were the most frequent among all occupations analyzed.

CONCLUSIONS

Understanding the occurrence of injuries among Colorado agriculture and agri-business workers is critical to implementing and evaluating effective intervention programs for specific agriculture-related occupations. The development of safety interventions that address the worker-animal interface, fall protection systems, machinery usage, and overexertion prevention strategies is recommended.

Percutaneous injuries among dental professionals in Washington State

BACKGROUND

Percutaneous exposure incidents facilitate transmission of bloodborne pathogens such as human immunodeficiency virus (HIV), hepatitis C virus (HCV) and hepatitis B virus (HBV). This study was conducted to identify the circumstances and equipment related to percutaneous injuries among dental professionals.

METHODS

We used workers' compensation claims submitted to the Department of Labor and Industries State Fund during a 7-year period (1995 through 2001) in Washington State for this study. We used the statement submitted by the injured worker on the workers' compensation claim form to determine the circumstances surrounding the injury including the type of activity and device involved.

RESULTS

Of a total of 4,695 accepted State Fund percutaneous injury claims by health care workers (HCWs), 924 (20%) were submitted by dental professionals. Out of 924 percutaneous injuries reported by dental professionals 894 (97%) were among dental health care workers in non-hospital settings, including dentists (66, 7%), dental hygienists (61, 18%) and dental assistants (667, 75%). The majority of those reporting were females (638, 71%). Most (781, 87%) of the injuries involved syringes, dental instruments (77, 9%), and suture needles (23%). A large proportion (90%) of injuries occurred in offices and clinics of dentists, while remainder occurred in offices of clinics and of doctors of medicine (9%), and a few in specialty outpatient facilities (1%). Of the 894 dental health care workers with percutaneous injuries, there was evidence of HBV in 6 persons, HCV in 30 persons, HIV in 3 persons and both HBV and HVC (n = 2) exposure.

CONCLUSION

Out of hospital percutaneous injuries are a substantial risk to dental health professionals in Washington State. Improved work practices and safer devices are needed to address this risk.

Tuberculin reactivity among health care workers in nonhospital settings

BACKGROUND

We used workers' compensation data to identify health care workers at risk of tuberculosis exposure in the hospital and nonhospital environment.

METHODS

We identified State Fund workers' compensation claims having a documented tuberculin skin test (TST) conversion (size >or=10 mm) with a previous negative skin test between 1996 and 2000 in the State of Washington.

RESULTS

Health care workers experienced an overall accepted workers' compensation claim rate of 2.3 claims/10,000 full-time equivalent employees (FTEs) per year for tuberculin reactivity. Receptionists accounted for the largest number, with 18.4% tuberculin reactivity claims. The number of tuberculin reactivity claims was the highest for offices and clinics of doctors of medicine (3.7 per 10,000 FTEs), followed by medical laboratories (2.6 per 10,000 FTEs).

CONCLUSION

This study allowed characterization of employees in various nonhospital health services locations with higher number of tuberculin reactivity.

A descriptive study of workers' compensation claims in Washington State orchards

BACKGROUND

Previous studies have reported high rates of occupational injury and illness among workers in the tree fruit industry. However, many common and preventable risk factors and conditions in orchards have not been investigated.

AIMS

To identify and rank risk conditions leading to workers' compensation claims among orchard workers with respect to frequency, severity and cost.

METHODS

State Fund workers' compensation claims between 1996 and 2001 for orchard workers in the main tree fruit growing region of Washington were reviewed and categorized according to cause of injury. Descriptive analyses were performed to characterize claims by cause of injury.

RESULTS

Of the 13,068 claims in the dataset, 4,020 (31%) were determined to be ladder-related injuries. Ladder-related claims accounted for nearly half (48%) of all 'compensable' claims (e.g. claims involving time loss, disability or 'loss of earning power' in addition to medical expenses). Claims related to ladders were not only the most frequent but also the most expensive collectively in terms of medical aid, time loss and other costs. On a per-claim basis, ladder-related injuries were among the most severe and costly reported injuries. Other common causes of injury among claims were branches and vegetation, structure and material and ground-related injuries.

CONCLUSIONS

There is a strong and compelling need to develop interventions to reduce the number of ladder-related injuries in orchards.

Workers' compensation claims for needlestick injuries among healthcare workers in Washington State, 1996-2000

OBJECTIVES

To characterize accepted workers' compensation claims for needlestick injuries filed by healthcare workers (HCWs) in non-hospital compared with hospital settings in Washington State.

DESIGN

Descriptive study of all accepted workers' compensation claims filed between 1996 and 2000 for needlestick injuries.

PARTICIPANTS

All Washington State HCWs eligible to file a state fund workers' compensation claim and those who filed a workers' compensation claim for a needlestick injury.

RESULTS

There were 3,303 accepted state fund HCW needlestick injury claims. The incidence of needlestick injury claims per 10,000 full-time-equivalent HCWs in hospitals was 158.6; in dental offices, 104.7; in physicians' offices, 87.0; and in skilled nursing facilities, 80.8. The most common mechanisms of needlestick injury by work location were as follows: for hospitals, suturing and other surgical procedures (16.7%), administering an injection (12.7%), and drawing blood (10%); for dentists' offices, recapping (21.3%) and cleaning trays and instruments (18.2%); for physicians' offices, disposal (22.2%) and administering an injection (10.2%); and for skilled nursing facilities, disposal (23.7%) and administering an injection (14.9%). Nurses accounted for the largest (29%) proportion of HCWs involved, followed by dental assistants (17%) and laboratory technicians and phlebotomists (12%) in non-hospital settings. Rates of needlestick injury claims increased for non-hospital settings by 7.5% annually (95% confidence interval [CI95], 4.89% to 10.22%; P < .0001). Rates decreased for hospital settings by 5.8% annually, but the decline was not statistically significant (CI95, -12.50% to 1.34%; P < .1088). HCWs were exposed to hepatitis B, hepatitis C, and human immunodeficiency viruses in non-hospital settings.

CONCLUSION

There was a difference in the incidence rate and mechanisms of needlestick injuries on review of workers' compensation claim records for HCWs in non-hospital and hospital settings.

Occupational contact dermatitis

The dermatologist should be aware of the many facets of occupational skin diseases, which can be caused by physical, chemical, and biological insults. The most common manifestation of occupational skin diseases is contact dermatitis (both irritant and allergic). Three factors point out the importance of occupational skin diseases as diseases that have a public health impact: 1) occupational skin diseases are common; 2) they often have a poor prognosis; and 3) they result in a noteworthy economic impact for society and for an individual. They are also diseases amenable to public health interventions. Specific industries and exposures may put a worker at risk of occupational contact dermatitis. The accuracy of the diagnosis of occupational contact dermatitis is related to the skill level, experience, and knowledge of the medical professional who makes the diagnosis and confirms the relationship with a workplace exposure. Prevention of occupational contact dermatitis is important, and a variety of prevention strategies are available.

Injuries and Illnesses From Wood Framing in Residential Construction, Washington State, 1993–1999

The construction industry is associated with high rates of work-related injury. We used workers compensation data to describe the injuries and illnesses, claim rates, and claim costs associated with wood framing activities in construction. From 1993 to 1999, there were 33,021 accepted state fund workers compensation claims with direct costs of over $197 million. The average annual claim rate was 45 per 100 full-time equivalent. Statistically significant downward trends were noted in claim rates for all injuries and illnesses, compensable time loss claims, eye and fall injuries. However, these trends were not statistically significantly different from those observed in all other construction risk classes combined. The information in this report can be used to guide prevention efforts and to evaluate the effectiveness of Washington state initiatives to reduce injury and illness rates in wood frame construction.

Occupational dermatoses among Polish private farmers, 1991-1999

BACKGROUND

Little is known about work-related skin diseases among Polish self-employed farmers. In the National Register of Occupational Diseases, private farmers are placed in one category together with other agricultural workers, despite fundamental differences in compensation legislation and separate insurance institutions. The Agricultural Social Insurance Fund reports only on numbers of compensated cases. The aim of this study was to create reliable statistics on occupational dermatoses among private farmers.

METHODS

All cases of work-related skin diseases diagnosed from 1991 to 1999 were included in the statistics. Compensation records of the Agricultural Social Insurance Fund were analyzed for diagnoses, causative factors, and health impairment of the skin.

RESULTS

The first occupational dermatosis was registered in 1992. Until the end of 1999, there were 101 cases (63 women and 38 men). The incidence rose from 0.006/10000/year in 1992 to 0.189/10000/year in 1999. Allergic contact dermatitis was the most common diagnosis (86%), followed by infectious skin diseases (10%), irritant contact dermatitis (3%), and urticaria (2%). The most frequently identified causative factors were plant dusts (38%), animal allergens (36%), metals (29%), pesticides (18%), and rubber chemicals (15%). The median impairment due to skin disease was 20% (range 2-36%).

CONCLUSIONS

Since the introduction of workers' compensation, the numbers of occupational dermatoses diagnosed in Polish private farmers have increased rapidly. However, compared to countries with a longer experience in this field, these figures remain low, probably due to low detection of these diseases.

The importance of occupational skin diseases in the United States

Occupational skin diseases and disorders (OSDs) are the most commonly reported non-trauma-related (acute or cumulative) category of occupational illnesses in the United States. This factor, along with their potential chronicity, their effect on an individual's vocational and avocational activities, and the fact that they are preventable, point out the public health importance of OSDs. It can be difficult to obtain accurate epidemiological data for OSDs in the US, and all sources have their limitations. OSD cases that result in days away from work are important categories to study, since days away from work may be used as an indicator of the severity of a case. Descriptive epidemiology may be used to provide further information on these "more severe" cases, to determine, for example, high-risk industries, occupations, and exposures, and then to use this information to target the high-risk, "more severe" cases for prevention strategies. The goal of the US Public Health Service for the year 2010, as established in its "Healthy People 2010: National Health Promotion and Disease Prevention Objectives", is to reduce national OSDs to an incidence of no more than 46 per 100,000 full-time workers. Both irritant and allergic contact dermatitis are considered to be priority research areas as outlined in the National Occupational Research Agenda introduced in 1996 by the National Institute for Occupational Safety and Health. Increased knowledge and awareness of occupational skin diseases will assist in the achievement of the national public health goals.

Occupational contact dermatitis

Skin reactions are common in the workplace. The skin, which constantly is exposed to chemicals and industrial processes, develops inflammatory reactions, most commonly dermatitis, which may have an allergic or irritant basis. The epidemiology, pathophysiology, and clinical features of common occupational dermatoses are discussed. Irritant, allergic, and urticarial contact reactions are compared, and their clinical features are outlined. Important occupational irritants and allergens, their sources, and the industries in which they most commonly are found are listed. The prognosis and therapy of these occupational reactions are examined.

Natural rubber latex allergy workers' compensation claims: Washington State healthcare workers, 1991-1999

Occupational reaction to natural rubber latex experienced by healthcare employees was examined using data of all workers' compensation claims filed by state-insured healthcare employees in Washington State for the period 1991-1999 (n = 65,703). As latex reaction is not a condition for which there are specific identification codes, these claims were estimated by coupling source and nature of injury records that were consistent with reactions to latex. It was found that the claim rate was on average 2.66 per 10,000 state-insured healthcare workers annually. The most common condition experienced was dermal (84.3%), and most common body part affected was the hand (70.0%). Because few claims cited respiratory or conjunctivitis as reaction experienced, little evidence was discovered to support that glove powder acted as a widespread latex allergen transmitter in healthcare environments. Most cases did not require indemnity payment for lost work time (81.2%), suggesting most reactions were minor. The average cost per natural rubber latex claim was $2,759.10, compared to $3,178.18 for the average healthcare worker claim for all causes. Overall, the average cost per state-insured healthcare worker employed during this time was under $0.74 per year. Nursing aides/orderlies were the most frequent healthcare occupation filing a claim (33.2%). The majority of claimants were female (87.9%), and unmarried workers (52.0%) filed slightly more claims than married workers (48.0%). In comparison with other workers' compensation claims filed by healthcare workers during this period, 0.34 percent of the total was potentially related to natural rubber latex, with other common healthcare workplace items cited more frequently as source of occupational injury.

Surveillance scheme for occupational skin disease in the Saarland, FRG. First report from BKH-S

Occupational skin disease (OSD) is a significant public health concern. To keep OSDs under surveillance, a register of OSDs (BKH-S) was implemented in 1999 in the Saarland, FRG. We conducted a population-based register study to analyse all initial reports of OSDs reported to the BKH-S. 336 cases were prospectively assessed from July 1999 to June 2001. In 78% (n = 263) of the cases an occupational cause for the skin disease was stated, 91% (n = 240) of which fell within 16 occupational groups. This is equivalent to 6.8 cases per 10,000 workers per year within these occupational groups. Notably, young age groups (median age 35 years) were affected with a female predominance. The most frequent final diagnosis was irritant contact dermatitis (75%) followed by allergic contact dermatitis (34%) and atopic dermatitis (19%). The overall prevalence of occupationally relevant delayed-type reactors was 21% and of immediate-type reactors 17%. Work-related delayed-type sensitizations to potassium dichromate (n = 8) and immediate-type sensitizations to natural rubber latex (n = 11) were the most frequently observed. Questionnaire results showed frequent occupational skin contact with wet work (59%), detergents (48%), and disinfectants (38%). The second valid surveillance scheme for OSD in the FRG has been introduced and can be made available for further analysis.

Washington State hospital survey 2000: gloves, handwashing agents, and moisturizers

Hand dermatitis as a result of frequent exposure to water and cleansing agents is a significant problem in the health care industry. In developing prevention efforts to address this problem, it is necessary to make appropriate recommendations for moisturizers that are compatible with latex gloves and/or handwashing agents that contain chlorhexidine gluconate (CHG). Infection control personnel or employee health nurses in all 106 Washington hospitals were interviewed to determine what types of gloves, handwashing agents, and moisturizers are in current use in the hospital setting. The interview also addressed awareness of skin care issues involving the compatibility of moisturizers with latex gloves and handwashing agents that contain CHG. Latex gloves were available in 90% of the hospitals. Handwashing agents containing CHG were available in 33% of the hospitals. Moisturizers were supplied for the nursing personnel in 61% of the hospitals; most of these moisturizers were compatible with latex gloves and agents containing CHG. Seventy-four percent of the infection control personnel were aware of the compatibility issues of petroleum-based moisturizers with latex gloves, and 48% were aware of the need to avoid the use of anionic moisturizers in combination with CHG handwashing agents.

Integrating occupational health services and occupational prevention services

BACKGROUND

Despite the human and monetary costs of occupational injury and illness, occupational health care has focused more on treatment than prevention, and prevention is not part of many clinical occupational health practices. This represents a failure of occupational health care to meet the health care needs of the working patients.

METHODS

MEDLINE searches were conducted for literature on occupational medical treatment and the prevention of occupational injury and illness were reviewed to for linkages between prevention and treatment. Policy discussions which identify examples of programs that integrated prevention and treatment were included.

RESULTS

Although examples of the integration of clinical and preventive occupational health services exist, there are challenges and barriers to such integration. These include inaction by clinicians who do not recognize their potential role in prevention; the absence of a relationship between the clinician and an employer willing to participate in prevention; economic disincentives against prevention; and the absence of tools that evaluate clinicians on their performance in prevention.

CONCLUSIONS

Research is needed to improve and promote clinical occupational health preventive services.

Occupational skin diseases in Northern Bavaria between 1990 and 1999: a population-based study

BACKGROUND

Occupational skin diseases (OSDs) account for a large portion of occupational diseases in Europe, but population-based epidemiological studies are missing.

OBJECTIVES

We analysed the initial reports of OSDs in our register of OSDs in Northern Bavaria (BKH-N).

METHODS

A total of 5285 cases were assessed prospectively and registered from 1990 to 1999. As the German Federal Employment Office provides specific occupational data in relation to the total employed population of Northern Bavaria, it was possible to conduct a population-based study that investigated the trend in incidence rates between two study periods (1990-92 and 1993-99) in 24 different occupational groups.

RESULTS

A total of 3097 cases of OSD (median age 25 years) were recorded in the 24 occupational groups. There was a significant decline (P < 0.001) in the overall incidence rate of OSD with 10.7 cases per 10,000 workers per year for the first study period and 4.9 cases per 10,000 workers per year for the second study period. This general trend in incidence rates was also significant for hairdressers and barbers, bakers, health-care workers, cooks and metal processors.

CONCLUSIONS

The BKH-N provides national data based on the notification of OSDs in Germany. The results demonstrate the rank of occupations hazardous for the skin and are helpful for defining target groups for prevention.

Results of a pilot study reviewing dermatitis claims submitted to the Ontario Workplace Safety and Insurance Board

BACKGROUND

Workers who develop occupational skin disease are often eligible for workers' compensation benefits; however, there is little known about the decision-making process for adjudicating claims submitted for work-related skin problems.

OBJECTIVE

The objective of this pilot study was to test a file abstraction instrument and determine the nature of information that was available for decision-making.

METHODS

Files submitted to the Ontario Workplace Safety and Insurance Board (WSIB) in 1995 for dermatitis were identified. The last 51 files were abstracted to collect information concerning demographics, physicians seen, information available in the claim file for decision making, as well as type of claim and outcome of the claim.

RESULTS

Approximately 70% of the claims were "no-lost-time" and one-third of total claims were accepted for compensation. Although there was reasonable information related to the clinical status, most claims had no information that related to workplace issues such as exposures or association with work. Claims that were for lost time or were accepted had more information available.

CONCLUSIONS

The pilot study has demonstrated that there is a lack of information related to workplace issues that would be important in decision-making. The study will be extended to examine the entire year's claims in order to develop a strategy to enhance the understanding of the WSIB and providers regarding the information necessary for decision-making and to determine methods to facilitate its collection.

Selected topics related to occupational exposures. Part III. Occupational dermatology

Occupational skin disorders are very common and are a surprisingly frequent cause of lost work time. Failure to suspect an occupational cause can lead to repeated treatment failure and needlessly prolong patient misery and frustration. Primary care providers play a key role in recognizing possible occupational causes and arranging appropriate education, preventive measures, and treatment. Occupational skin conditions often occur in nonindustrial settings in workers such as hairdressers, health care personnel, and food handlers. Irritant contact dermatitis is by far the most prevalent occupational skin condition and is emphasized in this article. Allergic contact dermatitis, infections, skin cancers, and acneform eruptions may also have significant occupational associations. We will present criteria that suggest on occupational exposure, list common offending agents, and review the clinical presentations and relevant pathophysiology. We provide guidance on a directed history and physical examination and suggest when diagnostic testing is most likely to have value. Finally we outline preventive measures such as contact avoidance, barrier creams, and protective gloves and address therapy and indications for referral.