Professional Cleaners' and Healthcare Workers' Ability to Recognize Hand Eczema

Timely intervention reduces the risk of a poor prognosis in hand eczema, making early recognition of symptoms important in high-risk professions. However, limited data exist regarding the ability of cleaners and healthcare workers to recognize hand eczema. The aim of this study was to examine cleaners' and healthcare workers' ability to recognize hand eczema in clinical photographs and to assess the severity of the disease. Cleaners and healthcare workers completed a questionnaire consisting of 16 questions and participated in a structured interview referring to a validated photographic severity guide for chronic hand eczema, which comprised clinical photographs of hand eczema at varying levels of severity. Eighty cleaners and 201 healthcare workers (total N = 281) participated in the study. The rates of correctly identified hand eczema in clinical photographs (cleaners/ healthcare workers) were: 41.2%/57.7% (mild hand eczema), 81.2%/92.0% (moderate hand eczema), 85.0%/94.5% (severe hand eczema) and 82.5%/97.0% (very severe hand eczema). The proficiency of healthcare workers in recognizing hand eczema was significantly higher than that of cleaners. The results indicate that a large proportion of cleaners and healthcare workers fail to recognize mild hand eczema in clinical photographs. Healthcare workers had higher success rates in recognizing hand eczema in all severity categories. Symptom underestimation may lead to under-reporting of the true prevalence of hand eczema, with consequent loss of opportunities for prevention.

Assessing the efficacy of a German-inspired intervention on occupational contact dermatitis in Denmark: A randomised controlled trial with 3-month follow-up

BACKGROUND

Occupational contact dermatitis (OCD) is a prevalent, often chronic disease that poses a risk for job loss and decreased quality of life. In Germany, a multi-step prevention programme emphasising early detection and highly specialised multidisciplinary treatment has been implemented with great success.

OBJECTIVES

To examine the effectiveness of a Danish-adapted version of the German prevention effort on OCD severity, quality of life and occupational consequences at 3-month follow-up.

METHODS

Randomised, controlled trial. Participants were recruited after the first referral from General Practitioner to Dermatologist with suspected OCD. The intervention group (IG) received a Danish-adapted, multidisciplinary intervention, while the control group (CG) navigated the Danish healthcare system without interference from the study. OCD severity, occupational consequences and quality of life were assessed at 3-month follow-up using self-reported questionnaires.

RESULTS

A statistically significant decrease in the severity of eczema was found at 3-month follow-up in the IG compared to the CG. The IG were statistically significantly more likely to have seen a dermatologist at 3-month follow-up. Higher treatment level in the IG was indicated by the results but was not statistically significant. No significant difference was found in quality of life or occupational consequences.

CONCLUSIONS

These initial findings suggest that early and specialised treatment of OCD improves OCD prognosis.

Design and validation of pictograms and educational video clips to improve the knowledge of skin care and protection: Comprehension and recall among professional hospital cleaners

INTRODUCTION

Insufficient knowledge about protection and care of the skin among Danish hospital cleaners, particularly immigrant cleaners, is guessed to be a widespread issue that can increase the likelihood of them developing occupational hand eczema (OHE). This study aimed to design and validate 10 pictograms and 10 short video clips showing recommendations for skin care that would help prevent OHE among professional cleaners.

METHODS

Ten pictograms and 10 short, educational video clips, based on standard, recommended information were developed in collaboration with a medical illustrator and a video director. The materials were validated in a two-step process that included bus drivers (primary validation) and professional cleaners (secondary validation).

RESULTS

During the primary validation, 5 of the 10 pictograms (50%) were comprehended correctly by at least 85%. Those that were misinterpreted, were modified and retested several times until they were understood correctly by at least 85%. During the secondary validation, all 10 pictograms achieved acceptable levels of comprehension among professional cleaners. All the video clips were comprehended correctly by both bus drivers and cleaners.

CONCLUSION

Ten easy-to-understand pictograms and 10 educational video clips for cleaners about the prevention of OHE have been designed and validated.

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.

Acceptance of skin products in healthcare workers: an empirical investigation

BACKGROUND

Healthcare workers (HCWs) are at high risk of developing hand eczema (HE). This can be exacerbated by hygiene measures related to the coronavirus disease (COVID-19). Using mild skin cleansers and emollients or moisturizers is central in the prevention of HE-especially with increased COVID-19 hygiene regimes.

AIMS

This study aimed to assess parameters important for the acceptance of a skincare concept in HCWs.

METHODS

In this proof-of-concept user trial, HCWs were provided ad libitum with hand wash oil and hand cream during the 6-month period, when occupationally acquired COVID-19 infections among HCWs were peaking in Germany and then surveyed about acceptance of the products using questionnaires.

RESULTS

Of 135 HCWs, 115 (85%) responded. Skin tolerance of the hand wash oil and the hand cream was rated very good by 63% and 52% of the 115 participants, respectively. Of the 115 participants, 58% and 57% were very satisfied with the hand wash oil and the hand cream, respectively.

CONCLUSIONS

Acceptance of skin cleansing and skincare products in HCWs seems influenced by parameters such as self-assessed skin tolerance and self-reported overall satisfaction. It must be assumed that products are only used as recommended if they are well-accepted. Employers might survey employees about acceptance of products using the parameters identified to adjust concepts if necessary to sustainably contribute to the prevention of HE.

Occupational Hand Dermatitis amongst Cassava Processors in Rural Communities in Southwest Nigeria

BACKGROUND

Hand dermatitis (HD) is an inflammatory disorder of the hand. Agricultural industries (farming) have been reported as one of the leading occupation predisposing workers to health risks. Practices such as dumping cassava peels in farm environment, removal of heaps of peels, soaking of cassava and clearing of ditches have been identified as potentially harmful. These processes, which are wet works, are often done with bare hands predisposing cassava processors to HD.

AIMS

This study aimed to determine the prevalence, predisposing factors and characteristics of HD amongst cassava processors in some rural communities in Southwest Nigeria.

METHODOLOGY

This was a cross-sectional prospective study involving females engaged in farming and processing of raw cassava into 'garri' meal using the traditional methods. Four hundred and twenty-six female cassava processors were included. The questionnaire used was an adaptation of the Nordic Occupational Skin Questionnaire (NOSQ-2002) which is used to document work related skin diseases of the hand and forehand, and exposures to environmental factor.

RESULTS

The mean age was 38.7 years and age range 13 - 70 years. Fifty-seven (13.4%) participants presented with HD within 12 months. Itching was the most common symptoms reported by 44 (10.3%) participants followed by pain 26 (6.1%) and small bumps 23 (4.9%) . The palmar surface of the right hand was most affected. None of the participants who use gloves regularly reported any symptoms of HD.

CONCLUSION

Cassava processors have been shown to be at potential risk of occupational HD; hence, health education and use of protective materials are important measures for prevention.

[Hand eczema and wet work]

Occupational hand eczema (HE) has continuously been the most frequently recognised occupational disease, comprising > 95% of all recognised occupational skin diseases. Irritant contact dermatitis constitutes > 70%, where wet work is the main eliciting factor. Knowledge on the dose-response relationship between wet work and HE is pivotal concerning preventive interventions, job counselling and medico-legal regulations, which is summarised in this review. New findings indicate a significant risk of having HE at an exposure level of no more than 30 minutes of wet work per day.

Prophylactic Dressings for Maintaining Skin Integrity of Healthcare Workers When Using N95 Respirators While Preventing Contamination Due to the Novel Coronavirus: A Quality Improvement Project

PURPOSE

Extended use of N95 respirator masks is far more prevalent during the coronavirus disease 2019 (COVID-19) pandemic. As WOC nurses, we were tasked with formulating procedures for protecting the facial skin integrity of healthcare workers (HCWs) using personal protective devices when caring for patients with suspected or active COVID-19, while avoiding contamination when the masks are donned or doffed. This quality improvement project describes how we approached this project within the limited time frame available as we cared for patients with established and suspected COVID-19.

PARTICIPANTS AND SETTING

This project focused on HCW use of N95 respirator masks and dressings currently available in our facility. The 4 WOC nurses acted as quality improvement project directors and as participants. The setting for our project was our facility's simulation laboratory.

APPROACH

We evaluated 6 topical products (an alcohol-free liquid acrylate, thin film dressing, thin hydrocolloid dressing, hydrocolloid blister care cushion, thin foam transfer dressing, and thick foam dressing) applied to skin in contact with 3 N95 respirators; all are available on our facility's formulary and all are in widespread clinical use. After the product was applied to the face and nose, the N95 respirator was donned and evaluated for fit. Participants then wore the devices for 10 hours and doffed the mask using established facility procedures. In order to evaluate for potential contamination including possible aerosolization, we applied a commercially available fluorescent lotion to simulate the presence of infectious particles. Contamination was assessed using an ultraviolet light for all dressings except for the alcohol-free liquid acrylate. We also evaluated cutaneous responses (skin integrity, irritation, comfort) during this period.

OUTCOMES

We found that contamination of the simulated pathogen did not occur with removal of any of the protective products. No skin irritation was noted with any of the tested products after a 10-hour wear time underneath the N95 respirator masks, but mild discomfort was experienced with 3 of the dressings (thin film dressing and both hydrocolloid dressings).

CONCLUSION

Based on these experiences, we recommend application of an alcohol-free liquid acrylate film to prevent facial skin injury associated with friction from the extended use of an N95 respirator mask. We further recommend performing a fit test and user-performed seal check with the use of any topical dressing and especially those that add cushion. For the duration of the COVID-19 pandemic, we recommend use of protective dressings to maintain skin integrity and protection from coronavirus infection as HCWs continue to provide care to all of patients under their care.

Interventions for preventing occupational irritant hand dermatitis

BACKGROUND

Occupational irritant hand dermatitis (OIHD) causes significant functional impairment, disruption of work, and discomfort in the working population. Different preventive measures such as protective gloves, barrier creams and moisturisers can be used, but it is not clear how effective these are. This is an update of a Cochrane review which was previously published in 2010.

OBJECTIVES

To assess the effects of primary preventive interventions and strategies (physical and behavioural) for preventing OIHD in healthy people (who have no hand dermatitis) who work in occupations where the skin is at risk of damage due to contact with water, detergents, chemicals or other irritants, or from wearing gloves.

SEARCH METHODS

We updated our searches of the following databases to January 2018: the Cochrane Skin Specialised Register, CENTRAL, MEDLlNE, and Embase. We also searched five trials registers and checked the bibliographies of included studies for further references to relevant trials. We handsearched two sets of conference proceedings.

SELECTION CRITERIA

We included parallel and cross-over randomised controlled trials (RCTs) which examined the effectiveness of barrier creams, moisturisers, gloves, or educational interventions compared to no intervention for the primary prevention of OIHD under field conditions.

DATA COLLECTION AND ANALYSIS

We used the standard methodological procedures expected by Cochrane. The primary outcomes were signs and symptoms of OIHD developed during the trials, and the frequency of treatment discontinuation due to adverse effects.

MAIN RESULTS

We included nine RCTs involving 2888 participants without occupational irritant hand dermatitis (OIHD) at baseline. Six studies, including 1533 participants, investigated the effects of barrier creams, moisturisers, or both. Three studies, including 1355 participants, assessed the effectiveness of skin protection education on the prevention of OIHD. No studies were eligible that investigated the effects of protective gloves. Among each type of intervention, there was heterogeneity concerning the criteria for assessing signs and symptoms of OIHD, the products, and the occupations. Selection bias, performance bias, and reporting bias were generally unclear across all studies. The risk of detection bias was low in five studies and high in one study. The risk of other biases was low in four studies and high in two studies.The eligible trials involved a variety of participants, including: metal workers exposed to cutting fluids, dye and print factory workers, gut cleaners in swine slaughterhouses, cleaners and kitchen workers, nurse apprentices, hospital employees handling irritants, and hairdressing apprentices. All studies were undertaken at the respective work places. Study duration ranged from four weeks to three years. The participants' ages ranged from 16 to 67 years.Meta-analyses for barrier creams, moisturisers, a combination of both barrier creams and moisturisers, or skin protection education showed imprecise effects favouring the intervention. Twenty-nine per cent of participants who applied barrier creams developed signs of OIHD, compared to 33% of the controls, so the risk may be slightly reduced with this measure (risk ratio (RR) 0.87, 95% confidence interval (CI) 0.72 to 1.06; 999 participants; 4 studies; low-quality evidence). However, this risk reduction may not be clinically important. There may be a clinically important protective effect with the use of moisturisers: in the intervention groups, 13% of participants developed symptoms of OIHD compared to 19% of the controls (RR 0.71, 95% CI 0.46 to 1.09; 507 participants; 3 studies; low-quality evidence). Likewise, there may be a clinically important protective effect from using a combination of barrier creams and moisturisers: 8% of participants in the intervention group developed signs of OIHD, compared to 13% of the controls (RR 0.68, 95% CI 0.33 to 1.42; 474 participants; 2 studies; low-quality evidence). We are uncertain whether skin protection education reduces the risk of developing signs of OIHD (RR 0.76, 95% CI 0.54 to 1.08; 1355 participants; 3 studies; very low-quality evidence). Twenty-one per cent of participants who received skin protection education developed signs of OIHD, compared to 28% of the controls.None of the studies addressed the frequency of treatment discontinuation due to adverse effects of the products directly. However, in three studies of barrier creams, the reasons for withdrawal from the studies were unrelated to adverse effects. Likewise, in one study of moisturisers plus barrier creams, and in one study of skin protection education, reasons for dropout were unrelated to adverse effects. The remaining studies (one to two in each comparison) reported dropouts without stating how many of them may have been due to adverse reactions to the interventions. We judged the quality of this evidence as moderate, due to the indirectness of the results. The investigated interventions to prevent OIHD probably cause few or no serious adverse effects.

AUTHORS' CONCLUSIONS

Moisturisers used alone or in combination with barrier creams may result in a clinically important protective effect, either in the long- or short-term, for the primary prevention of OIHD. Barrier creams alone may have slight protective effect, but this does not appear to be clinically important. The results for all of these comparisons were imprecise, and the low quality of the evidence means that our confidence in the effect estimates is limited. For skin protection education, the results varied substantially across the trials, the effect was imprecise, and the pooled risk reduction was not large enough to be clinically important. The very low quality of the evidence means that we are unsure as to whether skin protection education reduces the risk of developing OIHD. The interventions probably cause few or no serious adverse effects.We conclude that at present there is insufficient evidence to confidently assess the effectiveness of interventions used in the primary prevention of OIHD. This does not necessarily mean that current measures are ineffective. Even though the update of this review included larger studies of reasonable quality, there is still a need for trials which apply standardised measures for the detection of OIHD in order to determine the effectiveness of the different prevention strategies.

[Occupational allergic contact dermatitis: the role of occupational physician in the prevention.]

OBJECTIVES

Occupational contact dermatitis are the second occupational diseases in industrialized countries and the preventive action and/or early diagnosis done by occupational physician (OP) is of paramount importance.

METHODS

OP in the process of risk evaluation must suggest products, detergents and personal protective equipment with low irritant or sensitization potential. During work, the use of skin creams has to be promoted to prevent irritation that is the first step towards impairment of the skin barrier and sensitization.

RESULTS

During periodical medical surveillance OP can control skin conditions of workers looking for signs of irritant and contact dermatitis, can give advice about preventive measures and information about products used to permit an early and correct diagnosis.

CONCLUSIONS

At the retour to work workers with a diagnosis of occupational dermatitis must avoid direct contact with irritant and sensitizing products.

Safer Soap: A Look at Harmful Ingredients Found in Hand Cleansers

According to the Centers for Disease Control and Prevention, up to 40 percent of workers will suffer from occupational dermatitis at some point in their working lives.

Biomonitoring and exposure levels of imidacloprid in air of workplace and on skin of workers exposed to pesticides

The article presents results ofhygienic studies on work conditions in using imidacloprid-based pesticides in agriculture. Analysis covered imidacloprid levels in air of workplace, on skin and in urine of workers.

Hand Dermatitis Risk Factors Among Clinical Nurses in Japan

The purpose of this study was to establish hand dermatitis (HD) risk factors among Japanese nurses. A questionnaire was administered to 1,162 clinical nurses, from whom 860 replies were received (response rate of 74.0%). Their overall HD prevalence was 53.3%. Several risk factors were identified: using latex gloves (odds ratio [OR] 1.9), allergies in adulthood (OR 2.7), urticaria as an adult (OR 1.5), atopic dermatitis as an adult (OR 2.7), any allergies to latex products (OR 5.2), skin irritation following contact with latex (OR 4.1), contact dermatitis following contact with latex (OR 3.5), family history of hay fever (OR 1.6), and family history of atopic dermatitis (OR 1.9). The use of hand cream was associated with a 50% reduction in HD risk (OR 0.5). In this study, we found that Japanese clinical nurses suffer a significant occupational burden from HD. As such, it is essential that hospital managers consider interventions to reduce this troublesome occupational disease among clinical nurses in Japan, as elsewhere.

Occupational Allergic Contact Dermatitis from Mioga (Zingiber Mioga Rosc.) in Greenhouse Cultivators

Mioga ( Zingiber mioga Rosc.) is a member of the ginger family (Zingiberaceae), which is native to tropical Asia. In Japan, the young flower buds are used as a spice, and hand dermatitis suspected as being an allergy to mioga has been recognized in mioga greenhouse cultivators. To investigate the extent of the problems and the causes of dermatitis, 20 householders cultivating mioga in their greenhouses were asked to participate in a questionnaire study. Consecutive patch tests were performed on some subjects with dermatitis. Self-reported questionnaires were distributed to the main cultivator in each household who attended a lecture of mioga cultivation methods held at an agriculture cooperative association in the area. Some subjects who answered as presenting or having had hand dermatitis were patch tested for mioga (as is), four kinds of mioga extracts, and three kinds of natural rubber gloves. Results: 35 cultivators from 16 households answered the questionnaire. Eight of the 35 subjects (22.9%) answered that they had experienced hand dermatitis since they started mioga cultivation. Four of the 8 subjects were patch tested. Two of the 4 subjects showed allergic reactions to mioga (as is) and the extracts. The other two cases showed irritation to mioga (as is). The first two cases also showed allergic reactions to natural rubber gloves. To our knowledge, there is no previous report of allergic contact dermatitis from mioga.

OCCUPATIONAL CONTACT DERMATITIS AMONGST DENTISTS AND DENTAL TECHNICIANS

Since the working medical personnel including dentists and dental technicians mainly use their hands, it is understandable that the most common occupational disease amongst medical personnel is contact dermatitis (CD) (80%-90% of cases). Development of occupational CD is caused by contact of the skin with various substances in occupational environment. Occupational etiologic factors for dental personnel are foremost reactions to gloves containing latex, followed by various dental materials (e.g., metals, acrylates), detergents, lubricants, solvents, chemicals, etc. Since occupational CD is relatively common in dental personnel, its timely recognition, treatment and taking preventive measures is needed. Achieving skin protection at exposed workplaces is of special importance, as well as implementing necessary measures consequently and sufficiently, which is sometimes difficult to achieve. Various studies have shown the benefit of applying preventive measures, such as numerous protocols for reducing and managing latex sensitivity and other forms of CD in dentistry. Active involvement of physicians within the health care system, primarily dermatologists, occupational medicine specialists and general medicine doctors is needed for establishing an accurate medical diagnosis and confirmation of occupational skin disease.

Saving the Barrier by Prevention

One third of all occupation-related diseases are diseases of the skin, and in most of these cases the skin barrier is involved. Professions such as metalworkers, hairdressers, and health care and construction workers are mainly affected. Among them, contact dermatitis is the leading skin disease. It usually presents as hand eczema caused by or leading to impaired barrier function. All this significantly impacts the function of the hands, reduces the ability to work and especially impairs the patient's quality of life. Diagnostics and therapy are of great importance; in addition, prevention programs are meanwhile an important mainstay of the overall therapeutic concept. They comprise measures of secondary (outpatient) and tertiary (inpatient) prevention. Secondary prevention measures include occupation-tailored teaching and prevention programs, and the dermatologist's examination and report. In severe cases or if therapy is not successful in the long term, or if the diagnosis is not clear, measures of tertiary prevention may come into action. They are offered as an inpatient treatment and prevention program. The aims are prevention of the job loss, but especially to reach a long-term healing up and getting back to normal occupational and leisure life in the sense of attaining full quality of life. During the last years, research in Germany has shown that the different measures of prevention in occupational dermatology are very effective. This integrated concept of an in-/outpatient disease management reveals remarkable pertinent efficacy for patients with severe occupational dermatoses in at-risk professions.

[Quality management in occupational dermatology]

BACKGROUND

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

OBJECTIVES AND METHODS

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

RESULTS

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

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

INTRODUCTION

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

MATERIAL AND METHODS

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

RESULTS

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

DISCUSSION

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

CONCLUSIONS

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

[Barrier creams in prevention of hand dermatoses]

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

Latex allergy in women's health care

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

[Prevention of occupational dermatitis in an international perspective]

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

Recent advances in research on lacquer allergy

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

Epoxy pipe relining - an emerging contact allergy risk for workers

BACKGROUND

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

[Laboratory animal; allergy; asthma]

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

Helping hands

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

Teaching interventions in contact dermatitis

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

Prevention of occupational dermatitis

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

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

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

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

INTRODUCTION

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

OBJECTIVES

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

MATERIAL AND METHODS

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

RESULTS

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

CONCLUSIONS

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

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

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