Occhealth Bulletin
03 June 2009
Preventing Occupational Skin Disorders
Category: Reviews
Occupational Skin Diseases (OSDs) occur when the outer protective barrier of the skin (stratum corneum of the epidermis) is breached and skin irritants (agents that directly damage skin cells) and sensitizers (allergens), derived from work processes, are allowed to permeate into deeper layers of the skin and bloodstream. OSDs are extremely common in the working population; there were 41,400 reported cases in the US in 2006 and in Germany it is suggested that 25% of all occupational-related compensation payments are made to those suffering with OSDs. Workers in certain occupations are known to be more susceptible to OSD than others due to the nature of the chemicals or agents that they come into contact with on a regular basis. Healthcare industry workers such as hospital and care home workers are prone to OSDs as a result of exposure to detergents, disinfectants, latex rubber proteins, medicines and tasks that involve a lot of wet-work.
A workplace intervention study on geriatric care nurses has recently been published by Dulon and co-workers (2009). The aim of the study was to discover whether the introduction of a skin care program reduced OSDs experienced by geriatric care nurses and encouraged further protective measures to be taken in order to reduce their occurrence. The randomized study took place on 388 clinical staff working in 24 nursing homes in four regions of North Germany. Each nursing home had at least 30 geriatric care nurses. One hundred forty six workers were included in the intervention group (IG) whilst 242 were included in the control group (CG). Participants’ hands, from both IG and CG, were examined for signs of OSD by occupational physicians at the start of the study (between August 2004 and March 2005) and exactly one year later. All participants were also asked to fill out a questionnaire on exposure.
The researchers included a clear plan for intervention during the study. The first included training for senior staff nurses and managers which began with a day-long seminar outlining information regarding risk-factors for skin diseases and conditions such as eczema, study information and practical skin care information. This was followed by an advisory service (meetings between the senior members of staff and the course instructor). Training for the geriatric care nurses included a 2-hour course providing information on OSDs and practical instructions for skin care. A checklist, at the start of the study and three months after the study intervention, was also completed to document the preventative measures that employers had initiated to protect their workers against OSDs.
At the start of the study, the researchers found that there were no differences between the intervention group and the control group in terms of skin changes or work-related behavior. Due to intervention, the frequency of skin disease in the IG was significantly reduced from 26% (at the start) to 17% (follow-up phase). Conversely, there was no difference in the frequency of skin disease from the start of the study to follow-up in the CG. The researchers noted changes in behavioral patterns with the IG including changes from using water in hand washing to hand disinfection and the use of moisturizers. Employers also provided cotton gloves and barrier creams at the IG places of work. The researchers concluded that geriatric care nurses would benefit from implementation of an effective skin care program in their workplace together with an advisory support service for their senior managers to reduce the incidence of OSDs.
For more information on skin exposure at work and the rules and regulations that surround this issue, take a look at the Examinetics, Inc Pathfinder titled ‘Dermal Exposure’.
Reference
Dulon, M., Pohrt, U., Skudlik, C. and Nienhaus, A. (2009) Prevention of occupational skin disease: a workplace intervention study in geriatric nurses. British Journal of Dermatology. Epub – ahead of print.