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Occupational irritant contact dermatitis (ICD) is a major problem for healthcare workers due to their frequent exposure to water and chemicals that can damage skin. Nurses and other healthcare staff are at high risk of developing ICD, which can lead to sore, dry hands and increased absenteeism. Controlling ICD is crucial for healthcare organizations because damaged skin increases bacterial growth and infection risks. Adopting a rigorous hand hygiene regime using alcohol-based products appropriately selected by pharmacists can help avoid ICD and ensure effective infection control.
Occupational irritant contact dermatitis (ICD) is a major problem for healthcare workers due to their frequent exposure to water and chemicals that can damage skin. Nurses and other healthcare staff are at high risk of developing ICD, which can lead to sore, dry hands and increased absenteeism. Controlling ICD is crucial for healthcare organizations because damaged skin increases bacterial growth and infection risks. Adopting a rigorous hand hygiene regime using alcohol-based products appropriately selected by pharmacists can help avoid ICD and ensure effective infection control.
Occupational irritant contact dermatitis (ICD) is a major problem for healthcare workers due to their frequent exposure to water and chemicals that can damage skin. Nurses and other healthcare staff are at high risk of developing ICD, which can lead to sore, dry hands and increased absenteeism. Controlling ICD is crucial for healthcare organizations because damaged skin increases bacterial growth and infection risks. Adopting a rigorous hand hygiene regime using alcohol-based products appropriately selected by pharmacists can help avoid ICD and ensure effective infection control.
Occupational Irritant Contact Dermatitis in Healthcare Workers
Meeting the Challenge of revention a report by Dinah Gould Professor of Nursing, Faculty of Health, South Bank University, on behalf of SSL International plc Introduction !hich the skin is e"amine# $y me#ical personnel are more likely to yiel# vali# fin#ings% atch&testing is ' Irritant contact #ermatitis (ICD) is the term use# to re*uire# to i#entify the irritant% + #escri$e re#, sore, itchy skin resulting from mechanical or chemical in-ury% It may #evelop very Which Occupational Groups are . *uickly or up to /0 hours later% ICD is usually a mil#, Most at Risk? self&limiting con#ition $ut recurs !ith repeate# e"posure an# may $ecome chronic% It is #istinguishe# eople !ho !ork in heavy in#ustry, those !hose / from atopic #ermatitis, a con#ition that results from !ork involves contact !ith harsh chemicals that have e"posure to an allergen in suscepti$le in#ivi#uals% the potential to #amage skin an# those !ho are Ho!ever, those !ith a history of atopy are more at re*uire# to un#ertake !et !ork routinely are most at risk% ICD occurs most often in people !hose !ork risk% They inclu#e1 young, other!ise fit, men e"poses them to prolonge# contact !ith !ater (2!et employe# as metal!orkers, ru$$er!orkers, $eauty / .3 !ork4) an# the han#s are fre*uently affecte#% therapists an# $akers% Hair#ressers have $een the .. ./ su$-ect of numerous research stu#ies $ecause of the Occupational ICD is #efine# as a pathological many hours they engage in !et !ork !ith e"posure con#ition of the skin for !hich occupational to harsh chemicals such as #yes an# styling flui#s% 5 e"posure can $e sho!n to $e the main causal or ma-or inci#ence stu#y among /,/6/ trainee contri$utory factor% It is a ma-or pro$lem that hair#ressers in 7ermany reveale# that '/. (89:) 8 employers cannot affor# to overlook, accounting for #evelope# skin changes #uring the three years of more #ays lost from !ork than any other their apprenticeship% 5##itional factors . 8 occupational #isor#er apart from musculo&skeletal contri$uting to risk inclu#e#1 lo! am$ient con#itions% ;or e"ample, in the <=, the Health an# temperature (causing skin to #ry)> youth (-uniors #o 0 Safety ?"ecutive (HS? .++@) has estimate# that over most !et !ork) an# a history of atopy% .0 '0,333 people #evelop occupational ICD !ith four million !orking #ays lost each year% ICD Affecting Healthcare Workers 0 Much has $een !ritten a$out occupational ICD an# Specialists in occupational health me#icine recognise the literature is international, although more research that nurses an# other healthcare !orkers are appears to have $een con#ucte# in ?urope than the particularly at risk of ICD in vie! of their e"posure <= or the <S% to !et !ork an# chemicals (#etergents, antiseptics) that can #amage skin% It has $een estimate# that How Many eople are Affected? nurses in Denmark un#ertake an average 8%@ hours (range 3%@ to + hours) #aily an# are e"pose# to 5 *uestionnaire stu#y among /3,333 ran#omly #isinfecting pro#ucts on an average of /. (range 3 to selecte# citiAens in S!e#en reporte# that /@: ha# 63) occasions% Self&report *uestionnaire stu#ies / #evelope# symptoms #uring the previous year% confirm this high risk of e"posure% @ . @ ,. 9 Women are more likely to $e affecte# an# to perceive their symptoms as severe% Bisks in the In these stu#ies, *ualifie# nurses ten#e# to report 9 general population also appear to $e associate# !ith fe!er episo#es an# less severe #amage than heavy #omestic commitments, especially chil# care un*ualifie# healthcare assistants an# cleaners% This is an# lack of access to mo#ern #omestic appliances% pro$a$ly $ecause nurses must un#ergo a 6 comprehensive occupational health assessment $efore Disa#vantages of the self&report approach employe# they commence training% 5pplicants !ith a history of in these stu#ies are1 lo! response rate, $iase# fin#ings severe atopy are not consi#ere# suita$le on (those !ith pro$lems !ill respon#) an# reliance on occupational health groun#s, thus removing one of ! self&report (!hich may $e inaccurate)% Stu#ies in the ma-or risk factors% ;or nurses, ICD is a nuisance C <SI D? SS C B I?; ID 71 ? <B O ? 5D H 5B M5C O TH? B 5E / 338 (?F TB 5CT)
Technology & Services rather than a reason for leaving their profession% intrinsically resistant to anti$iotics rises, !ith Devertheless, it is an occupational health pro$lem concomitant increase in the total num$er of $acteria, that shoul# not $e #ismisse# $y managers% so that more are present to contri$ute to cross& infection% There is also significant occupational Besearch stu#ies have repeate#ly #emonstrate# that health risk to staff% 5$rasions provi#e a route of entry sore, #ry han#s are a ma-or #isincentive to practising to parenterally sprea# viruses such as HIG, hepatitis C han# hygiene% ;ailure to comply !ith han# hygiene an# C, !hich are associate# !ith consi#era$le . 6 protocols is highly un#esira$le $ecause han# hygiene mor$i#ity an# mortality% These risks are / 8 is accepte# $y infection control e"perts !orl#!i#e as compoun#e# $ecause nurses are reluctant to take sick the single most effective an# cost&effective metho# of leave, continuing to !ork #espite marke# #iscomfort preventing infection in healthcare settings% Most from ICD% .' . @, . 9 healthcare&relate# infections are #isseminate# via the han#s an# #econtamination after patient contact has5nother compelling reason for controlling any $een #emonstrate# to re#uce cross&infection% occupational health haAar# among healthcare . + Tra#itionally, !ashing !ith soap an# !ater removes professionals, especially nurses, is that recruitment transient $acteria on the skin that are easily an# retention is no! recognise# to $e a pro$lem transferre#, resulting in cross&infection% Durses internationally% Dursing is no longer a popular / 3 /0 report that soaps #ry the skin an# make han#s sore, a option among school&leavers $ecause the hours are pro$lem that is !orse !ith antiseptics% Ho!ever, long an# unsocia$le, !ith poor pay, particularly as antiseptics are recommen#e# !hen risks of infectionthe career options open to young !omen the are particularly high $ecause they #estroy $acteriatra#itional recruits to nursing have no! much an# are thus more effective than soap% improve#% The e"istence of occupational health / 3 haAar#s !ill contri$ute to the poor image of the Han# hygiene has $ecome so esta$lishe# in stan#ar# profession to ne! recruits an# !ill not encourage infection control policies internationally that there is those alrea#y employe# to stay% Wise managers !ill no possi$ility that nurses or other healthcare !orkers $e a!are of this pro$lem an# !ill !ish to tackle it $y !oul# ever $e a#vise# not to un#ertake it% ;or #oing all they can to re#uce occupational health risks e"ample, !earing gloves #oes not eliminate the nee# such as ICD% to #econtaminate han#s% If the gloves are $eing use# to prevent the transfer of infection to a suscepti$le How ICD can "e A#oided patient !hen performing an aseptic techni*ue (e%g% #ressing a !oun#, catheterisation) the han#s must 5ll employees at risk of ICD shoul# $e traine# to first $e #econtaminate# $ecause gloves can perforate% recognise early signs of irritation an# take preventative action promptly, reporting symptoms Decontamination is necessary !hen gloves have $een that #o not resolve% 9 remove# $ecause the han#s may $ecome contaminate# through acci#ental contact !ith their Healthcare !orkers are a#vise# to a#opt a rigorous outer surfaces% 7loves themselves may increase the regime of han# care to re#uce suscepti$ility% / @ risk of #eveloping sore, #amage# skin% 5llergy to the urchasers shoul# seek the a#vice of pharmacists an# late" in many $ran#s can $e e"acer$ate# $y the infection control teams so that han# hygiene pro#ucts po!#er they contain is a common pro$lem amongare chosen carefully, in line !ith evi#ence&$ase# healthcare !orkers% 5lthough the inci#ence of recommen#ations% Throughout ?urope, the <= an# /. allergy can $e re#uce# $y provi#ing alternatives tothe <S, alcoholic preparations are increasingly late" an# po!#er&free pro#ucts, the han#s $ecome recommen#e#% 5n alcohol gel or solution is applie# / 9 macerate# #uring occlusion, friction causes irritation #irectly to the han#s, then massage# to contact all han# an# there is increase# likelihoo# of #eveloping ICD surfaces% 5lcohols are $ecoming popular $ecause they in response to soaps an# antiseptics as a result%are highly effective !hen fre*uently applie# #uring /. patient care, convenient to use (canisters of pro#uct can ICD is $ecoming such an issue among healthcare $e place# at the $e#si#e, so there is no nee# to !aste !orkers that, in some countries, it is attracting the time !alking to a sink) an# are ine"pensive% attention of tra#e union officials% / / ?mollients are incorporate# into the pro#uct so that Why Controlling ICD is Crucial for the alcohol content #oes not cause #e&fatting an# #ry Healthcare Workers the skin% Ho!ever, some staff are reluctant to use alcohol $ecause their han#s are alrea#y chappe# Damage# skin is associate# !ith an increase in the through fre*uent tra#itional #econtamination an# it num$er an# composition of the $acterial flora of causes stinging% The ans!er is to persevere !ith the skin% The prevalence of clinically significant species alcoholic preparation so that the skin heals% The / 8 $ such as Staphylococcus aureusan# 7ram&negative ro#s initial #iscomfort !ill then resolve% C <SID ? SS C B I?; ID 71 ? <B O ? 5D H 5B M5C OT H? B 5E /3 38 (?F TB 5CT)
Occupational Irritant Contact Dermatitis in Healthcare Workers The emollients incorporate# into alcohol pro#ucts from home% Self&selection an# supply may not $e the eventually $uil# up so that tra#itional !ashing is $est policy, ho!ever, as staff may have limite# re*uire# to remove them% When this is necessary, the information concerning pro#uct ingre#ients or con#ition of the skin can $e maintaine# $y applying effectiveness an# may ina#vertently increase the risks #econtaminant to han#s that have alrea#y $een of cross&infection $y re&using open tu$es that have moistene#, rinsing thoroughly an# careful #rying $ecome contaminate# through repeate# han#ling% !ith goo# *uality, a$sor$ent #isposa$le paper to!els% 5nec#otal reports from hospitals in !hich alcoholic In a later stu#y, the same authors foun# preliminary pro#ucts have $een intro#uce# in#icate that there are evi#ence that supplying staff !ith emollients at !ork no! fe!er reports of sore, #ry han#s $ut the pro$lem helpe# to counteract the effects of repeate# #econtam& is $y no means era#icate#% 5t times !hen staff are ination% The pro#uct !as #ispense# in single&use 8 . o$lige# to #econtaminate fre*uently, for instance sachets an# !as !ell&tolerate#% Devertheless, there are #uring an out$reak or long shifts (at night shifts), many unans!ere# *uestions relating to protocols for there !ill al!ays $e some risk of ICD% application% Optimal fre*uency remains to $e esta$lishe# an# pro$a$ly #epen#s on the con#ition of Managers shoul# ensure that gloves are purchase# in the in#ivi#ual4s skin, the num$er an# types of a choice of #ifferent materials an# that staff have $een #econtamination performe# (soap, a*ueous antiseptic a#vise# not to !ear the same ones over long perio#s or alcohol)% Techni*ue of application also #eserves of time% If prolonge# use is necessary, they shoul# $e attention% 5#e*uate cover of the han#s !ith emollient remove#, han#s shoul# $e !ashe# an# #rie# is essential to ensure protection areas of the skin that thoroughly an# ne! gloves put on% The fre*uency escape contact !ill not $e protecte#% Trials have / . !ith !hich gloves shoul# $e replace# is not state# in #emonstrate# that application is poor in all occupa& the literature% ;rom clinical e"perience, 83 minutes tional groups so far e"amine#, inclu#ing hospital seems a reasona$le length of time $ut it may vary cleaners% ?mployees !ere aske# to coat the han#s 8 / $et!een in#ivi#uals% !ith la$elle# emollient, ultraviolet (<G) light !as then use# to #emonstrate !hich areas escape# contact% T!o types of han#&cream have $een #evelope# to Most (H.@3, 96:) #i# not a#e*uately protect han#s help re#uce the risk of #ermatitis1 $arrier an# although they recognise# the importance of skincare emollient creams% Carrier creams effectively protect an# purchase# their o!n pro#ucts% 5ll registere# the skin against harsh chemicals $ut have no surprise at the num$er of han# surfaces (#orsum, moisturising effect% Ia$oratory stu#ies !ith animal fingers, inter#igital spaces) left !ithout protection% / 6 mo#els an# human volunteers have #emonstrate# that emollients have a $eneficial effect on the 5 later intervention stu#y $y the same authors con#ition of the stratum corneum, increasing the #emonstrate# that employees can $e taught ho! to !ater content an# preventing the #rying effect of ensure even cover of han#s !ith emollient using the e"perimentally&in#uce# irritation% Moreover, <G light techni*ue% Continue# application $y this / ' 8 8 regular application of emollients can prevent metho# over si" !eeks significantly improve# the #etergent&in#uce# ICD in healthy volunteers $y con#ition of skin, compare# !ith a group instructe# re#ucing transepi#ermal !ater loss an# encourages $y vi#eotape #emonstration only% esta$lishe# lesions to heal% ?mollient han#&creams / + appear to $e the most suita$le for controlling Conclusion occupational ICD in healthcare settings !here the main risks are e"posure to repeate# !et !ork an# ICD is a significant occupational health pro$lem lo!&gra#e irritants such as #etergents% Compliance throughout ?urope, the <= an# the <S% 5lthough it has $een goo# !hen emollient creams have $een affects many occupational groups more severely than teste# un#er 2in use4 con#itions !ith hospital staff% healthcare !orkers, healthcare staff re*uire special / consi#eration $ecause ICD resulting in $roken skin %he Role of &kin Care in increases the possi$ility of cross&infection, especially if re#enting and %reating ICD the associate# soreness operates as a #isincentive to compliance !ith han#&hygiene protocols% In a##ition, The use of emollient creams to prevent an# treat !ork in healthcare settings is likely to involve han#ling esta$lishe# ICD has $een recommen#e# $y $loo# an# $o#y flui#s, placing staff at risk of #eveloping occupational health e"perts !ith application $efore serious, potentially fatal parenteral infections% ICD can 8 3 prolonge# glove use to re#uce maceration, occlusion, $e re#uce# $y careful choice of han# #econtaminants an# friction% 5 preliminary stu#y !ith .86 nurses in an# gloves, provi#ing emollient creams an# / . the <S confirme# the increase# rate of $acterial encouraging staff to use them as part of the overall carriage on #amage# skin% Most of the nurses applie# infection control an# occupational health strategy% han#&cream t!o to three times per shift to re#uce the urchasers, managers an# pharmacists play a key role in ' associate# soreness an# #ryness, $ringing supplies #eveloping an# implementing these policies% C <SI D? SS C B I?; ID 71 ? <B O ? 5D H 5B M5C O TH? B 5E / 338 (?F TB 5CT)
Technology & Services References 1! " Uter, et al!, #Han$ %er&atitis in a Prospectively' follo(e$ )ohort of Hair$ressing *pprentices+ Final 1! S "eltfrien$, et al!, #Irritant %er&atitis,, -esults of the PS.H Stu$y,, Contact Dermatitis, Dermatology , /th e$!, )hapter 0, F N 1ar2ulli an$ 1 314445, pp! 6078609! H I 1aibach 3e$s5, "ashington+ :aylor ; Francis 314495, pp! 0<8110! 1/! = La&&intausta an$ = =al&o, #*topy an$ Han$ %er&atitis in Hospital "et "ork,, Contact 6! U Bern$t, et al!, #Han$ >c2e&a in 1etal(orker Dermatitis , < 314015, pp! ?718?70 :rainees 8 *n *nalysis of the -isk Factors,, Contact Dermatitis ,? 367775, pp! ?6<8??6! 19! H * S&it, et al!, #Prevalence of Han$ %er&atitis in %ifferent .ccupations,, International Journal of ?! > %ouglas, et al!, #Is .ccupational %er&atitis Being ?pi#emiology , 66 3144?5, pp! 600864?! :aken Seriously by U= In$ustries@,, Occupational Me#icine , 6 314445, pp! 0/841! 1<! % A Boul$, #NursesC Han$(ashing Practice+ -esults of a Local Stu$y,, Journal of Hospital Infection, ! Health an$ Safety >Decutive, #Self'reporte$ "ork' 60 31445, pp! 1/8?7! relate$ Illness in 144/+ -esults fro& a Househol$ Survey,, http+EE(((!hse!gov!ukEstatisticsE6776E 10! National *u$it .ffice, The Management an# s(i4/!p$f Control of Hospital&ac*uire# Infection in 5cute DHS Trusts in ?nglan# , National *u$it .ffice, /! B 1e$ing, #Nor&al Stan$ar$s for %er&atological Lon$on! Health Screening at Places of "ork,, Contact Dermatitis , 6< 314465, pp! 69486<7! 14 > Larson an$ > = =ret2er, #)o&pliance (ith Han$(ashing an$ Barrier Precautions!,, Journal of 9! B 1e$ing, #%ifferences Bet(een SeDes (ith -egar$ to Hospital Infection , ?7 3144/5 Suppl!, pp! "ork'relate$ Skin %isease, Contact Dermatitis , ? 008179! 367775, pp! 9/8<1! 67! A >hrenkrant2, #Blan$ Soap Han$(ash or <! > Nillson, et al!, #*topy, .ccupation an$ %o&estic Han$(ash *ntisepsis@ :he Pressing Nee$ for "ork as -isk Factors for Han$ >c2e&a in Hospital )larity,, Infection Control an# Hospital "orkers, Contact Dermatitis , 1? 3140/5, pp! ?pi#emiology , 1? 314465, pp! 6448?71! 619866?! 61! > Hel$ an$ L L Aorgensen, 5merican Journal of 0! H * S&it, et al!, #>valuation of Self'a$&inistere$ Contact Dermatitis , 17 314445, pp! 1981/6! Fuestionnaire on Han$ %er&atitis,, Contact Dermatitis , 69 314465, pp! 11819! 66! S Fre$erickes, #:he *ns(er is in your Han$s,, Dursing De! Kealan# , Auly 144?, pp! 11816! 4! * Boosens #1ini&ising the -isks of 1issing a )ontact *llergy,, Dermatology , 676 367715, pp! 6?! > Larson, et al!, #)hanges in Bacterial Flora 1098104! *ssociate$ (ith Skin %a&age on Han$s of Health )are Personnel,, 5merican Journal of Infection 17! - Ger&eulen, et al!, #*scertain&ent of Han$ Control , 69 314405, pp! /1?8/61! %er&atitis Using a Sy&pto&'base$ Fuestionnaire+ *pplicability in an In$ustrial Population,, Contact 6! A Buchan, #Planning for )hange+ %eveloping a Policy Dermatitis , 6 314445, pp! 6768679! Fra&e(ork for Nursing Labour 1arkets,, International Dursing Bevie! , < 367775 , pp! 11! ) -o&aguera an$ A Gilplana, #.ccupational )ontact 144867! %er&atitis fro& Hlang'ylang .il,, Contact Dermatitis , ? 367775, p! 6/1! 6/! *non!, #:ips for Nurses "ho "ash :oo 1uch,, Begistere# Durse , 9? 367775 ?, pp! ?8?<! 16! * Bauer, et al!, #Skin Protection in BakersC *pprentices,, Contact Dermatitis , 9 367765, pp! 69! % Paulson, et al!, #* )lose Look at *lcohol Bel as 0180/! an *nti&icrobial Saniti2ing *gent,, 5merican Journal of Infection Control , 6< 314445, pp! 1?! H A Sch(ant2 an$ " Uter, #Inter$igital %er&atitis+ ??68??0! Sentinel Skin %a&age in Hair$ressers,, Critish Journal of Dermatology , 16 367775, pp! 6<! P :reffel, et al!, #>valuation of Barrier )rea&s+ *n 1,71181,716! In Gitro :echniIue on Hu&an Skin,, 5cta ( Dermato&Genereologica , < 31445, pp! <811! C <S ID ?SS C B I? ;ID 71 ? <B O ?5D H 5B M5C O TH? B 5E /338 (?F TB 5CT)
Occupational Irritant Contact Dermatitis in Healthcare Workers 60! % " -a&sing an$ : *gner, #Preventative an$ ?6! " "igger'*lberti, et al!, #Self'application of a :herapeutic >ffects of 1oisturi2er! *n >Dperi&ental Protective )rea&! Pitfalls of .ccupational Skin Stu$y of Hu&an Skin,, 5cta Dermato& Protection,, 5rchives in Dermatology , 1?? Genereologica , << 3144<5, pp! ??/8??<! 3144<5, pp! 091809 64! * Hannuksela an$ =innunen, #1oisturi2ers Prevent ??! " "igger'*lberti, et al!, #:raining "orkers at -isk Irritant %er&atitis,, 5cta Dermato& for .ccupational )ontact %er&atitis in the *pplication Genereologica , <6 314465, pp! 68! of Protective )rea&s+ >fficacy of a Fluorescence :ech' niIue,, Dermatology , 14/ 3144<5, pp! 16481??! ?7! H Jhai an$ H I 1aibach, #1oisturi2ers in Preventing Irritant )ontact %er&atitis+ *n Contact Information .vervie(,, Contact Dermatitis , ?0 314405, pp! 6186! SSL International plc ?/ Ne( Bri$ge Street ?1! > Larson, et al!, #*ssess&ent of *lternative Han$ Lon$on >)G 9H-, Unite$ =ing$o& Hygiene -egi&ens to I&prove Skin Health *&ong :el+ 35 1/9/ 96/777 Neonatal Intensive )are Nurses,, Heart an# Iung , http+EE(((!ssl'international!co& 64 367775, pp! 1?9816! ) C <SI D? SS C B I?; ID 71 ? <B O ? 5D H 5B M5C O TH? B 5E / 338 (?F TB 5CT)