Contact Dermatitis Among Healthcare Workers
Contact dermatitis is the most common form of skin condition reported amongst healthcare workers, and nurses are most at risk. Nurses are particularly prone to developing contact dermatitis due to important infection prevention and control measures such as frequent hand hygiene measures and wearing gloves as personal protective equipment.
The term dermatitis simply means inflammation of the skin, but the root cause of dermatitis can come from different sources, including infection, allergies and exposure to an irritating substance. Contact dermatitis occurs when the skin comes in contact with a substance that causes a delayed allergic reaction (allergic contact dermatitis), or when there is an injury to the skin's surface (irritant contact dermatitis) (Cleveland Clinic, 2019). Symptoms of contact dermatitis include red, inflamed skin that is often hot or itchy, swelling, dry skin, tender skin, tight skin, blisters with or without oozing, and it can be a very painful condition especially when it occurs on the hands where the skin needs to move a lot.
Severe cases of contact dermatitis may result in a nurse needing to take sick leave to allow skin to heal. This can affect the nurses’ personal occupational health record, as well as organisational budgets, unit staffing levels, and ultimately patient safety.
The reduction and prevention of the incidence of healthcare acquired infections (HCAIs) is a global healthcare goal, with a big emphasis on the importance and efficacy of hand hygiene measures. Some worldwide campaigns to increase the understanding of the importance of hand hygiene practices and to increase these practices in the clinical area have included “Clean Your Hands” (UK, 2004), “Clean Hands Count” (USA, 2016), and The National Hand Hygiene Initiative” (Australia, 2009). There is also a Global Handwashing Day that occurs annually on the 15th October since 2008, and the World Health Organisation created the World Hand Hygiene Day that is held in May. It is thought that this increase in requirements of hand hygiene and PPE measures are contributing to the problem of contact dermatitis experienced by nurses and other healthcare workers. However it is still vital that nurses perform these measures in order to prevent the transmission of infection.
A National UK study that spanned over 17 years aimed to evaluate whether interventions used to decrease the incidence of HCAIs have coincided with an increase of work-related contact dermatitis attributed to hand hygiene measures and other hygiene measures in healthcare workers. The whole study can be found on the following link: https://onlinelibrary.wiley.com/doi/full/10.1111/bjd.13719
It analysed voluntary data provided from dermatologists within the UK to a voluntary organisation called The Health and Occupation Research Network (THOR), which was opened in 1996. During 2005-2007 60% of eligible UK dermatologists participated. Dermatologists were asked to report cases of Irritant Contact Dermatitis (ICD) that were likely to have been caused or aggravated by work, as well as the patient’s occupation and the suspected causal agent. A total of 7,138 cases of ICD were reported between 1996 and 2012. Of which 1,796 were healthcare workers, and 5,342 were in other occupations. This incidence amongst healthcare workers had grown steadily over time, as opposed to the decline in incidence amongst other occupations.
It states that when the study finished in 2012, there was around 4.5 times as many reports of ICD attributed specifically to hand hygiene in healthcare workers as there was in 1996 when it began. The rate of increase in ICD amongst healthcare workers attributed to hygiene procedures was at it’s steepest between 1996 to 2003. The National “Clean Your Hands” campaign was undertaken between 2004 and 2008, which promoted the importance of hand hygiene in NHS trusts by using media and poster campaigns aimed at healthcare workers and patients, as well as increasing the availability of hand rubs at the bedside and other key clinical areas. The incidence did start to decline in 2011, and this is likely to be due to the increased focus of healthcare organisations about the importance of skin care whilst still practicing effective hand hygiene practices in the clinical area.
However, this study only included cases with ICD as the sole diagnosis, and excludes data where allergic contact dermatitis may exist also. It also only requests data from dermatologists, however most people who experience ICD may manage their condition themselves or with the assistance of their GP, suggesting that the incidence is likely to be much higher.
In the Netherlands, a single-site randomised control trial is aiming to examine whether an intervention program based on the provision of hand creams and regular feedback on consumption can improve the skin condition of nurses engaged in wet work when compared to a “care as usual” control group. A link to the details for the statistical analysis of the “Healthy Hands Project” can be found here: https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-018-2703-7
This article is aiming to provide statistical data on recommendations made by both The Dutch Society of Occupational Medicine (in 2006) and the Netherlands Society of Dermatology and Venereology (in 2013). They both recognise the importance of the skin barrier, and promote the regular use of emollients and ointments in the prevention of irritant contact dermatitis.
Obviously it is important that you follow organisational policy and comply with all of their infection prevention and control measures. However, if you experience any of the symptoms of dermatitis named above, please visit your healthcare provider. They may suggest an allergy test for you if they suspect you have allergic dermatitis, or they may prescribe you some emollient creams or steroid creams or ointments to ease your symptoms and prevent further breakouts. Remember, open wounds are an infection control risk in the healthcare area, and it is important that you help to remain as healthy as possible in your job. Treatment for dermatitis is often more effective and quicker when started early. Often for people prone to or at risk of contact dermatitis, preventative measures (emollients and avoidance of contact with known allergies or irritants) are necessary.