Individual prevention courses for occupational skin diseases: changes in and relationships between proximal and distal outcomes.

BACKGROUND: To treat people with occupational contact dermatitis, the German Accident Prevention and Insurance Association in the Health and Welfare Services offers 2-day individual prevention (IP) seminars. OBJECTIVES: We investigated whether there are short-term and medium-term changes in proximal (e.g. behaviour) and distal (e.g. symptoms) outcomes after an IP seminar, whether changes in proximal outcomes are associated with changes in distal outcomes, and whether subgroups can be identified that benefit in particular. PATIENTS/MATERIALS/METHODS: In a prospective study, 502 participants of 85 IP courses completed the health education impact questionnaire (heiQ™) and skin symptom questionnaire (Skindex-29) at the start of the course, immediately thereafter, and after 6 months. Change was assessed according to standardized effect size. Regression techniques were used to analyse associations between proximal and distal outcomes. RESULTS: After 6 months, participants showed improved self-management skills and preventive behaviour, and less fear of job loss, disease-related symptoms, and emotional distress. Significant associations between proximal and distal outcomes were found. Participants who felt more limited by their skin disease showed greater effects. CONCLUSIONS: The results are consistent with the assumption that IP courses provide a range of benefits for people with occupational contact dermatitis. Changes in distal outcomes may be influenced by changes in proximal outcomes.

The durability of examination gloves used on intensive care units.

BACKGROUND: The use of examination gloves is part of the standard precautions to prevent medical staff from transmission of infectious agents between patients. Gloves also protect the staff from infectious agents originating from patients. Adequate protection, however, depends on intact gloves. The risk of perforation of examination gloves is thought to correlate with duration of wearing, yet, only very few prospective studies have been performed on this issue. METHODS: A total number of 1500 consecutively used pairs of examination gloves of two different brands and materials (latex and nitrile) were collected over a period of two months on two ICU's. Used gloves were examined for micro perforations using the "water-proof-test" according to EN 455-1. Cox-regression for both glove types was used to estimate optimal changing intervals. RESULTS: Only 26% of gloves were worn longer than 15 min. The total perforation rate was 10.3% with significant differences and deterioration of integrity of gloves between brands (p<0.001). Apart from the brand, "change of wound dressing" (p = 0.049) and "washing patients" (p = 0.001) were also significantly associated with an increased risk of perforation. CONCLUSION: Medical gloves show marked differences in their durability that cannot be predicted based on the technical data routinely provided by the manufacturer. Based on the increase of micro perforations over time and the wearing behavior, recommendations for maximum wearing time of gloves should be given. Changing of gloves after 15 min could be a good compromise between feasibility and safety. HCWs should be aware of the benefits and limitations of medical gloves. To improve personal hygiene hand disinfection should be further encouraged.

Occupational contact allergy caused by rubber gloves--nothing has changed.

BACKGROUND: Allergic contact dermatitis caused by rubber gloves is not infrequent, and has almost exclusively been attributed to contact sensitization to accelerators. Thiurams have been the most frequent allergens, followed by dithiocarbamates. OBJECTIVES: To describe the current allergen pattern in patients with occupational allergic contact dermatitis caused by rubber gloves. METHODS: This study was a retrospective analysis of data from the Information Network of Departments of Dermatology (IVDK), 2002-2010. RESULTS: Of 93 615 patients patch tested in the IVDK, 3448 both suffered from occupational dermatitis and were tested because of suspected glove allergy. Among these, healthcare workers were the largest group (n = 1058). Of all occupational dermatitis patients, 13% were sensitized to thiurams, 3.5% to dithiocarbamates, 3% to mercaptobenzothiazole and/or its derivatives, and 0.4% to thioureas. Positive test reactions to 1,3-diphenylguanidine were seen in 3.0%. Reaction frequencies varied with the years, but showed no uniform time trend. CONCLUSIONS: As compared with a former IVDK data analysis (1995-2001), there was no change in sensitization pattern and no decline in sensitization frequencies. This is in line with data from the literature. Particularly in healthcare, there is a need for (i) allergen declaration on the glove package, and (ii) gloves with reduced accelerator content.

Evidence of increased skin irritation after wet work: impact of water exposure and occlusion.

BACKGROUND: Exposure to humid environments/water and prolonged glove occlusion are both believed to cause irritant contact dermatitis. OBJECTIVES: To study the effects of different forms of wet work, especially the differences between water exposure and occlusion, by using an experimental model simulating occupational wet work. METHODS: The responses to water exposure and occlusion over multiple daily exposure periods for 7 days were compared in 73 volunteers. After the 1 week exposure, the sites were irritated with sodium lauryl sulfate (SLS). Comparison was performed via visual inspection and bioengineering methods. RESULTS: Whereas occlusion did not induce measurable alterations in skin physiology, water exposure for more than 3 hr daily caused a significant increase in transepidermal water loss (TEWL) as compared with the control areas. SLS irritation of the previously occluded and the water-exposed sites induced higher TEWL and clinical scores in a time-dependent fashion as compared with the control areas, with more pronounced reactions in the water-exposed sites than in the occluded sites. CONCLUSION: Both previous occlusion and water exposure were capable of inducing higher susceptibility to SLS irritation. Skin hydration by occlusion had a different biological effect than water exposure. Short occlusions seem to harm the skin less than water exposure for the same duration.

Safety, effectiveness and comparability of professional skin cleansers.

BACKGROUND: There are no widely-accepted methodical specifications with which to objectify cleansing effectiveness and skin compatibility of occuptional skin cleansing products in Europe. Therefore the German Social Insurance Agency (DGUV) initiated a study with the goal to evaluate such products in view of the potency and the safety of hand cleansers. A market analysis was a part of the project. METHODOLOGY: The product descriptions and safety data sheets of 120 products (5-20/manufacturer) of 11 manufacturers were evaluated between 02/2008 and 04/2008. RESULTS: The manufacturers used mainly ingredients of low irritancy. The declaration of the applied ingredients was in the majority of the cases correctly labeled according to the INCI Declaration. Although there was documentation of skin tolerability for most products, the manufacturers used widely differing tests of skin compatibility. Evidences for cleansing effectiveness were not declared or have not been provided. One manufacturer even promised medical effects of its products. There was no uniform general classification of products making it difficult to identify characteristics of cleansers and choose between them. CONCLUSIONS: Presently, there are no commonly accepted criteria to classify products in view of cleansing effectiveness und skin compatibility. Generally accepted criteria and test methods are needed for the evaluation of hand cleansers in order to provide the possibility of transparency and comparability.

A 7-step consultation plan for health care workers and hairdressers.

BACKGROUND: Skin diseases are among the most common occupational disorders in health care workers and hairdressers. Optimal prevention methods make it possible for more individuals to remain active in their profession. We devised a 7-step consultation plan which was employed in a standard fashion and then evaluated. PATIENTS AND METHODS: 264 employees were evaluated in the Education and Support Center of the German Accident Prevention and Insurance Association in the Health and Welfare Services (BGW schu.ber.z Berlin) from 2003 to 2005 in a standardized manner. Included were detailed history, physical examination, skin physiology measurements (transepidermal water loss, corneometry, sebumetry) and then making a diagnosis and therapeutic recommendations. RESULTS: Within the study group of 264 employees the most frequent diagnosis were toxic-irritant hand eczema (28.4%), allergic contact eczema (19.7%), atopic eczema (15.5%) and irritant contact eczema with atopic diathesis (13.6%). The frequency of contact sensitivity was high in the study group (80.7%). The skin physiological parameters were not remarkably altered and did not differ between individuals with an atopic diathesis versus without an atopic diathesis. CONCLUSION: This standardized protocol for a "7-step consultation plan"when applied in a standardized manner offers quality-controlled but also individually-adapted support considering dermatological, educational and occupational aspects. Skin physiology parameters did not provide any further information indicating the need of the development of novel techniques to measure skin barrier function.

Skin protection training. The route to practical applications.

A skin protection cream can only provide effective protection at exposed workplaces if it is applied sufficiently and without gaps. This is sometimes difficult to achieve. Various studies have shown that success in the primary, secondary and tertiary prevention of occupational skin diseases is possible with intervention measures which include skin protection training. However, knowledge alone does not automatically lead to a change of attitudes, and this in turn may not automatically lead to a change of behaviour. The generation of health protection behaviour is in fact a very complex process. This complexity, together with the various intervention time points (primary, secondary or tertiary prevention) and the target groups should be taken into account when deciding the goals, contents and methods of skin protection training as well as the selection of the trainer. Typical goals, contents and methods are given for practical training which allow 'learning with head, heart and hand'.

Osnabrueck hand eczema severity index--a study of the interobserver reliability of a scoring system assessing skin diseases of the hands.

An easy-to-use standardized instrument is needed for the clinical assessment of the severity of occupational hand eczema by dermatologists as well as occupational physicians. The Osnabrueck hand eczema severity index (OHSI) was developed for this purpose and the interobserver reliability investigated. The clinical severity was evaluated on the basis of the extension or clinical characteristics of six morphological characteristics. For the validation of the OHSI, hand eczema in 28 patients was investigated independently by one dermatologist and 2 occupational physicians. The agreement between the observers was determined by using kappa values, Kendall's coefficient of concordance, the intraclass correlation coefficient (ICC) and the 95% limits of agreement. The ICC for the total OHSI was 0.80 and the estimated limits of agreement (-3.6 and 3.0) were sufficiently small to expect that ratings according to OHSI performed by independent observers of different medical specialities should produce similar results. It could be demonstrated that the use of the OHSI is simple and practicable. The interobserver reliability for the summary score is good. OHSI seems a reliable tool for assessing the severity of occupational hand eczema.