Providing healthcare workers with free health education and unlimited skin cleaning and care products to use at work and at home prevented new cases of hand eczema in a recent controlled intervention study.
Shanina C. Knighton, PhD, RN, CIC
“Healthcare workers who were supplied with hand cleaning and care products to use in both the healthcare setting and at home were less likely to acquire hand eczema and to lose time at work due to their condition than were workers who did not receive those interventions,” Shanina C. Knighton, PhD, RN, CIC, infection preventionist, nurse scientist, and adjunct associate professor in the Frances Payne Bolton School of Nursing at Case Western Reserve University in Cleveland, Ohio, told Medscape Medical News.
“The findings can help healthcare organizations implement ways to support their workers in the healthcare setting and at home,” Knighton, who was not involved in the study, added in a phone interview. “This support is especially important during the ongoing COVID-19 pandemic, which has been requiring more intensive contact with skin-damaging products.”
Hand eczema, a common bothersome and often chronic condition in healthcare workers, can become so severe that it prevents them from working, the authors write. Owing to increased COVID-19 hygiene measures, hand eczema has become more prevalent, and related treatment costs and absence from work have increased.
As reported in Contact Dermatitis, lead study author Cara Symanzik, Dr. rer. nat., MEd, and her colleagues at Osnabrück University in Osnabrück, Germany, recruited staff — nurses, surgical assistants, physiotherapists, and others — in an unblinded trial at two area hospitals between December 2020 and January 2021.
All 135 participants with no known allergies to fragrances or oat flour at one hospital received free online health education and free unlimited access to hand cleaning and care products, and 167 participants at a second hospital received no interventions.
The treatment group received a lipid-containing synthetic detergent and an emollient for use at work and at home as well as access to a 35-minute online training course and a leaflet on hand eczema and its prevention.
At baseline and at 6 months, all participants underwent skin examinations by dermatologists experienced in occupational skin diseases. The severity of their hand eczema was scored using the validated Osnabrück Hand Eczema Severity Index. Participants also completed questionnaires that asked whether they currently have hand eczema, whether they’ve ever had an itchy rash that came and went for at least 6 months, and other questions about their skin and skin care behavior.
At baseline, participants were, on average, in their mid-30s and early 40s in the treatment and control groups, respectively. In both groups, around 85% were women, more than half were nurses, and around half in both groups had completed intermediate school. Work weeks in both groups averaged around 36-37 hours.
In the treatment and control groups, respectively, 23.7% and 17.4% of participants reported having an itchy rash that came and went for at least 6 months, and 50.0% and 51.7% of participants, respectively, reported skin crease involvement. In both groups, roughly one third of participants reported having hay fever, and around 10% reported having asthma.
About 64% of the intervention group had worked in their occupations for 11 years or longer, and more than 40% had worked longer than 20 years. By contrast, just under 40% of the control group had 11 or more years on the job, and about 25% had more than 20 years of experience.
The researchers found that:
During the observation period, no new hand eczema cases were found among the 115 members of the treatment group who completed the study, and 12 cases (8.8%) were found among the 136 control participants.
At 6 months, daily use of emollients in the treatment group was higher than in the control group at work and at home.
“The study was very well organized,” Knighton said. “An unlimited supply of skin care products supplied for both the healthcare and work settings, as well as health education, were good interventions. Including worker occupations and education levels in the demographic breakdown allowed the authors to hone in on healthcare occupations that, while very important, may be missed.”
“One limitation to the study was that the participants were not blinded,” she added. “The Hawthorne effect — people who know they are being observed tending to change or improve their behavior — may have influenced the results.”
Knighton would like to know how the longer experience of the intervention group compared with the control group might have influenced the outcomes.
“As the authors write, the intensified hand hygiene measures implemented during the pandemic have led to increased skin issues among healthcare and other workers,” she said. “After contacting harsh agents at work, many workers, especially those who work at lower levels, again contact harsh agents at home. And they miss work due to their disease.”
“We need to acknowledge that, in the United States, many of our healthcare workers, especially lower-level workers, are living in poverty. They may also be living in hygiene poverty and unable to afford skin-care products,” Knighton noted. “We need to support these workers who at times may work more closely with patients than do nurses, and who may be handling substances that are harsher to their skin.”
Knighton recommends that healthcare organizations make dermatologists available to advise workers about maintaining their skin health at work and in other settings.
The authors and Knighton report no relevant financial relationships. The study received monetary support and donation of products used in the study from Beiersdorf AG, which was not involved in the study design, data collection and analysis, decision to publish, or manuscript preparation.
Contact Dermatitis. Published online August 22, 2022. Full text
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