2 Factors Raise Risk for Hand Eczema in Healthcare Workers
2 Factors Raise Risk for Hand Eczema in Healthcare Workers
April 10, 2012 — Hand eczema is common among healthcare workers. A study published online April 6 and in the May print issue of Contact Dermatitis examines exposures that may elevate risk for the condition.
In Denmark, one fifth of individuals with skin eczema work in healthcare professions. Efforts to minimize incidence require knowledge of the relationship between eczema and frequency of hand washing, and how aspects of hand washing differ in the workplace and home environments.
Kristina S. Ibler, MD, from the Department of Dermatology, Roskilde University Hospital, and the Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Denmark, and colleagues sent a questionnaire addressing hand washing practices and eczema to 3181 healthcare workers. The 2269 (71%) respondents were physicians, nurses, nursing assistants, and clinical technicians working in 3 hospitals in the same part of Denmark.
The questionnaire probed the details of hand washing in the workplace (use of disinfectants and gloves; extent of patient care; exposure to medications, laboratory reagents, rubber, plastic, food, detergents, and plaster) and in the home environment (childcare, gardening, engine repair, decorating, doing laundry, cleaning, cooking, etc). Time spent with household exposures was noted as less than 0.5, 0.5 to 3, more than 3 to 5, and more than 5 hours per day. Frequency of washing/disinfecting was rated as 1 to 5, 6 to 10, 11 to 15, 16 to 20, and more than 20 times per day.
The questionnaire asked about use of moisturizers (not used; used, but not every day; used once or twice a day; and used more than twice a day), physical activity, and smoking. Respondents rated eczema severity using photos.
"Participants with hand eczema washed their hands significantly more often than those without (P < .001)," found the researchers. Most respondents washed their hands 6 to 10 times daily while at work. Of those participants with hand eczema, 52% washed more than 10 times a day, whereas 43% of those without hand eczema wash their hands that often. Respondents with eczema also washed their hands more while outside the workplace than those participants without eczema (23% vs 16%; P < .001, washed more than 10 times per day outside of work, respectively).
Thirty-four percent of respondents with eczema reported use of synthetic rubber gloves compared with 27% of those without eczema, which is statistically significant (P = .009). Use of cotton gloves, reported by 2% of those with eczema and less than 1% of those without it, was also significant (P = .03). Use of natural rubber gloves was more common among those without eczema, with the difference not being statistically significant.
In the workplace, hand eczema was significantly associated with use of protective gloves while handling drugs and collecting blood. Severity of eczema was not related to the extent of hand washing or use of gloves.
Intriguing results emerged for use of moisturizers. "[O]ur study found that frequent use of moisturizers outside of work was reported by significantly more of those with hand eczema and was positively correlated with the severity degree of hand eczema," the authors write, concluding that this finding likely reflects treatment of the skin condition at home.
The researchers also found that domestic exposures that increase risk for eczema include caring for children younger than 4 years and cooking, cleaning, and washing dishes and clothing while using gloves. Gardening, decorating, repairing engines, smoking, and physical activity level were not related to either hand eczema or its severity.
The researchers suggest that use of disinfectants perhaps replace some episodes of hand washing, based on the association of frequency of hand washing and development of eczema, and to be consistent with recommendations for healthcare workers to disinfect rather than wash if the hands are visibly clean. "The educational strategy for healthcare workers with hand eczema may benefit from a re-evalution focusing on influencing the pattern of hand washing," they write.
A limitation of the study was the self-assessment aspect. The researchers suggest that future studies address the psychological reasons for excessive hand washing that may predispose healthcare workers to developing hand eczema.
"Attention should...be paid to healthcare workers with small children at home," the authors suggest. They also remark in their conclusion that "[t]he preventive effect of moisturizers used during working hours should be tested in future follow-up studies."
The study was funded by the Zealand Region Research Fund and the Danish Working Environment Research Fund. The authors have disclosed no relevant financial relationships.
Contact Dermatitis. 2012;66:247-253. Abstract
April 10, 2012 — Hand eczema is common among healthcare workers. A study published online April 6 and in the May print issue of Contact Dermatitis examines exposures that may elevate risk for the condition.
In Denmark, one fifth of individuals with skin eczema work in healthcare professions. Efforts to minimize incidence require knowledge of the relationship between eczema and frequency of hand washing, and how aspects of hand washing differ in the workplace and home environments.
Kristina S. Ibler, MD, from the Department of Dermatology, Roskilde University Hospital, and the Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Denmark, and colleagues sent a questionnaire addressing hand washing practices and eczema to 3181 healthcare workers. The 2269 (71%) respondents were physicians, nurses, nursing assistants, and clinical technicians working in 3 hospitals in the same part of Denmark.
The questionnaire probed the details of hand washing in the workplace (use of disinfectants and gloves; extent of patient care; exposure to medications, laboratory reagents, rubber, plastic, food, detergents, and plaster) and in the home environment (childcare, gardening, engine repair, decorating, doing laundry, cleaning, cooking, etc). Time spent with household exposures was noted as less than 0.5, 0.5 to 3, more than 3 to 5, and more than 5 hours per day. Frequency of washing/disinfecting was rated as 1 to 5, 6 to 10, 11 to 15, 16 to 20, and more than 20 times per day.
The questionnaire asked about use of moisturizers (not used; used, but not every day; used once or twice a day; and used more than twice a day), physical activity, and smoking. Respondents rated eczema severity using photos.
"Participants with hand eczema washed their hands significantly more often than those without (P < .001)," found the researchers. Most respondents washed their hands 6 to 10 times daily while at work. Of those participants with hand eczema, 52% washed more than 10 times a day, whereas 43% of those without hand eczema wash their hands that often. Respondents with eczema also washed their hands more while outside the workplace than those participants without eczema (23% vs 16%; P < .001, washed more than 10 times per day outside of work, respectively).
Thirty-four percent of respondents with eczema reported use of synthetic rubber gloves compared with 27% of those without eczema, which is statistically significant (P = .009). Use of cotton gloves, reported by 2% of those with eczema and less than 1% of those without it, was also significant (P = .03). Use of natural rubber gloves was more common among those without eczema, with the difference not being statistically significant.
In the workplace, hand eczema was significantly associated with use of protective gloves while handling drugs and collecting blood. Severity of eczema was not related to the extent of hand washing or use of gloves.
Intriguing results emerged for use of moisturizers. "[O]ur study found that frequent use of moisturizers outside of work was reported by significantly more of those with hand eczema and was positively correlated with the severity degree of hand eczema," the authors write, concluding that this finding likely reflects treatment of the skin condition at home.
The researchers also found that domestic exposures that increase risk for eczema include caring for children younger than 4 years and cooking, cleaning, and washing dishes and clothing while using gloves. Gardening, decorating, repairing engines, smoking, and physical activity level were not related to either hand eczema or its severity.
The researchers suggest that use of disinfectants perhaps replace some episodes of hand washing, based on the association of frequency of hand washing and development of eczema, and to be consistent with recommendations for healthcare workers to disinfect rather than wash if the hands are visibly clean. "The educational strategy for healthcare workers with hand eczema may benefit from a re-evalution focusing on influencing the pattern of hand washing," they write.
A limitation of the study was the self-assessment aspect. The researchers suggest that future studies address the psychological reasons for excessive hand washing that may predispose healthcare workers to developing hand eczema.
"Attention should...be paid to healthcare workers with small children at home," the authors suggest. They also remark in their conclusion that "[t]he preventive effect of moisturizers used during working hours should be tested in future follow-up studies."
The study was funded by the Zealand Region Research Fund and the Danish Working Environment Research Fund. The authors have disclosed no relevant financial relationships.
Contact Dermatitis. 2012;66:247-253. Abstract
