Overall excellent agreement existed for both inter- and intraobserver reliability and the scoring system is suggested for use in future clinical studies on HE. Because HECSI is an entirely objective assessment of clinical signs, in addition, inclusion of patient-rated symptoms should be considered.

The present study was designed as an intervention study to investigate whether an educational programme was efficient in preventing work-related skin problems on the hands. 107 student auxiliary nurses (61 in the intervention group and 46 in the control group) were followed during the first 10 weeks of their initial practical training in county hospitals. The intervention group was given an educational programme before the practical training started. For evaluation the participants had questionnaires, clinical examination of the hands, measurement of transepidermal water loss (TEWL) and patch testing. The use of hand disinfectants, which was discouraged in the educational programme, was significantly lower in the intervention group as compared to the control group (p=0.002). 48% of the intervention group and 58% of the control group had aggravation of skin problems during practical training (p>0.05). Use of hand disinfectant agents was significantly associated with aggravation of skin problems (p=0.016). A significant increase in TEWL for the control group (p<0.005), but not for the intervention group, was seen after 10 weeks of practical training. In conclusion, the present intervention study shows promising results from the use of an educational programme.

Aims: To evaluate the effect of implementation of an evidence based skin care programme for wet work employees as part of an occupational health and safety management system. Methods: 375 wet work employees were included in a prospective randomised controlled trial, allocated to either intervention (n = 207) or control (n = 168). The intervention group was exposed to a skin care programme during the five month study period. The intervention included an educational programme for a group of frontline employees, who underwent formalised training, and subsequently introduced the information to their colleagues. As part of the intervention a skin care policy including written instructions was established at each workplace. Both groups answered a test quiz, completed questionnaires on behaviour and symptoms, and underwent clinical examination of their hands before and after the five month period. Results: No difference between the intervention and the control group was found at baseline with respect to clinical symptoms or behaviour. Evaluation after the five months of intervention revealed a significantly higher information level on skin care in the intervention group compared to the control group, a significant change in behaviour in the intervention group but not in the control group, and significantly less skin symptoms as evaluated clinically in the intervention group but not in the control group. No significant difference was found for self reported skin problems. Conclusions: The intervention was successful with respect to information level (knowledge), behaviour, and clinical symptoms. Implementation of a skin care programme as part of an occupational health and safety management system is recommended as a prophylactic measure for employees in wet occupations.