The three moments of skin cream application: an evidence‐based proposal for use of skin creams in the prevention of irritant contact dermatitis in the workplace

Abstract

Contact dermatitis is one of the most common occupational diseases, with serious impact on quality of life, lost days at work and a condition that may be chronically relapsing. Regular prophylactic skin cream application is widely acknowledged to be an effective prevention strategy against occupational contact dermatitis; however, compliance rates remain low. To present a simple programme for skin cream application in the workplace with focus on implementation to drive down the rate of occupational irritant contact dermatitis, an expert panel of eight international dermatologists combined personal experience with extensive literature review. The recommendations are based on clinical experience as supported by evidence‐based data from interventional studies. The authors identified three moments for skin cream application in the work place: (i) before starting a work period; (ii) after washing hands; and (iii) after work. Affecting behaviour change requires systematic communications, monitoring and reporting, which is proposed through Kotter's principles of organizational change management. Measurement tools are provided in the appendix. Interventional data based on application of this proposal is required to demonstrate its effectiveness.

Evaluating the effect of electronic monitoring and feedback on hand cream use in healthcare workers: Healthy Hands Project

“…In The Netherlands, the guidelines on the prevention of contact dermatitis recommend the use of emollients on a regular basis, and creams are often provided by the employer . Similar recommendations have been proposed by the working group for diagnosis, prevention and treatment of hand eczema of the ESCD, stating that moisturizers should be applied on the hands during the working day and especially after work and before bedtime . Interestingly, almost half of the HCWs (46% and 50%, in respectively, in the IG and in the CG) reported at baseline never using hand creams “after the shift,” which is a “key application time” recommended by the ESCD working group .…”

“…Despite the improvement in self‐reported hand cream use in this trial, the electronically monitored cream use of 0.4 events per HCW per shift in the IG remained below the recommended frequency of at least two times per shift. As more than one third of HCWs reported that, apart from electronic dispensers, they (also) used their own creams, this electronically measured application frequency might be somewhat underestimated, but it is still probably below the current recommendations of two to three times per day …”

“…2 Similar recommendations have been proposed by the working group for diagnosis, prevention and treatment of hand eczema of the ESCD, stating that moisturizers should be applied on the hands during the working day and especially after work and before bedtime. 3,12 Interestingly, almost half of the HCWs (46% and 50%, in respectively, in the IG and in the CG) reported at baseline never using hand creams "after the shift," which is a "key application time" recommended by the ESCD working group. 3 After the intervention, this proportion decreased to 26% in the IG and to 36% in the CG.…”

“…As more than one third of HCWs reported that, apart from electronic dispensers, they (also) used their own creams, this electronically measured application frequency might be somewhat underestimated, but it is still probably below the current recommendations of two to three times per day. 2,3,12 The finding that, at follow-up, almost 20% of the HCWs still reported never using hand cream is worrying, especially as at least one third of HCWs reported skin problems. HD is not only a problem for the affected individual, but may also pose a health hazard for patients, as damaged skin increases the amount of bacterial flora.…”

The tissue viability imaging system—Suitable method for discovering minimal skin changes in occupational screenings? Results of a cross‐sectional field study

“…For many years, work‐related skin diseases were leading the list of notifications of suspected occupational diseases in Germany (http://www.dguv.de) in spite of intensive primary and secondary prevention measures . High incidence rates of hand eczema and a tendency to become chronic lead to high costs.…”