Effectiveness of a skin care programme for the prevention of contact dermatitis in healthcare workers (the Healthy Hands Project): A single‐centre, cluster randomized controlled trial

Abstract

Background Healthcare workers (HCWs) are at risk of developing hand dermatitis (HD). Guidelines recommend moisturizers to prevent HD, but in practice their effectiveness has been poorly investigated. Objectives To assess whether an intervention aimed at improving skin care leads to a reduction in HD severity. Methods In this 1‐year randomized controlled trial, 9 wards (285 HCWs) were allocated to an intervention group (IG), and 10 wards (216 HCWs) were allocated to the control group (CG). The intervention included provision of cream dispensers with electronic monitoring of use, regularly communicated to the HCWs. The primary and secondary outcomes were change from baseline in Hand Eczema Severity Index (HECSI) score (ΔHECSI) and change in natural moisturizing factor (NMF) level (ΔNMF). Results At 12 months, the rates of loss to follow‐up were 41% and 39% in the IG and the CG, respectively. The HECSI score was reduced in the IG by −6.2 points (95%CI: −7.7 to −4.7) and in the CG by −4.2 points (95%CI: −6.0 to −2.4). There was no significant difference in ΔHECSI or ΔNMF between the groups. Relative improvement in the HECSI score was significantly higher in the IG than in the CG (56% vs 44%). In a subgroup of HCWs with mild HD, the IG showed a larger HECSI score decrease than the CG ( P < 0.001). Conclusion Although there was no significant effect on the primary outcomes, the intervention showed overall positive effects on the HECSI score.

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

“…Previously, Visser et al found that washing of hands >10 times per shift doubles the risk of HD . Consistently, in this intervention study, we found that exposure to wet work as estimated from soap use at a ward level was a significant risk factor for HD . Also, we found high use of disinfectants; >80% of HCWs used these >15 times per shift.…”

“…Improving skin care behaviour is an important goal for preventing HD in HCWs. In an intervention study focused on prevention of HD in the healthcare setting, we investigated whether provision of hand creams accompanied by electronic monitoring and feedback on hand cream use may prevent HD . Here, we show that the intervention was successfully implemented, and resulted in improved adherence to recommended skin care practices.…”

“…At baseline, 501 HCWs were recruited from 19 wards randomized into an IG (9 wards, 285 HCWs) and CG (10 wards, 216 HCWs). The demographic characteristics of the study population are described in detail elsewhere . At baseline, there were no marked differences concerning a history of self‐reported HD, exposure to wet work and hand cream use between the two arms (Table ).…”

“…The primary outcome, change in HD severity, will be reported in a separate article . Here, we focus on the process outcome defined as the effect of the intervention on the use of hand creams.…”

Hand eczema: epidemiology, prognosis and prevention

“…Examples of successful regulations are the EU legislation to reduce exposure to chromate in cement, 73,74 and the EU nickel regulation. 80,82 Skincare programmes may be more effective for mildmoderate eczema than for severe cases. 44,76 Results point towards a positive effect of use of moisturizers; however, due to great variance in studies, evidence is currently insufficient for primary intervention of irritant HE in the workplaces.…”