Incidence of occupational contact dermatitis in healthcare workers: a systematic review

Abstract

Healthcare workers (HCWs) can be considered at an increased risk of developing occupational contact dermatitis (OCD) due to repetitive hand washing with soaps and disinfectants and extended use of gloves for many hours during the day.The aim of this study was to summarize the incidence of OCD in HCWs. We searched the databases PubMed/MEDLINE (1980-present), EMBASE (1980-present) and Cochrane Library (1992-present) through May 2020 using the search term 'incidence of contact dermatitis in HCWs' according to Preferred Reporting Items for Systematic Reviews and Metaanalyses (PRISMA) guidelines. Overall, 16 studies (six cohorts; 10 register-based) with follow-up periods between 1987 and 2013 fulfilled the inclusion criteria. The incidence of OCD reported in studies using registers of occupational diseases ranged from 0.6 to 6.7 per 10 000 person-years. The cohort studies reported incidence from 15.9 to 780.0 per 10 000 person-years; the incidence was higher in studies which included apprentice nurses. A higher incidence was also observed amongst dental practitioners, particularly dental technicians and nurses, compared to other HCWs. Studies reporting incidence data are very scarce and results differed by study design, type of contact dermatitis and investigated HCWs. Our study highlighted the dearth of high-quality data on the incidence of OCD and the possible underestimation of disease burden. Prospective cohort studies with harmonized designs, especially exposure assessment and outcome ascertainment, are required to provide more accurate, valid and recent estimates of the incidence of OCD. A high incidence amongst specific occupational groups suggests the need to undertake intervention studies with a focus on prevention, particularly during pandemics such as COVID-19.

Prevalence and incidence of hand eczema in hairdressers—A systematic review and meta‐analysis of the published literature from 2000–2021

“…A decline in the incidence rate of hand eczema as a function of years in the profession, has also been described in health care workers. Among apprentice nurses, a reduction in the incidence rate from 20.0/1000 person years in first year to 8.5/1000 person years in the second and third years of apprenticeship has been reported and a recent systematic review even found prospective studies to yield a 100‐fold decrease in incidence rate when comparing apprentices and fully trained health care workers 36,37 . Thus, the early debut of hand eczema is not unique to the hairdressing profession, although the high incidence rate in hairdressing apprentices compared to apprentice nurses is noteworthy.…”

“…Among apprentice nurses, a reduction in the incidence rate from 20.0/1000 person years in first year to 8.5/1000 person years in the second and third years of apprenticeship has been reported and a recent systematic review even found prospective studies to yield a 100-fold decrease in incidence rate when comparing apprentices and fully trained health care workers. 36,37 Thus, the early debut of hand eczema is not unique to the hairdressing profession, although the high incidence rate in hairdressing apprentices compared to apprentice nurses is noteworthy. This difference may be explained by a particularly high exposure to wet-work and a vaster array of allergens in the hairdressing profession.…”

Characteristics of hand eczema in final‐year apprentice nurses during the COVID‐19 pandemic

“… 1 , 2 , 3 , 4 A recent systematic review suggested that a higher incidence of occupational contact dermatitis during apprenticeship compared with HCWs was due to the “healthy worker effect,” with the selection of susceptible persons during training. 22 …”

“…It has been indicated that apprentices and young workers in high‐risk professions should be considered vulnerable for developing injuries at work and occupational diseases, including OSDs 21 . This was confirmed by a recent systematic review about the incidence of occupational contact dermatitis in HCWs, 22 which showed that the incidence of occupational contact dermatitis is more than 100 times higher during apprenticeship compared with cohorts of HCWs. Our recent research suggests significant exposure of hairdressing and beautician apprentices to skin irritants and allergens during practical education in vocational schools, with early development of hand eczema already during vocational education in 40% of final‐year hairdressing and 36% of final‐year beautician apprentices 23‐25 .…”

Acceptance of semipermeable glove liners compared to cotton glove liners in health care workers with work‐related skin diseases: Results of a quasi‐randomized trial under real workplace conditions

“…Health care workers (HCWs) are at risk of developing work‐related skin diseases (WRSDs) primarily due to a high amount of wet work and repeated exposure to irritants (eg, cleansers, detergents, and disinfectants). 1,2 The most common WRSD is hand eczema, with a 1‐year prevalence of about 20% in HCWs 3,4 . Wearing of protective gloves is mandatory in health care to avoid exposure to occupational hazards, including pathogenic germs 5‐10 .…”