The effectiveness of a skin care program for the prevention of contact dermatitis in health care workers (the Healthy Hands Project): study protocol for a cluster randomized controlled trial

Abstract

BackgroundHealth care workers (HCW) are at high risk for developing occupational hand dermatitis (HD) due to frequent exposure to ‘wet work’. Amongst HCWs, nurses are at highest risk, with an estimated point prevalence of HD ranging between 12 and 30%. The burden of disease is high with chronicity, sick leave, risk of unemployment and impaired quality of life. Despite evidence from the medical literature on the risk factors and the importance of skin care in the prevention of HD, in practice, compliance to skin care protocols are below 30%. New preventive strategies are obviously needed.Methods/designThis is a cluster randomized controlled trial, focusing on nurses performing wet work. In total, 20 wards are recruited to include 504 participating nurses in the study at baseline. The wards will be randomized to an intervention or a control group and followed up for 18 months.The intervention consists of the facilitation of creams being available at the wards combined with the continuous electronic monitoring of their consumption with regular feedback on skin care performance in teams of HCWs. Both the intervention and the control group receive basic education on skin protection (as ‘care as usual’). Every 6 months, participants of both groups will fill in the questionnaires regarding exposure to wet work and skin protective behavior. Furthermore, skin condition will be assessed and samples of the stratum corneum collected. The effect of the intervention will be measured by comparing the change in Hand Eczema Severity Index (HECSI score) from baseline to 12 months. The Natural Moisturizing Factor (NMF) levels, measured in the stratum corneum as an early biomarker of skin barrier damage, and the total consumption of creams per ward will be assessed as a secondary outcome.DiscussionThis trial will assess the clinical effectiveness of an intervention program to prevent hand dermatitis among health care workersTrial registrationNetherlands Trial Register (NTR), identification number NTR5564. Registered on 2 November 2015.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-017-1803-0) contains supplementary material, which is available to authorized users.

Methylisothiazolinone allergic contact dermatitis: Assessment of relapses in 139 patients after avoidance advice

“…Indeed, 40% of our cases (55/139) were attributable to occupational or combined exposure (Table ), with hand soap being the most common cause (15/55, 27.3%), as previously reported in the study of the French REVIDAL‐GERDA network . The relationship between lesion severity and sick leave rates and economic impact was comparable to that in other reports …”

“…10 The relationship between lesion severity and sick leave rates and economic impact was comparable to that in other reports. 21,22 The main cause of relapses, particularly in cases of mildly severe dermatitis, which were observed in one third of our patients, could have been accidental exposure to numerous hidden sources of MI in everyday life, such as leather, fabrics, soaps and cosmetics used in the workplace or in public areas, where it is often difficult to verify product composition. 23,24 This could explain the short median time in the future.…”

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

“…Inclusion criteria were the provision of written informed consent and employment as a nurse or nutrition assistant at one of the included wards with exposure to “wet work”. Participants were excluded if they were employed at more than one ward during the trial period . Ethics approval to conduct the trial was granted by the Medical Ethics Review Board of the Academic Medical Centre (reference number NL54372.018.15).…”

“…The study design has been described in detail in a previously published study protocol and flow chart . The IG was provided with hand cream dispensers placed at accessible locations in wards, continuous electronic monitoring of cream use, and feedback on the frequency of cream use at ward level.…”

“…Participants were excluded if they were employed at more than one ward during the trial period. 11 Ethics approval to conduct the trial was granted by the Medical Ethics Review Board of the Academic Medical Centre (reference number NL54372.018. 15).…”