Frank Jungbauer

Exposure of the hands to wet work in nurses.

Prevention of hand dermatitis among nurses can be achieved by reduction of wet‐work exposure. A preventive programme should be based on knowledge of exposure levels. An accurate method to assess such exposure levels is needed. Duration and frequency of wet‐work activities were assessed by a questionnaire, in various parts of the health care sector. In addition, a randomly chosen sample from this population was observed for the duration and frequency of wet work. In contrast to the questionnaire, the observation method showed less than half the duration of wet work. Observation detected almost double the frequency that was reported with the questionnaire. Gloves were observed to be used daily in special care units for short time periods. A questionnaire does not accurately assess the quantity of wet‐work activities. On regular wards, the exposure to irritants is mainly associated with the frequency of wet hands, rather than the duration of wet hands. We assume that the short‐term use of gloves on special care units does not cause an increased risk of hand dermatitis. Preventive programmes can focus on decreasing the frequency of wet hands by encouraging the use of gloves; the use of gloves should not only be advised to prevent infections but also to protect against hand dermatitis.

Toxic hygroscopic contact reaction to N-methyl-2-pyrrolidone.

Case Reports 3 employees of a manufacturers of toddler car-seats, age 21–29 years, were referred to the Accident & Emergency Department because of acute painful swelling and excessive wrinkling of the skin of their hands, after exposure to N-methyl-2-pyrrolidone (NMP) (Fig. 1). 2 had no dermatological history; the eldest had a history of mild hand eczema, without signs of atopy, for which no medical treatment was used. They had all been newly exposed to N-methyl-2pyrrolidone (NMP) as a solvent to clean parts of a device with which a newly introduced glue was applied to textile fabrics, to attach them to layers of protective foam. The 3 patients had used NMP as a cleaner for the previous 3 days. The parts that had to be cleaned were washed in a basin with NMP (99% concentration) with unprotected hands. This procedure was repeated several times, for a few minutes only, during their work shifts. The workers had decided to use their unprotected hands, because the polyvinyl chloride (PVC) gloves that were used initially rapidly became ill-fitting due to shrinkage caused by NMP exposure.

Characteristics of wet work in the cleaning industry

Wet work is the main cause of occupational contact dermatitis in the cleaning industry. Dermatologists and occupational physicians need to base their primary and secondary prevention for workers in the cleaning industry on the characteristics of wet work exposures. We quantified the burden of wet work in professional office cleaning activities with a continuous standardized observation by trained observers of 41 office cleaners. Duration and frequency of wet work exposure and of different cleaning activities were assessed. Wet work made up 50% of such cleaning work. Within a typical 3‐hr shift, a mean frequency of 68 episodes of wet work was observed, which classifies office cleaning as wet work. Skin exposure to irritants was markedly different among cleaners who did the same cleaning activities. Reduction in skin irritation can be achieved by training the workers. Because this group of workers, who have a low level of education, has a high risk of developing irritant hand dermatitis, a special effort on training and instruction should be made. A reduction of exposure can be achieved by: using gloves more often; using gloves for a shorter period of time; using gloves while doing activities that otherwise cause the skin to be in contact with water and cleaning substances and washing hands with water only, reserving soap for when the hands are visibly dirty.

Airborne irritant contact dermatitis and conjunctivitis after occupational exposure to chlorothalonil in textiles

Chlorothalonil (tetrachloro‐1,3‐benzenedicarbonitrile, CAS 1897‐45‐6) is a pesticide that has been on the market for many years. It is used as a fungicide in agriculture, horticulture, and floriculture; as a wood preservative; and in paint. We report an epidemic of airborne irritant contact dermatitis, conjunctivitis, and upper airway complaints among seamstresses in a Portuguese trailer tent factory, which we attribute to chlorothalonil. All exposed workers had work‐related skin symptoms. After patch testing, we showed that none of these were of allergic origin. Instead of allergic reactions, we noticed a delayed type of irritation after 72 hr to chlorothalonil and to the textile extracts containing high concentrations of chlorothalonil. Although allergic and irritant contact dermatitis from chlorothalonil has been described before, this is, as far as we know, the first time that a delayed type of dermatitis, conjunctivitis, and upper airway irritation after exposure to chlorothalonil in tent‐cloth is described.

Hand eczema among healthcare professionals in the Netherlands: prevalence, absenteeism, and presenteeism

Healthcare professionals have a high risk of developing hand eczema. Hand eczema can interfere with their work.

Inventory of the chemicals and the exposure of the workers' skin to these at two leather factories in Indonesia.

PurposeTannery workers are exposed to hazardous chemicals. Tannery work is outsourced to newly industrialized countries (NICs) where attention into occupational health hazards is limited. In this study, we investigated the skin exposure to hazardous chemicals in tannery workers and determined the prevalence of occupational skin diseases (OSDs) at tanneries in a NIC.MethodsA cross-sectional study on the observation of the working process and an inventory and risk assessment of the chemicals used. Classification of chemicals as potential sensitizers/irritants and a qualitative assessment of exposure to these chemicals. Workers were examined and interviewed using Nordic Occupational Skin Questionnaire-2002/LONG.ResultsThe risk of OSDs at the investigated tanneries was mainly related to the exposure of the workers’ skin to chemicals in hot and humid environmental conditions. In 472 workers, 12% reported a current OSD and 9% reported a history of OSD. In 10% of all cases, an OSD was confirmed by a dermatologist and 7.4% had an occupational contact dermatitis (OCD). We observed that personal protective equipment (PPE) used was mainly because of skin problems in the past and not as a primary protection against OSD.ConclusionWe observed a high frequency and prolonged exposure to many skin hazardous factors in tannery work although PPE was relatively easily available and which was generally used as a secondary preventative measure. The observed point-prevalence in this study was at the same level as that reported for other high-risk OSDs in Western countries and other tanneries in NICs. However, the observed point-prevalence in this study was lower than that reported in India and Korea. The results of our study and those of other studies at tanneries from other NICs were probably influenced by Healthy Worker Survivor Effect (HWSE).

Hands4U: a multifaceted strategy to implement guideline-based recommendations to prevent hand eczema in health care workers: design of a randomised controlled trial and (cost) effectiveness evaluation.

BackgroundWorkers in wet work occupations have a risk for developing hand eczema. Prevention strategies exist, but compliance to the proposed recommendations is poor. Therefore, a multifaceted implementation strategy (MIS) is developed to implement these recommendations to reduce hand eczema among health care workers performing wet work.Methods/DesignThis study is a randomised controlled trial in three university hospitals in the Netherlands. Randomisation to the control or intervention group is performed at department level. The control group receives a leaflet containing the recommendations only. The intervention group receives the MIS which consists of five parts: 1) within a department, a participatory working group is formed to identify problems with the implementation of the recommendations, to find solutions for it and implement these solutions; 2) role models will help their colleagues in performing the desired behaviour; 3) education to all workers will enhance knowledge about (the prevention of) hand eczema; 4) reminders will be placed at the department reminding workers to use the recommendations; 5) workers receive the same leaflet as the control group containing the recommendations. Data are collected by questionnaires at baseline and after 3, 6, 9 and 12 months. The primary outcome measure is self-reported hand eczema. The most important secondary outcome measures are symptoms of hand eczema; actual use of the recommendations; sick leave; work productivity; and health care costs.Analyses will be performed according to the intention to treat principle. Cost-effectiveness of the MIS will be evaluated from both the societal and the employers perspective.DiscussionThe prevention of hand eczema is important for the hospital environment. If the MIS has proven to be effective, a major improvement in the health of health care workers can be obtained. Results are expected in 2014.Trial registration numberNTR2812

Occupational allergic contact dermatitis and patch test results of leather workers at two Indonesian tanneries.

Background. Tannery workers are at considerable risk of developing occupational contact dermatitis. Occupational skin diseases in tannery workers in newly industrialized countries have been reported, but neither the prevalence of occupational allergic contact dermatitis nor the skin‐sensitizing agents were specifically examined in those studies.

Hands4U : the effects of a multifaceted implementation strategy on hand eczema prevalence in a healthcare setting. Results of a randomized controlled trial

Healthcare workers have an increased risk of developing hand eczema. A multifaceted implementation strategy was developed to implement a guideline to prevent hand eczema among healthcare workers.

Hands4U: the effectiveness of a multifaceted implementation strategy on behaviour related to the prevention of hand eczema—a randomised controlled trial among healthcare workers

Objectives To investigate the effects of a multifaceted implementation strategy on behaviour, behavioural determinants, knowledge and awareness of healthcare workers regarding the use of recommendations to prevent hand eczema. Methods The Hands4U study is a randomised controlled trial. A total of 48 departments (n=1649 workers) were randomly allocated to the multifaceted implementation strategy or the control group (minimal implementation strategy). Within the departments designated to the multifaceted implementation strategy, participatory working groups were set up to enhance the implementation of the recommendations for hand eczema. In addition, working group members were trained to become role models, and an education session was given within the department. Outcome measures were awareness, knowledge, receiving information, behaviour and behavioural determinants. Data were collected at baseline, with a 3- and 6-month follow-up. Results Statistically significant effects were found after 6 months for awareness (OR 6.30; 95% CI 3.41 to 11.63), knowledge (B 0.74; 95% CI 0.54 to 0.95), receiving information (OR 9.81; 95% CI 5.60 to 17.18), washing hands (B −0.40; 95% −0.51 to −0.29), use of moisturiser (B 0.29; 95% CI 0.20 to 0.38), cotton under gloves (OR 3.94; 95% CI 2.04 to 7.60) and the overall compliance measure (B 0.14; 95% CI 0.02 to 0.26), as a result of the multifaceted implementation strategy. No effects were found for behavioural determinants. Conclusions The multifaceted implementation strategy can be used in healthcare settings to enhance the implementation of recommendations for the prevention of hand eczema. Trial registration number NTR2812.