Screening for hand dermatitis in healthcare workers: Comparing workplace screening with dermatologist photo screening

Nichol, Kathryn; Copes, Ray; Kersey, K.; Eriksson, Jonas; Holness, D. Linn

doi:10.1111/cod.13231

Cited by 15 publications

(10 citation statements)

References 36 publications

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“…The gold standard was a hand examination by a dermatologist and the single question had a higher negative predictive value than a symptom-based questionnaire [10]. Our findings that the specificity of a self-report question was higher than the sensitivity in detecting hand dermatitis has been found in other studies involving healthcare workers [6,11]. The results provide a compelling case for undertaking a study evaluating the use of a self-report screening questionnaire containing our single self-assessment dermatitis question in workplace hand dermatitis health surveillance programmes targeting nurses and other healthcare workers If such a tool were practicable to deliver and proves to be a clinically reliable and cost-effective method of screening out 'clear' (no hand dermatitis) cases, further action would only be necessary if positive cases are reported.…”

Section: Discussionsupporting

confidence: 52%

A self-report questionnaire to detect hand dermatitis in nurses

Parsons

Williams

English³

et al. 2020

Occupational Medicine

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Background Hand dermatitis is highly prevalent among nurses due to their frequent exposure to wet work. Providing cost-effective dermatological health surveillance for this occupational group presents a challenge to health service providers. Aims To ascertain the predictive value of nurses’ self-assessment of whether they had current hand dermatitis using a screening questionnaire when compared with the assessment made by a dermatologist of the nurses’ hand photographs. Methods We conducted a cross-sectional study comparing the self-report decision made by student and intensive care nurses using a single hand dermatitis screening question with the clinical assessment of their hand photographs made by dermatologists using a standardized photographic guide. Results We analysed data collected at study baseline (n = 1599). The results showed that the screening question had a high negative predictive value (91%; 95% CI 89–93), but a low positive predictive value (39%; 95% CI 34–45). It demonstrated acceptable accuracy in distinguishing those with and without the disease (area under the receiver operator curve = 0.7) and had a high specificity (86%; 95% CI 84–88) but a sensitivity of only 52% (95% CI 46–59) in identifying hand dermatitis. Conclusions We found that nurses were able to accurately self-assess themselves as not having any signs of hand dermatitis. By contrast, they were less able to accurately self-assess positive cases suggesting under-recognition of early disease. We propose that a questionnaire containing a single hand dermatitis screening question should be considered as a tool for screening out clear cases as part of a workplace health surveillance programme for detecting hand dermatitis.

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Section: Discussionsupporting

confidence: 52%

A self-report questionnaire to detect hand dermatitis in nurses

Parsons

Williams

English³

et al. 2020

Occupational Medicine

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“…Wet work is one of the strongest known risk exposures for the development of work-related hand eczema (HE) ( 1 – 3 ), which is ranked among the top notified occupational diseases in several European countries, revealing a large potential for successful prevention strategies ( 3 – 6 ). Although wet work is a pivotal risk factor for developing work-related HE, the exposure–response relationship between extent of wet work and development of work-related HE remains to be further investigated ( 7 , 8 ).…”

mentioning

confidence: 99%

Risk of work-related hand eczema in relation to wet work exposure

Lund¹,

Petersen²,

Flachs³

et al. 2020

Scand J Work Environ Health

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Objective Albeit a pivotal risk for the development of hand eczema (HE), the exposure-response relationship between wet work and HE remains to be further investigated. Knowledge on exposure-response is important regarding preventive measures, medico-legal regulations and job-counseling. Recently, a job-exposure matrix (JEM) for wet work was developed, providing information on the likelihood of wet work. By combining the JEM with data on HE we aimed to investigate the relationship between extent of wet work and HE. MethodsThis study is a case-referent study including patients registered in the National Database of Contact Allergy, Denmark, and comprises data on sex, age, atopic dermatitis, HE, face eczema and patch testing results. Patients with HE served as cases and patients with facial eczema served as referents. Information on profession was retrieved from the DOC*X database in accordance with the DISCO-88 classification system. A wet-workspecific JEM provides -for each profession -an estimate for (i) the likelihood of wet work lasting ≥2 hours/day and (ii) the average number of hours of wet work per day. ResultsAfter two hours of wet hands and glove wear, the odds ratio (OR) was 3.49 and 3.19, respectively, for females and 2.41 and 1.82, respectively, for males. Females had a higher risk of HE than males with probability of wet hands <75% (OR 2.34, 95% CI 2.12-2.58 compared to males 1.68, 95% CI 1.22-2.31) and regarding glove wear at all exposure levels. ConclusionOur data confirms a close association between wet work and HE. Exposure lasting less than the current definition of wet work (having wet hands for ≥2 hours per day) may be of importance.

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“…As early identification and management improves outcomes, screening to detect early disease would be desirable but is difficult to achieve in practice. A validated screening tool for hand dermatitis in health care workers has been developed as a self-administered questionnaire [ 12 ]. Limited information is available regarding its usability in other work environments.…”

Section: Early Detection and Preventionmentioning

confidence: 99%

Occupational Contact Dermatitis: An Individualized Approach to the Worker with Dermatitis

Houle¹,

Holness²,

DeKoven³

2021

Curr Derm Rep

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Purpose of Review To provide an up-to-date, customizable approach to the worker presenting with dermatitis. Recent Findings Occupational contact dermatitis (OCD) is often a result of combined allergic, irritant, and endogenous factors. Potential causes of OCD can be categorized in 3 main groupings: workplace materials, personal protective equipment, and skin care. Although patterns of dermatitis may provide some indication of the etiological factor(s), patch testing remains essential in the diagnosis of allergic OCD. Management of OCD may require changes in workplace practices to reduce worker exposure to the causative agents and improve skin care practices. Summary OCD is a multifaceted condition with significant consequences for affected workers and their families, employers, and insurers. A methodical and individualized approach to the patient with OCD should ensure timely and accurate diagnosis(es).

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Screening for hand dermatitis in healthcare workers: Comparing workplace screening with dermatologist photo screening

Cited by 15 publications

References 36 publications

A self-report questionnaire to detect hand dermatitis in nurses

A self-report questionnaire to detect hand dermatitis in nurses

Risk of work-related hand eczema in relation to wet work exposure

Occupational Contact Dermatitis: An Individualized Approach to the Worker with Dermatitis

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