Effectiveness of a skincare- feedback program in healthcare workers

Workers in Healthcare (HCW) are at high risk for developing occupational hand
dermatitis (HD) mainly due to frequent exposure to skin irritants such as
detergents, disinfectants, and wearing of occlusive gloves. The one year
prevalence of HD among HCW is around 20%, while the life-time prevalence in the
general population is 15%. Amongst HCW, nurses are the group at highest risk
of HD, with an estimated point prevalence of 12-30%.
Both the socioeconomic burdenand the strong impair ment of the quality of life
of affected persons seem substantial.
Almost 60% of HCW has eczema related sick leave during the first year after
notification of disease. The annual costs for occupational skin diseases for
medical care, abseeintism and disability pensions are estimated to be ¤98
million in the Netherlands.
Development of HD results largely from multiple sub-threshold damage of the
skin barrier by skin irritants which affect the lipids and structural proteins
of the stratum corneum (SC) which is the principal barrier of the skin. E.g.
contact with the soaps and organic acids leads to the strong reduction of the
levels of the natural moisturizing factors (NMF) in the skin which are crucial
for hydration of the skin. A dry skin will further facilitate ingress of skin
irritants and allergens leading eventually to the skin inflammation.
Furthermore, a damaged skin is one of the reasons mentioned by HCW as to why
they may be discouraged to comply with hand hygiene protocols. Therefore,
maintenance of a proper skin barrier in HCW is of crucial importance. Regular
use of skin care products such as emollients and moisturizers has therefore
been recommended as an integral part of current prevention programs in various
countries. Use of skin care creams has been shown to reduce prevalence of HD in
different occupations with increased risk for HD. Despite this, adherence to
the use of skin care remains poor among HCW. This is supported by a survey
among nurses, which found that only 15% of the 204 respondents reported to
apply hand creams after handwashing. In a study among 1355 metal workers, 28%
indicated use of hand creams as generally recommended. The reason for poor
adherence in these groups is not clear. It is likely that the costs of the hand
cream and its accessibility might pose a barrier for their use. Therefore, in
the proposed trial the hand cream will be provided and placed at strategic
places. Provision of skin care products will be coupled with regular education
and group feedback on the electronically monitored skin care consumption. The
effectiveness of this intervention will be investigated by comparison of the
skin condition in the intervention and control group which will receive only
regular education on skin care.

The primary objective
To assess the effectiveness of an intervention program, consisting of provision
of skin care products and regular group feedback, on the skin condition in
health care workers

The secondary objective
To assess whether this intervention program increases the consumption of hand
creams

This is a two-arm, cluster randomized trial, based on departments as the unit
of randomization. Wards will be randomly selected to be an intervention or
control group.

The intervention consists of two elements:
1) provision of protective hand creams and 2) regular group feedback on hand
cream consumption

Negligible risk. The possibility of a (mild) allergic reaction to an ingredient
in the creams is not expected, but can't be totally ruled out, just like other
over the counter products.