A. Palmer, C. Higgins, R. Nixon
We recently reviewed our experience of the assessment of 685 healthcare workers (HCW) in our Occupational Dermatology Clinic over a period of 22 years. Some 555 (81.0%) were diagnosed with occupational contact dermatitis, with the most common diagnosis being irritant contact dermatitis (ICD) (79.1%), followed by allergic contact dermatitis (ACD) (49.7%). The major substances causing ACD were rubber glove chemicals (thiuram mix and tetraethylthiuram disulphide), preservatives (formaldehyde, formaldehyde releasers, and isothiazolinones), excipients in hand cleansers, which are hard-to-avoid weak allergens, and antiseptics. ACD caused by commercial hand cleansers occurred much more frequently than ACD caused by alcohol-based hand rubs (ABHRs).It is important that HCW understand that ACD is rarely caused by ABHR, and that use of ABHR is extremely important from an infection control viewpoint. Stinging on immediate contact is related to ICD, not ACD.
We proposed that education of HCW be undertaken by the incorporation of skin care advice into hand hygiene education. This has been achieved through a project with Safe Work Australia and a partnership with Hand Hygiene Australia. Advice about skin care is now incorporated into hand hygiene modules nationally. The use of ABHRs is encouraged and use of after-work moisturising creams for the hands is recommended for HCW. In addition, we have had contact with manufacturers with regard to substituting weak allergens in skin cleansers. Accelerator-free gloves are also recommended for HCWs with OCD.
Higgins CL, Palmer AM, Cahill JL, Nixon RL. Occupational skin disease among Australian healthcare workers. 1993– 2014. Contact Dermatitis 2016; 75:213–22.