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What is Occupational Contact Dermatitis (OCD)?
OCD is inflammation of the skin caused by contact with external substances in the workplace. It can occur at any time of life, whether or not you have a history of allergies.
Occupational dermatitis is a common condition but one that can significantly affect people’s enjoyment of life, as it commonly affects the hands. If untreated, it can sometimes spread to other parts of the body, and become difficult to treat.
Occupational Contact Dermatitis has many implications including:
- medical and pharmaceutical costs
- workers compensation
- job retraining
- job modification
- quality of life.
Dermatitis will make the skin:
- dry (often starting in the web spaces between the fingers)
- red and itchy
- split and crack
- flake and peel
- burn and sting
- occasionally blister.
As with all cases of broken skin, there is a risk of infection complicating the initial problem.
Irritant contact dermatitis
Accounts for 60-70% of cases
- Everybody is sensitive to skin irritation
- Cumulative in nature – it builds up over time
- Personal or family history of asthma/eczema/hay fever makes people susceptible
The most common causes of this type of contact dermatitis are:
- Water and wet work
- Soaps and detergents
- Heat and sweating
Allergic contact dermatitis
Accounts for 20-30% of cases
- Allergic contact dermatitis is an individual response and can occur at any time in a person’s life. E.g. after first exposure or after many years of exposure.
- Allergic contact dermatitis only requires a very small amount of contact with the allergen to cause a reaction and takes days or weeks to heal. It is a lifelong allergy and is diagnosed by patch testing.
- Affected people may or may not have a personal or family history of asthma/ eczema/ hayfever.
Common causes of allergic contact dermatitis include:
- hair dye
- cement and leather
- glues and coatings
- preservatives in some products.
Accounts for 5% of cases
Contact urticaria is a different type of allergy and happens immediately on skin contact with an allergen (usually within 10-30 minutes of contact with the allergen). It can cause hay fever-like symptoms or asthma, as well as skin reactions. Contact urticaria is diagnosed by skin prick-testing or a blood test.
Common causes of contact urticaria are:
- natural rubber latex
- hairdressing bleach
- some foods.
Latex allergy usually starts as contact urticaria on the skin, but on occasions can then develop into anaphylaxis.
It is best to wear non-powdered disposable latex gloves or gloves made from an alternative material such as nitrile.
Those allergic to latex must not have any contact with any latex product. This includes balloons and condoms.
Those with a latex allergy must not forget to tell dentists or medical practitioners about the allergy before any medical procedure.
Sometimes people use the words eczema and dermatitis to mean the same thing but they are different. A good way to explain the different is eczema comes from within the body and dermatitis is caused by something ‘outside’ of the body.
- runs in families
- is often associated with asthma and hay fever
- is common in infancy and childhood
- often affects non-exposed areas of body
People who have eczema may experiences flares of eczema associated with work.
The people who are most at risk are those performing wet work. Surprisingly, water is the most common skin irritant! Wetting and drying of the hands is very irritating to the skin. Hairdressers, nurses, cleaners and mechanics are most commonly affected, and it is very common in the healthcare industry.
However, some chemicals cause allergic reactions that may result in more severe dermatitis. These include chromate in cement and leather, rubber chemicals in some gloves and epoxy resins, in glues and some floor finishings. Understanding which jobs are associated with occupational dermatitis is important, so people in these occupations can be forewarned and take extra precautions.
In addition, people with a history of eczema, even as a baby (but may have grown out of the eczema since), are more at risk of occupational dermatitis, and need to be aware of protecting their skin.
It is important to note that OCD is not infectious, so it cannot be passed on to others.
Possible causes of irritant contact dermatitis are:
- Water and wet work. This is where the hands are:
- in water for longer than two hours a shift
- handling wet things for more than two hours a shift
- in occlusive gloves for longer than two hours a shift
- washed more than 20 times a shift. Guidelines on wet work are available at www.safeworkaustralia.gov.au
- Use of disinfectant style hand cleaners
- Constantly wearing occlusive gloves, which cause heat and sweating
- Frequent drying with paper towel
Causes of allergies include:
- ingredients used in the manufacture of rubber gloves (rubber accelerators)
- preservatives, fragrances and other ingredients in hand cleansers and moisturisers.
Prevention for Healthcare workers
Employers have a responsibility to prevent Occupational Contact Dermatitis (OCD) in their workplace. This may include:
- replacing powdered latex gloves with non-powdered varieties
- replacing an irritating hand wash with a less irritating hand wash
- providing a choice of gloves, such as latex and non-latex varieties
- substituting hand washing with anti-bacterial hand rub, where appropriate
- supplying wall dispensers for hand wash, moisturisers, or anti-bacterial hand rub, which dispense the appropriate amount.
Develop an ‘action plan’ or management plan for workers who develop OCD – a good example is the Royal Children’s Hospital’s ‘Sore Hands’ program.
Workers also have a role in preventing OCD in the workplace by:
- consulting with infection control/hand hygiene personnel about suitable hand wash, moisturiser and glove alternatives
- ensuring hands are not dry or irritated – dry and irritated hands carry more bugs and micro shed, which is a risk to patient health
- taking rings off at work, as water and soap can become trapped underneath, causing dermatitis
- following a good skincare plan including moisturising, washing hands, and wearing appropriate gloves
- reporting skin problems to management
- seeking the advice from a health professional if they experience skin irritation.
Healthcare workers must remember:
- Consult with infection control staff about suitable hand wash, moisturiser and gloves.
- Don't ignore contact dermatitis or hand eczema.
- Dry, irritated and damaged hands carry more bugs and are a risk to yourself and your patients.
- Work together to modify the work environment
- Follow a good skin care plan, use a good moisturiser, hand cleanser and appropriate gloves (avoid powdered latex gloves).
- Early detection and diagnosis of skin problems is crucial.
- Report skin problems to management.
Healthcare workers wear gloves for many tasks they perform to protect themselves, patients, and other workers from germs, bodily fluids, and harmful substances/products.
Sometimes gloves can be overworn, which leads to sweating and can cause irritation. If you are a healthcare worker who is required to wear gloves regularly, remember to:
- change gloves regularly to reduce sweating
- avoid wearing an incorrect glove type – this can be hazardous and provide inadequate protection from bodily fluids and biological hazards
- continue to follow other measures of good hand hygiene – wearing gloves does not eliminate the need for hand hygiene.
Types of gloves
Latex, nitrile, neoprene/polychloroprene, polyurethane and polyisoprene gloves are suitable for tasks where there is exposure to bodily fluids, such as:
- invasive procedures
- patient bathing, if risk of contact with bodily fluids
- pathology collection.
Healthcare workers should use vinyl gloves only when exposure to bodily fluids is unlikely.
When handling chemotherapy drugs, double-gloved, sterile latex or nitrile gloves should be worn. PVC gloves are not suitable in this situation as drugs can penetrate.
Bone cement can penetrate through most gloves, including latex, so double-gloved, sterile neoprene gloves may be used (follow advice from manufacturers of bone cement and manufacturers of gloves).
Sterilisation formaldehyde-based products can sometimes penetrate through latex, neoprene and polyvinyl gloves, so double-glove nitrile or polyethylene gloves for the most effective protection. More information is available at www.ansell.com.au.
It is very important for healthcare workers to avoid wearing powdered latex gloves.
Occupational dermatitis is a common condition but one that can significantly affect people's enjoyment of life, as it commonly affects the hands. If untreated, it can sometimes spread to other parts of the body, and become difficult to treat.
A dermatologist can particularly help through the process of making a diagnosis about what is causing the problem. Sometimes a form of allergy testing is necessary (patch testing). In addition, a dermatologist can offer a variety of early interventions that treat the problem and prevent complications.
Often, there may be multiple processes contributing to occupational dermatitis. A person may have eczema, but also irritant contact dermatitis, and allergic contact dermatitis, and sometimes contact urticaria as well!
- Patch testing is used to diagnose a contact allergy, e..g. to fragrances, preservatives or rubber chemicals in gloves.
- It is performed over a series of three appointments. During patch testing, small amounts of chemicals or products that are used at work or home are diluted and placed onto discs mounted on hypoallergenic tape and then placed on the back.
- Patches are applied to the back with small samples of ingredients
- Patch testing is not used to diagnose food allergies
- More information is available at: www.occderm.asn.au/services
Occupational Dermatology ClinicContact Dermatitis Clinic
Treatments for occupational dermatitis include:
- appropriate skin protection: use of the right gloves for the job
- the use of moisturising creams
- soap substitutes
- topical steroids
- antibiotics if there is secondary infection.
- systemic therapy (oral tablets or injections) may occasionally be used in severe cases.
Phototherapy (or light therapy) can also be effective in treating more serious cases of occupational dermatitis. The Skin Health Institute has also pioneered the use of Grenz rays, a superficial form of radiotherapy, to treat occupational hand dermatitis.
Good skincare is vital in the prevention and treatment of OCD. All workplaces should have a good skincare plan. This should include the use of mild hand cleansers, alcohol-based hand rubs and moisturisers.
Moisturising is an important part of a good skincare regime as it can help prevent dry skin and dermatitis.
- Where possible, you should apply your moisturiser before work and at meal breaks.
- If not possible to use during the day, apply when you get home and before bed.
When selecting a moisturiser, choose a fragrance-free ointment or cream moisturiser. A lotion pump pack is useful during the day and should be used frequently.
When moisturising, rub cream all over your hands and wrists and include web spaces and sides of fingers.
Moisturiser for Healthcare Workers
Healthcare workers should be extra careful when selecting a moisturiser to help prevent dry skin and dermatitis, and remember:
- to check that the moisturiser is suitable for use with chlorhexidine-based hand wash, as some moisturisers can affect the antiseptic properties
- the moisturiser also needs to be compatible with an alcohol-based hand rub
- water-based moisturisers should be used in a healthcare environment
- oil-based moisturisers are not suitable as they can sometimes destroy the protective properties of latex gloves and polyisoprene gloves.
Hand Cleansers for Healthcare Workers
There are several types of hand cleansers used in healthcare including soaps, antimicrobial hand washes and alcohol-based hand rubs.
- Soaps are used for general hand washing, while antimicrobials are used for ‘clean’ procedures; however, both can be drying to the skin.
- Repeated hand washing, especially in combination with frequent wet work and use of paper towelling – this can lead to development of irritant contact dermatitis.
- If you have irritated hands it is important to avoid antimicrobial soaps. Instead, use alcohol-based hand rubs or another suitable alternative, and speak to infection control personnel about your irritation.
Healthcare workers can use alcohol-based hand rubs to cleanse their hands. Alcohol-based hand rubs:
- reduce the need to use the traditional hand washing technique (therefore reduce contact with water, soaps and paper towel-common causes of irritant contact dermatitis)
- should only be used when hands are not visibly soiled
- are gentle on the skin, have added emollients, are fast to use and have better ‘bug killing’ power
- will sting hands that are cracked or irritated (this does not mean you are allergic to the rub).
What to do if you have skin problems?
Tell manager/report problem
- Report skin problems early. Do not wait until your hands are in a really bad condition.
- If hands are sore, do not stop following hand hygiene as you risk your own health and your patients’ health through hospital-acquired infection.
- Reporting a skin problem can allow workplaces to keep a register of hand problems in a particular department or across the whole organisation.
Always care for your skin at work and home
- Use simple hand cleansers that are pH neutral.
- Products used at work should be on the Health Purchasing Victoria list.
- Use anti-bacterial hand rub approved by your workplace infection control personnel.
- If you have anti-bacterial hand rub build-up in hands, wash with warm water and plain hand wash.
- Follow correct hand-washing techniques, ensure soap is washed off thoroughly with warm water (not hot).
- Moisturise when possible.
- At home, use a soap substitute and greasy moisturiser.
Seek medical advice
- See your GP.
- Your GP may recommend you try corticosteroid ointment or cream.
- Your GP may also take a blood test for total IgE and latex (RAST).
- You may need to see a dermatologist.
- You may require time off work or job modification to allow your skin to heal.
- If there is no improvement with previous treatments or an allergy is suspected, patch testing may be required.