Healthcare workers (HCW) are at risk for developing hand dermatitis (HD) caused by exposure to wet work. Guidelines for the prevention of HD recommend regular use of moisturizers, however in practice their use remains low and their effectiveness is poorly investigated.The main objective of this randomized control trial was to assess whether an intervention aimed at improving skin care leads to reduction in HD severity. The intervention included provision of cream dispensers with electronic monitoring of use, regularly communicated to the HCW. The primary and secondary outcomes were change from baseline in Hand Eczema Severity Index score (ΔHECSI) and Natural Moisturizing Factor (ΔNMF) levels as a biomarker of early changes in the skin barrier. Nine wards (285 HCW) were allocated to an intervention group (IG) and 10 wards (216 HCW) to the control group (CG).At baseline, IG and CG had similar exposure to wet work, use of skin care and severity of HD. At follow-up (1 year) the IG showed significantly higher frequency of hand cream use as compared to the CG (self-reported data). Though, electronically collected data in the IG showed that the average frequency of 0.4 cream applications/shift was far below recommended 2 applications/shift. The HECSI reduced significantly in the IG for −6.2 (95%CI −7.7,−4.7) and in the CG −4.2 points (95% CI −6.0,–2.4). There was no difference in ΔHECSI or ΔNMF between IG and CG, however the subgroup showing mild symptoms showed significantly larger improvement in HD symptoms as compared with CG.The intervention proved overall positive effects on severity of HD symptoms, supporting the benefits of skin care in the workplace. The fact that the intervention showed a larger effect in a subgroup with mild symptoms suggests that this intervention might be of particular importance for primary prevention.
Skin care education and individual counselling versus treatment as usual in healthcare workers with hand eczema: randomised clinical trial
