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An essential read for all healthcare workers
Occupational irritant hand dermatitis (OIHD) is an important cause of discomfort in the working population. It is an inflammatory reaction of the skin occurring in people who come in contact with water, detergents, chemicals and other irritants in their working day. The incidence rate of hand dermatitis was 5.5 cases/1000 persons-years (women = 9.6 and men = 4.0).1 It was stated that the high-incidence rate was associated with the female sex, contact allergy, atopic eczema and wet work. This is very pertinent to nurses and other healthcare workers when you consider the implications of constant hand washing for infection control, use of gloves and antiseptic detergents that are used to reduce infections across the NHS.
This systematic review was very thorough and methodological. The authors searched The Cochrane Skin Group Specialised Register, The Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE for randomised controlled trials (RCTs) studying the effectiveness of barrier creams, moisturisers, gloves, complex educational interventions and other interventions for the prevention of OIHD. Only four studies fulfilled the review criteria.2 The review looked at what preventive measures are in place and how effective they are. A total of 21 RCTs were looked at closely with 14 being excluded, and 3 awaiting assessment (literature search May 2010), leaving 4 RCTs which were included in the study.
Included in the review
These four studies had 894 participants, which is very small. The focus was on individuals who wore gloves, protective clothing, used barrier creams and moisturisers. Details of the studies and data collected were included in the appendices of this systematic review.
The article is set out in an easy-to-read format and is very thorough, but no meta-analysis was carried out because of the lack of quantitative data in two of the four studies. There was no subgroup analysis or investigation of heterogeneity, as the occupation, sex and the age distribution were not similar. All four studies were, however, field studies in occupations prone to OIHD, and these can be expensive and difficult to set up.
The authors highlighted that only one study provided enough information regarding the generation of the randomisation sequence, and that all studies failed on attempts to conceal allocations. Likewise, there was only one study that had blinded participants, clinicians and outcome assessors. There were incomplete outcome data from all four studies, especially relating to drop outs which could have impacted the risk of bias as some studies were quite small. Selective reporting appears in two of the studies. No information was given regarding frequency of reapplication of any moisturisers, barrier or after work creams. All four studies had clear objectives and outcomes yet had different diagnosis criteria. Diagnoses were made by dermatologists or occupational physicians who regularly dealt with OIHD though no diagnosis tests were used. OIHD developed over an extended period of weeks to months, which was not reflected in the length of all the studies.
Implication to practice
The authors of this article suggested that barrier creams, moisturisers, after-work creams and complex educational interventions had a protective effect in the short and long term for primary prevention of OIHD though the results were not statistically significant. There was an absence of evidence to support or refute the use of protective gloves in the prevention of OIHD.
Recommendations for research
The review highlighted the need for larger RCTs for extended periods of time to determine whether complex or single interventions are effective to prevent OIHD in people with skin risk occupations.
It should also be noted that a recent double blind, randomised article by Williams and colleagues,3 published after the search date of the present systematic review, supported the view that regular applications of moisturiser offer a protective effect against repeated exposure to irritants without damaging the epidermal barrier.
Competing interests None.
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