The complex workplace environment increases the potential for healthcare workers to be exposed to many irritants and allergens that can damage the skin. Healthcare workers with damaged skin on their hands are at greater risk of compromising infection control, risking their own health and potentially patients’ health also.
Healthcare workers can develop both irritant contact dermatitis and allergic contact dermatitis, and are also at a higher risk of developing latex allergy because of their exposure. It is not uncommon for healthcare workers to have a combination of these diagnoses. In addition, individuals with pre-existing eczema may experience aggravation of their skin condition.
Irritant contact dermatitis
Irritant contact dermatitis (ICD) is the most common form of dermatitis experienced by healthcare workers.
Common irritants affecting healthcare workers include:
- Water and wet work, mainly due to frequent handwashing
- Antiseptic skin cleaners and soaps
- Drying of the skin using paper towels
- Heat and sweating, especially if wearing occlusive gloves for long periods of time
- Low humidity
- Glove powder
ICD can be severe enough that an individual requires job modification, or extended time away from work.
Skin dryness in the web spaces of the fingers: an early sign of irritant contact dermatitis (known as the sentinel sign)
Allergic contact dermatitis
Common allergens affecting health workers include:
- Thiurams – found in many rubber gloves
- Colophony – found in sticking plasters
- Formalin releasing preservatives used in water-based products such as hand washes and moisturizers
- Coconut diethanolamide – found in many skin cleansers, especially hand washes
- Fragrances – used in skin cleansers and moisturisers
Healthcare workers have been the occupational group most commonly affected by latex allergy, although fortunately this is not as common as ICD or ACD. Latex gloves (particularly powdered varieties), are one of the more common causes of latex allergy. The powder facilitates the transfer of the latex allergen to the skin and also aerolises it, so latex proteins that have attached to the powder can be inhaled, or enter the skin via cracks and splits in the skin.
For further information please refer to Section 2.3 on latex allergy.
During the COVID pandemic, the Skin Health Institute reviewed many healthcare workers with facial dermatoses related to face masks, usually aggravating underlying skin conditions such as acne, seborrheic dermatitis and atopic dermatitis. Additionally pressure and friction from mask components may cause irritation. Allergic contact dermatitis from face masks is rare. The Australasian College of Dermatologists have released a document on how to avoid skin problems associated with mask wearing.
Additionally they have also released information to help support clinicians when providing mask exemptions.
Advice for healthcare workers
- Be aware of the risks for developing contact dermatitis
- Minimise contact with known skin irritants and allergens where possible
- Use alcohol-based hand rubs whenever possible and appropriate
- Ensure appropriate moisturiser is available at all times. Please refer to Section 7.2 on Skin Care for further information
- Protect the skin by using gloves appropriately
- Gloves should be changed regularly to reduce sweating
- Appropriate gloves should be worn such as non-powdered latex (to reduce the risk of latex allergy), or non-latex such as nitrile gloves. Vinyl gloves are not appropriate for healthcare workers as they do not provide adequate protection against bodily fluids
- Develop and implement an effective skin care policy in the workplace
- Implement a referral system for those with skin problems
- Liaise with infection control staff about appropriate gloves and hand washes if skin is damaged
- If skin problems persist see your local doctor or staff clinic who may refer you to a dermatologist
- It is also important to look after skin at home, such as wearing gloves when washing dishes, regularly using a moisturiser and using soap substitutes.
A comprehensive online contact dermatitis module for healthcare workers is available on the Hand Hygiene Australia website https://www.hha.org.au/online-learning/complete-a-module.
Patch testing and healthcare workers
When patch testing a healthcare worker, consider the following:
Videos to watch:
Healthcare Workers with hand dermatitis: issues in diagnosis and management – October 2020 Patch test training Teleconference (A/Prof R. Nixon)
How to evaluate HCWs Talk 28
Dermatitis in HCWs Talk 30
HCWs with hand dermatitis Talk 49
A comprehensive online contact dermatitis module for healthcare workers is now available on the Hand Hygiene Australia website https://www.hha.org.au/online-learning/complete-a-module. Please complete this module and email your certificate of completion to [email protected].
2016 Higgins CL, Palmer AM, Cahill JL, Nixon RL. Occupational skin disease among Australian healthcare workers: a retrospective analysis from an occupational dermatology clinic, 1993-2014. Contact Dermatitis 2016; 75:213-22.