The complex workplace environment increases the potential for healthcare workers (HCW) to be exposed to many irritants and allergens that can damage the skin. HCWs with damaged skin on their hands are at greater risk of compromising infection control, risking their own health and potentially patients’ health also.
HCWs can develop both irritant contact dermatitis (ICD) and allergic contact dermatitis (ACD), and are also at a higher risk of developing latex allergy because of their exposure. It is not uncommon for HCWs to have a combination of these diagnoses. In addition, individuals with pre-existing eczema may experience aggravation of their skin condition.
Irritant contact dermatitis
ICD is the most common form of dermatitis experienced by HCWs (Figure 1).
Common irritants affecting HCWs include:
- Water and wet work, mainly due to frequent handwashing
- Antiseptic skin cleaners and soaps
- Drying of the skin using paper towels
- Hot water
- 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.
Figure 1 – Example of ICD with the sentinel sign
Allergic contact dermatitis
Common allergens affecting HCWs include:
- Thiurams – found in many rubber gloves
- Colophony – found in sticking plasters
- Formaldehyde 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
Latex allergy
HCWs 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, ingested or enter the skin via cracks and splits in the skin.
For further information please refer to Section 2.3 Contact Urticaria and Latex Allergy
Face masks
During the COVID pandemic, the Skin Health Institute assessed many HCWs with facial dermatoses related to face masks, which usually lead to aggravation of underlying skin conditions such as acne, seborrheic dermatitis and atopic dermatitis. Additionally pressure and friction from mask components may cause irritation. ACD 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
- 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.
This will be covered in Section 7.2 Skin Care and Section 7.3 Glove Selection
Patch testing and healthcare workers
When patch testing a healthcare worker, consider the following:
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Videos to watch:
- Rash presentations – healthcare workers
- Hand sanitisers
- Skin problems with masks
- Gloves and healthcare workers
- Management of skin problems
- Contact dermatitis in healthcare workers
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]
