Aims of the resource

The aim of this education and training resource is to equip facilitators with the knowledge and skills to:

recognise skin damage to hands which may be associated with work-related substances

educate colleagues how to better understand good hand care and how to prevent skin damage

Structure of the resource

This resource was developed to complement hand surveillance skills. The presentation may also be used by the link person to educate other health care workers how to protect their hands and prevent skin damage.

Carrying out hand surveillance is out with the scope of this resource. This education will be provided by your local Occupational Health Department.

A hand dermatitis pocket guide to complement this presentation can be found on the website at:www.nes-hai.info

Content

Introduction

Normal structure and function of the skin

What we can do to keep hands healthy

Early warning signs of skin damage

Most common types of hand dermatitis

Treatment for hand dermatitis

Other skin conditions affecting the hands

Introduction

Introduction

Hand dermatitis is a common condition

Health care workers are vulnerable

Good hand care and simple precautions can reduce your risk of developing hand dermatitis

Structure and function of the skin

Structure and function of the skin

Consider the normal structure and function

Our skin has the capacity to renew itself

Largest and most visible organ of the body

Main protective barrier against damage

Skin barrier is like a brick wall

Healthy Skin

Preventative approach

Skin remains intact

Barrier function strong

Healthy skin

Damaged Skin

Skin barrier breakdown

Cracks in the skin

Loss of natural oils

Damaged skin

What we can do to keep hands healthy

Good hand care: the background

World Health Organisation (WHO)

“skin irritation is the most common barrier to good hand hygiene technique”

Health and Safety at Work etc. Act 1974 Employees and employer are responsible for good introduction of hand care techniques

NHSScotlandStrong focus on patient safety. Good hand hygiene is essential in reducing risk of infection

Good hand care: the background

Health and Safety Executive

Most common causes of dermatitis in health care workers - working with wet hands and contact with soaps and cleansing materials

CoSHHEmployers are required to control exposure to substances that are hazardous to health

Good hand care: practical advice

5 moments of hand hygiene

WHO acknowledges the Hôpitaux Universitaires de Genève (HUG), in particular the members of the Infection Control Programme, for their active participation in developing this material.

Emollient

Soap substitute and moisturiser

Alcohol based hand rubs

Work by evaporation which protects the skin

May produce a stinging sensation

Hand cleansing technique

Good hand care: practical advice

Early warning signs of skin damage

Early warning signs of skin damage

Hand dermatitis is a common condition

Hand dermatitis is an inflammatory condition

Regularly inspect your hands

Changes you may see on the skin

Check other body areas

Changes in sensation

Images of damaged skin

Most common types of hand dermatitis

Most common types of hand dermatitis

Three main types of hand dermatitis:

Irritant contact dermatitis

Allergic contact dermatitis – including latex rubber allergy

Contact urticaria

Most common form of contact dermatitis

Two main types

acute

chronic

Irritant Contact Dermatitis

Mild dryness to severe reaction

Inflammation

Pain

Rash in finger webs which may spread to palms and/or backs of the hands

Note: the affected area tends to be sore rather than itchy

Changes you might experience in your hands

Identify cause

Avoid substance

Exercise good skin care

Steps you can take

Note: if your hands do not improve with avoidance and good skin care seek advice

Common substances causing reactions

The most common substances which can cause reactions in health care workers

Allergic Contact Dermatitis

Develops in two stages:

Phase 1 - the skin becomes sensitive to a specific substance which results in an allergic reaction

Phase 2 - repeated contact results in long term sensitivity to the substance

Note: it may take several days for the skin to react

Note: if untreated or substance not identified, long term problems can lead to dryness, scaling and cracking of the hands

Changes you might experience in your hands

Mild to severe reaction

Intense itching

Well defined patches of redness

Blistering may also occur

Note: if allergy is confirmed by patch testing it will be lifelong

Speak to line manager if you know or suspect a substance is causing any harm

Referral to occupational health department

Possible referral to dermatologist for patch testing to confirm or exclude allergy to a specific substance

Steps you can take

Note: if latex allergy or sensitivity is confirmed this will be life-long

For a few people a severe reaction to latex may be a medical emergency

One of the more common causes of allergic reaction in health care workers

Thought to be due to repeated exposure through use of latex gloves, medical devices

Powder free, low protein latex has reduced occurrence

Latex / rubber allergy

Contact Urticaria

Common condition also known as:

Nettle rash

Wheals

Hives

A reaction to a substance usually happens very quickly:

Swelling

Red border with white centre

Itching

Blistering

Changes you might experience in your hands

Note: this may last for a few hours but can last for up to 24 hours

If you know or suspect a substance is causing changes to your hands, discuss with your line manager for advice on avoidance

Steps you can take

Treatment for hand dermatitis

Avoiding or minimising contact with the identified substance

Good general skin care

Practice appropriate skin cleansing at work

Treatment for hand dermatitis

Other skin conditions affecting hands

Other skin conditions affecting hands

If you have any change in your skin it is always best to seek advice from GP, practice nurse, pharmacist, occupational health department or line manager.

AThere are many other skin conditions which may

affect the hands.

Health care workers should regularly examine their hands

To keep hands healthy, good hand care should be carried out by all health care workers

If irritation is present remember the three key elements of treatment

Seek help if there is no improvement

Conclusion

WHO: http://www.who.int/en/

http://www.who.int/gpsc/tools/GPSC-HandRub-Wash.pdf

CoSHH:

http://www.hse.gov.uk/coshh/

Health & Safety Executive Skin at Workhttp://www.hse.gov.uk/skin/index.htm

NHS Scotland Infection Prevention and Control Manual:

http://www.hps.scot.nhs.uk/haiic/ic/guidelinedetail.aspx?id=49785

References

Credits

Authors:

Janice Bianchi, Independent Medical Education Specialist

Barbara Page, MBE, Dermatology Nurse Specialist, NHS Fife

Sheila Robertson, Dermatology Nurse Specialist, NHS Fife

Contact Details:

NHS Education for Scotland

Healthcare Association Infections Team

e-mail: hai@nes.scot.nhs.uk

web: www.nes-hai.info

Produced November 2014

A transcript of this resource can be made available, in full or summary form, in alternative formats and community languages. Please contact us on 0131 656 3200 or e-mail altformats@nes.scot.nhs.uk to discuss how we can best meet your requirements.

© NHS Education for Scotland 2014

You can copy, reproduce or distribute this resource for use within NHSScotland and for non-commercial educational purposes. Use of this resource for commercial purposes is permitted only with the written permission of NES.