From: [log in to unmask] [mailto:[log in to unmask]] On Behalf Of Cheatle, Jane L.
Sent: 22 August 2008 09:35
To: [log in to unmask]
Subject: Re: Frequent hand washing and wearing of gloves

From: [log in to unmask] [mailto:[log in to unmask]] On Behalf Of Chris Packham
Sent: 22 August 2008 08:38
To: [log in to unmask]
Subject: Re: [OCC-HEALTH] Frequent hand washing and wearing of gloves

Stella

This is a common problem here in the U.K. as well. It sounds from your e-mail that what you are dealing with is a case of irritant contact dermatitis where the RN's skin is bouncing around just above or below her threshold, such that the exposure at work pushes her over the threshold and then when away from work the skin recovers slightly, but not enough to prevent a repeat. To explain this in greater detail I will e-mail you direct our Technical Bulletin on irritant contact dermatitis.

What is commonly termed "wet work" is the most common form of occupational contact dermatitis. Studies have shown that frequent, short duration exposures to water are more damaging to the skin that a single, long term exposure. Furthermore, wearing occlusive gloves is equivalent to having your hands in water. So your RN has the worst of both worlds!

Since it is the occlusion that is contributing to the dermatitis, changing gloves will not improve matters. Indeed, it may make things worse. The only thing you can do is to limit the amount of hand washing and glove wearing by carrying out a proper risk assessment and then deciding when hand washing (as opposed to a properly buffered alcohol gel) and glove wearing are really necessary. In my experience this is rarely done in the NHS and I suspect may be the same in your country. With the gloves the only answer is for her to wear separate cotton gloves underneath the occlusive ones. It has been shown that this significantly reduces the damage that the occlusion can cause.

As you will see when you read the Technical Bulletin, perhaps time away from the hand washing and glove use might allow her skin to recover adequately so that, with the appropriate precautions, she can return to her normal work.

Obviously, in an e-mail on the forum I cannot respond in great depth, but I hope that the above is of some help. If you feel you need more please feel free to contact me direct.

Regards

Chris

P.S. Incidentally, provided you use only unpowdered, low free protein natural rubber gloves these represent virtually no hazard, except to those who are already sensitised to the latex protein. The latex allergy problem was caused by the powdered, high free protein gloves that were purchased due to their low price. I am seeing increasing numbers of cases of allergic contact dermatitis in those healthcare organisations who have changed to nitrile. There have now even been two reported cases of type I allergy to nitrile gloves. Similar situation exists with the thin vinyl gloves.

EnviroDerm Services (UK) Ltd.
2 Amery Lodge Farm, North Littleton, Evesham, WR11 8QY, U.K.
Tel: 0044 1386 832 311
Dermatological Engineering for a healthier workplace
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