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Protecting Your Skin [April 2008]

Published: 01st Apr 2008 in Health and Safety International

How to prevent dermatitis

In my role as an occupational physician I frequently see employees who have problems with dermatitis related to work. Given that most work involves extensive use of the hands, it is not surprising that the main area affected is the hands and forearms.

Hand Dermatitis

What do we mean by dermatitis? This is a skin condition that is the same as eczema. In the past doctors tended to use the terms to mean two different things. “Eczema” was used to describe the condition that runs in families, starts in childhood and is present in the absence of external irritants or allergens. The phrase “dermatitis” however was used where a specific cause had been identified. Today the term dermatitis is used to cover both situations in the UK, but terminology still varies throughout Europe.

The employee with dermatitis complains that the skin feels sore and itchy, looks red and feels dry. It can be flaky and cracked with bleeding and sometimes blistering. Sometimes large deep cracks develop in the skin creases of the digits and palm, which are intensely painful. Often the most affected areas are in between the fingers and over the back of the hands but sometimes the dermatitis affects the thicker skin of the fingers on the palm side of the hand.

Sometimes the dermatitis extends up the forearm as far as the sleeves. Employees exposed to fumes such as solder fume, which contains rosin also known as colophony, and volatile chemicals may develop eyelid and facial dermatitis rather than hand dermatitis.

There are two main types of work related hand dermatitis: irritant and allergic. Irritant dermatitis is by far the most common type of dermatitis seen in industry and is caused by constant and repeated exposure to substances and processes that damage or remove the outside layer of the skin. In contrast, allergic hand dermatitis is caused by a substance to which the employee has an allergic reaction, and is thankfully much less common. Allergic skin reactions occur at much smaller exposures than in irritant dermatitis and can be very difficult to prevent and control once developed.

Many people who have irritant dermatitis continue with the problem despite intervention at the workplace. Furthermore, research has shown that contrary to all expectations, changing jobs does not necessarily solve the problem. Therefore, preventing the condition and looking after your hands is really important if you work in an environment where you may develop hand dermatitis.

How to prevent and manage dermatitis

Often very simple measures can prevent, and improve existing, irritant dermatitis at work.

Dermatitis often occurs around the areas neglected in hand washing, in particular under rings and in between the fingers. Grease, oil, food ingredients and metal powders easily get underneath rings and jewellery and are more difficult to remove during hand washing. The exposure to the skin irritant therefore increases and this is compounded by residues of skin cleansers, sweat and water also under the ring. Therefore, do not wear rings at work or other jewellery on your arms and hands.

Selecting suitable gloves

Under the Control of Substances Hazardous to Health, gloves should be used as a control measure as a last resort. They may be required as a physical protection against physical or biological hazards or may need to be resistant to chemicals. General things to consider are:

  • Manual dexterity will be reduced by wearing gloves
  • Washing the glove to remove chemicals before removing the glove to reduce the chances of contaminating the hands
  • Wearing occlusive gloves for more than 10 -15 minutes will increase the risk of irritant dermatitis. Wear cotton inner gloves if you need to use gloves for any longer
  • Do not use moisturiser inside latex gloves as this can degrade the glove
  • Implementing a skin protection programme

When you are selecting protective gloves you will need to consider the following:

  • Always read the material hazard data sheet to find out which gloves are recommended. It may be necessary to contact the manufacturer of the substances used in the process and the glove manufacturer to ensure that you obtain the best glove for the circumstances
  • Remember to also consider what chemicals are created in the process to complete assessment fully
  • Some gloves degrade when exposed to certain chemicals. The speed and extent of degradation will depend on the chemical composition of the glove, the chemical being used, the exposure time and the level of exposure
  • The length of the glove must be sufficient to ensure that chemicals do not get into the inside of the glove from the sleeve end of the glove. If needed wear gauntlets
  • There is a risk of allergy from the glove material if the gloves contain latex protein. Latex gloves are useful for protection against blood borne viruses but other types of glove should be used if this is not the hazard. If latex gloves are worn they should always be low protein residue and powder free
  • Contamination of the work - latex gloves are not suitable for use in catering due to potential contamination of the food with latex protein

References

Protective gloves for occupational use. Edited by Anders Boman, Tuula Estlander, Jan E Wahlberg, Howard I Mailbach. CRC Press

Choosing gloves for work with chemicals:
http://www.hse.gov.uk/pubns/indg330.pdf
http://physchem.ox.ac.uk/MSDS/glovesbychemical.html

Pre-work creams

Pre-work (barrier) creams are heavily promoted, but in many cases do not protect the hands. They will not prevent many chemicals getting into your skin and their main purpose is to maintain the natural secretions of the skin. Use protective pre-work creams if you work bare-handed, but don’t use more pre-work cream than necessary.

Protective clothing

Whilst pre-work skin creams do not protect the outer layer of the skin very much, suitable protective clothing can and does, if used correctly. Gloves alone will not prevent forearm exposure and gauntlets may therefore be needed as well. It depends on what the exposure is, as to what is appropriate to use as a glove:

nitrile, vinyl, butyl and latex all have their uses and disadvantages. You will need to consult the Material Data Sheets and COSHH assessment to work out which is best for your process.

Gloves should be in good order, clean and dry inside: don’t wear gloves that are dirty or oily on the inside, as the glove will increase the skin contamination and damage. Likewise don’t wear oily protective clothing. Discard disposable gloves at the end of the day, or sooner if they are heavily contaminated. Ensure that non-disposable gloves are in good condition without holes or tears. Replace them if and when they have holes. Don’t wear gloves for any longer than needed.

Ideally, when protective gloves are used for more than 10-15 minutes, clean cotton gloves should be worn underneath as this soaks up sweat and reduces the chances of the skin coming into contact with the glove. This is not always feasible as a result of reduced dexterity, but should be used as a general principle. Some gloves come with an integral cotton lining, but only work if the cotton is dry and clean.

Gloves and alcohol gels in health care

Latex gloves are very effective mechanical barriers to infection but can cause irritation and rarely latex allergy. Latex allergy is more common in people who have had multiple exposures such as those who have had repeated surgery or have spina bifida. Latex glove allergy is much less common in users of low protein gloves with no added powder.

As a matter of policy only low protein residue, non-powdered gloves should be used in health care.

In health care, employees do not need to wear gloves for many tasks, and often do not need to wear them for prolonged periods of time. Think before you put gloves on: is there a risk, if not why are you wearing them? When gloves are used for more than 10-15 minutes, clean cotton gloves should be worn underneath. Using cotton inners is not always feasible as a result of reduced dexterity, but should be used as a general principle.

If you use latex gloves, make sure that you wash and dry your hands before you put the gloves on. This is to clean the hands and remove moisturisers and alcohol gels that will adversely affect the integrity of the latex. You should also wash your hands after removing the gloves to remove any residual latex proteins, which increase the risk of developing latex sensitisation.

Alcohol gels should only be used by health care workers on visibly clean skin to decontaminate the hands after patient contact, but only up to 3 times before washing the hands again with a suitable hand cleaner.

Alcohol gels contain a moisturiser and therefore can be of benefit in the prevention and management of irritant dermatitis.

Skin cleansing

Wash regularly, but not too frequently, in the washrooms using the creams provided. If you do not know which cream to use, ask the Health and Safety Officer or person responsible for skin protection in your work place.

Wet your hands first if possible prior to placing cleanser on hands. Clean your skin with the correct cleanser at the end of each day and before breaks - use an approved skin cleanser and not soap. Do not use stronger cleanser than is required. Wash your hands in lukewarm water, not hot water as this damages the skin. Pay attention to: thumbs, fingertips and between the fingers, around the wrist/lower arm if gloves with elasticated ends have been worn. Avoid using a brush; do not use alcohol, paraffin, thinners or spray wash bottles for hand cleansing. Health care workers who need to use a brush should only use sterile single use brushes to avoid transmitting infection. Rinse your hands thoroughly after washing under running lukewarm water.

Drying your hands

Dry your hands gently and thoroughly after washing, but never use soiled towels to dry the skin. If possible use a hot air blower rather than hand towels for drying the skin as this damages the skin less. After cleaning and drying your hands use a moisturiser. This will need to be washed off before donning gloves if you are a health care worker.

Moisturisers

Use a moisturiser as required before, during and after work. This should be the one provided in a dispenser. Moisturisers should be applied all over the hands including and especially between the fingers, the fingertips and back of the hand and wrist. Health care workers should not use a moisturiser from a communal pot as this may transmit infection, or before wearing gloves as this may damage the glove as a protective garment.

Skin at work: action plan

Practical action by employers is the key to preventing work related dermatitis caused by chemicals. A suitable step-by-step action plan may be summarised as follows:

  • For every task undertaken at your workplace, know what products or substances are being used or generated
  • Find out what are the health and safety hazards associated with each of the substance or product used or generated. Find out whether these substances carry warnings signs and hazard information on dangers to the skin. You can find these on product labels and/or in Safety Data Sheets. SDS must be provided by the supplier of the chemical
  • Frequent contact with water (wet working) is a major cause of work related dermatitis (WRD). Some substances (eg: formaldehyde in metal working fluids) may be generated during work and can cause WRD. Take account of wet work and substances generated during work in the next step
  • Find out what control measure you have in place
  • Based on these make a judgement whether your employees are at risk of getting WRD
  • If there is a risk of WRD, can you get rid of the chemical altogether? This is the best and simplest solution
  • If you cannot get rid of the offending chemical, can you able to replace it with a less harmful chemical
  • Introduce process controls so that skin does not come into contact with the chemical. If the contact is by immersion, or splash find a solution that would provide a safe working distance (SWD) between the chemical and the skin
  • If the exposure is due to dust, vapour in the air, install a ventilated enclosure or provide local exhaust ventilation
  • If you have provided all the above controls and you consider that skin exposure could not be prevented altogether, then provide chemical protective gloves and coverall as appropriate. Selection of gloves is a complicated process. Always seek the help of your chemical supplier or a reputable PPE supplier
  • Make sure employees: have been taught on safe working practices; use the controls provided; have been trained to correctly use process equipment and PPE; know how to check their skin for signs of dermatitis; understand the benefits and limitations of skin care creams
  • Ensure pre and post work creams are used
  • Seek the help of occupational health professionals if you suspect that you may have dermatitis problem at your workplace
  • Put in place a management system that checks that all of these actions are carried out in practice

Courtesy of:
http://www.hse.gov.uk

And outside of work

Having taken all this time and trouble to look after your hands, it is now well worth taking a look at what you do outside of work that involves your hands. Take care when doing housework, use clean dry protective gloves for dishwashing and jobs that involve exposure to household chemicals and oils. Don’t forget to use the cotton liner if you use the glove for more than 10 minutes.

When you go out on cold days in winter wear warm gloves to protect your hands and finally, use a moisturiser last thing at night before going to bed.

Conclusion

We often take our skin for granted, but with simple measures we can not only reduce the chances of developing problems but also help to manage them.

Published: 01st Apr 2008 in Health and Safety International

Author


Dr Martin Cosgrove MRCGP MFOM


Dr Martin Gosgrove MRCGP MFOM, Specialist Occupational Physcian

TWI

Granta Park

Great Abington

CAMBRIDGE

CB21 6AL

Martin Cosgrove works as an independent occupational physician in the Cambridge area.  He works for TWI, the National Health Service and many small East Anglian companies.


Dr Martin Cosgrove MRCGP MFOM

Website:
http://www.hse.gov.uk/skin/index.htm

Email:
drmartincosgrove@yahoo.co.uk

drmartincosgrove@yahoo.co.uk
http://www.hse.gov.uk/skin/index.htm

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