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:

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

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

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 NHSScotland Strong 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 CoSHH Employers 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

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

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

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: CoSHH: Health & Safety Executive Skin at Work NHS Scotland Infection Prevention and Control Manual: 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 web:

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 or 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.