1. SCIN trial Skin care intervention in nurses Time 9.30 - 9.45 The SCIN team Funded by the National Institute for Health Research Health Technology Assessment (HTA) Programme

2. Background NIHR funded £1.4 million 4 years First UK trial in OH departments Answering an important clinical question Important for nurses and important for OH YOU are very important Enjoy and learn

3. Occupational Dermatitis Clinical aspects and pathology Dr Julia Smedley Time: 9.45 – 10.15 Funded by the National Institute for Health Research Health Technology Assessment (HTA) Programme

4. Definitions Occupational contact dermatitis –occupational irritant contact dermatitis, where agents at work have a direct toxic effect on the skin –occupational allergic contact dermatitis which involves a delayed or type IV hypersensitivity reaction as the result of a T cell mediated immune response to skin sensitisers at work Atopy –The genetic tendency to develop the classic allergic diseases atopic dermatitis (eczema), allergic rhinitis (hay fever) and asthma

5. Epidemiology OCD is the most common occupational skin disease The most reliable studies estimate the incidence of OCD to be between 11 and 86 cases per 100,000 workers per year. Irritant occupational contact dermatitis occurs more commonly than allergic occupational contact dermatitis.

6. Costs and consequences Once dermatitis becomes chronic the medical and work prognosis is poor: Impaired quality of life Ongoing treatment (33%) Loss of job, change of career, long term sickness absence (5%)

7. What is dermatitis? Literally - inflammation of the skin. Histological features –Intercellular oedema in the epidermis –Accumulation of fluid, intra-epidermal vesicles –Infiltration with lymphocytes Chronic changes –Subclinical impairment of barrier function

8. Severe acute appearance: Within 2 days. Redness, Swelling, Weeping, Blistering What does it look like?

9. More common appearance (subacute): Redness, Dry flaky skin, Cracks, Crusty exudates

10. What does it look like? Chronic appearance: Flaking, Scaling, Cracking, Thickening (lichenification)

11. Personal risk factors for O.C.D Atopy Previous history of eczema or dermatitis

12. Causative agents: irritant O.C.D Chemical –Alcohols –Cutting oils –Degreasers –Disinfectants –Petroleum products –Soaps and cleaners –Wet work –Solvents Physical (<1%) –Friction –Low humidity

13. Causative agents: allergic O.C.D Cobalt Chromium Cosmetics, fragrances Epoxy resins Nickel Plants Preservatives Acrylics

14. Risk factors in nursing

15. Prevention of O.C.D Substitution reduces the incidence of occupational contact dermatitis and urticaria. Good hand care, careful rinsing and drying PPE Limited wearing of gloves can help to reduce the incidence of irritant occupational contact dermatitis when coupled with other preventive measures.

16. Prevention of O.C.D Emollients The regular application of emollients helps to prevent the development of occupational contact dermatitis.

17. Prevention of O.C.D Education and hand care Appropriately targeted and sustained educational intervention induce important behavioural changes.

18. Role of collaborators and field workers Time: 11.15 - 11.45 Dr Julia Smedley Funded by the National Institute for Health Research Health Technology Assessment (HTA) Programme

19. Collaborators in Core Team Prof David CoggonProf Hywel Williams Dr Lesley RushtonDr Alison Wright Dr John English Prof Dame Tina Lavender Ms Georgia Ntani Miss Caroline MurphyProf Paul McCrone Prof Barry CooksonDr Julia Smedley

20. Collaborators Multidisciplinary –Doctors –Nurses –Psychologists –Statistician –Clinical Trials Unit Stakeholders –Patients –OH providers Specialist knowledge –Dermatology –Behavioural change interventions –Research methodology –Statistics and analysis –Infection Prevention

21. Local site leads’ responsibilities –nurse or doctor (+/- input from R&D team) –Get local permissions, Trust and University –Arrange for signature on research contracts –Complete IRAS form –Create a favourable environment: encourage engagement –Make practical arrangements for recruitment, follow-up and data capture. Robust, practicable –Assure provision of data to trial manager

22. Engagement In principle: Enthusiastic champion Inspirer of –ICU nurses –Student nurses Influencer of –Nursing leads –Nursing educators Awareness of real world barriers, e.g OH workload In practice: Meet ICU lead nurses Meet Uni. course leads Posters Letters Uni. or Trust website Trust briefings Ward meetings Text messages Twitter/facebook

23. Field workers OH nurses Research nurses Must work together to –streamline recruitment and follow-up –maximise participation rates –COMMITMENT of trial participants –preserve subject experience

24. Field worker tasks – student nurses 1.Re-inforce information about the study at the “new starter” clinic – in the waiting room 2.Consent, and check contact details 3.Photograph hands 4.Collect questionnaire (or give out & arrange return) 5.Give care instructions and hand care leaflet 6.Inform student about follow-up arrangements 7.Arrange to meet to give out & collect final questionnaire and take photographs

25. Field workers tasks ICU nurses 1.Attend appointed room at agreed times 2.Give information and consent, check contact details 3.Photograph hands 4.Collect questionnaire (or give out & arrange return) 5.Give care instructions and hand care leaflet 6.Inform ICU nurses about follow-up arrangements 7.Ensure provision of emollients and hand rubs on ICUs, and do fortnightly audit 8.Arrange to meet to give out & collect final questionnaire and take photographs

26. Contact details Vaughan Parsons (SCIN trial manager) Ph: 020 7188 7188 ext 53678 / Mob: 07715 897633 Email: SCINTrial@gstt.nhs.ukSCINTrial@gstt.nhs.uk (vaughan.parsons@kcl.ac.uk)vaughan.parsons@kcl.ac.uk Barbara Smiley (Trial Administrator) Ph: 020 7188 7397 Email: barbara.smiley@gstt.nhs.uk Address: c/o Occupational Health Service St Thomas’ Hospital, Education Centre 75 York Rd Waterloo SE1 7EH

27. SCIN trial Maintaining scientific validity Time: 11.45 - 12.15 Ira Madan Funded by the National Institute for Health Research Health Technology Assessment (HTA) Programme

28. What we need We need as many participants as possible We need participants to stay in the trial We need participants to return their questionnaires We need participants to have their hands photographed at the end of the trial

29. Maintain commitment from participants Help them understand the commitment at recruitment Only three questionnaires and questionnaire B is short All will have an intervention Altruism- helping others

30. Randomised trial Don’t deliberately select participants with dermatitis above those who don’t Do emphasise that everyone will be receiving an intervention We will be blind to which site is intervention plus and which is intervention light Don’t change behaviour- leave that to us!!

31. SCIN trial Principles of taking consent Time: 11.45 -12.15 Ira Madan Funded by the National Institute for Health Research Health Technology Assessment (HTA) Programme

32. Mental capacity

33. Informed

34. Right to withdraw

35. If a participant withdraws…. The ‘right’ to withdraw Common reasons for withdrawal Has the participant completed the study? Identifying whether participants are still in the study Recording specific information (Withdrawal form)