1. The SCIN (Skin care intervention in nurses) Trial A cross-sectional feasibility study in Wales Vaughan Parsons (King’s College London), Dr Shuja Din (ABM Health Board, Wales), Dr Alison Wright (King’s College London), Prof David Coggon & Ms Georgia Ntani (MRC Lifecourse Epidemiology Unit, Southampton), Prof Hywel Williams (University of Nottingham), Dr John English (Nottingham University Hospitals NHS Trust), Dr Ira Madan (Guy’s and St Thomas’ NHS Foundation Trust), Dr Julia Smedley (University Hospital Southampton NHS Foundation Trust) 1.To assess the numbers of eligible participants that can be expected in the main study and the response rates that are likely to be obtained. 2. To test the main study protocol and standard operating procedures 3. To test the behavioural change programme to ensure that it is understandable and acceptable in format 4. To assess the baseline prevalence of hand dermatitis to refine power calculations for the main study. 5. To test the feasibility of recruitment of participants through the local occupational health service. AIMS METHODS Occupational irritant hand dermatitis is a major risk in healthcare with a 1-year prevalence estimated to be 24%, compared with less than 10% in the general population. The cost to the NHS of its workforce developing hand dermatitis is estimated to be £125 million/year. Amongst healthcare workers, nurses are the group at highest risk; this is attributed to frequent hand washing with soap & water and infrequent use of hand moisturisers Current hand-cleansing policies in the NHS are driven by efforts to reduce colonisation / transmission of infections. Little attention is paid to prevent of hand dermatitis. Once an individual has developed irritant hand dermatitis the prognosis is poor. Educational programmes based on the Theory of Planned Behaviour can facilitate longer-term behaviour change. Purpose of the study To support the implementation of an upcoming large-scale cluster randomised controlled trial across the UK. Recruitment Study group one ‘ Student nurses ’ (n=22) who were about to start their first clinical placements, and who were at increased risk of hand dermatitis because of a past history of atopic disease or hand eczema. Study group two ‘ ICU nurses ’ (n=26) working in a large hospital in South Wales who were at increased risk of hand dermatitis because of frequent hand-washing with cleansers and water. Intervention A paper-based behavioural change programme (BCP) which included support and information on when and when not to use: gloves; antibacterial hand rubs; and moisturising cream and reminders to contact the occupational health department early if hand dermatitis occurs. * Participants were asked to form implementation intentions for performing each behaviour in their workplace. * The BCP was supported by provision of personal supplies of moisturising cream (student nurses), and provision of optimal equipment for washing and drying hands together with moisturising cream dispensers on the wards (ICU nurses). Data Collection Questionnaires: Baseline demographic data, and information on atopy, hand care and risk factors for developing hand dermatitis both in and out of work. Preliminary assessment of hand dermatitis: Assessment by the OH clinician of the presence of hand dermatitis. Ascertainment of hand dermatitis and descriptions of the photographic method: Assessment by dermatologists using an assessment scale of the presence of hand dermatitis from photographic images of participants’ hands/wrists. Hand/wrist Swabs: Assessment by microbiology of the presence of staphylococcus areus, Beta haemolytic Streptococcus Lancefield Group A and MRSA. Ward-based audit: Monitoring the availability of hand cleansing cream, hand moisturising cream and paper towels at the participating site. Interviews: Qualitative feedback from participants on the acceptability and user-friendliness of the methods of data collection and the BCP. Qualitative feedback was also sought from the field worker on the ease of use of the study protocol and standard operating procedures. ACKNOWLEDGEMENT / DISCLAIMER Funded by the National Institute for Health Research Health Technology Assessment (HTA) Programme 11/94/01. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the HTA, NIHR, NHS or the Department of Health. CONCLUSION BACKGROUND Recruitment: 22/23 (95%) eligible student nurses and 24/24 (100%) eligible ICU nurses Completeness of questionnaires: A range of errors were identified with the accurate completion of study questionnaires by participants (e.g. incomplete or inconsistent responses) resulting in further revisions to the content, format and style of questionnaires for the main study. Baseline prevalence of hand /wrist dermatitis: ICU and student nurse participants underestimated the point prevalence of their hand dermatitis, whereas the OH fieldworker overestimated the point prevalence. The diagnosis by two consultant dermatologists were considered to be the gold standard. Example:19% ICU self–reported hand dermatitis v. OH field worker 57.7 % v. dermatologists 38.5% Prevalence of hand colonisation of organisms following swabbing Only 1/48 of participants ( a student nurse) had evidence of hand colonisation of organisms Qualitative feedback from local OH field worker (Key themes): ‘Developing procedural and technical skills and competencies’, ‘Developing streamlined systems and the value of experiential learning and working in teams’, ‘Maintaining good research governance practices when dealing with time pressure’ and ‘The importance of study flowcharts and standard operating procedures to support technical skills’. PRELIMINARY RESULTS In summary, the feasibility study resulted in: Revisions to the main study protocol and standard operating procedures Changes to study questionnaires and data collection tools Streamlining of study processes Omission of self-diagnosis of hand dermatitis and diagnosis by OH field workers Collection of random sample of swabs only in the main study