Contact dermatitis is the most common form of work-related skin disease suffered by nurses and other health and social care professionals. Each year an estimated 1000 nurses develop work-related contact dermatitis.
Dermatitis is an inflammatory condition of the skin caused by contact with outside agents which can result in irritation, redness, cracking and blistering.
HSE has a skin at work website with information on:
- how to prevent work-related skin diseases in your workplace
- where you can get further help if you need it
The microsite contains guidance on dermatitis and specific guidance on reducing the risks of work-related dermatitis in healthcare and dentistry.
Health surveillance for occupational contact dermatitis
Employers should carry out suitable and sufficient risk assessments considering the risks from:
- irritant contact dermatitis caused by wet work, chemicals, and physical and biological agents
- allergic contact dermatitis caused by sensitising chemicals
- occupational contact urticaria caused by proteins in food or latex
If appropriate, identify suitable health surveillance, which should be based on risk and form part of your overall system for managing occupational health (OH) risks. You may wish to involve a health professional (OH doctor or nurse) in your health surveillance programme. Their competent advice will help develop your scheme, train a 'responsible person', and/or manage the programme as a whole.
A responsible person is someone who is given the responsibility to help deliver a system of occupational health surveillance. They will have received training or coaching on what they need to do in order to perform this role effectively. This may involve training from a health professional, management, health and safety professional or other, as appropriate. This person may be a supervisor, first-aider, safety representative or the employer and the role will be clearly defined. They will be someone trusted by the workforce with good communication and interpersonal skills.
Health surveillance for occupational contact dermatitis could include the following elements:
- regular visual skin inspections by a 'responsible person' (frequency as advised by a health professional)
- annual employee questionnaires
- general training of employees on likely exposures and symptoms
- general training of employees on how (and to whom) to report such symptoms
- assessing workers' skin condition as soon as possible after they start a relevant job to provide a baseline (for example within 6 weeks).
To identify a suitable level of health surveillance you need to consider a number of factors including:
- the individual's work activities
- type of hazard
- degree of risk
- length of exposure
- type of PPE/gloves
- likely health affects (irritation or allergy)
- history of other affected employees
It is important to consider all activities that may present a risk of occupational contact dermatitis and provide a level of health surveillance that will help manage the highest risk of exposure. For example, healthcare employees may be at risk of exposure from more than one hazard, frequent hand washing, glove use and other hazardous agents.
The following examples are provided to help organisations identify a suitable level of health surveillance. However, HSE expects all of the above factors to be considered, so the level of surveillance may vary between individuals doing similar work.
A higher level of health surveillance is appropriate
This is appropriate when the evidence for a hazard is clear and/or there is potential for significant exposure, for example:
- an employer has identified that a chemical he uses can cause severe occupational contact dermatitis, they know that despite risk reduction measures being in place, exposure can happen, and that occupational contact dermatitis is not uncommon in their industry.
- for hygiene reasons, a worker cannot avoid frequent handwashing. The worker's employer knows that as a rule of thumb, a worker is at risk of developing occupational contact dermatitis, if they wash their hands more than 20 times a day
HSE would expect all of the above elements of health surveillance to be included.
A lower level of health surveillance is appropriate
This is appropriate when there is weak evidence of a hazard and/or there is limited potential for significant exposure, for example:
- workers are required to wear low protein powder-free latex gloves intermittently at work. There are many different types of protective glove available and HSE does not have the evidence to identity the appropriate level of health surveillance for all glove materials. However, for powder-free, low protein, single-use latex gloves, the evidence suggests the risks of developing occupational contact dermatitis are low.
- a worker uses an irritant substance but exposure is controlled effectively without reliance on personal protective equipment.
HSE accepts that a lower level of health surveillance is likely to be sufficient. Skin inspections by a responsible person may not be necessary, but employee questionnaires and providing appropriate information, instruction and training so they know when and how to report their own skin problems would be required.
Keeping a record of health surveillance
Health surveillance programmes must include keeping a health record for each individual. This should include:
- the activity that can cause dermatitis
- worker's name, address and National Insurance number
- products or process they work on, and how often
- protective measures provided
- date of starting work with the product or process
- the result of skin inspections