Mari-Ann Flyvholm, MSc, PhD, National Institute of Occupational Health, Copenhagen, Denmark (Corresponding Author)
Lone Borg, MSc, PhD, National Institute of Occupational Health, Copenhagen, Denmark
Karen Mygind, MSc Pharm, National Institute of Occupational Health, Copenhagen, Denmark

Occupational skin diseases are among the most frequent occupational diseases in many countries. More than 90% of the occupational skin diseases are hand dermatitis and the majority of these are contact dermatitis. Occupational skin diseases are often recurrent with a long-standing course. Wet work occupations such as the health care sector and the food processing industry have a high risk of occupational skin diseases.

Prevention of occupational skin diseases in the food processing industry is particularly challenging. Skin exposures to occupational factors causing dermatitis range from, e.g., soaps, hand disinfectants and skin care products, over water to foodstuffs. Work procedures and methods are usually manual and automation is often not possible due to a necessity of individual handling of the foodstuffs. Thus, measures to prevent contact dermatitis in the food processing industry cannot solely be based on controlling the work process or changing products or raw materials used. Even though much can be done by choosing less skin damaging products, the prevention of skin diseases in wet work occupations should also take into account changing the workplace routines and habits of the employees and developing the overall safety climate throughout the organization.

Occupational and environmental risk factors of importance for occupational skin diseases should be thoroughly documented, i.e., based on scientific evidence, in order to explain the reasons for changing workplace routines, work procedures, methods or equipment. This scientific documentation has to be transferred to logic and understandable recommendations on how to reduce exposures to skin damaging factors. An evidence-based prevention program for occupational skin diseases including evidence-based recommendations derived from scientifically documented risk factors is a necessary but not sufficient prerequisite for workplace prevention of occupational skin diseases.

Another prerequisite for a successful prevention of occupational skin diseases (i.e., an intervention) is the implementation of the prevention program at the workplace.

One way of achieving changes in workplace routines, safety climate and attitude to occupational skin diseases is to establish and maintain an occupational health and safety management system in regard to the elimination or minimization of skin risk associated with the production activities.

A local project group should establish the occupational health and safety management system. This group must include representatives from all organizational levels, i.e., members of the safety board and the top management. The project group should go through an educational program covering the necessary theoretical and practical background for understanding the prevention program and subsequently establish the occupational health and safety management system. This involves developing a skin prevention policy, and in addition, to drawing up written instructions referring to the prevention program and adapted to the workplace and the work. Furthermore, the tasks for the project group include introduction of the prevention program and supervision during the daily work to colleagues in order to reduce the risk of occupational skin diseases.

This strategy for prevention of work-related skin diseases, combining the prevention program and its implementation, is used in an ongoing intervention study in the Danish food processing industry. The aim of this study is to develop and test an integrated prevention concept, which includes an evidence-based program for prevention of occupational skin diseases and an evidence-based method for implementation of the intervention at the workplaces, as described above. The study design is a randomised controlled trial including all Danish gut cleaners at swine slaughterhouses. The effect of the intervention will be evaluated by questionnaire surveys using a trade-modified version of the Nordic Occupational Skin Questionnaire — NOSQ-2002 (Flyvholm, et al., 2002) supplemented by questions on work routines, safety climate, attitudes, information flow, safety behavior, etc. The questionnaires are administrated by telephone interview and include employees at both intervention workplaces and comparison workplaces. The surveys are carried out immediately before the intervention activities and repeated one year later. In addition, a process-evaluation documenting the implementation of the intervention will be carried out for the intervention workplaces.

Reference
M-A Flyvyholm, P Susitaival, B Meding, L Kanerva, M Lindberg, Å Svensson, JH Ólafsson (2002) Nordic Occupational Skin Questionnaire — NOSQ-2002. Nordic questionnaire for surveying work-related skin diseases on hands and forearms and relevant exposures, Nordic Council of Ministers, Copenhagen, TemaNord 2002:518. (The questionnaire files can be downloaded from http://www.ami.dk/NOSQ in Word and PDF-format. A link to the Nordic Council of Ministers and download of the report in PDF-format is included at this website. Others are encouraged to modify, use and provide feedback about this questionnaire.)