Abstract for Plenary Talk No 1.2

 

 

Wet work: Quantifying the Burden to the Skin

P.-J. Coenraads, University Hospital, Groningen, The Netherlands

Background

Wet work can be described as all occupational activities that a): cause the skin of one or both hands to be in contact with water or watery soap solutions, and b): necessitate the wearing of protective gloves over a prolonged period of time, causing the hands to become moist from perspiration. Typical occupations where wet work dominates are, for example, cleaning, hairdressing, metalwork, nursing. In occupational skin disease notification registries these occupations rank high in terms of frequency of irritant contact dermatitis. Regulation of wet work has been proposed, and has reached the stage of guidelines in Germany, but little is known about the duration and frequency of exposure to wet work in such occupations, and little is known about the limits of such exposure which should be the basis of guidelines.

Methods

In one study the aim was to quantify the duration of wet work activities in nursing work at different wards. With a continuous observation method all activities during typical morning shifts of 45 randomly chosen nurses were monitored by trained observers on duration and frequency of different wet work activities. The findings were compared with those from a questionnaire on frequency and duration of wet work in the same nurses.

A similar continuous observation method was applied by trained observers to monitor 41 office cleaners.

Based on the findings of the duration and frequency of nursing work, we modelled exposure to soap or hand-alcohol, in combination with wearing a glove, in a group of 39 volunteers. This experiment lasted 3 weeks, after which skin damage was assessed by changes from baseline TEWL.

Results

In nurses, the duration of wet work varies from 9% of the time of a morning shift in a regular ward, to 24% of the time of a morning shift in an intensive care unit. The frequency of wet work episodes varies from 39 to 49. The wet work activities have a relative short mean duration. Mean duration of occlusion by gloves was varied from 3.1 minutes on regular wards, to 6.7 minutes in intensive care units. The questionnaire grossly overestimated the duration of wet work in these nurses, while it grossly underestimated the frequency of wet episodes.

In the cleaning industry wet work made up 50% of the time. Within a typical 3-hour shift a mean frequency of 68 episodes was observed. Skin exposure was markedly different among cleaners who had the same task, and dry work was often unnecessarily done with occlusive gloves.

In the 3-week modelled exposure experiment, there was less skin damage (assessed by change in TEWL) in the hand-alcohol group. A negative effect of occlusive gloves could be shown in the group who used soap, while there was no negative effect in the hand-alcohol group.

Conclusion

In nursing work exposure to irritants is mainly associated with the frequency of wet hands; preventive programs could focus on decreasing the frequency of wet hands by encouraging the use of gloves. Questionnaires are not suitable to assess wet-work exposure. According to the German guidelines, nursing-work would have to be regulated. Also cleaning work would have to be regulated according to the German guidelines.

In the cleaning industry reduction of exposure can be achieved by dedicated instructions to the employees, focussing on using gloves for wet tasks more often and for a shorter period of time, while reducing unnecessary glove usage for dry tasks.

To disinfect the skin, hand-alcohol should be preferred over soap. Increased occlusive exposure from gloves does not seem to have an additional irritant effect when using a hand-alcohol, provided the duration of the wearing of occlusive gloves is restricted to 4 minutes maximum.

 

 

 

Figure 1. One-to one continuous observations of 45 nurses by trained observers

 

 

Content last modified: 3 April 2005