Thursday, November 01, 2007

Prevalence of Hand Dermatitis in Inpatient Nurses at a United States Hospital

Prevalence of Hand Dermatitis in Inpatient Nurses at a United States Hospital

Posted 10/19/2007
Heather P. Lampel; Nisha Patel; Kathryn Boyse; Sarah H. O'Brien; Matthew J. Zirwas


Abstract
Background: Hand dermatitis is a significant problem among inpatient nurses. Accurate population-based data on the prevalence and risk factors for hand dermatitis in this group are lacking.
Objective: To determine the prevalence of hand dermatitis in inpatient nurses at a US hospital.
Methods: Each nursing unit in a single hospital was visited twice by a single physician. All nurses working at the time of each visit were questioned and examined. No nurses were enrolled twice.
Results: Fifty-five percent (92 of 167) of the nurses had hand dermatitis. Among intensive care unit (ICU) nurses, the prevalence was 65% (35 of 54); among non-ICU nurses, the prevalence was 50% (57 of 113). In nurses with self-reported atopic dermatitis, the prevalence was 71% (12 of 17); in nurses without self-reported atopic dermatitis, it was 53% (80 of 150). Data collection on variables such as hand hygiene and glove use relied on subject recall and was considered unreliable. There was a low prevalence of atopic patients.Conclusions: Hand dermatitis affects over 50% of inpatient nurses. Hand dermatitis appears to be more common in the ICU setting and in nurses with a self-reported history of atopy.

Introduction
It is well known that hand hygiene is encouraged and even mandated in the health care profession in order to reduce the spread of nosocomial infections.[1-5] Hospital workers who provide direct patient care are encouraged to wash their hands frequently.[1] Hospitals offer both soap and water (SW) and alcohol-based cleansers (ABCs) for hand hygiene. Both SW and ABCs have been associated with hand dermatitis although it appears that the risk with ABCs is lower than with SW.[6]

The aim of this study was to determine the prevalence and risk factors for hand dermatitis in an unselected cross section of intensive care unit (ICU) and non-ICU inpatient hospital nurses at a US hospital. In reviewing the existing work on this topic, we performed literature searches with keywords and word combinations including both "hand dermatitis" and "nurses/nursing staff/hospital staff." Several studies in the United States used self-reporting or questionnaires,[7-11] some of which included physical measurements of epidermal characteristics.[12] This search revealed no studies in the United States that rely on direct standardized examination by a single physician. This method of data collection would be expected to provide a more accurate measure of the prevalence of hand dermatitis.[13]
Methods
Data were collected from January 2005 through May 2005 at a large academic hospital. Institutional review board approval was obtained prior to beginning the study. Each inpatient floor was visited twice by an occupational medicine physician; each visit occurred during a different nursing shift to maximize nurse participation. All nurses working at the time of each visit were asked to participate, and 98% (167 of 170) participated.

After verbal consent was obtained, each participant was surveyed in a standard manner. Survey questions regarding potential risk factors were derived primarily from the authors' experience ( Table 1 ). A visual examination of the hands was then recorded ( Table 2 ). Fissuring, blistering, erythema, and edema were noted on a scale of 0 to 5. A nurse was defined as having hand dermatitis if the investigator graded erythema as greater than or equal to 1 and graded scaling, fissuring, or both as greater than or equal to 1. These criteria were designed to differentiate simple xerosis (scaling and/or fissuring without erythema) and simple palmar erythema (due to hormonal or other causes) from true hand dermatitis. The prevalence of hand dermatitis in ICU versus non-ICU nurses and in nurses with and without self-reported histories of atopic dermatitis was compared with the chi-square test. Possible risk factors for hand dermatitis were analyzed with logistic regression.

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