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

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.

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]
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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