Occupational contact dermatitis: Return to work using a multidisciplinary clinic model.

BACKGROUND: Occupational contact dermatitis often results in work disruption. Return-to-work (RTW) is an important outcome. OBJECTIVE: The objective of this study was to determine RTW outcomes and factors associated with such outcomes using a multidisciplinary clinic model. METHODS: Chart abstraction was performed for 194 workers who received RTW assistance over a 6-year period. Elements abstracted included demographic and diagnostic information and information about the RTW program including principles, program components, barriers, and facilitators. RESULTS: Of the 902 workers seen for dermatologic assessment, 194 received RTW assistance. At initial assessment, 37% were not working because of their skin disease, and at follow-up, 7% were not working because of their skin disease. The RTW plan components included a graduated or trial of RTW, specific recommendations for avoiding exposure, personal protective equipment, skin management, and ongoing skin monitoring. Principles associated with successful RTW included good communication and the availability of modified work and a worker adherence to the plan. Barriers included lack of modified work, unresponsive employers, and ongoing skin problems. CONCLUSIONS: Specific approaches are important to identify if RTW is to be successful for workers with occupational contact dermatitis.

The Utility of an Occupational Contact Dermatitis Patch Test Database in the Analysis of Workplace Prevention Activities in Toronto, Canada.

BACKGROUND: Occupational skin diseases are common suggesting that there are still gaps in workplace prevention. Patch test surveillance systems provide an opportunity to collect work related information in addition to clinical information and patch test results. OBJECTIVES: To examine 5 years of data related to workplace prevention by industry sector in a patch test surveillance database for workers with a diagnosis of occupational contact dermatitis. METHODS: The study was approved by the Research Ethics Board of St Michael's Hospital. Information including demographics, clinical history, healthcare utilization, and workplace characteristics and prevention practices in addition to patch test results was collected from consenting patients. RESULTS: Workers in the healthcare and manufacturing sectors were more likely to report workplace training including skin protection training, whereas those in services and construction were less likely to report training. CONCLUSIONS: Collecting basic workplace information with patch test surveillance databases can inform the occupational health and safety system about prevention practices in the workplace and identify areas for focussed intervention.

Gaps in Workplace Education For Prevention of Occupational Skin Disease.

Background: Occupational contact dermatitis (OCD) is a common occupational disease. Evidence suggests that education and training are effective prevention strategies. In spite of these known prevention strategies, workers continue to develop OCD. Little is reported regarding the actual training experience of workers. Objective: To examine the training experience of workers with contact dermatitis to identify areas for improvement. Methods: Participants were workers being assessed for contact dermatitis in an occupational health clinic. The anonymous survey collected demographics, workplace characteristics, and education and prevention practices. Results: Approximately 80% reported general occupational health and safety training; however, only 49% reported skin-specific training (SST). For workers reporting SST, most received information regarding exposure avoidance, hand washing, and glove use. This content was reported as helpful by at least 50%. Workers who did not receive SST indicated the most important content would be warning signs of skin problems, how to avoid exposure and skin care while using gloves. Conclusions: While the study was anonymous and used self-reported of training experience, the study suggests there are gaps in skin protection training. Addressing these gaps may lead to improved prevention and reduction in OCD.

The development and testing of a tool to assess joint health and safety committee functioning and effectiveness.

BACKGROUND: Concern regarding functioning and effectiveness of joint health and safety committees (JHSCs) in Ontario hospitals was raised following the Severe Acute Respiratory Syndrome outbreak in 2003. A subsequent literature review revealed a lack of studies focused within the healthcare sector. METHODS: A tool to measure JHSC effectiveness was developed by a panel of occupational health and safety experts based on a framework from the healthcare sector. Usability testing was conducted in two phases with members of five hospital JHSCs before, during and after a committee meeting. RESULTS: Usability of the tool was scored high overall with an average of > 4 on a 5 point scale across twelve items. Downward adjustment of self-assessment scores was reported following JHSC meetings. CONCLUSION: Findings demonstrated that the tool was easy to use, effective in supporting discussion and in assisting participants in reaching consensus on rating a large number of JHSC characteristics. Am. J. Ind. Med. 60:368-376, 2017. © 2017 Wiley Periodicals, Inc.

Return to Work for Nurses With Hand Dermatitis.

BACKGROUND: Occupational skin disease is common in healthcare workers. If the healthcare worker develops moderate to severe dermatitis, return to work (RTW) may be challenging. OBJECTIVES: The study objectives were to review the impact of an RTW program on the work status of nurses with occupational hand dermatitis and to identify successful intervention methods and strategies. METHODS: Nurses who received RTW services at a tertiary occupational medicine clinic were identified, and information related to their diagnosis and RTW was abstracted from their charts. RESULTS: Eighteen nurses with irritant hand dermatitis who received RTW services were identified. Twelve nurses (67%) were performing administrative duties because of their skin condition when admitted to the RTW program, and others were performing patient care with modifications. A graduated RTW trial was commonly implemented with optimized skin care management and monitoring by physicians and the RTW coordinator. Upon discharge, 14 nurses (78%) had returned to their nursing roles with direct patient care, 3 (17%) were working as nurses in non-patient care roles, and 1 (6%) was on permanent disability. CONCLUSIONS: A graduated RTW trial to reduce cumulative irritant exposure is a crucial strategy to facilitate nurses' transition back to work and to maintain direct patient care nursing roles.

Joint health and safety committees - What is their impact in the acute care hospital?

BACKGROUND: There is very little in the literature on the effectiveness of Joint Health and Safety Committees (JHSCs) in the healthcare sector and a paucity of information on how JHSCs are perceived in the workplace. OBJECTIVE: This study was carried out to explore hospital worker, hospital management, and healthcare sector stakeholder views on the effectiveness of JHSCs in the acute healthcare setting. METHODS: The study used a qualitative descriptive design with: (1) nineteen focus groups and twenty two individual interviews in three hospitals of different sizes; and (2) eight individual interviews with external stakeholders. RESULTS: Study findings showed gaps in awareness and understanding of the role and responsibilities of the Joint Health and Safety Committee. Some participants indicated that JHSCs lacked profile and had low visibility in the organization. Facilitators and barriers to JHSC effectiveness were investigated and measures to assess effectiveness identified. The attributes of a "gold standard" JHSC were outlined by respondents and can be used to develop an evidence-driven assessment tool to evaluate JHSCs. CONCLUSIONS: The results of this study indicate both a continuing need for education and training related to JHSCs and the need to develop better tools to assess JHSC functioning and effectiveness.

Glove Use and Glove Education in Workers with Hand Dermatitis.

BACKGROUND: Occupational skin diseases are common. The occurrence of occupational skin diseases represents a failure of primary prevention strategies that may include the use of personal protective equipment, most commonly gloves. OBJECTIVE: The objective of this study was to describe current glove use and education practices related to gloves in workers being assessed for possible work-related hand dermatitis. METHODS: Participants included consecutive patients being assessed for possible work-related hand dermatitis. A self-administered questionnaire obtained information on demographics, workplace characteristics and exposures, glove use, and education regarding gloves. RESULTS: Ninety percent of the 105 participants reported using gloves. Only 44% had received training related to glove use in the workplace. Major gaps in training content included skin care when using gloves, warning signs of skin problems, and glove size. If the worker indicated no glove training received, the majority reported they would have used gloves if such training was provided. CONCLUSIONS: Although the majority of workers being assessed wore gloves, the minority had received training related to glove use. Particular gaps in training content were identified. Those who had not received training noted they would likely have used gloves if training had been provided.

The development and test re-test reliability of a work-related asthma screening questionnaire.

OBJECTIVE: Work-related asthma (WRA) is under-recognized and delays in recognition contribute to long-term morbidity. The objective of the project was to develop a WRA screening questionnaire for use by primary care providers in the assessment of individuals with asthma, and to evaluate the respondent burden, test re-test reliability and face validity of the questionnaire. METHODS: A literature search was undertaken and an expert advisory committee was convened. A questionnaire was drafted and assessed for feasibility of use and content validity. The study enrolled patients with asthma attending outpatient clinics and an asthma education center. Participants were asked to respond to the questionnaire on two occasions, and comment on the content (face validity) and ease of completion (respondent burden). Ethics approval was obtained from an institutional review board. RESULTS: A 14-item self-administered screening questionnaire was created. Thirty-nine participants were recruited, and 26 participants completed a second administration of the questionnaire. The items on the relation of asthma symptoms to work demonstrated substantial agreement between testings. The workplace exposures items were found to have good reproducibility. The majority of participants denied that items were repetitive, not useful or difficult to understand. CONCLUSIONS: We have developed a WRA screening questionnaire designed to aid primary care providers in the recognition of possible WRA. The tool exhibited content and face validity, good test re-test reliability and low respondent burden. Participant feedback is being considered in revisions of the questionnaire.

International guidelines for the in vivo assessment of skin properties in non-clinical settings: part 1. pH.

BACKGROUND: Skin surface pH is known to influence the dissolution and partitioning of chemicals and may influence exposures that lead to skin diseases. Non-clinical environments (e.g., workplaces) are highly variable, thereby presenting unique measurement challenges that are not typically encountered in clinical settings. Hence, guidelines are needed for consistent measurement of skin surface pH in environments that are difficult to control. METHODS: An expert workshop was convened at the 5th International Conference on Occupational and Environmental Exposure of Skin to Chemicals to review available data on factors that could influence the determination of skin surface pH in non-clinical settings with emphasis on the workplace as a worst case scenario. RESULTS: The key elements of the guidelines are: (i) minimize, to the extent feasible, the influences of relevant endogenous (anatomical position, skin health, time of day), exogenous (hand washing, barrier creams, soaps and detergents, occlusion), environmental (seasonality), and measurement (atmospheric conditions) factors; (ii) report pH measurements results as a difference or percent change (not absolute values) using a measure of central tendency and variability; and (iii) report notable deviations from these guidelines and other relevant factors that may influence measurements. CONCLUSION: Guidelines on the measurement and reporting of skin surface pH in non-clinical settings should promote consistency in data reporting, facilitate inter-comparison of study results, and aid in understanding and preventing occupational skin diseases.

International guidelines for the in vivo assessment of skin properties in non-clinical settings: Part 2. transepidermal water loss and skin hydration.

BACKGROUND: There is an emerging perspective that it is not sufficient to just assess skin exposure to physical and chemical stressors in workplaces, but that it is also important to assess the condition, i.e. skin barrier function of the exposed skin at the time of exposure. The workplace environment, representing a non-clinical environment, can be highly variable and difficult to control, thereby presenting unique measurement challenges not typically encountered in clinical settings. METHODS: An expert working group convened a workshop as part of the 5th International Conference on Occupational and Environmental Exposure of Skin to Chemicals (OEESC) to develop basic guidelines and best practices (based on existing clinical guidelines, published data, and own experiences) for the in vivo measurement of transepidermal water loss (TEWL) and skin hydration in non-clinical settings with specific reference to the workplace as a worst-case scenario. RESULTS: Key elements of these guidelines are: (i) to minimize or recognize, to the extent feasible, the influences of relevant endogenous-, exogenous-, environmental- and measurement/instrumentation-related factors; (ii) to measure TEWL with a closed-chamber type instrument; (iii) report results as a difference or percent change (rather than absolute values); and (iv) accurately report any notable deviations from this guidelines. CONCLUSION: It is anticipated that these guidelines will promote consistent data reporting, which will facilitate inter-comparison of study results.

Propylene glycol dermatitis in the printing industry: the fundamental role of a workplace visit.

Workers in the printing industry serve as an example of a working population that is at high risk of developing occupational skin disease. Daily exposures include both irritants and sensitizing agents. While many substances have been associated with occupational contact dermatitis in this population, no detailed cases of allergic contact dermatitis (ACD) from propylene glycol (PG) have been reported to date. We present a case of a printing tradesman who developed work-related ACD from PG and who was subsequently able to return to work after a multidisciplinary team assessment that included a comprehensive worksite visit by a clinical occupational hygienist.

Rapid development of allergic contact dermatitis from dicyclohexylmethane-4,4'-diisocyanate.

Isocyanates are widely used in the manufacturing of rigid and flexible foams, fibers, and coatings such as paints, varnishes, and elastomers but are rarely reported as contact sensitizers. The aliphatic diisocyanate dicyclohexylmethane-4,4'-diisocyanate (DMDI) is known to be a strong cutaneous sensitizer. We report a 27-year-old woman who developed a severe eczematous eruption on the arms, trunk, and abdomen within 2 weeks of employment at a company using the product Chem-Dec 808 isocyanate (containing 40-70% weight per weight DMDI). Patch testing was performed with the North American screening series, an isocyanate series, and 1% Chem-Dec 808 isocyanate. At day 7, a +++ reaction to Chem-Dec 808 isocyanate and a ++ reaction to the aromatic isocyanate diphenylmethane-4,4'-diisocyanate were observed. DMDI has strong sensitizing potential and requires rigorous safety monitoring in the workplace.

Form and function of joint health and safety committees in Ontario acute care hospitals.

Even though joint health and safety committees (JHSCs) have been in existence in Ontario workplaces for almost 30 years and healthcare workers are at high risk for workplace injury, there has been little research done related to JHSC functioning in Ontario's healthcare sector. In his recent review of the 2003 outbreak of severe acute respiratory syndrome in Toronto, Justice Archie Campbell found that JHSCs in Ontario hospitals were not fulfilling their intended roles and responsibilities. The objective of this study was to gain a deeper understanding of the role, resources, structure and functioning of JHSCs in Ontario hospitals.

Hand dermatitis in auto mechanics and machinists.

BACKGROUND: Auto mechanics and machinists presenting with suspected allergic contact dermatitis (ACD) have traditionally been patch-tested with a standard screening tray and a specialty tray such as the Oil and Cooling Fluid Series. While this has proven useful for patch-testing the machinist, there is a need for the development of a more specific allergen testing tray for the auto mechanic. OBJECTIVE: The objective of the study was to compare clinical features and patch-test results of auto mechanics and machinists with hand dermatitis to evaluate differences in allergen profiles. METHODS: We performed a chart review of 33 auto mechanics and 24 machinists referred to our Occupational Contact Dermatitis Clinic from 2002 to 2005 for evaluation of hand dermatitis. RESULTS: With a panel of 84 allergens, 52 positive reactions were detected in 17 cases of ACD in mechanics. The profiles were different from the cases of ACD diagnosed in 10 of 24 machinists. CONCLUSIONS: Mechanics and machinists differ in the spectrum of occupational exposures. Patch testing with greater numbers of allergens likely identifies a larger proportion of mechanics with occupationally relevant ACD. Further study is needed to determine the most appropriate allergens to include in a clinically useful "mechanic's tray."

Perceptions about hearing protection and noise-induced hearing loss of attendees of rock concerts.

BACKGROUND: This study examines perceptions of rock concert attendees about risk of noise-induced hearing loss (NIHL) and use of hearing protection at a busy Toronto rock concert venue. METHODS: Two hundred and four questionnaires were completed and returned (75% response rate) by attendees at four rock concerts. RESULTS: The respondents had an average age of 20.6 years and 55.4% were male. Thirty-four point three percent (34.3%) thought that it was somewhat likely and 39.8% thought it was very likely that noise levels at music concerts could damage their hearing, but 80.2% said that they never wore hearing protection at such events. Tinnitus and other hearing disturbances were experienced by 84.7% and 37.8% of attendees, respectively. Both experiencing hearing disturbances and concern about developing hearing loss were statistically significantly associated with concert attendees' use of hearing protection. Previous use of hearing protection, a higher score on a scale of readiness for behavioural change (Prochaska scale) and lack of concern about the appearance of ear plugs were statistically significantly associated with a reported willingness to use hearing protection in the future if it were provided for free at the door. CONCLUSION: Hearing protection is currently not worn by most attendees of rock concerts who are at risk of developing NIHL. Ear plugs and tactful NIHL education should be provided at the door, coupled with strategies to reduce music sound levels to safer listening levels.