Hands4U: the effects of a multifaceted implementation strategy on hand eczema prevalence in a healthcare setting. Results of a randomized controlled trial.

BACKGROUND: Healthcare workers have an increased risk of developing hand eczema. A multifaceted implementation strategy was developed to implement a guideline to prevent hand eczema among healthcare workers. OBJECTIVES: To investigate the effects of the implementation strategy on self-reported hand eczema and preventive behaviour. METHODS: A randomized controlled trial was performed. A total of 48 departments (n = 1649) were randomly allocated to the multifaceted implementation strategy or the control group. The strategy consisted of education, participatory working groups, and role models. Outcome measures were self-reported hand eczema and preventive behaviour. Data were collected at baseline, and 3, 6, 9 and 12 months of follow-up. RESULTS: Participants in the intervention group were significantly more likely to report hand eczema [odds ratio (OR) 1.45; 95% confidence interval (CI) 1.03-2.04], and they reported significantly less hand washing (B, - 0.38; 95%CI: - 0.48 to - 0.27), reported significantly more frequent use of a moisturizer (B, 0.30; 95%CI: 0.22-0.39) and were more likely to report wearing cotton undergloves (OR 6.33; 95%CI: 3.23-12.41) than participants in the control group 12 months after baseline. CONCLUSIONS: The strategy implemented can be used in practice, as it showed positive effects on preventive behaviour. More research is needed to investigate the unexpected effects on hand eczema.

Management of nosocomial scabies, an outbreak of occupational disease.

BACKGROUND: The optimal approach to managing institutional scabies outbreaks has yet to be defined. We report on outbreak managements are needed. METHODS: We report on a large outbreak of scabies in three acute care wards in a tertiary university teaching hospital in the Netherlands. RESULTS: The outbreak potentially effected 460 patients and 185 health care workers who had been exposed to the index patient. CONCLUSION: Containment of an outbreak relies on a quick and strict implementation of appropriate infection control measures and should include simultaneous treatment of all infested persons and exposed contacts to prevent secondary spread and prolonged post-intervention surveillance.

Hands4U: the effectiveness of a multifaceted implementation strategy on behaviour related to the prevention of hand eczema-a randomised controlled trial among healthcare workers.

OBJECTIVES: To investigate the effects of a multifaceted implementation strategy on behaviour, behavioural determinants, knowledge and awareness of healthcare workers regarding the use of recommendations to prevent hand eczema. METHODS: The Hands4U study is a randomised controlled trial. A total of 48 departments (n=1649 workers) were randomly allocated to the multifaceted implementation strategy or the control group (minimal implementation strategy). Within the departments designated to the multifaceted implementation strategy, participatory working groups were set up to enhance the implementation of the recommendations for hand eczema. In addition, working group members were trained to become role models, and an education session was given within the department. Outcome measures were awareness, knowledge, receiving information, behaviour and behavioural determinants. Data were collected at baseline, with a 3- and 6-month follow-up. RESULTS: Statistically significant effects were found after 6 months for awareness (OR 6.30; 95% CI 3.41 to 11.63), knowledge (B 0.74; 95% CI 0.54 to 0.95), receiving information (OR 9.81; 95% CI 5.60 to 17.18), washing hands (B -0.40; 95% -0.51 to -0.29), use of moisturiser (B 0.29; 95% CI 0.20 to 0.38), cotton under gloves (OR 3.94; 95% CI 2.04 to 7.60) and the overall compliance measure (B 0.14; 95% CI 0.02 to 0.26), as a result of the multifaceted implementation strategy. No effects were found for behavioural determinants. CONCLUSIONS: The multifaceted implementation strategy can be used in healthcare settings to enhance the implementation of recommendations for the prevention of hand eczema. TRIAL REGISTRATION NUMBER: NTR2812.

Implementation of recommendations for hand eczema through a multifaceted strategy. A process evaluation among health care workers.

Process data give important insights into how an intervention is implemented. The aim of the present study is to conduct a process evaluation, alongside a randomised controlled trail, on the implementation of recommendations for the prevention of hand eczema. The intervention was carried out in healthcare workers' departments and consisted of working groups and role models. The role models were selected based on their representativeness, their influence on colleagues, and their motivation. The focus of the working group was to implement recommendations for hand eczema at the department by choosing solutions to overcome barriers for implementation. Out of the 104 solutions, 87 were realised. Solutions regarding moisturisers and use of cotton under gloves, were used by 90.9% and 30.8% of the employees, respectively. Of all participants, 58.2% actively engaged with the role models. This process evaluation showed that the intervention was executed according to protocol and that the solutions were implemented well. However, the role model component in the intervention should be improved.

Hand eczema among healthcare professionals in the Netherlands: prevalence, absenteeism, and presenteeism.

BACKGROUND: Healthcare professionals have a high risk of developing hand eczema. Hand eczema can interfere with their work. OBJECTIVES: To investigate the prevalence of self-reported hand eczema among healthcare professionals in the Netherlands, and to investigate absenteeism and presenteeism resulting from hand eczema. METHODS: A questionnaire-based observational study was performed. Participants were recruited from hospitals and nursing homes in the Netherlands. The study population consisted of 1232 healthcare professionals. We used the NOSQ-2002 to measure hand eczema and the PRODISQ for absenteeism and presenteeism. RESULTS: The 1-year prevalence of hand eczema among healthcare professionals was 12%. Among all participants, 47% reported symptoms related to hand eczema. Sick leave resulting from hand eczema was reported by 0.3% of healthcare professionals in general, and by 1.7% of healthcare professionals with hand eczema. In the group with hand eczema, 3.1% reported a large effect on presenteeism. CONCLUSIONS: The 1-year prevalence of hand eczema among healthcare professionals in the Netherlands is low, but the prevalence of symptoms related to hand eczema is quite high. Hand eczema seems to have little impact on work in terms of absenteeism and presenteeism.

Hands4U: a multifaceted strategy to implement guideline-based recommendations to prevent hand eczema in health care workers: design of a randomised controlled trial and (cost) effectiveness evaluation.

BACKGROUND: Workers in wet work occupations have a risk for developing hand eczema. Prevention strategies exist, but compliance to the proposed recommendations is poor. Therefore, a multifaceted implementation strategy (MIS) is developed to implement these recommendations to reduce hand eczema among health care workers performing wet work. METHODS/DESIGN: This study is a randomised controlled trial in three university hospitals in the Netherlands. Randomisation to the control or intervention group is performed at department level. The control group receives a leaflet containing the recommendations only. The intervention group receives the MIS which consists of five parts: 1) within a department, a participatory working group is formed to identify problems with the implementation of the recommendations, to find solutions for it and implement these solutions; 2) role models will help their colleagues in performing the desired behaviour; 3) education to all workers will enhance knowledge about (the prevention of) hand eczema; 4) reminders will be placed at the department reminding workers to use the recommendations; 5) workers receive the same leaflet as the control group containing the recommendations. Data are collected by questionnaires at baseline and after 3, 6, 9 and 12 months. The primary outcome measure is self-reported hand eczema. The most important secondary outcome measures are symptoms of hand eczema; actual use of the recommendations; sick leave; work productivity; and health care costs.Analyses will be performed according to the intention to treat principle. Cost-effectiveness of the MIS will be evaluated from both the societal and the employer's perspective. DISCUSSION: The prevention of hand eczema is important for the hospital environment. If the MIS has proven to be effective, a major improvement in the health of health care workers can be obtained. Results are expected in 2014. TRIAL REGISTRATION NUMBER: NTR2812.

[Occupational physicians should play a more active role; multidisciplinary practice guidelines pay attention to work]. / Bedrijfsartsen moeten een actievere rol spelen; multidisciplinaire richtlijnen hebben aandacht voor arbeid.

The practice guideline 'Diagnosis and treatment of the subacromial pain syndrome' provides a thorough overview of the treatment possibilities that a doctor has when a patient with a painful shoulder presents. This guideline recognizes the importance of occupational exposure and functioning in the development, maintenance and treatment of health problems too. As is the case with so many multidisciplinary guidelines, it can be seen as an appeal to doctors to inquire about work and an appeal to occupational physicians to become active in the functional recovery of patients with a subacromial pain syndrome.

[Is the caregiver fit to help Ebola patient?]. / Is zorgverlener geschikt voor hulp aan ebolapatiënt?

Ebola is an exceptionally risky infection and safety measures are therefore unprecedentedly strict. However, despite stringent measures infection of health care providers by the Ebola virus cannot be excluded. Strict barrier care is physically and mentally demanding for the care provider. Before undertaking care for Ebola patients, 'fit for the job'screening is necessary. We should only expose our care givers if we know that they are physically and mentally up to the task.

[Hand exzema: think about work]. / Handeczeem: denk aan werk.

Skin conditions such as acne, urticaria, psoriasis, and particularly eczema (dermatitis) may have many causes. However, a work-related aetiology is often forgotten. Hand eczema is the most common occupational dermatosis. Exposure to skin irritants is the main cause with wet work playing a major role. The cause cannot be inferred from the clinical picture and it is almost impossible to distinguish between irritant and allergic contact dermatitis. Besides observation and history-taking, epicutaneous contact allergological (patch) testing is necessary for this. In occupational dermatoses, patch testing using the European Standard Series alone is often inadequate for diagnosing. Everyone with hand eczema in a risk profession is eligible for patch testing. The prognosis of hand eczema is poor: in 60% of patients the eczema becomes chronic. Genetic predisposition, such as atopic dermatitis, is seriously underestimated. This is the main risk factor for irritant contact dermatitis and, indirectly, for allergic contact dermatitis. This predisposition should give direction to career choices in young people.