Management of occupational dermatitis in healthcare workers: a systematic review.

OBJECTIVES: This systematic review informed evidence-based guidelines for the management of occupational dermatitis, with a particular focus on healthcare workers. METHODS: A multidisciplinary guideline group formulated questions about the management of healthcare workers with dermatitis. Keywords derived from these questions were used in literature searches. We appraised papers and developed recommendations using the Scottish Intercollegiate Guideline Network (SIGN) methodology. RESULTS: Literature searches identified 1677 papers; 11 met the quality standard (SIGN grading ++ or +). A small body of evidence indicated that dermatitis is more likely to be colonised with micro-organisms than normal skin, but there was insufficient evidence about the risk of transmission to patients. There was limited evidence that using alcohol gel for hand decontamination is less damaging to skin than antiseptics or soap. A small body of evidence showed that conditioning creams improve dermatitis, but are not more effective than their inactive vehicle. A small inconsistent body of evidence showed that workplace skin care programmes improve dermatitis. CONCLUSIONS: Healthcare workers should seek early treatment for dermatitis and should be advised about the risk of bacterial colonisation. Work adjustments should be considered for those with severe or acute dermatitis who work with patients at high risk of hospital-acquired infection. Healthcare workers with dermatitis should follow skin care programmes, and use alcohol gel where appropriate for hand decontamination. Further research should explore whether healthcare workers with dermatitis are more likely to transmit infection to their patients, and whether health surveillance is effective at reducing dermatitis.

Measuring implementation of evidence-based guidance on promoting workers' health.

BACKGROUND: The National Health Service (NHS) employs 1.4 million people in England. In health care, improved workforce health has been associated with improved outcomes for patients. The UK's National Institute for Health and Clinical Excellence (NICE) has produced evidence-based guidance on improving workers' health. However, the extent of implementation of evidence-based guidance has not previously been measured. AIMS: To measure progress with implementation of NICE guidance on workplace health and identify opportunities to improve this. METHODS: All NHS organizations in England were invited to participate in an audit of implementation of NICE guidance. A web-based tool was developed to collect information on the extent to which each organization had implemented NICE guidance addressing health promotion in the workplace. RESULTS: The number of organizations that participated was 282. These employed a total of 868 979 workers. Organizations were more likely to involve staff in planning and designing an organizational approach to each topic where health and well-being was a regular board agenda item. Those with an overarching strategy were more likely to have staff health and well-being as a regular board agenda item (P < 0.05) and more likely to have specific policies for obesity, physical activity and promoting mental well-being (all P <0.01). CONCLUSIONS: Implementation of NICE guidance on health at work is incomplete across the NHS in England. Implementation was more complete where boards were leading health and well-being plans and the workforce were actively involved. There is scope to improve the implementation of evidence-based guidance to improve workers' health.

Continence care for older people in England and Wales: data from a national audit.

INTRODUCTION: A number of policy documents have identified deficiencies in continence services in England and Wales, and have called for the development of integrated services. A national audit was conducted to assess the quality of continence care for older people and whether these requirements have been met. METHODS: The audit studied incontinent individuals aged 65 years and older. Each site returned data on organizational structure and the process of 20 patient's care. Data were submitted via the Internet, all were anonymous. RESULTS: The national audit was conducted across England, Wales, and Northern Ireland. Data on the care of patients/residents with bladder problems were returned by 141 of 326 (43%) Primary Care Trusts, 159 of 196 (81%) secondary/acute care trusts (198 hospitals), and 29 of 309 (9%) invited care homes. Fifty-eight percent of Primary Care Trusts, 48% of hospitals, and 74% of care homes reported that integrated continence services existed in their area. While basic provision of care appeared to be in place, the audit identified deficiencies in the organization of services and in the assessment and management of urinary incontinence in the elderly. CONCLUSION: The requirement for integrated continence services has not yet been met. Assessment and care by professionals directly looking after the older person were often lacking. There is an urgent need to reestablish the fundamentals of continence care into the practice of medical and nursing staff, and action needs to be taken with regard to the establishment of truly integrated quality services in this neglected area of practice.