Healthcare workers and skin sensitization: north-eastern Italian database

Occupational Exposure of Employees in a Multispecialty Hospital to Factors Causing Contact Dermatitis-A Questionnaire Study

Background and Objectives: Allergic contact dermatitis (ACD) is a serious health and socio-economic problem. Accurate and reliable assessment of exposure to ACD factors in the work environment would increase quality of life and work of employees. The aim of this study was to assess the level of exposure of workers of a multidisciplinary hospital to the factors causing ACD. Material and Methods: The proprietary OSDES-16 questionnaire was used. The effectiveness of the OSDES-16 was confirmed statistically. The study included 230 employees of the medical center in Polanica Zdrój, divided into groups. Results: The differences in the overall assessment of exposure between the individual groups in the OSDES-16 scale were statistically insignificant (p > 0.05). There was no significant correlation between the current workplace and the level of exposure to ACD (p > 0.05). The level of exposure to ACD in the group of employees with work experience in the current position for more than 10 years was significantly higher than those working less than 6 years (p < 0.05). Conclusions: Nurses, midwives and paramedics are the occupational group most exposed to the development of contact allergy related to exposure to factors present in the work environment. The seniority of more than 10 years in the current position was linked with a higher level of occupational exposure.

Incidence of skin diseases in healthcare workers before and during the COVID-19 pandemic at Trieste Hospitals (northeastern Italy)

BACKGROUND

Occupational skin diseases (OSDs) are common in healthcare workers (HCWs).

OBJECTIVES

To investigate and compare the incidence and clinical features of OSDs amongst HCWs before and during the COVID-19 pandemic.

MATERIALS & METHODS

Incident cases of OSDs were investigated in the cohort of HCWs at Trieste Hospitals from July 1, 2018 (3340 workers) to October 31, 2021 (137,532 person-months).

RESULTS

The monthly incidence was ranging from 0 to 11.90 cases per 10,000 person-months in pre-COVID-19 period (cumulative incidence 4.22; 95%CI 2.9-6.0) and from 0 to 13.61 cases per 10,000 person-months in COVID-19 period (cumulative incidence 5.06; 95%CI 3.6-6.9). The incidence rate ratio (IRR) between COVID-19 and pre-COVID-19 period was 1.22 (95% CI 0.73-1.98). The incidence of OSDs in the COVID-19 period was 6.1 (4.2-8.6) and 2.7 (95%CI 1.1-5.6) cases * 10,000 person-months for women and men, respectively with an IRR of 2.25 (95%CI 0.98-5.9). Incidence in nurses in the COVID-19 period was 6.7 (95%CI 4.2-10.2) cases * 10,000 person-months.

CONCLUSIONS

Incidence of OSDs was a little bit higher during the COVID-19 pandemic compared to the previous period but fluctuation of numbers were mainly related to calendar period, with higher incidence in winter and spring. Incidence data were higher than that observed in 2004-2013 in the same cohort. Face dermatitis cases doubled after the start of COVID-19 pandemic. Overall data demonstrated a non-significant increase of OSDs in HCWs during the pandemic, probably due to the preventive strategies set up in our cohort over the years. This article is protected by copyright. All rights reserved.

Contact Dermatitis in Construction Workers in Northeastern Italian Patch Test Database Between 1996 and 2016

BACKGROUND

Contact dermatitis in construction workers (CWs) is frequent due to the widespread exposure to sensitizing substances and irritating agents and the wet and cold working conditions.

OBJECTIVE

Our objectives were to evaluate contact dermatitis characteristics among CWs who underwent patch test in northeastern Italy and to identify related allergens.

METHODS

Seven hundred ninety-five CWs were studied and their data were compared to 2.099 male white-collar workers. The associations between patch test results and occupations were assessed by multivariate logistic regression analysis. Incidence data were calculated from 1996 to 2016.

RESULTS

CWs with confirmed occupational dermatitis presented an increased risk to be sensitized to potassium dichromate [OR 3.1 (95%IC 2.0-4.8)], to thiurams [OR 8 .6 (95%IC 4.0-18.4)], and to epoxy resins [OR 12.7 (95%IC 6.1-26.4)]. Sensitization to chromate decreased significantly after 2004, following EU regulation of chromate content in concrete, while sensitization to epoxy resins and thiurams increased. The overall incidence of occupational contact dermatitis in CWs decreased significantly.

CONCLUSION

Our study demonstrated the effectiveness of EU regulations in reducing chromate sensitization in CWs and the overall incidence of occupational contact dermatitis. However, sensitization to other haptens is increasing, though improvement of protective measures is compulsory.

Skin sensitization among night shift and daytime healthcare workers: a cross sectional study

OBJECTIVE

Allergic contact dermatitis (ACD) in the healthcare sector is a major occupational health hazard. There are many reasons for a higher frequency of ACD in healthcare personnel compared to other populations: among others, simultaneous exposure to multiple substances, use of aggressive detergents and wet work. However, studies that systematically correlate skin symptoms with the presence of sensitization investigated through patch tests in specific categories of health workers are very rare and conflicting. Although some studies have reported a correlation between skin disease and night shift, the strength of the evidence is rather limited. The purpose of our study was to investigate by means of patch testing the skin sensitization (SS) to common allergens in the hospital setting in a group of healthcare workers (HCW) reporting symptoms related to dermatitis, according to their job activity and their shift status.

METHODS

132 HCWs visiting a health surveillance centre were investigated by means of specific questionnaire for dermatitis, followed by patch test evaluation including 40 haptens of the SIDAPA 2016 series.

RESULTS

Skin sensitization was observed in 1/3 of the subjects investigated by patch tests. The nursing job was strongly associated with cutaneous reactivity after controlling for the confounding of gender, age and other factors. Shift work was related to the prevalence of SS.

CONCLUSIONS

In our study, the nurse's role and shift work were significantly associated with the risk of cutaneous sensitization, in particular for common antigens.

Allergic contact dermatitis in healthcare workers

BACKGROUND

Allergic contact dermatitis is a common occupational skin disease among healthcare workers (HCWs).

AIMS

This study describes causes of allergic contact dermatitis in New Zealand HCWs.

METHODS

All HCWs undergoing patch testing between July 2008 and January 2020 at a public hospital patch test clinic and between June 2019 and January 2020 at a private dermatology clinic were included. Data collected included patient demographics, occupation, results of patch testing and pre- and post-patch test diagnoses.

RESULTS

Out of 837 patients tested, 67 were HCWs. The mean age of HCWs was 41 years (SD 14) and 58 (87%) were female. The most common occupations were nurses (40%), allied health (22%) and doctors (18%). Forty-six (69%) patients had a background of atopic dermatitis. Hand dermatitis was the most common presentation (49%), followed by facial/neck dermatitis (25%). Thirty-eight (57%) had at least one positive reaction on patch testing, including 19 (28%) with a positive result of current relevance. There were 16 relevant reactions to rubber accelerators, 11 to fragrances, 10 to preservatives and 6 to corticosteroids. The most frequent relevant allergens were methylisothiazolinone/methylchloroisothiazolinone (4%), hydroxyisohexyl 3-cyclohexene carboxaldehyde (4%) and methylisothiazolinone (4%).

CONCLUSIONS

The most common allergens in HCWs were rubber chemicals, fragrances, preservatives and topical corticosteroids. Important allergens for patch testing HCWs are outlined, in particular, those with hand dermatitis should be tested to a rubber series.

Dermal exposure to the immunomodulatory antimicrobial chemical triclosan alters the skin barrier integrity and microbiome in mice

Triclosan is an antimicrobial chemical used in healthcare settings that can be absorbed through the skin. Exposure to triclosan has been positively associated with food and aeroallergy and asthma exacerbation in humans and, although not directly sensitizing, has been demonstrated to augment the allergic response in a mouse model of asthma. The skin barrier and microbiome are thought to play important roles in regulating inflammation and allergy and disruptions may contribute to development of allergic disease. To investigate potential connections of the skin barrier and microbiome with immune responses to triclosan, SKH1 mice were exposed dermally to triclosan (0.5-2%) or vehicle for up to 7 consecutive days. Exposure to 2% triclosan for 5-7 days on the skin was shown to increase trans-epidermal water loss levels. Seven days of dermal exposure to triclosan decreased filaggrin 2 and keratin 10 expression, but increased filaggrin and keratin 14 protein along with the danger signal S100a8 and interleukin-4. Dermal exposure to triclosan for 7 days also altered the alpha and beta diversity of the skin and gut microbiome. Specifically, dermal triclosan exposure increased the relative abundance of the Firmicutes family, Lachnospiraceae on the skin but decreased the abundance of Firmicutes family, Ruminococcaceae in the gut. Collectively, these results demonstrate that repeated dermal exposure to the antimicrobial chemical triclosan alters the skin barrier integrity and microbiome in mice, suggesting that these changes may contribute to the increase in allergic immune responses following dermal exposure to triclosan.

Contribution of antimicrobials to the development of allergic disease

Antimicrobials represent a broad class of chemicals with the intended purpose of eliminating or controlling the growth of harmful microorganisms. Exposure can occur occupationally or through the use or consumption of consumer products. The use of antimicrobial agents has been associated with an increased incidence of allergic diseases, including asthma, atopic dermatitis, and less commonly, anaphylaxis. Very diverse immunological mechanisms and mediators have been identified in the sensitization response to antimicrobial chemicals and the importance of the local microenviroment in the response is increasingly being recognized. A complete understanding of the mechanisms of allergic diseases resulting from antimicrobial exposure will help to ensure safe environments and exposure limits.

Self-report occupational-related contact dermatitis: prevalence and risk factors among healthcare workers in Gondar town, Northwest Ethiopia, 2018-a cross-sectional study

Background

Occupational skin diseases are the second most common occupational diseases and are responsible for an estimated 25% of all lost work days. Occupational contact dermatitis (OCD) comprises 70–90% of all occupational skin diseases. In Ethiopia, information about the prevalence and factors which determine developments of contact dermatitis is not recognized. The objective of this study was to investigate prevalence and factors influencing the occurrences of occupational-related contact dermatitis among healthcare workers in Gondar town, Northwest Ethiopia.

Methods

We employed a healthcare-based cross-sectional study from March to April 2018. A stratified sampling method followed by simple random sampling method was used to select 422 participants. The standardized Nordic Occupational Skin Questionnaire was pretested and interviewer-administered for data collection. We used SPSS version 20 to conduct a binary logistic regression analysis. We set ≤ 0.05 p value to ascertain significance and 95% CI with odds ratios to evaluate the strength of associations.

Results

Response rate was 100%. The majority, 52.4% (N = 221), were males. The mean age was 22.6 (SD ± 6.3) years. The overall prevalence of self-report occupational contact dermatitis in the previous 12 months was 31.5% (N = 133) [95% CI (27, 36.2)]. The highest symptoms indicated was redness, 28.5% (n = 38), followed by burning, 17.3% (n = 23). The hand is the most commonly affected body sites, 22% (N = 93). Hand washing frequency [AOR 1.80, 95% CI (1.10, 3.20)], pairs of hand gloves used per day [AOR 3.22, 95% CI (2.05, 5.87)], personal history of allergy [AOR 2.37, 95% CI (1.32, 4.61)], and lack of health and safety training [AOR 2.12, 95% CI (1.12, 2.25)] were factors considerably associated with contact dermatitis.

Conclusions

The prevalence of occupational-induced contact dermatitis is common among healthcare workers in Ethiopia. Therefore, our finding indicates that intervention aiming at workers’ health and safety training demands urgent public health responses to tackle the ailment. The result also demonstrates that healthcare workers should be aware of when and how hands should be washed. The number of pairs of gloves used per day should also be taken into consideration while devising prevention strategies.

Contact Sensitization to Formaldehyde in Veterinary Medicine - An Unexplored Field in Occupational Health

Background:

Veterinary staff and students could be exposed to formaldehyde – a ubiquitous agent, common cause of contact allergy.

Aim:

To evaluate the incidence of contact sensitization to formaldehyde in exposures in veterinary medicine.

Settings and Design:

A cross-sectional study was conducted during July–December 2017.

Materials and Methods:

A total of 206 individuals were included, patch tested with formaldehyde 1.0%/aq – 36 veterinary medicine students, 20 veterinarians, 47 students and 28 trainees of dental medicine, 41 dental professionals, and 35 non-occupationally exposed individuals.

Results:

The incidence of contact sensitization to formaldehyde among the whole studied population was 48.1%, highest being among the students of veterinary medicine (94.4%) and the veterinarians (85%). With very high significance, the sensitization incidence was higher in the groups of students of veterinary medicine and veterinarians, if compared to the control group (P < 0.001); (P = 0.004), dental professionals (P < 0.001); (P = 0.001), trainees of dental medicine (P < 0.001); (P = 0.005), and students of dental medicine three-fourth year of education (P < 0.001); (P = 0.001). Significantly, higher was the incidence of contact allergy in the control group if compared to those of dental professionals (P = 0.033) and dental students three-fourth year of education (P = 0.028).

Conclusions:

The exposure to formaldehyde during the education in veterinary medicine and practice could be an important risk factor for the onset of contact sensitization. Stricter preventive measures are needed to reduce veterinary student's and lecturer's exposures. Equipment of dissection tables with local exhaust ventilation system could reduce the concentration of formaldehyde in the gross anatomy laboratory.

Skin reactions to latex in dental professionals - first Croatian data

Purpose. To determine the prevalence of undesirable skin reactions to latex in dental professionals and students of the School of Dental Medicine in Zagreb, Croatia. Methods. Our research included 444 participants, of which 200 agreed to undergo a skin prick test (SPT). All participants answered a questionnaire in which we asked about incidence of skin lesions, duration of occupational exposure to latex, localization of skin lesions and symptoms. Statistical analysis of the questionnaire and test results was then carried out. Results. Of the total 444 participants surveyed, 249 (56.1%) reported lesions on their skin (professionals 64.8%, students 6.1-58.5%). From the questionnaire, 239 (96.0%) respondents reported lesions on the hands and fingers, mostly in the form of erythema (37.0%) and occasional dryness of skin (29.0%). Positive SPT results were found in 14 (7.0%) out of the 200 respondents who underwent the test. Conclusions. While a large number of subjects (56.1%) reported skin lesions when using latex products at their workplace, the SPT test was positive only in 7.0%. The results show that the prevalence of self-reported skin lesions was significantly related to the length of occupational exposure, with a substantial effect size (p < 0.001; V = 0.334).