Occupational risk factors for hand dermatitis among professional cleaners in Spain

Evaluation of Health Education Based on Pictograms and Video Sequences in the Prevention of Hand Eczema Among Hospital Cleaners: A Cluster-Randomised Controlled Trial With 24 Weeks Follow-Up

BACKGROUND

Hand eczema (HE) is common among hospital cleaners, yet no specific prevention programme exists for this group in Denmark.

OBJECTIVES

To evaluate the effectiveness of visual aids (pictograms and video scenes) based on evidence-based skin care and protection recommendations on HE outcomes, focusing on disease severity, point prevalence and skin care and protection knowledge.

METHODS

A cluster-randomised controlled trial was conducted in professional cleaners from three Danish hospitals. Intervention Group A received pictograms, video clips and a short group-based educational session. Intervention Group B received only pictograms and video clips. The control group received treatment as usual. HE severity and prevalence were assessed clinically, while knowledge was measured using self-reported data.

RESULTS

Out of 234 invited cleaners, 224 (96%) participated (Intervention Group A: 73, Intervention Group B: 78, Control Group: 73). After 24 weeks, both intervention groups showed significant reductions in HE severity and prevalence compared to the control group. Knowledge of skin care and protection also improved significantly in both intervention groups.

CONCLUSION

Visual aids effectively reduced HE prevalence and severity in hospital cleaners. Pictograms are a cost-effective strategy that can be widely implemented, addressing the substantial burden of HE in the cleaning industry across diverse settings.

A Qualitative Analysis of Immigrant Latinx Housecleaners' Experiences of How Power Relations With "Employers" Influence Working Conditions in New York City: The Safe and Just Cleaners Study

BACKGROUND

Housecleaning work has been characterized as precarious employment with unstable work hours, arbitrary and low pay and benefits, and exposures to chemical, physical, and psychosocial stressors. Understanding how interpersonal power dynamics between workers and clients, a component of precarious work, contributes to work exposures can inform and improve prevention programs.

METHODS

We used reflexive thematic analysis of data from seven focus groups with Latinx immigrant housecleaners in New York City to explore workers' experience of interpersonal power dynamics with their clients-whom they referred to as their "employers"-and its influences on working conditions.

RESULTS

Employer direction and monitoring varied and mostly reduced workers' autonomy to choose products, sometimes leading workers to complete tasks in more hazardous ways. Housecleaners reported using larger quantities of products, products with stronger scents, and more physical exertion to increase the efficiency of their cleaning, to complete tasks quickly, and to please their clients. Allotted time, tasks, and pay were interconnected, often resulting in negative reports about health and well-being. As immigrants, they also experienced discrimination and intimidation, which compounded their anxiety due to their employment insecurity. Nevertheless, participants learned and navigated high variance in employers' cleaning preferences and attempted to take control over the conduct of their work, when possible, and sometimes expressed self-advocacy.

CONCLUSIONS

Housecleaners' precarious employment arrangements affect how they navigate interpersonal relationships with employers, which impairs their working conditions and occupational exposures. Improvements in labor and social protections, such as designing supportive policies and training for workers and employers, are needed to improve working conditions.

Reporting of self-reported hand eczema as an occupational disease in hospital cleaners: A cross-sectional questionnaire-based study

BACKGROUND

Hand eczema (HE) is a prevalent disease among professional cleaners.

OBJECTIVES

To investigate how often cleaners have their self-reported HE, induced or worsened by cleaners' occupational activities, reported as an occupational disease to the authorities in Denmark and to identify reasons for underreporting. In addition, consultation by physicians and treatment for HE among cleaners were also investigated.

METHODS

This cross-sectional questionnaire-based study included hospital cleaners at three different hospitals in Region Zealand, Denmark.

RESULTS

We included 224 out of 234 cleaners from three hospitals (response rate: 96%). The lifetime prevalence of self-reported HE with onset in adulthood was 18.3% (n = 41), with cleaners believing every case to be caused or exacerbated by their occupation. Only 9.7% (n = 4/41) of the cases were reported as an occupational disease to the authorities. The most common reasons for non-reporting were a lack of perceived seriousness of the disease (40.5%) and unawareness of the risk of self-reported HE being of occupational origin (32.4%). Remarkably, only 75.7% (n = 28/37) of workers with unreported cases had consulted a physician at some point. Additionally, among cleaners who self-reported HE attributed or aggravated by their occupation, but not officially reported as such, only 56.8% (n = 21/37) had ever used hand moisturisers, while less than 45% had ever used topical steroids or calcineurin inhibitors.

CONCLUSION

Our findings reveal substantial underreporting of self-reported HE, perceived to be induced or worsened by the cleaner's occupational activities, as an occupational disease to the authorities.

Respiratory and Other Hazard Characteristics of Substances in Cleaning Products Used in Healthcare Centres in England and Wales

Occupational use of cleaning products can cause asthma in healthcare workers but the cleaning agents responsible are not yet known. This study aimed to identify respiratory and other hazards in cleaning products on the National Health Service (NHS) supply chain online catalogue and used in the NHS. Information on cleaning products, their composition, and H-statements that identified hazard characteristics of chemical substances in them was obtained from chemical safety data sheets (SDSs). Furthermore, a quantitative structure-activity relationship model and a published asthmagen list were used to identify potential additional respiratory hazards. 473 cleaning products and 229 substances were identified. SDSs reported only 4 respiratory sensitizers but an additional 51 were suggested by the other 2 methods. In contrast, 25 respiratory irritants were identified using SDSs and only one from the asthmagen list. This comprehensive overview of cleaning agents' hazards has potential use in future risk assessment and epidemiological studies.

The correlation between self-reported hand eczema and clinically based diagnosis in professional cleaners

BACKGROUND

Most studies investigating the prevalence of hand eczema (HE) in professional cleaners use self-reported questionnaire-based data. However, no validation studies of self-reporting of HE among professional cleaners have previously been conducted.

OBJECTIVES

To investigate (1) the point prevalence of self-reported HE, (2) the point prevalence of HE estimated by physical examination of the hands and (3) the sensitivity and specificity of self-reporting of HE compared with the diagnosis based on physical examination among professional cleaners.

METHODS

Professional cleaners at three different hospitals in Region Zealand were invited to fill out a questionnaire. The point prevalence of self-reported HE was estimated based on questions from the Nordic Occupational Skin Questionnaire. After completing the questionnaire, each cleaner underwent a physical examination of the hands by a dermatologist on the same day.

RESULTS

In total, 234 cleaners were invited to participate in the study, and 224 (response rate = 96.0%) agreed to take part. Based on the self-reported questionnaires, 5.3% (n = 12) of the cleaners had current HE. Based on an examination by a physician, 19.2% (n = 43) of the cleaners had current HE. The sensitivity of self-reported HE was found to be 28.0%, while the specificity was found to be 100.0%. The positive predictive value was found to be 100.0%, while the negative predictive value was 85.0%.

CONCLUSION

The true point prevalence of HE among professional cleaners is underestimated when based on self-reporting.

Prevalence and risk factors for hand eczema among professional hospital cleaners in Denmark: A cross-sectional questionnaire-based study

BACKGROUND

Professional cleaners are commonly affected by hand eczema (HE) due to wet work and exposure to cleaning products in the work environment.

OBJECTIVE

To investigate (1) the prevalence of HE in a group of professional hospital cleaners, (2) the association of HE with various comorbidities and self-reported signs/symptoms of skin lesions and (3) the association of HE with various occupational and personal risk factors in the same population.

METHODS

A cross-sectional questionnaire-based study including all cleaners working in three hospitals in Denmark. The questionnaire was composed of 35 questions. Prevalence is reported using proportions with 95% confidence intervals and compared using difference of proportions and Fisher's exact test.

RESULTS

A total of 122 out of 180 cleaners (response rate = 68%) participated in this study. The self-reported lifetime prevalence of HE among the cleaners was 30.3%, while the 1-year prevalence was 18.9%. HE was significantly associated with a history of atopic diseases. There was a significant correlation between having HE, and self-reported redness and itch of the hands in the last 12 months, as well as the use of hydrochloric acid ≥4 days/week during the last 12 months. Logistic regression analysis found HE significantly associated with washing hands ≥20 times during a working day and a history of atopic dermatitis.

CONCLUSION

Cleaners are at an elevated risk of developing HE. More focus on education/information regarding the prevention and treatment of HE is necessary for the cleaning profession. Self-reported redness and itching of the hands may be a useful prediction of HE in cleaners.

Design and validation of pictograms and educational video clips to improve the knowledge of skin care and protection: Comprehension and recall among professional hospital cleaners

INTRODUCTION

Insufficient knowledge about protection and care of the skin among Danish hospital cleaners, particularly immigrant cleaners, is guessed to be a widespread issue that can increase the likelihood of them developing occupational hand eczema (OHE). This study aimed to design and validate 10 pictograms and 10 short video clips showing recommendations for skin care that would help prevent OHE among professional cleaners.

METHODS

Ten pictograms and 10 short, educational video clips, based on standard, recommended information were developed in collaboration with a medical illustrator and a video director. The materials were validated in a two-step process that included bus drivers (primary validation) and professional cleaners (secondary validation).

RESULTS

During the primary validation, 5 of the 10 pictograms (50%) were comprehended correctly by at least 85%. Those that were misinterpreted, were modified and retested several times until they were understood correctly by at least 85%. During the secondary validation, all 10 pictograms achieved acceptable levels of comprehension among professional cleaners. All the video clips were comprehended correctly by both bus drivers and cleaners.

CONCLUSION

Ten easy-to-understand pictograms and 10 educational video clips for cleaners about the prevention of OHE have been designed and validated.

Prevalence, risk factors, and prevention of occupational contact dermatitis among professional cleaners: a systematic review

OBJECTIVE

The aim of this study was to investigate the prevalence, risk factors, and prevention of occupational contact dermatitis (OCD), as well as risk factors and consequences of OCD among professional cleaners.

METHODS

A systematic review following PRISMA guidelines was performed using Medline, EMBASE, and Cochrane Library.

RESULTS

Thirty-nine studies containing over 109.000 participants were included in the review. The prevalence of OCD varied between 2.2% and 30.1%. Main occupational risk factors for developing OCD among cleaners included wet work and irritants in cleaning products (bleach, chlorine, ammonia, multi-use-cleaning) and skin contact to metal. The most common contact allergies included rubber, biocides, nickel/cobalt, and perfumes. Other risk factors were inconsistent use of protective gloves and low educational level. Consequences associated with OCD included significant impairment in quality of life, tendency to have unscheduled absence from work, sick leave, increased rate of disability, and recognized degree of injury. Only one prevention study has been published investigating the effect of an educative course in skin-protective behavior in cleaners. The study reported a higher degree of knowledge of skin protection, a decrease in the severity of hand eczema, and a shift toward fewer daily hand washings at follow-up after 3 months.

CONCLUSION

Our study proves that OCD is common in cleaners, and the main risk factors included wet work, irritants, and contact allergies, as well as inconsistent use of protective gloves and low educational level. More focus and a greater number of studies are needed on skin protection in this population.

Employment Quality and Mental and Self-Reported Health Inequities among Latinx Housecleaners: The Safe and Just Cleaners Study

Precarious employment, such as housecleaning, is one important structural contributor to health inequities. We used an employment quality (EQ) framework to characterize the impact of employment conditions on mental and self-reported ill-health among Latinx housecleaners in the New York City metropolitan area. Using a community-based participatory research approach, we collected cross-sectional survey data from 402 housecleaners between August 2019 and February 2020 to characterize housecleaners' EQ and its association with depression, perceived stress, and self-reported health. We also measured work-related irritant eye, skin, and respiratory symptoms, which have been shown in previous research to be associated with housecleaners' exposure to chemical components of cleaning products. Our housecleaner cohort was largely female and immigrant and most had worked at least five years. Survey items capturing the EQ dimensions of unbalanced interpersonal relations, low material resources, and violations of workers' rights were associated with increased odds of depression, perceived stress, and self-reported ill-health. Work-related irritant eye, skin, and respiratory symptoms were also independently associated with mental and self-reported ill-health and some of the effects of EQ on health were potentially partially mediated through their association with work-related irritant symptoms. Findings can inform directions for community-based educational and policy initiatives to improve housecleaners' employment quality.

Work-related allergy and asthma associated with cleaning agents in health workers in Southern African tertiary hospitals

BACKGROUND

Health workers (HWs) are exposed to diverse cleaning agents in large hospitals. This study determined the prevalence of work-related symptoms, allergic sensitization, and lung function abnormalities in HWs of two tertiary hospitals in Southern Africa.

METHODS

A cross-sectional study of 699 HWs (South Africa: SAH, n = 346; Tanzania: TAH, n = 353) was conducted. Health outcomes were assessed using a standardized ECRHS questionnaire, immunological tests (specific IgE antibody to common aero-allergens and to occupational allergens: natural rubber latex [NRL]  Hev b5 and Hev b6.02, chlorhexidine, and ortho-phthalaldehyde [OPA]), spirometry [pre-and post- bronchodilator], methacholine challenge, and fractional exhaled nitric oxide (FeNO).

RESULTS

A large proportion of participants (78%) were women. Median age was 42 years, with 76% nurses, 12% cleaners, and 5% administrative workers. Current smoking was more common in SAHWs (12%) than TAHWs (1%). The overall prevalence of doctor-diagnosed asthma was 7%. Atopy was present in 43% of HWs, while 4% were sensitized to OPA, 2% to NRL, and 1% to chlorhexidine. Prevalence of work-related ocular-nasal symptoms (16%) was higher than skin (12%) and chest (7%) symptoms. TAHWs had significantly lower mean lung volumes, higher degrees of significant airflow obstruction and impaired lung function. The prevalence of bronchial hyperresponsiveness in SAHWs (14%) was high. Overall, 23% of HWs had abnormal FeNO; 6% having high (>50 ppb) levels. FeNO was positively associated with sensitization to occupational allergens, primarily OPA and NRL.

CONCLUSIONS

HWs from both hospitals had similar prevalence of work-related respiratory symptoms. Sensitization to OPA and NRL appears to be contributing to allergic airway inflammation in these HWs.

Racial and Ethnic Differences in the Perceptions of Health, Work Environment and Experiences of Work-Related Symptoms Among Cleaning Workers

This study explored racial and ethnic differences in perception of work environment, safe work practices, general health status, experience of work-related injury or illness and subsequent symptom reporting and health care seeking behaviors among cleaning workers. This study analyzed cross-sectional data obtained from 183 cleaning workers employed in a university hospital or a health sciences campus in Northern California. The sample included 120 Asians (65.6%), 37 Hispanics (20.2%), and 27 other ethnicities (14.2%); 85.7% were foreign-born. Asian workers perceived lower job control and supervisor support and higher job strain than other workers. The odds of perceiving general health as excellent or very good were lower among Asians compared to Hispanics and Others. Asians who experienced chemical-related symptoms were less likely than Hispanics and others to report the symptoms to their supervisor or seek healthcare. Our study findings indicated racial/ethnic differences in perceptions of work and general health, seeking healthcare, and reporting behaviors among cleaning workers. Asian workers, specifically, may need special attention to improve their experiences of work environments and health in the workplace.

Causes of irritant contact dermatitis after occupational skin exposure: a systematic review

PURPOSE

Irritant contact dermatitis (ICD) is a major cause of occupational disease. The aim was to review the relation between exposure to occupational irritants and ICD and the prognosis of ICD.

METHODS

Through a systematic search, 1516 titles were identified, and 48 studies were included in the systematic review.

RESULTS

We found that the evidence for an association between ICD and occupational irritants was strong for wet work, moderate for detergents and non-alcoholic disinfectants, and strong for a combination. The highest quality studies provided limited evidence for an association with use of occlusive gloves without other exposures and moderate evidence with simultaneous exposure to other wet work irritants. The evidence for an association between minor ICD and exposure to metalworking fluids was moderate. Regarding mechanical exposures, the literature was scarce and the evidence limited. We found that the prognosis for complete healing of ICD is poor, but improves after decrease of exposure through change of occupation or work tasks. There was no substantial evidence for an influence of gender, age, or household exposures. Inclusion of atopic dermatitis in the analysis did not alter the risk of ICD. Studies were at risk of bias, mainly due to selection and misclassification of exposure and outcome. This may have attenuated the results.

CONCLUSION

This review reports strong evidence for an association between ICD and a combination of exposure to wet work and non-alcoholic disinfectants, moderate for metalworking fluids, limited for mechanical and glove exposure, and a strong evidence for a poor prognosis of ICD.

OUP accepted manuscript

Using data from the Swedish Products Register, hosted by the Swedish Chemicals Agency (KemI), national occupational injury and disease statistics, and call records from the Swedish Poisons Information Centre (PIC) we characterize health hazards of marketed cleaning products and recorded injuries, disease, and incidents linked to cleaning or disinfection agents. The results show that cleaning agents pose many kinds of health hazards, although corrosion and irritation hazards dominate, in particular for the eyes (54% of all included products). Few products were recognized as inhalation hazards. The nature of the health hazards is reflected in the occupational disease and injury statistics and PIC records for eyes and skin but not for the respiratory tract. Among occupational disease cases attributed to cleaning or disinfection agents, 61% concern skin and 26% the respiratory tract. Among occupational injury cases 64% concern chemical burns. However, only a small part (<0.5%) of all reported diseases and injuries were explicitly attributed to cleaning or disinfection agents. On average, there were 11 cases of disease attributed to cleaning or disinfection agents per million workers and year. For occupational injuries the corresponding number was 8. The data concern a broad range of sectors and occupations, but notable sectors were healthcare, accommodation and food service, and manufacturing. Women were more likely to suffer from disease, men and women equally likely to suffer from injury. PIC cases were evenly distributed between men and women, but the clear risk cases more frequently involved men. Occupational diseases increased many-fold in 2020 while injuries decreased, which could be due to COVID-19 changing use patterns of cleaning and disinfection agents at work. We conclude that cleaning agents pose a variety of risks to a large part of the workforce, although particular attention for preventive efforts may need to be directed to the healthcare, accommodation and food service, and manufacturing sectors.

Occupational Contact Dermatitis in Hospital Cleaning Workers

BACKGROUND

Health care workers and hospital cleaning workers are at high risk regarding the development of occupational contact dermatitis (OCD).

OBJECTIVES

To determine the prevalence and risk factors of OCD in hospital cleaning workers.

METHODS

A questionnaire was conducted in 245 cleaning workers in our cross-sectional study. The 236 cleaning workers formed the study group. In workers who were prediagnosed with dermatitis, physical examination was performed in the Dermatology Outpatient Clinic, and when necessary, patch test, skin biopsy, and investigation for total immunoglobulin E were conducted. Patients with definite contact dermatitis were diagnosed as having OCD by using the Mathias criteria.

RESULTS

The prevalence rate of OCD was 21.6% and was significantly higher in female workers (26.4%) when compared with male workers (11.0%). Female sex; low educational level; cleaning the external surfaces of the medical equipment, monitors, and accessories; and mixing the cleaning products and use them while performing cleaning activities were determined as the independent risk factors for OCD.

CONCLUSIONS

Occupational contact dermatitis was present at a high rate in hospital cleaning workers. The risk factors should be taken into consideration for prevention of OCD and improvement of the health status of hospital cleaning workers.

Gender differences in experience and reporting of acute symptoms among cleaning staff

BACKGROUND

Cleaning tasks pose risks of hazardous chemical exposure and adverse health effects for cleaning workers. We examined gender differences among cleaning staff in the experience of chemical-related symptoms and in reporting to supervisors.

METHODS

We analyzed cross-sectional reports from 171 university hospital or campus cleaning staff on chemical exposures to cleaning products, experience of acute symptoms, reporting of symptoms to supervisors, as well as demographic and psychosocial factors (risk perception, job demand/control, supervisor/co-worker support, and safety climate). Results were analized using multivariable logistic regression, adjusting for demographic, job, and psychosocial factors. Interactions of gender and psychosocial variables were also examined.

RESULTS

Men and women reported different frequencies for exposure-related tasks. Acute symptoms of chemical exposure were more prevalent in women compared with men (46.0% vs. 25.4%; adjusted odds ratio [OR] = 2.63; 95% confidence interval [CI] 1.27-5.46). Women were more concerned about exposure to cleaning chemicals (p = 0.029) but reported symptoms to their supervisor less often than men (18.5% vs. 40.6%, adjusted OR = 0.28; 95% CI 0.09-0.93). More supervisor support was significantly associated with less frequent symptom experience among women (OR = 0.83; 95% CI 0.70-0.99). Asian workers and less educated workers were less likely than others to report symptoms to supervisors. Gender differences in symptom reporting to supervisors were not explained by psychosocial factors.

CONCLUSIONS

Women may have increased susceptibility or perception of symptoms from cleaning compared to men, but this may be mitigated by supervisor support. Female Asian workers with lower education may perceive more significant barriers in reporting work-related symptoms to supervisors. Further research is needed to explore factors related to underreporting.

Hand Dermatitis in the Time of COVID-19: A Review of Occupational Irritant Contact Dermatitis

Occupational contact dermatitis accounts for 95% of all cases of occupational skin disease with irritant contact dermatitis (ICD) constituting 80% to 90% of these cases. Health care workers, hairdressers, and food service workers are typically most affected by occupational ICD of the hands as these occupations require frequent hand hygiene and/or prolonged exposure to water, also known as "wet work." In the context of the current COVID-19 pandemic, frequent hand hygiene has become a global recommendation for all individuals, and new workplace guidelines for hand sanitization and surface sterilization are affecting occupations not previously considered at risk of excessive wet work including grocery or retail workers, postal workers, sanitization workers, and others. In this review, we discuss the etiology and pathogenesis of occupational ICD with additional focus on treatment and interventions that can be made at an institutional and even national level for education and prevention of ICD resulting from frequent hand hygiene.

Occupational dermatoses in the Brazilian South region recorded in a reporting system (2007 to 2016)

Background

Occupational dermatoses must be mandatorily reported in Brazil.

Objective

To characterize the reporting of occupational dermatoses in the Brazilian South region, and describe the profile of the involved workers.

Method

Retrospective and descriptive study of 396 cases of occupational dermatoses reported from 2007 through 2016 via the Information System for Notifiable Diseases.

Results

3.6 and 2.2 cases / 10,000 workers / year were of men and women, respectively. The highest incidence of occupational dermatoses corresponded to age range 50 to 64 years old, 1.8 cases / 10,000 workers / year, and to maintenance and repair workers, 3.6 cases / 10,000 workers / year. Most cases involved whites (77%) and workers not having completed elementary school (37.6%). Patch testing was only performed for 11.4% of cases.

Conclusion

Reinforcing measures to promote the use of personal protective equipment is necessary, as well as to improve reporting and sensitize professionals to perform accurate reports in official systems.

Determinants of hand dermatitis, urticaria and loss of skin barrier function in professional cleaners in New Zealand

This study assessed the risk of dermatitis, urticaria and loss of skin barrier function in 425 cleaners and 281 reference workers (retail workers and bus drivers). Symptoms, atopy and skin barrier function were assessed by questionnaire, skin prick tests, and measurement of transepidermal water loss. Cleaners had an increased risk of current (past 3 months) hand/arm dermatitis (14.8% vs. 10.0%; OR = 1.9, p < 0.05) and urticaria (11% vs. 5.3%; OR = 2.4, p < 0.05) and were more likely to have dermatitis as adults (17.6% vs. 11.4%; OR = 1.8, p < 0.05). The risk of atopy was not increased, but associations with symptoms were more pronounced in atopics. Transepidermal water loss was significantly higher in cleaners. Wet-work was a significant risk factor for dermatitis and hand washing and drying significantly reduced the risk of urticaria. In conclusion, cleaners have an increased risk of hand/arm dermatitis, urticaria and loss of skin barrier function.

Contact dermatitis: a practice parameter-update 2015

This parameter was developed by the Joint Task Force on Practice Parameters, which represents the American Academy of Allergy, Asthma & Immunology (AAAAI); the American College of Allergy, Asthma & Immunology (ACAAI); and the Joint Council of Allergy, Asthma & Immunology. The AAAAI and the ACAAI have jointly accepted responsibility for establishing "Contact Dermatitis: A Practice Parameter-Update 2015." This is a complete and comprehensive document at the current time. The medical environment is changing and not all recommendations will be appropriate or applicable to all patients. Because this document incorporated the efforts of many participants, no single individual, including members serving on the Joint Task Force, are authorized to provide an official AAAAI or ACAAI interpretation of these practice parameters. Any request for information or interpretation of this practice parameter by the AAAAI or ACAAI should be directed to the Executive Offices of the AAAAI, the ACAAI, and the Joint Council of Allergy, Asthma & Immunology. These parameters are not designed for use by the pharmaceutical industry in drug development or promotion. Previously published practice parameters of the Joint Task Force on Practice Parameters for Allergy & Immunology are available at http://www.JCAAI.org or http://www.allergyparameters.org.

Recent Trends in Occupational Contact Dermatitis

Occupational contact dermatitis (OCD) remains prevalent among workers and impacts quality of life and workability. The purpose of this review is to summarize the recent advances in occupational contact dermatitis as well as potential hazardous agents in the workplaces causing OCD. The review covers new developments in the epidemiology, etiology, diagnosis, and management of occupational contact dermatitis. This article also provides updated information on the prevalence of work-related skin symptoms and on new contact allergens among working population. It is emphasized that in the context of prevention of OCD, special attention should be focused on the identified high-risk occupational groups, especially healthcare workers and hairdressers starting with the apprentices. Current approaches include working out the standards and guidelines to improve the education, knowledge, diagnosis, and management of OCD based on a multidisciplinary team of medical specialists and an employer.

Cleaning and disinfecting environmental surfaces in health care: Toward an integrated framework for infection and occupational illness prevention

BACKGROUND

The Cleaning and Disinfecting in Healthcare Working Group of the National Institute for Occupational Safety and Health, National Occupational Research Agenda, is a collaboration of infection prevention and occupational health researchers and practitioners with the objective of providing a more integrated approach to effective environmental surface cleaning and disinfection (C&D) while protecting the respiratory health of health care personnel.

METHODS

The Working Group, comprised of >40 members from 4 countries, reviewed current knowledge and identified knowledge gaps and future needs for research and practice.

RESULTS

An integrated framework was developed to guide more comprehensive efforts to minimize harmful C&D exposures without reducing the effectiveness of infection prevention. Gaps in basic knowledge and practice that are barriers to an integrated approach were grouped in 2 broad areas related to the need for improved understanding of the (1) effectiveness of environmental surface C&D to reduce the incidence of infectious diseases and colonization in health care workers and patients and (2) adverse health impacts of C&D on health care workers and patients. Specific needs identified within each area relate to basic knowledge, improved selection and use of products and practices, effective hazard communication and training, and safer alternatives.

CONCLUSION

A more integrated approach can support multidisciplinary teams with the capacity to maximize effective and safe C&D in health care.

Cleaning products and short-term respiratory effects among female cleaners with asthma

OBJECTIVE

We evaluated the short-term effects of exposure to cleaning products on lung function and respiratory symptoms among professional cleaning women.

METHODS

Twenty-one women with current asthma and employed as professional cleaners participated in a 15-day panel study. During 312 person-days of data collection, participants self-reported their use of cleaning products and respiratory symptoms in daily diaries and recorded their forced expiratory volume in 1 s (FEV1) and peak expiratory flow (PEF) three times per day using a handheld spirometer. We evaluated associations of cleaning product use with upper and lower respiratory tract symptoms using Poisson mixed regression models and with changes in FEV1 and PEF using linear mixed regression analyses.

RESULTS

Participants reported using an average of 2.4 cleaning products per day, with exposure to at least one strong irritant (eg, ammonia, bleach, hydrochloric acid) on 56% of person-days. Among participants without atopy, lower respiratory tract symptoms were associated with the use of hydrochloric acid and detergents. Measurements of FEV1 and PEF taken in the evening were 174 mL (95% CI 34 to 314) and 37 L/min (CI 4 to 70), respectively, lower on days when three or more sprays were used. Evening and next morning FEV1 were both lower following the use of hydrochloric acid (-616 and -526 mL, respectively) and solvents (-751 and -1059 mL, respectively). Diurnal variation in FEV1 and PEF increased on days when ammonia and lime-scale removers were used.

CONCLUSIONS

The use of specific cleaning products at work, mainly irritants and sprays, may exacerbate asthma.

Wet-work Exposure: A Main Risk Factor for Occupational Hand Dermatitis

Wet-work can be defined as activities where workers have to immerse their hands in liquids for >2 hours per shift, or wear waterproof (occlusive) gloves for a corresponding amount of time, or wash their hands >20 times per shift. This review considers the recent literature on wet-work exposure, and examines wet-work as a main risk factor for developing irritant contact dermatitis of the hands. The aim of this paper is to provide a detailed description of wet-work exposure among specific occupational groups who extensively deal with water and other liquids in their occupations. Furthermore, it highlights the extent and importance of the subsequent adverse health effects caused by exposure to wet-work.

Self-reported skin symptoms and skin-related quality of life among Latino immigrant poultry processing and other manual workers

BACKGROUND

Manual labor employment occurs in environments with exposures likely to impact skin-related quality of life (SRQOL).

OBJECTIVES

The objectives of this paper are to (1) document the dimensions of SRQOL, (2) examine its association with skin symptoms, and (3) identify the predictors of SRQOL in Latino manual workers.

METHODS

A population-based survey of 733 Latino manual workers obtained Dermatology Life Quality Index (DLQI) and skin symptoms in the prior year.

RESULTS

Two-thirds of workers were employed in production. Skin symptoms in prior year were reported by 23%. Impaired SRQOL was reported by 23%. In multivariate analyses, reduced SRQOL was associated with age, occupation, childhood indigenous language use, and experience of skin symptoms in the prior year.

CONCLUSIONS

Despite overall high SRQOL exposures in some immigrant occupational groups produce reduce SRQOL. This rural, immigrant population faces significant obstacles to obtaining dermatological care; efforts are needed to improve their SRQOL.

Contact dermatitis in the cleaning industry

PURPOSE OF REVIEW

The review summarizes recent findings on contact dermatitis in the cleaning industry.

RECENT FINDINGS

Contact dermatitis is still an important issue in cleaning. Recent studies identified cleaning work sites and tasks, as well as specific cleaning products, which incur a risk increase for occupational contact dermatitis in cleaning. Workers involved in cleaning outdoors prevalence ratio [PR 1.85, 95% confidence interval (CI) 1.16-2.96], cleaning common areas of residential buildings (PR 1.77, 95% CI 1.11-2.84), schools (PR 1.84, 95% CI 1.15-2.93) and cleaning building sites (PR 1.87, 95% CI 1.18-2.95) showed significantly higher rates of contact dermatitis. Relevant allergens in cleaning are rubber chemicals and disinfectants. Leading allergens are thiurams (11.6%, 95% CI 9.1-14.1) and formaldehyde (3.4%, 95% CI 2.0-4.7), but contact with metal allergens might also be important. The most likely allergen sources for sensitization against rubber chemicals are protective gloves. High sensitization rates for disinfectants might result from the fact that employees in cleaning often use single-use medical examination gloves while cleaning. These gloves are not resistant to chemicals, which may break through the gloves within a short period of time, depending on glove material and thickness. No differences in sensitization rates and sensitization profiles were seen in cleaners of younger (≤40 years) and older (>40 years) age.

SUMMARY

Prevalence of occupational contact dermatitis is still high in cleaning. Irritant contact dermatitis is prevailing, but allergic contact dermatitis is quite frequent, too. Up to now, prevention strategies in cleaning seem to be insufficient.

Functional and biological characteristics of asthma in cleaning workers

OBJECTIVES

Cleaning workers have an increased risk of asthma but the underlying mechanisms are largely unknown. We studied functional and biological characteristics in asthmatic cleaners and compared these to healthy cleaners.

METHODS

Forty-two cleaners with a history of asthma and/or recent respiratory symptoms and 53 symptom-free controls were identified. Fractional exhaled nitric oxide (FeNO) was measured and forced spirometry with reversibility testing was performed. Total IgE, pulmonary surfactant protein D and the 16 kDa Clara Cell secretory protein were measured in blood serum. Interleukins and other cytokines, growth factors, cys-leukotrienes and 8-isoprostane were measured in exhaled breath condensate. Information on occupational and domestic use of cleaning products was obtained in an interview. Associations between asthma status, specific characteristics and the use of cleaning products were evaluated using multivariable linear and logistic regression analyses.

RESULTS

Asthma was associated with an 8% (95% confidence interval (CI) 1-15%) lower postbronchodilator FEV1, a higher prevalence of atopy (42% vs. 10%) and a 2.9 (CI 1.5-5.6) times higher level of total IgE. Asthma status was not associated with the other respiratory biomarkers. Most irritant products and sprays were more often used by asthmatic cleaners. The use of multiuse products, glass cleaners and polishes at work was associated with higher FeNO, particularly in controls.

CONCLUSIONS

Asthma in cleaning workers is characterised by non-reversible lung function decrement and increased total IgE. Oxidative stress, altered lung permeability and eosinophilic inflammation are unlikely to play an important underlying role, although the latter may be affected by certain irritant cleaning exposures.