Skin problems in healthcare personnel

Author: Brian Wu PhD. MD Candidate, Keck School of Medicine, Los Angeles, USA. Chief Editor: Dr Amanda Oakley, Dermatologist, Hamilton, New Zealand, January 2016.

The medical profession is a major employer worldwide. It has strong employment growth, as demand increases for doctors, nurses and other medical personnel. However, it is also considered to be a profession at high risk for the development of occupation-related skin dermatoses. For instance, one study surveying 706 nurses found that 47.3% of them had some form of occupational skin disease, allergic contact dermatitis and irritant contact dermatitis being the most commonly reported.

Why are medical personnel at risk for occupational skin disease?

There are many factors which increase the risk of developing an occupational skin disorder, including:

Understanding occupational skin disorders

The skin has evolved as a protective barrier against invasion by pathogens and contact with irritants or sensitisers. However, the nature of some professions compromises this barrier, including dental and medical personnel, construction workers, food handlers and farmers/agricultural workers. Healthcare workers are considered to be at high risk of developing skin problems.

Medical personnel are at particular risk of latex allergy, contact dermatitis and mechanical injury.

Latex allergy

Latex allergy is Type 1 hypersensitivity reaction to latex proteins (contact urticaria) and in extreme cases can rarely be fatal. Diagnosis is based on medical history of immediate redness and swelling on exposure to the gloves. Latex reactions can be severe, but generally resolve within an hour or so.

Contact dermatitis

Contact dermatitis can stem from either allergens (like rubber accelerants) or irritants (water, harsh soaps, friction), with irritant dermatitis being considered more common. Studies have shown that rubber, aldehydes and hydrogen peroxide are associated with an increased risk of dermatitis. Long work hours and prolonged exposure can also be causative factors. The most common signs and symptoms of dermatitis including redness and itching, but swelling, pain, burning sensations and scaling also occur.

Mechanical injury

Due to exposure to needles and other sharps, medical personnel are at extremely high risk of needlestick injuries, cuts or punctures. In the United States, the Occupational Health and Safety Administration (OSHA) estimates that 5.6 million healthcare workers annually suffer from mechanical injuries. This puts doctors and nurses at extremely high risk for transmission of disease such as human immunodeficiency virus (HIV), hepatitis C or for secondary bacterial infections.

Workplace risk assessment

The medical profession is highly regulated and thorough workplace risk assessments mandated by most governing bodies. Assessment should include:

Workplace safety must be a priority for both administration and workers.

Personal protective equipment

Due to the risk for disease transmission between patients and medical personnel, gloves are mandated for workers performing direct personal care or handling bodily fluids or other potentially infectious material. Gloves should also be worn when coming into contact with disinfectants, cleaners and other chemicals. However, if gloves are made of rubber, they may cause latex sensitivity or dermatitis; the increased use of non-latex gloves in the medical profession has helped to reduce this risk.

Hand care advice for medical personnel

Proper hand care reduces the chances of occupational dermatoses and includes:

Diagnosis and treatment of occupational skin disease

Diagnosis of occupational skin disorders should include:

Treatment of occupational skin disorders can include:

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