Intervention implementation research: an exploratory study of reduction strategies for occupational contact dermatitis in the printing industry

BACKGROUND: Occupational dermatitis is a problem in the printing industry but can be avoided through adequate protective measures. Research into intervention implementation is fundamental to the success of a formal intervention effectiveness trial. OBJECTIVES: The preliminary testing of four risk reduction strategies for occupationally caused dermatitis, which represent a range of approaches and cost implications. PATIENTS/METHODS: The strategies, the provision of (i) skin checks plus treatment advice; provision of (ii) gloves of the correct type/size plus use of an after-work cream; provision of (iii) information highlighting the problem of occupational dermatitis and (iv) development of a best practice skin care policy, were evaluated over 3 months in two non-randomly selected companies. A post-intervention evaluation into the effectiveness and efficacy of the intervention was also carried out. RESULTS AND CONCLUSIONS: All interventions were found to be acceptable to some extent. No single intervention appeared to be completely effective. The most practical intervention appeared to be the regular use of gloves of the correct type and size. This preliminary intervention study has demonstrated an improvement in the skin condition of workers examined and points towards the need for further testing of risk reduction strategies for the prevention of dermatitis in the printing industry on a much larger scale.     

Hand dermatitis in the pottery industry

Irritant hand dermatitis has long been recognized in the pottery industry. In our series, among workers handling glaze, sensitization to chromate was common and allergy to other metals and to biocides also occurred. Allergy to oil additives was found in mould makers. Whilst irritant hand dermatitis does occur, allergy to metals and biocides should be looked for in workers handling glazes, and allergy to oil additives in mould makers.     

Ascertainment of hand dermatitis using a symptom-based questionnaire; applicability in an industrial population

In this study, the applicability of a symptom-based questionnaire on hand dermatitis was assessed in a population of rubber workers. The questionnaire was previously validated in a study among nurses. 224 subjects employed in 9 different companies completed a questionnaire on skin complaints. Subsequently, 202 workers attended the physical examination of the skin by a dermatologist. The ascertainment of skin complaints according to the questionnaire was compared to the medical evaluation. The 2 different diagnostic tools used for assessing dermatitis resulted in dissimilar estimates of the prevalence of active hand dermatitis, ranging from 6.9% to 38.1% of all workers. Using the medical evaluation as 'gold standard' we observed a moderate sensitivity and specificity (respectively 71.4%; 95% CI: 47.7-95.1 and 76.1%; 95% CI: 70.0-82.2), a low positive predictive value (18.2%; 95% CI: 8.0-28.4) and a high negative predictive value (97.3%; 95% CI: 94.7-99.9) for the classification based on the self-administered questionnaire. When evaluated against 'first symptoms of dermatitis' the sensitivity decreased, while the specificity remained almost the same. The deviant findings between the present and the original validation study of the same questionnaire among nurses hamper its applicability in populations with different occupations. Therefore, if questionnaires are to be used, validity studies have to be carried out to evaluate differences in perception of skin diseases between different (occupational) populations.     

Occupational nickel dermatitis in the electroforming industry

An outbreak of occupational dermatitis in an electroforming plant where there was heavy exposure to nickel is described. Patch test investigations confirmed nickel allergy in 13 of 27 exposed individuals. Nickel chloride was found to be a more reliable patch test allergen than nickel sulphate. Improvements in industrial hygiene led to an immediate decrease in the incidence of dermatitis. Persistent patch test sensitivity to nickel was found in three individuals who had been removed from the process chemicals for some years.     

A study of dermatitis in the lacquerware industry

Contact dermatitis from lacquer has been documented. The causative agent is a resin from a lacquer trees that induce either irritation or sensitization. Thai and Japanese lacquer trees 2 distinct species hut are both members of the Anacardiaceae family. We report 3 eases of contact dermatitis from Thai lacquer resin. Observation and study of the lacquer plantation and working process at the factory were made to elucidate the aetiology of the dermatitis.     

Recruitment strategies for a hand dermatitis prevention programme in the food industry

Background:  An interdisciplinary 'Skin Disease Prevention Programme (SDPP) in the baking, hotel, and catering industries' was established. However, only 30% of the eligible employees suffering from occupational hand dermatitis (OHD) participated in the programme.
Objectives:  The aim of the present study was to increase the participation rate in the SDPP from 30% to 50% by specific recruitment strategies.
Patients/Methods:  Two hundred and twenty five baker and catering trade employees suffering from OHD were included in a prospective controlled intervention study. The employees were invited to take part in the SDPP using (i) a standard invitation letter ( n  = 40), (ii) a newly developed, personalized, and targeted invitation letter ( n  = 52), (iii) the new invitation letter and a case report ( n  = 75), and (iv) the new invitation letter, the case report, and the additional information ( n  = 58).
Results:  The commitment of the employees to join the SDPP increased significantly from 30% to 54% ( P  < 0.02) in the group receiving the new personalized targeted invitation letter. Neither the additional case report nor the supplementation with additional information concerning the SDPP did further increase the recruitment.
Conclusions:  The strategy to personalize and target the new invitation letter was successful to influence the employees' commitment to participate in the SDPP.     

Prognosis of occupational contact dermatitis in New South Wales, Australia

570 patients with occupational contact dermatitis (OCD) were seen between 1984 and 1990 at the Skin and Cancer Foundation in Sydney. 336 (59%) were followed up 1 to 5 years later. Roughly 1/3 were healed, 1/3 were improved without complete healing, 1/4 had no change and 1/12 of the patients had deteriorated. The overall improvement rate was in excess of 70%. Data derived from these patients demonstrated that changing the work duties of patients with OCD improved their outcome ( p < 0.01), whilst leaving the industry altogether resulted in a greater overall healing rate ( p < 0.01). No difference existed between the outcome of irritant contact dermatitis compared with allergic contact dermatitis. Atopics as expected had a worse prognosis. The outcome in the construction industry was significantly poorer than other industries. Patients suffering from allergic contact dermatitis from chromate also had a dismal prognosis.     

Occupational contact dermatitis due to glutaraldehyde in health care workers

Allergic contact dermatitis to glutaraldehyde was found in 13 health-care workers with hand dermatitis. Concomitant sensitivity to other chemicals was noted in 10. The positive patch test response was only evident for every 2nd observation in 4. The eruption persisted for more than 6 months in 10 subjects. In 5, the skin disease forced the worker to leave his occupation.     

Contact dermatitis in tie and dye industry Workers

A survey of the 'Tie and Dye' industry of Jodhpur City in India was made to investigate occupational dermatoses. 49 (16.6%) of 250 workers had incapacitating dermatitis. Skin lesions were seen mostly over the dorsa of the hands and fingers. 26 patients were patch tested with various dyes and chemicals; 14 were positive. Fast Red RC salt was the most potent sensitizer. Other dyes showing positive reactions were Orange GC salt, Bordeaux GP salt, Blue B salt, Red B base and naphthol.     

Occupational dermatitis due to 1,2-benzisothiazolin-3-one in the pottery industry

Three men working as mouldmakers in the pottery industry acquired a contact allergic dermatitis to a releasing oil. All three were shown to he sensitized to the biocide (1,2-benzisothinzolin-3-one) in the oil.