Extract

Background and study aims Hand dermatitis (eczema) is a common cause of discomfort and loss of productivity in the NHS workforce with treatment costs amounting to £125 million/year. Different preventive measures are used to reduce hand dermatitis in healthcare workers but it is not clear how effective these are. To prevent infections spreading between patients, nurses have to wear gloves and wash their hands a lot of the time. This constant contact with detergents and water often leads nurses to develop hand dermatitis, which in turn may mean that they are more likely to carry harmful bacteria on their hands. The risk of getting hand dermatitis is particularly high in nurses with a past history of allergic disease such as asthma and childhood eczema and among nurses who work in intensive care units (ICUs) where patient contacts and hand washing are more frequent. Hand dermatitis can be reduced by avoiding unnecessary overuse of gloves and washing of hands, drying hands properly after washing, and regular use of hand creams (moisturisers). However, hand care by nurses is often poor. We will study nurses at high risk of hand dermatitis (student nurses with a past history of allergic disease and ICU nurses) and test the effectiveness and value for money of an online training programme (Behavioural Change Package or BCP) which aims to change nurses’ beliefs and behaviours in looking after their hands. Who can participate? This study aims to recruit, through the participating trust's Occupational Health (OH) department, at least 40 ICU nurses and 40 first year student nurses at each of 26 NHS trusts in England. What does the study involve? NHS trusts will be randomly allocated to one of two groups. 13 trusts will receive BCP and 13 trusts to act as controls. Nurses in the control trusts will be provided with the same written information as the nurses in trusts receiving BCP, and will be encouraged to report hand dermatitis early to their OH department. They will otherwise receive advice in accordance with their local trust's existing policies. Nurses receiving BCP will be encouraged to develop detailed plans to help them change their behaviours, supported by online reminders. The student nurses will be provided with personal tubes of moisturising cream. On ICU wards, facilities for washing and drying hands will be reduced and dispensers of moisturising creams installed. The participants will be asked to complete a questionnaire at the start of the study about past and current hand dermatitis, allergies, beliefs about hand care, use of gloves, soaps, alcohol hand rubs, moisturisers, activities outside work which may lead to dermatitis and current quality of life. BCP will then be implemented in the allocated trusts. We will ask the nurses to complete a shorter questionnaire soon after they have received the BCP and again at the end of 12 months. In addition, any nurses who report hand dermatitis at any stage of the study will be asked to have their hands photographed and checked for harmful germs. Nurses with hand dermatitis will be treated according to normal practice in their trust. Two dermatologists from the study team will review the photographs to grade the severity of dermatitis. We will also randomly check the hands of nurses who do not have dermatitis. What are the possible benefits and risks of participating? All nurses participating in the study will benefit from intensive hand care advice. If the programme is effective, those in the BCP-receiving group will benefit from a lower risk of developing hand dermatitis. The results of the study will be circulated to the participants so that all nurses in the study will benefit from increased awareness of the importance of hand care at work. The study has been designed to have few, if any, adverse effects on the study participants. The programme is not painful or intrusive and should have little inconvenience. Once an individual has developed irritant hand dermatitis the outlook is poor. Individuals may develop sleep disturbance and hampered leisure activities. Where is the study run from? This study is being led by Guy's and St Thomas' NHS Foundation Trust but involves senior researchers and experts from King's College, London; the University of Southampton; Imperial College, London; University College London; the University of Manchester and Nottingham University Hospitals NHS Trust. When is the study starting and how long is it expected to run for? After a feasibility study in a hospital in Wales, the main study will start in September 2014 and will last until May 2017. Who is funding the study? The project is funded by the National Institute for Health Research (NIHR), UK Who is the main contact? Dr Ira Madan [email protected]

Inclusion criteria

• Hand dermatitis

Links

• ictrp
• isrctn