Skin-specific training experience of workers assessed for contact dermatitis

Abstract

Background

Contact dermatitis is a common and preventable work-related disease. Skin-specific training may be effective for preventing occupational contact dermatitis, but little information is available regarding actual workplace training and its effectiveness.

Aims

To describe workplace skin-specific training among workers with suspected contact dermatitis.

Methods

Patch test patients being assessed for suspected contact dermatitis at an occupational health clinic in Toronto, Canada, completed a questionnaire on training experiences, workplace characteristics, exposures and skin protection practices.

Results

Of 175 patients approached, 122 (71%) workers completed questionnaires. Many (80%) had received general occupational health and safety and hazardous materials training (76%). Fewer (39%) received skin-specific training. Of those with work-related contact dermatitis, 52% did not receive skin-specific training. Skin-specific training was commonly provided by health and safety professionals or supervisors using video, classroom and online techniques. Content included glove use, exposure avoidance and hand washing information. Workers that received skin-specific training found it memorable (87%), useful (85%) and common sense in nature (100%).

Conclusions

This study indicates gaps in workplace training on skin disease prevention for workers with contact dermatitis. Workers perceived skin-specific training to be useful. Understanding worker training experiences is important to prevention programme development and reducing work-related skin disease.

Introduction

Work-related contact dermatitis (CD) is one of the most common occupational diseases [1]. Skin-specific training (SST) interventions have been shown to be effective for improving prevention practices and reducing frequency of CD among a variety of worker groups [2–6]. SST typically includes theoretical and practical information on healthy and diseased skin, skin care, protection of skin from workplace hazards and recognition of symptoms of skin disease [5,6]. Little information is available regarding actual workplace training practices, training effectiveness and workers’ perceptions of training value. This study aimed to describe the SST experiences of workers with suspected CD.

Methods

The Research Ethics Board at St. Michael’s Hospital in Toronto, Canada, approved the study. We invited patients attending a specialized occupational health clinic in Toronto, Canada, who were (i) being assessed for suspected CD, (ii) working or off work due to skin disease and (iii) able to complete a questionnaire in English, to participate.

The survey contained questions about training experiences, workplace characteristics, skin exposures and prevention practices. We developed the survey based on results from qualitative interviews [7], literature review [5,6] and previous surveys distributed in clinic [8,9]. We analysed the data using the R Project for Statistical Computing (Version 3.2.1). We calculated simple descriptive statistics, including means and frequencies. We assessed comparisons between groups using chi-square and Fisher’s exact test.

We defined wet work as having wet hands for ≥2 h per shift, using gloves for ≥2 h per shift, or hand washing >20 times per workday [1].

Results

The response rate was 71% (124/175). We did not collect any information about non-responders. Of the 124 patients who completed the surveys, we excluded two due to incomplete responses. The mean (SD) age of all participants was 43 (11) years and 58% were female. Characteristics of workplaces, training, skin exposures and skin protection practices for the whole group and for those who reported and did not report SST are presented in Table 1. Workers were employed in a variety of industries and company sizes, primarily in non-unionized workplaces. The majority reported general occupational health and safety (OHS) training (80%) and Workplace Hazardous Materials Information System (WHMIS) training (76%), both being required training in Ontario. Far fewer (39%) reported SST. Workers who reported SST were more likely to report receiving general OHS and WHMIS training, the availability and use of Material Safety Data Sheets (MSDS) in the workplace, the provision of skin exams at work, skin problems among their co-workers and being exposed to wet work.

Information related to SST is presented in Table 2. Training was delivered primarily through videos, classroom-style demonstrations and online modules. Twenty-eight (60%) recipients reported that the training had been delivered in a manner specific to their job tasks. Training was most commonly provided by OHS professionals or supervisors and predominantly covered content about glove use, exposure avoidance and hand washing. Information on skin problems resulting from exposure, cream use and early recognition of disease symptoms was less commonly reported. Forty (80%) who reported SST felt it had been useful, 41 (87%) reported that they could remember at least half of the content, and all felt that it had been common sense in nature.

Discussion

Our study findings indicate gaps in SST among workers with possible CD. At least half of at-risk workers (wet workers and workers who acknowledged skin problems among their co-workers) did not receive SST. SST was more commonly reported among workers who also received general OHS and WHMIS training; those employed in workplaces where skin exams were performed, and where MSDS were used. These workplaces may be characterized by a heightened awareness of skin exposure and resulting skin disease and may emphasize workplace training.

Strengths of this study include representation of workers from a variety of industries and work environments. It also provides an indication of SST characteristics combined with workers’ attitudes about the usefulness of that training. Limitations include the self-report nature of the data and modest number of respondents who reported SST and were therefore able to comment on it. Because we surveyed a patient rather than worker group about workplace experiences, we were unable to determine the actual training delivered in the workplace. Workers may not always recall training received. However, what workers remember about training is important and may influence what they apply in their day-to-day work.

There is little information available regarding the current state of SST in actual workplaces. Our findings on the proportion of workers trained in general OHS, WHMIS and skin protection is similar to previous reports from the same clinic [8,9]. Far fewer workers received SST, and of those that did, content about skin problems resulting from exposure, recognition of early symptoms of skin disease and cream use was not commonly reported.

Most workers found the SST useful and memorable, and all workers that received this training found the content to be common sense in nature. Gerber suggest that workers who see training as common sense may have been informed by years on the job where workers may learn the concepts covered during SST, or alternatively, the training may have seemed common sense because the content was delivered in a practical manner [10].

This study highlights gaps in workplace training for workers with CD. Closing these gaps in training may help reduce occupational skin disease through improved prevention. The experiences captured in this study may add necessary context for prevention programme development and implementation in workplaces. Future studies are needed to characterize the current state of prevention training in a variety of workplaces.

Funding

Centre for Research Expertise in Occupational Disease funded by the Ontario Ministry of Labour.

Competing interests

None declared.

References