Abstract Background Nurses are at high risk of hand dermatitis. Regular hand moisturizing can prevent dermatitis, but nurses’ use of hand moisturizers is suboptimal. Aims To establish (i) what beliefs about hand dermatitis and hand moisturizer use are associated with hand moisturizer use by nurses at home and at work and (ii) if hand moisturizer use behaviours in nurses are associated with the prevalence of hand dermatitis. Methods We used a questionnaire to investigate nurses’ knowledge, beliefs and behaviours regarding hand dermatitis and use of hand moisturizers. Results The response rate was 55/65 (85%). Forty-two (76%) participants agreed that applying hand moisturizers reduced the risk of dermatitis, and 53 (96%) agreed that dermatitis increased the risk of skin carrying pathogenic organisms. Frequent moisturizer application was associated with beliefs that it was part of the nurse’s role to apply hand creams, a belief that they had had training in the use of moisturizers and believing that patients approved of them moisturizing their hands. Conclusions Hand moisturizer use by nurses can be improved by enhancing their beliefs that it is part of their professional role to apply hand cream regularly. Behaviour, beliefs, hand dermatitis, hand moisturizers, nurses Introduction Nurses are at high risk of developing occupational hand dermatitis , which can be uncomfortable, may be an infection control risk and can lead to increased sickness absence, negative psychosocial consequences and unemployment [2,3]. UK national guidelines recommend regular hand moisturizing to prevent and treat occupational dermatitis . However, a recent study suggests that nurses usually apply hand moisturizers after hand washing only when they develop symptoms of dermatitis . The influence of beliefs on nurses’ use of hand moisturizers, particularly at work, is not known, but this information is needed to inform interventions to increase the use of hand moisturizers in this occupational group. The aims of this study were to establish (i) what beliefs about hand dermatitis and hand moisturizer use are associated with hand moisturizer use by nurses at home and at work and (ii) if hand moisturizer use behaviours in nurses are associated with the prevalence of hand dermatitis. Methods We created a self-administered questionnaire based on elements of the Theoretical Domains Framework  and the Long Nordic Occupational Skin Questionnaire (NOSQ-2002) , assessing beliefs and training regarding hand dermatitis and use of hand moisturizers. The questionnaire is available from the authors on request. We limited the number of questionnaire items to facilitate completion by busy nurses and improve response rate. We distributed questionnaires in person to all qualified nurses (all nursing staff who were degree level or equivalent) on medical and surgical wards at a London hospital between 8 April 2015 and 20 May 2015. We analysed data using SPSS software version 24. For association analysis, we calculated non-parametric correlations (Spearman’s rho, ρ) between frequency of moisturizing hands on a daily basis/after hand washing at work/home. Ethical approval was not required as the NHS staff were recruited by virtue of their professional role . Results The response rate was 85% (55/65) and the mean age of respondents was 35 (SD 9.3) years. Respondents were predominantly female 51 (93%); 22 (40%) had worked as a nurse for <5 years, 10 (18%) for 5–10 years and 21 (38%) for ≥10 years (2 nurses did not answer). Eight (15%) nurses reported having dermatitis frequently (‘always’ or ‘often’) in the past 12 months and eight (15%) nurses reported frequently (‘always’ or ‘often’) applying moisturizer after hand washing at work or home (in response to ‘how often do you moisturize your hands after hand washing at work/home?’, recorded on a five-point Likert scale: ‘never’, ‘rarely’, ‘sometimes’, ‘always’ and ‘often’). Forty-two (76%) participants agreed that applying hand moisturizers reduced the risk of dermatitis, and 53 (96%) agreed that dermatitis increased the risk of skin carrying pathogenic organisms. Nurses who more strongly believed that ‘At work it’s my responsibility to apply moisturizers after washing my hands’ were more likely to report using moisturizer daily at work (ρ = 0.296, P < 0.05) and after hand washing at work (ρ = 0.289, P < 0.05). Use of moisturizers after hand washing at work was also significantly positively associated with the belief, ‘I consider it part of my job to apply moisturizer after I wash my hands’ (ρ = 0.355, P < 0.01), with perceived skills, ‘At work I’ve been trained in the correct application of moisturizer after hand washing’ (ρ = 0.304, P < 0.05) and with stronger agreement that ‘Patients approve of me using hand moisturizers’ (subjective norms) (ρ = 0.294, P < 0.05). We did not test whether any other beliefs were associated with hand moisturizer use at work. There was no association between hand moisturizer behaviour at home or at work and 12-month hand dermatitis prevalence (based on 50 participants, as 5 participants answered ‘not sure’). Discussion The 12-month prevalence of hand dermatitis in our participants was 15%. One strength of the study was the high response rate (85%). However, because we used a cross-sectional design we were unable to elicit causal relationships between beliefs and behaviours. The 12-month prevalence of hand dermatitis in nurses in our study was lower than the point prevalence reported in previous studies of nurses (20%), but higher than the reported general UK population (2–10%) . National UK guidelines and the Centre for Disease Control and Prevention recommend that healthcare workers should moisturize between hand hygiene procedures in order to prevent and treat dermatitis [3,4]. We found the reported frequency of application of moisturizers after hand washing was low at approximately 15%, in keeping with previous studies . Others have suggested that the low use of moisturizing cream by nurses could be due to lack of knowledge . However, our participants had a high level of knowledge about moisturizers’ role in preventing dermatitis and the potential for hand dermatitis to harbour pathogenic organisms. Lack of knowledge did not explain poor adherence. Although the associations found in our study were generally weak (ρ < 0.36) we found that nurses’ application of moisturizers was associated with their seeing it as part of their professional role and responsibilities, and believing they had been correctly trained in its application. This supports the importance of giving clear training to nurses regarding use of hand moisturizers and promoting a sense of professional responsibility and pride in appropriate hand moisturizer use at work. Interestingly, greater hand moisturizing after hand washing was associated with believing that patients approved of nurses doing so, perhaps due to the patient-centred approach of the study participants. We found no association between hand dermatitis prevalence and application of hand cream (whether at home or at work), which may be due to the cross-sectional study design or inaccurate self-reports of dermatitis prevalence. These issues warrant further investigation. As hand moisturizing is recommended best practice, nurses that did not follow practice, or had ‘embarrassing’ dermatitis, may have provided socially desirable responses, which could explain the low prevalence of dermatitis. Further research would enable a broader range of psychological factors to be assessed, and to establish if changes in beliefs change hand moisturizer behaviour and prevent hand dermatitis . Key points In this study, nurses had good knowledge of the benefits of hand moisturizers, but low rates of use. Appropriate use of hand moisturizers could be promoted as a key aspect of nurses’ professional roles. Providing training to nurses on correct use of moisturizers after hand washing may be valuable. Competing interests None declared. References 1. Campion KM . A survey of occupational skin disease in UK health care workers . Occup Med (Lond) 2015 ; 65 : 29 – 31 . Google Scholar CrossRef Search ADS PubMed 2. Ibler KS , Jemec GB , Agner T . Exposures related to hand eczema: a study of healthcare workers . Contact Dermatitis 2012 ; 66 : 247 – 253 . Google Scholar CrossRef Search ADS PubMed 3. Kampf G , Löffler H . Prevention of irritant contact dermatitis among health care workers by using evidence-based hand hygiene practices: a review . Ind Health 2007 ; 45 : 645 – 652 . Google Scholar CrossRef Search ADS PubMed 4. Nicholson PJ , Llewellyn D , English JS ; Guidelines Development Group . Evidence-based guidelines for the prevention, identification and management of occupational contact dermatitis and urticaria . Contact Dermatitis 2010 ; 63 : 177 – 186 . Google Scholar CrossRef Search ADS PubMed 5. Visser MJ , Verberk MM , van Dijk FJ , Bakker JG , Bos JD , Kezic S . Wet work and hand eczema in apprentice nurses; part I of a prospective cohort study . Contact Dermatitis 2014 ; 70 : 44 – 55 . Google Scholar CrossRef Search ADS PubMed 6. Cane J , O’Connor D , Michie S . Validation of the theoretical domains framework for use in behaviour change and implementation research . Implement Sci 2012 ; 7 : 37 . Google Scholar CrossRef Search ADS PubMed 7. Susitaival P , Flyvholm MA , Meding B , et al. Nordic Occupational Skin Questionnaire (NOSQ-2002): a new tool for surveying occupational skin diseases and exposure . Contact Dermatitis 2003 ; 49 : 70 – 76 . Google Scholar CrossRef Search ADS PubMed 8. Department of Health . Governance Arrangements for Research Ethics Committees . 2011 [updated April 2012].https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/213753/dh_133993.pdf ( 24 January 2018 , date last accessed). 9. Grosse-Schutte K , Assadian O , Hubner NO , Loffler H , Kramer A . Practices of skin care among nurses in medical and surgical intensive care units: results of a self-administered questionnaire . GMS Krankenhaushyg Interdiszip 2011 ; 6 : Doc08 . 10. Madan I , Parsons V , Cookson B , et al. A behavioural change package to prevent hand dermatitis in nurses working in the national health service (the SCIN trial): study protocol for a cluster randomised controlled trial . Trials 2016 ; 17 : 145 . Google Scholar CrossRef Search ADS PubMed © The Author(s) 2018. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: firstname.lastname@example.org This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices)
Occupational Medicine – Oxford University Press
Published: May 7, 2018
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