Skin-specific training experience of workers assessed for contact dermatitis

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. Creams, dermatitis, education, gloves, occupational contact dermatitis, occupational disease, occupational exposure, prevention, skin protection, training 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. Table 1. Workplace, training, exposure and prevention characteristics Overall (n = 122) (100%) SST (n = 47) (39%) No SST (n = 75) (61%) Sector  Manufacturing and automotive 29 (24) 13 (28) 16 (21)  Health care 31 (25) 15 (32) 16 (21)  Service 29 (24) 8 (17) 21 (28)  Government and finance 11 (9) 1 (2) 10 (13)  Other 22 (18) 10 (21) 12 (16) Company size  <20 36 (30) 18 (39) 18 (24)  20–100 36 (30) 11 (24) 25 (33)  >100 49 (40) 17 (37) 32 (43) Workplace is unionized 52 (43) 24 (51) 28 (37) Workplace has a JHSC (company size >20 workers) 92 (90) 35 (92) 57 (89) MSDS available in workplace 94 (77) 42 (89) 52 (69)* Employer sees OSD as a problem 36 (31) 15 (34) 21 (29) Employer provides skin exams 11 (9) 10 (22) 1 (1)*** Co-workers experience skin problems 59 (54) 29 (69) 30 (44)* General OHS training provided 97 (80) 44 (96) 53 (71)** WHMIS training provided 93 (76) 42 (89) 51 (68)*  Education 85 (70) 42 (89) 43 (57)***  MSDS 79 (65) 39 (83) 40 (53)**  Labels 81 (66) 37 (79) 44 (59)*  Procedures 68 (56) 33 (70) 35 (47)*  Pictograms 50 (41) 24 (51) 26 (35) Wet worker 84 (69) 38 (81) 46 (61)*  Hands are wet for >2 h/workday 37 (30) 16 (34) 21 (28)  Wears gloves for >2 h/workday 65 (53) 31 (66) 34 (45)*  Washes hands >20 h/workday 44 (36) 18 (38) 26 (35) Wears gloves at work 84 (69) 40 (85) 44 (59)**  Wears cotton liner gloves 18 (15) 9 (19) 9 (12) Uses hand or barrier creams 86 (72) 35 (75) 51 (70) Uses MSDS at work 50 (41) 30 (64) 20 (27)*** Overall (n = 122) (100%) SST (n = 47) (39%) No SST (n = 75) (61%) Sector  Manufacturing and automotive 29 (24) 13 (28) 16 (21)  Health care 31 (25) 15 (32) 16 (21)  Service 29 (24) 8 (17) 21 (28)  Government and finance 11 (9) 1 (2) 10 (13)  Other 22 (18) 10 (21) 12 (16) Company size  <20 36 (30) 18 (39) 18 (24)  20–100 36 (30) 11 (24) 25 (33)  >100 49 (40) 17 (37) 32 (43) Workplace is unionized 52 (43) 24 (51) 28 (37) Workplace has a JHSC (company size >20 workers) 92 (90) 35 (92) 57 (89) MSDS available in workplace 94 (77) 42 (89) 52 (69)* Employer sees OSD as a problem 36 (31) 15 (34) 21 (29) Employer provides skin exams 11 (9) 10 (22) 1 (1)*** Co-workers experience skin problems 59 (54) 29 (69) 30 (44)* General OHS training provided 97 (80) 44 (96) 53 (71)** WHMIS training provided 93 (76) 42 (89) 51 (68)*  Education 85 (70) 42 (89) 43 (57)***  MSDS 79 (65) 39 (83) 40 (53)**  Labels 81 (66) 37 (79) 44 (59)*  Procedures 68 (56) 33 (70) 35 (47)*  Pictograms 50 (41) 24 (51) 26 (35) Wet worker 84 (69) 38 (81) 46 (61)*  Hands are wet for >2 h/workday 37 (30) 16 (34) 21 (28)  Wears gloves for >2 h/workday 65 (53) 31 (66) 34 (45)*  Washes hands >20 h/workday 44 (36) 18 (38) 26 (35) Wears gloves at work 84 (69) 40 (85) 44 (59)**  Wears cotton liner gloves 18 (15) 9 (19) 9 (12) Uses hand or barrier creams 86 (72) 35 (75) 51 (70) Uses MSDS at work 50 (41) 30 (64) 20 (27)*** Due to missing data, the denominator varies across variables. JHSC, Joint Health and Safety Committee; OSD, occupational skin disease. *P < 0.05 for difference between SST and no SST. **P < 0.01 for difference between SST and no SST. ***P < 0.001 for difference between SST and no SST. View Large Table 1. Workplace, training, exposure and prevention characteristics Overall (n = 122) (100%) SST (n = 47) (39%) No SST (n = 75) (61%) Sector  Manufacturing and automotive 29 (24) 13 (28) 16 (21)  Health care 31 (25) 15 (32) 16 (21)  Service 29 (24) 8 (17) 21 (28)  Government and finance 11 (9) 1 (2) 10 (13)  Other 22 (18) 10 (21) 12 (16) Company size  <20 36 (30) 18 (39) 18 (24)  20–100 36 (30) 11 (24) 25 (33)  >100 49 (40) 17 (37) 32 (43) Workplace is unionized 52 (43) 24 (51) 28 (37) Workplace has a JHSC (company size >20 workers) 92 (90) 35 (92) 57 (89) MSDS available in workplace 94 (77) 42 (89) 52 (69)* Employer sees OSD as a problem 36 (31) 15 (34) 21 (29) Employer provides skin exams 11 (9) 10 (22) 1 (1)*** Co-workers experience skin problems 59 (54) 29 (69) 30 (44)* General OHS training provided 97 (80) 44 (96) 53 (71)** WHMIS training provided 93 (76) 42 (89) 51 (68)*  Education 85 (70) 42 (89) 43 (57)***  MSDS 79 (65) 39 (83) 40 (53)**  Labels 81 (66) 37 (79) 44 (59)*  Procedures 68 (56) 33 (70) 35 (47)*  Pictograms 50 (41) 24 (51) 26 (35) Wet worker 84 (69) 38 (81) 46 (61)*  Hands are wet for >2 h/workday 37 (30) 16 (34) 21 (28)  Wears gloves for >2 h/workday 65 (53) 31 (66) 34 (45)*  Washes hands >20 h/workday 44 (36) 18 (38) 26 (35) Wears gloves at work 84 (69) 40 (85) 44 (59)**  Wears cotton liner gloves 18 (15) 9 (19) 9 (12) Uses hand or barrier creams 86 (72) 35 (75) 51 (70) Uses MSDS at work 50 (41) 30 (64) 20 (27)*** Overall (n = 122) (100%) SST (n = 47) (39%) No SST (n = 75) (61%) Sector  Manufacturing and automotive 29 (24) 13 (28) 16 (21)  Health care 31 (25) 15 (32) 16 (21)  Service 29 (24) 8 (17) 21 (28)  Government and finance 11 (9) 1 (2) 10 (13)  Other 22 (18) 10 (21) 12 (16) Company size  <20 36 (30) 18 (39) 18 (24)  20–100 36 (30) 11 (24) 25 (33)  >100 49 (40) 17 (37) 32 (43) Workplace is unionized 52 (43) 24 (51) 28 (37) Workplace has a JHSC (company size >20 workers) 92 (90) 35 (92) 57 (89) MSDS available in workplace 94 (77) 42 (89) 52 (69)* Employer sees OSD as a problem 36 (31) 15 (34) 21 (29) Employer provides skin exams 11 (9) 10 (22) 1 (1)*** Co-workers experience skin problems 59 (54) 29 (69) 30 (44)* General OHS training provided 97 (80) 44 (96) 53 (71)** WHMIS training provided 93 (76) 42 (89) 51 (68)*  Education 85 (70) 42 (89) 43 (57)***  MSDS 79 (65) 39 (83) 40 (53)**  Labels 81 (66) 37 (79) 44 (59)*  Procedures 68 (56) 33 (70) 35 (47)*  Pictograms 50 (41) 24 (51) 26 (35) Wet worker 84 (69) 38 (81) 46 (61)*  Hands are wet for >2 h/workday 37 (30) 16 (34) 21 (28)  Wears gloves for >2 h/workday 65 (53) 31 (66) 34 (45)*  Washes hands >20 h/workday 44 (36) 18 (38) 26 (35) Wears gloves at work 84 (69) 40 (85) 44 (59)**  Wears cotton liner gloves 18 (15) 9 (19) 9 (12) Uses hand or barrier creams 86 (72) 35 (75) 51 (70) Uses MSDS at work 50 (41) 30 (64) 20 (27)*** Due to missing data, the denominator varies across variables. JHSC, Joint Health and Safety Committee; OSD, occupational skin disease. *P < 0.05 for difference between SST and no SST. **P < 0.01 for difference between SST and no SST. ***P < 0.001 for difference between SST and no SST. View Large 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. Table 2. SST characteristics Overall (n = 47) (%) Training provider  Health and safety staff 19 (40)  Supervisor/manager 19 (40)  Self 7 (15)  External agency 6 (13)  Union school 3 (6)  Vocational school 2 (4)  Co-worker 2 (4)  Other 10 (21) Method of delivery  Video 16 (34)  Classroom demonstration 15 (32)  Online 14 (30)  Seminar 9 (19)  Workstation demonstration 8 (17)  Poster 8 (17)  Brochure 7 (15) Content covered  Use of gloves 43 (92)  Avoiding or minimizing exposure 36 (77)  Hand washing 35 (75)  Skin problems resulting from exposure 15 (32)  Use of creams 13 (28)  Early symptoms of skin disease 9 (19) Content was specific to job task 28 (60) Duration of SST  <15 min 19 (41)  15–30 min 22 (48)  >1 h 5 (11) Attendance recorded 32 (68) Quiz administered 24 (51) Amount of SST retained  <25% 6 (13)  50% 24 (51)  >75% 17 (36) Supervisor or manager follow-up 13 (28) SST was useful 40 (85) SST was common sense 47 (100) Overall (n = 47) (%) Training provider  Health and safety staff 19 (40)  Supervisor/manager 19 (40)  Self 7 (15)  External agency 6 (13)  Union school 3 (6)  Vocational school 2 (4)  Co-worker 2 (4)  Other 10 (21) Method of delivery  Video 16 (34)  Classroom demonstration 15 (32)  Online 14 (30)  Seminar 9 (19)  Workstation demonstration 8 (17)  Poster 8 (17)  Brochure 7 (15) Content covered  Use of gloves 43 (92)  Avoiding or minimizing exposure 36 (77)  Hand washing 35 (75)  Skin problems resulting from exposure 15 (32)  Use of creams 13 (28)  Early symptoms of skin disease 9 (19) Content was specific to job task 28 (60) Duration of SST  <15 min 19 (41)  15–30 min 22 (48)  >1 h 5 (11) Attendance recorded 32 (68) Quiz administered 24 (51) Amount of SST retained  <25% 6 (13)  50% 24 (51)  >75% 17 (36) Supervisor or manager follow-up 13 (28) SST was useful 40 (85) SST was common sense 47 (100) View Large Table 2. SST characteristics Overall (n = 47) (%) Training provider  Health and safety staff 19 (40)  Supervisor/manager 19 (40)  Self 7 (15)  External agency 6 (13)  Union school 3 (6)  Vocational school 2 (4)  Co-worker 2 (4)  Other 10 (21) Method of delivery  Video 16 (34)  Classroom demonstration 15 (32)  Online 14 (30)  Seminar 9 (19)  Workstation demonstration 8 (17)  Poster 8 (17)  Brochure 7 (15) Content covered  Use of gloves 43 (92)  Avoiding or minimizing exposure 36 (77)  Hand washing 35 (75)  Skin problems resulting from exposure 15 (32)  Use of creams 13 (28)  Early symptoms of skin disease 9 (19) Content was specific to job task 28 (60) Duration of SST  <15 min 19 (41)  15–30 min 22 (48)  >1 h 5 (11) Attendance recorded 32 (68) Quiz administered 24 (51) Amount of SST retained  <25% 6 (13)  50% 24 (51)  >75% 17 (36) Supervisor or manager follow-up 13 (28) SST was useful 40 (85) SST was common sense 47 (100) Overall (n = 47) (%) Training provider  Health and safety staff 19 (40)  Supervisor/manager 19 (40)  Self 7 (15)  External agency 6 (13)  Union school 3 (6)  Vocational school 2 (4)  Co-worker 2 (4)  Other 10 (21) Method of delivery  Video 16 (34)  Classroom demonstration 15 (32)  Online 14 (30)  Seminar 9 (19)  Workstation demonstration 8 (17)  Poster 8 (17)  Brochure 7 (15) Content covered  Use of gloves 43 (92)  Avoiding or minimizing exposure 36 (77)  Hand washing 35 (75)  Skin problems resulting from exposure 15 (32)  Use of creams 13 (28)  Early symptoms of skin disease 9 (19) Content was specific to job task 28 (60) Duration of SST  <15 min 19 (41)  15–30 min 22 (48)  >1 h 5 (11) Attendance recorded 32 (68) Quiz administered 24 (51) Amount of SST retained  <25% 6 (13)  50% 24 (51)  >75% 17 (36) Supervisor or manager follow-up 13 (28) SST was useful 40 (85) SST was common sense 47 (100) View Large 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. Key points There are gaps in provision of training on skin exposures and skin protection among workers with contact dermatitis. More than half of the at risk workers in our study, who may have benefitted most from skin specific training, did not receive such training. Most workers who received skin-specific training found it useful, memorable and common sense in nature. Funding Centre for Research Expertise in Occupational Disease funded by the Ontario Ministry of Labour. Competing interests None declared. References 1. Diepgen TL . Occupational skin diseases . J Dtsch Dermatol Ges 2012 ; 10 : 297 – 313; quiz 314 . Google Scholar PubMed 2. Seyfarth F , Schliemann S , Antonov D , Elsner P . Teaching interventions in contact dermatitis . Dermatitis 2011 ; 22 : 8 – 15 . Google Scholar PubMed 3. van Gils RF , Boot CR , van Gils PF , et al. Effectiveness of prevention programmes for hand dermatitis: a systematic review of the literature . Contact Dermatitis 2011 ; 64 : 63 – 72 . 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. Agner T , Held E . Skin protection programmes . Contact Dermatitis 2002 ; 47 : 253 – 256 . Google Scholar CrossRef Search ADS PubMed 6. Schwanitz HJ , Riehl U , Schlesinger T , Bock M , Skudlik C , Wulfhorst B . Skin care management: educational aspects . Int Arch Occup Environ Health 2003 ; 76 : 374 – 381 . Google Scholar CrossRef Search ADS PubMed 7. Zack B , Arrandale VH , Holness DL . Workers with hand dermatitis and workplace training experiences: a qualitative perspective . Am J Ind Med 2017 ; 60 : 69 – 76 . Google Scholar CrossRef Search ADS PubMed 8. Holness DL , Kudla I . Workers with occupational contact dermatitis: workplace characteristics and prevention practices . Occup Med (Lond) 2012 ; 62 : 455 – 457 . Google Scholar CrossRef Search ADS PubMed 9. Rowley K , Ajami D , Gervais D , et al. Glove use and glove education in workers with hand dermatitis . Dermatitis 2016 ; 27 : 30 – 32 . Google Scholar CrossRef Search ADS PubMed 10. Gerber R . The concept of common sense in workplace learning and experience . Education+ Training 2001 ; 43 : 72 – 81 . Google Scholar CrossRef Search ADS © The Author(s) 2018. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com 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) http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Occupational Medicine Oxford University Press

Skin-specific training experience of workers assessed for contact dermatitis

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© The Author(s) 2018. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com
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Abstract

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. Creams, dermatitis, education, gloves, occupational contact dermatitis, occupational disease, occupational exposure, prevention, skin protection, training 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. Table 1. Workplace, training, exposure and prevention characteristics Overall (n = 122) (100%) SST (n = 47) (39%) No SST (n = 75) (61%) Sector  Manufacturing and automotive 29 (24) 13 (28) 16 (21)  Health care 31 (25) 15 (32) 16 (21)  Service 29 (24) 8 (17) 21 (28)  Government and finance 11 (9) 1 (2) 10 (13)  Other 22 (18) 10 (21) 12 (16) Company size  <20 36 (30) 18 (39) 18 (24)  20–100 36 (30) 11 (24) 25 (33)  >100 49 (40) 17 (37) 32 (43) Workplace is unionized 52 (43) 24 (51) 28 (37) Workplace has a JHSC (company size >20 workers) 92 (90) 35 (92) 57 (89) MSDS available in workplace 94 (77) 42 (89) 52 (69)* Employer sees OSD as a problem 36 (31) 15 (34) 21 (29) Employer provides skin exams 11 (9) 10 (22) 1 (1)*** Co-workers experience skin problems 59 (54) 29 (69) 30 (44)* General OHS training provided 97 (80) 44 (96) 53 (71)** WHMIS training provided 93 (76) 42 (89) 51 (68)*  Education 85 (70) 42 (89) 43 (57)***  MSDS 79 (65) 39 (83) 40 (53)**  Labels 81 (66) 37 (79) 44 (59)*  Procedures 68 (56) 33 (70) 35 (47)*  Pictograms 50 (41) 24 (51) 26 (35) Wet worker 84 (69) 38 (81) 46 (61)*  Hands are wet for >2 h/workday 37 (30) 16 (34) 21 (28)  Wears gloves for >2 h/workday 65 (53) 31 (66) 34 (45)*  Washes hands >20 h/workday 44 (36) 18 (38) 26 (35) Wears gloves at work 84 (69) 40 (85) 44 (59)**  Wears cotton liner gloves 18 (15) 9 (19) 9 (12) Uses hand or barrier creams 86 (72) 35 (75) 51 (70) Uses MSDS at work 50 (41) 30 (64) 20 (27)*** Overall (n = 122) (100%) SST (n = 47) (39%) No SST (n = 75) (61%) Sector  Manufacturing and automotive 29 (24) 13 (28) 16 (21)  Health care 31 (25) 15 (32) 16 (21)  Service 29 (24) 8 (17) 21 (28)  Government and finance 11 (9) 1 (2) 10 (13)  Other 22 (18) 10 (21) 12 (16) Company size  <20 36 (30) 18 (39) 18 (24)  20–100 36 (30) 11 (24) 25 (33)  >100 49 (40) 17 (37) 32 (43) Workplace is unionized 52 (43) 24 (51) 28 (37) Workplace has a JHSC (company size >20 workers) 92 (90) 35 (92) 57 (89) MSDS available in workplace 94 (77) 42 (89) 52 (69)* Employer sees OSD as a problem 36 (31) 15 (34) 21 (29) Employer provides skin exams 11 (9) 10 (22) 1 (1)*** Co-workers experience skin problems 59 (54) 29 (69) 30 (44)* General OHS training provided 97 (80) 44 (96) 53 (71)** WHMIS training provided 93 (76) 42 (89) 51 (68)*  Education 85 (70) 42 (89) 43 (57)***  MSDS 79 (65) 39 (83) 40 (53)**  Labels 81 (66) 37 (79) 44 (59)*  Procedures 68 (56) 33 (70) 35 (47)*  Pictograms 50 (41) 24 (51) 26 (35) Wet worker 84 (69) 38 (81) 46 (61)*  Hands are wet for >2 h/workday 37 (30) 16 (34) 21 (28)  Wears gloves for >2 h/workday 65 (53) 31 (66) 34 (45)*  Washes hands >20 h/workday 44 (36) 18 (38) 26 (35) Wears gloves at work 84 (69) 40 (85) 44 (59)**  Wears cotton liner gloves 18 (15) 9 (19) 9 (12) Uses hand or barrier creams 86 (72) 35 (75) 51 (70) Uses MSDS at work 50 (41) 30 (64) 20 (27)*** Due to missing data, the denominator varies across variables. JHSC, Joint Health and Safety Committee; OSD, occupational skin disease. *P < 0.05 for difference between SST and no SST. **P < 0.01 for difference between SST and no SST. ***P < 0.001 for difference between SST and no SST. View Large Table 1. Workplace, training, exposure and prevention characteristics Overall (n = 122) (100%) SST (n = 47) (39%) No SST (n = 75) (61%) Sector  Manufacturing and automotive 29 (24) 13 (28) 16 (21)  Health care 31 (25) 15 (32) 16 (21)  Service 29 (24) 8 (17) 21 (28)  Government and finance 11 (9) 1 (2) 10 (13)  Other 22 (18) 10 (21) 12 (16) Company size  <20 36 (30) 18 (39) 18 (24)  20–100 36 (30) 11 (24) 25 (33)  >100 49 (40) 17 (37) 32 (43) Workplace is unionized 52 (43) 24 (51) 28 (37) Workplace has a JHSC (company size >20 workers) 92 (90) 35 (92) 57 (89) MSDS available in workplace 94 (77) 42 (89) 52 (69)* Employer sees OSD as a problem 36 (31) 15 (34) 21 (29) Employer provides skin exams 11 (9) 10 (22) 1 (1)*** Co-workers experience skin problems 59 (54) 29 (69) 30 (44)* General OHS training provided 97 (80) 44 (96) 53 (71)** WHMIS training provided 93 (76) 42 (89) 51 (68)*  Education 85 (70) 42 (89) 43 (57)***  MSDS 79 (65) 39 (83) 40 (53)**  Labels 81 (66) 37 (79) 44 (59)*  Procedures 68 (56) 33 (70) 35 (47)*  Pictograms 50 (41) 24 (51) 26 (35) Wet worker 84 (69) 38 (81) 46 (61)*  Hands are wet for >2 h/workday 37 (30) 16 (34) 21 (28)  Wears gloves for >2 h/workday 65 (53) 31 (66) 34 (45)*  Washes hands >20 h/workday 44 (36) 18 (38) 26 (35) Wears gloves at work 84 (69) 40 (85) 44 (59)**  Wears cotton liner gloves 18 (15) 9 (19) 9 (12) Uses hand or barrier creams 86 (72) 35 (75) 51 (70) Uses MSDS at work 50 (41) 30 (64) 20 (27)*** Overall (n = 122) (100%) SST (n = 47) (39%) No SST (n = 75) (61%) Sector  Manufacturing and automotive 29 (24) 13 (28) 16 (21)  Health care 31 (25) 15 (32) 16 (21)  Service 29 (24) 8 (17) 21 (28)  Government and finance 11 (9) 1 (2) 10 (13)  Other 22 (18) 10 (21) 12 (16) Company size  <20 36 (30) 18 (39) 18 (24)  20–100 36 (30) 11 (24) 25 (33)  >100 49 (40) 17 (37) 32 (43) Workplace is unionized 52 (43) 24 (51) 28 (37) Workplace has a JHSC (company size >20 workers) 92 (90) 35 (92) 57 (89) MSDS available in workplace 94 (77) 42 (89) 52 (69)* Employer sees OSD as a problem 36 (31) 15 (34) 21 (29) Employer provides skin exams 11 (9) 10 (22) 1 (1)*** Co-workers experience skin problems 59 (54) 29 (69) 30 (44)* General OHS training provided 97 (80) 44 (96) 53 (71)** WHMIS training provided 93 (76) 42 (89) 51 (68)*  Education 85 (70) 42 (89) 43 (57)***  MSDS 79 (65) 39 (83) 40 (53)**  Labels 81 (66) 37 (79) 44 (59)*  Procedures 68 (56) 33 (70) 35 (47)*  Pictograms 50 (41) 24 (51) 26 (35) Wet worker 84 (69) 38 (81) 46 (61)*  Hands are wet for >2 h/workday 37 (30) 16 (34) 21 (28)  Wears gloves for >2 h/workday 65 (53) 31 (66) 34 (45)*  Washes hands >20 h/workday 44 (36) 18 (38) 26 (35) Wears gloves at work 84 (69) 40 (85) 44 (59)**  Wears cotton liner gloves 18 (15) 9 (19) 9 (12) Uses hand or barrier creams 86 (72) 35 (75) 51 (70) Uses MSDS at work 50 (41) 30 (64) 20 (27)*** Due to missing data, the denominator varies across variables. JHSC, Joint Health and Safety Committee; OSD, occupational skin disease. *P < 0.05 for difference between SST and no SST. **P < 0.01 for difference between SST and no SST. ***P < 0.001 for difference between SST and no SST. View Large 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. Table 2. SST characteristics Overall (n = 47) (%) Training provider  Health and safety staff 19 (40)  Supervisor/manager 19 (40)  Self 7 (15)  External agency 6 (13)  Union school 3 (6)  Vocational school 2 (4)  Co-worker 2 (4)  Other 10 (21) Method of delivery  Video 16 (34)  Classroom demonstration 15 (32)  Online 14 (30)  Seminar 9 (19)  Workstation demonstration 8 (17)  Poster 8 (17)  Brochure 7 (15) Content covered  Use of gloves 43 (92)  Avoiding or minimizing exposure 36 (77)  Hand washing 35 (75)  Skin problems resulting from exposure 15 (32)  Use of creams 13 (28)  Early symptoms of skin disease 9 (19) Content was specific to job task 28 (60) Duration of SST  <15 min 19 (41)  15–30 min 22 (48)  >1 h 5 (11) Attendance recorded 32 (68) Quiz administered 24 (51) Amount of SST retained  <25% 6 (13)  50% 24 (51)  >75% 17 (36) Supervisor or manager follow-up 13 (28) SST was useful 40 (85) SST was common sense 47 (100) Overall (n = 47) (%) Training provider  Health and safety staff 19 (40)  Supervisor/manager 19 (40)  Self 7 (15)  External agency 6 (13)  Union school 3 (6)  Vocational school 2 (4)  Co-worker 2 (4)  Other 10 (21) Method of delivery  Video 16 (34)  Classroom demonstration 15 (32)  Online 14 (30)  Seminar 9 (19)  Workstation demonstration 8 (17)  Poster 8 (17)  Brochure 7 (15) Content covered  Use of gloves 43 (92)  Avoiding or minimizing exposure 36 (77)  Hand washing 35 (75)  Skin problems resulting from exposure 15 (32)  Use of creams 13 (28)  Early symptoms of skin disease 9 (19) Content was specific to job task 28 (60) Duration of SST  <15 min 19 (41)  15–30 min 22 (48)  >1 h 5 (11) Attendance recorded 32 (68) Quiz administered 24 (51) Amount of SST retained  <25% 6 (13)  50% 24 (51)  >75% 17 (36) Supervisor or manager follow-up 13 (28) SST was useful 40 (85) SST was common sense 47 (100) View Large Table 2. SST characteristics Overall (n = 47) (%) Training provider  Health and safety staff 19 (40)  Supervisor/manager 19 (40)  Self 7 (15)  External agency 6 (13)  Union school 3 (6)  Vocational school 2 (4)  Co-worker 2 (4)  Other 10 (21) Method of delivery  Video 16 (34)  Classroom demonstration 15 (32)  Online 14 (30)  Seminar 9 (19)  Workstation demonstration 8 (17)  Poster 8 (17)  Brochure 7 (15) Content covered  Use of gloves 43 (92)  Avoiding or minimizing exposure 36 (77)  Hand washing 35 (75)  Skin problems resulting from exposure 15 (32)  Use of creams 13 (28)  Early symptoms of skin disease 9 (19) Content was specific to job task 28 (60) Duration of SST  <15 min 19 (41)  15–30 min 22 (48)  >1 h 5 (11) Attendance recorded 32 (68) Quiz administered 24 (51) Amount of SST retained  <25% 6 (13)  50% 24 (51)  >75% 17 (36) Supervisor or manager follow-up 13 (28) SST was useful 40 (85) SST was common sense 47 (100) Overall (n = 47) (%) Training provider  Health and safety staff 19 (40)  Supervisor/manager 19 (40)  Self 7 (15)  External agency 6 (13)  Union school 3 (6)  Vocational school 2 (4)  Co-worker 2 (4)  Other 10 (21) Method of delivery  Video 16 (34)  Classroom demonstration 15 (32)  Online 14 (30)  Seminar 9 (19)  Workstation demonstration 8 (17)  Poster 8 (17)  Brochure 7 (15) Content covered  Use of gloves 43 (92)  Avoiding or minimizing exposure 36 (77)  Hand washing 35 (75)  Skin problems resulting from exposure 15 (32)  Use of creams 13 (28)  Early symptoms of skin disease 9 (19) Content was specific to job task 28 (60) Duration of SST  <15 min 19 (41)  15–30 min 22 (48)  >1 h 5 (11) Attendance recorded 32 (68) Quiz administered 24 (51) Amount of SST retained  <25% 6 (13)  50% 24 (51)  >75% 17 (36) Supervisor or manager follow-up 13 (28) SST was useful 40 (85) SST was common sense 47 (100) View Large 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. Key points There are gaps in provision of training on skin exposures and skin protection among workers with contact dermatitis. More than half of the at risk workers in our study, who may have benefitted most from skin specific training, did not receive such training. Most workers who received skin-specific training found it useful, memorable and common sense in nature. Funding Centre for Research Expertise in Occupational Disease funded by the Ontario Ministry of Labour. Competing interests None declared. References 1. Diepgen TL . Occupational skin diseases . J Dtsch Dermatol Ges 2012 ; 10 : 297 – 313; quiz 314 . Google Scholar PubMed 2. Seyfarth F , Schliemann S , Antonov D , Elsner P . Teaching interventions in contact dermatitis . Dermatitis 2011 ; 22 : 8 – 15 . Google Scholar PubMed 3. van Gils RF , Boot CR , van Gils PF , et al. Effectiveness of prevention programmes for hand dermatitis: a systematic review of the literature . Contact Dermatitis 2011 ; 64 : 63 – 72 . 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. Agner T , Held E . Skin protection programmes . Contact Dermatitis 2002 ; 47 : 253 – 256 . Google Scholar CrossRef Search ADS PubMed 6. Schwanitz HJ , Riehl U , Schlesinger T , Bock M , Skudlik C , Wulfhorst B . Skin care management: educational aspects . Int Arch Occup Environ Health 2003 ; 76 : 374 – 381 . Google Scholar CrossRef Search ADS PubMed 7. Zack B , Arrandale VH , Holness DL . Workers with hand dermatitis and workplace training experiences: a qualitative perspective . Am J Ind Med 2017 ; 60 : 69 – 76 . Google Scholar CrossRef Search ADS PubMed 8. Holness DL , Kudla I . Workers with occupational contact dermatitis: workplace characteristics and prevention practices . Occup Med (Lond) 2012 ; 62 : 455 – 457 . Google Scholar CrossRef Search ADS PubMed 9. Rowley K , Ajami D , Gervais D , et al. Glove use and glove education in workers with hand dermatitis . Dermatitis 2016 ; 27 : 30 – 32 . Google Scholar CrossRef Search ADS PubMed 10. Gerber R . The concept of common sense in workplace learning and experience . Education+ Training 2001 ; 43 : 72 – 81 . Google Scholar CrossRef Search ADS © The Author(s) 2018. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com 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)

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Occupational MedicineOxford University Press

Published: Feb 17, 2018

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