Policy for the Prevention & Management of Work Related Skin Disorders in Trust Employees

Contents Page1 Introduction 32 Purpose 33 Function of the Policy 34 Occupational Dermatoses

4.1 Corrosion and chemical burns.4.2 Dermatitis4.3 Other

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5 Risk assessment5.1 Glove Selection & Risk Assessment

5.1.1 Glove Selection5.1.2 Non Clinical Setting

5.2 Control measures for reducing Occupational Skin Disorders

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6 Responsibilities6.1 The Trust 6.2 Director of Workforce & Organisational Development6.3 Managers and Supervisors6.4 All Staff6.5 Occupational Health6.6 Risk Management6.7 Infection, Prevention & Control Team6.8 Clinical Skills team6.9 Procurement

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7 Skin Health Surveillance & Promotion 98 Definitions 109 Dissemination/Circulation 1010 Implementation 1111 Process for Monitoring Compliance and Effectiveness 1112 Equality Impact Assessment 1213 References 14

Appendix 1 Glove Selection & Usage 15Appendix 2 General Glove Selection 16Appendix 3 Relevant Legislation 17Appendix 4 On Employment Screening For Employees Potentially exposed to latex

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Appendix 5 – Occupational Health Skin Health Surveillance Questionnaire

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Author: Dr. B Blackburn

Consultant Occupational Health Physician

Date: January 2019

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Policy for the Prevention and Management of Work Related Skin Disorders in Trust Employees January 2019

1 IntroductionDermatitis is a common occurrence within current NHS hand hygiene practices and hence results in occupational disease. The commonly encountered categories are Irritant contact dermatitis and contact dermatitis.

As with all occupational disease prevention is the key where applicable and with most cases of occupational skin disorders, preventing skin contact as far as is practicable with causative chemicals or other skin damaging agents could prevent the disorder from developing or progressing.

This updated policy also now incorporates the previous ‘Protocol for Glove Selection’ CG109 into the contents of the policy.

2 PurposeThe xxx NHS Foundation Trust, (hereinafter referred to as the "Trust"), believe that an excellent organisation is, by definition, a safe organisation. This policy has been developed to ensure that the Trust complies with the requirements of the Health and Safety at work Act 1974, Management of Health and Safety at Work Regulations 1999 and the Control of Substances Hazardous to Health 2002 (as amended) and the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013.

The policy is to promote, as far as is reasonably practical, a work environment and work practices that protect the health, safety and welfare of its staff. It aims to reduce the risk of skin disorders due to exposure to substances at work and maintain and promote safe systems of work and behaviour that will achieve a reduction in Skin health adverse outcomes. 

3 Function of the PolicyThis policy has been developed to:

Clearly identify responsibilities, roles and provide guidance for the prevention and/or reduction of occupational skin disorders.

Provide guidance on Risk assessment of Hazards to skin in the Trust workplace. Minimise the risks to staff from substances and practices that could affect skin. Promote good practice through increased knowledge of risks and its management. Raise awareness of the effects on skin by exposure to substances hazardous to skin.

4 Occupational DermatosesOccupational Dermatoses, (also known as occupational skin disorders within this policy) can be placed into three major categories:

4.1 Corrosion and chemical burnsDiscuss with health and Safety Team and Occupational Health for relevant advice and recommendations.

Author: Dr. B Blackburn

Consultant Occupational Health Physician

Date: January 2019

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Policy for the Prevention and Management of Work Related Skin Disorders in Trust Employees January 2019

4.2 Dermatitis Contact Allergic Irritant Type 1 hypersensitivity /Urticarial Reactions.

- Latex hypersensitivity – See Appendix 3

4.3 Other (less frequent) skin conditions- e.g. Psoriasis, Vitiligo, Acne (Chloracne) etc.

5 Risk assessmentAll Managers should have the required risk assessments undertaken as per COSHH (2002) completed and recorded in their work areas. When assessing the risk of skin exposure the following should be determined:   List of hazards- the substance or substances being used that could harm skin according

to safety data sheets. The substance strength or potency. How long and how often the substance touches the skin. Who are exposed and how frequently.

5.1 Glove Selection & Risk Assessment

The Trust promotes a latex glove free environment as far as is reasonably practical.

Gloves should be selected according to the risk assessment for the job.. Risk assessment should take into account not only personal risk but also risk to patients with latex sensitivity. When you select protective gloves, base your choice on the work, the wearer and the environment they work in. You need to consider the following five factors: (ref- Hse Glove selection)

Identify the substances handled. Identify all other hazards. Consider the type and duration of contact. Consider the user - size and comfort. Consider the task.

It is the responsibility of the health care worker undertaking the task to select the appropriate gloves from the departmental selection. See glove selection flow chart in Appendix 1 and General glove selection Appendix 2.

Latex (non- powdered) gloves should be rarely selected and only where it is risk assessed to be in the best clinical interest and safety of procedures performed on the patient.

Non-sterile latex gloves Should NOT be used in the Trust as there are many suitable alternatives available.

Vinyl examination gloves should be worn where there is a low risk of contamination, non-invasive clinical care, or environmental cleaning /catering/handling of most .Examination (‘Non-sterile’) nitrile gloves should be worn for non-invasive procedures where there is a high risk of exposure to Blood Borne Viruses (BBV’s) and high barrier protection is needed.

Author: Dr. B Blackburn

Consultant Occupational Health Physician

Date: January 2019

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Policy for the Prevention and Management of Work Related Skin Disorders in Trust Employees January 2019

Any area using sterile latex gloves must have completed a COSHH risk assessment, (see section 10 of the Trust COSHH Protocol CG206) and liaised with OH to ensure appropriate skin health surveillance is in place for staff using latex gloves.

5.1.1 Glove Selection

Several factors influence glove selection, for example the need for:

High barrier protection from BBVs High manual dexterity Minimal hand fatigue High tensile strength, and Tear and puncture resistance Appropriate for the chemical used at work

Where, following risk assessment, sterile latex surgical gloves are selected, they must be low protein and non-powdered gloves.

5.1.2 Non-Clinical Setting

Gloves used in a non-clinical setting may be worn to protect against thermal, mechanical or chemical hazards.

Thermal hazards include contact with very hot or cold objects, sparks or flames when welding or cutting hot metal. Mechanical hazards such as handling materials with rough or sharp surfaces. Chemical hazards such as substances containing strong acids, alkalis, solvents or

irritants may cause dermatitis or even burns.

 5.2 Control measures for reducing Occupational Skin Disorders

Use of safer alternatives where possible e.g. non latex gloves, accelerator/ or other chemicals free gloves.

If no alternative is found, then further assessment of risk reduction is needed. Personal protection equipment to protect skin from contact with the hazard should be

considered as a last resort. Training on correct and appropriate glove usage and selection, hand hygiene and

moisturising protocols should be given regularly, by the employing Trust. Skin Health monitoring/surveillance should be in place where identified for health or

COSHH (Control of Substances Hazardous to Health) reasons.

6.0 Responsibilities

6.1 The TrustIn accordance with COSHH Regulation 2002 the Trust has overall responsibility, as far as reasonably practicable, for monitoring the effective implementation of this Policy and for

Author: Dr. B Blackburn

Consultant Occupational Health Physician

Date: January 2019

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Policy for the Prevention and Management of Work Related Skin Disorders in Trust Employees January 2019

ensuring that all appropriate actions are taken to reduce the risk of developing/progressing skin disorders due to exposure to substances at work.

Law requires employers to:

assess risks; provide adequate control measures – and ensure the use and maintenance of these; provide information, instruction and training; and in appropriate cases, provide health surveillance

6.2 Director of Workforce & Organisational DevelopmentThe Director of Workforce & Organisational Development has overall responsibility as far as reasonably practicable for ensuring that a redeployment/institution of adjustments process is in place and for ensuring managers apply the process fairly and consistently across the Trust.

6.3 Managers and SupervisorsIt is the responsibility of all Managers and Supervisors to ensure that this Policy is brought to the attention of all their staff, and that they understand and adhere to the control measures contained within. All managers and supervisors have responsibility, as far as reasonably practicable, to:

Ensure that they are trained and they will be supported by OH and Risk assessment teams as appropriate and need

Ensure that suitable and sufficient risk assessments are undertaken as per COSHH (2002), so as to identify hazards for Occupational Skin Disease and to provide written control measures for eliminating/reducing the risk of Occupational Skin Disorders. 

Inform employees about the hazards they will encounter and the control measures in place

Ensure the provision of appropriate and adequate training for employees to recognise and report skin symptoms i.e. keeping up to date with mandatory training for infection control and health & safety training/ risk management.

Review and record appropriately staff members response to their skin surveillance questions as part of their annual appraisal process.

Monitor all staff with skin symptoms related to work and ensure that those with symptoms are referred to Occupational Health (OH).

Implement advice received from Occupational Health regarding skin health at work. Ensure that all diagnosed Occupational skin conditions are reported via the Trust's

Incident reporting Form (Datix). Inform OH about staff who need to use latex gloves to ensure proper COSHH required

health surveillance. Ensuring all skin surveillance records are stored by their managers for 40 years from the

date of the last exposure in line with the COSHH requirements for records management

Author: Dr. B Blackburn

Consultant Occupational Health Physician

Date: January 2019

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Policy for the Prevention and Management of Work Related Skin Disorders in Trust Employees January 2019

6.4 All StaffThis Policy applies to all staff employed by the Trust whilst on Trust premises, incidents within patients' homes and on other non-Trust premises whilst on official business. It is the responsibility of all staff employed by the Trust as far as reasonably practicable to: All staff should be aware how to self refer to OH as part of their general induction. All staff on declaration of a health problem, inclusive of skin symptoms will be

appropriately assessed by OH team. Co-operate with Managers and Supervisors in achieving compliance with this policy. Safeguard their own health by following the advice set out both in this policy and the

Trust’s Hand Hygiene policy, in particular the use of standard precautions, appropriate glove selection and skin care to protect against damage.

Contact OH as soon as they are aware of skin symptoms that impact or could impact in future on work and health. Inform their line manager if they develop any skin symptoms related to and/or made worse by their work.

Comply with advice received from OH regarding glove use and/or skin health as far as practicable

6.5 Occupational HealthIt is the responsibility of the Trust's OH department as far as is reasonably practicable to:

provide advice on methods for eliminating/reducing the risk of developing skin disorders participate in staff training for skin health, where identified provide skin awareness health promotion to staff on a regular basis, at least annually to raise awareness of the management of skin in the workplace to all new staff as part of

the OH induction session on their Trust Corporate Induction conduct/assist in skin risk assessments as required advise the Director of Workforce and Organisational Developments of incident trends,

levels of performance with regards to targeted reductions and matters of concern requiring attention

Ensure all new staff who will be considered ‘wet workers’ (see section 10) complete a skin questionnaire as part of their initial health screening for their post providing advice to the new staff and their employing manager on the appropriate management of the skin condition in the workplace

Carryout skin surveillance assessments (using Appendix 4) on staff who report/develop skin problems

Liaise with Managers of existing staff where a diagnosis of occupational skin disorders is made by an OH Physician providing advice on the appropriate management of the skin condition in the workplace

Liaise with the Dermatology /Immunology specialists to ensure a procedure is in place for Trust staff identified as having occupational skin disorders by the OH Consultant Physician to be referred for further assessment and potential treatment.

Inform the Trust Risk manager of any confirmed cases of Occupational Skin Disease to be reported via RIDDOR to the Health and Safety Executive (HSE)

In the event of a positive work related skin condition, if individual or work factors present, OH/Risk management Team will investigate as appropriate.

Liaise with Procurement, Infection Prevention & Control Team (IPCT) and Risk department to review the use of latex gloves in the Trust annually and support managers to ensure appropriate risk assessments are in place to manage any use of latex gloves and where possible replace with non-latex alternatives

Author: Dr. B Blackburn

Consultant Occupational Health Physician

Date: January 2019

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Policy for the Prevention and Management of Work Related Skin Disorders in Trust Employees January 2019

Where notified by managers, ensure a process is in place to carryout skin health surveillance on those staff who use latex gloves

Monitor OH appointments for any trends relating to skin health Coordinate the Trusts skin health surveillance programme Provide an annual report to the Director of Workforce & Organisational Development,

Director of Nursing, Medical Director and Infection Prevention and Control Committee (IPCC) regarding Skin health and surveillance in the Trust. including area’s of compliance/non-compliance and any trends identified.

Ensuring all skin surveillance records are stored by their managers for 40 years from the date of the last exposure in line with the COSHH requirements for records management

6.6 Risk ManagementIt is the responsibility of risk management as far as reasonably practicable to:

Ensure that a process to monitor that Risk Assessments are undertaken as per COSHH (2002) in all areas of the Trust helping to eliminate/reduce the risk of developing skin disorders.

Analyse trends in the Trust for occupational skin disorders and liaise with OH to achieve reduction in incidents.

Report cases of Occupational Skin Disease via RIDDOR to the HSE, when notified by OH clinical team.

In the event of a positive work related skin condition, if general work factors present, Risk management Team will investigate with OH support where appropriate.

Advise on any Legal/H&S issues if relevant to such cases If requested, train the managers on glove selection.

6.7 Infection Prevention & Control Team (IPCT)It is the responsibility of the Trust's IPCT as far as is reasonably practicable to:

Provide advice and training on hand hygiene in the workplace including methods for eliminating/reducing the risk of developing skin disorders.

If identified during training, to advise any staff with skin problems to contact Occupational Health for further assessment

6.8 Clinical Skills Team

It is the responsibility of the Trust’s Clinical Skills Training team as far as reasonably practicable to:

Provide advice and training on hand hygiene in the workplace during training sessions delivered

If identified during any such training, to advise any staff with skin problems to contact Occupational Health for further assessment

Author: Dr. B Blackburn

Consultant Occupational Health Physician

Date: January 2019

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Policy for the Prevention and Management of Work Related Skin Disorders in Trust Employees January 2019

6.9 ProcurementIt is the responsibility of the Trust’s Procurement department to as far as reasonably practicable:

Liaise with the IPCT, Occupational Health and the Trust Risk Manager if changes are being made to the sourcing of products such as gloves, hand sanitisers including foam and gel products.

Provide OH with an annual report on the gloves ordered in the Trust.

7.0 Skin Health Surveillance & PromotionAs part of the Trust annual appraisal process all clinical staff and those considered ‘wet workers’ (see section 10) including housekeeping, catering and facility staff, will be asked the following question on their skin health.

If you wash your hands 20 40 times a shift, have you experienced any skin symptoms, since your last appraisal which you feel are caused by or made worse by your work?

*If Yes – Ensure you show your manager your hands. Your manager will refer you to Occupational Health for assessment, or you can self-refer.*Managers please refer to Values in Action Managers guide or Occupational Health for further information

All Doctors, who use the appraisal system will be required to acknowledge any health problems as part of their declaration process in appraisal.

For those areas where, following a risk assessment, latex gloves are in use,

The manager will be asked to provide OH with a list of staff using latex gloves.

OH will coordinate with the manager to provide a skin surveillance questionnaire (see appendix 5) which will need to be completed by staff and returned to OH within a set time period i.e. 2 weeks.

OH will assess all forms received and take further action where required.

At the end of the skin health surveillance period Occupational Health will provide a report to the Director of Workforce & Organisational Development, Senior Management for each care group, Health and Safety Committee and the IPCC highlighting compliance achieved. Any trends / areas of concern identified noted during surveillance will also be raised along with recommendations to address any trends/concerns.

Occupational Health will deliver annual skin health promotion over a dedicated 1 month period in the year, for example the month of May, this will include promoting the importance of skin health, monitoring skin and hand hygiene to Trust Staff as follows.

Delivering skin awareness poster’s to ALL appropriate area’s of the Trust both clinical and non-clinic such catering and facilities departments

Skin Health promotion stands outside main Trust restaurant

Author: Dr. B Blackburn

Consultant Occupational Health Physician

Date: January 2019

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Policy for the Prevention and Management of Work Related Skin Disorders in Trust Employees January 2019

Message to all staff via Trust Round-Up e-mail regarding skin health.

Screen saver message to staff on skin health during the dedicated period

In addition the IPC team will highlight the importance of skin health via mandatory training both e-learning and face to face and the Clinical Skills team will highlight importance of skin health when delivering training sessions to staff.

8.0 Skin CareThe Trust promotes good robust Skin care and hand washing and Skin care training is given at Induction and Infection control mandatory training. Very helpful leaflets and information is found at HSE websites.e.g http://www.hse.gov.uk/pubns/indg233.pdf.

The leaflet will help you identify what tasks and substances may cause harm, and introduces practical steps for controlling the risks.

Use the APC (avoid, protect, check) approach to reduce or control the risks:(ref HSg262)

Avoid contact with materials that cause these conditions where possible, and take advice on this from OH

Protect the skin, with proper hand hygiene measures , with special note to dryoing skin after washing and appropriate and regular moisturising. Moisturisors are provided in all trust hand washing areas , but OH will guide on this if further advice is required.

Check for early signs of dermatitis, and refer to OH if any symptoms are present.

Early detection can prevent more serious dermatitis from developing, and prevention as far as possible remains the aim. Regular checks could see if the preventative measures are working, if not refer to OH .

Further advice can be found at: www.hse.gov.uk/skin

9.0 Definitions Work related Skin disorders: skin conditions caused by work or aggravated by work.

Occupational Dermatoses: skin disorders caused by agents at work.

Occupational Dermatitis: an inflammatory condition of skin caused by a hazard at work.

Acute injury: any cuts, burns, lacerations etc where skin tissue is damaged.

Sensitisation: an reaction to a particular substance that results in the development of skin inflammation and itchiness therefore making the skin to become increasingly reactive to the substance, in smaller concentrations, as a result of subsequent exposures.

Irritant: A skin irritant is any non-infective agent, physical or chemical, capable of causing cell damage if applied to the skin for sufficient time and in sufficient concentration.

Author: Dr. B Blackburn

Consultant Occupational Health Physician

Date: January 2019

9

Policy for the Prevention and Management of Work Related Skin Disorders in Trust Employees January 2019

Wet Work - Wet work is the term used to describe prolonged or frequent contact with water (particularly in combination with soaps, cleansers and other chemicals). Wet work can cause the skin to over-hydrate. Dermatitis from wet work is common in trades such as, catering, cleaning and health care. There is no exact definition on when wet work is likely to be a risk. However, prolonged contact of more than about 2 hours (or more than 20-40 hand washes/ contacts a day) is likely to lead to irritant contact dermatitis. (HSG 262)

10.0 Dissemination/CirculationThe policy will be available on the Trust Intranet in:

Trust Intranet\Departmental\Legal Services & Corporate Risk\Shared Documents Trust Intranet\Policies & Procedures/Clinical Documents/Occupational Health An email alerting all staff that a Policy on Skin Management at Work is available on the

intranet. All Department managers will be made aware by Occupational Health of this policy and

the requirement of Risk Assessment of all Skin Hazards within their departments to be made.

 

11.0 ImplementationAppropriate training will be provided by the Trust to equip managers and staff with the skills to recognise and report symptoms of Occupational Skin Disorders and thus to minimise risks of occupational skin disorders.

It will be the responsibility of Occupational Health to liaise with Infection Control and Risk Management to ensure appropriate and sufficient training and awareness sessions on skin health.

12.0 Process for Monitoring Compliance and Effectiveness

Aspect of compliance or effectiveness being monitored

Monitoring method

Individual or dept. responsible for the monitoring

Frequency of the monitoring activity

Group/committee which will receive the findings/ monitoring report

Committee/ individual responsible for ensuring that the actions are completed

Referrals to OH due to skin problems

Management / Self Referrals to OH

OH Quarterly Health & SafetyCommittee

OH

Confirmed /suspected occupational skin disorders

Appointments with OH

OH Annually Health & SafetyCommittee

OH

Risk Annual review Departme Annual Health & Risk Manager

Author: Dr. B Blackburn

Consultant Occupational Health Physician

Date: January 2019

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Policy for the Prevention and Management of Work Related Skin Disorders in Trust Employees January 2019

Assessment completed

ntal Manager

SafetyCommittee

RIDDOR reports

OH referrals to Risk Manager

Risk Manager

Annually Health & SafetyCommittee / Trust Board

Risk Manager

Trust Appraisal rate

Monthly appraisal report

OH Annually Health & SafetyCommittee

OH

 

13.0 Equality Impact Assessment  Part 1: Initial ScopingFor each of the nine protected groups identified in the table below, respond to the identified questions with a Yes (Y); No (N); or Unclear (U)

Age

Sex

Dis

abili

ty

Rac

e

Gen

der

Rel

igio

n or

Bel

ief

Sexu

al O

rient

atio

n

Mar

riage

and

Civ

il Pa

rtne

rshi

p

Preg

nanc

y an

d M

ater

nity

Do different groups have different needs, experiences, issues and priorities in relation to the proposed policy/change proposal?

N N N N N N N N N

Is there potential for or evidence that the proposed policy/change will not promote equality of opportunity for all and promote good relations between different groups?

N N N N N N N N N

Is there potential for or evidence that the proposed policy will affect different population groups differently (including unintended discrimination against certain groups)?

N N N N N N N N N

Is there public concern (including media, academic, voluntary or sector specific interest) in potential discrimination against a particular population group or groups?

N N N N N N N N N

Part 2: Evidence and Feedback that has informed your analysis

Author: Dr. B Blackburn

Consultant Occupational Health Physician

Date: January 2019

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Policy for the Prevention and Management of Work Related Skin Disorders in Trust Employees January 2019

Please identify below the data, information or feedback that you have drawn on to reach the conclusions above. This will be information that has enabled you to assess the actual or potential impacts in the context of the key needs to eliminate unlawful discrimination, advance equality of opportunity and foster good relations with respect to the characteristics protected by equality law. These sources could include:

Equalities monitoring information of staff/service users affected by the identified provision/policy etc.

Engagement (internal/external or both) with or feedback from relevant stakeholders e.g. staff; patient groups, commissioners, external agencies.

Staff Survey Data; Patient Survey Data etc. Research or information available relative to the identified protected group. Project leads professional knowledge of the issues the policy/change is seeking to enact.

The above policy is concerned with protecting the health of those staff who may have or develop any skin problems at work. There is no evidence to suggest that individuals will be impacted differently based on the criteria outlined above.

The policy has been widely consulted in with those outlined in the policy as having responsibilities and also including senior nursing groups as well as staff side unions.

If the analysis under Part 1 has concluded that there are equality impacts or that the impacts are unclear (i.e. you responded ‘Yes’ or ‘Unclear’ in Part 1), please move on to Part 4 of the assessment. If no equality impacts are identified, please move on to Part 3 below to conclude the assessment

Part 3: NarrativeIf you have concluded there are no equality impacts related to the policy/provision, please provide a brief narrative to explain why you have come to this conclusion:

The policy seeks to protect the skin health of staff in the workplace and there is no evidence to suggest that the processes outlined above would in any way impact individual based on the above criteria.

If no equality impacts have been identified, this concludes the equality impact assessment. Please complete the declaration below:

Author: Dr. B Blackburn

Consultant Occupational Health Physician

Date: January 2019

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Policy for the Prevention and Management of Work Related Skin Disorders in Trust Employees January 2019

Based on the information set out above I have decided that a full equality impact assessment is (please delete as appropriate):

Necessary / Not necessary.

Name, Job title and signature:

ReferencesControl of Substances Hazardous to Health Regulations (COSHH) 2002Department of Health, 2001, Latex sensitisation, London, DHHealth and Safety at Work etc Act 1974Health and Safety Executive, Skin At Work online, available at: http://www.hse.gov.uk/skin/ [accessed 5th January 2016]Medical Devices Agency Bulletin 9601, 2003. Latex sensitisation in a health care setting. DHReporting of Illness, Diseases and Dangerous Occurrences Regulations (RIDDOR) 1995Personal Protective Equipment (PPE) Regulations 2002 Health and Safety Executive 2015 Managing Skin exposure risks at work HSG262 2nd Edn

Author: Dr. B Blackburn

Consultant Occupational Health Physician

Date: January 2019

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Policy for the Prevention and Management of Work Related Skin Disorders in Trust Employees January 2019

Appendix 1 Glove Selection and Usage for Cross Infection Purposes

Author: Dr. B Blackburn

Consultant Occupational Health Physician

Date: January 2019

14

Gloves are required for procedures where there is a risk of cross infection between staff and patients and further risk assessments should be carried out

Gloves are not required for procedures where there is minimal risk of cross infection between staff and patients, e.g. Basic care procedures without

contact with blood or bodily fluids Making uncontaminated bed /

change uncontaminated patient clothing

Taking patient observations including blood pressure, temperature, pulse

Closed endotracheal suction

Is there high risk of exposure to blood and bodily fluids?

YES NO

Is a sterile field required?

Non-sterile, Non latex gloves to be used

YES NO

NOSterile non-latex gloves ONLY to be used

YESSterile Gloves non-latex gloves to be used (preferable)

ORIf required sterile non-powdered latex gloves can be used in line with completed COSHH risk assessment.Staff using Latex Gloves will be required to complete annual (at minimum)Health Surveillance via OH

Are gloves really required for this process?

Will the procedure be carried out in Theatre / Maternity / Ophthalmology / Pharmacy Aseptic Departments?

Policy for the Prevention and Management of Work Related Skin Disorders in Trust Employees January 2019

Appendix 2 General Glove SelectionIt is important to select the right type of gloves for the task. The type and degree of protection depends on the material of the glove and the way in which it is made. A compromise may need to be made between comfort, sensitivity of touch, grip and the degree of protection for the job. The following factors should be considered:

Gloves should be the right size, and fit comfortably - too loose a fit will impede work, while too tight a fit will be uncomfortable

Gloves should be chosen with the task in mind, for example long gauntlet type gloves may be particularly suitable for handling manmade mineral fibre insulation or where chemical splashing may occur

Offer a selection of suitable gloves - this will make it easier for users to find a good fit.

Loose fitting gloves should never be used when using machinery where an entanglement risk exists.

Chemical Protection

Gloves which are used with chemicals should be selected bearing in mind that the chemical may eventually penetrate the glove. Gloves highly resistant to one chemical, for example acid, may give no protection against others, for example solvents, alkalis and so on. Chemical protection categories have been designed to overcome this which are available for gloves which have the EN 374 rating. These categories provide protection against specific chemicals as no one type of glove exists that provides protection against all chemicals. It is vitally important that the glove providing the most effective protection against the chemical and the application is selected.

As a general guide nitrile gloves provide the most effective protection against oil-based chemicals (solvents, oils and greases) whilst natural rubber latex gloves are suited to protect against water based chemicals (acids and alkalis).

Examples of gloves meeting these categories provided by one manufacturer can be found at:http://www.marigoldindustrial.com/en/search_chemical_78,386.aspx

The categories are based on permeation times – where a chemical passes through a glove. In many cases the permeated material may appear unchanged to the human eye.

Permeation performance levels are assessed by measuring the time for a chemical to break through to the inside surface of the glove sample.

Glove SpecificationsBS 697: 1986 Specification for rubber gloves for electrical purposesBS 1651: 1986 Specification for industrial glovesprEN 374 Protective gloves against chemicals and micro organismsprEN 388 Protective gloves: Mechanical test methods and specificationsprEN 407 Protective gloves against thermal hazardsprEN 420 General requirements for glovesprEN 511 Protective gloves against cold

Author: Dr. B Blackburn

Consultant Occupational Health Physician

Date: January 2019

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Policy for the Prevention and Management of Work Related Skin Disorders in Trust Employees January 2019

Appendix 3 - Relevant Legislation

1) Section 2,3 and 7 Health and Safety at Work etc Act 19742) Regulation 3 Management of Health and Safety at Work Regulations 1999 (as amended)3) Control of Substances Hazardous to Health Regulations 20024) Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013

Employers have a duty under the Control of Substances Hazardous to Health (COSHH) Regulations 2002 and the Management of Health and Safety at Work Regulations 1992 to prevent your employees from coming into contact with substances hazardous to health which cause dermatitis. If it is not reasonably practicable for you to prevent their exposure to these substances, the law says you must do what you can as far as reasonably practicable, to control that exposure and reduce the risk of skin diseases due to the exposure.

Employees have a legal duty to cooperate with your employer on health and safety matters and to take reasonable care of your own health: you must use the equipment/procedures that your employer provides to protect your health and inform your manager if you have any concerns about your skin and substances you are exposed to at work Regulation 11 of COSHH requires the employer to implement a system of health surveillance where: There is exposure to 'wet work' and/or substances known to cause dermatitis and There is a reasonable likelihood that the working procedures in place would lead to

dermatitis. Under the Reporting of Injuries, Disease and Dangerous Occurrences (RIDDOR) Regulations 2013Occupational dermatitis is a reportable disease that must be notified to the Health & Safety Executive via their website at http://www.hse.gov.uk/riddor/report.htm

Name, Job title and signature:

Author: Dr. B Blackburn

Consultant Occupational Health Physician

Date: January 2019

16

Policy for the Prevention and Management of Work Related Skin Disorders in Trust Employees January 2019

Appendix 4 On Employment Skin Health Screening For Employees

Author: Dr. B Blackburn

Consultant Occupational Health Physician

Date: January 2019

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Policy for the Prevention and Management of Work Related Skin Disorders in Trust Employees January 2019

Appendix 5 - Occupational Health – Skin Health Surveillance Questionnaire

Employee Details

Employee Name

Employee D.o.B

Address Contact Number

E-mail address

Department

Job Title

In accordance with the Control of Substances Hazardous to Health Regulations 1999 and the Management of Health & Safety at Work Regulations 1999 you MUST complete health surveillance by completing the questions below.

Information contained within this document is governed by the Data Protection Act 1998. Disclosure of information is only with your informed consent. Recommendations to your employer will be directed to essential information regarding your health and the hazards and risks of your employment and with due reference to other relevant statutory requirements and professional practice.

If you answer YES to any of the following questions please provide details

1 Do you experience any redness / itchiness or swelling of the hands and/or fingers? Any persistent substantive dryness?

YES/NO

2 Do you experience any cracking of the skin on the hands and/or fingers? YES/NO

3 Do you experience blisters on hands and/or fingers? YES/NO

4 Do you suffer from flaking or scaling of skin on hands, fingers or forearms? YES/NO

5 a) Do you have any spots redness swelling or rashes on any other parts of your body?

b) Have you or anyone in your household have had crops of boils?

YES/NO

YES/NO

6 If you experience skin problems, do your symptoms get worse at any particular time of the day?

YES/NO/NA

7 If you experience skin problems, do your symptoms get better when you are away from work?

YES/NO/NA

8 If you experience skin problems, are they made worse by any part of your working area?

YES/NO/NA

Author: Dr. B Blackburn

Consultant Occupational Health Physician

Date: January 2019

18

Policy for the Prevention and Management of Work Related Skin Disorders in Trust Employees January 2019

9 Do you now have, or have had in the past, any other condition of the skin? YES/NO

10 Has your doctor or specialist ever prescribed you any ointments or creams for your skin to use at work?

YES/NO

11 Do you use any hand creams, special skin cleansers or degreasers during or after work?

YES/NO

12 Have you noticed that gloves you wear are causing a skin problem YES/NO

13 Have you had any recent itchy and or runny nose or eyes YES/NO

14 Have you had any itchy bumps (urticarial), breathing difficulties, tingling of the lips?

YES/NO

14 Do you have any known allergies? YES/NO

15 Do you wish to mention anything else concerning your skin health?

Employee signature: Print Name: Date

FOR OCCUPATIONAL HEALTH USE ONLYHand Skin Visual Assessment

NORMAL / RED / DRY / CRACKED SKIN

Advice Given:

Highlight any areas of dry, red or cracked skin on the hand pictures below

Left Hand Right Hand

Action Required: Further assessment required with OH Nurse / DoctorNo further OH action required, routine management skin surveillance to be maintained Placed on Skin Health Surveillance for review in ____ months

OH Nurse Signature: Print Name: Date

Author: Dr. B Blackburn

Consultant Occupational Health Physician

Date: January 2019

19

Policy for the Prevention and Management of Work Related Skin Disorders in Trust Employees January 2019

Author: Dr. B Blackburn

Consultant Occupational Health Physician

Date: January 2019

20

Policy for the Prevention and Management of Work Related Skin Disorders in Trust Employees January 2019

Appendix 6

Author: Dr. B Blackburn

Consultant Occupational Health Physician

Date: January 2019

21

Policy for the Prevention and Management of Work Related Skin Disorders in Trust Employees January 2019

Author: Dr. B Blackburn

Consultant Occupational Health Physician

Date: January 2019

22