The SCIN (Skin care intervention in nurses) TrialA cross-sectional feasibility study in Wales

Vaughan Parsons (King’s College London), Dr Shuja Din (ABM Health Board, Wales), Dr Alison Wright (King’s College London),

Prof David Coggon & Ms Georgia Ntani (MRC Lifecourse Epidemiology Unit, Southampton), Prof Hywel Williams (University of Nottingham), Dr John English (Nottingham University Hospitals NHS Trust), Dr Ira Madan (Guy’s and St Thomas’ NHS Foundation Trust)

1.To assess the numbers of eligible participantsthat can be expected in the main study and theresponse rates that are likely to be obtained.

2. To test the main study protocol and standardoperating procedures

3. To test the behavioural change programme (BCP)to ensure that it is understandable and acceptable informat

4. To assess the baseline prevalence of handdermatitis to refine power calculations for the mainstudy.

5. To test the feasibility of recruitment of participantsthrough the local Occupational health service.

AIMS METHODS

• Occupational irritant hand dermatitis is a major risk in healthcare with a 1-year prevalence estimated to be 24%, compared with less than 10% in the general population.

• The cost to the NHS of its workforce developing hand dermatitis is estimated to be £125million/year.• Amongst healthcare workers, nurses are the group at highest risk of hand dermatitis.• Once an individual has developed irritant hand dermatitis the prognosis is poor. In a 15-year follow-up study about a third of those with hand dermatitis needed

on-going medical treatment and 5% experienced long periods of sickness absence, loss or change of job, or ill-health retirement. • The high prevalence of hand dermatitis in nurses is attributed to frequent hand washing with soap and water, infrequent use of hand moisturisers and poor hand-

drying techniques.• Current hand-cleansing policies in the NHS are driven by efforts to reduce colonisation and transmission of infections. Little attention is paid to prevention of

hand dermatitis.• Educational programmes based on the Theory of Planned Behaviour can facilitate longer-term behaviour change.

Purpose of the studyTo support the implementation of an upcoming large-scale cluster randomised controlled trial across the UK (excluding Wales).

RecruitmentStudy group one ‘Student nurses’ who were about to start their first clinical placements, and whowere at increased risk of hand dermatitis because of a past history of atopic disease or hand eczema.Study group two ‘ICU nurses’ working in a large hospital in south Wales whowere at increased risk of hand dermatitis because of frequent hand-washing with cleansers and water.

Intervention• A paper-based BCP which included support and information: on when and when not to use

gloves; on when to use antibacterial hand rubs; on when and how to wash and dry hands; on when to use moisturising cream; and reminders to contact OH early if hand dermatitis occurs.

• Participants were asked to form implementation intentions for performing each behaviour in their workplace.

• The BCP was supported by provision of personal supplies of moisturising cream (study group one: student nurses), and provision of optimal equipment for washing and drying hands together with moisturising cream dispensers on the wards (study group two: ICU nurses).

Data Collection Questionnaires: Baseline demographic data, and information on atopy, hand care and risk factors for developing hand dermatitis both in and out of work. Preliminary assessment of hand dermatitis: Assessment by the OH clinician of the presence of handdermatitis.Ascertainment of hand dermatitis and descriptions of the photographic method: Assessment bydermatologists using an assessment scale of the presence of hand dermatitis from photographic images ofparticipants’ hands/wrists. Hand/wrist Swabs: Assessment by microbiology of the presence of staphylococcus areus, Beta haemolyticStreptococcus Lancefield Group A and MRSA. Ward-based audit: Monitoring the availability of hand cleansing cream, hand moisturising cream and papertowels at the participating site. Interviews: Qualitative feedback from participants on the acceptability and user-friendliness of the methodsof data collection and the BCP. Qualitative feedback was also sought from the field worker on the ease ofuse of the study protocol and standard operating procedures.

ACKNOWLEDGEMENT / DISCLAIMER

Funded by the National Institute for Health Research Health Technology Assessment (HTA) Programme 11/94/01.

The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the HTA, NIHR, NHS or the Department of Health.

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BACKGROUND