title: Occupational skin disease among Australian healthcare workers: a retrospective analysis from an occupational dermatology clinic, 1993-2014.
abstract: BACKGROUND
  Healthcare workers (HCWs) are at risk of developing occupational skin disease (OSD).
  
  
  OBJECTIVE
  To ascertain the causes of OSD in Australian HCWs in a tertiary referral clinic.
  
  
  METHODS
  A retrospective review was performed of patients assessed at the Occupational Dermatology Clinic in Melbourne from 1993 to 2014.
  
  
  RESULTS
  Of 685 HCWs assessed in the clinic over a period of 22 years, 555 (81.0%) were diagnosed with OSD. The most common diagnosis was irritant contact dermatitis (ICD) (79.1%), followed by allergic contact dermatitis (ACD) (49.7%). Natural rubber latex allergy was also relatively frequent (13.0%). The major substances causing ACD were rubber glove chemicals (thiuram mix and tetraethylthiuram disulfide), preservatives (formaldehyde, formaldehyde releasers, and isothiazolinones), excipients in hand cleansers, which are hard-to-avoid weak allergens, and antiseptics. ACD caused by commercial hand cleansers occurred more frequently than ACD caused by alcohol-based hand rubs (ABHRs). Occupational ICD was mostly caused by water/wet work and hand cleansers, and environmental irritants such as heat and sweating.
  
  
  CONCLUSIONS
  Understanding the causes of OSD in HCWs is important in order to develop strategies for prevention. We suggest that skin care advice should be incorporated into hand hygiene education. The use of ABHRs should be encouraged, weak allergens in skin cleansers should be substituted, and accelerator-free gloves should be recommended for HCWs with OSD.
authors.affiliation: Occupational Dermatology Research and Education Centre, Skin and Cancer Foundation Inc., Carlton, Victoria, 3053, Australia. chiggins@skincancer.asn.au.
authors.forename: Claire L
authors.initials: CL
authors.lastname: Higgins
authors.affiliation: Occupational Dermatology Research and Education Centre, Skin and Cancer Foundation Inc., Carlton, Victoria, 3053, Australia.
authors.forename: Amanda M
authors.initials: AM
authors.lastname: Palmer
authors.affiliation: Occupational Dermatology Research and Education Centre, Skin and Cancer Foundation Inc., Carlton, Victoria, 3053, Australia.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Cahill
authors.affiliation: Occupational Dermatology Research and Education Centre, Skin and Cancer Foundation Inc., Carlton, Victoria, 3053, Australia.
authors.forename: Rosemary L
authors.initials: RL
authors.lastname: Nixon
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000485:Allergens / Q000009:adverse effects; D000891:Anti-Infective Agents, Local / Q000009:adverse effects; D001315:Australia; D017449:Dermatitis, Allergic Contact / Q000175:diagnosis / Q000209:etiology*; D017453:Dermatitis, Irritant / Q000175:diagnosis / Q000209:etiology*; D009783:Dermatitis, Occupational / Q000175:diagnosis / Q000209:etiology*; D004202:Disinfectants / Q000009:adverse effects; D004221:Disulfiram / Q000009:adverse effects; D005260:Female; D005557:Formaldehyde / Q000009:adverse effects; D005659:Fungicides, Industrial / Q000009:adverse effects; D017575:Gloves, Protective / Q000009:adverse effects; D006229:Hand Dermatoses / Q000175:diagnosis / Q000209:etiology*; D019981:Health Care Sector; D006282:Health Personnel; D006801:Humans; D007509:Irritants / Q000009:adverse effects; D020315:Latex Hypersensitivity / Q000175:diagnosis / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D010328:Patch Tests; D012189:Retrospective Studies; D013893:Thiram / Q000009:adverse effects; D055815:Young Adult
chemical_list: D000485:Allergens; D000891:Anti-Infective Agents, Local; D004202:Disinfectants; D005659:Fungicides, Industrial; D007509:Irritants; D013893:Thiram; D005557:Formaldehyde; D004221:Disulfiram
keywords: alcohol-based hand rub; allergic contact dermatitis; contact allergy; hand cleanser; hand wash; irritant contact dermatitis; nurses; patch test; preservatives; rubber chemicals; rubber gloves