Policy Title: Prevention and Management of Occupational Skin Disease Reference and Version No: RM26 Version 3 Author and Job Title: Jude Cooper Head of Occupational Health and Wellbeing Executive Lead - Director of Operations Process Policy Flowchart Ward/Unit/Team managers to carry out an occupational skin disease risk assessment for their area Guidance There is a corporate Occupational Skin Disease risk assessment on DATIX for assistance ID: 3868 Utilise current information: Validated By: Health and Safety Policy Review Group Ratified By: Health, Safety Welfare and Environment Committee Date Issued: 18 January 2016 Date for Review: 10 November 2018 Related Documents: IC2 Hand Hygiene Policy RM16 Control of Substances Hazardous to Health Policy (COSHH) C17 Latex Policy RM10 Health and Safety Policy Identify staff groups at risk of occupational skin disease within your area Where there is risk of skin disease introduce below the elbow skin checks by a responsible person Raise awareness of staff re the risk of occupational skin disease COSHH assessments Incident statistics Occupational health referrals Sickness absence statistics Training for responsible person is available from the Occupational Health department. Guidance provided in appendix 2 This can be done via appraisals, regular briefings at team meetings, posters etc. This Policy is Intended for: All Staff Groups. Ensure all cases of skin problems are reported to Occupational Health It is important to catch symptoms early to prevent more serious problems The Trust is committed to the fair treatment of all, regardless of age, colour, disability, ethnicity, gender, gender reassignment, nationality, race, religion or belief, responsibility for dependants, sexual orientation, trade union membership or non membership, working patterns or any other personal characteristic. This policy and procedure will be implemented consistently regardless of any such factors and all will be treated with dignity and respect. To this end, an equality impact assessment has been completed on this policy 1 of 9 (Date for review 10 November 2018)
CONTENTS 1. Introduction/Purpose 2. Definitions 3. Roles and Responsibilities 4. Policy and Process 5. Review and Revision arrangements 6. Monitoring 7. References Appendices Appendix 1 Appendix 2 Responsible Person Competencies Guidance for implementing skin care checks 2 of 9 (Date for review 10 November 2018)
1. Introduction/Purpose Occupational skin diseases, also known as occupational dermatoses, are skin diseases primarily caused by occupation. Skin disease is the third most common occupational disease, with contact dermatitis accounting for 70-90% of all occupational skin disease. Occupational contact dermatitis often has adverse effects on quality of life and the long term prognosis is poor unless workplace exposures are addressed. The known risk factors are frequent hand washing, exposure to irritant and allergenic chemicals, and frequent or persistent glove wearing. The purpose of this policy is to prevent the occurrence of occupational dermatoses and to communicate the requirements to all relevant staff of risk identification and control. The policy will provide processes for staff to follow should they experience occupational skin disease. 2. Definitions Substances capable of causing dermatitis can be divided into two groups, irritants and sensitisers. 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. Sensitisers: A skin sensitiser, or allergen, is a substance capable of causing allergic contact dermatitis. Contact Dermatitis: an inflammatory disorder to the skin. It is either irritant or allergic. Irritant Contact Dermatitis (ICD) is caused by a direct toxic effect on the skin, mostly due to irritant chemicals and wet work. It is a common problem affecting the skin of the hands in Health Care Workers and maybe due to frequent hand washing, incomplete hand drying and frequent contact with soaps and other irritant substances. Allergic contact dermatitis (ACD) is an allergic reaction (type 1V delayed immune response) to specific sensitising agents, e.g.; latex. Contact Urticaria: Contact urticaria is a wheal-and-flare (small swellings on the skin surrounded by areas of redness) response occurring rapidly on the application of certain substances to intact skin. Responsible Person: A person appointed by the employer, who is competent to carry out assessments for early signs of dermatitis. 3. Roles and Responsibilities General duties in relation to compliance with health and safety legislative requirements are documented with the Health and Safety Policy. The specific roles and responsibilities relating to this policy are as follows. 3.1 General Managers/Departmental Heads This policy and its requirements are communicated to all staff within their area of responsibility 3 of 9 (Date for review 10 November 2018)
3.2 Ward/Unit/Team Managers/Supervisors Communicating the requirements of this policy to all staff within their area Identifying hazards and undertaking appropriate risk assessments. Will act as the responsible person for carrying out below the elbow skin checks on staff in areas of greater risk as identified within the departmental occupational skin disease risk assessment On completion of COSHH/Risk assessments inform Occupational Health where health surveillance is required Provision of suitable Personal Protective Equipment (PPE). Releasing staff for appropriate training and health surveillance Referring staff to Occupational Health in a timely manner if they have a staff member with concerns and/or signs and symptoms of Occupational skin disease. Provision of suitable skin cleansing agents and conditioning cream. Encouraging staff of the requirement of early reporting of skin disease. To offer temporary suitable alternative employment if deemed necessary by Occupational Health Department 3.3 Employees Reading assessments, following the correct processes and implementing control measures detailed within assessments when using hazardous substances. Complying with control measures put in place to protect their skin including wearing any necessary PPE and cooperating with health surveillance procedures Be aware of risk of dermatitis, what dermatitis is and need for early reporting. Examine own skin for any symptoms and immediately report to line manager any signs or symptoms of skin disease. Ensure correct hand washing and drying techniques as detailed in Hand Hygiene Policy IC2 v 8 Awareness of the importance of maintaining good skin care out of work. 3.4 Infection and Prevention Control Provision of Infection and Control Hand Hygiene Training Programme. Reiterating the requirement of staff to attend Occupational health department if they are experiencing skin problems. Advise on standard infection control precautions. 4 of 9 (Date for review 10 November 2018)
3.5 Occupational Health Department Undertake pre-employment screening to identify staff that may have pre-existing allergies and skin problems. Provide managers with appropriate advice to manage these individuals Receive referrals from Managers or from staff that have concerns about hand care, Latex / glove allergy or skin problems that may cause an infection control risk. Record information relating to hand problems, Latex allergies or adverse skin reaction to protective gloves in individual staff health records and advise Managers accordingly. Review staff with skin problems/latex allergy and make recommendations to the appropriate Manager on the management of these staff. Advise the appropriate Health and Safety and Risk Management Committees on incidences and trends. Assist in risk assessment Provide all staff with information, instruction and training on the nature or risks to health and precautions to be taken. This MUST include characteristic signs and symptoms of the particular dermatoses. Undertake appropriate health surveillance as identified from risk assessment. Carry out regular examinations of at risk workers to identify early signs of skin disease and where appropriate refer to Occupational Physician Advise management on adjustments at work if a healthcare worker has severe or acute dermatitis. These individuals should be restricted temporarily from clinical work with patients who are at risk from hospital acquired infection. Adjustments can be reversed when skin lesions are no longer severe or acute. If dermatitis deteriorates as a result of clinical work OH will advise temporary and, if necessary, longer term adjustments to duties and/or redeployment to facilitate recovery. Refer to Dermatology where appropriate for diagnosis. Notify Health and Safety Executive under the Reporting of Incidents, Diseases and Dangerous Occurrences Regulations (RIDDOR) 1995 when a diagnosis of work related Contact Dermatitis has been confirmed. 3.6 Corporate Health and Safety and Non clinical Risk Service Advise and assist in undertaking suitable and sufficient risk and COSHH assessments. Providing on going support to managers who need assistance with assessments e.g. need for health surveillance. 5 of 9 (Date for review 10 November 2018)
3.7 Procurement A key control for minimising the risk of hazardous substances is a robust policy of purchasing from an approved list of substances. All substances should be purchased through supplies via the CARDEA system. Will monitor all products, which have the potential to cause contact dermatitis (e.g. latex gloves) liaising with manufacturers, and advise management of their findings. Only allow areas/departments designated through risk assessment to order products with the potential to cause dermatitis e.g. latex gloves. 4. Policy and Process 4.1 Prolonged use of hazardous substances and chemicals may cause occupational skin disease if used incorrectly and precautions not followed or personal protective equipment not used. It is important therefore that all substances have been assessed following the Trusts COSHH Policy and assessment results communicated to all relevant staff. 4.2 Allergic reactions following exposure to natural rubber latex (NRL) have increased significantly over the last twenty years, particularly within healthcare occupations as a consequence of the increased usage of latex gloves, and in particular powdered latex gloves. All staff that use latex must be made aware of the Trust latex policy. The corporate latex risk assessment on datix provides information on controls in place. 4.3 Maintaining good skin care both in and outside of work including washing and drying hands thoroughly will minimise the risk of contact dermatitis. All staff must monitor their own skin and any signs of skin disease should be reported to their line manager who may refer to Occupational Health for advice. 4.4 Skin checks will be carried out by the responsible person (see appendix 1 for responsible person competencies) in areas of greater risk or where incidents of occupational skin disease are occurring. These areas will be identified within the local departmental occupational skin disease risk assessments. Guidance on the method, and frequency of skin checks is available in appendix 2. 4.5 Purchasing of substances, materials and personal protective equipment should only be via the CARDEA system. Advice can be sought from Procurement, Occupational Health, Infection Prevention Control or the Corporate Health and Safety and Non clinical Risk Departments. 4.6 Staff experiencing occupational skin disease will be supported by Occupational Health and department managers to remain at work. Advice will be given about the elimination or reduction of perpetuating or exacerbating factors at work. Occupational Health will advise on adjustments to work or temporary redeployment if a healthcare worker has severe or acute dermatitis. The individual may be temporarily restricted from clinical work with patients who are at high risk from hospital-acquired infections. 4.7 A healthcare worker who has mild dermatitis may be allowed to continue with clinical work, provided: They are able to follow normal infection control requirements including hand hygiene and glove wearing, without making the dermatitis worse 6 of 9 (Date for review 10 November 2018)
They have not been implicated in a case of transmission of infection from colonised or infection dermatitis lesions to a patient The dermatitis does not deteriorate as a result of clinical work. 4.8 If dermatitis deteriorates as a result of clinical work, advice will be given to their manager re temporary and, if necessary, longer-term adjustments to duties and/or redeployment to facilitate recovery 5. Review and Revision Arrangements 5.1 The policy will be reviewed three yearly or earlier following any revision to legislation or adverse event which instigates a policy review. 5.2 Revisions to the policy following any review will be carried out by the Head of Occupational Health and Wellbeing. 6. Monitoring 6.1 Incidents/trends will be monitored by the Occupational Health Department and reported to the Health, Safety and Welfare Committee annually. 6.2 All occupational skin disease risk assessments placed onto DATIX will be flagged to Occupational Health for review to ensure suitable and sufficient. 7. References Concise guidance to good practice. Diagnosis, management and prevention of occupational contact dermatitis. Medical aspects of occupational skin disease MS24 HSE Dermatitis Occupational aspects of management A national guideline Latex allergy Occupational aspects of management. A national guideline 7 of 9 (Date for review 10 November 2018)
Appendix 1 Responsible Person Competencies The responsible person should be competent to carry out skin checks. To be competent, the person should know: Which processes at their work are associated with the potential to cause skin disease The substances (used in the processes) at the workplace that are likely to cause skin conditions such as dermatitis i.e. the hazards What type of skin conditions may be caused by the substances What control measures should be in place to prevent or adequately control dermal exposure What types of shortcomings in control measures are likely to lead to dermal exposure What the early visible signs on the skin that may be noted and raise concern that there might be a problem What should be done if control measures are not working and/or signs of skin problems are noted 8 of 9 (Date for review 10 November 2018)
Guidance for implementing skin care checks Appendix 2 The monitoring, frequency of skin care checks, health surveillance and provision of information to staff will be based on the level of risk identified within the risk assessment in each area as detailed in the table below. Level of Risk Level of Risk 1 3 Very Low (Green) Example risks Monitoring Provision of Information, instruction and training No Latex No patient contact Infrequent hand washing Minimal use of use of irritants/ substances Skin care checks: not required Health surveillance: not required Skin care awareness provided to staff, including the need to report any skin problems. Skin care leaflet issued 4-6 Low (Yellow) 8 12 Moderate (Amber) 15-25 High (Red) No Latex No patient contact Frequent wet work Uses irritants and substances Latex used Patient contact Frequent we work Regular use of irritants and sensitising substances Staff with latex allergy Symptoms of Occupational skin disease Skin care checks: annual checks Health surveillance: not required Skin care checks: Monthly checks Health surveillance: Annual surveillance Red risks will require immediate action to reduce the level of risk Skin care awareness provided to staff, including the need to report any skin problems. Skin care leaflet issued Skin care checks carried out at appraisal as a minimum and recorded Skin care awareness provided to staff, including the need to report any skin problems. Skin care leaflet issued Skin care checks recorded N/A Members of staff identified with work related dermatitis will be managed via Occupational Health and will require more stringent monitoring and management. 9 of 9 (Date for review 10 November 2018)