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TOPIC: Occupational Dermatitis in Healthcare Workers

Occupational Dermatitis in Healthcare Workers 7 years 2 months ago #1

  • bolam56
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Having been a surgical scrub for over a quarter of a century, I've seen some nurses and techs with dry skin, irritant and contact dermatitis from all the hand hygiene we do from time to time, but I've never seen anything like what is going on now. I'd like to post my experience so that others may benefit from what I've learned. Judging from the dermatitis epidemic in the healthcare workers of my community, this problem must be widespread, and if you've come down with this, you are not alone.

Three employees in one unit and two others in sister hospitals have developed chronic/recurring exudative dermatitis (AKA wet/weeping/dyshidrotic/vesicular eczema) in the past year or so, and I, unfortunately am the latest casualty. All of us are surgical workers, and I feel this may have something to do with the newer surgical scrub solutions that offer a \"persistent antimicrobial effect\".

This exudative dermatitis is quite different from the dry, cracked skin one can treat with lotions, creams and moisturizers. It is a devastating and career ending condition that once started, is very difficult to manage.

Tiny little hard bumps pop up on our hands and arms that itch like crazy. When you scratch them open, a clear fluid runs out, and the next day you've got a small but deep hole in your skin where the bump was. They tend to come in groups and eventually join together to form crusty red coin shaped/sized patches that won't heal unless you take off work for a few weeks.

If you go back to work too soon, back it comes, worse than before. With the third recurrence or so, this dermatitis begins to spread and become \"generalized\" over other parts of your body that are not even exposed to the harsh disinfectants we use on our hands and arms. Once it reaches this state, your career is in big trouble, and this is where I am now. Off on a work comp leave of absence, wondering what will become of me.

Occupational health put me on modified duty and prescribed steroid ointment (Fluocinonide) which worked well; but what I didn't realize at the time was that steroid creams/ointments have a rebound effect when you stop using them. Once my hands healed, I would stop using the creams and go back to scrubbing. This would cause an immediate relapse. I felt guilty being on modified duty for so long and would push to go back to work before my condition was completely resolved. This was a big mistake! Once dermatitis becomes chronic, it is very difficult to resolve without many months away from high hand hygiene duties.

I'm seeing a dermatologist for patch testing, and he has already told me I need to start thinking about a new occupation. He said there is a slight chance we may get me back to my old job again, but this would be the exception to what usually occurs in his experience.

In the mean time, I have been using a \"coal tar\" ointment (Elta-tar). Coal tar is the old school medicine for dermatitis of this kind. It's not as quick and effective as steroids, but it does not have a rebound effect when you stop using it. I'm hoping this will ease my skin back to normal without a rebound/relapse when I go back to work.

In researching what is in these new \"antimicrobial persistent\" surgical scrub solutions, I have found they all contain \"emollients\" that cause the skin to wick up these disinfectants and carry them deep into the tissues of your skin, where they can not be rinsed off. I know the terrible cheap perfume they put in these new scrubs and rubs stays on my hands all night. I've tried everything to wash it off and it's just no use.

I am concerned this may be related to why this new and serious dermatitis is spreading like wildfire through the healthcare community. In looking at the emollients, \"squalane\" is the only one I've identified. Squalane is a saturated form of Squalene, and squalene is the adjuvant everyone was making such a fuss about in the flu shots last year, as a possible cause of auto-immune problems!

I have yet to comprehend exactly what eczema is, as it seems to be a mystery to the medical profession too, but it certainly seems to have some auto-immune like characteristics. This would seem to indicate a possible link between the squalane emollients in the persistent antimicrobial scrubs and the new and nasty form of dermatitis that is going around hospitals now days.

It may be the squalane is not the problem, but the disinfectant chemicals it carries deep into our skin is. Remember, squalane permeates the skin, and carries the disinfectant in the surgical scrub with it, deep into the dermis and sub-Q!

I'll follow-up on this post when I learn more. In the mean time... If you're a healthcare worker who's come down with this type of dermatitis, my advise is to stay on modified duty as long as possible, and don't try to resume your normal duties too soon. When this type of dermatitis reoccurs, it is almost impossible to get rid of!<br /><br />Post edited by: bolam56, at: 2010/09/10 11:14
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Re:Occupational Dermatitis in Healthcare Workers 7 years 1 month ago #2

  • bolam56
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Update: What a difference a dermatologist makes...

General Practitioners are quick to diagnose \"Irritant Dermatitis\" in healthcare workers, due to the frequent hand washing they are required to do, and irritant dermatitis makes up the bulk of this type of problem.

There is however another form that causes up to 25% of dermatitis cases in healthcare workers that wear gloves for extended periods (surgical personnel!), and this is \"Allergic Contact Dermatitis\". ACD can be identified by the vesicular eruptions that result in weeping/wet dermatitis, rather than the dry/cracked skin of irritant dermatitis.

The traditional manifestation of ACD is Latex Allergy, but latex gloves are fading into history as more and more patients have latex allergies. When healthcare workers are already wearing latex free gloves, ACD is often overlooked, as many practitioners do not realize there are other components in surgical gloves that can cause allergic response.

\"Vulcanization Accelerators\" are chemicals glove manufacturers use to speed up the process of making their gloves, and these accelerators remain in the gloves and are causing problems for a lot of surgical personnel. I don't know if the manufacturers are adding more of this stuff lately, but I've seen a minor epidemic of dermatitis in my surgical community lately, and the doctors treating us are having a hard time figuring out what's going on.

Two of the most common accelerators used are Thiuram, and Carbamate, and sensitivity to these compounds make up the bulk of ACD in surgical personnel who become reactive to non-latex gloves. Dermatology patch testing (T.R.U.E. or thin-layer rapid-use epicutaneous) can show specifically which accelerant you are sensitive to, so that the proper gloves can be found. I showed a positive for \"Carba Mix\".

Ansell makes surgical gloves that are Thiuram and Carbamate free, and this may well be the only hope for surgical personnel who have developed this type of ACD. Google - Chemical Accelerators in Medical Gloves - and Ansell's page on this should pop up in the results (look for a pdf file). Google - Ansel Gammex PF DermaPrene - for another good pdf on these gloves.

Remember... If your dermatitis is wet/weeping it is most likely allergic (Type IV delayed hypersensitivity), and NOT irritant dermatitis. It took my work comp doctor and I six months to figure this out, and nearly cost me my job, not to mention the anxiety of having one's career implode on you! We'll see what happens when I go back to work with the new Ansell gloves.

Wish Me Luck! (I need it)
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Re:Occupational Dermatitis in Healthcare Workers 5 years 6 months ago #3

  • danddad33
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any luck I too have come down with this. Surgical tech with four years. What do you do???


I will let you know what I come up with
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Re:Occupational Dermatitis in Healthcare Workers 5 years 5 months ago #4

  • ortho
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I am a nurse and I have worked in the OR for two years now. I have been a scrub nurse for 7 months now and the past two months I have developed a rash. The dermatologist said I had contact dermatitis. They didn't know to what, but they assumed latex. Did a blood draw for allergy testing at first and all came back was food. The symptoms go worse and I ended up in the ER. I stopped scrubbing for a couple of weeks and I got better. Now fast forward after a month of horrible itching and fear of not being able to scrub anymore the allergist found I was allergic to carba mix andThiuram. This weekend had been crying hoping there are gloves and gowns I can wear. I have only been a nurse for almost three years and love being in the OR. Please help and glad I'm not the only one dealing with his issue. Thank you.
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Re:Occupational Dermatitis in Healthcare Workers 5 years 5 months ago #5

  • danddad33
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I work today, but I will pass on the gloves that I use. They seem to be work fine for my hands. My hospital had them on hand and I was trying to find out why. These gloves are for this reaction and I am the only one with it. Don't know why we had them... I will get back to you.... There is hope...

Dan
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Re:Occupational Dermatitis in Healthcare Workers 5 years 5 months ago #6

  • ortho
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Hello Everyone,
I was a little nervous about trying the ansell gloves that everyone recommend because it stated it was a neoprene glove. I was told to avoid neoprene gloves because it contains thiuram mix and carba mix. I tried these gloves when my outbreak was already in worst state. I got in contact with an ansell rep and they informed me that those neoprene accelerator free gloves didn't contain those chemicals and that's the difference in these neoprene gloves. Yay!! My only question is what gown does everyone wear? Most gowns that contain elastic on the cuff, which usually contains thiuram and carba mix. That is where most of my irritation was, especially when I tried the new ansell gloves a rep sent me to try. A rep said some gown manufactures make a cuffless gown. Please help. Thanks to all who has helped and has given me hope.
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