Volume 41 Number 4

Hand dermatitis among nurses during the COVID-19 pandemic: frequency and factors

Ayla İrem Aydın, Meryem Atak, Nurcan Özyazıcıoğlu Nurcan and Vahit Dalkızan

Keywords nursing, Wound care, handwashing, COVID-19, dermatitis, hygiene

For referencing Aydın Aİ et al. Hand dermatitis among nurses during the COVID-19 pandemic: frequency and factors. WCET® Journal 2021;41(4):10-14

DOI https://doi.org/10.33235/wcet.41.4.10-14
Submitted 7 December 2020 Accepted 10 February 2021

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Author(s)

References

中文

Abstract

Objective To determine the frequency of hand dermatitis among nurses during the COVID-19 pandemic and factors affecting its prevalence.

Methods The research sample consisted of 175 nurses working in state hospitals. Research data were collected via Google Survey between October and September 2020. The data were collected using a Sociodemographic Data Collection Form, and a self-assessment form was used to determine dermatologic symptoms.

Results The frequency of hand dermatitis among nurses was 70.9%. A statistically significant difference was found between sex, allergy history, and increased frequency of handwashing and the frequency of hand dermatitis. No significant difference in terms of the frequency of hand dermatitis was found between the nurses who provided care to patients who were COVID-19 positive versus the nurses who did not provide care to patients who were COVID-19 negative. However, the frequency of washing hands and using hand disinfectants and hand creams was found to have increased significantly during the COVID-19 pandemic compared to the prepandemic period.

Conclusions The frequency of hand dermatitis increased among nurses during the pandemic. The increased frequency of handwashing during the pandemic poses a risk for hand dermatitis among nurses, although this should not discourage nurses from appropriate hygiene.

Introduction

The World Health Organisation has declared COVID-19 a global pandemic. According to the latest data, approximately 230 million people have been infected and 4.7 million have died.1 Nonpharmacologic preventive practices such as maintaining social distance, wearing face masks, and washing hands have been recommended to hinder the spread of the virus.2 These practices play an important role in reducing the risk of transmission by preventing the spread of aerosols and protecting vulnerable populations. Studies suggest that hand hygiene is an important prevention strategy for healthcare professionals and societies in places where the pandemic is most prevalent. Hand hygiene remains a critical element of infection control.3-5

The COVID-19 pandemic has also had the effect of reminding nurses about the need for regular hand hygiene with soap, water, or alcohol-based sanitisers. Handwashing is recommended as an inexpensive and common preventive measure to protect oneself from a number of viral infections and prevent disease spread in general.6

Proper handwashing technique is a part of effective hand hygiene.5 The CDC recommends handwashing with soap because it reduces the amount of germs and chemicals on the hands.2 The World Health Organisation (WHO) also recommends handwashing with soap for 40 to 60 seconds using an appropriate technique when hands are noticeably dirty.7 When soap and water are not available, a hand sanitiser with at least 60% alcohol can be used.2 If hands are not visibly soiled, using an alcohol-based hand disinfectant for 20 to 30 seconds with the appropriate technique is preferred to provide hand hygiene.7 Washing hands with an alcohol solution can reduce the risk of infection in medical staff and others in the community by reducing the number of bacteria and viruses on hands.2,8

However, the solutions used, frequency of handwashing, level of moisture, and hand drying process may disrupt the skin barrier and lead to symptoms of hand dermatitis.9-12 Accordingly, the aim of this study was to determine the frequency of hand dermatitis among nurses during the COVID-19 pandemic and the factors affecting its incidence.

Methods

Sample

The research population consisted of nurses working in three different state hospitals in Bursa, Turkey. The research sample consisted of 175 nurses who voluntarily agreed to participate in the study.

Data Collection

The study data were collected by the researchers between September and October 2020 via Google Survey. Data collection tools included two forms prepared by the researchers: one form collected sociodemographic information and the other assessed dermatologic symptoms.

Sociodemographic Data Collection Form. This form consisted of questions about the sex, age, and education level of the nurses who participated in the study, as well as about the hospital and clinic they worked in, and their total years of employment.

Form to Determine Dermatologic Symptoms. This form included questions about allergy history, medication use, the COVID-19 status of the nurse’s patients, frequency of handwashing, and use of hand disinfectants and hand creams. In the last part of the form, nurses were asked to self-assess any dermatologic symptoms specific to hand dermatitis. The form was translated into Turkish by a researcher and a native English speaker. The translations were compared, the most appropriate terminology was selected, and the final version was then translated back into English. The translated text was compared with the original form and revised accordingly. The authors of the study have previously used this self-assessment form with pediatric nurses and nursing students.11,12 The form co-evaluates the symptoms of irritant and allergic contact dermatitis and was designed according to the criteria of Smit et al.13,14 Permission was obtained from Coenraads et al for the use of this form.13,14

Questions were posed about the presence of any of the following symptoms over the last 12 months:

  1. Scaling and redness on the hands and between the fingers
  2. Fissures and redness on the hands
  3. Irritation or itching on hands
  4. Swelling and redness of the hands
  5. Vesicles between hands and fingers

Participants who answered “Yes” to one or more of these questions were diagnosed with symptoms of hand dermatitis.

The following questions were also asked:

  1. Did two or more of these symptoms last longer than 3 weeks?
  2. Did two or more of these symptoms occur more than once?

Participants who answered “Yes” to either of these questions were diagnosed with recurrent or severe hand dermatitis. The Cronbach α coefficient of the form was 0.888.

Data Analysis

Numeric and percentile distributions were used for sociodemographic data and Mann Whitney U test, Wilcoxon Sign rank test, and Pearson χ2 test were used for comparisons. The SPSS for Windows Version 23.0 of was used for data analysis.

Ethical Considerations

Ethical approval for the research was received from Bursa Uludağ University Health Sciences Research and Publication Ethics Committee (date and decision number: 29.07.2020; 92662996-04). Legal permission was obtained from the relevant health institutions. Consent was obtained from the nurses who participated in the study via the Google Survey.

Results

Table 1 shows the personal characteristics of the nurses participating in the study. The frequency of hand dermatitis among the nurses was 70.9% (124 of 175). The frequency of hand dermatitis was significantly higher in women than in men. The frequency of hand dermatitis was significantly higher among nurses who had a history of allergies compared with those without an allergy (P < .05). The mean age of the nurses participating in the study was 29.14 ± 7.22, and the mean years of employment were 6.68 ± 8.02. No significant difference was found in the frequency of hand dermatitis among nurses by mean age or years of employment. When the incidence of hand dermatitis was examined by unit where the nurses worked, the frequency was higher among nurses working in pediatric (76.1%), surgical (76%), and COVID-19 wards (69.5%). However, no significant difference was found by unit (P > .05).

 

Table 1. Participant characteristics

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The most frequently reported symptoms were redness and fissures (sharply defined linear tears in the epidermis and dermis; 77.1%), irritation and itching (76%), and scaling/rash (67.4%; Figure 1).

 

ayla Fig 1 - en.png

Figure 1. hand dermatitis symptoms

 

The frequency of hand dermatitis was 71.5% among nurses who provided care to patients who were COVID-19 positive, whereas the frequency of hand dermatitis was 66.7% among nurses who did not provide care to COVID-19 positive patients. This difference was not significant (Table 2).

 

Table 2. Frequency of hand dermatitis based on whether nurses cared for patients positive for COVID-19

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Nurses’ hand hygiene behaviours before and during the COVID-19 pandemic were examined (Table 3). It was determined that the frequency of handwashing per day, the use of disinfectants, and the use of hand cream/moisturiser had increased significantly during the pandemic (P < .001). In terms of handwashing frequency, 48% (84 of 175) of the nurses washed their hands more than 25 times a day. The frequency of hand dermatitis significantly increased with the frequency of handwashing (Table 4; P < .05). The frequency of hand disinfectant and hand cream use did not significantly affect hand dermatitis (P > .05). The most frequently used handwashing substances were liquid soap, liquid soap and alcohol-based gel, chlorhexidine-based gel, and alcohol-based gel (Figure 2).

 

Table 3. Hand hygiene behaviors of nurses before and during the pandemic

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Table 4. Frequency of hand dermatitis by hygiene behavior

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Figure 2. substances used by nurses for handwashing

 

Discussion

Hand dermatitis is a common disease that can progress either acutely or chronically and has different etiologies.15 In the current study, the frequency of hand dermatitis among nurses during the COVID-19 pandemic was 70.9%. The results of the current study were similar to those obtained in other studies conducted on hand dermatitis in health workers during the COVID-19 pandemic. One study conducted during the pandemic revealed that 84.6% of health workers had unwanted skin reactions on their hands.16 Another study reported that 74.5% of primary health workers had skin damage on their hands.10 A study conducted at the beginning of the pandemic found that 90.4% of health workers had acute symptoms of hand dermatitis.17

In a study conducted before the pandemic in the same region as the current study, 47.5% of the nurses working in pediatric clinics were reported to have hand dermatitis.11 The frequency of hand dermatitis was found to be 12%,18 21%,19,20 and 22.1%21 in other studies conducted before the pandemic. Given these results, it is clear that the frequency of hand dermatitis had increased among health workers during the pandemic.

In this study, the frequency of hand dermatitis was significantly higher in women than in men. Alluhayyan et al22 conducted a study with health workers and found that women were more prone to dermatitis. Likewise, Gupta et al23 found that hand dermatitis was slightly more common in women than in men. However, other studies have reported that sex did not have a significant effect on the frequency of hand dermatitis.12,21

Allergies are abnormal hypersensitivity reactions of the immune system against foreign substances.24,25 This response can be observed in early childhood as well as in adolescence and adulthood.25,26 The frequency of hand dermatitis was significantly higher among nurses who had a history of allergy compared with those without an allergy, which is consistent with previous studies.12,19,21,23 However, Kiely et al27 concluded that a history of allergy did not affect the development of dermatitis, despite reporting that the risk of developing dermatitis was significantly higher in health workers with a history of dermatitis.

One of the most common methods to prevent the spread of viruses is effective hand hygiene. In the fight against COVID-19 it is essential that effective hand hygiene habits are acquired in childhood.28 Kiely et al27 reported that the frequency of handwashing increased among almost all health workers (99.26%) during the pandemic. When the prepandemic and pandemic periods were compared in the current study, the frequency of handwashing and use of hand disinfectants/creams had increased significantly (Table 3). Similarly, Guertler et al17 conducted a study with physicians and nurses and found similar results. All of the guidelines for combating COVID-19 recommend thorough and frequent hand hygiene practices.2,5 Although the increase in the frequency of handwashing is one of the factors that contributes to the development of dermatitis, this should not dissuade health workers from appropriate hand hygiene practices during the pandemic.4

Nurses are the primary caregivers in a medical setting and are thus prone to infection with and transmission of the COVID-19 virus. It is vital that they comply with the guidelines for preventing and controlling infections to fight the pandemic.29

In another study conducted during the pandemic, Lan et al10 concluded that the frequency of hand dermatitis increased significantly in health workers who washed their hands more than 10 times a day. Studies conducted before the pandemic reported a significant relationship between an increased frequency of handwashing and the frequency of hand dermatitis.12,30 However, the present study found no significant difference in the frequency of hand dermatitis by use of hand cream. However, the hand creams used by nurses may not be ideal. The use of skin moisturisers is recommended to maintain healthy skin;31,32 for skin protection, humectants such as topical urea and propylene glycol and occlusive emollients such as petrolatum-based products, lanolin, mineral and vegetable oils, and waxes together are recommended. Concomitant use is beneficial to keep the stratum corneum moist and soothe the skin.33

Conclusions

This study found that the frequency of hand dermatitis among nurses during the pandemic was high. Sex, history of allergy, and increased frequency of handwashing were among the factors increasing hand dermatitis. Hand hygiene increased significantly among health workers during the pandemic. It was also found that nurses increased the measures they took to protect their skin to avoid dermatitis.

Hand disinfection plays an important strategic role in the fight against COVID-19. However, the skin and mucosa barrier are likely to be damaged in nurses who are consistently practicing good hygiene. Nurses should take proper measures to protect their skin while carrying out their duties.


COVID-19大流行期间护士的手部皮炎:频率和因素

Ayla İrem Aydın, Meryem Atak, Nurcan Özyazıcıoğlu Nurcan and Vahit Dalkızan

DOI: https://doi.org/10.33235/wcet.41.4.10-14

Author(s)

References

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摘要

目的 确定COVID-19大流行期间护士患手部皮炎的频率以及影响其患病率的因素。

方法 研究样本包括在州立医院工作的175名护士。在2020年10月和9月期间通过Google Survey收集研究数据。使用社会人口统计学数据收集表收集数据,并使用自我评估表来确定皮肤病症状。

结果 护士患手部皮炎的频率为70.9%。性别、过敏史、洗手频率增加和手部皮炎频率之间存在统计学显著差异。为COVID-19阳性患者提供护理的护士与没有为COVID-19阴性患者提供护理的护士在患手部皮炎频率方面未发现显著差异。然而,在COVID-19大流行期间,发现洗手以及手部消毒剂和护手霜使用频率比大流行前显著增加。

结论 大流行期间护士患手部皮炎的频率增加。大流行期间洗手频率增加给护士带来了患手部皮炎的风险,尽管这不应妨碍护士适当保持卫生。

引言

世界卫生组织宣布COVID-19为全球大流行。根据最新数据,约有2.3亿人受到感染,470万人死亡。1建议采取非药物预防措施,如保持社交距离、佩戴口罩和洗手,以阻止病毒传播。2这些措施通过防止气溶胶扩散和保护弱势群体,在降低传播风险方面发挥着重要作用。研究表明,在大流行病最流行的地区,手部卫生是专业医护人员和学会采取的一项重要预防战略。手部卫生仍然是感染控制的一个关键要素。3-5

COVID-19大流行还起到了提醒护士需要定期使用肥皂、水或酒精基消毒剂保证手部卫生的作用。建议将洗手作为一种低成本且常见的预防措施,以保护自己免受多种病毒感染,并防止疾病传播。6

正确的洗手技术是保证有效手部卫生的一部分。5CDC建议用肥皂洗手,因为它可以减少手上的细菌和化学物质。2世界卫生组织(WHO)还建议在手上有明显污垢的情况下,使用适当的方法用肥皂洗手40至60秒。7在没有肥皂和水的情况下,可以使用含有至少60%酒精的洗手液。2如果手上没有明显污垢,最好使用适当的方法用酒精基手部消毒剂清洁20至30秒,以保持手部卫生。7 用酒精溶液洗手可以通过减少手上的细菌和病毒数量来降低医务人员和社区其他人的感染风险。2,8

然而,所使用的溶液、洗手频率、水分水平和手部干燥过程均可能破坏皮肤屏障,导致出现手部皮炎症状。9-12因此,本研究的目的是确定在COVID-19大流行期间,护士患手部皮炎的频率以及影响其患病率的因素。

方法

样本

研究人群包括在土耳其布尔萨三家不同的州立医院工作的护士。研究样本包括175名自愿同意参与本研究的护士。

数据收集

研究数据由研究人员于2020年9月至10月通过Google Survey收集。数据收集工具包括研究人员编制的两个表格:一个表格用于收集社会人口统计学信息,另一个表格用于评估皮肤病症状。

社会人口统计学数据收集表。该表格包括参与研究的护士的性别、年龄和教育水平等方面的问题,以及这些护士工作的医院和诊所、他们的总工作年限等方面的问题。

确定皮肤病症状的表格。该表格包括过敏史、药物使用、护士护理患者的COVID-19状态、洗手频率、手部消毒剂和护手霜的使用等问题。在表格的最后一部分,要求护士们自我评估手部皮炎特有的任何皮肤病症状。该表格由一名研究人员和一名英语母语人士翻译成土耳其语。对这些译文进行比较,选择最合适的术语,然后将最终版本译回英语。将译文与原文进行了比较,并作了相应的修订。本研究的作者之前曾对儿科护士和护理实习生使用过这一自我评估表。11,12该表格共同评价了刺激性和过敏性接触性皮炎的症状,且根据Smit等人的标准设计。13,14使用此表格已获得Coenraads等人的许可。13,14

有人对在过去12个月内是否存在以下任何症状提出疑问:

  1. 手部和手指之间的脱皮和发红
  2. 手部龟裂和发红
  3. 手部刺激或瘙痒
  4. 手部肿胀和发红
  5. 手部和手指间的水疱

对其中一个或多个问题回答“是”的受试者被诊断为出现了手部皮炎症状。

还询问了以下问题:

  1. 这些症状中是否有两个或两个以上的症状持续超过3周?
  2. 这些症状中是否有两个或两个以上的症状出现过不止一次?

对上述任一问题回答“是”的受试者均被诊断为患有复发性或重度手部皮炎。该表格的克隆巴赫系数为0.888。

数据分析

社会人口统计学数据采用数字分布和百分位数分布形式,比较采用Mann-Whitney U检验、Wilcoxon符号秩检验和Pearson χ2检验。使用Windows版本23.0 SPSS进行数据分析。

伦理事宜

该研究获得了布尔萨乌鲁达大学健康科学研究和出版伦理委员会的伦理批准(日期和决定编号:2020年7月29日;92662996-04)。已获得相关卫生机构的法定许可。已通过Google Survey获得参与研究的护士的同意。

结果

表1显示了参与研究的护士的个人特征。护士患手部皮炎的频率为70.9%(124/175)。女性患手部皮炎的频率显著高于男性。有过敏史的护士患手部皮炎的频率显著高于无过敏史的护士(P<.05)。参与研究的护士的平均年龄为29.14±7.22岁,平均工作年限为6.68±8.02年。按平均年龄或工作年限划分,未发现护士患手部皮炎的频率存在显著差异。当按护士工作的单位检查手部皮炎的患病率时,在以下单位工作的护士的患病率较高:儿科(76.1%)、外科(76%)和COVID-19病房(69.5%)。然而,单位间差异无统计学显著性(P>.05)。

 

表1.受试者特征

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最常报告的症状为发红和龟裂(表皮和真皮中出现清晰的撕裂线;77.1%)、刺激和瘙痒(76%)以及脱皮/皮疹(67.4%;图1)。

 

图1.手部皮炎症状

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对于为COVID-19阳性患者提供护理的护士,患手部皮炎的频率为71.5%;对于没有为COVID-19阳性患者提供护理的护士,患手部皮炎的频率为66.7%。这一差异不具有显著性
(表2)。

 

表2.基于护士是否护理COVID-19阳性患者的手部皮炎频率

ayla table 2 - cn.png

 

对护士在COVID-19大流行前和期间的手部卫生情况进行了检查
(表3)。经确认,在大流行期间,每天洗手的频率、消毒剂以及护手霜/润肤霜的使用频率显著增加(P<
.001)。在洗手频率方面,48%(84/175)的护士每天洗手超过25次。患手部皮炎的频率随着洗手频率的增加而显著增加(表4;P<.05)。手部消毒剂和护手霜的使用频率对手部皮炎无显著影响(P>.05)。最常用的洗手物质为液体肥皂、液体肥皂和酒精基凝胶、洗必泰凝胶和酒精基凝胶(图2)。

 

表3.大流行前和大流行期间护士的手部卫生行为

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表4.按卫生行为划分的手部皮炎频率

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图2.护士洗手用物质

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讨论

手部皮炎是一种常见的疾病,可能出现急性或慢性进展,存在不同的病因。15在当前研究中,COVID-19大流行期间护士患手部皮炎的频率为70.9%。当前研究结果与其他在COVID-19大流行期间对卫生工作者的手部皮炎所进行的研究结果相似。在大流行期间进行的一项研究显示,84.6%的卫生工作者手部出现了不良皮肤反应。16另一项研究报告称,74.5%的初级卫生工作者手部出现了皮肤损伤。10在大流行初期进行的一项研究发现,90.4%的卫生工作者出现了手部皮炎的急性症状。17

在大流行之前在当前研究所在的同一地区进行的一项研究中,据报告,47.5%的儿科诊所护士患有手部皮炎。11在大流行之前进行的其他研究中发现,患手部皮炎的频率分别为
12%、1821%19,20和22.1%21。鉴于这些结果,很明显,在大流行期间,卫生工作者患手部皮炎的频率有所增加。

在本研究中,女性患手部皮炎的频率显著高于男性。Alluhayyan等人22对卫生工作者进行了一项研究,发现女性更容易患皮炎。同样,Gupta等人23发现,女性患手部皮炎的频率略高于男性。然而,其他研究报告称,性别对手部皮炎的频率无显著影响。12,21

过敏为免疫系统对外来物质的异常超敏反应。24,25这种反应可以在幼儿期以及青春期和成年期观察到。25,26有过敏史的护士患手部皮炎的频率显著高于无过敏史的护士,这一结果与先前的研究一致。12,19,21,23然而,Kiely等人27得出结论,尽管有报告称有皮炎病史的卫生工作者患皮炎的风险显著较高,但过敏史并不影响皮炎的发生。

预防病毒传播最常用的方法之一是保持有效手部卫生。在对抗COVID-19过程中,在儿童时期养成有效的手部卫生习惯是至关重要的。28Kiely等人27报告称,在大流行期间,几乎所有卫生工作者的洗手频率均有所增加(99.26%)。在当前研究中对大流行前和大流行期间进行比较,洗手和使用手部消毒剂/护手霜的频率显著增加(表3)。同样,Guertler等人17对医生和护士进行了一项研究,发现结果类似。所有COVID-19对抗指南均建议彻底和频繁的手部卫生习惯。2,5虽然洗手频率的增加是导致皮炎发生的因素之一,但这不应该阻止卫生工作者在大流行期间保持正确的手部卫生习惯。4

护士是医疗环境中的主要护理者,因此很容易感染和传播COVID-19病毒。至关重要的是,护士必须遵守预防和控制感染指南,以对抗这一大流行病。29

在大流行期间进行的另一项研究中,Lan等人10得出结论,每天洗手超过10次的卫生工作者患手部皮炎的频率显著增加。在大流行之前进行的研究报告显示,洗手频率增加与手部皮炎频率之间存在显著关系。12,30然而,本研究发现,使用护手霜对患手部皮炎的频率无显著差异。然而,护士使用的护手霜可能并不理想。建议使用皮肤润肤霜以保持皮肤健康;31,32对于皮肤保护,建议同时使用保湿剂(如局部尿素和丙二醇)和封闭性润肤剂(如石蜡基产品、羊毛脂、矿物油和植物油以及蜡)。两类产品同时使用有利于保持角质层湿润和舒缓皮肤。33

结论

研究发现,大流行期间护士患手部皮炎的频率很高。性别、过敏史和洗手频率的增加均为导致手部皮炎频率增加的因素。在大流行期间,卫生工作者的手部卫生需求显著增加。研究还发现,为避免皮炎,护士们采取了更多保护皮肤的措施。

手部消毒在抗击COVID-19方面发挥着重要的战略作用。然而,对于一贯保持良好卫生习惯的护士来说,皮肤和粘膜屏障很可能受损。护士在履行其职责时应采取适当措施保护自己的皮肤。


Author(s)

Ayla İrem Aydın*
MSc, RN
Research Assistant, Department of Pediatric Nursing, Faculty of Health Sciences, Bursa Uludağ University, Turkey

Meryem Atak
MSc, RN
Research Assistant, Department of Pediatric Nursing, Faculty of Health Sciences, Bursa Uludağ University, Turkey

Nurcan Özyazıcıoğlu Nurcan
PhD, RN
Professor, Dean of Faculty of Health Sciences
Department of Pediatric Nursing, Faculty of Health Sciences, Bursa Uludağ University, Turkey

Vahit Dalkızan
RN
Nurse in the ICU, Ministry of Health Bursa City Hospital, Turkey

* Corresponding author

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