Changes in Infection Prevention Practices and Occurrence of Skin Symptoms among Healthcare Workers, Cleaners and Day-care Workers in Norway during the COVID-19 Pandemic
Keywords:COVID-19, facial skin symptoms, hand eczema, health personnel, occupational exposures
The COVID-19 pandemic has resulted in increased attention on infection prevention measures. This study aims to assess whether changes in hand hygiene procedures, use of personal protective equipment and moisturizers during the first year of the COVID-19 pandemic were associated with changes in the occurrence of skin symptoms among healthcare workers, cleaners, and day-care workers. A total of 602 participants (40%) responded to an electronic questionnaire, including questions on previous and current occupational exposure and skin problems. Increased frequency of hand washing, use of hand disinfectants, use of disposable gloves and moisturizers were all associated with an increased symptom score on the hands, wrists, forearms. Participants who increased their use of masks or respirators had a higher risk of facial skin symptoms, compared with those with non-increased occupational exposure. In conclusion, a change of behaviour among healthcare workers, cleaners and day-care workers during the first year of the COVID-19 pandemic, with an increase in occupational exposures and use of moisturizers, was associated with higher occurrence of facial skin symptoms and symptoms on the hands, wrists and forearms.
Vindenes HK, Svanes C, Lygre SHL, Hollund BE, Langhammer A, Bertelsen RJ. Prevalence of, and work-related risk factors for, hand eczema in a Norwegian general population (The HUNT Study). Contact Dermatitis 2017; 77: 214-223.
Behroozy A, Keegel TG. Wet-work exposure: a main risk factor for occupational hand dermatitis. Saf Health Work 2014; 5: 175-180.
Lund T, Petersen SB, Flachs EM, Ebbehoj NE, Bonde JP, Agner T. Risk of work-related hand eczema in relation to wet work exposure. Scand J Work Environ Health 2020; 46: 437-445.
World Health Organization (WHO) Guidelines Approved by the Guidelines Review Committee. WHO guidelines on hand hygiene in health care: first global patient safety challenge clean care is safer care. Geneva: World Health Organization; 2009.
Visser MJ, Landeck L, Campbell LE, McLean WHI, Weidinger S, Calkoen F, et al. Impact of atopic dermatitis and loss-of-function mutations in the filaggrin gene on the development of occupational irritant contact dermatitis. Br J Dermatol 2013; 168: 326-332.
World Health Organization, United Nations Children's Fund. Water, sanitation, hygiene, and waste management for the COVID-19 virus: interim guidance, 19 March 2020. Geneva: World Health Organization, 2020.
World Health O. Mask use in the context of COVID-19: interim guidance, 1 December 2020. Geneva: World Health Organization, 2020.
Lan J, Song Z, Miao X, Li H, Li Y, Dong L, et al. Skin damage among healthcare workers managing coronavirus disease-2019. J Am Acad Dermatol 2020; 82: 1215-1216.
Hamnerius N, Pontén A, Bergendorff O, Bruze M, Björk J, Svedman C. Skin exposures, hand eczema and facial skin disease in healthcare workers during the COVID-19 pandemic: a cross-sectional study. Acta Derm Venereol 2021; 101: adv00543.
Simonsen AB, Ruge IF, Quaade AS, Johansen JD, Thyssen JP, Zachariae C. High incidence of hand eczema in Danish schoolchildren following intensive hand hygiene during the COVID-19 pandemic: a nationwide questionnaire study. Br J Dermatol 2020; 183: 975-976.
Simonsen AB, Ruge IF, Quaade AS, Johansen JD, Thyssen JP, Zachariae C. Increased occurrence of hand eczema in young children following the Danish hand hygiene recommendations during the COVID-19 pandemic. Contact Dermatitis 2021; 84: 144-152.
Stenberg B, Lindberg M, Meding B, Svensson A. Is the question 'Have you had childhood eczema?' useful for assessing childhood atopic eczema in adult population surveys? Contact Dermatitis 2006; 54: 334-337.
Susitaival P, Flyvholm MA, Meding B, Kanerva L, Lindberg M, Svensson A, et al. Nordic Occupational Skin Questionnaire (NOSQ-2002): a new tool for surveying occupational skin diseases and exposure. Contact Dermatitis 2003; 49: 70-76.
Lund T, Flachs EM, Sørensen JA, Ebbehøj NE, Bonde JP, Agner T. A job-exposure matrix addressing hand exposure to wet work. Int Arch Occup Environ Health 2019; 92: 959-966.
Hamnerius N, Svedman C, Bergendorff O, Bjork J, Bruze M, Engfeldt M, et al. Hand eczema and occupational contact allergies in healthcare workers with a focus on rubber additives. Contact Dermatitis 2018; 79: 149-156.
Yüksel YT, Ebbehøj NE, Agner T. An update on the prevalence and risk exposures associated with hand eczema in Danish hospital employees: a cross-sectional questionnaire-based study. Contact Dermatitis 2022; 86: 89-97.
Yüksel YT, Nørreslet LB, Flachs EM, Ebbehøj NE, Agner T. Hand eczema, wet work exposure, and quality of life in health care workers in Denmark during the COVID-19 pandemic. JAAD Int 2022; 7: 86-94.
Erdem Y, Altunay IK, Aksu Çerman A, Inal S, Ugurer E, Sivaz O, et al. The risk of hand eczema in healthcare workers during the COVID-19 pandemic: do we need specific attention or prevention strategies? Contact Dermatitis 2020; 83: 422-423.
Guertler A, Moellhoff N, Schenck TL, Hagen CS, Kendziora B, Giunta RE, et al. Onset of occupational hand eczema among healthcare workers during the SARS-CoV-2 pandemic: comparing a single surgical site with a COVID-19 intensive care unit. Contact Dermatitis 2020; 83: 108-114.
Hamnerius N, Svedman C, Bergendorff O, Bjork J, Bruze M, Ponten A. Wet work exposure and hand eczema among healthcare workers: a cross-sectional study. Br J Dermatol 2018; 178: 452-461.
Mollerup A, Veien NK, Johansen JD. An analysis of gender differences in patients with hand eczema - everyday exposures, severity, and consequences. Contact Dermatitis 2014; 71: 21-30.
Ruff SMD, Engebretsen KA, Zachariae C, Johansen JD, Silverberg JI, Egeberg A, et al. The association between atopic dermatitis and hand eczema: a systematic review and meta-analysis. Br J Dermatol 2018; 178: 879-888.
Meding B, Lindahl G, Alderling M, Wrangsjo K, Anveden Berglind I. Is skin exposure to water mainly occupational or nonoccupational? A population-based study. Br J Dermatol 2013; 168: 1281-1286.
Williams C, Wilkinson SM, McShane P, Lewis J, Pennington D, Pierce S, et al. A double-blind, randomized study to assess the effectiveness of different moisturizers in preventing dermatitis induced by hand washing to simulate healthcare use. Br J Dermatol 2010; 162: 1088-1092.
Visser MJ, Verberk MM, van Dijk FJ, Bakker JG, Bos JD, Kezic S. Wet work and hand eczema in apprentice nurses; part I of a prospective cohort study. Contact Dermatitis 2014; 70: 44-55.
Ho WYB, Tan LYC, Zhao X, Wang D, Lim JH. Epidemiology of occupational dermatoses associated with personal protective equipment use in the COVID-19 pandemic: risk factors and mitigation strategies for frontline healthcare workers. JAAD Int 2022; 8: 34-44.
Niesert AC, Oppel EM, Nellessen T, Frey S, Clanner-Engelshofen BM, Wollenberg A, et al. "Face mask dermatitis" due to compulsory facial masks during the SARS-CoV-2 pandemic: data from 550 health care and non-health care workers in Germany. Eur J Dermatol 2021; 31: 199-204.
Lund T, Flachs EM, Ebbehøj NE, Bonde JP, Agner T. Wet work exposure: comparison of observed and self-reported data. Int Arch Occup Environ Health 2019; 92: 317-326.
Svensson A, Lindberg M, Meding B, Sundberg K, Stenberg B. Self-reported hand eczema: symptom-based reports do not increase the validity of diagnosis. Br J Dermatol 2002; 147: 281-284.
Meding B, Barregård L. Validity of self-reports of hand eczema. Contact Dermatitis 2001; 45: 99-103.
How to Cite
Copyright (c) 2023 Hilde K. Vindenes, Randi J. Bertelsen, Stein H.L. Lygre, Tone Morken, Ole J. Møllerløkken, Kaja Irgens-Hansen
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All digitalized ActaDV contents is available freely online. The Society for Publication of Acta Dermato-Venereologica owns the copyright for all material published until volume 88 (2008) and as from volume 89 (2009) the journal has been published fully Open Access, meaning the authors retain copyright to their work.
Unless otherwise specified, all Open Access articles are published under CC-BY-NC licences, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for non-commercial purposes, provided proper attribution to the original work.