Research - current projects
Wet work guidance notes
Keep an eye out for the recently developed 'Guidance on the prevention of dermatitis caused by wet work.' These have been developed by ODREC and OASCC. These guidelines aim to encourage employers and their employees to be more aware of wet work and what wet work can do to a person's skin. Excessive wet work leads to dermatitis and this can often be avoided with some careful planning in the workplace.
These guidance notes are expected to be available by the end of 2006. For more information visit www.occderm.asn.au or visit www.dewr.gov.au
Occupational contact dermatitis and Workers' Compensation
Under reporting of occupational contact dermatitis to workers' compensation schemes is well known. This study aimed to develop an understanding of factors impacting upon the decision to claim or not. Patients diagnosed with significantly work-related contact dermatitis at our clinic in Melbourne participated.
Only 40% of respondents had claimed. Factors such as gender, work influences and knowledge of the workers' compensation system were significantly related to lodging a claim. Other factors were lost time, age of worker and duration of disease. Workers who received compensation were more likely to report improvement of their skin condition than workers who did not claim. One third of non-claimants did not know about the workers' compensation system or how to claim.
It would appear that a workers' compensation scheme that places the onus on the worker to initiate the claim does not function equitably.
This article has been submitted for publication.
SPOT (The incidence and prevalence rates for occupational contact dermatitis in an Australian suburban area)
Occupational contact dermatitis regularly causes high levels of worker morbidity; however, this is often not reflected in available statistics. This study aimed to collect and verify OCD reports/referrals and generate disease estimates for a defined geographical area in Melbourne Australia. This study utilized reports from GPs and dermatologists to provide OCD disease estimates and validation data for an OCD disease register. An occupational dermatologist used a gold standard process that included diagnostic patch testing to verify suspected cases. The incidence rate for confirmed cases of OCD was 20.5 per 100,000 workers. The 1-year-period prevalence rate was 34.5 per 100,000).
See recent publications list for full reference.
Work and Skin: Hairdressers Education Development (WASHED)
Occupational contact dermatitis is common amongst hairdressers. In this population-based study, 193 trainee hairdressers and 184 practicing hairdressers completed a questionnaire detailing their knowledge of skin hazards, the skills they practiced and the frequency of glove use. Participants were also asked about the existence of past or present atopy including eczema, asthma or hay fever. Hairdressers also had their hands examined.
The questionnaire highlighted that 59.2% had a past or present history of atopy. Almost 60% of hairdressers and trainees had experienced changes on their hands since commencing hairdressing, while 29% had abnormal skin on examination on the day of participation. Knowledge of skin hazards was poor in both groups. While up to 70% of participants correctly identified hairdressing chemicals as potential skin hazards, less than 15% correctly identified the role of wet work. Only a small proportion recognised that hairdressing chemicals could cause allergy. Glove use was inadequate, particularly when performing work at the basin, which both junior and senior hairdressers did on a regular basis.
As a result of these findings, educational resources were developed for hairdressers and hairdressing trainees. These included a poster, brochure and a CD-Rom.
Skin@Work
Keep an eye out for the “Skin@Work” kit which will be available to all schools early 2006. The “Skin@Work” education kit aims to raise awareness of a potential work-related skin problem. It has been specifically designed and developed for career counsellors, and includes resources for students and their parents. Career counsellors are targeted because they have an important role in advising students about their future job choice. The “Skin@Work” resource package encourages career counsellors to talk about skin safety when counselling students.
RASH - Resources About Skin Health: A training package for workplaces and training centres to prevent dermatitis.
It has been proposed that a training package will be developed to educate the workforce and students attending training institutions about OCD, and raise awareness about appropriate ways to prevent this condition. This training package will be designed to be used in the workplace setting, and also in training centres, including TAFE and private training institutions. The training package will be designed so it can be incorporated into OH&S components of training courses but also as part of training sessions or updates on OH&S in the workplace. The resource will be a 'train the trainer' style education tool, with comprehensive resources.
Evaluation of Economic Impact of OCD
This project aims to compile existing data set sources to form a complete picture of OCD in Australia, in order to undertake an evaluation of the economic impact of OCD.
It is planned to obtain information from external data sets (e.g. BEACH study) and internal ODREC data sets and utilise these to develop an estimation of the economic costs of OCD in Australia.
Once the compilation of the data sets is complete, a consultant with expertise in health economics will assist with the descriptive economic analysis, and in particular, looking at health service utilization and the burden of disease.
Surveillance of OCD Presenting to Dermatologists, Occupational Physicians, Occupational Health Nurses and other Occupational Medical Practitioners
This project aims to undertake surveillance of OCD presenting to specialist dermatologists and occupational physicians in Australia.
This study is based on the UK based Epiderm study which reported the incidence and prevalence of occupational dermatitis presenting to dermatologists and occupational physicians in the UK, and the Victorian-New South Wales project SABRE (Surveillance of Australian Workplace Based Respiratory Events), which reported the incidence and prevalence of occupational respiratory disease in Australia. These studies have provided informative data, and have also raised the awareness of diagnosing occupational diseases.
Once this study has been established, it will require relatively little maintenance for it to continue, especially if reporting of cases can be done electronically. This will then become a useful tool to observe trends in the incidence and prevalence of OCD in this country.
Clinic Database Analysis
This project aims to complete a database analysis of approximately 1750 attendees at the Occupational Dermatology Clinic, contributing information on causes of OCD, including relevant allergens and irritants, occupations affected, and contribution to understanding of risk factors for OCD.
Data of approximately 1750 patients assessed and patch tested from February 1993 until December 2003 at the Occupational Dermatology Clinic will be analysed with respect to information including diagnosis, sites of dermatitis, duration of dermatitis, work relatedness, relevant allergens and irritants, and presence of atopy.
The project will be a significant contribution to the existing literature as there are very few international studies of this size. The data will contribute to the identification of risk factors for OCD, as well as providing information with regard to specific industries and occupations.
Follow-up of Clinic Attendees (Skin Watch)
Skin Watch is an outcome study, involving follow-up of clinic attendees to ascertain the prognosis of their skin condition, effect on their employment and also impact on social and economic factors.
This project will involve a follow-up study of patients who have previously attended the clinic, in order to assess the prognosis of OCD. Risk factors, which contribute to a worse prognosis for occupational contact dermatitis, will be identified. This will contribute to the development of strategies for the prevention of OCD in the future. The project will build on previous work undertaken by ODREC.
Quality of Life Study and Occupational Dermatitis Disease Severity Index (QOL/ODDI)
This project aims to determine the social and economic impact of occupational contact dermatitis in Quality of Life study, and the characteristics of those affected.
Occupational contact dermatitis may have an appreciable effect on the quality of life of sufferers, with both social and economic effects. Patients attending the Occupational Dermatology Clinic complete a questionnaire based on published Dermatology Quality of Life criteria.
In addition, a rating scale for the assessment of the severity of OCD has been developed Occupational Dermatitis Disease Severity Index (ODDI). Measuring the occupational, psychological and social effects of OCD, together with a formalised and replicable measurement of its severity and associated functional limitation will provide a more accurate assessment of the impact of this condition.
GP Education Program
This project was concerned with the development and implementation of an educational program for general practitioners (GPs), including optimisation of both treatment and referral of OCD.
An educational program was developed and delivered to GPs participating in the SPOT study in June, 2003. In addition, information supplied by the SPOT reporters has contributed to our understanding of GP educational requirements. Other opportunities to raise awareness of this information to general practitioners have been sought in different settings.
Teaching of Dermatology and Occupational Medicine Registrars
The aim of this project was to teach both Australian dermatology and occupational medicine registrars about occupational contact dermatitis.
There is no formal training of dermatology registrars in OCD, although currently their training is defined by a syllabus listing textbooks specified by the Australasian College of Dermatologists. Dr Nixon made a successful submission to the Chief Censor, Australasian College of Dermatologists to include a more concise and up to date text on OCD in the Dermatology Reading List.
Education for Users of Epoxy Resins
This project aimed to develop appropriate educational information regarding appropriate glove use to users of epoxy resins. Allergic contact dermatitis to epoxy resins is an important cause of OCD in the Occupational Dermatology Clinic and workers who present with this problem are still unaware that specialized gloves exist which reduce the likelihood of sensitization.
This issue has been raised with both NOHSC and a glove manufacturer (Ansell) in order to encourage debate and discussion regarding the most effective approach to this problem.
Material Safety Data Sheet Review
This project was concerned with the assessment of the adequacy and accuracy of material safety data sheets (MSDS) with respect to skin hazards.
It is important that MSDS accurately depict the skin hazards of a chemical, including its propensity for sensitisation. Past experience has suggested that this is often not the case.
MSDS pertaining to substances handled at work, by the clinic attendees, have been assessed for accuracy, particularly with regard to the listing of skin irritants and sensitisers. In addition, ODREC has performed a case-control study in order to assess whether the listing of sensitizers in MSDS is a factor in the development of allergic contact dermatitis.
Compilation of National Patch Test Data
This project aimed to expand the use of the CAMS© program to other patch testers in Australia to facilitate improved data collection and collaborative projects in the future. All users are receiving an upgrade of their program to enable an annual summary of patch testing results to be submitted and collated by ODREC. We have also proposed that dermatologists who patch test patients, but do not utilise CAMS©, will be able to submit de-identified patch test data via our website.
Latex Allergy Awareness
Glove powder has been shown to be a risk factor in the development of latex allergy. While hospitals are now well aware of this problem especially after a number of well-publicized court cases, many nursing homes and hostels still provide powdered gloves for their staff. Throughout this project there will be ongoing activities to prevent latex allergy, and raise awareness regarding the hazards of use of powdered disposable gloves.